Southern Medical and Surgical Journal, 1850

J-IBMRYBIMDESrClT

ATI AHTA

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

I. P. GARVIN, M.D.,

PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS AND MEDICAL
JURISPRUDENCE, IN THE MEDICAL COLLEGE OF GEORGIA.

Medical College of Georgia.
uJa prciuls le bicn oujc k Irouvc."

VOL. VI. 1850. NEW SERIES.

JAMES McCAFFERTY,

PRINTER AND PUBLISHER.
18.r)0.

TO THE READER.

In the November number of the Southern Medical and Surgical Journal,
the announcement was made, that after the completion of the current volume,
Dr. P. F. Eve would retire from the Editorship, and that in future, the editorial
department would be under the management of the undersigned. It is much to be
regretted that the Journal should lose the benefit of Dr. Eve's supervision, under
which it has acquired so high a character ; but circumstances, to which he has
alluded in his valedictory remarks, have induced him to relinquish his post. Many
medical gentlemen in various sections, have expressed an earnest wish that the
Journal should be continued, and urged the Faculty of the Medical College of
Georgia, under whose auspices the work was established, to make such arrange-
ments as would secure its continuance. With this request they have complied,
and have assigned to us its future management. "With this number, we enter upon
the discharge of our duties, with much diffidence in our own abilities, but with a
resolute determination to spare no effort to make the Journal useful to its patrons,
and honorable to the South. But to effect these desirable ends, the co-operation of
those who feel an interest in the advancement of the medical sciences, and in the
character of the medical profession, will be requisite : for no one, though endowed
with a capacity far beyond that to which we may lay claim, can carry on a work
of the kind, without the aid of able collaborators. We would therefore respectfully
yet earnestly, call upon our medical friends to aid us in our undertaking. The
medical profession in the South, contains within its ranks as much intellect and
scientific attainments as that of any other section, and an effort is all that is neces-
sary to secure that place .in the public estimation to which it is justly entitled.
Already many of the contributors to this Journal have made themselves favorably
known to their brethren throughout our country, and we hope that many more,
through the same agency, will obtain a like honorable distinction.

If it were necessary, many reasons might be adduced to show why Southern
physicians should make public the results of their observations. Causes are in con-
tinued operation in our region which develope diseases peculiar in their character,
and produce modifications in those which are more general in their prevalence.
Moreover we have among us a large population whoso physical peculiarities mod-
ify the features of many of their diseases. We arc aware that attempts havebeon
made in certain quarters, to shew that as the principles of our science are the same
every where, it matters but little, whether the physician be instructed by thoso
N. S. VOL. VI. NO. I. 1

most familiar with the diseases of the region in which he is to practice his profes-
sion, or not. The absurdity of such a position is manifest. What are the princi-
ples of pathology but deductions from well ascertained facts, and to whom shall
we go for these facts, but to those who have observed them. No one would ven-
ture to assert that the physicians of Paris are as competent to determine the ques-
tions connected with the origin, nature, symptoms and treatment of yellow fever,
as the physicians of New Orleans. If, then, we have diseases peculiar to our region,
and if important modifications are impressed by our climate, the physical pecu-
liarities of a portion of our population, and other agencies, upon such as are common
to all sections, it becomes the duty of every medical practitioner among us to report
the results of his experience.

Whilst the number of medical Journals in the South is very small, intelligent
physicians are exceedingly numerous. If every one of these gentlemen would sus-
tain at least one Southern medical periodical, by his subscription and by the con-
tribution of important facts which may come under his observation, the number of
such works might be largely increased. The field is sufficiently ample for many
more laborers. The legitimate object of the medical press is not the advancement
of pecuniary interests, or the gratification of personal ambition it has higher ends
and nobler aims in view ; therefore, among them can be no rivalry , but rather a
noble emulation to excel each other in efforts to advance the cause of medical
science, and thus to promote the physical welfare of their fellow men.

Communications intended for insertion in the Journal, should be addressed to
the undersigned, at Augusta, Georgia.

I. P. GARVIN, M. D.

January 1st, 1850.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. JANUARY, 1S50. [No. 1.

PART FIRST.

r i g x n a I (Communications.

ARTICLE I.

Remarks on Typhoid Fever. By H. V. Wooten, M. t)., of
Lowndesboro', Alabama.

I do not propose to write a treatise on this fever, or to at-
tempt a settlement of the controversial points of its character ;
but simply to give some account of its history as it has occur-
red under my own observation. This disease is becoming
more and more prevalent in this particular region ; and from
the reports of physicians,. I have no doubt that this is the case
generally throughout our state ; and a remarkable circum-
stance connected with it, is, that it appears more prevalent
upon the more elevated portion of country, than on the lower
and more miasmatic regions. My circle of practice compre-
hends a high ridge, 200 feet above the level of the surrounding
prairie plains and river low-crrounds. This ridge is about six
miles long, by from one to three miles broad, and about one-
third of the population of my circle resides upon the ridge,
and two-thirds upon the low grounds : yet of Typhoid Fever,
I meet with twenty cases upon the ridge, to one elsewhere.

By some practitioners, this fever is considered as identical
with the latter stages of obstinate or neglected remittent. But
however similar the two fevers may be, in many of their
symptoms, it seems to me, that a close examination will mark a
very decided difference in the true characteristics of these

4 Wooten, on Typhoid Fever. [January,

fevers. They do not prevail to an equal extent, in the same
localities, or at the same season of the year. The Typhoid oc-
curs frequently in spring and early summer, and even the
winter months, whilst the remittent, or Bilious, as it is some-
times called, almost invariably prevails in the latter months of
summer, and in autumn. Remittent and intermittent fevers
will prevail at once in the same neighborhood, and in the same
families ; but it will be very rare that a case of genuine Ty-
phoid will be found amongst them, while on the other hand,
a prevalence of the typhoid, affords to an experienced observer,
no grounds to fear the occurrence of remittents or intermit-
tents. Prof. T. D. Mitchell has published the opinion, that all
fevers are essentially remittent, or intermittent ; that the so-
called Typhoid fever is nothing but a remittent, and ought to be
cured by Quinine. I was one of the first to adopt, and have
continued to be one of the most uniform in, the use of quinine
in remittent fever, and I have tried its virtues in every form,
stage, and condition of Typhoid, without the least benefit, except
in some particular conditions hereafter mentioned, wherein its
use was 'adapted to some of the minor and incidental symp-
toms. I have seen, as elsewhere mentioned,* regular chills and
exacerbations of fever occur periodically, upon a true typhoid
fever; and have administered the quinine, so as effectually to
arrest these paroxysms, and thoroughly impress the system with
its peculiar powers, without, in the ieast degree, checking the
course of the fever, but on the contrary, in some instances, it
has aggravated some of the worst symptoms. In Typhoid, there
are in many cases at least, remissions, as distinct, so far as
febrile heat is concerned, as those of remittent fever, but a
careful attention to the case, will discover a distinct difference.
The remissions in Typhoid, do not recur at regular periods, and
when the febrile heat abates, all the other symptoms, as fre-
quency of pulse, oppression of the vital powers, head-ache, &c,
do not abate as during the remissions of regular remittent.
This difference in the remissions is more decided after the first
few days. On the other hand, when the remissions of true
Remittent occurs, it is at regular periods, the pulse lessens in
force and frequency, the breathing is regular, thirst abates,
* Bartlett, on Fevers of U. S. p. 127.

1850.] Wooten, on Typhoid Fever.

patient feels decidedly better, and in fact it is more of a true
and complete remission. When I have doubted concerning
the true character of the case, I have found the quinine a very
good test. If this medicine is freely given during the remission,
it will prolong, and very probably perpetuate it in remittent,
while in Typhoid, it will generally shorten the remission, and
aggravate the exacerbation. I have almost uniformly found
the indications afforded by this test, to be borne out by the
subsequent course of the disease.

But, without running a parallel with other fevers, a strict
examination, of the particular and distinct characteristics of
the Typhoid, will sufficiently establish its individuality.

Much has been written, pro and con, upon the restriction of
Typhoid fever, as a distinct disease, to a peculiarly diseased
condition of the intestinal and mesenteric glands. Able rea-
soners have appeared on both sides of the question, and it is
not yet settled in a satisfactory manner. It is contended by
the restrictionists that all cases of Typhoid fever that prove
fatal, exhibit this particular intestinal lesion, and they have an
impregnable argument by which to sustain the doctrine. For,
if you give them ocular demonstration to the contrary, they
will meet it by a denial that the case was typhoid fever, and
prove it by your own evidence the absence of the peculiar
lesion, even though they had pronounced it the genuine dis-
ease, prior to death, and treated it accordingly. This occurred
with M. Louis himself, who pronounced one of his own cases
of Typhoid in life, not Typhoid post-mortem, because this es-
sential lesion was not to be found. Then, those who deny that
this lesion is essential to Typhoid fever, are forced, under the
restriction which they deny, to yield the point. But the justice
and propriety of the restriction still remains an unsettled ques-
tion. We are told by these authorities, that, of a given num-
ber of subjects who have died of genuine Typhoid making
the peculiar intestinal disease the test a certain proportion
will exhibit a diseased condition of the brain. Now, suppose
we call this disease of the brain, Typhoid fever, and see what
proportion of cases will exhibit the peculiar intestinal disease.
Perhaps, under this restriction, the bowels would fall as far
short, in their quota of distinction, as did the brain under the

Wooten, 071 Typhoid Fever. [January,

other. I am not prepared to make the comparison, but surely
those who have had such ample, means of investigating the dis-
ease, and have labored so assiduously in these investigations,
ought to have tried it.

But, admitting that this intestinal lesion is never wanting in
Typhoid fever, every experienced observer knows, that it is
often far from being the most important and dangerous portion
of the disease ; and it is very rare that we see grave cases, in
which diseased action is confined exclusively to the intestinal
and mesenteric glands. According to my own observation,
this peculiar intestinal lesion, although a common, perhaps in-
variable, occurrence in the fever, is but one item, though a
grave one frequently, in the group of morbid actions, which
together, make up the disease called Typhoid fever.

I have not attempted to argue, much less to settle this ques-
tion of restriction, or even to take sides upon it ; but my object
has been simply to notice it so far as was necessary to an un-
derstanding of my own views in the premises, which are these:
That Typhoid fever, as a disease, does not restrict the action
of its destructive powers, to any organ or tissue of the system,
but that all suffer under their influence, varying in their pro-
portions in different cases ; while some organs may be uniform-
ly diseased in a greater or less degree, none may be considered
exempt. And, I will remark further, that I view this exclusive
view of the disease, as very hurtful to the treatment; and it
will, in a great degree, account for the discrepancy amongst
physicians on this point, and also, in the results of the same
treatment, in different hands, and at different times and places.

I have found that in all cases of Typhoid fever, two great
divisions of the system suffer in a greater or less degree, viz.,
the cerebro-spinal, or nervous, and the mucous surfaces ; and
as either of these sub-systems exhibit the predominant amount
of diseased action, I class the case as JServous or Mucous. It
seems to me, that a classification, or division of this sort, is the
most convenient plan for describing the course, symptoms and
treatment of the disease; bearing in mind, however, that I do
not mean to say, that in any case, either the nervous or mucous
system is free from disorder or disease ; but merely to classify
the case, according to the system that exhibits the greater
amount of disease.

1850.] Wooten, on Typhoid Fever. 7

First, then, I will notice the nervous class, or those cases in
which the nervous system exhibits the leading and most im-
portant phenomena of the disease. For several days, perhaps
a week or more, the patient feels a dizziness which gradually
increases; vision grows daily weaker, and a disposition is no-
ticed to draw the brows together, and to fix the eye upon objects
of examination ; a dullness of hearing occurs, with a low but
constant ringing in the ears ; there is a sense of tightness,
sometimes, between the ears, as though a cord was drawn from
one to the other ; with a feeling of oppression in the central
portions of the brain. The senses of taste and smell, grow
weak or become perverted : a strong desire is felt for such ar-
ticles as have a very strong taste or odour. There is great
and regularly increasing lassitude : the patient is continually
disposed to drop the head, or lean it upon something for support.
The head feels heavy, and a sort of indescribable numbness is
about it. The countenance is expressive of great listlessness,
and sometimes a drooping melancholy. There is great languor
and a sense of general muscular weakness the patient is in-
disposed to any kind of action or exertion, either mental or
physical ; thought is weak, memory confused, and mental ap-
plication, even for a short time, impossible. These symptoms
gradually increase, until the patient finds that he is not dispo-
sed to rise from his recumbent position, and when he does so,
he cannot walk, without great dizziness and tremor of the ex-
tremities. He is now found to have fever; stupor gradually
steals on him; he rarely speaks, except wThen called with em-
phasis, and answers questions in as few words as possible, gen-
erally saying he feels better. His tongue is usually found clean,
perhaps slightly furred, moist and flat, and greatly troubled
with tremor, when he attempts to put it out. There is gener-
ally no thirst ; pulse is usually from eighty to one hundred beats
per minute, pretty full, but not very firm or quick ; tempera-
ture moderately elevated, especially about the head and trunk,
and there is often perspiration upon the forehead. He lies
upon his back and appears to rest quite easy : raise him up and
he will lie down at the earliest possible moment, and seem to
prefer to be let alone. The slight spasmodic jerks or tremors
of the extremities, set in and continue through the case, though

Wooten, on Typhoid Fever. [January,

they are not often troublesome, except when the patient moves
the parts, or attempts to take hold of any thing. These symp-
toms continue with great uniformity through at least the first
stage of the disease, which usually last about nine or ten days.
It is generally a day or two before the close of this stage, that
the lenticular, rose-colored spots, make their appearance upon
the surface, usually over the trunk and neck more particularly^
and continue through the second stage.

In the second stage, the stupor runs into a sort of low, mut-
tering delirium, with more restlessness; the irritation of the
mucous surfaces is apt to become more decided; cough may
become troublesome, but will remain dry and harsh : though
this does not often occur in this variety. The tongue some-
times becomes more pointed, dry and brown, though this is
only in proportion as the case partakes of the mucous variety.
Haemorrhage from the nose is most apt to occur in this stage.
The perspiration about the face becomes more profuse and
constant ; the stupor gradually increases ; patient gets more
and more disposed to lie still ; and, if you can get his attention
at all, he always says that he feels pretty well, or "right smart,"
but not another word. I have noticed that when cases of this
class prove fatal, it is most apt to occur towards the close of
this stage ; if, however, the patient should neither die or con-
valesce at the end of the second stage, the stupor falls into
decided coma, with great prostration of all the powers. Evac-
uations from the bowels are involuntary ; there is either incon-
tinence or suppression of urine, a hissing and hurried breathing
and every symptom of exhaustion. This condition will gener-
ally last from nine to twelve days, when the patient will be
found to have rigid contractions of some of the muscles or
this may exist throughout this stage and in this condition he
will die. Should convalescence occur, it will be so gradual as
to be scarcely perceptible for several days, but will be mani-
fested by a relief of all the bad symptoms, and a return to the
healthy functions.

The mucous variety commences with the usual symptoms
of slight fever; there is great lassitude, the appetite is variable,
sometimes voracious, and again perhaps, in the same day, entire-
ly wanting. The action of the bowels is irregular, sometimes

1850.] Wooten, on Typhoid Fever.

constipated and again free, alternately ; the stools are copious and
watery. If, during the constipation, a purgative is given, it
will induce prostrating hyper catharsis, however mild its usual
effects. Most generally there will be three or four watery
evacuations a day, without pain. Febrile exacerbations are of
short duration, and irregular recurrence. The skin is gener-
ally dry; and there is frequently great soreness of the muscles
and a sense of stiffness about the joints. There is frequently a
pain, more or less severe, in the frontal region, which is contin-
uous. The tongue is generally pointed, with edges and tip red,
and very often a brown fur over the centre. The tendency to
diarrhoea is generally not very hard to control, if desired, but
purgatives of the mildest character are not tolerated. In this
stage, the fever often runs very high : the pulse is apt to be
quick, and from 100 to 130 per minute, in frequency; but less
full and firm than in the nervous variety. The patient is more
restless, than in the other variety, and if the mind is affected,
it is a delirium instead of a stupor : watchfulness is apt to oc-
cur, instead of somnolence. When the mucous coat of the
stomach is disordered, there is thirst, and sometimes bilious
vomiting; the conjunctiva is apt to exhibit turgescence, and
there is often complaint of soreness about the tonsils, epiglottis,
&c, so as often to produce some difficulty in swallowing; a
dry, frequent cough, often troubles the patient, out as yet there
is no expectoration. These symptoms continue from six to
ten days, when we find them all more or less alleviated, and
convalescence appears to be at hand. But, although the ten-
dency now is evidently towards restoration, still, far the greatest
number of cases, after a very short amelioration, fall into the
second stage of the fever.

The second stage is one of greater depression of the vital
powers, more suffering to the patient, and more serious in every
respect. The diarrhoea becomes more constant and persistent,
and less under the control of remedies ; yet there is generally, no
pain in the bowels. This, however, is not uniform ; I have
sometimes seen patients suffer violent pain in the bowels : this
will occur when there is peritonitis sometimes the large intes-
tine becomes involved, which produces a griping and again,
the patient may suffer neuralgic pains in the abdomen. I look

10 Wooten, 07i Typhoid Fever. [January,

upon all these affections, or their symptoms, as mere complica-
tions, and variations from the regular course of the fever, as it
is most uniformly seen. In this stage, the abdomen is usually
flat, and presents nothing remarkable, either in appearance or
feeling. The stools are large, from five to ten a day, and have
been aptly compared, in appearance, to new cider. In this
stage, all the symptoms of the disease of the mucous surfaces
are much increased. The eyes frequently become sensitive to
the approach of light ; there is more cough, and not uncom-
monly a bronchial rattle, with more or less tenacious expecto-
ration. The lenticular eruption appears in this stage. In the
commencement of the second stage, the tongue is frequently
clean, and sometimes moist, presenting a florid, smooth surface.
This "cleaning off" of the tongue, with other favorable changes,
have very often deceived both patient and physician, into the
belief that the " fever was broke." But soon, the tongue be-
comes dry, dark brown, cracked and often bleeds, &c, as all
the symptoms of this stage advance. The buccal membrane
becomes spotted with aphthous eruptions, which often degener-
ate into ulcers that bleed and are painful. These, with the
soreness about the throat, frequently give the patient more an-
noyance, and receive more of his attention, than all the other
symptoms together. This stage, which may be called the
eruptive, or inflammatory, usually continues from a week to
ten days, when the third stage sets in.

The patient now becomes greatly prostrated ; emaciation
which in this variety, particularly, has been remarkably great,
all along, now becomes extreme. The simple act of breathing
seems to produce fatigue ; the tongue and extremities exhibit
more tremor ; the eyes appear more sunken and open ; the
features sharp and the complexion extremely palid, except in
cases in which the stomach and duodenum are much involved,
and those in which the bronchial surfaces have suffered much
engorgement : in the former, the complexion is icteroid; in the
latter, livid or bronzed. The stools change from a cider, to a
dark, dirty color, which has been compared to pea-soup, and
very offensive ; they are often streaked with mucous, some-
times purulent matter and specks of blood, subsultus increases,
and attempts at sleep result in a muttering delirium. The ul-

1850.] Wooten, on Typhoid Fever. 11

cerations of the mouth and throat become much more trou-
blesome, and the act of deglutition becomes not only difficult,
but distressing ; the pulse grows weaker, and sometimes inter-
mittent ; watchfulness persists. There is now more tenderness
upon the ileo-ccecal region than before, and often more fullness
of the abdomen, even when tympanitis has not ensued, as it
often does in this stage. There is a swelling of the sub-maxilary
and sub-auricular glands which often occurs in this, or the pre-
ceding stage, and sometimes it results in suppuration ; when
this occurs, it is always in the latter part of the third stage.
This third stage, might be termed the period, or stage of ulcera-
tion, as I believe it never passes without that special patholo-
gical condition. It generally runs its course in about the same
length of time of the other stages, but it oftener transcends the
limits than the others, particularly when the patient recovers.
The first favorable indication of approaching convalescence,
is a lessening of the frequency, and an increase in the consist-
ency of the stools. It often happens, that at the commencement
of improvement, the evacuations of the bowels cease altogether
for several days, if not improperly interfered with, and when
resumed, present very little departure from the healthful char-
acter. It may be said that this division of stages is arbitrary,
and so it is, to some extent ; yet its observance is very useful
in describing the disease, particularly the mucous variety, and
I think the three stages may well be characterized, as those of
turgescence, inflammation, and ulceration. It is at the junction
of these stages that a change of treatment is most frequently
required, and at these points also, a prognosis is most easily
made out, and most decisive. It is true, that many cases do
not pass through all these stages, or the number of days as-
signed them. Some die at the end of each stage, while many
convalesce at the termination of the first, and second as well as
the third. Again, the length of these stages cannot be any
thing like definite. In many cases, the first and second stages
are passed through in the time assigned to one, and sometimes
they are all, and particularly the third, of twice the ordinary
duration. But all these are variations from the general rule :
as far the greatest number of unbroken cases observe their

course with much regularity.

12 Wooten, on Typhoid Fever. [January,

I have thus attempted a description of the course and symp-
toms of the two classes of cases, (as I have observed them,) and
I would add the remark, that in all cases of both classes, the
symptoms of both exist to a greater or less degree, and it is in
accordance with this degeee that each case is classified, as
nervous or mucous. It must be admitted, that there are cases,
in which both classes of symptoms are so nearly equal in num-
ber and force, that they could not properly be assigned to
either variety especially. These are usually very grave cases,
and it is amongst them, that the greater proportionate amount
of fatality is met with.

A tall athletic negro man, aged 27, complained of great
weakness, heaviness of head, inability to walk, or even sit up ;
tongue covered with a thick whitish slime, and so tremulous as
to be protruded with difficulty; no thirst or febrile heat. A
dose of blue pills, followed in six hours by castor oil, produced
copious and frequent watery evacuations ; these were checked
by laudanum, and I was called to him. This was on the third
day of the attack. I found him lying upon his back, with his
legs extended, eyes closed, deep breathing ; temperature of the
head and trunk a little elevated, that of the extremities natural ;
pulse 112, rather full and quick, but soft ; complains of nothing
when not questioned ; no pain in the abdomen, pressure over
the ileac region produced the gurgling noise ; no tenderness,
abdomen full, but not tense; tongue pointed, covered with
brown fur, and dry, so tremulous that it could not be protruded ;
said his throat was sore ; every attempt to use his hands, in-
duced violent tremors, and sometimes spasmodic jerks ; could
not sit up at all, even when supported ; troubled with a fre-
quent, but not violent, dry cough. He continued in about the
same condition, with from three to six of the cider evacuations
per day, until the seventh day of his confinement, when he
became decidedly comatose ; pupils dilated, hissing respiration,
and cool extremities ; stools became of a dark colour, more
copious, involuntary and very offensive. On the thirteenth day
tympanitis ensued, with some signs of restlessness, which con-
tinued, with a general decline of all his forces, until the 16th,
when he died.

Physical appearances, ten hours ^0s/-wor/em.-*-Pia-mater

1850.] Wooten, on Typhoid Yever. 13

highly vascular, moderate effusion between this, and the arach-
noid coat, slight injection of the medullary portion of the brain;
several ulcers upon the lining membrane of the throat, some
mucus along the trachea, and bronchial tubes, with tumes-
cence of the mucous membrane. The mucous membrane of
the stomach appeared thickened, but presented no evidence of
inflammation. The liver was pale, rather soft, and appeared to
be somewhat enlarged. The mucous membrane of the small
intestines was thickened and of a dark red color throughout ;
the eliptical plates were generally decidedly elevated, and in
the lower portion, near the ileo-ccecal valve, there were seve-
ral jagged and uneven ulcers, some of them so deep as nearly
to perforate the intestinal coats, others more superficial. The
mucous surface of the large intestine was not diseased, but un-
usually pale. In the contents of the bowels, there were found
some small specks of blood, which had not been discovered in
the evacuations. This examination was made merely to test
the diagnosis, and was not so minute or comprehensive as it
ought to have been, or the notes sufficiently full and exact for
a report, which was not, at the time, contemplated. But the
history of the case, as well as the post-mortem notes, may
serve my present purpose, which is, merely to illustrate the
double or complex variety of this fever.

The prognosis of this fever is very difficult and uncertain:
cases presenting some of the gravest symptoms will occasion-
ally recover ; and again, those which exhibit no alarming
symptom will sometimes disappoint us, and die. I attended
once the case of a young man, who passed through all the
stages, with some of the worst symptoms of both the nervous
and mucous classes, and finally recovered. And I saw another
who had gone through all the stages, with scarcely any symp-
toms but those of the mucous class, and of a mild character
even through the second stage, he could sit up a little and take
light nourishment every day ; but late in the third stage, he
grew suddenly worse, and I was sent for, for the first time. I
found him suffering much pain^and distention of the abdomen,
laborious breathing, delirium, &c. This was at 3 o'clock, p. m.,
and at 6 next morning he died. On examination, there were
several plainly marked recent cicatrices on the mucous mem-

14 Wooten, on Typhoid Fever. [January,

brane of the small intestines, near the coecum, and there was
one ulcer, which when spread out, was about the size of a
twenty-five cent piece. It was deepest in the centre, where it
had perforated the peritoneal coat of the intestines, and much
of the contents of the bowels had escaped into the cavity of
the peritoneum the peritoneum exhibited marks of very high
inflammation throughout.

The amount of febrile excitement proper, affords of itself
very little grounds of prognosis. The manner, especially the
rapidity with which the disease manifests itself, affords some
ground upon which to form an opinion as to its progress and
termination. Those cases in which the system is violently as-
sailed and rapidly prostrated, I have usually found to be more
grave throughout ; and a far greater number of them prove fatal
than of those which are more gradual in their first seizure,
even though they grow severe eventually. But, in consider-
ing the prognosis of this disease, it will be most convenient to
continue the use of the classification heretofore adopted. In
the nervous variety, I have found the degree of violence which
the cerebral or nervous symptoms manifest, a good criterion
by which to judge of the gravity and danger of the case. If
the somnolence, or stupor, is great in the first stage, I view it
as of serious portent, for it will be prone to increase in the se-
cond stage, and if it does so, it will probably pass away no more.
A drowsiness, from which the patient can be easily aroused,
and drawn into connected and thoughtful conversation, is of no
serious import. But that kind of stupor which will answer
your most urgent and important enquiries with monosyllables,
and without any appearance of thought, is a very different and
much more grave affair, and more especially when it is found
to increase from day to day. Dilatation of the pupil, when
permanent, is unfavorable, as well as dryness and fixedness of
the eye. Greater prostration of strength than the emaciation
of the muscular system will account for, is unfavorable. The
subsultus tendinum, or muscular agitation, I have not found to
afford much indication as to the danger of the case, but a rigid
contraction is very bad, and apt to be associated with other
symptoms of evil augury. Profound and persisting coma is
one of the very worst symptoms. Delirium of ordinary vio-

1850.] Wooten, on Typhoid Fever. 15

lence and remitting, I have usually found to pass off pretty
well ; but when it is violent, continuous, and associated with
unceasing watchfulness, I consider it very unfavorable. There
is a kind of delirium to which patients are subject in the last
stage of this fever which very much resembles some forms of
hysteria : the patients imagine that they are, or have been at
some distant place, most generally they either suppose that they
are about to die, or that they are entirely well, and have not
been sick 1 have seen several females take leave of their
friends, and make all their arrangements to die, when in fact,
they were really recovering and decidedly improved from a
very threatening condition. This kind of delirium I do not
consider unfavorable as to recovery; but such patients are apt
to exert their powers more than they can bear, and on that
account, they require very watchful management. In this class
of cases, a pulse of over an hundred beats per minute is unfa-
vorable, particularly if it continues to increase in frequency,
and 130 is very alarming. An eminent practitioner and writer
on this subject, has said, that be never lost a patient by this
fever, in which the bowels remained constipated. My expe-
rience satisfies me that he certainly never could have had
many grave cases of the cerebral variety, or that he treated it
under some other name ; for although I look upon violent diar-
rhoea as a very bad symptom, still some of the worst cases that
I have seen those which yielded least to remedies, and gave
the most fatal indications from the beginning, and which died
in the shortest time had not more than one evacuation per
day, and some others had none except those which were indu-
ced by medicine or the syringe. Yet, as exempt as these cases
were from symptoms of diseased bowels, those which I have
examined after death, (four in all) exhibited the same lesions of
the intestinal glands only in a less advanced state as those
which had suffered from profuse diarrhoea, though the disease
generally covered a less extent of surface.

The favorable indications in this class of cases are, an improv-
ing clearness of the mind and an increasing power and inclina-
tion to think. A lighting up of the countenance, so to speak ;
the reappearance of intelligent expression, &c, are very fa-
vorable. A lessening of the frequency of the pulse ; a more

16 Wooten, on Typhoid Fever. [January,

regularly distributed temperature ; a return of tastes or senses,
which have been suspended or perverted ; the ability to sleep
soundly and awake clearly ; a returning muscular strength and
steadiness; a desire for food, with a natural taste for it; are
each very favorable, but when they occur together, I consider
convalescence as begun.

In cases of the mucous variety, early, copious and persisting
diarrhoea is unfavorable. A diarrhoea of increasing violence
with rapid decline of strength, at any stage, portends badly.
A frequent pulse, over 120 in men, or 130 in women, without
abatement, is very threatening, particularly in the second and
third stages, and feebleness or intermittence adds to the gravity
of the case. A hurried, or laborious breathing, is bad ; lividi-
ity of the lips and cheeks is indicative of engorgement of the
pulmonary mucous membrane, and is more or less unfavorable ;
and the permanently bronzed cheek is very threatening; deaf-
ness and blindness are unfavorable in proportion to their degree,
but are only serious according to their association with other
phenomena. I have seen only three cases of actual haemor-
rhage from the bowels two of them recovered and one died;
this one was associated with most of the very bad symptoms.
Softness and bleeding of the gums, indicate, at best, a tedious
case. The tongue is not a very good index in this disease I
have noticed in several fatal cases, a very peculiar tongue
which I have seen in no other disease : it is small, contracted
in every aspect, dry, and of a pale dark brown, resembling in
colour an old weather-dried oak leaf. I have observed this
tongue only in fatal cases, and it occurs in the latter part of the
second stage. Much ulceration of the throat, with difficulty of
deglutition, is rather bad. Epistaxis, unaccompanied with
other haemorrhage, is not serious. Vomiting in the second or
third stage, if not easily controlled, is unfavorable. A jaun-
diced conjunctiva, and surface generally, is rather a serious
sign. Tympanitis is bad,' and accompanied with jactitation
and delirium, it is amongst the worst of symptoms. Involun-
tary discharges from the bowels or bladder denote an alarming
state of things, and suppression of urine may be placed in the
same class of symptoms.

I view the prospect of recovery as good, when the pulse is

1850.] Wooten, on Typhoid Fever. 17

under 110 in men and 120 in women, and regular; tempera-
ture Well distributed ; diarrhoea controllable, cough moderate,
strength equal to muscular fullness, and the mind clear when
awake. The taste and appetite returning, the stools lessening
in frequency and increasing in consistency, and sleep refresh-
ing, are indications of convalescence.

It is unnecessary to remark, that cases of either class are
the more grave and dangerous, in proportion as they exhibit
the more serious symptoms of the other class ; or manifest the
greater number of those of their own ; and further, the consti-
tution of the patient must be taken into consideration, as a
matter of no minor importance, in all such cases as are not de-
terminate in their own characters, above all natural or medicinal
influences.

In my own practice, counting those cases which were well
marked and decided, and which were fairly under treatment,
there have died, of the nervous class, one in eighteen ; of the
mucous class, one in twenty-four ; and of those which were
strongly marked by the symptoms of both classes, so that they
could not well be classified, one in four. A good number of
these cases were negroes at * the quarter," and their general
management was not under my control, as it ought to have been.

The treatment of this fever is as difficult to systematise or
specify, as the prognosis ; and my experience confirms the
opinion expressed by Prof. Bartlett, that there can be no strictly
systematic rule of treatment, that is of universal, or even gen-
eral application. So far from it, that I think any routine or
specific course, universally applied, will injure more cases than
it will benefit. * When we approach the treatment of this fever,
we must remember, that when once fairly established upon the
system, it has a course to run, the various stages and incidents
of which must be taken into account. The effect of a given
treatment, upon a particular stage or state of things, is to be
considered, not only in relation to that special state of the case,
but its influence upon subsequent events which may be antici-
pated, must also be looked to. I have found that in all varieties
and stages of this fever, the age, habits, constitution, and par-
ticular circumstances of the patient, are to be noted with as
much circumspection as possible, because these things mnst

n. s. VOL. VI. no. i. 2

18 Wooten, on Typhoid Fever. [January,

have always a modifying, and often a controling influence in
the treatment.

In speaking of the treatment, it will be most convenient to
continue the classification already used, and first to notice the
nervous class. If, in the first stage, the pulse is full and pretty
firm, with much fullness of the head, without diarrhoea, I bleed
from the arm until I have made some impression upon the vas-
cular force ; if, afterwards, relief is not decided or permanent,
I resort to scarified cups to the back of the neck, and along
the interscapular spine. In these cases, the hair should be
closely trimmed, and the heat of the head kept down by cold
applications. Under this state of things, I have known ice and
cold water kept constantly to the whole scalp for three weeks ;
for it was found to be effectual in controlling the distressing
cerebral disturbance, and indispensible to that end, and was
doubtless the chief agent in saving the patient. After the re-
pletion of the vascular system has been sufficiently reduced, if
stupor, or other evidence of cerebral engorgement exists, blis-
ters to the cervical spine have been found very serviceable,
and to continue their beneficial influence, it will often be neces-
sary to repeat their application, in some cases several times.
It is in this class of cases, that the repetition of purgatives is in
many cases allowable, and in a smaller number, beneficial.
The irritation of the mucous membrane and glands of the small
intestines, is not so great, particularly in the first stage, as to
require extreme caution in their disturbance, and when it is a
mere turgescence, which involves the portal circle generally,
I have found that twenty grains of blue-mass, administered in
four doses, at intervals of three hours, and followed by seidlitz
water, if necessary, or olive oil, according to indications, is of
decidedly good service, both as a revulsive to the head, and in
lessening the intestinal engorgement, thereby reducing its
mischievous power in making lesions upon the surface. Further
than this, I have learned to administer purgatives, even in the
most appropriate cases, with great caution. Several years ago,
I saw the case of a young man who was suffering under a ra-
ther serious case of this variety, to whom purgative doses of
calomel had been pretty freely administered, until late in the
second stage ; when it was suspended on account of symptoms

1850.] Wooten, on Typhoid Fever, 19

of exhaustion. After several days had passed, without improve-
ment, a distinguished practitioner was called in consultation .'
he gave the case a slight examination, and told the attending
physician that his favorite course of purgation, would " break
the fever," with great certainty and promptness. He was the
oldest and most distinguished physician, and his ptescription
was agreed to, and put immediately into practice. Fifteen
grains of calomel with half-grain of tartarized antimony, were
given, and repeated at the end of two hours. Three hours after
this, a dose of infusion of senna with epsom salts was given.
This * course " was advised to be repeated at the expiration
of twenty-four hours ; but before that time had half elapsed,
the patient was in a most alarming collapse ; and so continu-
ously were mustard, capsicum, brandy and morphine, in use,
that the "second course," which was to give the finishing
touch, Was never even mentioned, although its confident advo-
cate was in attendance.

After once clearing the alimentary canal of irritating mat-
ters, I prefer, for the purpose of simple purgation, the use of
the syringe, and avoiding, even in that way, the introduction of
all irritating matters. During the first stage, or while febrile
excitement runs pretty high, I have found good results from
the use of the super-citrate of potash. Sometimes, it appears
in the course of the first and second stages that the secretory
functions are suspended, not for want of general vital power,
but of organic secretory action. Under these circumstances,
I have found alteratives of good service : two grains of calomel
alone, or with the same of opium or ipecacuana, as the intesti-
nal irritation may require, made into six doses, one to be admin-
istered every three hours. This prescription I sometimes find
it expedient to repeat, after an interval of twenty-four hours
or more.

In the latter stage of this variety of cases, the vital action
sometimes becomes very weak, extremities cool, and all the
functions which are not suspended, are sluggish and imperfectly
performed. For this condition, I have used with benefit the
nitric, or nitro-muriatic acid, three drops at intervals of four
hours, in gum mucilage, and if there is restlessness or watch-
fulness, it is advantageous to give it in hop-tea. In this state

20 Wooten, on Typhoid Fever. [January,

of prostration, the subsultus frequently becomes very trouble-
some, and as it is associated with symptoms of general nervous
debility, I have resorted to the use of the ferro-cyanate of quinia
with great benefit. I employ it in doses of four grains, once
in four hours. I would suspend the use of the acids for this,
only when the indications for such change were decided. As
a more decided sedative to the nervous system, when no other
effect is required, the valerianate of quinia is preferable, in
doses of two grains once in three hours, simply dissolved in
distilled water. I have repeatedly witnessed the most decidedly
beneficial results from the use of these preparations of quinia,
under proper indications.

In this fever, there are occasionally many minor symptoms
or compilations that have to be looked after, and amongst
these, one of the most troublesome is neuralgic pain. This
may occur in almost any part of the body, but I have most
often found it in the extremities, about the joints ; frequently
in the hip-joint ; sometimes in the ears. For this distressing
complication, I find the best effects from the use of the extract
of belladonna, applied externally in the form of plaster, and
continued until the pain ceases. I have never seen any bad
result from its use in this way. Sometimes, when the stupor is
rapidly degenerating into coma, and the vital energies generally
in a state of prostration, I have shaved the head and applied a
blister over the scalp, and in two or three instances, the patient
has recovered, and I have been disposed to attribute the good
result to the blister ; but most frequently I have seen no appar-
ent benefit from it : no doubt, I have generally applied it when
the case was beyond the reach of remedies.

In the treatment of the mucous class of cases, it is not often
necessary to resort to general depletion, unless it is in cases
which are complicated with some special organic inflammation.
When we are first called to these cases, the diarrhoea is pointed
out as the chief disorder requiring our attention ; and it is very
often an important question, to what extent we may properly
interfere to arrest it. The disturbing power is holding the
physiological functions in check, and this leading symptom is
often the result of nature's efforts to relieve herself of the ac-
cumulated burthen, through unusual channels. If we can sue-

1850.] Wooten, on Typhoid Fever. 21

*

ceed in arresting the discharge, while we make no provision for
the relief of the engorged and oppressed organs, we have, at best,
but smothered the flame, while the consuming fire is ready to
break out again, and very rarely fails to do so, after a very short
period. When first called to patients, I generally find that
the diarrhoea has been checked, perhaps several times, by
laudanum. A simple suppression of the discharge increases
the cephalalgia and all the febrile symptoms, and no doubt in-
creases and confirms the visceral engorgements. What we
want to do, is to so far relieve the mucous coat of the small
intestines, as to prevent or lessen as much as possible, the mis-
chief there, while at the same time, we re-establish the natural
secretory action and relieve the necessity for their morbid
substitutes. Can we do this ? While we are bound to admit
that we are liable to failure, we have well established thera-
peutic principles to sustain the attempt, and we will very fre-
quently succeed. For this purpose, I frequently employ with
success, blue mass, 16 grs., opium, 2 grs., made into four pills,
one to be given every third or fourth hour, as the urgency of
the diarrhoea may indicate. Sometimes it is found necessary
to increase the amount of opium, but most generally four of
these pills will put a- check to the discharges for several hours,
after which the re-establishment of the secretory functions will
be manifest, to a greater or less degree. The urine becomes
more copious and clear ; the skin, if not moist, is more pliant
and soft, and ail the symptoms of general disturbance quieted.
The stools become less frequent, are more consistent, and ex-
hibit evidences of biliary secretion, and the tongue grows
more moist and pliant. When the mucous irritations are de-
cided or extensive, this amelioration will be but temporary, and
it is frequently found necessary to repeat the pills several
times during the first stage. Although this course may not
often cure a case, it undoubtedly lessens visceral engorgements,
by which means it often prevents some of the worst complica-
tions of the fever, and I have witnessed its action in several
cases in which I thought that it was the chief agent in prevent-
ing structural lesions, and bringing on convalescence at the
end of the first stage. While alterative medicines are being
used, if the fever is high, soda water or the neutral mixture

22 Wooten, on Typhoid Fever, [January,

may be given, as well as at other times when they are indicated.
I believe it is decidedly beneficial to use a solution of gum
arabic, as a constant drink. There are cases in which there
is a sense of fullness in the bowels, stools frequent and scanty,
evincing turgescence of the intestinal mucous membrane, of a
primary character. When this occurs early in the first stage,
saline purgatives may be administered with benefit, and repeat-
ed, if necessary. It is sometimes found expedient to follow
the alterative pills with a purgative of this class, when the
evacuations are not resumed with sufficient freedom. The
various states of the particular functions, &c, with their ac-
companying visceral disorders, have given rise to the various
contradictory modes of treatment which different authors in-
sist upon with so much earnestness. One gives emetics, ano-
ther cathartics, another bleeds, a fourth does about nothing at
all, and each urges his own particular plan as the very best
mode of curing the fever. These men have formed their opin-
ions upon a number of cases which they have observed ; the
cases of each being influenced by circumstances, and controlled
by forces which had no influence whatever on the cases of the
others ; remedies curing, or being tolerated at least, in one
set of cases, which would have been pernicious in another.
But the true and only rational p Ian is, to watch each case in-
dividually, note well its extent, violence, and complications, and
all the modifying agencies attending it ; and then apply the
best remedies that medical science and watchful experience
can furnish.

Experience has taught me to employ purgatives with great
caution in this class of cases I now, never resort to them after
the first stage, and during that stage I rarely venture anything
more than the mildest aperients I have observed this caution
for ten years, and success has confirmed my opinion of its im-
portance. Some of our best authorities advise that the bowels
should be opened every day, by purgatives. There are many
cases that will stand such a course of treatment, but even these
would do much better under different management. In 1840,
1 knew the case of a young man who had passed through the
second, and nearly the third stage, and was considered better
in every symptom, although he was greatly emaciated and very

1850.] Wooten. on Typhoid Fever. 23

feeble ; a physician (there were several attending) called, and
found that he had not had an evacuation of the bowels for forty
hours, and there was fur on his tongue ; *he was almost shocked
at the idea of a patient remaining so long without an action,
and insisted that he should have fifteen grains of calomel, which
was administered : active purging ensued, and the patient died
in forty-eight hours. From many similar cases that I have
seen and treated, I am convinced that this one was lost by in-
judicious purging. In 1843, I had a very grave case, which
exhibited most of the bad symptoms of both varieties, amongst
them an offensive and persisting diarrhoea. He had almost
reached the lowest point of exhaustion, when the stools lessen-
ed to three per day, and in three days ceased altogether. The
patient (a young negro man) lay in a semi-comatose state,
completely prostrated, and had no motion of the bowels for
nine days. During this time, a light liquid and stimulating
nourishment was cautiously administered, and his strength very
slightly and slowly improved; his taste and senses generally
returned, his pulse increased in fullness and lessened in fre-
quency, and all his symptoms were improved. Commencing
two days before the lessening of the diarrhoea, I administered,
#. Copaiba ol. Terebinth, a a 3ii.

Acid nitric, 3i.

Tine. opi. acet, 3 li.-

Aqua menth. pip., q. s. to fill a $iv. vial, well shaken,
a teaspoonful every fourth hour. After the fourth day of
the suspended intestinal action, the opiate was left out of the
prescription. A blister over the abdomen was kept running
all the time. In 1844, I had another case that of a girl aged
nineteen, very similar in every respect, and in which the evac-
uations from the bowels were suspended seven days ; and a
third in 1846, in a girl fifteen years old, in which the suspen-
sion followed immediately upon checking an alarming haemor-
rhage from the bowels in the third stage, and continued six
days. In all these cases, these long suspensions of stools im-
mediately preceded convalescence, and all were finally moved
by mild enemata, but no purgative medicine was administered.
It was difficult to persuade those interested, that it was best not
to disturb the stomach and intestines with irritating agents,
and continual appeals were made to " open the bowels."

24 Wooten, on Typhoid Fever. [January,

In the latter stages of this fever, we know that the mucous
coat of the intestines is inflamed, perhaps ulcerated, and the
philosophy of curing this disease by continual action and irri-
tation, is totally invisible to my conception. I have found it
important to with-hold every thing of a solid nature, although,
as nourishment, it may be as feeble and mild as possible. By
this, we keep undigested and irritating remains from disturbing
the inflamed mucous surface, and thereby keep this irritation
much more under our control. As to the morbid secretions,
whose effects upon the mucous disease of the bowels are so
much dreaded by many, I have not found it necessary to assist
its discharge by medicine, but I have often found it difficult to
hold it sufficiently under restraint.

When the symptoms of mucous inflammation are well es-
tablished, as indicated by a pointed tongue, with edges red and
dry brown centre, and in fact when the second stage has fairly
set in, I use, with much confidence and success, the copaiba,
with laudanum or black drop, as the state of the case may in*
dicate: $. Copaib, ss.

Acac. Gum. 3 ii,

Tincopi. acet. 3i.

Aqua menth. pip., q. s. to fill a 5 viii. vial.
Mix well, and give a tablespoonful every fourth hour, varying
the quantity of each ingredient, according to the particular in-
dications of each case. If the diarrhoea persists, the opiate
may be increased ; if the surface is cool, pulse feeble, &c, the
spts. of turpentine may be substituted for the copaiba, or com-
bined with it in suitable proportions. I use this prescription,
modified according to indications, through both the second and
third stages, with a success that gives me confidence in its vir-
tues, as the most generally applicable of any that I have resort-
ed to. I have sometimes resorted to mild alteratives, such as
minute doses of calomel, blue mass, or hydr. cum creta, in ad-
dition to the balsamic mixture, but only when especially indica-
ted, and never to the extent of purging. Sometimes the pros-
tration is so extreme, that almost every thing else has to give
place to stimulants, and such agents as are intended to sustain
the failing powers of life ; under these circumstances, the spts.
of turpentine is preferable to the copaiba ; or if neither is toler-

1850.] Wooten, on Typhoid Fever. 25

ated well, and an alterative is indicated, the nitric acid may be
resorted to with safety and benefit.

Blisters, though condemned and discarded by high authority,
(Louis,) in the treatment of this fever, I have found of the
greatest value. There is no single agent of which I think
more highly than blisters, in a large portion of cases. I have
sometimes had cases presented to me, which I considered in
the forming stage of this variety of the fever, and I gave a small
dose of blue-mass, followed, when necessary, by seidlitz water;
strict confinement and quiet, abstemious diet, allowing only the
mildest liquids ; and by this course, I have several times, as I
thought, succeeded in preventing an attack of fever. I men-
tion this circumstance here, to say that in this abortive treat-
ment, as it may be called, I have derived great benefit from
blisters these I apply over the small intestines, in such cases
as exhibit a tendency to much irritation there. I believe that
if physicians could have an opportunity sufficiently early,
more good might be done by medical treatment, in the forming
stage, than any other ; for if the disease cannot be prevented,
there is no doubt that it can, in almost every case, be greatly
moderated. When the second stage has fairly set in, and the
general febrile excitement is not very high, I view the indica-
tion for the application of blisters as decided, and if there is
tenderness of the bowels, imperative. Yet we must bear in
mind, that the inflammatory action id this fever does not pro-
duce pain and tenderness, so long as it is confined to the mucous
coat of the small intestines, and we must look to other symp-
toms for the evidences of its existence. To have the full ad-
vantage of blisters, they should not be suffered to cure up
entirely before the disease is removed. Here arises the error,
as I esteem it, of those who condemn blisters as useless. In the
first place, they may be applied too soon, in those cases in
which there is high febrile excitement, and only add to the dis-
turbance ; sometimes they are employed, while the internal
disease is so violent that their revulsive efiect is scarcely ap-
preciable, and they are neglected or discarded, just at the time
that their beneficial powers are most needed. Again, they are
sometimes applied, and afford relief while they are discharging,
which relief ceases as they heal, and without noticing this rela-

26 Wooten, on Typhoid Fever. [January,

tion of facts, they are dropped as a failure, or at best but a
temporary remedy, and something else resorted to in the usual
eagerness to " break the fever." 1 have made it a point of <
interest to watch the effects of blisters in this form of disease,
and I have almost invariably found, that as the blister healed or
ceased to discharge, the evidences of internal disease increased,
until the latter had itself abated to the healing point. My
course is to apply, at the proper time, a large blister over the
bowels, let it draw well, and whenever it heals, re-apply it, or
sooner, if the symptoms demand the renewal.

Haemorrhage from the bowels, I have usually been successful
in arresting by the sugar of lead and opium : sometimes,
when it did not succeed well by the mouth, I have given it by
injections, with decided success, though my experience in this
is very limited.

I have several times found hiccup very troublesome, and have
used musk, assafetida, and the usual list of antispasmodics, with
variable success. In the last case of this troublesome symptom
which I have treated, I found the valerianate of quinine in doses
of two grains, repeated every hour, for six hours, to arrest it
entirely, and it returned no more. In several cases that had
reached an advanced point in the third stage, and the symp-
toms of intestinal ulceration were obstinate, I have found great
benefit from the nitrate of silver, in \ grain doses, every six
hours ; and I may add, that from this course, I have never seen
the least bad effect.

Erysipelas, is a complication of this fever, that is sometimes
very troublesome. I am at this time treating a case of the kind.
It occurs upon any part of the body, but most generally upon
the lower extremities. This occurrence makes, usually, no dif-
ference in the general treatment of the fever, and the erysipelas
should be treated locally, as if it were independent of the fever ;
for this purpose, I find hop poultices very soothing; and when
the cuticle has broken, and the surface presents abrasions, I
find nothing so soothing and efficient as a liniment made of
equal parts of liquor plumbi subacetatis, and olive oil, applied
about once in eight hours.

Stimulants and tonics, are sometimes required, though I be-
lieve they are often used to a hurtful extent. I have not found

1850.] Wooten, on Typhoid Fever. 27

much satisfaction in the effects of any of the wines, for this
purpose. If alcoholic stimulants are necessary, I prefer the
French brandy, though I very rarely resort to it. When all
the actions are very feeble, and a nourishing stimulus is indica-
ted, I have found the brandy in the form of egg-nog, a good
preparation, given in such quantities as the case may require,
having regard to the powers and susceptibility of the stomach.
I first learned the use of this preparation in my own case : it
was given to me by a non- professional friend under the circum-
stances here referred to, at first in very small quantities, and
gradually increased it had a very happy effect. But purely
as a stimulant, there is nothing which I have found to answer
so good a purpose as the carbonate of ammonia, given with more
or less freedom, according to its effects and the necessities of the
case. Some authors recommend cinchona, and sulphate of
quinine, in the latter stages of Typhoid fever, as tonics. I have
given thes^ articles a full trial, with all my prejudices in their
favor, and I would not give a cent for all their benefits as tonics,
for I have seen none result from their use.

There are, I am aware, many points in the treatment of this
fever, which I have not noticed ; first, because it is my inten-
tion only to speak of such points as my own experience presents
prominently to view ; second, on all other matters, it is pre-
sumed that the reader is as competent to form opinions as
myself; and thirdly, I have, without going further into the
matter, written as much as the limits of a journal article will
admit. In fact, the treatment of this fever, depends so much
upon the character of each individual case, that it is difficult to
offer any thing on the subject of much real value, and my ob-
ject has been simply, to suggest some of the chief remedial
measures which I have found advantageous, and the principles
and circumstances which guide me in their employment.

A point of not the least importance in the treatment of this
fever, is the dietetic management. The patient is much ema-
ciated, very feeble ; -his complexion pale, and every exterior
indication of a want of nourishment ; yet it is very doubtful
whether or not nourishment, if he could properly appreciate it,
would be of more benefit than injury, while the inflammatory
disease exists. But the ability to digest, and appropriate nour-

28 Wooten, on Typhoid Fever. [January,

ishment, and the effect of taking it into the stomach and bowels,
while they are in a condition which forbids digestion, are
questions of more importance.

I do not believe that the patient ought to be nourished, while
the inflammation and fever are going on with unsubdued power.
It would but add to the force of morbid actions, and at least,
counterpoise the relief which nature and well-directed medical
art are striving to afford. Under the circumstances mentioned,
I have not seen a patient that could digest any article of nour-
ishment, except in some few cases, and then only of the mildest
kind, and given in the most sparing quantities ; and I know,
from sorrowful observation, that nothing is more pernicious
than to throw upon the disordered and diseased organs, tasks
which they cannot perform, and which leave upon their sensi- '
tive surfaces, agents that irritate and inflame. When I believe
a patient is in need of nourishment, and able to digest and ap-
propriate it at all, I allow it to him in very small quantities at
a time, and of the lightest and most digestible liquids. I prefer
liquids, because, under the same circumstances, they do not re-
main so long on the stomach; and again, if they are not digest-
ed, their presence in the alimentary canal is not so hurtful as
solid substances. I have seen the very worst consequences
from taking even mild solid food, when it could not be digested.
Rice, is thought by many to be a very light diet, and easily
digested, but observation has convinced me that it is not such.
I have seen several patients who, after convalescence had fairly
set in, had eaten rice in small quantities and well prepared, for
several days, and thought that it was well disposed of, but an
uneasiness of the bowels had gradually increased, until a cho-
lera returned all the rice they had eaten, in much the same
condition that they had last seen it. I prefer beginning with a
weak animal soup, well seasoned with cayenne pepper. If
there is still a disposition to diarrhoea, and no fever, boiled milk
is a very good diet. When convalescence is established, a
milk custard, or soft boiled egg, will be admissible; and if
these are well digested, the appetite and other improving symp-
toms increasing, a small piece of boiled bird, or something of
that class may be taken. If, however, any of these things pro-
duce a fullness of the stomach, dry mouth, or other indication

1850.] Eve, Case of Hydrocele. 29

of harm, they should be abandoned. But very little of any
thing should be taken, without waiting to see the effect, before
a repetition is allowed. These cautions may be carried to an
erroneous extent, but it is best to err on the safe side of the
question, if at all.

At the end of the first stage of this fever, there is frequently
a great tendency towards recovery : the fever abates, the patient
feels better in every respect, and the appetite returns. It is
difficult to convince the patient, under these circumstances, of
the importance of abstemiousness, when that alone is the reme-
dy that will secure a cure. But he indulges very moderately,
as he considers it, and the inflammatory stage sets in, laying
his body under siege for, perhaps, several weeks more. Of all
the vexations and disappointments with which I have ever met
in the treatment of Typhoid fever, far the larger portion have
grown out of a disregard for my prescriptions in regard to diet.
Influenced by the confidence they have in the physician, pa-
tients will swallow physic, by the quantity, or by the hour, as
he may direct ; while his prescription on the subject of diet,
which is often much the most important, is not heeded half so
much, as that of any sage femme who may happen to come
along, and volunteer advice.

ARTICLE II.

A Hydrocele containing forty ounces. By Paul F. Eve, M.D.,
Professor of Surgery in the Medical College of Georgia.

On the 23d of this month (November), I operated before the
present Class of our College on a case of Hydrocele, which,
from its size, may be deserving notice.

Aaron, the patient, is a negro man aged 70, who some fifteen
years ago. first noticed an increase of the left scrotum, and which
has continued to enlarge to the present time. He has also some
accumulation of fluid in the right tunica vaginalis, with a re-
ducible inguinal hernia on the same side, which however does
not descend into the scrotum. Through the kindness of a pro-

30 Transactions of the College of Physicians. [January,

fessional friend in a neighboring county, he was directed to my
Sursrical Infirmary.

The scrotum was tapped by the trocar, and Dr. Means meas-
ured forty ounces drawn off through the canula. Diluted
tincture of iodine was then injected, and the patient since has
been doing well, with a good prospect of cure.

On a former occasion, I drew off thirty-seven ounces of fluid
in a case of hydrocele, and permanently relieved the patient, by
the same therapeutic agent.

December 1st, 1849.

PART II.
U cox cm s an ft (Extracts.

Summary of the Transactions of the College of Physicians of

Philadelphia, from May 1st, to October 2d, 1849, inclusive.

8vo pp. 46.

Associations of intelligent physicians, for a free interchange
of opinion upon the various subjects connected with Medicine,
are always profitable to those who are thus associated, and
when they give to the public full histories of their transactions,
the profession at large is benefitted, and becomes interested in
their success. The College of Physicians of Philadelphia,
composed of a number of able and accomplished medical men,
are doing much in this way for the profession. The pamphlet
before us completes a volume of 467 pages, in which much
valuable information may be found.

At the meeting in June, some discussion took place in rela-
tion to the effect produced upon the healthfulness of the atmos-
phere, by the practice of keeping the principal streets wet,
during the summer, by frequent watering. Dr. Emerson ex-
pressed opinions unfavorable to the practice,

"He believed that frequent wetting the streets copiously,
daily, during the hot season of the year, was calculated to ex-
cite a morp active decomposition of the filth which is always
present, to a greater or less extent, and in this manner, would
tend to a greater vitiation of the atmosphere ; consequently,

1 S50.] Transactions of the College of Physicians. 3 1

that it should be suspended, particularly at a season when the
city is threatened with the visitation of a fearful epidemic."

Dr. Jackson gave a similar opinion,

" Washing the streets, by allowing a plentiful stream of wa-
ter to flow down them, at proper periods, would, in his opinion,
be beneficial, by carrying away from their surface whatever
decomposable materials they contained ; but to keep this filth
in a constantly moist condition, under the influence of an in-
tense noon-day sun, could not fail, he was convinced, to be
productive of more or less deterioration of the atmosphere."

Other gentlemen fully coincided in these views ; and we are
informed that a majority of quite a number of physicians, to
whom a circular had been addressed by a committee of the
City Councils, soliciting their views in relation to the practice,
had expressed opinions equally unfavorable. Dr. Wood, how-
ever, seemed to have a greater dread of dust, than malaria :

u Dr. Wood confessed that he was in favor of sprinkling the
streets with water during the summer season. Every one,
whether he walks or rides, must have experienced the incon-
venience of dusty roads in windy weather. The annoyance
resulting from this source to house-wives and store-keepers,
along our principal thoroughfares, is far greater than can pos-
sibly be produced by a judicious sprinkling of the streets.
Independently of the inconvenience which the dust produces
by entering our dwellings, and by the destruction of goods in
stores, we are constantly forced to inhale a large portion of it,
and thus a much greater quantity of decomposed vegetable
matter is admitted into our bodies, than can be from the evap-
oration of the water thrown upon the streets. It is doubtful
whether any morbific emanations are produced by the practice
of sprinkling our principal streets during the summer months.
It is certainly not true that the inhabitants of these streets are
more liable to disease than those who reside in the streets
which are not sprinkled. A reference to the facts would shew,
he believed, that less sickness actually occurred during the
warm weather in the former, than in the latter. He would not
wish, however, to be understood as attributing this difference
entirely to wetting or non-wetting the streets ; whatever, how-
ever, has a tendency to allay the intense heat of the atmosphere
during the summer, will certainly remove one of the most
fruitful sources of the bowel affections which usually prevail in
our city during this season."

A considerable portion of the summary is taken up withdis-

32 Transactions of the College of Physicians. [January,

cussions upon the subject of Cholera. We have read them
carefully, and do not find that they throw much light upon this
vexed question. We shall therefore not attempt any analysis.
At the October meeting, Dr. Hays made some interesting
references to a case of intense irritability of the retinic coat of
the eye, resulting from irritation of the dental branch of the
fifth pair of nerves. This condition of the eye, in many in-
stances, is produced by decayed teeth. Dr. Hays detailed the
following case of this kind :

" A gentleman, formerly a resident in this city, and devoted
to chemical inquiries, became a sufferer from extreme photo-
phobia, which he ascribed to having carried on very closely,
for a long time, a series of chemical analyses over a bright
charcoal fire. The affection of his eyes became so severe as to
prevent him from following his usual pursuits. . The glare of
the fire in his furnace became intolerable, and it was even im-
possible for him to read or write without intense suffering. He
was, at the same time, affected with neuralgic pains of the face
and orbit. Upon examining his mouth, it was found that a
number of his teeth were decayed ; the aconita ointment was
tried, and afforded some relief to the neuralgic pains. After
having, by Dr. H.'s advice, several of the most decayed teeth
removed, he found his photophobia diminished considerably in
intensity. He visited Baltimore on some business, and on his
return his eyes were again affected, as they had been previous-
ly. Dr. H. supposed that he had been too closely engaged whilst
at Baltimore, in pursuits which had over-exercised his eyes,
but this the patient declared was not the case ; he mentioned,
however, the fact that some of the remaining teeth had begun
to decay ; these the doctor advised him to have extracted,
which was done, and his photophobia was again relieved.
The gentleman's teeth decayed very rapidly, and others still
became diseased ; but upon their removal, the affection was
relieved as before. Many teeth were thus removed, and an
artificial set substituted. Dr. H. has been informed that he
still continues well."

Dr. F. G. Smith, also mentioned a similar case which had
fallen under his observation. His patient, a young lady, suf-
fered from intense intolerance of light, with neuralgic pains
over the brow and through the ball, and he supposed that a ten-
dency to amaurosis existed :

" After reading the cases related by Dr. Hays, as given in

1850.] Cod-liver Oil in Phthisis Pulmonalis. 33

the Summary of our Transactions, the suspicion arose that the
affection of the eyes, in the young lady alluded to, might be
caused by decayed teeth. A respectable dentist was requested
to examine her teeth, but he declared, after a close inspection,
that he could discover no defect in any of them. Dr. S. urged
a second examination, and, on going carefully over the teeth,
some degree of tenderness was detected in one of the bicuspids
on the side corresponding with the eye most affected. This
tooth was drawn, and an abscess was discovered to exist at its
root. With the extraction of the tooth, the photophobia and
pain ceased, and have not since returned, though several
months have elapsed, during which the lady has been subjected
to great mental distress from family afflictions. She can now
read by artificial light without experiencing the least incon-
venience, and has been enabled to resume her studies, which
had been previously suspended in consequence of her great
suffering."

Dr. Condie presented an outline of a case of Hydrophobia,
which is interesting, from the fact, that it was undoubtedly of
spontaneous origin.

On the use of Cod-Liver Oil in Phthisis Pulmonalis. By
Dr. C. J. B. Williams, F. R. S., Prof, of Medicine in Uni-
versity College. (Journ. of Medicine. Braithwaite.)

The unvarying fatality of pulmonary consumption, under
the usual modes of treatment, and its frequent occurrence,
render the following remarks of Dr. Williams, highly interest-
ing ; the more so, as his eminent professional standing entitles
his observations to a most careful consideration. Dr. W. does
not speak from a partial experience. His conclusions are based
on the observation of 400 cases, of which 234 are recorded in
his note book. Of these last, there were nine cases in which
the oil disagreed ; 19 in which it did no good ; and 206 in which
its use was followed by unequivocal improvement, varying in
degree, from a mitigation of the distressing symptoms, up to
an apparently complete restoration to health.

The effect of the cod-liver oil in most of these cases was
very remarkable. Even in a few days, the cough was mitiga-
ted, the expectoration diminished in quantity and opacity ; the
night-sweats ceased ; the pulse became slower and of better
volume ; and the appetite, flesh, and strength were gradually

n. s. VOL. VI. no. i. 3

34 Cod-liver Oil in' Phthisis Pulmonalis. [January,

improved. The first change manifest in the physical signs
was generally a diminution and gradual cessation of the
crepitus ; the breath-sound becoming drier and clearer ; but
the dulness, and tubular character of the breath and voice-
sounds were much more persistent, and rarely exhibited a
marked decrease, until after several weeks' use of this remedy,
in conjunction with regular counter-irritation. The tubular
sounds, in fact, frequently became louder at the first removal
of the crepitus, which in phthisis as well as in pneumonia, tends
to mask the signs of consolidation. In several instances, how-
ever, in which I have had the opportunity of examining the
patients under treatment, at several successive intervals of a
month or six weeks, the gradual removal of the consolidations
has been unequivocally proved, by the restoration of clearer
vesicular breath and stroke-sounds to the affected spots. In
several cases, in which the disease has existed long, the resto-
ration has never been perfect ; even where the health has been
completely re-established, and all common symptoms of disease
have entirely disappeared, there have remained perceptible
inequalities in the breath and stroke-sounds ; generally, with
prolonged expiratory sound, which has more or less of a tubular
note towards the root of the lung of the same side. These
signs, if unaccompanied by decided dulness on percussion, I
have learnt by the experience of many years, not to consider
as exceptional against recovery, for they appear to be de-
pendent on the puckering of the texture, often with pleural
adhesions and old deposits in the bronchial glands, so frequently
found after death at the summits and near the roots of the
lungs of persons who have not for many years exhibited
symptoms of any pectoral disease.

As might be anticipated, a large number of the phthisical
patients for whom I have been consulted, have been in the
first stage of the disease, in which the tubercles or deposits
are in the solid state. In these cases also, I have largely used
the cod-liver oil, and, so far as I have ascertained them, with
not less satisfactory results.

The physical signs of improvement are precisely the same
as those which take place tardily in the second stage after the
removal of the humid rhonchi : and in truth, the treatment
by the oil combined with counter-irritation, where successful,
seems to bring back the lungs from the second stage, that of in-
cipient softening, to the first stage, that of simple deposit, which is
tardier in its changes of increase or diminution, and may remain
long stationary without any obvious alteration. The same re-
mark is applicable to the chronic products of inflammation of the
lung, winch, as is known to the the profession, I consider to ap-
proximate in nature to the higher class of tuberculous deposits.

1850."| Cod-liver Oil in Phthisis Pulmonalis. 35

The most striking instance of the beneficial operation of
cod-liver oil in phthisis, is to be found in cases in the third
stage, even those far advanced, where consumption has not
only excavated the lungs, but is rapidly wasting the whole
body, with copious purulent expectoration, hectic, night-sweats,
colliquative diarrhoea, and other elements of that destructive
process by which, in a few weeks, the finest and fairest of the
human family may be sunk to the grave. The power of stay-
ing the demon of destruction, sometimes displayed by the
cod-liver oil is marvellous.

[After relating several cases of tuberculous lung-disease in
an advanced stage, in which the use of the oil combined with
counter-irritation gave rise to the most decided improvement,
Dr. Williams says :]

The results above stated give to cod-liver oil, even as a
tardative or palliative in phthisis, a rank far above any agent
hitherto recommended, whether medicinal or regiminal. I
have made extensive trials of several other medicines of reputed
utility in this disease, and on a future occasion may lay before
the profession the results of my experience, which prove some
of these agents to be by no means inoperative or useless ; and f
still consider them to be often salutary aids in the treatment of
this formidable malady, but their utility and harmlessness fall
so far short of those of the cod-liver oil, that I regard them now
chiefly as subsidiary means, and the more likely to be useful,
in proportion as they facilitate the exhibition or continuance of
this superior agent.

If the experience of the profession at large should accord
with my own, and with that of those who have proceeded me
in recommending the cod-liver oil, our prognosis with regard to
phthisis must undergo some modification. To what extent this
modification may reach, cannot be determined, until such cases
as those which I have recorded have been tested by years of
time ; but even now, when we repeatedly find forms and
degrees of disease, that former experience had taught us to be
utterly hopeless and speedily fatal, retarded, arrested, nay
sometimes even removed and almost obliterated by various
processes of restored health, we must pause ere we, in future,
pass the terrible sentence of " no hope" on the consumptive in-
valid.

Mode of operation of cod-liver oil. It seems scarcely neces-
sary to discuss the question, whether the oil owes its efficacy
to the iodine which it contains. The amount of this element
is so minute as hardly to admit of quantitative measurement ;
and to ascribe virtue to such infinitesimal fractions, when or-
dinary doses have no corresponding activity, is to adopt the

36 Cod-liver Oil in Phthisis Pulmonalis. [January,

fanciful and mischevous speculations of the homoepathist, which
cannot be too strongly deprecated by the scientific and con-
scientious practitioner. Several of the patients whose cases
are cited, and many more of whom I have records, had taken
iodise in various combinations before taking the oil, but without
any effects approaching to those which ensued on the change of
treatment. I am by no means incredulous of the salutary opera-
tion of iodine in some forms of tuberculous and scrofulous dis-
ease ; indeed until I used the pure oil, I considered it to be the
most useful remedy ; but in the last two years, the oil has so far
surpassed it and every other medicine in beneficial operation,
that I am convinced that it acts by a virtue peculiar to itself.

A perusal of the foregoing cases, and of others on record, at
once suggests that the cod-liver oil is a highly nutrient
material ; and it is commonly admitted by all practitioners who
have used it, that it possesses, in a pre-eminent degree, the
property of fattening those who take it for any length of time.
But its nourishing influence extends beyond the mere deposition
of fat in the adipose tissue. The muscular strength and activity
are sensibly and sometimes rapidly increased under its use ;
whilst the improved colour of the cheeks and lips implies a filling
of the vessels with more and better blood. Researches are
wanted, to elucidate this subject more clearly ; but the analysis
of the blood in one case of phthisis which had been under
treatment by the oil, showed a most remarkable increase of
the animal principles of the blood, especially the albumen,
which amounted to thirteen per cent., being nearly double its
usual amount, whilst the fat was not materially augmented ;
and the fibrin, which is generally high in phthisis, was reduced
below the'normal proportion. If these results should be con-
firmed by further observation, there will be no difficulty in
understanding that the cod-liver oil should prove a nutrient to
all the textures ; although it may yet be a question, whether
it does so by direct conversion into albumen or fibrin, or by pre-
venting the waste of the albuminous principles by protecting
it from the action of the oxygen absorbed in respiration.

But there is much reason to believe that the oil itself proves
serviceable in supplying the fat molecules which appear to be
essential to healthy nutrition, as forming the nucleoli of the
primary cells or rudiments of tissues. The important part
which fat thus performs in the process of nutrition, was first
pointed out by Ascherson of Berlin ; and that fat forms the
central molecules of the elements of granules and cytoblasts
of textures, is generally admitted though few agree with
Ascherson in his opinion that the fat forms the cells by its
power of coagulating albumen around it. It seems to have

1850.] Cod-liver Oil in Phthisis Pulmonalis. 37

been the opinion of Dr. Ascherson and of Dr. Hughes Bennett,
who cites it, that in scrofulous diseases there is a want of this
fat, and that the albumen derived from the food in digestion is
liable to be precipitated in an unorganized condition, (as
tubercle, etc.) for the lack of it. But it is now well ascertained
that scrofulous and tuberculous deposits, so far from being
deficient in fatty particles, contain them in greater quantity
than exists in the blood, or in its plasma in a healthy state.
The explanation which I have given of the chief salutary
action of the cod-liver oil, is not that it supplies fat where it is
wanting, but that it supplies fat of a better kind, more fluid,
more divisible, less prone to change, and more capable of being
absorbed into, and of pervading, the structures of the body ;
thus affording a fine " molecular base" in the chyle, and there-
in, a material for a better plasma ; and being conveyed into
the blood distributed through capillaries and around deposits
(in such quantity as to soften and dissolve the crystalline and
irregularly concreted fat scattered through them), it renders
them more amenable to the processes of reparation and
absorption. Hence its beneficial operation is more marked in
those stages of tuberculous disease in which the deposits abound
in fat ; that is, at the period of maturation and softening ;
although from the extent of mischief already done, both to the
part and to the system, the benefit may not be so lasting as in
the early stages of the disease.

One of the most remarkable effects of the cod-liver oil, in
some cases of the second and third case of phthisis, and in
other forms of scrofulous disease with extensive suppuration, is
the speedy removal of the sweats and other symptoms of
hectic fever. This can hardly be ascribed to its direct nutrient
powers ; but I think that it is due to its influence in diminishing
the unhealthy suppuration which is excited around the softening
and excavated tubercles. If my views of the chemical nature of
suppuration, that it consists of a further oxydation, of the exu-
dation corpuscle, be correct, then it is quite intelligible that the
presence of so highly combustible a material as oil, must check
this process of oxydation, and thus prevent the degeneration of
the corpuscles into the aplastic pus globules.

In fact, if it should prove to be correct, according to the
analysis above quoted from Simon, that cod-liver oil removes
the excess of fibrin e in the blood of phthisical patients this
also equally accords with my notion, founded on the inferences
of Mulder and others, that the formation of fibrine is due to a
process of oxydation of the albumen (forming a deutoxide of
protein, according to Mulder;) and that, by preventing this,
the oil removes that tendency to cacoplastic inflammatory dc-

38 Cod-liver Oil in Phthisis Pulmonalis. [January,

posits which largely contribute to increase the consolidation of
the lungs and other organs in phthisical subjects.

In making these surmises, I would not be supposed to adopt
the idea of Liebig, that pulmonary consumption is the result of
an excess of oxygen in the blood at large, consuming its ma-
terials and those of the textures. Many of the symptoms, as
well as the organic lesions of the disease, show that there is a
great deficiency in the process of respiration by which oxy-
gen is supplied to the blood ; and some of the most rapidly fatal
cases, exhibiting speedy emaciation, are, throughout their
course, in a condition bordering on asphyxia. Here is ob-
viously a great want of oxygen in the blood nay I believe,
the excess of fat in the liver, and in the tuberculous deposits, in
these instances, to be caused by this very scanty supply of
oxygen to the system. But although it is deficient in the
system, enough oxygen comes into contact with the exudations
from cavities in the lungs, and from the diseased bronchi in
their vicinity, to effect the formation of much unhealthy pus ;
and it is the formation and reabsorption of this that seems to
excite the hectic of phthisis, as well as to keep up much har-
rassing local irritation. Now, I believe it to be by diminishing
these exudations, and checking their further oxydation into
pus, that cod-liver oil acts so promptly in reducing the hectic
sweats and purulent expectoration of phthisis, which accel-
lerate and aggravate its destructive progress.

The limits of this paper will allow me to notice but briefly
one more point in regard to the action of cod-liver oil. Un-
like other ods or fats, it rarely disorders the stomach or bowels,
or disturbs the functions of the liver. If taken in any quantity,
vegetable oils commonly purge, and animal oils turn rancid in
the stomach, causing heartburn, bilious attacks, and even
jaundice. On the contrary, cod-liver oil generally improves
all the chylopoietic functions, and distinctly promotes the
action of the liver ; so that, as in several of the cases above
related, the appetite and power of digestion are restored, and
patients are enabled to take an amount and variety of food be-
yond what they were accustomed to, even in health. I can-
not help thinking, that this peptic influence of the oil is due to its
containing some biliary principle, which both favors its divisi-
bility in the process of digestion, and promotes the natural
secretions of the liver. The flow of bile, as indicated by the
colour of the faeces, is generally free and uniform during its ex-
hibition ; and I must not omit to notice another fact, which I
believe to be connected with increased activity of the liver. I
have in numerous instances remarked that the bulk of the liver
(as determed by percussion) becomes augmented during its

1850.] Cod-liver Oil in Phthisis Pulmonalis. 30

use ; yet without tenderness or any other sign of disorder. In
fact, this seems to be a kind of useful hypertrophy, induced by
the oil augmenting the bulk and quantity of the hepatic cells,
and supplying at once a material the more fitted for this
secretion, because it has already within it some elements of
biliary matter which served a similiar purpose in the liver of
the fish, and this at a lower temperature, and less favourable to
the activity of the process. The observation of this influence
of cod-liver oil has led me to use it in several cases of function-
al and structural disease of the liver, marked by defective or
depraved secretion, and in some instances with most satisfacto-
ry results, especially in one of habitual formation of gall-stones,
which had resisted all kinds of treatment, and was rapidly
destroying the health; the use of the oil has entirely stopped
the attacks, and has restored the patient to good health.

It appears probable, therefore, that although other oils might
be equally influential in promoting nutrition, and in preventing
and removing the cacoplastic and aplastic exudations of
scrofulous subjects, the oil from the cod's liver, and perhaps
those from the livers of other fish, have the advantage in point
of digestibility, and in promoting the action of the digestive
and biliary organs.

In all instances I have prescribed oil as free from taste and
smell as could be procured : and so little difficulty has been expe-
rienced in its administration, that the proportion of cases in which
it has decidedly disagreed has not amounted to four per cent.

The inofTensiveness of the oil implies the use of no process by
which it can be deprived of its proper qualities. All that is re-
quired is, to obtain it pure and fresh, as it existed in the hepatic
cells of the healthy fish when alive, without contamination by
any process of putrefaction, roasting, boiling, or the like.

My usual mode of administering cod-liver oil, is in doses of
a teaspoonful, gradually increased (if the stomach bear it) to a
table-spoonful, floating on some pleasant-flavored liquid, such
as diluted orange-wine, or the infus. aurantii comp., with a
little tinct. and syr. aurantii. The vehicle should be suited to
the taste and stomach of the patient ; and much of our suc-
cess in exhibiting the medicine will depend on our being able
to keep the palate and stomach at peace with the oil. In
numerous instances I have found that the addition of a little
diluted nitric acid to the vehicle will make it more grateful to
the palate, as wTell as serviceable to the stomach ; and we may
often combine with it other medicines which are not disagreea-
ble, and thus fulfil the indications of palliating symptoms by
their means. The fittest time for taking the oTl is" from one to
two hours after the three first meals of the da v. At this time

40 Treatment of Opacities of the Cornea. [January,

the chyme is beginning to pass from the stomach into the
duodenum; and it would appear that the oil passes quickly
with it, for given at this time it causes none of those unpleas-
ant eructations which are apt to occur when it is taken
either before or with food. There is nothing in the oil for the
stomach to digest ; and the less it is brought into contact with
it, and the sooner it passes out of it, the better. When it
mixes with bile and pancreatic juice in the duodenum, its
division and absorption begin and proceed, as in the case of all
fatty matters. Herein, too, we see a reason why the oil does
not agree so well either with the palate or stomach, when
mixed in an emulsion, or combined with liquor potassse, as re-
commended by some practioners.

In conclusion, I repeat, that further observations, and longer
time, are requisite to determine with accuracy the extent to
which this agent can control or remove tuberculous disease of
the lung ; but I would state it as the result of extensive experi-
ence, confirmed by a rational consideration of its mode of action,
that the pure fresh oil from the liver of the cod, is more beneficial
in the treatment of pulmonary consumption than any agent,medi-
cinal, dietetic, or regiminal, that has yet been employed.

Treatment of Opacities of the Cornea. By John Charles
Hall, M. L). (London Lancet.)

Simple nebula of the cornea can be removed without much
trouble by the daily application of a solution of nitrate of silver
in distilled water (distilled water, seven drachms; nitrate of
silver, one to three grains ; wine of opium, without the aroma-
tic, one drachm.) Or what is better still, in more severe cases,
by the following drops, which I have now been in the habit of
prescribing very frequently during the last ten years, and with
much advantage : Take of the bichloride of mercury, two
grains ; distilled water, an ounce : mix for a lotion, to be used
once or twice a day. I would repeat, that whatever lotion be
employed, it is far better not to drop it into the eye as we com-
monly see, even in hospitals ; a camel-hair pencil should be dip-
ped into the solution, and the opaque spot touched with it, by
which means the remedy is at once brought into direct contact
with the part to which you wish its operation to be confined,
and that, too, without decomposition or dilutation from the tears,
which must always be the case in the ordinary method.

Whoever has had much experience in diseases of the eye,
will have observed that when any of these drops are employed
for the purpose of removing opacities of the cornea, after a few

1850.] Treatment of Opacities of the Cornea. 41

weeks they appear to lose their useful effect, the disease becom-
ing, as it were, invincible to them ; I would, therefore, suggest
that the nitrate of silver ointment, or drops, should be used for
a week or ten days ; then a weak solution of the bichloride of
mercury ; then the opium wine, and then the nitrate of silver
a second time. This plan keeps up a continued state of im-
provement, and the disease is removed in a much shorter space
of time than if one of them only had been persisted in.

When a patient comes before- us with the worst possible
form of opacity, leucoma arising, as is too often the case, from
the extensive ulceration, which has altogether changed the
nature of the corneal surface, or with an extensive opacity, re-
sulting from the application of a powerful escharotic, (which
although it may not have destroyed the vitality of the part,
appears to have produced some chemical change in its
structure,) it is quite labour in vain to attempt the cure of such
an affection, and truly dishonest, time after time, to pick the
pocket of the unfortunate patient of fees, by exciting hopes
which can never be realized hopes, the blighting of which, in
the end, much increase his misery. Still, although this opacity
cannot be destroyed by any means at our command, nor re-
moved by the surgeon, this admission often only applies to the
central portion of leucoma. In many cases, we have the hap-
piness to find the edges becoming gradually less and less
opaque ; a halo of hope surrounds this dimness of vision, and
although it may not be within the compass of our art to im-
prove the more dense central portion, something may yet
be effected with the surrounding edges ; and I have been
consulted in cases where a steady continuance in the applica-
tion of remedies has most ceitainly produced very great
benefit, and the results recorded in the archives of the profes-
sion are doubtless such as to justify their employment in many
of these unfortunate cases.

According to my experience, the most useful remedy is the
nitrate-of-silver ointment, of a strength proportioned to the
condition of the affected eye. Counter irritation should also
be kept up behind the ears or at the nape of the neck by
blisters. Many advise certain ointments or liniments for pro-
ducing irritation on the skin. I have little practical experience
of their effects, but a very short trial of them most fully con-
vinced me that they were very inferior to blisters. In the first
place, several days must elapse before any useful influence can
be exerted, and, in addition to this loss of time, which is often
highly important, I am much mistaken if this St.-John-Long
practice of applying plasters of tartarized antimony, &c, above
the eyebrows, does not often produce permanently mischievous

42 Treatment of Opacities of the Cornea. [January,

results ; and too much care cannot be exercised in daily
watching their effects, more particularly when applied to the
head and face of young persons, in whom, in some cases, their
application has been followed by a state of inflammation and
sloughing which has even threatened the loss of life.

During certain stages of many inflammatory actions ex-
isting in the eye, setons and issues can be most advantageously
employed. They are easily made by the surgeon, cause little
pain or trouble, can be enlarged or diminished at pleasure, and
being perfectly manageable, combine, within any limits we
may be inclined to mark out, the advantage of a moderate de-
gree of counter-irritation with a most salutary discharge. The
advantages connected with the use of blisters are many the
convenience of their application the rapidity of their opera-
tion the quick subsidence of their effects when no longer
required.* There may, however, be cases in which, from
peculiar irritability of the skin, from the liability of the patient
to attacks of erysipelas, or from their having, on some former
occasion, produced a violent effect on the urinary organs, some
other form of counter-irritation must be used rather than
blisters.

The following is the form in which I have usually employed
the nitrate-of-silver ointment : To take nitrate of silver, from
three to ten grains ; solution of diacetate of lead, twenty drops ;
lard, one drachm. This ointment must be used every night or
every second night. A very small portion (not larger than a
large shot- corn) being put into the eye, it always creates more
or less ophthalmia, and its application must be regulated ac-
cordingly.

During the employment of this ointment, I would in many
cases most strongly advise the internal exhibition of the
bichloride of mercury. When there is nothing to counter-
indicate its use, I have given it for six or eight weeks in the
following form, without any severe affection of the gums,
irritation of the bowels, or any other symptom requiring that
the dose should either be intermitted or reduced. Ordered
solution of the bichloride of mercury, one drachm ; tincture of
bark, one drachm ; distilled water, seven drachms and a half.
To be taken twice a day.

As an alterative, the bichloride or oxymuriate of mercury,
though doubtless more frequently prescribed than formerly in
these cases, is not, I venture to think, so extensively used as it
ought to be. It can be given in solution, which is of con-

* With regard to the application of blisters in certain diseases of the eye, the
situation most desirable for applying them is the nape of the neck, or behind
the ears.

1850.] Treatment of Opacities of the Cornea. 43

siderable advantage, rendering its action much more certain,
more equal, and by readier absorption probably more effectual
in producing an alterative influence upon the whole system.
Dr. Holland remarks that he has "seen its influence in
augmenting the secretions, procuring the absorption of morbid
growths, altering the state of the skin in many cutaneous dis-
orders, and changing the character of morbid actions generally
throughout the system, in cases where he believes no other
medicine or combination of medicines would have had equal
effect. Its combinations with bark, steel, sarsaparilla, &c,
afford resources of the greatest value in the treatment of dis-
ease ; and though otherwise held by common opinion he thinks
it, on the whole, as safe a medicine as calomel in the hands of
the practitioner, inasmuch as its distribution can be made as
equal and determinate, and its effects, from being given in a
state of solution, are much less likely to be interrupted by
mechanical hindrances in the stomach and bowels."*

I would add also, and it is worthy of note, that this medicine
(bichloride of mercury) may be continued in uninterrupted use
for a very considerable period, without obvious injury or in-
convenience, and in certain cerebral and spinal affections, a
long unbroken course of this preparation is of singular avail ;
but to reap its fullest benefits, we must be watchful, patient,
and decided in its use, for in cases in which, in the end, the hap-
piest results follow the administration of the remedy, the
changes are often the slowest, and not testified by those instant
and obvious results which are sometimes desirable to fortify
even the mind of the physician in the perservance proper to
the practice, still more to convince the patient, his family and
friends, that time is necessary for the development of the full
and complete advantages of the means employed. Thus it fre-
quently happens that the patient, alarmed, it may be, at the
name of the medicine, and by the precautions taken as to its
dose and effects, or tired by the little progress he appears to
make, refuses after a time to go on with the remedy, very
often at the moment when becoming most effective, and when
there was every reason for thinking a dangerous or distressing
malady would eventually yield by a further employment of it.
I have many times seen the beneficial results arising from a
long-continued use of small doses of the bichloride of mercury,
in solution, in chronic iritis, and also in several cases of
paraplegia, the slow progress of the disease giving full scope
for its effects, and the great danger in prospect, justifying a
long trial of the remedy. Of course in strumous children,
mercury in any form can seldom be employed with ad van -

* Medical Notes and Reflections. Second Edition, p. 242.

44 Bibliographical [January,

tage, and in treating opacities of the cornea in them, in addition
to appropriate remedies to the eye, it will be necessary to
strengthen the system by attention to diet, shower-baths,
sponging the body with cold water, the administration of the
disulphate of quinine, and a residence of some months during
the summer, when the circumstances of the parents will permit,
at the sea-side.

BIBLIOGRAPHICAL NOTICES.

1. The Practice of Surgery ; embracing Minor Surgery, and the Ap-
plication of Dressings, <J*c., fyc. By John Hastings, M.D., U.S.N.,
Fellow of the College of Physicians of Philadelphia, &c, &c. With
numerous illustrations. Medical Practitioners and Students Libra-
ry, No. 4. Philadelphia: Lindsay & Blakiston. 1850. pp.470,
12mo.

We have been very favorably impressed by the previous volumes
of the series of manuals to which Dr. Hastings book belongs, and
regret that we are constrained to express a somewhat unfavorable
opinion of the work before us. There is a manifest want of judgment
exhibited in the arrangement of the subjects in this treatise, and a
remarkable unscrupulousness in its numerous unacknowledged appro-
priations from other Surgical works. Though the author mentions
in his preface, that he has "consulted and used freely" certain au-
thors, as Sir A. Cooper, Sir B. Brodie, Messrs. Miller, Druitt, Fergus-
son, and other, giving them the merit of the principles and practice
advanced in his pages, still we deem it but just that he should repeat
the acknowledgement, by inverted commas, or otherwise, when he
uses also as freely their own language to express these principles :
For instance, we would mention the similarity, in his definition of
Gonorrhoea, to that of Mr. Druitt, also, in the language in which the
treatment of the same is expressed. Again, in the account of Syphilis,
the plagiarism is verbatim, save the occasional substitution of one or
two terms in a sentence. We take, as an example, the first sentence
of each, on Syphilis : Mr. Druitt, says

" Primary syphilitic ulcers or chancres may be caused by the ap-
plication of the syphilitic virus to any surface, mucous or cutaneous,
entire, wounded, or ulcerated. Their most frequent seat is the
genitals ; and in men they are more frequently than otherwise found
on the inner surface of the prepuce, or the furrow between the pre-
puce and corona glandis, or the angle by the fraenum ; obviously be-
cause those spots are most convenient for the lodgment of filth. It is
notorious that persons with a long prepuce, whose glans is habitually

1850.] Bibliographical. 45

protected by it, and covered with a delicate semi-mucous membrane,
are more liable to suffer than those whose glans is uncovered and
clothed with a denser cuticle."

Dr. Hastings, says

" Primary syphilitic ulcers may be caused by the application of the
syphilitic virus to any surface, mucous or cutaneous, whether they are
entire, broken, or ulcerated. The most frequent site of a chancre is
the genital organs. There is great difference of susceptibility in
different individuals : persons who have the glans habitually covered
by the prepuce and a delicate semi-mucous membrane, are much more
liable to contract the disease than those with the glans uncovered and
protected by a firmer cuticle."

Time nor space has not allowed us to compare more than the lead-
ing sentences, and only to Mr. Druitt's work has our attention been
directed ; further investigation would discover, perhaps, further deprer
dations upon other authors as well as Mr. Druitt.

Although Druitt's contributions to this production are thus unac-
knowledged, we see that M. Ricord is not treated with the same slight ;
here the marks of quotation are affixed, and due credit thus given for
language, as well as principles.

Notwithstanding the above faults in the work, we will not withhold
the credit due it, as a concise compilation of much that is valuable
on many surgical subjects. Good taste has been exercised in the il-
lustrations, and the publishers have displayed their usual ability in
the manner of its execution. While we cannot recommend it as
being altogether what it professes to be, an Introduction to the Study
of Surgery, we still hope that the present edition may not be a very
large one, and that its defects and objectionable traits may be thoroughly
amended in the next. This we have little doubt will be done, for the
spirit of enterprise which has prompted its production, will, we feel
confident, secure great improvement in its future editions.

H. F. C.

2. Lectures on the Diseases of Infancy and Childhood. By Charles
West, M. D., Fellow of the Royal College of Physicians, Service
Physician to the Royal Infirmary for Children, &c., &c. Phila-
delphia: Lea & Blanchard. 1850. 1 vol. 8vo., pp. 451.

From the cursory examination of this work which our time has per-
mitted us to make, we are led to place a high estimate upon it. Any
one who will carefully peruse the first lecture of the series, cannot
fail to be favorably impressed by the evidences there exhibited of
sound judgment and great tact. We would especially recommend

46 Bibliographical [January,

this lecture to our young medical friends. Dr. West has heretofore
been but little, if at all known, in this country, and " has been fairly
born, in a bibliographical sense, without the assistance of a professed
accoucheur in the shape of a note manufacturer, now a distinct trade."
His opportunities for the observation of the diseases of early life, ap.
pear to have been ample, as he has occupied his present position as
physician to the Royal Infirmary for Children, for more than seven
years. He says in his preface, " very nearly 14,000 children have
been brought under my notice during the past nine years, and I have
kept accurate notes of the diseases of 600, as well as of the results of
180 dissections of cases in which those diseases terminated fatally."
We cordially recommend Dr. West's book to our readers.

3. Anaesthesia, or the Employment of Chloroform and Ether in
Surgery, Midwifery, fyc. By J. Y. Simpson, M. D., F. R. S. E.,
Professor of Midwifery in the University of Edinburg, etc., etc.
Philadelphia : Lindsay & Blakiston. 1849. 1 vol. 8vo., pp. 248.

The great event of the present day in Medicine, is the discovery of
the anaesthetic power of certain fluids. Next to vaccination, it is pro-
bably the greatest boon ever bestowed upon mankind by medical
science. The announcement of the discovery produced an intense
excitement throughout the medical world all hastened to experiment
with this new power, and in a short time the Journals began to teem
with the reports of operations performed and deliveries effected, with-
out pain or consciousness. An immense mass of facts has thus been
speedily collected, which authorises the adaptation of this new power
as one of the most precious resources of the healing art.

Among those who have materially aided in giving character to these
agents, and in pointing out the circumstances which permit or demand
their application, is Prof. Simpson. To him also are we indebted for
the introduction of a new anaesthetic agent, the chloroform, which is
free from the objections to sulphuric ether on account of its disagree-
able smell, its occasional tendency to irritate the bronchi during its
first inspiration, and the large quantity sometimes required, particu-
larly in protracted labors. His book is the substance of several of his
essays which have appeared in the Journals, and not only contains
the results of his own observation, but those derived from its applica-
tion in the practice of the different public hospitals in Great Britain,
Ireland, and in Paris.

Notwithstanding the obvious advantages to be derived from the ju-
dicious employment of anaesthetic agents, it is very evident that they

1850.] Bibliographical. Periscope. 47

are not to be indiscriminately used. The fatal results which have
followed in many cases, announce in language not to be mistaken,
that their great power is not to be invoked on trifling occasions. With
our present knowledge upon this subject, we feel no hesitation in giv-
ing the opinion, that their employment to the extent of producing in-
sensibility, should be restricted to the more important surgical and
obstetrical operations.

4. The three kinds of Cod-Liver Oil, comparatively considered with
reference to their Chemical and Therapeutic properties. By L. J.
de Jongh, M. D., of the Hague. Translated from the German,
with an Appendix and Cases, by Edward Caeey, M. D., to which
is added an Article on the subject from "Dunglinson on New Rem-
edies." Philadelphia: Leads Blanchard. 1849. l2mo., pp. 211.

Although the cod-liver oil was used so far back as the year 1771, as
a remedy for certain diseases, it has not been employed to much ex-
tent until within a few years past, its utility in scrofulous affections
was announced by some of the German physicians. Since that peri-
od, much attention has been directed to the article by notices which
have appeared from time to time in the Journals. At this time, this
oil has acquired considerable reputation in the treatment of pulmonary
consumption and other grave diseases. Dr. Jongh's work, as its title
imports, is directed to an examination of the chemical and therapeutic
properties of the oil : he has furnished a very full account of its source,
the mode in which it is obtained, and its physical properties. As the
article is now undergoing a pretty general experiment in cases of con-
sumption and other diseases, there is a great demand for it, which has
led to extensive frauds, and it behooves those who may desire to give
the oil a fair trial, to be certain that the article they procure is genu-
ine. To such as may be induced, by the favorable notices of the oil
which have appeared, to administer it to their patients, we would re-
commend Dr. Jongh's little work, in which they will find much im-
portant information.

PART III.
ill o n 1 1) I b \)tx\5tQipt.

On the Pneumonia of Children. By M. Valleix. (Bulletin de The-
rap. Med. Chir. Rev.) Contrary to formerly entertained opinions,
pneumonia is a frequent disease in children ; but it is to speak too
vaguely to treat of children in the mass, as great differences exist,
according to their ages. We may take three periods into account:

48 Periscope. [January,

1st, from birth to the second year ; 2d, from two to six ; and 3d, from
six to fifteen. And as a general statement making allowance for
even numerous exceptions, it may he said that the disease decreases
in severity from the first to the third of these periods. Careful re-
searches have proved that during the first two years pneumonia is
more frequent, more dangerous, more rapid, and oftener double,
than at any other period of life except extreme old age ; and the simi-
larity of the disease, at these two extreme periods of life, is in many
respects very remarkable. During even the first period, the danger of
pneumonia much depends upon the part of such period it occurs at.
Whatever the state of the child's health may be, if attacked during
the first month it may be regarded as doomed to certain death ; and
from the first to the sixth month there is little hope of saving it, if the
attack be at all severe. From the sixth to the twenty-fourth month
the cures become more frequent, but the prognosis is still very bad,
and should be most guarded, until convelescence is quite complete.
The general symptoms may seem to amend, and the local ones to
make little progress, but in from twenty-four to thirty-six hours a
recrudescence occurs, which proves rapidly fatal. If the patient
continue uninterruptedly to improve during thirty-eight hours, the
convalescence is almost always definitive. The local symptoms should
be especially watched ; for it is not here as in adults, in whom we
often see local symptoms continue for a considerable time after the
general ones have diminished, without any cause for alarm. If in the
infant there is not in twelve hours a notable improvement in the local
symptoms, a fatal relapse must be feared. Another peculiarity is the
lobular form of the disease, usually a consequence of an already se-
vere attack of capillary bronchitis. At this period, too, as in advanced
age, double pneumonia and pneumonia of the apex are common. M .
Valleix believes that there is some confusion in the statement of
MM. Bailly and Legendre, that the anatomical condition of the lungs
in these cases is due to a persistence of the foetal state ; for although
a condensed state of the pulmonary tissue, disappearing on insufflation,
may very often be found in very young infants, yet it is an error to
suppose that all the cases usually described as infantile pneumonia are
of this nature. He has, in such cases, met with even a denser hepa-
tization than in the adult, the lung rapidly sinking in water, and being
quite impervious to insufflation. The cases described by these wri-
ters would not, from their symptoms during life be considered by good
observers as pneumonia.

In proportion as we approach the second period, the pneumonia loses
its lobular character, and approaches nearer to that of the adult, while
its fatality diminishes also. Indeed, especially during the last two or
three years of this period, the benignity of the disease is remarkable ;
and little alarm need be excited, except if the child is already an in-
valid, when the supervention of pneumonia is exceedingly dangerous.
By benignity it is not meant that the symptoms are slight, but that the
cure is so sure ; for, in fact, the symptoms have a very alarming ap-
pearance, and yet, in spite of them, amendment takes place in from
two to four days, after which time the cure goes on rapidly.

1850.] Periscope. 49

In the third period, the disease still more resembles that of the
adult, and is still benign. A distinguishing circumstance at some part
of this period is the appearance of expectoration.

As a general rule, the younger the child, the greater is the diffi-
culty of the diagnosis. For auscultation, very young children should
be held, by an assistant placing his hands under the thorax and belly,
when examination can be made, especially as in this position the child
usually ceases crying for awhile. Older children should be held on
the mother's arm. In a case, in which auscultation was very difficult,
M. Valleix availed himself with success of the observation of the in-
creased thoracic vibration, indicated by Monneret.

Treatment. During the third period, the child is treated as the
adult. In the second, we must be more chary of our means, remem-
bering that there is a natural tendency to cure. One bleeding usual-
ly suffices, and antimony should be reserved for only severe cases,
and used wih great caution. With still greater caution should it be
given in the first period. Still, if there is great or increasing hepati-
zation, it is to be used in divided and infrequent doses. Small
cuppings are very preferable to leeching, and mild opiates are too
much dreaded by practitioners. Blisters should be wholly discoun-
tenanced, especially in the very young.

On the Use of Bandaging in relieving the Cramps in Cholera. By
Evory Kennedy, M. D. The habit of applying a knotted handker-
chief as a tourniquet over the spasmodically contracted muscles in
cases of cramps, and always with instantaneous relief, led me to test
the efficacy of bandaging, many years since, in a case of universal
cramps occurriug as the result of a violent sustained effort to maintain
his position on horseback in a person who had been run away with.
Every expedient had failed, the tourniquet only giving partial relief, as
the muscles of the trunk were engaged equally with those of the ex-
tremities. Bandaging each limb separately, and eventually the trunk,
was attended with immediate relief. The recollection of this case
induced me to try its efficacy in the cramps of cholera, and with such
results as justify me in calling attention to it, as it not only accom-
plished the object had in view, but also succeeded in keeping up the
temperature of the limbs more satisfactorily than by means of friction.
Those who have practically dealt with the worst cases of cholera
know but too well the difficulties attending the attempts to keep up
the heat of the extremities by any, or all of the plans at present in
operation; the copious clammy perspiration constantly exuding from
the surface, the evaporation of which tends to lower the temperature ;
the exposure unavoidable in keeping up the friction adding to the
chill; the impossibility of keeping up artificial heat so universally
over the limbs and trunk as to maintain an equable temperature. The
further objections against depending upon these means, from neglect on
the part of attendants, and restlessness, jactitation, and exhaustion on
the part of the patient, render it of importance to effect our object by
some means unattended with such grave objections, or at least to have

n. s. VOL. VI. no. i. i

50 Periscope. [January,

at our disposal an additional method which may be used as auxiliary
to these. Now, I imagine bandaging affords us this desideratum.
The bandages should be made of new flannel, cut into strips of two
inches broad ; should be applied from the toes and fingers up to the
groins and axillae, as tight as can be borne without inconvenience.
The copious perspirations, instead of evaporating, become absorbed
into the flannel, and act like a continued warm fomentation, the super-
incumbent bed-clothes assisting our object by preventing evaporation
and the abstraction of the animal heat of the body ; whilst our efforts
to sustain the temperature are still further aided by placing hot bottles,
heated bricks, salt, &c, in contact with the extremities and surface.
The disturbance of the patient precludes the application of a bandage
over the trunk, similiarto that of the extremities. A very simple ex-
pedient, however, is supplied in a piece of flannel, or an under-blanket,
about a yard and quarter long, by half a yard broad. This should be
torn down the centre for about a third of its length, and across the
remaining portion ten or twelve stripes of flannel, a yard and quarter
long by two inches broad, should be sewn. This should be slipped
under the patient's back, drawing the two torn ends over the shoulders
and down on the chest, and then the many-tailed bandages applied
across the chest and abdomen, alternately over-lapping each other,
as tightly as the patient can bear without inconvenience. This form
of bandage has the advantage of being easily removed and re-applied
when it becomes an object to make stimulating applications to the
abdomen. The bandages may however, be rendered available in
making our applications, whether stimulating or anodyne, without re-
moval, by pouring any fluid upon them, as they absorb it and keep it
in close contact with the surface. This, however, requires to be
done with care, else too great a degree of irritation might be induced
by allowing the bandages charged with stimulating applications to
remain too long in contact with the surface.

Quinine in Croup. (Bulletin Gen. de Therap.) Not long since,
it was announced that favorable results had been obtained with sulph-
ate of quinine in croup, by M. Puis. The Annales de la Societe de
Grand contain several cases related by Dr. Willems, still further illus-
trating its efficacy in this affection. In one case, that of a girl of six
or seven years, inflammation of the tonsils with some white specks
upon them, had existed for several days, at which time fever, pain in
the neck, cough and difficulty of breathing, appeared. Violent at-
tacks of suffocation soon came on, with the other usual concomitants
of croup. Calomel, sinapisms, leeching, emetics, &c, were employ-
ed with but slight and transient benefit. One of the emetics brought
away a false membrane, pierced in its centre, and about the size of a
franc piece. But the child still grew worse, and the paroxysms of suf-
focation seemed to threaten immediate death. At this stage, Dr. W.

1850.] Periscope. 51

began the use of the Quinine, 2 grains in an enema every two hours.
The child passed a calm night and had some sleep. On the next day
the symptoms were all much mitigated, and in three days disappeared,
with the exception of some hoarsness and cough. In another case,
that of a child of two and a half years, catarrhal symptoms existed
for five or six days, when the patient was suddenly attacked with croup
of so violent a character as to induce a fear ofimmediate suffocation.
Leeching, calomel, &c, were employed without success. Four grains
of Quinine, divided into four portions, was administered every hour for
four hours, when the cough was diminished. Five hours after, five
grains of Quinine were given in enema in four portions, one every
two hours. The child fell into a tranquil sleep, and the respiration
was much relieved. Two days afterwards, the child was convalescent.
A third case was that of a child about five years old, to whom, after
leeching, &c, Dr. W. prescribed the Quinine on the first day of the
attack. The dyspnoea, hoarse cough, and anxiety rapidly diminished,
and a cure was soon effected.

Glycerine a Remedy in Deafness. By J. Brown, M. D., &c, Lin-
colnshire. (London Lancet.) On reading the report of Mr. Thomas
H. Wakley, Surgeon of the Royal Free Hospital, on the subject of
glycerine, I procured from Mr. Bullock, a sample of that drug, and
have put it to the test in half-a-dozen cases, and the result, as far as it
goes, confirms the value of the remedy. In four cases out of the six,
the improvement was instantly apparent. One, a widow, from
Thorpe, aged fifty-five, came to me on account of an eruptive disease,
and was so deaf I could scarcely make myself heard by her. Hav-
ing just received my supply, I explained to her its pretensions, and
proposed its application. On examining the ear, I found the external
ear scaly and desquamating, and the inner dry and free from wax ; the
right ear, having had an abscess in it, was unsuitable for the experi-
ment, so the glycerine was applied to the other. I continued, after
the application, talking to her, gradually lowering my voice, until I
spoke in a whisper. She continued to reply to me, and I then ob-
served to her, " I am now speaking to you in a whisper, and you hear
me." She said, " I hear you perfectly ;" and after a little while, she
said, " I hear as well as I could wish to hear." Three of the other
cases were equally encouraging, and the patients equally pleased and
sanguine, but expecting disappointment to follow their favourable im-
pressions, I explained to them that the probable effect of this remedy
was that of lubricating the membrane of the drum, ami that, as the
membrane became dry again, a repetition would be necessary ; but
that, from its nature, not being disposed to dry or readily evaporate, the
effect might last several hours ; how long was not at present determin-
ed, but that the renewal might be required morning and evening.

52 Periscope. [January,

In one of the other two cases of doubtful use, a person, aged fifty-
seven, who had been deaf many years, and now too ill from incipient
hydro-thorax to care much about this remedy, I applied it to one ear,
and she could not say she heard better ; but a sister from the
neighbourhood of Horncastle, visiting her that day, as soon as she saw
her, exclaimed, "I am sure, my dear, you hear bettter;" and as this
was said without any knowledge of the application having been used,
in a first salutation, before any explanation had been made, it must, I
think, be taken as a favourable attribute to the new remedy.

Glycerine, it is probable, can only be useful where the membrane
is perfectly entire, neither indurated nor corroded, nor the subject of
purulent discharge ; but when, as in advancing years, there is the
absence of the natural secretion, the glycerine seems to supply a
singularly analogous substitute, and to give a temporary tone to the
membrane, and, in an instant, a lively perception to the organ.

Permanent cure of the states in which glycerine is useful, does not
seem to be claimed by Mr. Wakley as the probable result, but should
repetitions of the remedy be followed each time by a re-animation of
the sense of hearing, who that has suffered from the deprivation of that
sense, and has in his possession a means of revival so easy of attain-
ment, will deem it a trouble to repeat the application, even to the end
of life.

Iodide of Potassium in Ascites. The "Bulletin de l'Academie de
Medecine Belgique"' reports several cases of ascites successfully
treated with iodide of Potassium, by M. Trion. He administered the
remedy about every two hours, in such doses as to make an aggregate
of from 10 to 20 grs. per day, and continued the treatment for months if
necessary.

Prompt cure of Typhoid Fever. (Rev. Med. Chir.) M. Warner
read on the 1st October last, before the French Academy of Sciences,
a communication upon the radical cure of Typhoid fever at its outset
in 24 hours, or a few days at most. The only remedy being the in-
ternal administration of ice every minute without interruption.

Sugar in Hiccup. (Presse Madicale.) Dr. Schuermans, of Brus-
sels, has found in sugar a prompt remedy for the most intense and per-
sistent hiccup ; not merely for that form which occurs in a state of
health, but for those symptomatic cases of this affection which mani-
fest themselves in certain grave nervous affections. Dr. Schuermans
declares that he has uniformly succeeded in removing, by the admin-
istration of one or two bits of sugar, the hiccup which is often so
distressing to patients laboring under cholera.

1850.] Periscope.

Amaurosis a symptom of Albuminuria. (Rev. Med. Chir.) M.
Landouzy presented to the Academy of Sciences a memoir from which
he deduces the following corollaries: 1st, amaurosis is almost an in-
variable symptom of albuminous nephritis ; 2d,, it precedes the other
symptoms ; 3d, it disappears and returns with the albuminous depo-
sits in the urine ; 4th, it would seem to indicate the nervous system as
the primary seat of disease in albuminous nephritis.

On the Treatment of Chilblains. By M. Ossieue. (Bui. de Therap.
Med. Chir. Rev.) In the earliest stage, friction, either employed dry
or with brandy or sp. camphor, is the simplest and best means ; but when
the parts have become red, swollen, shining, and even covered with
phlyctenae, but prior to ulceration, the formula recommended by M.
Coffin may be used with the greatest advantage :

Camphor, 4 parts ;

Ess. Oil Turpentine, 30 parts.
When the practitioner is only consulted after ulceration has for some
time taken place, M. Devergie's ointment is then the best application:

Lard, 1 oz. ;

Liq. Plumb. Subac, 12 drops;

Thebaic Extract, 3 grains ;

Creosote, 10 drops.

Treatment of Ophthalmia neonatorum. By Dr. Desmarres. (Med.
Chir. Rev.) The most efficacious treatment, especially at the com-
mencement of this disease, and while there is yet no trace oframollis.
sement of the cornea, consists in suddenly arresting the inflammation
by means of the nitrate of silver. If the disease is just beginning, a
collyrium of this salt, of the strength of a grain and a half to two
drachms and a half (un decigramme pour dix grammes) of water,
dropped from hour to hour, between the eyelids, will suffice ; but if it
has already reached the second or third period, it will be necessary
to have immediate recourse to cauterization with the same salt, in
solution or solid. If we choose the former, about three parts of nitrate
of silver are dissolved in one part of water,* and we touch with a pen-
cil charged with this fluid all the surface of the conjunctiva, from the
free edge of the eyelids to the cornea exclusively ; this cauterization
is to be repeated at the' end of seven or eight hours during the first
two days. After the first, sometimes only after the fourth cauteriza-
tion, the swelling begins to abate : it is no longer necessary then to
repeat it but at intervals of twenty-four hours during some days, till the
secretion and swelling have almost disappeared. In the interval of
the first cauterizations, We apply over the eves compresses wet with
cold water; at the same time we wash the surface of the conjunctiva
frequently with a slightly astringent collyrium.

* Nitrate of silver being soluble in 1 part of cold or J part ot hot water, it is
impossible to dissolve 3 pari& of the salt in 1 part of water. If the salt be pow-
dered and mixed with water in this proportion, a kind of paste is formed. Rev.

54 Periscope. [January,

If we prefer cauterization with the pencil, as the application of it is
more easy, and the effect more active, we begin by separating the
eyelids with two elevators, then touch the ocular conjunctiva round
the cornea, taking the greatest care not to cauterize this last part ;
that being done, and the elevators being removed, we pass the pencil
rapidly over the whole conjunctiva of the upper and lower eyelids.

To prevent the caustic, which always remains in excess on the
cauterized parts, from extending to the cornea, and from becoming a
secondary cause of ramollissement of this part, each time that the
pencil touches the conjunctiva, I cause to be injected upon it a con-
siderable quantity of water, acidulated with hydrochloric acid {deux
cuillerees a cafe d'acide pour deux verres d'eau), and instantaneously
transform all the excess of nitrate of silver into an insoluble chloride,
which separates from the conjunctiva in small whitish flocks ; this
plan, tried a considerable number of times, has always been followed
by the best results.

I have found great advantage from numerous scarifications of the
palpebral conjunctiva, half an hour after each cauterization: it is an
excellent means for preventing temporary swelling which commonly
follows the use of the caustic.

It is useful, at the same time, especially when the inflammation
seems very acute, to apply near the eye, a leech, to be followed, if
need be, by another next day ; in the mean time some slight purga-
tives should be given to the little patient.

I have no sort of confidence in the treatment of this ophthalmia with
antiphlogistics, emollient lotions, and the mercurial preparations
vaunted by many practitioners, in the first period of the disease. Re-
vulsives seem to me to have no sort of efficacy. Mild colly ria, praised
by the greater number of authors, succeed only in those cases where
a simple catarrhal ophthalmy has been mistaken for purulent con-
junctivitis.

If the cornea begins to ulcerate, or undergo ramollissement to a
large extent, cauterization with nitrate of silver is far from being al-
ways efficacious ; it always causes the swelling and the secretion to
subside, but it by no means arrests the progress of the ulceration, at
least, in many cases. It is then that we must distrust the concentra-
ted eollyrium of nitrate of silver, because it hastens still more the
progress of the evil, and we must have recourse to purgatives, fric-
tions on the brow with belladonna, mixed with an equal portion of
blue ointment, and weak astringent colly ria. Still, it must not be
concealed, that these means, like all others, often fail.

Wine of Colchicum in Gonorrhoea. (Bulletin Gen. de Therap.)
Two years ago, Dr. Eisemmann recommended the employment of the
wine of colchicum seeds in combination with tincture of opium, in
gonorrhoea. Dr. Troinus, in a recent memoir, has published ten
cases successfully treated with this article, given at different periods
of the disease, and he adds that he has obtained favorable results in

1850.] Periscope. 55

fifty other cases. The mean duration of the cure is about seven days.
The disease in females seems to yield to the medicine as readily as in
males. The author has employed this remedy in every stage of the
malady, but deems it prudent to delay it, until the inflammatory stage
has passed. As the preparations of colchicum have a tendency to
produce hypercatharsis, their effects should be watched.

Treatment of Abscess. By J. P. Batchelder, M. D. (New
York Journal of Medicine.) When an abscess has formed, the rule
of practice is, in general, to imitate nature, and let the matter out.
She does this by ulceration the surgeon does it by incision or
puncture. If the abscess is large, and somewhat chronic, its cavity,
when emptied of the matter, should be filled to a moderate degree of
distention with a solution of corrosive sublimate, ten or twelve grains
to the pint, thrown in with a syringe, and allowed to remain a longer
or shorter time, according to the uneasiness or pain it occasions, when
it should be gently squeezed out, and the sides of the cavity be brought
as nicely in contact as possible, and kept so by well fitted and applied
compresses and bandages, and the whole kept wet with water, cold or
tepid, as is most congenial to the feelings of the patient. In this way
the writer has cured many abscesses in a few days, and occasionally
those of an acute character in a single day the whole interior surfaces
laid and kept in contact, have adhered and healed by the first intention,
without another drop of matter being discharged.* No case has come
to his knowledge in which unpleasant consequences have resulted from
this method of treatment. Often, indeed, many abscesses may be
speedily healed when thus treated, which if managed in the common
wray would have taken months to cure, or perhaps have cost the patient
his life.

It was formerly supposed that the admission of air into the cavity of
an abscess was the cause of the inflammation which so often came on
about the third day after the evacuation of its contents ; this opinion is
now pretty much abandoned ; but no very satisfactory explanation of
the fact has been given. The writer ventures to give the following :
By the withdrawal of the matter the vessels of the cyst, and those
about it, relieved of the pressure which it caused, are soon filled and
over-distended with blood, to a degree which stops the secretion.
This process requires about three days, for the effusion of lymph and
the secretion of pus, after which the abscess continues to discharge
good or ill-conditioned matter for a longer or shorter time. Now, by-
using the injection as proposed, we anticipate nature's process, and
produce a new inflammation and effusion of coagulable lymph, by
which the surfaces are glued together, and in which new or primitive
vessels, shooting from side to side, inosculate and cause the abscess to

The tincture of iodine is an excellent substitute for the bi-chloride of mer-
cury. I have seen it used in the N. Y. Hospital, by Dr. Buck, for the cure of
suppurated buboes, with very happy results.

56 Periscope. [January,

heal like a wound, by the first intention ; thus the secondary inflam-
mation,* to which we have alluded, and which so often comes on a
few days after the evacuation of collections of matter, is prevented, and
the patient saved from all the hazard and suffering incident to such an
occurrence.

In chronic abscesses, in which the secretion is vitiated and the con-
stitution cachectic, the injection of the solution of the corrosive subli-
mate is the most important remedy, especially when associated with
the internal use of cantharides, either in tincture or substance gradu-
ally increased so as to produce strangury the only sign by which we
know that the system has been brought under its influence, just as
mercury is known to have affected the constitution, when its specific
effects are manifested in the gums. The strangury thus induced is
immediately removed by the single introduction of a catheter ; or less
promptly by the spirits of camphor in sweetened milk, frequently re-
peated. The use of the medicine should be suspended and resumed
when the strangury has left, taking care to begin with a diminished
dose, i. e. somewhat less than that by which the specific effect was
produced.

Antisyphilitic Inoculation. (Gazette Medicale.) M. Diday, of
Lyons, France, under the belief that secondary syphilis can occur but
once, proposes, seriously, to inoculate all young men with the blood of
one affected with constitutional syphilis, for the purpose of protecting
them against subsequent attacks of the disease. He subjected sixteen
persons to the test, of whom, at the end of six months, only one had
taken the infection. We should not omit to state that he inoculated
himself, in testimony of his faith.

New Anaesthetic. (Gazette Medicale.) M. Velpeau, and other
Parisian physicians, are engaged in experimenting upon the value of
cold (by means of salt and ice,) in producing insensibility. It has thus
far been found to be entirely effectual for superficial operations, but
not for those reaching deep seated parts.

Treatment of External Haemorrhoids by Potassa Fusa. By F. C.
Jones, M. D. (London Lancet.) In laying before the public the
following treatment of external haemorrhoids, I am induced, both by
the difficulty of radical curative treatment hitherto practised, and also
the grave character and prolonged suffering of this state of varicose
veins upon the verge of the anus, to believe that any mode of treat-
ment (the success of which is borne out by numerous cases) would be
welcome to the generality of the profession. Within the last twelve

* When the abscess is large the inflammation is dangerous from the extent of
inflamed surface, and ihe secretion which follows is almost always of a highly
vitiated character, especially if the constitution is bad or much weakened.

1850.] Periscope, 57

months, I have, I presume, treated by potassa fusa, between sixty and
seventy patients suffering from external piles of various standing, and
I believe I may add, with a uniformity of success scarcely if ever
equalled in the treatment of any disease, and certainly never in this.

Observing that in all cases of spontaneous cure of external haemor-
rhoids, they primarily slough, I was led to think that if nature obliter-
ates the vessels by sloughing, it is feasible that artificial means might
induce the same remedial action.

In turning over in my mind the action of various remedies likely to
produce this condition, it struck me forcibly that poiassa fusa was pre-
cisely the agent required. I forthwith determined to apply it to the
first case that came under my care, and the results were that upon the
first application the patient complained of a burning sensation, which
passed off in the course of half an hour; at the end of four days, the
parts were considerably diminished in size, and by brushing a piece
of lint quickly over the part, I removed the superficial slough, and
again applied the potassa fusa: the same treatment was followed at.
the interval of four days, at the end of which time they had entirely
disappeared, leaving only a slight sore, which healed within a week.

This plan of treatment has been followed out by me with undevi-
ating success. Its superiority over all other modes of treatment,
consists in its not requiring the patient to lay up, not producing any
haemorrhage, no moral depressing effects arising from the use of the
knife, neither having recourse to ligature, but simply the production
ofa bounded sloughing inflammation, not extending beyond the part
required. These considerations alone, should, I think, be sufficient
to recommend it to the earnest attention of my professional brethren,
since I can hardly conceive any one who has not been repeatedly
disappointed in the issue of these cases. It is almost needless for me
to add, that the haemorrhoids must be considered simply as varicose
veins existing in parts which, to a great extent, precludes the possibili-
ty of having recourse to mechanical support, and consequently can
only' be cured by obliteration and subsequent attention to the state of
the bowels, so that impacted faeces may not have an opportunity of
aorain occurring.

Spermatozoa in encysted Hydrocele. Prof. Curling, of London,
states that he has within a few years observed at least twenty cases
in which spermatozoa were found in the fluid of encysted Hydrocele.
Prof. Liston made this discovery in 1843. Prof. Curling attributes the
presence of these animalcules under such circumstance, to a rupture
of the epididymis which would allow the spermatic fluid to pass into
the cyst and thinks it probable that such cases of hydrocele originate
from such rupture in consequence of blows or other external violence.

Application of forced flexion to wounds of the palmar arch. (Union
Med. Bulletin de Therap.) M. Durwell, of Gnebwiller, was called

58 Periscope. [January,

to a case in which the palmar arch had been wounded by a portion of
glass. The arteries of the fore-arm were compressed, but without
arresting the haemorrhage. This was a case in which ligation of the
arteries of the fore-arm, and perhaps even of the arm, was indicated,
but 31. Durwell was in the country where he could not receive the
necessary aid for the operation. Remembering that flexion alone
would obliterate, momentarily, the arteries at the elbow and knee, he
immediately flexed the fore-arm upon the arm at a very acute angle,
when the haemorrhage suddenly ceased. It occurred to him that this
temporary means of arresting the haemorrhage might be made a perma-
nent one, by keeping the limb in this flexed position. This he did by
means of bandages, first flexing the limb until pulsation at the wrist
could not be felt. The dressings to the hand were those of an ordi-
nary wound ; two graduated compresses, moderately tight, along the
course of the ulnar and radial arteries. On the third day, 31. Durwell,
through curiosity, took off the compresses without any haemorrhage
following. He then caused the fore-arm to be extended, but perceiv-
ing a jet of blood follow this movement, he again applied the bandages
and kept them on until cicatrization was nearly complete, when haemor-
rhage no longer followed the movements of the arm. Would it not
be prudent in future, at least when practicable, to try so simple and
inoffensive a treatment, before resorting to the operation of ligating
both arteries of the fore-arm ?

Lithontriptic Drops of Palmieri. This medicine, much celebrated
in Italy as a remedy in calcareous affections of the kidneys, has, in
fact, appeared efficacious in some cases, either by disintegrating the
stone, or by dilating the ureters and urethra so as to allow the calculus
to pass out when it is yet of moderate size.

The medicine is prepared by boiling one ounce of flowers of sulphur
in one pound of tar-water, until the liquor has acquired a ruby-red
color, it is then decanted and put aside for use. The dose of this as
a remedy is from 15 to 20 drops ; as a preventive 10 drops.

Compression of the Aorta in Uterine Hemorrhage. By Rob't Crane,
M. D. (Boston Medical and Surgical Journal.) The application of
arterial pressure to arrest formidable uterine hemorrhage, is not pre-
sented here as a novelty. The merit of its introduction is probably
due to the veteran Baudelocque ; after him, it was adopted and re-
commended by Chailly ; while the practice has been further con-
firmed by cases presented to the notice of the profession by Mr.
Pretty, J. D. Brown, and many others. Still its adoption has not

1850.] Periscope. 59

been in proportion to its merits ; and in circumstances where it
might have afforded timely succor, doubtful and hazardous experi-
ments have often been resorted to, attended with confusion to the
accoucheur and peril to the patient. It has been my reliance in
numerous instances during the past six years, and with so happy re-
sults, that I have come to regard any degree of postpartum
hemorrhage so easily controlled, as to constitute an accident of no very
grave moment. It is a resort at once safe, practicable and efficient.
Even when the stomach will readily tolerate ergot, and every other
ordinary means can be made subservient, there is often an interval
before their efficient operation can be obtained, when the patient's
life is momentarily endangered by delay. At this critical juncture,
compression of the aorta can be brought to bear with signal advan-
tage, while it will not embarrass, but rather assist the ordinary efforts
of both nature and art towards a favorable issue. We should by no
means neglect the usual appliances at hand ; but are at liberty, es-
pecially if the services of a reliable assistant are at command, to
resort to the application of cold, associated with manual compression
of the uterine tumor. By this means the patient's life is placed be-
yond jeopardy for the instant, and an extension of time is gained, in
which to induce that fixed contraction, short of which no attendant
could abandon his charge with any degree of intelligent satisfaction
and composure.

Neither in such cases should our aim be barely to save life from
the extremity of peril. There is a degree of hemorrhage, graduated
by individual circumstances, beyond which it should be considered a
calamity for our patients to succumb. The shock to the system pro-
duced by extreme depletion, frequently saps the foundations of health
and vigor, and opens avenues for the approach of some insidious and
and deadly mischief.

In relation to the modus operandi, the aorta should be compressed
in the umbilical region just before its iliac bifurcation. At this point,
after the partial descent of the uterus, there is seldom any intervening
obstacle; the parietes of the abdomen lie near the spine, and readily
yield on account of their flaccidity ; and should any portion of
intestine happen to be floating in the way, it readily eludes the touch,
and the hand is at once upon the aorta strongly pulsating, and feeling
under the finger like a large whip cord. The pulsations can be readi-
ly controlled by firm, steady, and not very forcible pressure : and this
can be brought to bear with the greatest facility by a thumb and one
finger, or any two fingers, so placed in juxta-position as to bring the
traingular space formed at their extremities to fit over the artery like
a saddle, and by this means prevent it rolling from the grasp, as it is
liable to do without some such precaution.

The demand for this arterial compression will of course be propor-
tioned to the intensity of the hemorrhage and the condition of the pa-
tient; but in the event of flooding, however sudden or appalling, I
believe the physician has here at ready command the key that may
infallibly and safely check the flow of the vital current.

CO

Miscellany.

January,

ill t ft u a I JIT x s r. 1 1 1 a n g .

Adulteration of Drags. Our readers are aware that in 1848 Con-
gress enacted a law prohibiting the importathfn of adulterated and
spurious drugs and medicines. In the report of Dr. Bailey, the special
examiner of drugs, &c, for the port of New York, we find ample evi-
dence of the extent to which this vile traffic in human life has been
carried on. In the first ten months after the law took effect, there
were rejected, at the single port of New York, under its provisions,
the following articles. The Report says :

" The law took effect at this port on the 12th of July, 1848 ; and
the following is a list of the more prominent articles of drugs and
medicines, with the quantities and place whence imported annexed,
which I have, during the months named, rejected under its provisions :
to wit

Rhubarb root,

Opium,

Jalap root,

Rhubarb root,'
do. do.

Gamboge,

Rhubarb,

Senna,

Spurious Yellow Bark,

Rhubarb,

Opium,

Iodine,

Jalap,

Rhubarb,

Rhubarb,

Myrrh,

Spurious Yellow Bark, do.
do. do do

Myrrh,

Iodine,

Opium,

Rhubarb,

Opium,

Myrrh,

Spurious Yellow Bark,

Jalap,

Pectoral Paste,

Rhubarb,

Jalap,

Spurious Bark,

Rhubarb,

Iodine,

July, 1848,

7,581 lbs.

August,

750 lbs.

do.

2,940 lbs.

do.

2,249 lbs.

September,

646 lbs.

do.

1,414 lbs.

do.

545 lbs.

do.

1,400 lbs.

do.

2,900 lbs.

do.

875 lbs.

do.

758 lbs.

do.

1,783 oz.

do.

1,075 lbs.

do.

4,275 lbs.

October,

788 lbs.

do.

227 lbs.

do.

13,120 lbs.

do.

1,875 lbs.

November,

412 lbs.

do.

1,280 oz.

do.

860 lbs.

do.

185 lbs.

December,

156 lbs.

do.

1,065 lbs.

do.

12,800 lbs.

do.

392 lbs.

Jan., 1849,

1,300 lbs.

do.

2,071 lbs.

do.

3,550 lbs.

do.

1,930 lbs.

February,

974 lbs.

do.

1,992 oz.

from Canton.

do.

Marseilles.

do.
do.

Tampico.
London.

do.

do.

do.

do.

do.

Hamburg.

do.

Leghorn.

do.

Bordeaux.

do.

Canton.

do.

London.

do.

do.

do.

Marseilles.

do.

Vera Cruz.

do.

London.

do.

do.

do.

Maracaibo.

do.

Bordeaux.

do.

London.

do.
do.

Glasgow.
Smyrna.

do.

London.

do.

do.

do.

do.

do.

Santa Martha

do.

Vera Cruz.

do.

San Juan.

do.

London.

do.

Havana.

do.

do.

Antwerp.
London.

do.

do.

arch,

1,104 oz.

do.

4,89-1 lbs.

do.

1,345 lbs.

do.

404 lbs.

do.

1,150 lbs.

pril,

425 lbs.

do.

1,273 lbs.

do.

550 lbs.

do.

816 lbs.

do.

1,450 lbs.

do.

600 lbs.

1 8 50 . ] Miscellany. 6 1

Croton Oil, from London.

Senna, do. do.

Spurious Bark, do. do.

Opium, do. do.

Valerian root, do. Paris.

Opium, do. London.

Myrrh, do. do.

Jalap, do. Vera Cruz,

do. do. Tampico.

Sarsaparilla, do. do.

Spurious Bark, do. Barranquilla.

Together with smaller quantities of various articles which have been
rejected from time to time, but which it is not necessary to enumerate
here making the entire amount, some 90,000 lbs. of various drugs,
&c, which have, up to the present time, been refused."

Every practitioner of medicine, nay, every individual within our
widely extended limits, is deeply interested in preventing frauds in
those articles upon the purity of which, professional reputation, health
and even life so often depend. It therefore becomes them at once to
take such measures as will prevent domestic adulteration of medicines,
to which the dishonest of our own countrymen will be led, by the pro-
hibition of the foreign. We hope our State Medical Association will
take this matter into consideration, at its next meeting, and devise some
plan to be submitted to our Legislature, to prevent the introduction and
sale of adulterated articles within our State.

Death by Chloroform. The recent French Medical journals con-
tain six new cases of death under the influence of chloroform one
reported by M. Robert, of Paris, one by M. Gorre, of Lyons, one by
M. Barrier, of Boulogne, and one by M. Confevron, of Langres, be-
sides one at Madrid and one at Edinburgh. Experienced physicians
administered in each case.

Banger of Smoking. An apothecary at Marseilles was recently
very severely burnt by the ignition of sulphuric ether, whilst pouring
it from a bottle, with a lighted cigar in his mouth.

Postage on Exchange Journals. It is a remarkable fact, and one
by no means creditable to our national legislators, that full postage is
charged on the exchanges of medical and other scientific periodicals.
It is the more remarkable, because such works are exclusively devoted
to the improvement of those branches of know ledge in which the
whole human family is interested, and are seldom, if ever published

62 Miscellany. [January,

with a view to private interest. Among the number which exist in
our country, there are few, if any, which yield an adequate compen-
sation to those who conduct them, and quite a large proportion are pub-
lished at a positive loss. Under such circumstances, we repeat that
it is surprising that Congress should be indifferent to the benefits con-
ferred upon the world by the medical and other sciences, and
impose upon these periodicals an onerous tax, which in the aggregate
can yield but a paltry revenue to the government. The newspaper
press is subject to no such burthen, but is free from all postal charges.
We claim that scientific periodicals are entitled to equal favor and
protection, and we believe that if the subject was properly brought
to the notice of Congress, the grievance would be redressed. We
would therefore respectfully suggest that the Editor of every such
work should address a memorial to Congress on this subject, and for-
ward it to the Chairman of the Post-office Committee.

Statistics of the Medical Establishments in France. There are in
France three Faculties of Medicine, and three Schools of Pharmacy,
those of Paris, Montpellier, and Strasburgh. Besides these, there are
twenty-one preparatory Schools of Medicine scattered among the prin-
cipal provincial towns. In Paris there are eight Medical Societies,
besides one society in each arrondissement intended for the protection,
and advancement of professional interests. In the provinces there
are twenty-four Medical Societies.

There are seventeen hospitals in Paris, besides various hospices for
the infirm poor, the blind, &c. The budget of the hospitals for the
year 1849 was but little less than 18,000,000 francs. In France there
are 1338 hospitals and hospices whose ordinary revenue amounts to
53,632,992 francs : the revenue of the Parisian hospitals is between
14 and 15,000,000 francs, whilst some of those in the provinces have
not more than two or three hundred. More than two-thirds of the
whole amount of hospital revenues, are in the possession of about one-
thirteenth of these institutions.

The number of indigent insane in France, who are supported
at the public expense, is 12,286, 5935 men, and 6351 women. More
than one-fifth of these are from the department of the Seine, in which
is the city of Paris. There are 73 establishments for the reception of
the insane.

In Paris there are twenty-four Medical Journals 3 are published
quarterly, 17 monthly, 2 weekly, and 2 three times a week. Bor-
deaux, Lyons, Marseilles, Montpellier, and Strasburgh, have each a
Medical Journal.

1850.] Miscellany. 63

The total number of pupils now in course of education in Paris,
amounts to 950, at Strasburgh 109, and at Montpellier 174. The
ao-o-reo-ate of pupils at the Ecoles preparatories is 792. At some of
these the number is exceedingly small at Rheims there are 15 pupils
and 8 professors. These numbers of course do not embrace those
foreigners who visit France for the purpose of instruction in Medicine,
but only those who are regularly registered.

The foregoing statistics are given by L'Union Medicale.

Medical School in Egypt. (Gaz. Med.) M. Clot-Bey has given us
some interesting intelligence in reference to the medical school which
he contributed to found in Egypt, under the administration of Mehe-
med-Ali. During a period of twenty-two years, 522 students finished
their studies in this school, and besides, there are 317 employed in the
army and navy, in the schools and arsenals.

It has just been decided that the names of the physicians and students
who died in France during their attendance upon Cholera patients, shall
be inscribed upon a marble tablet, and put in the Dupuytren museum.

(Letter from Dr. Long, to the Editor.)

Jefferson, Ga., Dec. 17th, 1849.

Dear Sir, The number of the Journal containing my account of
the first use of Ether as an anaesthetic in surgical practice, has been
received, and I see from the note, " our friend Dr. Long can lay no
claim to the introduction of ether as an exhilarating agent, when its
vapor is inhaled," that a portion of the article conveys an impression
different from what was intended. I did not design presenting any
claim to the discovery of the exhilarating powers of ether. The por-
tion of the account which conveys the incorrect impression, was in
part, written from reading an article in which the following sentences
occur : " The question now arises, how far is Dr. Jackson entitled to
the credit of having discovered the precise character of the uncon-
sciousness induced by inhaling the vapor of sul. ether, and especially
the important fact of the safety of the inhalation ? Before his obser-
vations, a state of complete insensibility from this cause was consider-
ed by the best authorities as one of greater or less danger," &c, &c.
(Littell's Living Age, No. 213, 10 June, 1848, page 501.) Believing
I had witnessed the use of ether as an exhilarating agent in a sufficient
number of cases, to establish the safety of its inhalation, prior to the
" observations" made by Dr. Jackson, 1 did not consider it inappropriate
to refer to the fact and procure certificates bearing on that point.

Another reason for alluding to the frequent inhalation of ether for
its exhilarating effects, was to show the steps by which I was gradually
led to believe etherization applicable in surgical operations. In re-

64

Meteorological Observations.

ferrinsr to the inhalation of ether as an exhilarating agent, in Jefferson
and Athens, I inadvertently used the word, "introduced," which ex-
pressed more than was designed. I considered the exhilarating pro-
perty of ether so well known, that I did not for a moment think of
there being the least probability of my language conveying the im-
pression that I laid claim to its discovery.

On the second page of the account, it is mentioned that one of the
company present the night of the first inhalation of ether in Jefferson, for
its exhilarating effects, related that he had previously inhaled it while
at school ; and after making this statement, it would have been absurd
in me to have claimed the discovery of this property, even if medical
authors had been silent on the subject.

The account was written while closely engaged in professional
business, and did not receive the emendation which was necessary.
I regret that the account needs this explanation, but justice to myself
requires that it be made. Yours, very respectfully,

C. W. LONG.

METEOROLOGICAL OBSERVATIONS, lor November, 1849, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet.

>

Sun Rise.

c

Ther.

Bar.

1

43

30 9-100

2

44

30 10-100

3

45

30 7-100

4

47

30 3-800

5

50

29 94-100

6

54

" 90-100i

/

55

" 81-100

e

50

" 60-100

9

40

" 69-100

10

37

" 84-100

11

42

" 86-1 no

12

45

" 83-100

13

52

11 87-100

14

50

" 88-100

15

52

" 77-100

16

51

" 83-100

17

51

" 80-100

18

55

" 62-100:

19

53

" 59-l00i

20

46

" 56-l00i

21

>42

" 80-100

22

39

" 83-100

23

45

" 88-1001

24

52

" 95-100

25

61

, 86-100

96

62

" 73-100

27

42

" 91-1001

28

36

30

29

35

29 95-100

30

44

" 76-1001

72
71
77
71
76
61
64
64
64
66

2, P. M.

Ther.

Bar.

68

30 12-100

74

30 5-100

78

30 3-100

78

29 97-100

78

" 90-100

79

" 85 100

78

" 68-100

62

" 59-100

66

" 74-100

70

" 85-100;

62

;t 82-100)

64

" 80-1001

75

" 89-100

73

" 83-100

74

" 76-1001!

70

" 83-100 i

67

" 72-100

58

" 57-100:

65

" 57-100

68

" 66-100

Wind.

" 83-100
" 80-100
" 90-100
" 92-100
" 78-100;
" 76-100
" 94-100
30 3-100
29 83-100
" 72-100

E.

W.
S. W.
S. W.

s. w.

S. E.

S.
N. W.

N. W.
N. W.

S.

E.
N. E.

N.
N. E.

N.

N.

N.
N. W.
N W.
N. W.

s. w.
s. w.

s.

s.

w.

w.

w.
s. w.
s. w.

Remarks.

l|Fair.
Fair.
Fair.
Fair. '
Fair.

Fair some cl'ds in afternoon.
'Fair do. do. storm at 7 p.m.,
JFair blow, [rain 20-100.

Fair.
Fair.
[Cloudy.
Cloudy.
Fair.
Fair.

Fair afternoon breeze.
Fair breeze.
Fair breeze.
Drizzle.
Cloudy.

Drizzle at 7 a.m. fair afternoon.
Fair.
Fair.
Fair.
Cloudy.

Cloudy. [90-100.

Cloudy rain from 12 to 11 a.m.
Fair.

Fair ice, first this season.
Fair.
Cloudy.

19 Fair days. Quantity of Rain 1 inch 10-100
days. West of do. do. 17 days.

Wind East of N. and S. 5
We are indebted to Dr. P. F. Eye, for our Meteorological tables.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. FEBRUARY, 1850. [No. t

" .-- . .

PART FIRST.

Original dommunicatton*.

ARTICLE III.

Elephantiasis its History, Symptomatology, JEtiology and
Pathology, with a Report of a Case and successful treat-
ment. By James M. Gordon, M. D., of Lawrenceville,
Gwinnett county, Ga.

The appellation of " Elephantiasis," was anciently given to
two distinct diseases of very dissimilar characters the one an
enlargement of some portion of the body, the other a scaly,
glossy, and tuberculated disease of the skin ; the former most
frequently attacked the extremities, whilst the latter usually
occupied the face and ears, and sometimes other portions of the
cutaneous surface. These terms have been retained ; and for
the purpose of preventing confusion, modern writers have
formed of them two divisions : the first, distinguished by the
epithet "Elephantiasis Arabium," or Arabic division the latter,
" Elephantiasis Graccorum," or the Grecian variety. The re-
marks in the present essay will be founded on the distinctive
subject of Elephantiasis Arabica.

History. The observations of some of the oldest writers on
Medicine go to establish the truth of its being a disease of great
antiquity. The earliest account that we have of it was by
Rhazes, a celebrated Arabian physician, who, as early as A. D.
850, accurately described it. Since this period, many writers
have given extended descriptions of the disorder : amongst

n. s. VOL. VI. NO. II. 5

66 Gordon, on Elephantiasis. [February,

them may be mentioned Morgagni, Chopart, Cheselden, Wal-
ther, Dionis, and Larrey ; yet, more recently, the subject has
engaged the attention and elicited the thorough investigation
of Tilley, Dalton, Adams and Scott. The disease has received
almost as many names as there have been writers engaged in
the description, frequently assuming in part the name of the
particular country, or place, in which it may be prevalent.
Dr. Good has called it " Bucnemia Tropica," from the fact that
it most generally occurs in tropical latitudes. In the Polyne-
sian islands it has been termed " Yava Skin," from the suppo-
sition that it originates from the use of a favorite beverage of
those islanders, called "yava." On the peninsula of India, it is
known as " Cochin leg." In Malabar, it has been called " Anay
Kaal," which name it takes from its supposed resemblance to
the elephants' leg. In Barbadoes, it is sometimes called "Bar-
badoes leg," in others, the "glandular disease of Barbadoes"
By some authors it has been termed " Yam leg," from its re-
semblance to that vegetable. On the island of Ceylon, it is
called "Galle leg," from its being most common in the vicinity
of the principal town of that name. In France, it is known as
" Lepra Elephantiasis," from the resemblance to the elephant's
leg. The Arabian physicians applied to it the name of " dal til,"
which also means elephant's leg.

It may, to the casual observer, appear a remarkable coinci-
dence, that so many different authors, located in different parts
of the globe, and all speaking different languages, should have,
with such unanimity, compared this disease to one and the
same object ; but it is only necessary for him to behold one
solitary case, to forcibly impress his mind wTith the correctness
of the simile. The enormous size of the part, with its clumsy,
unsightly and misshapen appearance, are not the only points of
resemblance to the leg of an elephant ; for at the same time the
rugose and scaly appearance, together with the rough and
uneven surface, bear close analogy to the skin of that animal.
It is neither a contagious nor infectious disease, but, like many
others, occurs endemically, exhibiting a strong predilection for
particular localities in Southern latitudes.

The countries in which this disease is in the most remarka-
ble degree endemic, are the islands of Ceylon and Barbadoes,

1850.] Gordon, on Elephantiasis. 67

Egypt, Abyssinia, Japan, all of the West India islands, and
some portions of South America and of Spain, the coast of
Malabar, and also in many of the South-sea islands. Sporadic
cases occasionally occur both in Europe and the United States*
As has been previously remarked, it is chiefly confined to
warm latitudes, prevailing most extensively in those particular
low, humid, and unhealthy situations, where malaria in abund*
ant quantities may be reasonably supposed to exist.

Liability of persons to the disease. On the island of Ceylon
it is wholly confined to the native inhabitants, including Creoles
and half-breeds. Foreigners, from whatever quarter of the
globe, are entirely exempt. In Barbadoes, it was confined to
the black population alone, till about the year 1704, wrhen the
first white inhabitant became its subject : since this period, it
has become very frequent even among the white inhabitants*
In Ceylon foreigners are not subject to it, until after having
become thoroughly acclimated by a long residence on the
island. In some other countries it is said to attack more fre-
quently the lower classes.

The young have also been represented as being more liable
to it than those in advanced life. There are none, however,
free from its dangers. It attacks all ages, both sexes, and indi-
viduals in every condition in life : the opulent, surrounded by
every comfort, and enjoying a life of luxury and ease, are equal-
ly obnoxious to its influences, with the hardy and industrious
peasant, who endures every privation in food and raiment, and
in his daily toil is exposed to all the inclemencies of weather,
and the greatest vicissitudes of temperature. There is no
immunity from its attacks.

Symptomatology. The onset of the attack is ushered in by
the symptoms common to inflammatory or febrile diseases,
such as rigors, with nausea, and sometimes vomiting, headache,
and pain in the dorsal and lumbar regions, these are succeed-
ed by considerable febrile excitement, with great thirst, and
intense heat of surface, followed by profuse perspiration. In
the mean time, the part destined to become the final seat of the
disease becomes tumefied, with increased heat and great pain,
particularly along the course of the lymphatics ; the skin pre*

68 Gordon, on Elephantiasis. [February,

sents a tense, smooth, and shining appearance, frequently of a
bright scarlet color, and in many respects resembles erysipela-
tous inflammation. Subsequently, and in the early stage of the
disease, it may possibly be mistaken for phlegmasia dolens, to
which it bears a close resemblance, but by careful observation
and minute investigation, the distinguishing marks betwixt the
two diseases will be sufficiently obvious to the skilful in diag-
nosis.

The attack usually lasts for several days, (from three to five,)
and generally yields to a mild course of antiphlogistic treatment,
and indeed frequently without any treatment at all, for there
appears to be a great proclivity to a spontaneous subsidence of
all symptoms of the disease for the time present. The febrile
symptoms gradually decline, and finally disappear ; the local
symptoms also subside, and frequently with desquamation of
the cuticle of the affected part, the patient being nearly restored
to his ordinary health. The limb, or part affected, does not,
however, return to the normal size, but remains somewhat
enlarged. To an individual unacquainted with the nature and
progress of the disease, it might reasonably be supposed that
here the case would terminate; nor could his mind be brought
to anticipate the horrible picture it may present, or the loath-
someness it may attain. Attacks similar to the first, follow
each other at earlier or later periods, the length of intermission
between the attacks varying in different cases. It has been
observed by a distinguished English author, that^a return of
the paroxysm is generally preceded by a feeling of weariness
along the course of the absorbents, with a benumbed sensation,
as if the limb was asleep. Then follows the ordinary symp-
toms attendant on a paroxysm : accelerated pulse, with general
febrile symptoms ; furred tongue, with a renewal of the swol-
len and painful condition of the limb or affected part. Similar
attacks continue to succeed each other, observing rather mark-
ed periodicity, each one leaving the part more swollen than the
preceding, till it attains an enormous size. Thus the malady may
gradually progress for months and years. After several attacks
have been passed through, an habitual swelling remains about
the ankle, dorsum of the foot, and toes, which is increased by
exercise in either walking or standing. At first the swelling is

1850.] Gordon, on Elephantiasis. G9

soft, producing a doughy sensation to the touch, becoming
gradually harder, till firm pressure produces only slight pitting;
the lymphatic glands in the neighborhood of the parts become
enlarged and indurated, especially those in the groin, if the
lower extremity be the part affected. In process of time, the
regular paroxysms of fever become less distinct, .and finally
subside altogether; the glandular swellings are diminished, and
there is much less pain along the course of the absorbents. It
is very rare that these swellings advance to suppuration. The
swelling up to this period has advanced slowly and regularly,
commencing at the toes, (if the disease be located in the lower
extremity,) and extending regularly up the foot and ]egf but it
does not preserve uniformity, in consequence of the constriction
about the ankle-joint ; the skin is formed into loose folds, which
produce ridges more or less elevated, with intervening fissures,
while the cuticle, becoming more rough and harder, interferes
very much with the capillary circulation. In the most aggrava-
ted cases, these folds of skin assume a fungous, tuberculated,
rugose or warty appearance. These warts or projections are
occasionally of such length and size, as to add very much to the
deformity of the part, and have not been inaptly compared to a
cock's spur. Appearances of this kind do not however attend
every grave case, for in some instances the tumefaction arrives
at a very great extent, with but little change in the appearance
of the skin, the principal alteration the part has undergone be-
ing in the sub-cutaneous structures, which seems to the touch
rough, uneven and knotty ; the shape of the part becomes very
much changed ; the foot acquires an enormous dimension and
a square form in shape, the swelling overlapping and wholly
hiding the toes from sight ; the shape of both the ankle and
knee joints become very much altered, and in truth the whole
extremity, from the tip of the toes, to above the knee, becomes
one huge mass of shapeless flesh. From the great distension
of the skin it cracks in many places, through which exudes a
thin, serous fluid, discharged abundantly, of a very disagreea-
ble odour, and so peculiar and remarkable that when once
observed, will ever afterwards serve to distinguish the disease,
even in the absence of other diagnostic symptoms. The lan-
guid condition of the capillary circulation, in addition to the

70 Gordon, on Elephantiasis. [February,

cracking of the skin, soon developes ulcers of a very unhealthy,
indolent appearance, with elevated, hardened edges, and small,
pale granulations, which never cease to discharge a fluid of
such offensive odour as to be almost insupportable. After the
appearance of ulceration, there is marked amelioration of the
symptoms ; the attacks of pyrexia, which before have regularly
recurred, no longer make their appearance ; the tumefaction,
previously on the increase, either remains stationary, or sensi-
bly diminishes ; pain, which has been a source of great annoy-
ance to the patient throughout the whole course of the disease,
is now materially modified, although not entirely absent its
character is changed, from that constantly attendant on an
increase of swelling, to the pain peculiar to this particular form
of ulceration. When, in the progress of the case, the extent
of ulcerated surface becomes greatly augmented, either by
multiplying their number, or enlarging the extent of boundary
to those already existing, alarming constitutional disturbance
is manifested. As a matter of course, an increase of ulceration
is attended by a corresponding increase in the quantity of
ulcerous discharges ; to this succeeds general debility, with
anorexia, mental imbecility, sleeplessness, pallid and anxious
countenance, emaciation, and general wasting of the tissues of
the body. Nature, accustomed to struggle against the ravages
of the disease, overpowered and exhausted by the combined
assaults, is no longer able to successfully contend with its adr
versary, but calmly yields the victory, and the revolting scene
is closed in death.

The parts most liable to elephantiasis are those most pendu-
lous, and in the neighborhood of a good supply of lymphatics
and surrounded by considerable quantities of adipose and cel-
lular tissues. The inferior extremity is the most common seat
of the disease, and in that member it produces more frightful
deformity than in any other location : it frequently attains a size
equal to that of a man's body, or larger. The next most common
position is the scrotum, and but for the testimony, upon the high-
est authority, it would be incredible to narrate the immense
magnitude that it has been known to reach, Mr. Liston reports
a case in which he removed the scrotum, which weighed fifty-five
pounds : it extended to the patient's knees. There is another

1850.] Gordon, 071 Elephantiasis. 71

report of the removal of the scrotum, which reached to the
feet of the patient, and was in weight ninety-two pounds, and
filled a pork barrel. The most extraordinary case of which
we have any account, is that mentioned by Dr. Titley. The
tumour rested upon the ground when the patient was in the
erect position, and after removal from the body, was ascertain-
ed to be of the astonishing weight of one hundred and sixty-jive
pounds ! Many of the patients that have been operated upon
have recovered. It is seldom that more than one portion of the
body is affected at a time in the same individual. There have
been a few exceptions to this rule. Dr. Scott* mentions the
case of a schoolmaster, at Point de Galle, in Ceylon, who had
both arms and bcth legs affected at the same time. The same
author reports another case of a woman, at the same place,
that had the disease in both legs at once. These are very rare
cases, and constitute the exceptions to the general rule. In
females, the vulva and mammary glands are occasionally the
seats of the disease : the clitoris has been removed for this
cause. Xext in frequency the arms become affected : then
follows the scalp, neck, ears, tongue, and penis. Some of the
internal organs have also been known thus diseased, as the
ovaria, uterus, and liver. In fine, every part of the body ap-
pears to be more or less liable to this malady.

JEtiology. In treating of this division of our subject, it
were better perhaps to adhere to custom, in sub-dividing the
causes into predisposing and exciting, although it will readily
be discovered that we have at our command no facts sufficient
to give a satisfactory explanation for either. After a careful
perusal of the most elaborate articles upon this subject, by some
of the enfinent authors previously mentioned, we feel con-
strained to say, that their remarks upon this particular division,
so far from being satisfactory and conclusive, amount to no-
thing more than mere hypothesis and vague speculation. Some
of their theories are, however, not only ingenious, but also have
the appearance of probability, as they are supported bv cor-
roborative circumstantial testimony.

In Demarara it is said to occur principally among the Creoles

Encyclopaedia Practical Medicine, p. 7T1.

72 Gordon, on Elephantiasis, [February,

(whether whites or Africans) and half-castes, while it rarely, if
ever, attacks the aboriginal inhabitants, or Europeans. It is in
this location, confined principally to the sea-coast. From these
facts alone, it would appear that the amalgamation of the races
predisposes to the disease. But in Ceylon, just the reverse is
true, in two essential particulars, to that which obtains in Deme-
rara. First, it scarcely, and perhaps never occurs except among
the aborigines ; secondly, it prevails most extensively at a dis-
tance of eighty miles from the sea-coast, where it is said that
at least one-third, and probably one-half of the population, are
affected with it. In every other respect, that portion of the
island appears as healthy as any other, being remarkably free
from intermittent or remittent fevers. It is in this part of the
island only, that the disease is endemic, and persons who for a
considerable length of time have been subject to its periodical
attacks, upon removal to some other portion of the country,
escape them, and not unfrequently perfectly recover. These
facts tend to controvert the opinion, that an admixture of the
races forms a predisposing cause to elephantiasis. But again,
the present history of the disease in Barbadoes contributes in
no small degree to confirm the correctness of the supposition,
that it does amount to a predisposition of no mean importance.
It has been previously observed, that on that island it was un-
known, except among the blacks, till the year 1704, and it will
be remembered that, prior to that period, the country was but
sparsely settled by Europeans, and they of but recent residence.
At that time, there were but few or no Creoles. Subsequent
to that time, the number of whites largely increased, and at the
present day, the whites and Creoles form a considerable por-
tion of the population. During the past few years, elephantia-
sis has there been of much greater frequency, and confined
principally to the Creole and white inhabitants. No satisfac-
tory explanation can be given of their greater liability, as there
appears to have been no change in the climate, and in no other
respect have diseases multiplied. The history of the disease,
wherever it has prevailed most extensively, shows that Creoles
and half-breeds, in proportion to number, have been the great-
est sufferers.
Among other predisposing causes may be enumerated

1850.] Gordon, on Elephantiasis. 73

peculiarity of habit. General constitutional derangement and
debilitv, also favors an attack; food of improper qualities, or
deficient in quantity ; an impoverished state of the blood, with
languid circulation ; the lymphatic temperament ; absent or
deficient transpiration all predispose to this affection. But if
all the causes mentioned as prolific sources of this disease, there
yet remains one, that has barely ever received even a passing
notice by any author upon the subject, and one in our humble
judgment of paramount importance to every other. We allude
especially to atmospheric causes and climatic influences, or in
other and less doubtful terms, to malaria.

Were there no other arguments to offer in favor of this opinion
than the analogy elephantiasis bears, from the very first prima-
ry symptom of the disease, throughout its whole subsequent
course, to our common forms of malarial fevers, it would be
sufficient to establish the greater or less identity of the two dis-
eases. The very first premonitory symptoms of elephantiasis,
are those most common to our remittent and intermittent
fevers, as regular exacerbations, attended with rigors, headache,
nausea, and vomiting, accompanied by pain in the back and
loins, and these symptoms being succeeded by a distinct inter-
mission. As before remarked, the paroxysms recur with con-
siderable periodicity, the only dissimilarity between this and
a case of common intermittent fever, consisting in the different
length of the period of intermission. Now we would not be
understood to say that the exacerbations return with the same
exactness as the chill in common intermittent fever. So far as
we are at present informed, no writer upon the subject has
given sufficient attention to determine the exact periods, as it
not unfrequently occurs that the intermission embraces several
weeks, and even months. We venture the prediction, that
when this point shall have received the proper attention, it will
be discovered that the paroxysms of the disease recur with
much more regularity, than has generally been supposed. It
may be said, however, that " out of the words of our own mouth
shall we be condemned," in reference to our previous state-
ment, that in Ceylon and Barbadoes intermittent and remittent
fevers are almost entirely unknown. But in answer to this
argument, we would suggest how readily it may be conceived,

74 Gordon, on Elephantiasis. [February,

not only possible, but probable, that the same morbific cause,
acting upon constitutions of peculiar susceptibilities, may and
does modify and ehange the character or type of the common
disease. Indeed, we know that this is true in regard to our
malarial fevers in this country. Every practitioner has ob-
served cases of entirely different types of fever, occurring not
only in the same neighborhood, but even in the same family,
the members of which had alike been exposed to the same
influences. If this be a true statement in respect to the mala-
rious diseases of this climate, certainly the same principles will
hold good in Ceylon and Barbadoes. Although the common
intermittent and remittent forms of fever may be unknown
there, yet it may be that the inhabitants of those isles are
scourged by the form of elephantiasis in lieu thereof.

An additional argument in favor of the malarious origin of
elephantiasis is, that our types of fever have been productive
of a somewhat similar affection, by instituting inflammation, in
the lymphatics, more particularly, of the inferior extremity.
The writer has now in vivid recollection several cases of mark-
ed phlegmasia dolens occurring in both sexes, and diversified
ages, as an attendant of Typhoid fever. The cases, although
not entirely analogous, are yet of sufficient similarity to throw
some weight of evidence in favor of our supposition. A worthy
member of the medical profession, in the West Indies, observes,
that during attacks of fever there, there is a manifest predispo-
sition to inflammation of the lymphatics, and a red line is fre-
quently seen throughout the whole length of the lower extremi-
ty marking the course of the lymphatic vessels. In conclusion,
upon this part of the subject, we need only advert to the fact,
that elephantiasis is most prevalent in warm latitudes, in the
vicinity of low, marshy tracts of country, bordering on rivers
and lakes, where malaria exists. In British Guiana, we have
it upon the testimony of Dr. Dalton, that the disease not only
resembles in many of its phases, but is also frequently associated
with intermittent fever.

The same obscurity veils a knowledge of the exciting, as of
the predisposing or remote causes. By high authority it has
been urged, that it is the result of vicissitudes of temperature;
but that opinion has been controverted by showing that in

1850.] Gordon, on Elephantiasis. 73

localities where it is most prevalent the temperature is remark-
ably uniform, the change not exceeding ten or twelve degrees
during a whole annual period. It has been regarded by some
authorities, entitled to confidence, as originally a local disease,
produced by some local irritation, and the attendant febrile
symptoms only the natural results of the local inflammation.
This opinion cannot be sustained either by arguments or facts,
and must, therefore, be untrue. If malaria be a predisposing
cause, it also at the same time becomes one of the most import-
ant exciting causes. The remarks upon that subject previously
made under the head of predisposing causes, would apply here,
but need no repetition.

As previously intimated, we evidently regard this as a con-
stitutional disease, and one that evinces a decided disposition to
localize itself early in its course, and exhibits an obvious ten-
dency to seize upon the lymphatic system. Upon post-mortem
examinations of subjects who have died of this disease, the
sub-cutaneous, cellular and adipose tissues, together with the
muscular aponeurosis of the affected parts, are found hard,
dense and tumefied. These changes appear as the result of the
effusion of a quantity of aero-albuminous fluid into these several
tissues, and which the absorbents are uimble to remove. The
effusion in this case differs from ordinary dropsical effusions, in
this, that it is always coagulated, and if left to the unaided
powers of nature, is never absorbed. It appears to be a fluid
sui generis in another particular, in that it never excites active
inflammation or suppuration. The muscles are considerably
atrophied and of a pale hue, and surrounded by much fatty
matter and cellular tissue. The larger veins are increased,
while the smaller are diminished in size, and many of them
attire]/ obliterated. The arteries ard not materially changed
in size, and are not very much enlarged, as from the hypertro-
phied state of the parts they supply might he supposed. The
nerves are a little flattened by the compression tl ey have sus-
tained. In cases of long standing, the disease is not alone
confined to the soft tissues, but the I 1 1 become di*

The general contour of the part, in the most aLr'_ri*av;itrd c
is frightful to behold, not only from its huge dimensions, hut
from the unnatural appearance produced by the linn agglutina-

76 Gordon, on Elephantiasis. [February,

tion of all the parts ; the skin being deprived cf all mobility and
covered with scales.

From the earliest notice of the disease, down to the present
time, it has been generally considered as one of the opprobria
medicorum, baffling the skill of the most scientific, and weary-
ing the patience of the most earnest enquirers, who have sought
to investigate its nature.

* As in the history of all other diseases, much light has been
thrown upon the subject by a gradual accumulation of facts, so
that it is now not only no longer a mooted question, as to the
possibility of ameliorating the condition of the patient, and
even affecting a permanent cure.

The treatment resolves itself into two divisions the consti-
tutional and local. The former comprises all those means that
have for their object the prevention of the successive returns
of the febrile paroxysms. The latter includes those remedies
calculated to diminish the hypertrophied part, by facilitating
the absorption of the effused fluid, or, in other words, to the
abortive and curative treatment

The first indication, which is to prevent the return of the
paroxysm, will be very much favored by a removal of the pa-
tient from the locality where the disease has been contracted,
and this should be the more imperative if it be endemic. If it
be a disease of malarious origin, and subsequent experience and
observation should prove its regular periodicity, then, in the
great anti-periodic powers of Quinine, we have, as we doubt
not, a most effectual remedy. Notwithstanding we know so
little of the modus operandi of this great and heroic remedy for
the largest class of diseases incident to southern climes, yet
we do know, that its effects upon the animal economy are
antagonistic to the periodicity of disease, and that it tends to
counteract the pernicious influences of malaria.

The removal of the effusion, and consequent reduction of the
diseased part, will be attained by the administration of such
remedies as will diminish the phlogistic predisposition of the
system, and increase the activity of the absorbents. The pa-
tient should be confined as much as possible to the recumbent
position, and the affected member should at all times, during the
course of treatment, be kept at perfect rest in the horizontal

1850.] Gordon, on Elephantiasis. 77

position. Mild meicurials, as pil. hydrarg., should be admin-
istered pro re nala, and followed, at the commencement of the
treatment, with a few brisk cathartics; but a continuance of
active purgatives is not only unnecessary, but may prove hurt-
ful. During the subsequent treatment, the more active cathar-
tics should be dispensed with, and mild laxatives substituted in
their stead, such as the supertart. potass, and the neutral salts :
not omitting, however, the moderate use of mercurials, which
should not be omitted, as they tend powerfully to increase the
activity of absorption. Their use should be discontinued short
of ptyalism. Particular care should be taken to sustain the
strength of the system, and, if necessary, recourse should be
had to stimulants, and tonics, combined with a generous diet.
The preparations of iodine, especially the iodide of potassium,
from their wrell known effects upon the glandular and absorbent
systems, stand unrivalled as remedies effectual in the cure of
this affection.

A well directed system of compression by means of the
roller-bandage, if practicable, will greatly facilitate the attain-
ment of the desired results. The pressure of the bandage
should be made from the toes upwards, and as firm as can be
borne, without great discomfort, or as is consistent with the
safety of the patient. The employment of severe friction, with
a stimulating liniment, immediately preceding each application
of the bandage, will tend greatly to accelerate the cure. The
improvement for the first few weeks will be very rapid, and
the re-application of the bandage often required, as it become*
loosened on account of the subsidence of the swelling. Under
such treatment, in the course of a month or two, there will be
found a considerable diminution in the size of the limb, or af-
fected part. The external appearances will also he very much
changed for the better The hard protuberances and rough-

! of the skin become much ieai distinct, and in ewrv par-
ticular, the part presents a much mora natural and healthy
appearance. I>ut the bandage is not to be discontinued until
long alter ever} vestige of the disease has subsided, and this

may require many months : if the treatment be 100 early aban-
doned, the disease rapidly returns. Tins unfortunate result
actually occurred to the writer, in oonsequew iect

78 Gordon, on Elephantiasis. [February,

of the attendant and nurse, in the interesting case herewith
reported, as will be seen in the sequel of this article.

In cases where ulceration exists, as in the advanced stages of
the disease, if the ulcers be large, it will first be necessary, be-
fore using the bandage, to diminish the size of the sores. The
application of poultices, succeeded by stimulating and astrin-
gent lotions, and then dressed with adhesive or Liston's plaster,
so as to approximate the edges of the ulcer, will generally
prove effectual. When the ulcers are small, they afford no
objection to the employment of the bandage, but on the contra-
ry, it is one of the most efficient remedies to promote their
healing, as with the contraction of the skin, and other tissues,
their edges become approximated and united. The use of the
knife is rarely required ; but cases of severe ulceration of the
leg, or insupportable pain, may demand amputation, and many
cases have been followed by complete recovery. It should
only be looked to as a resort when all other methods have fail-
ed to afford relief.

Case. We were requested on the morning of April 10th,
1847, to visit Peggy, a colored woman, belonging to Maj. Geo.
M. Waters, a wealthy planter of this county. Upon our arri-
val, we were absolutely startled and confounded at the huge,
misshapen, and unsightly appearance of her left lower extremity,
beginning at the toes, and extending to near the knee-joint.
The foot presented an enormous mass of flesh of rather a square
shape, the toes being almost entirely hidden from sight, by the
overlapping of a large mass of skin and flesh ; about the flexure
of the ankle-joint there appeared ridges of skin of considerable
elevation, with intervening fissures of corresponding depths.
The leg was of enormous dimensions, measuring about ten
inches in diameter. The surface presented a rough, scaly ap^
pearance, with a few long hairs interspersed here and there.
Upon the application of the touch, hardened protuberances
were observed, with intervening depressions of comparative
softness, which slightly pitted upon pressure. The entire limb,
from the toes to the knee, appeared one shapeless mass, and the
motion of the leg was very much impaired. In making out our
diagnosis, wTe had no hesitancy in pronouncing it a case of

1850.] Gordon, on Elephantiasis. 79

Elephantiasis, though in an experience of several years' prac-
tice, we had never previously met with one.

Treatment. Absolute rest, in the recumbent position, was
strictly enjoined, and she was directed to take pil. hydrarg.
6 grs., every other night, followed by an active cathartic on
the following morning. This course of treatment was faithful-
ly pursued for about ten days, when the pil. hydrarg. was
directed to be continued, but a mild saline laxative was sub-
stituted for the active cathartic on the morning following.
Hydriodate of potash, in doses of 5 grains, gradually increased
to 10, three times daily, was also added to the prescription, and
regularly administered. The diet was restricted to a moderate
allowance of bread and milk.

A strong roller was applied from the toes upwards to the
knee, as firmly as could be borne without pain, with directions
to have it re-applied, as often as it becomes loosened. Previ-
ous to the renewal of each application of the bandage, active
and severe frictions, with a stimulating liniment, was ordered
to be made over the whole extent of diseased surface. Under
this plan of treatment, the improvement was rapid. The swel-
ling diminished so rapidly that the bandage required to be re-
applied at least once every twenty-four hours.

This course of treatment, with but little variation, was
rigidly pursued with the best effects, until the 1st of November
following, during a space of seven months, at the end of which
time, the member having been reduced to very nearly the nor-
mal size, and presenting a natural appearance, the treatment
was discontinued without our knowledge.

After the discontinuance of treatment we lost sight of Peggy's
case, and heard nothing more from her until about the 1st of
November, 1848, just one year afterwards. Her owner then
informed us that the limb had never been quite reduced to the
size of the other, and had been occasionally painful ; that for
the last few months both the swelling and painfulness had been
rapidly on the increase, and that there appeared an evident
predisposition to a return of the former aggravated condition.

The method of cure previously adopted was again instituted,
with only slight modification, and with the same beneficial re-
sults. In the latter part of the treatment, the depletives were

80 Dugas, on Fractures. [February,

abandoned, and the patient put upon a course of tonics, with a
nutritious diet. The use of the stimulating frictions and the
roller bandage was directed to be continued for at least two
months, after every trace of the disease had disappeared. The
remedies were again discontinued in the early part of the pre-
sent year, since which, to the present time, she has remained
perfectly well.

We are enabled to give the following additional information
in relation to Peggy, particularly as regards her early history,
and the history of the disease in her case:

She was born in the Cherokee Nation, on the Etowah river,
and in wThat is now Cass county, and has been living at her
present place of abode, on the Chatahoochie river, twenty-six
years ; she is now about 46 years of age ; her father was a full
blooded Mexican Indian, and her mother a mustee ; her health
had been always previously good ; she is the mother of seven
children. The first symptoms of the disease were developed a
year before I saw her: she had been under the care of another
practitioner, whose plan of treatment I was unable to learn.
Menstruation ceased upon her one year prior to the attack.
She is very fat, her weight being 330 lbs. Her master writes
me, in answer to enquiry as to her present condition, dated
October 29th, 1849, "that Peggy says, when she has walked
about a great deal, during the day, the extremity is a little in-
clined to swell, and is also slightly painful in the afternoon.
She wears a shoe on that foot, and attends to her ordinary
business with little or no inconvenience."

ARTICLE IV

Remarks on the Treatment of Fractures. By L. A. Dugas, M.D.,
Prof, of Physiology, &c, in the Medical College of Georgia.

Although it may seem to be a work of supererogation to
write upon a subject so trite and so familiar to every practi-
tioner as that of Fractures, there are still some points upon
which surgeons differ, and upon which they should therefore
be heard. On the general principles of treatment all agree ;

1850.] Dugas, on Fractures.

but such is not the case when we come to the details. For
instance, the application of a roller bandage to the fractured
Umb is recommended by many and condemned by others.
Among the fornier, there are some who advise its immediate
application, and others who defer it until the inflammatory
stage shall have passed. In our country, the bandage is, I be-
lieve, very generally used, and it is for this reason I propose to
offer a few remarks against the propriety of such a course.

What are the ends proposed to be attained by the application
of the roller or other compressing bandage to a fractured limb?
They are, I believe, three-fold viz : to aid in retaining the
bones in their proper adaptation, to prevent the swelling of the
limb, and to reduce this after it has occurred. A serious objec-
tion to the bandage thus used, is that its application constitutes
by far the most painful portion of the dressing, especially if the
limb be held for the purpose by an unskilful aid. No one who
has ever witnessed the application of the roller bandage, from
the toes up to the pelvis, in fractures of the os femoris, when
every turn of the roller however gently carried, imparts mo-
tion and intense pain, can have failed to wish that it might be
dispensed with. Such, at least, is the case with the patient, if
not with the surgeon. This evil is aggravated by the necessi-
ty, which very soon occurs, of removing and re-applying the
bandage, as will be hereafter stated. Now, if the proper ap-
position of the fractured ends can be secured without iht roller
bandage, is not the difficulty and painfulness of its application
a sufficient reason to abandon it ? But it is also proposed to
prevent, by its use, the development of swelling. Let us see
if this object is ever attained. Every one knows how difficult
it is to apply the roller bandage to a whole limb in such a way
that the compression will be perfectly uniform, and the circu-
lation not impeded. Even expert surgeons sometimes fail in
this, and the less experienced will, of course, do so still more
frequently. Hut, however skillfully applied, the tendency to
swelling at the seat of 'fmctitrr, will very soon make the band-
age more ti^ht at this point than below it ; the venous circula-
tion will become impeded ; pain will supervene and increase
until the patient or his friends will be compelled to cut loose
the bandage, in order to release the strict ure. The patient will
n. s. VOL. VI. NO. II. 8

82 Dugas, on Fractures. [February,

then have to remain with an imperfect adjustment of dressings
until the physician can see him, which, in the country, may be,
not only hours, but days. Cases also unfortunately occur oc-
casionally in which, from the docility or fortitude of the patient,
he does not demand and obtain timely relief from the com-
pression, and suffers mortification to take place. One of the
most distinguished surgeons of the North stated to the writer, a
few months since, that he had been repeatedly called upon to
perform amputation, in consequence of the tightness of the
bandage occasioned by the supervention of swelling at the seat
of fracture. There can be no doubt that such accidents are
much more common than generally supposed, from the fact
that few men are as fond of reporting their unfortunate cases
as they are of heralding their successful achievements.

The third object proposed to be attained by the roller band-
age, is the reduction of the swelling or tumefaction usually
occasioned by fractures. For this purpose, the bandage is ad-
vised to be applied after the tumefaction shall have reached its
maximum. At this stage of the case the bandage is unques-
tionably less objectionable than it is at an earlier period ; yet
its application, even now, is very painful ; it is still difficult ; and
it may be so applied as to produce unequal pressure and conse-
quent strangulation, with all its inconveniences and dangers.
If it were absolutely necessary, these objections might be
waived ; but, if not, they should have their full weight in deter-
mining the practice to be adopted. It is certainly not abso-
lutely necessary thus to reduce the swelling ; and the utility of
the reduction by such means is extremely questionable. That
any real evil arises from such tumefaction as usually follows
fractures, has yet to be demonstrated. If left to the efforts of
nature it will subside in due time, without the use of any com-
pression whatever.

If the bones can be maintained in apposition and the swelling
be subdued without the roller bandage, and if this bandage
cannot, without great danger, be depended upon for the preven-
tion of tumefaction, the necessary inference is that it may be
omitted without impropriety. If, again, it be true that the
manipulations required for the application of the roller bandage
are always painful, that they have almost invariably to be repeat-

1850.] Dugas, on Fractures. 83

ed once or more as the swelling progresses, that the compres-
sion is generally the principal cause of pain in the treatment of
fractures, and that it occasionally induces mortification when
least expected, we should conclude, not only that it may be
omitted without impropriety, but that its use ought to be aban-
doned in general practice.

The writer wishes not to be understood as alluding here to
the starch bandage recommended by the distinguished surgeon
of Brussels. The number of victims to its use when first sug-
gested remains yet to be told. Suetin, however, no longer calls
it the "immovable bandage," but the " movable and immovable
bandage" and, so great is his apprehension that the roller
bandage, which constitutes a part of it, may be applied with a
view to compression, and therefore perhaps too tightly, that he
advises a bit of tape to be placed longitudinally along the two
sides of the limb before the roller bandage, and in such a man-
ner that the ends will project above and below : the roller
bandage is then to be applied with only as much tightness as
may be required to keep it in place ; after which, the ends of
the tape are to be drawn upon, for the purpose of ascertaining
by their freedom of motion that the compression is neither too
great nor unequal. If much swelling ensue, it will be manifest-
ed, not only by pain and the appearance of the distal end of
the limb, which is always to be left exposed for inspection, but
also by the difficulty of moving the tapes beneath the bandage ;
in which events he urges the bandage to be slit open and re-
adjusted more loosely. With these abundant precautions, upon
which Suetin now dwells with great earnestness, the plan is
unquestionably the best that can be devised, whenever the pa-
tient can have ready access to the surgeon or to an expert nurse
as soon as it may become necessary to modify the dressing.

In establishing rules of practice, whether in medicine or in
surgery, authors do not sufficiently discriminate between the
various circumstances in which both practitioners and patients
may be situated. What may be easy and proper under certain
circumstances, may prove difficult and injudicious under a dif-
ferent state of things. A system of practice may be highly
beneficial and unobjectionable in hospitals or cities, and be
entirely unsuited to the camp or country. What may be

84 Eve's Introductory Lecture, [February,

harmless in the hands of highly cultivated and experienced
physicians, may cease to be so under the administration of
practitioners less skillful. It is therefore important that the
principles as well as the details of general practice, be plain,
intelligible to all, and of easy execution. The safety of society
demands that dangerous expedients be discountenanced by the
profession, especially whenever more harmless procedures can
be substituted for them. The indiscriminate use of the roller
bandage in the treatment of fractures, has often occasioned the
most serious accidents, and should give way to the simple use
of splints and bandages applied in such a manner as to admit of
being modified, according to the progress of tumefaction, by
any person of ordinary intelligence. Let the more complica-
ted and hazardous processes be confined to such cases as may
be continually under the supervision of the surgeon.

PART II.
RetmtDS ctnir <xtratts.

An Introductory Lecture : delivered in the Medical College, of
Georgia, November bth, 1849. By Paul F. Eve, M. D,,
Professor of Surgery, &c. Published by the Class. Augus-
ta: James McCafferty. 1849. 8vo., pp.24.

This Lecture is devoted to a consideration of the causes
which conspire to degrade the profession of Medicine from
that rank in the public estimation, to which it is justly entitled.
That it does occupy a position far beneath that to which its
intellectual and benevolent character gives it a just claim, is
too plain to admit of argument. What is the cause that has
produced this unfortunate result, is a question that should
engage the careful consideration of every physician who pro-
perly appreciates the dignity and usefulness of his calling. We
are therefore persuaded that a brief analysis of a lecture devoted
to an examination of the causes which have lowered the stand-
ing of the profession of medicine will not prove unacceptable
to our readers.

The first cause assigned by the Lecturer for the low estimate
of the medical sciences, is "the want of harmony among its

1850.] Eve's Introductory Lecture, 85

advocates." It is true, ns is justly remarked, that physicians
exhibit little apparent unanimity, and that "doctors disagree"
has passed into a proverb. Yet the differences of opinion
among physicians are in truth neither greater nor more fre-
quent than among other professions. Law and Theology each,
have their written codes, yet their professors do not agree upon
the interpretation to be placed upon them, hence the multiplied
contradictory decisions, and the numerous religious sects.
The physician has' no guide but his observation of the laws of
vitality, and the modifications which these undergo from the
agency of numerous disturbing causes. It is not wonderful,
under such circumstances, that they differ, but that their dif-
ferences are not more numerous and fundamental. But the
contrariety of opinion among well instructed medical men is
not so great as is generally supposed.

f But differing, as we*freely acknowledge we do, and well
may, on so intricate and difficult a subject as medicine is known
to be, still the degree and extent of our disagreements are
greatly exaggerated by the community. Doctors truly dis-
agree, must necessarily, since their science is based upon ever
changing, complicated matter ; but that there exists among us
as contradictory and opposite opinions regarding the principles
of our profession, as is generally supposed, we do most unhesi-
tatingly deny. Because we employ various and apparently
contrary agents, and people cannot understand their action,
we are condemned as opposed to each other. When physicians
are called to a case of fever and one proposes bleeding, another
prescribes purgatives, a third gives tartar emetic, a fourth,
digitalis, a fifth nitre, it is at once concluded that they differ,
when in truth, they all harmonize, they are aiming at one and
the same result, the reduction of the arterial action and febrile
excitement. Moreover, as a purgative, one may select calomel,
another some one of the various salts or oils, or senna,
gamboge, scammony ; or of digitalis, one might give the
tincture, a second the infusion, a third the substance ; and thus
a hundred different opinions respecting fever alone would be ob-
tained, still in reality they all co-operate and concur in pro-
ducing the same effect."

Another reason advanced by the Lecturer for the want of
confidence in Medicine is, "that the errors of all who adminis-
ter physic, are charged to the profession."

"No distinction is now made between the regular and the

86 Eve's Introductory Lecture. [February,

irregular practitioner, between the learned and the illiterate in
medicine, between the physician and the quack. The wall of
separation has been broken down by law. No license is now
required to practice the healing art in these United States.
Formerly it was not so. It was then thought, that so difficult
and important an art as preserving health and alleviating dis-
ease, demanded some study, minute investigation, and enlight-
ened observation and experience, to practice it with success.
But our legislators have grown wiser than our fathers were,
and have abrogated all restrictions in regard to the practice
of medicine. In 1838, there were only four States of this
mighty Union which gave any legal protection to medical
science ; now there are not so many. The law of Georgia
offers a premium to empiricism and dishonesty, by declaring a
regularly educated physician shall not collect his dues without
a license, but exempting by special provision, "the Thomso-
nian or botanic practice, or any other practitioners of medicine
in this State :" these are the very words of the Act."

Among the causes of the degradation of our profession enu-
merated, this is one of the most potent. The land is over-
shadowed by quacks and impostors, who arrogate to themselves
the title of doctors of medicine, and are recognized as such by
a large portion of the community. The blunders of these men
are charged to the profession of medicine, and their arrogant
denunciations of principles which are universally recognized
among intelligent physicians as established upon immovable
bases, tend to confirm the popular error that there is nothing
certain in Medicine. But, besides these, there are too many
among those who have been regularly educated, who, seduced
by the prospect of pecuniary gain, or moved perhaps by other
less unworthy motives, embrace some of those empirical sys-
tems which the verdict of the great mass of enlightened physi-
cians has condemned as utterly repugnant to correct observa-
tion, and in many respects, to common sense. Such individuals
do more to discredit Medicine among the intelligent portion of
the community, than the whole tribe of self-styled doctors who
prey upon the popular credulity.

" A third cause for the present unfavorable opinion respect-
ing our profession is, that it is judged by those unqualified to
iorm a correct decision."

" To prove that the community is not prepared to render a

1850.] Eve's Introductory Lecture. 87

correct opinion of the importance of medical science to society,
we need only refer to the custom and practices of the day.
The whole system of empiricism is founded upon public
credulity, in what is novel, marvellous, or mysterious in treating
diseases ; and in the popular supposition, that every one can
best judge what is good or hurtful to his own system. In
conformity to these views, we find every person recommending,
and that most strenously, some favorite prescription, some
peculiar system of practice, or some nostrum. So universal is
this habit of prescribing, that for any complaint whatever, one
may instantly obtain a thousand pretended specifics. No man
ever thinks of committing the navigation of a ship to an un-
educated sailor ; but for derangements of the human system,
the most ignorant are often implicitly trusted. It was once
thought, that no one having a conscience would ever prescribe,
order or suggest medicine for a sick person, without he had
previously obtained a medical education. But now, even
timid women, boldly assume that difficult and responsible task,
and have no hesitation to criticise the prescriptions of
physicians."

"But the most striking proof, that the public are not
qualified to render a correct judgment upon the medical profes-
sion, is the prejudice which still prevails to some extent against
it. Against human dissection popular indignation has been
chiefly directed ; and with such success, that in but one State,
(Massachusetts) has the study of anatomy been legalized; in
all others, to dissect is a penal offence, subjecting the offender
to fine and imprisonment. Physicians are also liable for
damages if they commit errors in practice; and our actual
position is this for procuring or using the only means by
which we may comprehend our science we are punished ; and
again we are made to suffer, if our knowledge is not perfect
on the subject. The law is held over us in terrorem if we
dissect ; and on the other hand, we are mulcted in damages, if
we do not know that which we can only by dissection. That
the dead must be examined for the good of the living, all must
admit, however repugnant it may be to our feelings ; for in
the quaint but emphatic reply of Abernethey, before the
government of Great Britain, when interrogated c-n the subject
of human dissections, all ought to know, that if the dead be not
mangled, the living will be.'' "

The cause to which reference is here made lies at the founda-
tion of many of the others, but it is one for which there is no
direct remedy. It is impossible that any community should

88 Eve's Introductory Lecture. [February,

ever acquire such a knowledge of medicine as will fully qualify
them to sit in judgment upon the claims of medicine to a rank
among the sciences, or to determine the degree of individual
attainment. We pass on, therefore, to an examination of the
fourth reason why medicine has not a higher rank among other
learned professions. "It has not received from either govern-
ment or people, the same protection, encouragement and foster-
ing care that others have."

It has been justly remarked by a late French Journal, (Revue
des Connaissances Medico-Chirurgicale,) that republics have
never been favorable to physicians. In the republican Rome,
they were slaves : the first French republic abolished the Fa-
culties of Medicine the present republic is about to rob them
of their last obolus. Our republic manifests an equal disregard
for medicine. It is well known that our State governments,
so far from giving to it the encouragement that an enlarged
policy would dictate, and which is its just due, by endowing
institutions, and protecting the rights of those legitimately en-
gaged in its practice, actually encourage empiricism, and
oppress the physician. He pays a heavy professional tax,
which gives him no privilege, beyond those possessed by other
occupations which pay no such tax ; he is compelled to serve
on juries, and in the militia, and is universally expected to ex-
pend time, health, and even life itself in many instances, upon
the indigent sick, and that too without the remotest prospect of
compensation. The general government, so far as its limited
powers permit, pursues a course equally unjust. When the
trump of war is sounded it calls into service a large number
of medical men, and whilst rigidly exacting from such as may
seek its service, the most thorough preparation for their work,
they withhold all reward beyond the mere pittance which the
law allows. The recent war with Mexico affords many strik-
ing illustrations of this fact.

"In the recent war with Mexico, every officer who distin-
guished himself was promoted, some twice and even a third
time being brevetted. Others again who had never even visited
that country were also advanced in rank. We read of medical
men in both the regular army and volunteer service, perform-
ing most arduous duties during the whole campaign; of their
great efficiency as a corps ; of the gallant deeds of several

1850.] Eve's Introductory Lecture. 89

among them ; of the deaths of others, even under the fire
of the enemy ; but of all these surgeons and assistant surgeons,
where is the promotion recorded of the first among them ;
where the special honor or reward bestowed, by government or
the community,* upon a singls physician who served in Mexi-
co? All other officers have been advanced, some of them
most rapidly ; but not the slightest mark of distinction has
been yet conferred upon a single one connected with the medi-
cal profession. Similiar to this disregard of our army surgeons,
is the recent decision of the executors of the queen dowager of
Sardinia; who left by her will, that all her household officers
should continue to receive their salaries during the rest of their
lives. It was determined that her medical attendants were
the only persons not entitled to this boon. By the laws of
Georgia in relation to contagious diseases, provision is made
for all others, even for the payment of nurses to the sick; but
not one cent appropriated to physicians who may be called to
attend them. Well has Professor Simpson exclaimed, "the
lancet of Jenner has saved more human lives than the sword
of Napoleon destroyed. On the devastating European wars fol-
lowing the first French revolution, England lavished millions
of money, and freely bestowed honors, peerages, and heavy-
annual pensions, upon soldiers who were most successful in
fighiing her battles, and destroying their fellow men ; she
grudgingly rewarded Jenner with twenty thousand pounds for
saving twenty thousand of her subjects annually!" No less
than one hundred thousand human lives are annually saved by
vaccination alone. What a glorious boon is this from medical
science to humanity!"

The fifth and last reason advanced by Prof. Eve for the un-
favorable opinion entertained by the public, is, "that as a
science Medicine is the most difficult, obscure, and complicated
of all others."

" The fifth and last reason we shall advance for the unfa-
vorable opinion entertained by the public for the medical pro-
fession is, that as a science it is the most difficult, obscure and
complicated of all human learning. No other occupation
in life involves such varied and minute knowledge, such care-
ful observation of nature, such constant and absorbing study,
such heavy responsibility. The principles of other sciences are
well defined and are unchanging, as they are founded upon
inanimate matter, in which their actions are regular and uni-
form, and can therefore be calculated on with certainty.
Medicine, on the contrary, has to do with that which is in con-
tinual turmoil, and subjected to a thousand varying circum-

90 Eve's Introductory Lecture. [February,

stances and affecting causes. Our science rests in fact upon
human life. Now, besides the direct evidence given us by
revelation, daily observation teaches us the great uncertainty of
this of all earthly events, death may be considered the only
one absolutely certain. If then medical science is based upon
so shadowy and fleeting a thing as human life, what must
necessarily be its character? Can the practice of medicine
ever be certain ?"

The Lecturer has stated before, that mankind were not quali-
fied to form a correct estimate of our science. Medicine is not
a single science, but a combination of several, and among them,
some not easily acquired. The public, we repeat, cannot ac-
quaint themselves with these branches of knowledge to an
extent that will enable them to form a just estimate of their
character. Medicine, like Religion, will be judged by the char-
acters of those who profess it. If all physicians were honora-
ble, intelligent, and skillful, our science would soon occupy a
high rank. In the absence of all other means of forming a pro-
per estimate, men look to the general intelligence exhibited by
the practitioner of medicine. If he is ignorant upon all those
subjects with which every well educated man is acquainted, the
community will place a low estimate upon him, and upon the
profession of which he is a recognized member. How can a
non-medical man entertain a high regard for a science which
enrols among its votaries, men who are grossly ignorant of
every other branch of human knowledge how draw the dis-
tinction between the Charlatan or nostrum monger, and the
regular physician, if he finds both equally ignorant of those
subjects of general knowledge, with which he himself is ac-
quainted. It is the deficiency in the amount of literary and
general scientific attainments among too many medical men,
that has lowered the character of the profession and caused
it to be no longer considered, one of the "learned professions."
If none but well educated men were to engage in the practice
of medicine, a higher position would at once be conceded. We
do not mean that every physician should be a thorough classi-
cal scholar though we doubt neither the value nor importance
of classical learning but every one should possess a reasona-
ble amount of general literary and scientific knowledge. We
are aware that some very able physicians have labored under

1850.] The Kidney in Us Relation to Scarlatina. 91

this deficiency, but we venture to assert that it requires an un-
usual amount of intellect to raise one to eminence who is thus
situated.

Various schemes for the advancement of the medical pro-
fession have been proposed fvee medical schools longer
courses of lectures change in the modes of licensing, &c. ; but
all these, valuable as some of them doubtless are, will prove
fruitless, so long as the medical profession continues to enrol in
its ranks, so many who are deficient in the very elements of a
literary or scientific education.

The Kidney in its Relation to Scarlatina. Semeiology. By
James Miller, M. D. (London Lancet.)

The recent epidemic of scarlatina, has furnished an ample
opportunity of studying, in all its bearings, the important af-
fection known by the name of scarlatinal dropsy, or more com-
monly, dropsy after scarlet fever, the following remarks on the
disease in its connexion with the eruptive period, being the re-
sult of a somewhat extended observation of the epidemic in the
practice of a public institution.

The subject matter of these observations were enunciated,
for the first time, in a short paper I had the honor to submit
for discussion at the medical and Chirurgical Society of
London. I shall avoid, therefore, treating of points solelv open
to disputation, but embody the substance of the paper in the
following pages with the more practical detail; filling up, as it
were, the various parts of a sketch, of which that might be
considered the mere outline.

In an endeavor to treat of the pathology of this affection, in
the widest acceptation of the term, the first part of these ob-
servations will consist of a detail of the symptoms, and, in as
far as seems admissible, the ratio symptomatum. In the next
place, cases will be given, illustrative of the symptoms and
course of the disorder; and lastly, that branch of the pathology
which has more especially morbid anatomy for its basis, with
the general indications of treatment.

The prominent feature of this malady, indicated by its name,
that almost invariably claims our attention, is dropsy; and, in
addition to it, a very marked anaemia. They are those symp-
toms first obtruded on our notice as sequelae of a scarlatina
rash. As in true Blight's disease, of which this affection is the
prototype, it is a general dropsy, and for the most part associa-
ted with other symptoms of an acute character. It either

92 The Kidney in its Relation to Scarlatina. [February,

occupies the entire body, or certain localities simultaneously,
or successively, which circumstances stamp it with a general
character.

It would be quite foreign to the intention of this paper, to
treat of the theory of dropsies ; but of the acute general
dropsy, which, as a symptom, is now under notice, it is
necessary to point out some of the leading and distinctive
peculiarities.

Dropsy may be said to be not less a disease proper to the
bloodvessels than to the blood itself; plethora or distention of
the capillaries, more frequently originating on the side of the
veins, leading to a permeation, of serous fluid on the one
hand ; on the other, a manifest alteration in the physical and
chemical qualities of the circulating fluid. Either of these
elementary conditions may primarily and alone tend to the pro-
duction of dropsy, or both may mutually concur to produce the
same pathological result. Dropsies are either strictly local or
general. Local dropsy, properly so called, is invariably a dis-
ease pertaining solely to influences acting on the bloodvessels,
and whether obstruction exist near to, or remote from the
heart, all parts on the distal side of an obstructed vein, will be
found more or less the seat of serous infiltration.

The only general dropsy which has sole reference to the
vascular system, is that form termed by writers cardiac. Its
general character is marked by simutaneous or successive
serous effusions, more or less remote from the centre of the
circulation, but it wants many of the characters of renal gen-
eral dropsy, whether acute or chronic a form essentially com-
bining a lesion of the blood as one of its main inducing causes.
I may venture to say I have rarely seen general dropsy
occupying the entire superficial areolar tissue, which was
ascribed to cardiac disease, that had not conjointly a renal
origin. This is well shown in those affected with disease of
the heart and lungs, combining hypertrophy and dilatation,
with mitral regurgitation and chronic congestion of the pul-
monary vessels, (veins.) An effusion into one or more of the
serous cavities of the chest occurs. Increasing oedema of the
legs, beginning at the feet, is observed. At a later period, in
the general trouble of the circulation, congestion of the kidney
takes place, supervening, and favoured, or not, by anterior
chronic changes in the organ ; the urine becomes scanty and
coagulable, and all the features of renal are superadded to the
cardiac dropsy, such as infiltration of the integuments of the
thighs, buttocks, scrotum, abdomen, and more especially the
face ; the last, which, in disease of the heart, is more of a
turgor, now becomes converted into the characteristic oedema.

1850.] The Kidney in its Relation to Scarlatina. 93

The main feature of the acute general dropsy of scarlet fever,
is the sudden occuirence of anaemia, a circumstance owing to
the arrest of the depurating function of the kidneys, and certain
important changes induced in the physical and chemical quali-
ties of the blood. Superadded to dropsy, it imparts the well-
known condition leuco-phlegmaica. Such changes occur
simultaneously with the general plethora induced in the capil-
lary system by the interruption to the circulation at the kid-
ney in common words, the cutting off or obstruction to the
vascular circle at that point. The importance of the vascular
system of the kidney to the general circulation, may be esti-
mated by the relative size of its arterial and venous trunks with
those from which they spring or join. The importance of the
renal secretion must also be viewed solely in relation to its
balancing or compensating secretion viz : that of the skin and
digestive surface. The occurrence of general-surface oedema,
the characteristic of renal dropsy effusions at one and the
same time into various serous cavities fluxes, such as diar-
rhoea, bronchorrhoea, and albuminuria can be well conceived
in a disease affecting an organ that exerts so universal an influ-
ence over the systems of circulation and secretion. Renal
dropsy, then, may be either acute or chronic, according as the
vascular system of the kidney becomes suddenly or slowly hy-
peraemic, but is invariably and necessarily associated with
anaemia or apparent bloodlessness.

It is difficult to leave this point without alluding to another
general dropsy, essentially a blood-disease, but always of a
chronic nature. I allude to that arising from acute or chronic
suppression of the menstrual secretion. The occurrence of
anaemia is marked from the first, pointing out the important
changes effected in the blood through an arrest of the depura-
ting office of the uterus in its gland-like capacity ; and not un-
til this condition has existed for some time, does a slow and ill-
defined general dropsy become apparent. This is probably
sooner or later hurried, and the plethora of the capillary sys-
tem passively induced, by a weakened condition of the heart,
from long deprivation of its normal stimulus, red blood. These
forms of general dropsy may be superadded to the cardiac,
stamping it with the impress of their respective characters.

The preceding observations are simply to express in general
terms, the effect of derangement of important secreting struc-
tures on the blood. The converse of the general proposition,
is equally maintained by pathologists. Obscure " disorders of
the general health/' attended with anaemia, will, on more close
examination, however, appear oftentimes to arise out of some
impairment of important secreting structures. The skin, for

94 The Kidney in its Relation to Scarlatina. [February,

instance, in those long withdrawn from light and pure air, as in
miners, certain classes of artizans, &c; the lungs in their gland-
like capacity in chronic phthisis ; the uterus, in obedience to
the law of puberty, failing to act on the blood at its appointed
period, &c.

To return from this apparent digression from the subject to
anaemia as it exists in connexion with dropsy, we see that their
simultaneous occurrence is indicative of disturbance of an
important secerning organ, invariably arising from some acute
or chronic change affecting its circulation. It seems that in
this special renal affection, anaemia would claim our consider-
ation prior to the general infiltration of the tissues; and so it
almost invariably does in the more chronic cases. As symp-
toms, however, they are inseparable, viewing them in connex-
ion with their true cause, the renal disturbance.

These, anaemia and anasarca, are ushered in by fever of an
inflammatory type, of greater or less intensity. After a very
obvious malaise, of no definite duration, sometimes dating from
the disappearance of a scarlatina rash, a rigor occurs, often at-
tended with cephalalgia and vomiting. The rigor amounting,
in many cases, to a mere chilliness, is more rarely exalted into
a paroxysm of general convulsions, especially in very young
children. The functions of the sensorium may be much dis-
turbed, from the first accession of fever, and active delirium,
dilated pupils, with paitial or complete insensibility, may take
the lead. The pulse, under these circumstances, is often very
slow, but on the occurrence of reaction without head-symp-
toms, it is frequent and hard; the breathing is accelerated; the
heart's movements are tumultuous. We are generally led,
from the first, to auscult the chest, and not unfrequently surpri-
sed to find the physical signs of thoracic inflammation absent.
The first stage of pneumonia, a roughness with the first sound
of the heart, or signs of inflammation of one or more of the
serous cavities of the chest may, however, at this period, be
detected. The abdomen, generally complained of, is now ten-
der on pressure ; the patient is intolerant of manipulation about
the loins, hypogastria and umbilicus, and often have I believed
peritonitis to exist, where the kidney was solely the seat of dis-
order. Simultaneously is the urine frequently suppressed, or
very scanty, the patient passing, for many hours, only a few
bloody drops. I have observed not more than an ounce passed
for three days in succession. Under these circumstances, even
the fluid is rarely above the normal density, and varies much
in its degree of coagulability. With these symptoms, the
dropsy increases and becomes general, making its appearance
at an early period, in the face, about the legs and trunk of the

1850.] The Kidney in its Relation to Scarlatina. 95

body, and lastly, in one or more of the large serous cavities.
The intensity of the general symptoms is by no means, directly
proportioned to the extent of dropsy or amount of serous effu-
sion; of course omitting the consequences of pressure upon
the heart, lungs, or brain, as probable contingencies of the dis-
order. An absence of dropsical symptoms, by no means an
unfrequent occurrence, is oftentimes associated with severe
constitutional disturbance, and very great serous infiltration or
effusion, is often accompanied with unimportant symptoms.
At this period, anaemia, or apparent bloodlessness, is very
marked, however acute the attack of renal dropsy, and the
symptoms, at an early period, either assume a chronic form or
subside altogether. Such, however, may be developed so gra-
dually as to merit the name of a chronic or subacute affection ;
anaemia, general dropsy, with a hard pulse and slight febrile
movement, occurring from the very first.

The more important symptom, albuminuria, usually consider-
ed essential to confirm the diagnosis of this affection, I have
as yet only indicated, being desirous of showing how far anae-
mia and dropsy, wTith other symptoms, may be significant of
renal disturbance. Dropsy and coagulable urine were scarcely
more than shown to co-exist long before the law of albuminu-
ria and a special affection of the kidney was propounded by
Bright. The law alone is it which for the first time has placed
the kidney in its true relation to scarlatinal dropsy. Almost
coetaneous with the general dropsy, the urine is found coagu-
lable, and the slightest febrile movement, during suspected con-
valescence from a scarlatina-rash, at any period of the desqua-
mation-process, is a signal to institute an examination of this
secretion. In the very acute seizure it is. as before mentioned,
sometimes suppressed or very scanty ; tinged with blood ; of
moderate or strong coagulability, and loaded with amorphous
deposit on cooling. If sufficient be procured to ascertain the
density, although scanty, it will not be found to range above
the normal standard, unless heavily laden with lithates. Haemor-
rhage may take place from the kidney and the urine be pro-
fuse. Under such circumstances, it is invariably of low densi-
ty. A copious urine in the absence of haematuria is equally
low. A mutual relation may be observed between the quantity
and coagulability of the urine and the general dropsy. As a
general rule, the degree or intensity of albuminuria or haema-
turia is inversely to that of the dropsical affection. This is
merely the result of observations made in numerous and varied
cases, and I have long noticed the generality of the fact.

A very slight anasarca and albuminuria may, independent of
other internal phlegmasia, be associated with symptoms of

96 The Kidney in its Relation to Scarlatina. [February,

great intensity, due, probably, to both the capillary vessels gen-
erally, and those of the kidney, failing to relieve themselves in
the ordinary mode; the dropsy being simply an unloading of
the capillaries in a state of plethora, on the one hand ; albumi-
nuria, a similar depletion of the kidney, on the other ; haema-
turia, a more complete sign of the spontaneous depletion of the
organ. Albuminuria and haematuria, further, are not apt to
decline, pari passu, with the dropsy and other symptoms. To-
wards the close of the latter, the patient is to all appearance
convalescent; the urine often observed to increase or maintain
a high degree of coagulability, protracting itself to an indefinite
period while the patient remains in an anaemic condition. In
proportion as the quantity of albumen is on the increase, the
density of the secretion usually falls a circumstance due prin-
cipally to a deficiency of the proper constituents of the urine.
A higher specific gravity, with decreasing coagulability, mark
the returning eliminating function of the kidney. Long after
the disappearance of albumen from the urine, the secretion
often remains copious and limpid, and of very low density,
(from 1005 1010,) showing that, although albuminuria may
be absent, the proper function of the kidney has not been yet
restored. I have, however, met with several instances in this
disease, and in the acute renal anasarca, said to follow exposure
to cold, in which the urine has, early in convalescence, attain-
ed a density of 1035 1040, and yielding, on the addition of
nitric acid, a solid mass of the nitrate of urea. Here we have
the kidney ridding the blood of its excess of urea, and restored
to its proper function as a secreting organ. At various periods
of this disorder, the urine will be found to contain, on microsco-
pic examination, blood, casts of the tubuli uriniferi, apparently
consisting of cohering cylindrical masses of epithelial cells that
have been thrown off together. Hence the term desquamative
nephritis, usually now applied to this affection of the kidney.
Fragmentary casts, and others bearing only the impression of
the secreting cells, are usually seen at the same time ; mucus,
and more rarely pus cells ; vegetable cells of various sizes,
many resembling, in form, the yeast plant, some smaller ; others
elongated, (entophytes ?) may be observed at different times.
Of salts, the amorphous deposit of urate of ammonia, and rhom-
boidal crystals of uric acid are the most common. They seem
to occur at all periods of the disorder, and no rule can be estab-
lished for the conditions of their appearance or absence. More
rarely, oxalates are discernible. Crystals of the triple phos-
phate of ammonia and magnesia appear frequently, as the result
of early decomposition of the urine, and various animalculae
(entozoa?) are equally seen in specimens recently passed, as in
others long kept for examination.

1850.] The Kidney in its Relation to Scarlatina. 97

Whether does the general anasarca with anaemia or albu-
minuria claim priority in the order of symptoms significant of
disturbance of the renal circulation ? The dropsy, as I have
before stated, is usually first noticed, and not unfrequently
many hours, or even days, may elapse, ere albuminuria forms
one of the symptoms. Albuminuria more rarely mav be ab-
sent from first to last, or general anasarca may not make its
appearance during the entire progress of the disorder. Cases
of anasarca succeeding scarlatina without albuminuria, have
led some writers, Rayer especially, to ascribe the dropsy to
any other, in preference to a renal origin. From this opinion
I differ, fully believing that a certain form of dropsy, with
anaemia and other symptoms, are as characteristic of renal
disturbance as with the ordinarily associated symptom, albu-
minuria.

The preceding symptoms, acute or not, differing in degree
only, are of a strictly inflammatory character, and significant
of acute congestion of the kidney. Another important feature
in the pathology of this disease, is the very frequent occurrence
of inflammation set up at the outset, or succeeding the renal
attack. The most prominent are pneumonia, and inflamma-
tion of the serous and synovial membranes. The occurrence
in true Bright's disease, as consequent upon the changes pro-
duced in the blood by the kidney affection, has been conspicu-
ously set forth by Christian, Taylor, and other pathologists.
The more frequent complication of inflammation of serous
membranes, almost makes it appear as if the blood, contamina-
ted with urea, selected those delicate structures, and acted
directly upon them as an irritant poison. It is probably this
immediate contamination of the blood, superadded to the renal
congestion, as well as the frequent occurrence of secondary
inflammation, that tend to maintain the inflammatory character
of the fever and general dropsy.

As an important practical feature of this disease and its as-
sociated or secondary complications, it remains to be shown
how they differ from those more strictly denominated idiopa-
thic inflammations. However acute the symptoms of invasion,
or with whatever degree of intensity secondary inflammations
may set in, a remarkable proneness to asthenia or failure of the
heart's power manifests itself at an early period of the disease.
In the pneumonia, pleuritis, peritonitis, or severe uncomplica-
ted form of the disorder, whether the treatment adopted be
such as may be termed active or not, this tendencv is invaria-
bly shown, and the patient will often succumb under the best
advised remedies. This important feature is one of the utmost
practical moment that during the course of the disease a want

\. s. VOL. vi. xo. II. 7

98 The Kidney in its Relation to Scarlatina. [February,

of muscular power is invariably manifest ; and death, in the ab-
sence of cerebral complication a rare occurrence is brought
about by asthenia or failure of the heart's power and action.

Scarlatinal dropsy occurs generally at some period subse-
quent to the eruptiv e stage of the fever ; and various writers on
particular epidemics, more than usually characterized by this
affection, have fixed the twenty-first day as the most frequent
of its appearance, and that during the process of desquamation.
Wells, Pleneiz, and Hamilton may be named among the more
distinguished writers on this affection. The desquamation
characteristic of scarlatina is more manifest in some cases than
in others. A very perfect desquamation may occur where
only a scarlatina fever without a rash has been observed, and
cases accompanied by prolonged and vivid eruption sometimes
exhibit only a partial desquamation. Others are observed where
the rash is very trivial, the throat affection severe, (scarlatina
anginosa,) and desquamation scarcely or ever at all perceptible.
During this period scarlatinal dropsy is said usually to manifest
itself, and as a general rule I believe it is a correct one. Des-
quamation is a true sequela of one of the primary actions or
effects of the scarlatinal poison, and the scarlatinal dropsy, in
consequence of being invariably supposed to occur at this peri-
od, has also, by every writer on the subject, been termed a se-
quela of scarlatina. The question now almost forces itself upon
us, whether is this affection the result of supposed cutaneous
action taking place during the desquamation-process, in the
milder cases especially, as is usually ascribed, and those in
which the patient is most liable to an early exposure to cold,
and giving rise, in consequence, to congestion of the kidneys;
or is it the result of the specific operation of the scarlatinal
poison at some period of the disorder not exactly ascertained,
producing by its direct action on the kidneys, a symmetrical
hyperaemia of the organs themselves? Many facts derived
from the recent epidemic, explicable solely by the laws of the
action of morbid poisons in the human economy, favor the lat-
ter supposition.

Scarlatinal dropsy, as I have stated, has been invariably term-
ed a sequela of scarlet fever. Adopting the first theory or
explanation of its renal origin viz., a secondary action or
reaction of the cutaneous capillaries due to a primary impres-
sion made on the surface of the body during desquamation only,
as in the instance of acute anasarca following sudden or pro-
longed exposure to cold few would be disposed, viewing it in
that light only, to consider it other than a sequela ; but regard-
ing it as one of the primary effects of the direct action of the
poison of scarlatina on the kidney itself, it becomes entitled to

1850.] The Kidney in its Relation to Scarlatina. 99

be considered with the primary disease. Many of the facts con-
tained in the cases given in the sequel tend to show that it does
result from a primary or direct action of the poison of scarla-
tina upon the kidney itself; while others further indicate the
necessity of considering it as a distinct form of scarlatina.
Regarding it, however, in either light, we observe scarlatinal
dropsy occurring during suspected convalescence, either as an
acute affection, or one more chronic in its nature, at some
period or other of the desquamation-process, or, more correct-
ly, some period subsequent to the well-known phenomena of
scarlatina; sometimes immediately after, prior to desquama-
tion ; very commonly on the twenty-first day ; often much
later; and frequently after the healthy function of the skin has
been restored. As a general rule, the more acute the attack,
the sooner is it observed to follow the disappearance of the
rash. At a later period a more acute form attends. " The
actions of morbid poisons," says the late Dr. Williams,* "like
those of medicinal substances, are variously limited, some af-
fecting only one membrane or organ, while others involve two
or more systems of organs. That of scarlatina acts more es-
pecially on the mucous membrane of the fauces, also on the
skin, the synovial membranes, and also on the peritonaeum,
occasioning ascites."

He further says, "when mcrbid poisons act on more tissues
than one, their actions are sometimes simultaneous, but more
commonly they are consecutive, and frequently long intervals
of time elapse between the successive attacks. In scarlatina,
the peritonaeum is not affected till many days after the eruption
of the skin and ulceration of the throat have altogether disap-
peared."

"In typhus fever," says Dr. Gregory,! "m rheumatic fever,
we observe the implication of internal structures. These
most serious aggravations of eruptive malady, whether denomi-
nated secondary or tertiary, may occur at all periods of the
exanthem. They may accompany the first burst of the erup-
tion ; they may develop themselves gradually during the
maturative stage, but they prevail principally towards the
decline of the disorder, and in the course of secondary fever."
" Further," he says, speaking of scarlatina as compared with
small-pox and measles, "the variety of organs secondarily im-
plicated is still greater. The eye, the ear, the heart, the liver,
the kidney, the peritonaea! surface of the bowels, may each in
turn be the seat of superadded disorder. In certain cases, the
morbid poison acts as directly on these internal structures as
it does on the skin." The preceding passage only indicates

* On Morbid Poisons. t Lectures on the Exanthemata.

\

100 Tlie Kidney in its Relation to Scarlatina. [February,

the point I am desirous of illustrating, admitting, as it does, a
direct action of the poison of scarlatina on the kidney, at the
same time stating that such '' is not a normal course of the ex-
anthematous disorder." In that part, however, which treats
immediately of the affection in question, no mention is made of
the kidney, saving in reference to its secretion, and numbers
the dropsical affection among the sequelce of scarlatina. " The
anasarca," says Dr. Gregory, " is curable in a large proportion
of cases, a circumstance which proves that the dropsy often
depends on no serious disorganization about the heart, but ra-
ther on the continuance of inflammatory action in the cutane-
ous capillaries, and long absence of perspiration." Dr. Wil-
liams numbers this affection among what he terms tertiary
actions of the poison, "the dropsy being usually limited to a
disordered function of the cellular or serous membranes ; but
in a few cases it is preceded by inflammation of the pleura,
and, in either case, languor, feverishness, &c, precede it for a
few days."

This author distinguished the primary effects of a morbid
poison from the secondary and tertiary by the two latter alone
exhibiting specific effects. The primary effects are simply
fever, which would be, in short, the first manifestation of any of
the exanthematous poisons operating on and disturbing the
functions of the nervous centres, in reality the first visible
effects of the poison in its latent condition, the period of latency
or incubation being, as contra-distinguished from the pheno-
mena of eruption, &c, the unknown, the latter the known and
manifest effects of the operation of the morbid miasm. The
secondary effects are, then, according to this author, the
primary specific effects the tertiary, ulterior and less definite
effects.

Believing that a greater difference is made between the
primary and secondary manifestations of a morbid poison than
in reality exists, the actions of the scarlatinal poison will be
confined in these observations to their open, known, or primary
specific actions, bearing in mind the law, " that when morbid
poisons act on more tissues than one, their actions are some-
times simultaneous, but more commonly consecutive, long
intervals of time elapsing between each successive attack ;
and that morbid poisons, also, which act on a plurality of
tissues, are prone to exhaust themselves on one or more with-
out affecting the whole series." This law is well illustrated in
the phenomena of scarlatina maligna, the force of the poison
being almost always wholly expended on the tissues of the
throat. It is, moreover, well illustrated in the dropsical affec-
tion, or properly, the affection of the kidney, the intensity of

1850.] Scarlet Fever. 101

the poison exhibiting itself in this organ, as a general rule,
inversely to that upon the skin and throat, the former especial-
ly. The anginose form of scarlatina seems to combine both
skin and throat affection, the latter being the severer of the
two. Frequently, however, very little rash is observable in
this form, and then the attack tends to the malignant type of
scarlatina.

On Scarlet Fever. By Dr. Schxeemaxx. (London Lancet.)

The advantages of the treatment now about to be laid down
are, the annihilation of the injurious effects of the exanthem on
the functions of the skin. The skin (by this treatment) is not,
indeed, protected from the eruption, but this is so modified that
scarcely any desquamation takes place, and the functions of the
skin, instead of being disturbed, and burthening other functions,
produce, by their continuing in a state of integrity, so beneficial
an influence on the organs attacked by the malady, particular-
ly those of the throat, that the normal condition is in every
case, and in every part, speedily restored. In order to realize
such extensive promises, we must bring into operation the fol-
lowing rules of practice :

Applications. "From the first day of the illness, and as soon
as we are certain as to its nature, the patient must be rubbed
every morning and evening over the whole body with a piece
of bacon, in such a manner that, with the exception of the face (?)
and hairy scalp, a covering of fat is everywhere applied. In
order to make this rubbing-in somewhat easier, it is best to
take a piece of bacon the size of the hand, choosing a part still
armed with the rind, that we may have a firmer grasp. On
the soft side of this piece, slits are to be made in various direc-
tions, in order to allow the oozing out of the fat : and this is
still further promoted by placing the bacon, for some time pre-
viously to using it, near the stove, in the oven, or on the hob.
But it is not proper to make the friction with a warm piece,
and the fat must be allowed to cool before using it."

"The rubbing must be most conscientiously performed, and
not too quickly, in order that the skin may be regularly satura-
ted with fat. During the process, the body is never to be
wholly uncovered, but only that part on which the opera-
tion is being performed, and if considered necessary, the whole
can be done under the bedclothes. But such precaution as
this is unnecessary ; the children may safely get up. No inju-
ry will ever be done by it, and after once seeing it done, the
mother or nurse soon learns to relieve the medical man of his
task."

102 Scarlet Fever. [February,

" Although this plan, from the mess it makes, is not calcula-
ted to find favour in the fine world although it dirties bed and
linen, as well as the persons of the children, yet the first few
days of its application produce results which make all this for-
gotten, and inspire the mothers with enthusiasm for this me-
thod. With a rapidity bordering on magic, all, even the most
painful symptoms of the disease are allayed ; quiet, sleep, ap-
petite, and good humour, return, and there remains only the
impatience to quit the sick-room. To obtain this, however,
other things are necessary besides mere infriction with fat, but
still I think myself bound to impute the most important share of
the merit to this peculiar treatment of the skin. The truth of
this assertion will appear from a citation of the first results
which follow on the treatment indicated."

" 1. The improbability, I might say impossibility, of the pa-
tient getting cold while the skin is thus covered with fat ; a
point in no disease more important than here; were this the
sole benefit of the fatty infriction, it would still be of great ser-
vice."

"The dry brittleness of the skin, and the tormenting itching,
are by it not only materially alleviated, but for the most part
fully put a stop to. Every practitioner knows how often the
itching and burning of the skin in scarlet fever are unendurable
to children, keeping them constantly in distressing movement,
and robbing them of sleep. Hence, children are generally well
satisfied with this rubbing-in, and often ask for a repetition of
the proceeding long before the time is come."

"3. The influence on the physiological functions of the skin
is still more important. During the coming on of scarlet fever
the skin becomes diseased, in consequence of which it dies off.
During this illness, and until a new covering is again prepared
for the surface, the functions of the skin are naturally very
faultily, or during the desquamation, probably not at all, per-
formed. In order to explain the extent and importance of the
imperceptible functions of the skin, merely mechanically view-
ing the matter, I refer the reader to the accurate experiments
of Seguin, which fix the quantity of matter thrown off from the
outer skin at eleven grains per minute in a grown person, and
therefore more than two pounds per day. What efforts must
it cost the organism to lead so large a quantity into other paths,
in order to throw it off when the skin is incapable of doing so !
But the preservation of the whole being is the first and most
important law, and however great the effort may be, the outer
organs must perform this function."

(I must here observe, that at first Dr. Schneemann thought
and indeed, in this portion of his pamphlet, stated that no des-

1850.] Scarlet Fever. 103

quamation takes place under this treatment, so that, in fact, the
functions of the skin are maintained in full integrity. Later
observation, however, convinced him that, with all possible
care, desquamation to a certain extent will ensue. This he
communicated to me, requesting me to insert it in the transla-
tion. To resume.)

"4. With this disappearance of the desquamation disappear
all those bad symptoms which attend on it. This feature alone
of this method of treatment, will have its weight with the prac-
titioner in all ages."

" In order now to give a striking proof of the importance and
the bad influence which the interrupted functions of the skin
produce on the healthy activity of relative, even if distant, or-
gans, I may cite the fact, that death is always the result where
more than one-half of the skin has been destroyed by fire or
boiling liquid. Sooner or later such is the case."

" A similar destruction of the skin ensues in scarlet fever,
with this difference, that it takes place gradually, and thereby
the organism is better enabled, by employing all the activity of
the body, to find aid against the mischief which, to the injury
of the patient, must result from the cessation of the functions of
the skin."

" The oxidation of the blood is thus considerably promoted, the
interrupting of which is the cause of such serious phenomena."

" As the disease of the throat is not improbably in great part
due to the interruption of the functions of the skin and lungs, it
must naturally disappear, or not present itself, where these are
continued in integrity ; and such is found in practice to be the
case."

" 6. Owing to the fatty covering, the skin is kept in a moist
state, and the cuticle thrown off cannot be driven about the
room by currents of air, as happens where the patient has been
kept dry ; and thus one fertile source of infection is kept closed
up, it being well known that infection is most easily communica-
ted at the period of desquamation. The author believes, not
only that such is the case, but also that by this method the dan-
ger of infection under any circumstances is materially lessened
with the disappearance of the eruption from the skin ; inasmuch
as the process of generating infectious material is interrupted
by restoring the skin to its normal state, a point of which he
need not point out the importance."

"7. By shortening the period of desquamation, and protect-
ing the patient against the sequela of the disease, the duration
and treatment of this can be shortened to a period of six to ten
days an immense advantage to the patient and his relatives,
particularly as he is always liable to relapses, and is, even in
mild cases, considerably weakened."

104 Scarlet Fever. [February,

"8. The remedy is (cheap,) harmless, practical, and. is per-
haps never counterindicated.

" The linen must not be too frequently changed, as a clean
shirt takes up more of the fatty matter than one already satura-
ted, and hence the skin is sooner deprived of its fatty covering."

1 The rubbing-in is to be kept up twice a day for three weeks,
and once a day during the fourth.'

* The patient is, after this, to be daily washed with cold water
and soap, and then only, is the warm bath to be commenced/

" This process does not, as has been argued in some colleges,
interfere with the natural course of the malady, and thus expose
the individual to second and third attacks."

"In severe cases the remedy may be repeated three or four
times within the twenty-four hours. The main point is to keep
the skin always cool and moist ; and here, even with all possi-
ble precaution, the skin will sometimes come off in certain
places. But cases of this kind are only unimportant."

" The practitioner will do well to fix the exact hour at which
the rubbing-in is to take place ; it will then most probably be
better and more regularly performed."

"Other points, which are also important enough, now re-
main to be noticed."

Temperature. ' The free admission of cool air in a case of
disease where heat is one of the great features, is as natural as
an idea, as it is beneficial in practice.' Dr. Schneemann quotes
a long list of authorities to show how beneficial cold washing
has proved in this disease, and says, "All this goes to prove
that it requires no great daring to keep the patient cold instead
of hot ;" ' but no cold washing is to be employed, as it promotes
desquamation. Cool air seems to have a bracing influence on
the system, and a soothing one on the respiration ; and all dan-
ger is avoided by the fatty covering. The temperature of the
bed-room should never be above 13 R. Keeping patients
warm, and giving them warm drinks, is adding fuel to the fire.
The idea of throwing back the eruption by mere cold air is an
error ; a scarlet-fever patient is, by the increase of the vital
generation of warmth, more fully than another, protected
against this ; and great heat is much more likely than cold to
check it, seeing that an acute cerebral affection is generally at
the ground of this (the retrocession.) In fact, the fatal cases of
this kind are principally those where, through keeping the pa-
tient too hot, the cerebral affection has been brought on ; this
has given rise to paralysis, which appears sooner in the skin
than in other parts, and thus to the withdrawal of the eruption,
for the skin dies sooner than other parts, as shown in collapse,
where mustard poultices do not draw as in other states.

1850.] Scarlet Fever. 105

Bed. ' The patient should not remain in bed any longer than
is absolutely necessary. As soon as the fever, headache, and a
desire to remain in bed are gone, he may quit it, for in bed the
skin is between two fires,* and the functions of the body do not
go on so well as in moving about. Hence, even when the pa-
tient must lie down an hour or two daily, he should still go
about the rest of the time. Nor must he have on too warm
clothing.'

Diet. ' The diet should be light, but there must be no starva-
tion, and as rapid a return as possible to the usual lood.'

Washing. 'Although it brings on desquamation, it will be
as wrell to let the patient occasionally wash his hands and face
with water and soap.' ' It reconciles him to the dirt attendant
on the rubbing-in.'

'If constipation ensues, it must only be combated with medi-
cines, when at the end of forty-eight hours it makes no sem-
blance of disappearance. Then a clyster of poppy oil is the
best remedy.'

" The treatment, to be successful, must comprehend all these
means. The author begs to enter his protest against a partial
employment of the remedies recommended.

The only inconvenience. Dr. Schneemann has remarked,
where the patient goes out on the tenth day, is, " a little stiff-
ness of the neck, which, however, passes off in twenty-four to
thirty-six hours, and requires no remedies of consequence."

Complications. 1. Severe cerebral symptoms at the com-
mencement of scarlet fever.

1 The above method of treatment can naturally only be appli-
ed where time is allowed for the development of the restorative
process, whereby the re-establishment of order in the system is
produced. Occasionally the case is accompanied at its very
outset by severe cerebral affection and convulsions. Here
bleeding may be employed, and if necessary, unhesitatingly re-
peated.' To support this view, Dr. Schneemann instances the
authority of Armstrong, Bernd, Stieglitz, Hammond, Hinges-
ton, &c. Venesection is, accordingly, the sheet anchor. ' Other
remedies are 1. The application of concentrated cold to the
head, and the best form for this is ice. The cold dash is often
more hurtful than useful, on account of the serious reaction
which follows it, and exposes the patient more to the dangers of
an apoplectic attack, although its results for the minute are often
very flattering. At the end of every two hours, the bladder of
ice should be removed, in order that the uninterrupted effect
of the cold may not weaken too much the tone of the vessels
of the brain.'

* Here it will be as well to inform those who may be unacquainted with the
fact, that in Germany a leather-bed is constantly substituted lor bedclothes.

106 Calculi in the Kidneys. [February,

'Warm mustard plasters to the shins are a most valuable
remedy.'

1 Internal remedies are generally of very little use where the
above-given remedies fail ; the only one of any importance is
the carbonate of ammonia. Mercury is of little value, except
just to open the bowels ; for its specification never comes into
full play till the system is throwing off the affection. There
are, however, much better purgatives than calomel ; the saline,
for instance. Emetics ought not to be tried in cases complica-
ted with cerebral affection ; in others they may. The aconite
failed in the author's hands, both in tincture and solution.'

1 With regard to the treatment by leeches and ammonia, so
many writers have already pointed out its good results, that the
author can safely recommend it, but with the proviso, that in
urgent cases bleeding be substituted for leeches.'

2. The Affection of the Throat, a. Primary. ' As this is
but a link in the whole,' so must the measures taken for its re-
moval be such as will remedy the general affection.'

1 b. Secondary. For this, the rubbing-in, as it acts by pro-
phylaxis, is the best possible remedy; but where this has not
been brought into use, or where, from keeping the patient too
warm, desquamation has come on, and the secondary sore-
throat has set in, the best remedy is emetics ; ' they not only
remove the tough glazy slime, but excite the secretions and ex-
cretions to more equality and normal disposition, and this is
especially the case if the disorder have a more gastric charac-
ter.' (See Dewees, Pitschaft, Sundelin, Seifert, &c.) Many,
by confounding the employment of emetics in the early and
latter stages, have brought them into discredit. For the swel-
ling of the tonsils an excellent remedy is, a solution of nitrate of
silver, (twenty grains to an ounce of water.) with which they
and the soft palate are to be painted ; but so many varieties
present themselves in these secondary attacks following on
scarlet fever, that no general rules can be laid down. Here
every thing depends on the discrimination and judgment of the
practitioner.' ' Another proof how necessary it is at once to
quell the disorder on the principles above laid down.'

Cases of Calculi in the Kidneys, with Observations. By
Cathcart Lees, M. B., Physician to the Meath Hospital.
(Dublin Quarterly Journal.)

Although the present advanced state of pathology and che-
mistry has thrown much light on all the diseases of the kidneys,
yet the practitioner must confess that he often feels embarrassed
when called upon to decide as to the exact nature and cause of

1850.] Calculi in the Kidneys. 107

some of the frequent, though often obscure and painful symp-
toms, referred to these organs. It is, for instance, difficult to
pronounce whether a patient's sufferings are caused by mere
functional derangement, or are owing to some acute or sub-
acute inflammatory attack of the substance or lining membrane
of the kidney, requiring antiphlogistic treatment, but not likely
to return if properly treated ; or whether they are caused by
the presence of a calculus to the kidney, or some degeneration
of its substance malignant or otherwise, when the treatment
must be chiefly palliative, and our prognosis, to say the least,
very guarded as to the probable return and final result of such
attacks. I therefore think it may be interesting to the profes-
sion, to give the details of two cases of calculi in the kidneys,
where the symptoms were accurately observed by me during
life, and the diagnosis confirmed by post mortem examination.

J. B , aged 20, apprentice to a watchmaker, a strong

lad, but of a sallow, unhealthy appearance, had been under my
care occasionally for about two years, suffering from frequent
desire to pass urine, with pain in the loins, particularly in the
right side, sensation of nausea, and general uneasiness, but
never so as to incapacitate him from attending to his business.
The urine was always passed pale, turbid, and alkaline, a thick
ropy mucus coming with the first gush ; specific gravity 1-006 ;
albuminous, and contained very little urea. The quantity of
urine was scanty, but the deposit of ropy mucus very consid-
erable. He wTas examined by Sir Philip Crampton and Mr.
Read, who pronounced that there was no disease of the blad-
der ; the diagnosis was chronic suppuration of the kidney, with
probably granular degeneration. His father told me that the
lad had passed a small stone when he was about ten years old,
but had the ropy mucus in the urine from infancy ; and the
same appearance had also been present in his mother's urine.
He was relieved by treatment, but suffered from repeated
returns of the complaint, till at last, after exposure to cold, he
was attacked with severe pain across the loins, sickness of
stomach, and great debility. I found him suffering from
pyrosis, diarrhoea, dry parched tongue, constant nausea (no
dysuria) ; pulse 100, very feeble and intermitting; counten-
ance expressive of great suffering; the urine was pale, scanty,
highly alkaline when passed; a copious deposit of ropy mucus,
with a slight reddish tinge ; there was great tenderness on

Pressure along both ureters. A consultation was held with
Ir. Smyly, when we agreed that his sufferings were probably
caused by a calculus impacted in the ureter. Two days after-
wards, the abdomen being much retracted, I detected a hard
tumour a little above the level of the umbilicus in the right

108 Calculi in the Kidneys. [February,

lumbar region, anteriorly. The tumour was hard, tender, and
could be moved laterally ; he suffered constantly from severe
nausea and retching, like the worst form of sea-sickness, and
died suddenly, while being turned in bed ; but, strange to say
he had not been confined to bed till within four or five days of
his death.

The body was examined by Mr. Williams. Though it ap-
peared greatly emaciated, there was a considerable amount of
fat in the integuments of the abdomen. On putting aside the
omentum and intestines, the tumor came into view, covered
with fat, and lying close along the spine ; it proved to be the
right kidney, which was brought forward out of its proper
place, and joined to the left kidney across the vertebral column,
forming what is termed a horse-shoe kidney, the substance
of one being continued into that of the other by a transverse
portion passing across the spine. Both the sides and the trans-
verse portion were filled with calculi. The pelvis of the right
kidney was filled by a large calculus, which extended into the
calices, forming branches, and which constituted the tumour
felt during life ; but both kidneys were quite filled with calculi,
of various sizes. The tubular structure of the kidneys was
nearly obliterated, and the cortical substance much congested ;
the ureters were pervious, and slightly dilated ; the bladder
was of the natural size; no thickening of its walls, nor any
columnar fibres, which was satisfactory in confirming the
opinion as to the healthy state of that viscus, which had been
previously given. It presented, however, a curious appearance,
the mucous membrane being covered over with numerous
vesicles, which contained a gelatinous fluid. The other viscera
of the abdomen appeared healthy, as also the viscera of the
thorax. The calculi, when removed from the kidney, presen-
ted, over the most of their surface, a rough, white, granular ap-
pearance, covered here and there with patches of a dark brown
colour, composed of oxalate of lime ; the chief bulk of the
calculi was, however, composed of triple phosphate with phos-
phate of lime ; of these the latter was by much the more
abundant, as was proved by dissolving out the triple phosphate
by acetic acid, and by the calculus fusing only slowly and par-
tially before the blowpipe. The phosphate of lime, almost all
of which resisted the action of the acetic acid, was instantly
and completely dissolved on the addition of dilute muriatic
acid. One of the largest calculi weighed 1120 grains. I made
sections of some of the calculi, but the composition was the
same all through. He had never passed any sand in his urine,
in which, when examined with the microscope, minute acicular
prisms of the triple phosphate only were observed.

1850.] Calculi in the Kidneys, 109

William Clarke, a car-driver, was admitted into the Meath
Hospital for bronchitis. On going round the wards I observed
this man vomiting, and on inquiring as to the cause, he said
he vomited constantly, and attributed it to his cough. On
investigating his case I found that he suffered from constant
dull pain in the right lumbar region, with severe pains in his
feet, and vomited every morning, but passed urine without any
annoyance. He stated, however, that he was formerly a
soldier, and that in Africa, twenty years ago, he contracted
fever, and at that period suffered from some urinary affection,
having occcasional retention, with severe pain in the loins and
region of the bladder. He was discharged and gradually re-
covering, continued in good health till about six years since,
when he was attacked with severe pain in the lumbar and
pubic regions, accompanied by obstinate vomiting, which per-
sisted for three days, when, after violent straining, he passed a
small stone by the urethra. The urgent svmptoms immediately
subsided, and he continued free from suffering till about three
months since, when the symptoms of which he now complains
made their appearance. The urine was now found to be large
in quantity, of a pale opaline colour, alkaline immediately after
being passed, spec, gravity 1-007, albuminous; a copious de-
posit of white sediment subsides to the bottom of the vessel,
while an iridescent pellicle floats on the surface ; on submitting
the urine to microscopic examination, large triangular prisms
of the triple phosphate wTere seen, with amorphous phosphate of
lime. I made the diagnosis of a calculus in the right kidney,
and put him on a generous diet, with dilute nitric acid, and mild
counter-irritation to the right lumbar region, under which treat-
ment he was progressing favourable, when unfortunately he was
attacked with erysipelas of the face and fauces, which termina-
ted in death. Both kidneys presented evidences of considerable
congestion ; in the right one, firmly imbedded in its substance,
there was a calculus the size of a lozenge, elongated, curved at
its extremity, and the whole cortical substance of the organ
appeared to be undergoing the process of granular degenera-
tion. The mucus membrane lining the pelvis of the kidney
and commencement of the ureter was of a dull white colour,
and slightly thickened.

These cases present many points of interest, some common
to both, others peculiar to each. The appearance of both
these patients was strikingly characteristic of what Dr. Prout
has termed the phosphatic diathesis; they were both unhealthy-
looking, as if labouring under some form of cachexia. The
temper of the last patient, Clarke was peculiarly fretful,
irritable, and morose : the nurse, and even the patients, com-

110 Calculi in the Kidneys. [February,

plained that nothing would please him ; he was always
grumbling. The most constant complaint in both cases was of
pain in the back, and this is a symptom well worth investiga-
ting; as Sir Benjamin Brodie truly observes, "there is nothing
in practice which you will be so often consulted about as pain
in the loins." The gouty debauchee, the married female, the
hysterical girl, the athletic man, the victim of lumbago, all
complain loudly of pain in the back, although there may not
be the slightest organic change in the kidneys. Again, pain
in the back is a prominent symptom in aneurism of the abdo-
minal aorta, also in rheumatic inflammation of the interver-
tebral cartilages and vertebrae ; and such is the difficulty, in
some cases, of forming a correct diagnosis, that Sir B.
Brodie with great candour mentions a case which he and Dr.
Prout diagnosed and treated as calculus, which ultimately
proved to be caries of the vertebras ; so that we should be slow
in concluding that there is disease of the kidney because there
is constant pain of the back, unless we have other symptoms to
guide us, as in these cases, where we had a very important ad-
ditional symptom, viz., nausea and vomiting, particularly well
marked in Clarke's case, and which was caused, I feel confi-
dent, by the mechanical irritation of the tubular structure of
the kidney by the phoshatic crystals ; and in this irritation the
stomach participated, through the influence of the splanchnic
nerves, from which both the renal and gastric plexuses are de-
rived. This symptom is also of great use in aiding us to
distinguish the symptoms and signs caused by the presence of
a calculus from the effects of a simple chronic nephritis. Here
also there is languor, a cachectic appearance, pain in the
loins ; the urine pale-coloured, alkaline, phosphatic, occasional-
ly albuminous, but without vomiting, so that the mere secretion
of alkaline urine is not sufficient to cause vomiting. It is of great
importance in all these cases to ascertain whether the urine is se-
creted alkaline, or whether it has become so in consequence of
chemical changes taking place in it after its secretion. This
distinction has been particularly insisted on by Rayer, who
considers that urine which is secreted alkaline is an important
indication of simple chronic nephritis, and particularly so as
there is often no other very obvious sign of the disease. The
inflammation runs a very insidious course ; they complain of
some languor, look out of health, may or may not have some
aching about the loins. The bronchitis which Clarke com-
plained of on admission I regard also as another of those
sympathetic irritations, intimately connected with the morbid
state of the nervous system ; for there was no proportion be-
tween the apparent suffering caused by the bronchitis and the

1850.] Calculi in the Kidneys. Ill

physical signs on auscultation, the former being excessive, the
latter trivial; nor did the symptoms yield to the usual treat-
ment with the facility we would expect in a case of simple
bronchitis.

The physical and chemical characters of the urine were
highly important, as in both cases, it was very pale in colour,
alkaline, albuminous, and loaded with phosphates, affording a
good example of the co-existence of those deranged actions by
the influence of which the phosphates are deposited and albu-
men appears as a morbid product in the urinary secretion, and
exhibits one of the numerous complications which may accom-
pany albuminous action. This coincidence involved some
nicety in the examination of the urine ; for as the fluid was
alkaline, it was not coagulated by heat, which merely rendered
it turbid by causing a deposition of the phosphates, so that I
had first to dissolve them in acetic acid, which has no effect on
albumen, and then I coagulated the albumen with dilute nitric
acid, thus proving the existence of both abnormal elements in
the urine. Another important feature in the urine, was the
nature of the deposit; in the first case it consisted of a dense,
ropy mucus, as was proved by Mr. Moore, to whose valuable
assistance in the chemical and microscopic examination of
urine, on this as well as on other occasions, I feel much in-
debted, who found the addition of acetic acid to corrugate it,
and form a peculiar brainlike substance. This ropy mucus
always came out with the first gush of urine. Now these points
are of importance to bear in mind, as it is laid down in many
books as a means of diagnosis between disease of the kidney
and that of the bladder, " that in chronic inflammation of the
pelvis, and calices of the kidneys, there is dysuria, with a de-
posit of true pus which flows after the urine ; while, in catarrh
of the bladder, the deposit is glairy and viscous, consisting of
ropy mucus," but in this case the deposit was ascertained (by
Mr. Moore) to be mucus, not pus, and the chief part of it came
out before the gush of urine, as I had frequently asked the
patient about it, and he told me it always preceded it ; but we
should bear in mind, that a glairy appearance may be caused
in renal pus by the presence of a certain amount of alkali in
the urine; and I believe, as a general rule, whether pus or
mucus comes from the kidneys, ureter, or bladder, it is always
passed mixed with it, though in greater quantity, towards the
end of the emission. The urine in the second case, that of
Clarke, was also peculiar in depositing a copious sediment,
though of a very different nature, as in his urine there was no
mucus, but a copious deposit of earthy and alkaline phosphates,
forming a thick stratum like white gravel at the bottom of

112 Calculi in the Kidneys. [February,

the vessel. Now this is a rare circumstance when the urine
is pale, abundant, and of low, specific gravity, for though this
condition of the urine is generally considered to be charac-
teristic of what is termed the phosphatic diathesis, and to
consist in an excess of phosphates, yet it really is not the case.
This has been satisfactorily proved by the experiments of Dr.
Aldridge, detailed in the ''Dublin Journal of Medical science"
for March, 1843. He states "that in place of being increased,
the quantity of phosphates in the urine is actually generally
diminished in the so-called phosphatic diathesis;" and Rayer,
in his valuable work on diseases of the kidney, dwells particu-
larly on this state of the urine, as strongly indicative of a
chronic inflammation, or a subacute nephritis; in fact, the
term "phosphatic diathesis" does not necessarily imply any
actual excess of phosphates in the urine, while it recognises
their appearance as a deposit, determined by a deficiency of
acid, or by alkalescence of that fluid. Earthy phosphates are
very insoluble in alkaline fluids, and very soluble in dilute
acids, so that the slightest trace will be made visible if the urine
becomes alkaline, and a great excess will be concealed if the
urine is normally acid ; so that, as has been well proved by Dr.
Bence Jones, their non-appearance does not argue their
absence, nor their appearance their presence in excess. In
fact, though variations in the acidity and alkalescence of the
urine are common, yet an excess of the phosphates is very
rare. It may appear strange that some of the symptoms gen-
erally considered pathognomonic of calculi in the kidneys
were absent, such as pain shooting down the course of the
ureters, retraction of the testes, bloody urine; but I presume
that the calculus not having entered the ureter sufficiently ac-
counts for the absence of pain in this direction, and the nature
of the calculi being phosphatic and free from asperities ac-
counts for the absence of hsematuria. It is indeed surprising to
what a size phosphatic calculi may form in the kidney without
the occurrence of haemorrhage, or even any serious symp-
tomatic irritation, as long as they remain confined to the gland.
If they are too large to pass into the ureter, they generally
cause some disturbance, but not at all proportionate to their
size, as, their increase being generally very slow, the organs
gradually become accustomed to the stimulus, and accom-
modate themselves to the pressure, till the organization and
consequently the functions of the kidney are destroyed ; but if
the calculus be dislodged or fractured, as in the case of a fall,
or strain of the lumbar muscles, they are attacked with severe
pain in the back ; vomiting, often inflammation of the kidneys,
and suppression of urine, followed by coma and death, or sup-

1850.] Calculi in the Kidneys. 113

puration of the kidney may take place ; or they may escape
with merely an attack of violent pain, as occurred in a case
which Dr. Edwards Crisp has given me the particulars of.
A gentleman, sixty years of age, when jumping over a flower
bed in his garden, was seized with a sudden and violent
pain in his right loin, which continued for several hours, but
gradually subsided. He died about twelve months after, of dis-
ease of his heart, and in the pelvis of the right kidney a large
calculus was found, which was fractured in the middle. The
malformation of the kidneys in the first case, with their
anomalous position lying across the vertebrae, ought not to be
considered as a mere anatomical curiositv, for it misjht occasion
a serious error in diagnosis, either by causing the displaced
kidney to be mistaken for some morbid tumour in the abdomen,
or might divert our attention from the true source of the dis-
ease, in cases where the symptoms should lead us to suspect a
disease of the kidneys ; thus Raver, in his valuable work*
gives the particulars of a case of inflamed horse-shoe kidney,
which lay across the spine. The patient complained of severe
pain in the umbilical region, but none in the lumbar ; the dis-
ease of the kidney was not suspected, though the urine was
purulent. In my case the malformation proved of assistance
in making the diagnosis, as, from the kidneys being brought
forward in front of the spine, I was thus enabled to detect the
calculus. / am not aware of any other case in which a calculus
has been detected by feeling it through the abdominal parietes
anteriorly.

As for the treatment in these cases, acids appear to be
chiefly indicated, rather as general tonics in improving diges-
tion, than with the hope of rendering the urine acid, together
with good animal diet, cider, and Rhenish wrines. I generally
prefer the dilute nitric acid, as it agrees well with the stomach.
When the secretion of ropy mucus, or muco-purulent deposit,
is very great, I have found benefit from the balsam of Tolu,
alternately with preparations of Buchu. Pareira brava, bark
in effervescence, turpentine, cubebs, copaiba, are recommended,
but great caution should be obsered in their use, lest they
induce severe inflammatory action for though the secretion of
mucus, or muco-pus may be diminished by their use, yet the
paroxysms of pain are often increased. Opium, camphor,
and hyoscyamus, are valuable auxiliaries, with mild counter-
irritation, and belladonna to the loins. Our treatment should
be palliative and preventive ; and I cannot conclude this paper
better than by referring to the latest opinionf of Raver on this

* Maladies des Reins, vol. i. p. 406. t See Ranking's Retros., vol. ix. p. 73.
\. s. VOL. VI. NO. II. 8

114 Bibliographical. [February,

subject, though I think he overrates the frequency of inflam-
mation of the kidneys as the cause of alkaline urine, and under-
values the use of acids.

Unless the examiner is well versed in the microscopic in-
vestigation of uriue, he will sometimes find it difficult to form
a correct diagnosis, particularly in the case of phosphates, for
when they occur as minute acicular prisms, they are often
crystallized like uric acid on one of the fine transparent hairs
which are found in urine, and the irritation and excitement of
a calculus often causes the urine to be loaded with lithate of
ammonia ; but the history of the case, the absence of bloody
urine, and the invariably colourless crystals of the phosphatic
magnesian salt, will be sufficient to prevent his making an error.

BIBLIOGRAPHICAL NOTICES.

1. A Practical Treatise on the Diseases of Children. By D. Fran-
cis Condie, M. L>., Secretary of the College of Physicians, &c, &c.
Third Edition, revised and augmented, Philadelphia: Lea and
Blanchard. 1850. 1 vol. 8vo., pp. 703.

It can scarcely be necessary to express an opinion upon the merits
of a work which has become generally known to the profession, and
is so universally approved as to have reached a third edition. Our
principal object in noticing this new edition of Dr. Condie's work is
to call attention to the fact, that it is much improved, not only by the
addition of a full and well digested article on epidemic Meningitis,
but by the introduction of all the more important discoveries and im-
provements which have been made in the nature, diagnosis, and
treatment of the diseases of children. The work is what it professes
to be, a practical treatise, and no one can fail to be benefitted by its
perusal. After having named Messrs. Lea and Blanchard as the
publishers of Dr. Condie's book, any commendation of its mechanical
execution will be unnecessary.

2. On the Diseases of Infants and Children. By Fleetwood
Churchill, M. D., M. R. J. A., Hon. Fellow of the College of
Physicians, London; Hon. member of the Philadelphia Medical
Society, etc., etc.,; author of the "Theory and Practice of Mid-
wifery," " on the Diseases of Females," etc., etc. Philadelphia :
Lea and Blanchard. 1850. 1 vol. 8vo., pp. 636.

This work was written by Dr. Churchill, for the American press,
at the request of his American publishers, and is now for the first time
presented to the profession.

The high reputation Dr. Churchill has acquired in Europe and the

1850.] Bibliographical. 116

United States, by his work on Obstetrics and the Diseases of Women,
cannot fail to secure a favorable reception for the one now before us.

We were very much gratified at the appearance of this publication,
but still more on examining its valuable contents. In our estimate,
some little modification may be required in the treatment of certain
diseases, especially in the doses of certain medicines ; but with occa-
sional variations and adaptations to Southern practice, which any
physician of even moderate experience can readily make, its claims to
merit, both as a scientific and practical work, are of the highest order.

Whilst we would not elevate it above every other treatise on the
same subject, we certainly believe very few are equal to it, and none
superior. j. a. e.

3. Principles of Human Physiology, with their chief applications to
Pathology, Hygiene, and Forensic Medicine. By Wm. B. Car-
pester, M. D., F. R. S., F. G. S.. &c, &c. Fourth American
Edition. Philadelphia ; Lea and Blanchard. 1850.

The Physiological works of Dr. Wm. B. Carpenter are so exten-
sively and favorably known, that the mere announcement of a new
edition of his most complete production, " with extensive additions and
improvements by the author," is sufficient to secure for it a ready
sale. The career of Dr. C. as an author has been most brilliant,
both in Europe and in the United States. From the fact, however,
that the demand for a new issue in this country has anticipated that in
England, the author has had the opportunity of laying before his
American readers his latest views upon several topics of considerable
and growing interest, especially on the Nervous system and on Gen-
eration. The treatise before us may therefore be now regarded as
one of the most complete we have, and should be possessed by all who
desire to keep pace with the rapid strides of this very interesting de-
partment of medical knowledge, a correct acquaintance with which is
indispensable in the appreciation of the morbid as well as normal phe-
nomena of life. d.

4. Maclise Surgical Anatomy. Surgical Anatomy. By Joseph
Maclise, Surgeon ; with colored plates. Part 1st to the 16th
plate, inclusive. Large imperial quarto. Lea and Blanchard.
Philadelphia : 1850.

We have just received the first part of this beautiful work, contain-
ing sixteen plates representing dissections of the Thoracic, Cervical,
Axillary, Brachial, and anti-Brachial regions. The representations
appear to have been made from original dissections, and are remarka-
bly clear, and beautifully colored.

116 Bibliographical. [February,

Although we are not prepared to admit that any thing can supply
to the operator the place of actual dissections for it is only by this
means that we acquire such a definite idea of the conditions and rela-
tions of parts as will give confidence to our incisions still, to those
who have dissected, this work will be found a most valuable remem-
brancer of knowledge more thoroughly and laboriously acquired in
the dissecting room. The plates are accompanied by references and
explanations, and when the whole has been published, it will be a
complete and beautiful system of Surgical Anatomy, having an ad-
vantage which is important, and not possessed by colored plates gen-
erally, viz : its cheapness, which places it within the reach of every
one who may feel disposed to possess the work. Every practitioner,
we think, should have a work of this kind within reach, as there are
many operations requiring immediate performance in which a book
of reference will prove most valuable. H. F. c.

5. Stanley on the Bones. A Treatise on Diseases of the Bones. By
Edward Stanley, F. R. S., President of the Royal College of
Surgeons of England, and Surgeon to St. Bartholomew's Hospital.
Pp. 286. Lea and Blanchard, Philadelphia. 1849.

We have examined this excellent work with much satisfaction. It
is a concise and systematic treatise on the diseases of the Bones ; and
supplies a want in medical literature that has been much felt by the
p rofession. Heretofore we have been wholly dependant upon the few
pages in works on Pathology and Surgery, for the history of the ob-
scure, and often inscrutable diseases of this important part of our
organism ; hence, the student's information concerning them is gene-
rally imperfect, for want of more definite and elaborate treatises.
The only works now extant that are devoted entirely to the diseases
of the bones, are the Treatises of Petit, published in 1705, and of
Boyer, in 1803. These are not accessible to the whole of the profes-
sion ; and moreover are not of sufficiently modern date for the present
state of our science. The present work seems to be the result of much
study and patient investigation, under circumstances the most favora-
ble for affording the best practical deductions. The author, from his
position as Surgeon to St. Bartholomew's Hospital, has been enabled
to produce a work of practical, as well as scientific excellence, and
each of his chapters is well sustained and illustrated by cases which
much enhance the value of his teachings.

The work deserves a more extended notice than the limits of a
monthly journal permits ; we therefore must content ourselves with
giving it our unqualified recommendation. h. f. c.

1850.] Periscope. 117

PART III.
lllontljlg periscope.

On the Depuralive Action of the Bile. By Dr. Fauconneau-Du-
fresne. (Brit, and For. Med. Rev. N. Y. Journ. Med.) Speaking
of the function of the liver as auxiliary and vicarious to that of the
lungs, the author observes : In intra-uterine life, the bile, in the ab-
sence of respiration, purifies the blood by the removal of carbon. The
meconium of the foetus is the carbon of the blood, extracted in a liquid
form, which after birth will be eliminated in the gaseous form. If it is
objected that the biliary secretion in the foetus is not manifested until
towards the fourth month, it may be answered that, until this period,
the liver is of very considerable proportionate size, and that it retains,
for the purpose of its augmentation, materials, which, later, will serve
for the secretion of this fluid. This function of the bile is not so appli-
cable in extra-uterine life. In the different vertebrata, the develop-
ment of the liver is generally found to be inversely to that of the lungs.
This remarkable antagonism exists especially in fish, which respire
by the bronchiae. In certain species of serpents the bile is very
abundant, as if to compensate for their imperfect respiration.

MM. Sandras and Bouchardat (Annuaire de Therapeut. 1845,)
have established that, whatever be the nature of the aliment taken by
an animal in good health, the quantity of fatty matters found in the
blood is nearly the same, which gives rise to the supposition that they
are eliminated as fast as they are introduced into it. According to the
same authors, the fatty bodies which the liver separates from the
blood have a constant point of fusion, and consist principally of choles-
terine, which the blood of carnivora always contains, and of the mar-
garic and oleic acids, united with soda. The fatty bodies of the blood
are subjected to a series of successive oxidations, by which the solubili-
ty of the sodaic compound which they form, is indefinitely increased.
Cholesterine may result from the alteration of the fatty bodies ; for it
is a neutral fat, the point of fusion of which is very high, and which,
not having been burned in the blood, must necessarily become elimi-
nated from the economy.

Arsenic in Intermittent Fever. (Journ. des. Con. Med. Chirurg.)
From the first of January, 1843, to the first of January, 1846, five
hundred and seventy-four persons were admitted into the military hos-
pital of Versailles with intermittent fever. Of this number, one hun-
dred and forty -two had but slight fevers, and as their general health
was not sensibly affected, they were treated with emetics, and simple
hygienic means. The other cases in which the fever was well marked,
and originated in marshy localities, were treated with the sulphate of
quinine, or arsenious acid and emetics. Of the cases treated without
either quinine or arsenic, there were eight relapses. One hundred

118 Periscope. [February,

and eleven cases treated with the sulphate of quinine furnished four-
teen relapses, whilst of three hundred and eleven treated with the
arsenic, there were but ten. More than one -third of the cases sub-
mittted to the arsenical treatment, had previously taken the quinine.
The sojourn in the hospital of those who were treated with quinine
averaged thirty days ; those who took arsenic averaged but twenty -two
days.

It is very evident that the intermittents of France are more obsti-
nate than those of our region, or that our French brethren have yet
much to learn in relation to the mode of employing quinine in such
diseases. We hazard nothing in asserting that in the hands of the
most inefficient of our practitioners, nay, even under the management
of southern overseers, it would be a rare occurrence for any patient
laboring under intermittent fever to remain on the sick list for one half
of either of these average periods.

Frictions of Oil of Turpentine in Intermittent Fever. (Journ. des
Con. Med. Chir.) M, Maillier states that, since the year 1846, he
has employed frictions with oil of turpentine with uniform success
in cases of intermittent fever, even in such as had resisted the action
of quinine in very large doses. He uses a liniment composed of the
oil of turpentine, to which is added a small portion of laudanum, of
which a couple of spoonsful are rubbed along night and morning dur-
ing the apyrexia.

Nitrate of Silver in Cholera. (Bulletin Gen. de Therap.) By
N. Bakth.- The nitrate of silver was administered to hfty-three pa-
tients of all ages, and all more or less seriously attacked. To some,
it was administered only in enema, but in most instances it was also
taken by the mouth. The ordinary dose was one grain, and in enema,
five grains, and was administered one, two, or three successive days,
rarely longer. In many cases the desired effect was produced in
twenty-four hours ; when employed for three cr four days, without
any good result, its use was abandoned. The principal effect of the
nitrate of silver was to moderate the morbid secretions, and frequent-
ly in eight or ten hours, the diarrhoea was arrested. In many cases
the obstinate vomiting suddenly ceased after the first doses of the
medicine had been taken. In no instance did the nitrate produce any
inconvenience. In several instances, it produced no astringent effect,
especially when given too late, but it never caused pain in the bowels
or stomach, or was followed by any unpleasant consequences.

1850.] Periscope. 119

Combination of Mercurials and Chalybeaies in the treatment of Se-
condary Syphilis. (Journ. des Con. Med. Chir.) Secondary Syphilis
is often accompanied with a discoloration of the tissues with ansemic
symptoms, against which it has been remarked that preparations of
iron were very often efficient remedies, after the use of mercurials.

The following is a formula for making Mercurial Ferruginous
Pills, in imitation of those of M. Lagneau, which M. Bouchardat
recommends to the employment of practitioners.

R. Double Mercurial Oint., }

Vallet's Pill mass, aa. > 5 grammes.

Medicated Soap, )

Make 100 pills. Dose, from 2 to 6 per day, to be continued for the

space of two months.

Aloctic Febrifuge Elixir. (Journ. des. Con. Med. Chir.) A Jour-

nal attributes to M. Recamier the following formula for avoiding the

unpleasant consequences in the administration of Sulphate of Quinine;

R. Aloes, soc. in powder, ) a

i\r u \ 0 grammes.

Mvrrh, aa. ) o

Rheii, 150 ' "

Alcohol, at 32 20 "

Macerate for 24 hours, and filter. In this liquid, dissolve 6 grammes

of sulphate quinine, agitate the whole with 25 or 30 drops sulph. acid,

and add 2 grammes of Sydenham's laudanum. Dose, for an adult,

1 table-spoonful, and for a child, about a desert-spoonful. After each

dose, the patient should keep warm, and remain at least two hours

without drinking. By adding to this elixir 4 grammes of pulv. col-

chici, it becomes, according to M. Recamier, a good remedy in rheu.

matic affections.

On the Nutritive Properties of Fish Oil. By Robert Druitt, F.
R. C. S. (Med. Gaz. N. Y. Jour. Med.) Of the virtues of cod
liver oil there can be now no question ; and it seems capable of
doing two things. In the first place it fattens and adds to the bulk of
the body ; and, in the second place, it gives nutrition a better turn, as
it were ; it makes the fluids and solids healthier as well as bulkier,
and enables them to throw off a variety of cachectic derangements.
These useful qualities have been partially accounted for on the sup-
position that they are due to a minute quantity of some biliary
principal contained in the oil. This supposition seemed to me ex.
tremely improbable, especially on considering the numerous adultera-
tions to which the oil was liable ; and accordingly I determined on
making a few experiments on the subject, the results of which I beg
to forward to you.

120 Periscope. [February,

For this purpose I applied to my oilman for some specimens of the
purest and sweetest lamp oil, and procured several varieties of whale
and seal oil, decidedly fishy and rank in flavor, but not rancid or oxy-
dized or putrescent. In fact, the flavor of the oil commonly called
" southern oil," the produce of the black whale, which I chiefly em-
ployed, is not disagreeable to any one who is free from fancies on
the subject ; and if mixed with three or four parts of almond oil, is
not a whit more offensive to the taste than the common oleum jecoris
asselli.

Case I. and II. Two brothers, S., aged 3 and 5, flabby, pasty
children, each suffering from pustular eruption on the head and face.
A wound made on the head of one of them a week since had degen-
erated into a flabby sore. No deficiency of food. Both took a
teaspoonful of seal oil three times a day in lemonade. Their mother
reports that they were excessively fond of their medicine ; they took
it for a fortnight, when the skin of each was quite healthy, and com-
plexion clear.

III. J. W., a pale, unhealthy child, aged 2\ years, subject to pus-
tular eruptions on the face. Cured by the same dose of southern oil,
thrice daily for a week. Cured far more readily than on former occa-
sions by calomel. Likes the oil extremely.

IV. J. L., a miserable child; glands in neck, greatly enlarged ;
purulent discharge ' from ears ; abdomen swelled and hard. This
child got better under the use of seal oil, but did not take it regularly
enough to make the case of any value.

V. J. E., aged 2, subject to skin disease from birth ; his mother
has had syphilis : his complexion peculiarly pasty and sallow. Took
southern oil in the above doses for a month. Greatly improved in
flesh and complexion ; but at the end of the course had an attack of
eczema in the arms.

VI W. aet. 30 ; subject to sciatica. Took the southern oil ; is
certain that it has done him much good.

VII. J. W., get. 36. Was largely bled for acute rheumatism a
twelvemonth since. #Has never recovered flesh or strength, and is
racked with pains in the back and shoulders. Took cod liver oil for a
month with benefit last May ; left it off during the summer ; became
thinner and weaker. Took southern oil in the dose of two drachms
thrice daily for three weeks ; likes it much ; feels stronger, and looks
as decidedly fatter and better in condition as he did from the cod liver
oil.

Mrs. P., suffered from puerperal mania whilst suckling last autumn ;
has continued anaemic and despondent ; has taken every form of min-
eral and vegetable tonic with temporary benefit. Took southern oil
for three weeks, is unmistakeably plumper, clearer in complexion, and
in better spirits.

IX. J. M., a sallow child, aet. 4, took the southern oil for a week,
for impetiginous eruptions on the face and legs. The improvement in
flesh and clearness of complexion was extraordinary, and the eruption
nearly disappeared.

1850.] Periscope. 121

These few cases do not prove much : out, so far as they go, are
satisfactory. No one who had seen the children above mentioned be-
fore and after their course of oil, could doubt that a most beneficial
change had been wrought by something. The great delight which
the little wretches took in their dose is another point worth noticing.
I would therefore suggest, that it is well worth while to make a fair
experiment on a large scale, to determine whether it is fish oil in gen-
eral that does good, or only the oil of the cod's liver. If, as I believe,
almost any kind offish oil will answer the purpose, then many of the
poor will be able to use the cheaper kinds, who could not afford the
nicer but more costly cod liver oil.

Remarks on the good effects of the ointment of Nitrate of Silver, in
the treatment of venereal buboes. By Dr. Robin, Sainte-Etienne,
Loire. (Bui. Gen. de Therap.) Encouraged by the success of Dr.
Lutens (of Anvers) in the treatment of venereal buboes, by nitrate of
silver, I had recourse to its employment in my venereal practice, at
the hospital of Sainte-Etienne, and employed it in more than twenty
cases of double adenitis, and at all stages of inflammation.

These are the results : In twelve cases the inguinal engorgement
disappeared in eight or ten days, using the ointment morning and
night ; in the remaining four, it was necessary to continue the fric-
tions for a few days longer.

In four cases I punctured the tumor, to allow the pus, which had
collected, to escape, and to prevent a too great destruction of skin.
Friction was continued on the remaining portions of the tumor, and a
cure was quickly effected.

The stage of suppuration was so far advanced in two other cases, at
their entrance into the hospital, that I was obliged to confine myself to
the knife and emollients.

Such results should encourage practitioners in the use of this oint-
ment in the treatment of syphilitic buboes, and in analogous cases.
There is no doubt, but that indurated orchitis, bronchocele, parotitis,
&c, might be successfully treated in this manner.

This ointment does not occasion pustular eruptions, as mercurial,
and other ointments do, but only an itching. The nitrate of silver
should be first dissolved in a very small quantity of water, before mix-
ing it with the adeps.

The ointment used by Dr. Lutens consists of 4 gram, of the salt to
30 gram, of adeps, but that used by myself contained but 2 gram, of
the salt, and the results were so satisfactory, that I deemed it unne-
cessary to increase the strength.

122 Periscope. [February,

New mode of Tamponning the Nasal Canals. By M. Merat.
(Union Med., Sept. 1849. Bui. Gen. de Therap.) On examining
the nasal cavities, they are found to be narrow, crooked canals, nar-
rower behind than in front, and lined by a highly sensible mucous
membrane. We know that the most frequent seat of nasal hemor-
rhage is at the anterior and superior part of the canal. In considera-
tion of this anatomical and pathological circumstance, and also the
difficulty of the ordinary mode of operating, M. Merat thought that a
more certain method might be adopted, which would also be less com-
plicated and easier of performance, for arresting the hemorrhage.
This consists in introducing, through the anterior opening of the nostril
only, small balls of lint, pushing them back as far as possible, there
being no danger of forcing through the posterior opening, since the
canal diminishes as it proceeds backward, and the efforts at expecto-
ration and coughing will tend to keep them forward.

This method has, according to M. Merat, the advantage of being
within the reach of every one, for cotton, paper, dec, may be substi-
tuted for lint.

This mode produces but little pain compared to Bellocq's, and it
does not produce tumefaction and that fetid secretion from the mucous
membrane, which the last named method sometimes does. And ano-
ther advantage which M. Merat ascribes to it is, that it can be used
immediately.

Conclusions respecting Laryngotomy in Croup. By F. Churchill,
M. D. 1. That the larynx is not mechanically closed by false mem-
brane ; that in all cases, as Dr. Cheyne has remarked, there is suffi-
cient space for the access of air; that if the larynx be closed, it must
be by spasm in addition to the exudation ; and that, therefore, to at-
tempt relief by a mechanical operation would be superfluous, to say
the least of it.

2. That it is extremely difficult to say that exudation has taken
place, and still more to fix the limits of it, and pronounce in any case
that it has not extended below the larynx ; and yet upon this depends
the utility of the operation ; for

3. If the false membranes have extended below our incision, the
operation, being purely mechanical, can afford no relief, but may se-
riously add to the danger.

4. Bronchitis or pneumonia may exist at the time of the operation,
or may very likely arise very soon after, and render it altogether use-
less.

5. The operation itself is not without danger, nor quite so easy as
has been stated, especially with young infants. In addition to hemor-
rhage and escape of blood into the trachea, the patient may be at-

1850.] Periscope. 123

tacked by prolonged syncope, asphyxia or convulsions, as occurred in
M. Trousseau's practice, and occasionally either of them may prove
fatal.

6. That the risk of inflammation and other accidents after the ope-
ration is very considerable, and materially diminishes its value.

7. That the results of the operation hitherto, although successful to
a considerable extent, are not sufficient to justify our having recourse
to it under ordinary circumstances. .** If," says Mr. Porter, "it were
possible to place a host of those cases in which bronchotomy had not
proved serviceable, in array against those wherein it had seemed to be
useful, it would scarcely be necessary to advance any further argu-
ment in proof of its uncertainty. "? On Dis. of Inf. and Childhood.

Reciprocal Influence of Pregnancy and Phthisis. ( Journ. des Con.
Med. Chirurg,) The influence which pregnancy and phthisis exert
reciprocally upon each other. In a memoir read by M. Grisolle, un-
der this head, he states as his opinion that pregnancy does not arrest
the progress of phthisis, as it is supposed, but on the contrary it rather
increases the organic lesion. Here are the results of his observations
in seventeen cases.

1. It is rare to see conception take place in confirmed phthisis ;
but, on the contrary, the first symptoms of pulmonary tubercles often
appear suddenly during pregnancy, and particularly during the first
three or four months.

2. If unfavorable hygienic conditions, grief and misery, seem
sometimes to explain the development of the organic affection, it is
certain that in the greater number of instances pregnancy was the
only observable change in the condition of the woman, and that it
acted as the exciting cause. But pregnancy did not produce the dis-
ease ; it only predisposed to it, as any other physiological or patholo-
gical change would have done.

3. Pregnancy and phthisis appearing at or about the same time, ran
their course without seeming to influence each other.

4. I have however observed, by comparison, that the organic lesion
ran its course more rapidly than when pregnancy did not exist.

5. What proves, moreover, the evil effects of pregnancy, is that, as
soon as parturition takes place the disease relents in its progress, or
remains stationary, provided the disease was not too far advanced be-
fore delivery.

6. Pulmonary tubercles do not modify pregnancy, at least in the
majority of cases. This point has already been established by
Desormeaux and M. P. Dubois.

124 Periscope. [February,

Suppression of Uterine Hemorrhage. Machen. (Lancet.) More
than three years ago, I wrote to a medical publication, suggesting an
apparatus somewhat similar, but, I think, more applicable to those
distressing cases haemorrhage after labour ; indeed, its simplicity is
such, that an ordinary midwife could with ease make use of it ; for
the greatest number of deaths occur in the practice of that class of
obstetricians.

Having provided a bullock's bladder of the largest size, and an
ordinary enema apparatus, I fix the neck of the bladder to the enema-
tube, softening it, however, before use, in warm water. The bladder
is introduced into the uterus, and cold water pumped into it. The
direct application of cold will soon cause the open orifices of the
bleeding vessels to close, and the uterus to contract; and that the
water might escape as the uterus contracts, I would have the tube
double, and furnished with a stop-cock, which could be open to suffer
the water already pumped in to run out, while the pump might con-
tinue throwing in fresh cold water until the desired effect is fully ob-
tained.

Craniotomy ; the Child Born Alive. (Medical News.) We copy
the following extraordinary case from the Pro v. Medical and Surgical
Journal :

" A remarkable case is narrated in the annals of the Medical So-
ciety of Flanders, in which craniotomy was performed in consequence
of deformed pelvis; but the child could not be extracted. As a last
resource, the Caesarean section was performed, and, to the astonish-
ment as well as horror of the surgeon, the infant was extracted alive,
and exhibiting an immense lacerated wound of the skull. The brain
was completely denuded, and appeared to be reduced to a complete
pulp. The child survived, and suppuration was established, large
quantities of brain coming away at intervals with the purulent matter.
When exhibited to the Society, the child (a boy) was nine years
old, and did not appear intellectually inferior to the average of boys
of his age. The mother did well, and died some years afterwards
of fever."

Dysmenorrhea. (American Journal.) Dr. N. Ward, of Burling-
ton, Vermont, reports that in several cases of menstruation, he has
obtained the best results from the use of \ gr. of sulph, ferri, with a
slightly laxative dose of sulph. magnesia, every day during the interval
of the monthly periods, or for the last ten days of the interval.

1850.] Miscellany. 125

itUbual fHtsrellang.

We have received a communication from Dr. J. D. Brooks, of
Bellevue, Georgia, in reference to a singular epidemic which oc-
curred in his neighborhood in August last, and to which the people
assigned the name of " Bellows," the principal symptom being great
difficulty of breathing, without cough or other indication of inflamma-
tion of the respiratory organs. The cases generally yielded in a day
or two to an emetic, a mercurial cathartic, and sinapisms to the breast
and spine. It is to be regrettted that no post-mortem examination was
made, by which more light might have been elicited in relation to
the real pathology of these cases.

Creosote to remove the Taste of Cod-liver Oil. (N. Y. Jour. Med.)
One drop of Creosote added to each dose of half an ounce of Cod-liver
oil, is said, by Dr. Barclay, to succeed in almost every instance in
obviating the sickness which so generally follows the administration
of this oil.

Danger of using Gutta Percha Catheters. (London Med. Gaz.)
Caesar Hawkins, Esq., Surgeon to St. George's hospital, says:

Very soon after they were introduced, I was obliged to give up the
use of catheters and bougies made of gutta percha, on account of the
great irritation they generally excited in the urethra an irritation
which is also found in many cases to prevent the employment of splints
made of this substance in the treatment of fractures and diseased joints,
for which it would otherwise be well adapted. The case of a man
who this day leaves the hospital, induces me to point out the actual
danger to life which may be occasioned by catheters of gutta percha,
and is the necessary result of the mode in which they are construct-
ed ; not of accidents or carelessness, which will occasionally lead to
the breaking of the ordinary gum catheter also.

The catheter is made, it would appear, of a slip of gutta percha
nearly an inch wide, and of the necessary length for making the ca-
theter, which is twisted round a stilette, so as to make the edges of the
slip join together, in which position a moderate degree of heat makes
them cohere to constitute a tube, when the stilette is withdrawn. Of
course, if this slip is screwed up in one direction, the edges are pressed
together ; but when twisted in the contrary direction, unless made to
cohere very firmly, the catheter is readily untwisted into the original
long narrow slip of the material employed, and probably the warmth of
the body facilitates this separation of the edges of the slip. A second
catheter, which my patient used on only one occasion, was thus opened
at one point of junction, and was easily unrolled for its whole length ;
others are not so easily broken up, but all must be dangerous.

126

Miscellany.

[February,

Death by Chloroform. The January number of the London Lancet
contains the history of a casein which the inhalation of not more than
one drachm of chloroform was followed by fatal consequences, in six
or seven minutes. The case was one of a trifling character (onychia
of the left great toe), and affords another striking illustration of the
impropriety of resorting to so powerful an agent, except in the more
serious surgical and obstetrical operations.

Frequency of Poisoning by Arsenic. (London Lancet.) From the
following table, drawn up by Messsrs. Chevallier and BoysdeLoury,
the relative frequency of the use of arsenic (arsenious acid) for crimi-
nal purposes in France will be seen at one glance.

Arsenious Acid, .... 34

Acetate of Copper, . - - - 7

Cantharides, ... - . 5

Corrosive Sublimate, ... 5

Nux Vomica, 4

Fly Powder, ... - . 3

Nitric Acid, 2

Sulphur of Arsenic, - - - 1

Tartar Emetic, - -
Opium, - - - - *
Acetate of Lead, - -

Cerussa,

Sulphuric Acid, - -
Sulphate of Zinc, - -
Mercurial Ointment, -
Undetermined nature of Poison,

Inportant discovery in Ventilation. (Lit. Gaz. London Lancet).
Dr. Chowne has enrolled a patent for improvements in Ventilating
rooms and apartments, of the perfect efficacy of which, we believe,
there cannot be a doubt, and on a principle at once most simple and
unexpected. Without going into details at present, we may state that
the improvements are based upon an action in the inverted syphon
which had not previously attracted the notice of any experimenter
viz., that if fixed with legs of unequal length, the air rushes down into
the shorter leg, and circulates up, and discharges itself from the
longer leg. It is easy to see how readily this can be applied to any
chamber, in order to purify its atmosphere. Let the orifice of the
shorter leg be disposed where it can receive the current, and lead it
into the chimney (in mines, into the shaft.) so as to convert that
chimney or shaft into the longer leg, and you have at once the cir-
culation complete. A similiar air syphon can be employed in ships,
and the lowest holds, where disease is generated in the close berths
of the crowded seamen, be rendered as fresh as the upper decks. The
curiosity of this discovery is, that air in a syphon reverses the action
of water, or other liquid, which enters and descends or moves down
in the longer leg, and rises up in the shorter leg ! This is now a
demonstrable fact ; but how is the principle to be accounted for ? It
puzzles our philosophy. That air in the bent tube is not to the sur-
rounding atmosphere as water, or any heavier body, is evident ; and
it must be from this relation that the updraft in the longer is caused,
and the constant circulation and withdrawal of polluted gases carried

1850.] Miscellany. 127

on. But be this as it may, one thing is certain that a more useful
and important discovery has never been made for the comfort and
health of civilized man. We see no end to its application. There is
not a sanitary measure suggested to which it may not form a most
beneficial adjunct. There is not a hovel, a cellar, a crypt, or a black,
close hole anywhere, that it may not cleanse and disinfect. We trust
that no time will be lost in bringing it to the public test on a large
scale, and we foresee no impediment to its being immediately and
universally adopted for the public weal. We ought to remark that
fires or heating apparatus are not at all necessary ; and that, as the
specification expresses it, ' this action is not prevented by making
the shorter leg hot while the longer leg remains cold, and no artificial
heat is necessary to the longer leg of the air-syphon to cause this
action to take place.' "

Medical Education in Spain. (London Lancet.) We learn from
an official return, that there are in Spain 290 professors belonging to
the universities. Out of these, 86 give lectures on medicine and
pharmacy. The number of medical professors is 75. There are,
namely, 19 in Madrid, 14 in Barcelona, 14 at Valencia, 13 at
Santiago, and 15 in Sevile. Of the 11 pharmaceutical professors,
there are 6 in Madrid, and 4 in Barcelona. The 290 professors of
the various universities of Spain cost the government 4,860,000 reals
(52,488.) The medical professors have salaries varying from
130 to 220 a year, and the whole of the medical and pharmaceutical
professors, taken together, cost the state about 17,971. A glance
at the profession in actual practice, shows that there are in Spain
5500 physicians and medico-surgeons, more than 7000 surgeons and
3300 pharmaciens. It will therefore not appear surprising that the
majority of practitioners are in great distress.

Mortality in Cities. The deaths in the city of New-York during the
year 1849, amounted to 22,374, or 1 in 20.11, estimating the popula-
tion at 450,000. Of this number 3718 died of consumption, and 5072
of cholera. If the deaths from cholera are deducted, the mortality
from other diseases would be in the proportion of 1 in 26.

The deaths in Boston in 1849, are stated by the Boston Medical
Journal at about 5300. The editor estimates the population at
130,000, which fixes the rate of mortality at 1 in 24.53.

The deaths in Augusta, during the same period, amounted to 215,
of which 107 were whites, and 108 blacks. If we estimate the popu-
lation at 9000, which is certainly under the mark, the ratio of deaths
is 1 in 41.86. Of these deaths, 55 were from cholera infantum, and
other diseases ofthe bowels.

128

Meteorology.

AUGUSTA, January 2, 1850.

At a meeting of the Students of the Medical College of Georgia, Messrs.
George Lumpkin, A. C. Hanson and W. S. Harden, were appointed a Com-
mittee to report resolutions expressive of their regret at the decease of their
friend and fellow student, Charles C. C. Williams, of Florida, which occurred
this morning.

At a subsequent meeting of the Faculty and Students, the Committee reported
the following resolutions, which were unanimously adopted:

Recolved, That by dispensation of Divine Providence we have been bereft of
a companion, whose gentlemanly deportment and amiable character had se-
cured to him the respect and affection of all who had made his acquaintance.

Resolved, That we deeply deplore the loss we have thus sustained, but that
our sorrow is mitigated by the fact that, although far from his cherished home,
he received from the Faculty, from his fellow Students, and from his relatives,
every kindness which true and heartfelt sympathy could dictate.

Resolved, That we tender to the afflicted mother and relatives of the deceased
our sincere condolence on this melancholy occasion.

Resolved, That as a token of respect, we wear crape upon the left arm for
thirty days.

Resolved, That a copy of these proceedings and resolutions be forwarded to
the mother of the deceased, and also presented to the Editors of the city papers
and of the Southern Medical and Surgical Journal for publication.

L. D. FORD, Chairman. '

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet. By Dr. Paul F. Eve.

for December, 1849, at Augusta,
32' west Wash. Altitude above

6

Sun Rise.

2, P. M.

to

c

Ther.

Bar.

Ther.

Bar.

1

56

29 67-100

60

29 58-100

s.

2

63

" 48-100

64

" 44-100,

s.

3

46

" 65400

54

" 71-100,

w.

4

45

" 87-100

48

" 87-100;

N. W.

5

36

" 76-100

71

" 70-100;

w.

6

43

" 72-100

72

" 74-100,

s. w.

7

44

" 90-100

66

" 95-100,

N. E.

s

44

30

50

:< 94-100

N. E.

9

46

29 84-100

57

79-100

N.

10

55

" 74-100

73

" 67-100J

S.

11

58

95-100

57

30 11-1001

N. W.

12

32

30 32-000

51

30 34-100

N. E.

13

39

30 14-100

39

29 92-100,

K.

14

39

29 82-100

42

80-100;

N. W.

15

43

" 90-100

45

" 93-100,

E.

lf

45

" 93-100

52

" 89-100

E.

17

54

" 89-100

73

" 92-100

W.

18

47

30 7-100

66

30 7-100

N. W.

19

52

30 10-100

68

30 3-100

S.

20

53

29 91-100

60

29 84-100

s. w.

21

54

" 80-100

60

" 77-100

s.

22

56

" 46-100

53

" 60-100

w.

33

43

" 69-100

52

" 63-100

s. w.

21

54

" 50-100

68

" 50-100

s. w.

25

34

" 77-100

52

" 85-100

w.

26

32

30

60

30

E.

27

35

30

68

30 3-100

N. W.

28

43

30 6-100

67

30 6-100

W.

29

48

29 95-100

70

29 87- 10C

S. W.

30

53

" 84-100

61

" 80-100

E.

31

40

90-100

54

30 5-100

N.

Remarks.

tiny. )
tiny. 5

95-100-storm at 6 p. m.

Rai

Rail

Cloudy.'

Cloudy.

Fair.

Fair.

Fair.

Cloudy light rain.

Cloudy light rain, ) all night,

Cloudy rain, f 95-100.

Fair-blow r. last night 35-100.

Fair frost, first decided freeze.

Rain, 70-100.

Cloudy.

Cloudy drizzle, )

15-100.

Cloudy drizzle,

Fair afternoon.

Fair.

Fair morning.

Rain, 50-100. [70-100.

Cloudy rain storm all night,

Fair blow.

Cloudy.

Fair afternoon blow.

Fair.

Fair.

Tolerably fair.

Fair morning.

Cloudy shower at 7 p.m.

Cloudy rain at night, 65-100.

Fair.

9 Fair days. Quantity of Rain 4 inches 95-100. Wind East of N. and S. 7
days. West of do. do. 16 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES MARCH, 1850. ~[i\o. 3.

PART FIRST.
Original dommtinicattons.

ARTICLE V.

Thoughts on the Modus Operandi and Therapeutic Properties
of the Sulphate of Quinine in Malarial Fevers. By John
Davis, M. D., of Abbeville, So. Ca.

It is not designed, by the following observations, to enter
into a labored attempt to reconcile the differences existing
among medical men as to the modus operandi of the Sulphate
of Quinine; but merely to bring before the readers of the
Journal the results of our observations, with such views and
deductions as seem to be most compatible with physiological
science : and, for this, we conceive, there can be no apology
necessary other than the fact, that many different and opposite
views are set forth, upon this subject, by men equally entitled
to credit. When the whole field is calmly and impartially
surveyed, we are inclined to think that the greater differences
of opinion depend more upon the importance attached to terms
and technicalities, than upon facts and results.

A long essay might be devoted to the questions, as to what
is a sedative, and what is a stimulant, without shedding one ray
of light upon the modus operandi, or therapeutic properties of
the Sulphate of Quinine; for these terms, the former especial-
ly, seem to aid but little in the explanation of the curative pro-
perties of any individual article of the materia medica. The
human system may be said to be in a sedative state or condition,
when it is enjoying the most perfect health when it is free

n. s. VOL. VI. NO. III. 9

130 Davis, on Action of Quinine in Malarial Fevers. [March,

from all irritation and morbid action ; and any remedy, whate-
ver, whose tendencies are to preserve or induce this healthy
condition of the system, when diseased, is as much a sedative
as any other, whether it be Calomel, Ipecac, Opium, Brandy,
Quinine, Blisters, or Blood-letting. If this view of the subject
be correct, then, the word sedative should not be applied to any
one particular remedy or agent, rather than to another; since, in
the main, they all tend, when properly administered, to restore
the system to health to remove the existing morbid impres-
sions, and thereby to induce a healthy, and consequently a seda-
tive action of all the functions of the system. So, if the word
sedative has any meaning at all, it can only mean, in physiolo-
gical science, perfect health, in the general acceptation of that
term, and cannot be applicable, strjctly speaking, to any remedy
whose tendency is to induce that state, since, it must be con-
fessed, that the remedy can only bring about the result by
establishing a vital impression of its own, in the place of the
one for which it was given.

But, when we turn our attention to the word stimulant, we
find it has a just claim to attention; for, as we have intimated,
it is a law of nature, and especially exemplified in the animal
system, that to remove an existing impression we must estab-
lish, or substitute, another in its stead ; consequently a stimu-
lant impression is a reality an effect not without a cause ; for
when we look into the modus operandi and the therapeutic pro-
perties of any and all of our medicinal agents, according to the
generally received principles of physiological science, we are
forced to the conclusion, that they all act by altering vital ac-
tion, by means of impressions made upon the system. To say
that any remedy (we care not what may be its name) can alter
vital action, without at the same time producing a vital impres-
sion, would be to claim an effect without a cause. It may,
however, be said, that reputed sedatives diminish existing im-
pressions, and, in this way, tend to cure disease. If so, they
must also diminish, or suspend, existing action, and by the latter
effect render null and void the former; for if the morbid im-
pressions are not removed, by the substitution of others of their
own kind, how can diseased action be removed, or vital action
changed ? Hence, wTe conclude that all medicinal agents oper-

1850.] Davis, on Action of Quinine in Malarial Fevers. 131

ate upon the system by making impression, (the word impres-
sion being only another term for stimulation.) and that different
articles operate, as it seems, by predilection upon different
organs: some upon the circulatory system, some upon the
nervous and sensorial functions, and some upon the secreting
and excreting functions ; all of which organs or systems are so
intimately connected together as to render it impossible for any
one of them to be materially impressed without, at the same
time, the others partaking more or less of the impression.
Alcohol may be said to act upon the circulatory system, prima-
rily and chiefly ; opium, and its preparations, upon the brain
and nervous system, primarily and chiefly, and calomel upon
the secretions and excretions, and so on. It would be quite as
proper to ask why the elements of water are oxygen and hy-
drogen, as to ask why this difference in the modus operandi of
medicines. We know the fact in the one case, and we only
know it in the other : the why, or the wherefore, in either case,
is equally sub luce, and beyond which it would be altogether
futile to attempt an inquiry.

From what we have said, it is obvious that we consider the
Sulphate of Quinine a stimulant; and here it may not be amiss
to state that we do not consider it an "antiperiodic" or atonic
any more than opium, brandy, or calomel, unless it is designed
to mean nothing more by the words antiperiodic and tonic,
than that all medicines, when properly administered, tend to
change, or remove the internal pathological conditions, upon
which the external phenomena of disease depend. If this be
the intended meaning of the words antiperiodic and tonic, we
readily admit it as being quite applicable to the quinine, and
not to quinine only, but to all other remedies, in an equal de-
gree with their curative virtues. An individual is attacked,
to-day, with a chill, and it assumes the intermittent type : he
takes quinine, during the intermission, and gets well, without
another chill. Now is it fair or just to conclude, from these
circumstances, that the quinine is peculiarly tonic or antiperi-
odic? The disease is, especially so far as the external phe-
nomena are concerned, more or less periodic, (and so are all
other diseases,) but this does not necessarily imply that the
quinine, which cures it, or the remedy, or remedies, which cure

1 32 Davis, 07i Action of Quinine in Malarial Fevers, [March,

other diseases, are antiperiodics or tonics, any more than that
the patient was perfectly free from all disease, or morbid action,
during the intermission ; for there must be in all cases, and at
all stages of an intermittent, as well as in a remittent, however
trivial the attack, more or less derangement of the nervous and
sensorial functions, of the circulatory system, and of the secret-
ing and excreting organs; though usually much less during
the intermissions and remissions than during the stages of ex-
citement. Now, to cut off the stages of excitement, all we
have to do is to give the quinine, judiciously, during the inter-
vals, and thus remove or change the nature of the existing
morbid derangements, upon which the stages of excitement
depend. Having much less to contend with during the inter-
missions and remissions, the quinine will certainly more fully
display its virtues, as a curative agent. It is in this way, as
we conceive, that this remedy has secured the appellation of
antiperiodic, and not from any peculiar or intrinsic virtue that
it may possess in anticipating and wTarding off diseased action.
It will not be pretended that there is, in any disease, a sepa-
rate and distinct lesion for every seemingly different and dis-
tinct symptom. This is especially true as to the periodic
fevers of the Southern and South-western States. Climate,
sex, age, manner of life, occupation, epidemic changes, and
vicissitudes of weather, as well as temperament, to say nothing
of the different intensities of affection, all tend to modify very
materially the external symptoms, without at the same time
affording, in the most of cases, any just ground for a change of
remedies, if the remedies be properly selected at the outset.
This leads us to believe that the leading principles of the
pathology, and consequently of the practice in our malarial
fevers are but few, and simple. We always find patients,
laboring under the primary symptoms of fever, however mild
the grade, to complain of weakness in the limbs, with more or
less inability to exercise the mental faculties, in some instances
for days, and even weeks, before they are said to be taken sick.
It is not, reasonable to conclude that the weakness of body and
mind, here, depend upon the excited state of the circulation, for
this is but little, if at all, changed from the healthy standard,
nor on a super-invigorated state of the brain and nerves. The

1850.] Davis, on Action of Quinine in Malarial Fevers. 133

patient is quite rational, and there is yet but little or no de-
rangement of the secretions. Why all this weakness? Does
it not seem evident that there is debility in. or a want of energy
on the part of the brain and its appendages? We think this
question can only be answered in the affirmative. In this state
of thing?, if we give quinine, in moderate and repeated doses,
the strength and vigor of both body and mind will be increased,
the pulse become less frequent, softer and fuller; the peculiar
febrile restlessness, anxiety and lassitude, subside* the skin be-
come more moist and softer; the thirst less urgent; and, in
short, the condition and feelings of the patient will undergo a
radical change for the better. Xow if these are not the effects
of the judicious administration of the quinine, in the forming
stages of our autumnal fevers, we are ready to confess that it
has no effect at all. But we go a step farther, and meet with
cases presenting all the phenomena of our severest intermit-
tens, where there is great anxiety and restlessness, the patient
pitching and throwing himself from one side of the bed to the
other, gasping, as it were, for fresh air, with great oppression and
sickness at stomach, his extremities cold and clammy, whilst the
temperature ofthe body is nearly or quite natural ; a quick, weak,
and frequent pulse, numbering from 120 to 140; great difficulty
of breathing, with a dark reddish tint ofthe surface, with watery
evacuations from the bowels, and more or less derangement of
the mind. Such cases as these are by no means of very uncom-
mon occurrence in the Southern States, and to look upon them
is to be convinced that much that threatens life is at work. Is all
that we behold dependent upon the excessive derangement ofthe
secretions and excretions? or does it depend upon the great
derangement ofthe circulatory system, proper? or upon the
disturbance of the nervous and sensorial functions? or, finally,
does it depend upon violent and excessive functional disorder
of all these systems of organs, in equal, or in different degrees?
We would say that the first step in the morbid chain of diseased
action in these cases is, (as we have intimated, was the case in
the milder grades of our fevers.) derangement ofthe brain and
nervous centres, and that this derangement consisted in debili-
ty, or a loss of energy ; and that the next step, in the series of
morbid action, was derangement of the circulatory system, and

134 Davis, on Action of Quinine in Malarial Fevers. [March,

that this derangement consisted chiefly in congestions of the
internal vital organs; and that the third step in the series of
morbid actions was, derangement in the secreting and excreting
organs; and that all these organs are more or less affected in
all cases of malarial or other fevers : they are not, however,
disordered in every case equally ; for we often find that the
brain is more affected than any other organ, and again that the
circulatory system, or it may be the secreting and excreting
systems, suffer most; hence the diversity of symptoms, pre-
sented by the different attacks of the same type of fever.
Whilst some are mild, others are exceedingly violent, owing to
the different degrees of disturbance of one, or more, or all the
different systems of organs involved.

Now, every practitioner who has had any experience in the
management of the severer forms of intermittent, or " conges-
tive fever " cannot have failed to notice that the patient had
had one or two milder chills, previous to the severer ones, or,
if not, had been, in the general understanding of the term, un-
well for one, two, or three days, befote he was taken with the
('congestive') chill; and, further, that this previous ill health
differed, in no essential particular, irom that preceeding con-
finement to bed from other types of fever, viz : weakness of
body and mind ; lassitude, with an aversion to both corporeal
and mental effort, all denoting debility, or a want of energy,
in the nervous and sensorial functions, in very many cases, long
before the case became at all alarming, or there was any chill.
Now, if these facts prove any thing, they shew that the first
step, in the chain of morbid action (as has been intimated)
manifests itself in the brain and nervous system ; for if we will
take the trouble to observe closely the train of symptoms here,
we will, in nine cases out of ten, find that a want of energy in
the nervous and sensorial functions, invariably precedes any
appreciable change in the vascular or circulatory system, even
in those cases in which the patient may be carried off in ten or
twenty hours after he is said to be first taken. In fact, we
have made it a matter of particular observation, that patients
invariably complain more or less of those feelings which indi-
cate a want of nervous energy, for some time before the circu-
lation becomes at all excited, or deranged, especially if the

1850.] Davis, on Action of Quinine in Malarial Fevers. 135

patient remained at rest. Finally, the chill comes on with a
decided pain in the head, back and limbs ; excited pulse, inter-
nal congestions, which are followed of necessity by more or
less derangement in the secreting and excreting organs, as they
are chiefly composed of the capillary extremities of the arte-
ries.

Now what are the legitimate deductions to be drawn, as to
the practice? Here, according to the universally acknow-
ledged principles of physiological science, we must not attempt
a cure by drastic cathartics or emetics ; nor by regulating the
action of the heart or arteries, by blood-letting. Neither can
we expect a cure by the free use of brandy or alcohol, in any
modification whatever. The reason is, (as we conceive,) that
when we depend upon cathartics or emetics, or both, we only
reach, and operate upon, the third morbid change in the suc-
cession of diseased action derangement of the secreting and
excreting organs, which depends upon the derangement of the
circulation, and thus, instead of tending to effect the cure, we
add fuel to the fire, by increasing the already existing gastric
and intestinal irritation and debility, without, in the slightest
degree, reaching and operating (favorably at least) upon the
primary derangement the debility or depression of the ner-
vous and sensorial functions. As to the blood-letting, the same
principles hold good ; for by it we can only attempt the remo-
val of the effect without removing the cause the debility or
depression of the nervous energies. The same objection applies
to the effects of the brandy or alcohol, in any of its modifica-
tions; for these operate more directly upon the circulatory
system than upon the nervous, and thereby tend to aggravate
the already existing derangement and irritation, here, as well
as that existing in the secreting and excreting organs, without
at the same time operating, beneficially, upon the brain and
nervous centres.

If it be a fact that all medicines act, in curing disease, by
changing vital action, and that this change can only take place
by the remedy substituting an impression, and mode of action,
of its own ; if it be a fact, that the difference, in the effects pro-
duced by the different articles of the materia medica, are as
great as their number, or as the organs and tissues, composing

136 Davis, on Action of Quinine in Malarial Fevers, [March,

the human system, and that no two operate in every respect
alike, and that some operate, as it would seem, by predilection
upon one organ, or system of organs, and some upon others ;
if it be a fact, (which we think cannot be denied with any show
of truth,) that in all our malarial fevers, over which the quinine
holds such universal sway, the first morbid derangement inva-
riably is debility or depression of the nervous and sensorial
functions ; that the next morbid change is in the circulatory
system proper ; that the last, shows itself in the secretory and
excretory organs, and that the first depends upon a particular
cause, such as malaria, or a number of causes combined, and
that the second depends upon the first, and the last upon the
second, and that this is the invariable order of the succession
of morbid action, in all our malarial fevers, from the most
trivial to the most alarming cases, and that the diseased action
is always the same, in kind, or quality, the external phenomena
differing only in consequence of the different degrees of inten-
sity of affection of any one or all the organs involved ; and still
further, if it be a fact, that inflammation does not necessarily
constitute a part of these fevers, and, further still, if it be true,
as has been amply attested by experiment, and otherwise, that
the effects of the sulphate of quinine, upon the brain and ner-
vous system, when given in large doses, are very analogous to
those of the alcoholic stimulants, without at the same time pro-
ducing the same amount, of vascular action, then we think we
can offer, at least an apology for our views upon the modus
operandi and therapeutic properties of the Sulphate of Quinine,
in our malarial fevers.

Whilst we consider quinine a stimulant, we do not deem it a
stimulant, whose modus operandi, or therapeutic properties,
are similar to those of the alcoholic stimulants; for this very
obvious reason, that whilst trie primary and almost the entire
effects of the former are spent upon the nervous, the primary
and almost entire effects of the latter are expended upon the
circulatory system, especially when they are both administered
in quantities not transcending the rational indications of physio-
logical practice. This, when we take into consideration the
indications, presented to our view, of the internal conditions of
all the systems of vital organs, readily accounts for the differ-

1850.] Davis, on Action of Quinine in Malarial Fevers. 137

ence of their modes of operation. All things being equal,
whilst the quinine gives vigor and a controling energy to the
nervous functions, the brandy, or alcohol in any form, tends to
increase and to aggravate the already too highly excited condi-
tion of the circulatory functions, and thereby increases the
existing derangement of the secreting and excreting organs
whilst the quinine tends to remove the cause, the brandy tends to
farther develope the sequent whilst the quinine will relieve
internal congestions through the medium of the nervous system,
the brandy will inflate, as it were, the vascular forces, and pro-
duced a supee-excitatiox through the medium of the circulatory
system.

We freely admit that alcohol will excite and stimulate the
nervous system, yet we deny that this is its proper field of ac-
tion. We admit also that quinine will stimulate the circulatory
system, more or less, when given to an undue extent; but we
at the same time deny that this is its field of action. Why
should we refuse to call quinine, with opium and its prepara-
tions, stimulants, if their effects are different from those of the
alcoholic class, or even from each other, especially, when we
recollect that whilst the one class operates upon the nervous,
the other acts upon the circulatory system. Might it not be
anticipated, that whilst we admit all of them to be stimulants,
their results upon the system would be quite different ?

Thus it is seen that we are not only inclined to reject the
notion of quinine being a sedative, but also to reject the notion
of all sedatives, as well as antiperiodics and tonics, upon the
same grounds, as without any foundation, either in observation
or physiological science.

What then is the conclusion ? It must be already fully anti-
cipated. Apart from experiment and observation, the conclu-
sion that forces itself upon us is, that quinine, in the proper and
obvious sense of the term, is a stimulant, differing in many
respects from all others; and that to realize the benefits of its
proper and legitimate effects, as a curative agent, it should
always be given, if possible, in exact proportion to the extent
of the debility or depression of the nervous and sensorial func-
tions. In the milder cases of our periodic fevers, from one to
two grains every hour, or every two hours, will suffice; whilst

138 Garvin, on Internal Hemorrhoids. [March,

in the more malignant attacks, from five to ten grains every
hour, or oftener, may be required.

In conclusion, we would state, that there may be many
objections to the views advanced in this article ; but vve are
confident that they will come with much more ease and plausi-
bility in the shape of questions than answers, founded upon
reason and observation, for it is much easier to ask questions,
especially in medical philosophy, than to answer them.

ARTICLE VI.

Remarks on the Treatment of Internal Hemorrhoids. By
I. P. Garvin, M. D.

There is probably no disease of more frequent occurrence
than Hemorrhoids, nor are there many in which the ordinary
modes of treatment are usually less efficient. Comparatively
few adults in our section, who reach the middle period of life,
escape the annoyances produced by this troublesome com-
plaint. In a large proportion of cases, the disease is slight, and
is borne without any call for medical aid ; but the instances
are not infrequent in which it is sufficiently severe to produce
much suffering, and to impair seriously the general health.
When such a state of things occurs, many physicians recom-
mend the extirpation of the tumors by a surgical operation.
That such advice is sometimes judicious, we are not disposed
to deny, but such operations are not free from dangers, both of
a primary and secondary character, and should therefore al-
ways be avoided, when possible. We are fully persuaded that
an operation would be rarely necessary if a proper treatment
were adopted, and perseveringly followed for a sufficient length
of time. Circumstances that need not be mentioned have
induced us to give a considerable share of attention to this sub-
ject, and as we have treated a very considerable number of
cases, some of them very severe, and of long standing, with
very general success, we have supposed that a brief account of
the treatment adopted would not prove useless or unacceptable
to the readers of the Journal. But we must premise that in

1850.] Garvin, on Internal Hemorrhoids. 139

this treatment there is nothing novel, for the remedy upon
which we mainly rely is cold water, yet our mode of employ-
ing it is not in general use.

The application of cold topics to inflamed tumors is univer-
sally known to be a very efficient treatment, but the incon-
venience of such applications to such tumors as are internal,
generally prevents a resort to this remedy. For many years
we have been in the habit of employing enemata of cold water
in every case of internal piles which we have been called to
treat. We direct that about a gill of cold water be thrown into
the rectum immediately before every attempt to evacuate the
bowels, and that this enema be retained several minutes if pos-
sible. This usually produces an evacuation of the fceces, which
have been so far softened on their surface, as to permit their
escape without the least straining or irritation. After every
evacuation, it will be proper to use ablutions of the parts, more
especially in such cases as are attended by some protrusion of
the bowel.

Though this treatment is a valuable palliative from the
moment it is begun, it will do much more than palliate, if
perseveringly continued. The length of time required will
necessarily vary in each case. The proper course is to con-
tinue this treatment until some days after all uneasiness is
removed. In old or very severe cases, to effect such amend-
ment, generally requires several weeks. It is highly important
to impress upon the patient, the absolute necessity of perse-
verance in the use of the cold water, even though he should
be so far relieved as to feel almost well, for if it be suspended
too soon, a very slight cause will bring on a relapse. So de-
cided is the relief afforded by this treatment, that few persons
would be disposed hastily to abandon it, but for the inconveni-
ence of applying it daily. The ordinary apparatus for enemata
are so unwieldy, that they cannot be carried about convenient-
ly. All difficulty from this source may be obviated by the
employment of a small pewter syringe with a ring handle to
the piston. One which will hold two ounces is very conveni-
ent, and may be carried in the pocket, when necessarv.

When such enemata of cold water fail to procure sufficient
alvine evacuations, the quantity of fluid may be increased to

140 Garvin, on Internal Hemorrhoids. [March,

half a pint, or it may be necessary to resort to mild laxatives.
Active purgation must be carefully avoided. The patient
should be advised, never to aid the natural expulsive action of
the bowels by straining. If an evacuation cannot be procured
without such efforts, it is best to postpone it until aided by the
action of a laxative. If the convenience of the patient will
permit, it will prove advantageous to change the usual hour for
the daily defecation, to a regular hour in the evening just be-
fore retiring for the night. This will obviate the gravitation
of blood consequent upon the erect position.

This treatment will usually succeed equally well in hemor-
rhoids attended by hemorrhage. In this form of the disease,
cold water will be found a most efficient astringent. We have
employed enemata composed of the vegetable astringents, and
also of the acetate of lead, but have never found them to suc-
ceed so well as the cold water. They are, moreover, liable to
the objection of producing considerable pain, and disposition to
strain, when they are evacuated. The effects of this simple
mode of treatment are often surprising in some of the worst
cases of hemorrhagic piles, especially when aided by such other
treatment as the state of the general system may require.
About two years ago we prescribed for a gentleman who had
been a martyr to this form of the disease for several years.
From having been remarkably fleshy, he had become very
much emaciated. His skin had assumed a cadaverous hue, his
nervous system was much disordered, and his strength greatly
reduced. He at once began the use of the cold water enemata,
and for the relief of the anaemic condition took five grains of
the Citrate of Iron twice a-day. Such paliatives as the de-
ranged state of his nervous system required, were given from
time to time. In the course of two or three weeks, the amend-
ment was very evident : the hemorrhage was sensibly dimin-
ished his strength began to return, and the roses once more
to bloom upon his cheek. The amendment was steadily pro-
gressive, and after the lapse of a few weeks, the patient was
restored to his former rotund dimensions, and the enjoyment
of general good health. Since then, there have been occasional
indications of relapse, which have been promptly removed by
a return to the cold water enemata.

1850.] Eve Case of Hematocele. 141

In the summer of 1848, we prescribed this treatment for a
gentleman who had labored under bleeding piles with consid-
erable prolapsus of the bowel, for a long period, but whose
general health had as yet suffered but little. We heard nothing
of him for several months, when he informed us that he had
left off the enemata because they had checked the discharges
of blood so completely, as to induce a fear lest its sudden sup-
pression should develop some other malady. We might cite
a number of cases treated with similar results, but we deem
it unnecessary, as we presume those referred to are sufficient
to demonstrate the value of the treatment.

Many cases are connected with chronic diarrhoea, hepatic
derangement, etc., etc., and will require appropriate general
treatment as well as the local. As it has not been our purpose
to write an essay upon hemorrhoids, but merely to urge the
employment of a very simple and at the same time a very
effectual topical remedy, we have not noticed the general treat-
ment required by those cases in which something more than
local remedies is necessary.

While we have no sympathy for Hydropathy, or any other of
the empirical systems which have become so fashionable, we are
free to admit that wre look upon cold water as an invaluable, yet
too much neglected remedy in many diseases, and we are per-
suaded that its simplicity has tended very much to cast its virtues
in the shade. Whilst the medical profession very properly reject
Hydropathy as a system, it certainly becomes them not to turn
over to its followers, an agent so potent for good, as cold water.

ARTICLE VII.

Dissection of a large encysted Hcematocele from the Spermatic
Cord. By Paul F. Eve, M. D., Professor of Surgery in the
Medical College of Georgia.

On the 24st January last, Col. G., of South Carolina, brought
to me a negro man aged about 25, laboring under inguinal Her-
nia of the right side, and a large Tumor in the spermatic cord
of the same side. The rupture was of some years duration,
was reducible, and a truss was worn for it. The tumor was of
recent origin, dating back only five or six weeks, and was grad-

142 Uterine Displacements. [March,

ually increasing in size. It was for this second affection that
I was consulted. The patient said, in lifting a carriage ob-
structed in the road, he felt something give way at the place
where the tumor now exists, and he soon after detected a swel-
ling there about the volume of a partridge egg.

In operating the next day before the Class in the College, an
encysted tumor of the spermatic cord, containing blood or wa-
ter, was pronounced to be the diagnosis. It was quite evident
that the hernia did not communicate with it. A careful dis-
section was now commenced upon the tumor, dividing tissue
after tissue, making some eight or ten laminae, opening the
cord so as to expose its vessels, the veins particularly, and
finally, a tumor the size of an orange was presented in the
palm of the hand. It was almost perfectly round, as much so
as any one I have ever seen; its cyst was laid open, and bloody
serum was discharged with a coagulum, and the internal sur-
face covered over by fibrine.

The patient was under chloroform, which acted admirably.
There has been considerable tumefaction in the scrotum since
the operation, but the patient is now up and doing well.

PART II.
HXtvxzxos anir (ftxtvatis.

The Causes, Effects and Treatment of Uterine Displacements.
By M. Velfeau.* (Revue Med. Chir.)

Causes of displacements. Arising from mechanical causes,
deviations of the uterus seem at first to act only mechanically,
and give rise alone to mechanical disorders. Among those
who support the doctrine of uterine engorgement, there are

An interesting discussion of the subject of uterine engorgements has re-
cently taken place in the French Academy of Medicine, and has been protracted
through several meetings. The remarks of M. Velpeau appear to have excited
much attention and opposition, as his views are adverse to those held by most
practitioners. The high professional rank and eminent ability of M. Velpeau,
impart great interest to everything which emanates from his pen, and we there-
fore have given his remarks at length. Should the views of other gentlemen
opposed to him be written out, we will endeavor to present them to our readers.

[Edt.

1850.] Uterine Displacements. 143.

some who admit the existence of uterine deviations, but attribute
them to engorgement. According to these, the uterus does
not descend, does not deviate, nor is it inflected, but by its
weight, when augmented by excess of volume at some point
in a word, deviation, is not a primitive state ; it is only an effect,
a consequence of engorgement. Nothing is exact in this doc-
trine. I have proved in a number of instances, both upon the
living and the dead, the existence of uterine deviations, without
there being the least increase either in the size or weight of
the organ. When there is hypertrophy with deviation (which
I have occasionally observed, sometimes throughout, sometimes
in the anterior or posterior portion only.) I am convinced that,
so far from being the cause, the engorgement was the result of
deviation. Once bent upon itself, the uterus is not as perme-
able to the circulating fluids in certain portions as it was be-
fore; hence the derangement in its functions, which might
evidently produce hypertrophy. I will admit, on the other
hand, that rigidity of a portion of the organ may favor one of
the inflections of which I speak; but, at the same time, this
etiology is only applicable in cases of deviation where there
exists at the same time an excess either in volume or weight
of the uterus ; and I repeat that these cases are by far the
most rare.

It is under the influence of chronic inflammations, old adhe-
sions in the regions of the peri-uterine tissues, repeated pressure,
&c, that uterine deviations are produced. Cough, vomiting,
the act of lifting or carrying a weight, efforts at stool, every
thing, in short, which compresses the viscera upon the body of
the uterus, the neck being naturally more firmly fixed in front
and behind, either by the utero-sacral or utero-vesical liga-
ments, predispose to this kind of lesion. Any quick or sudden
motion w7hen the uterus is relaxed to a certain degree, as at
the approach of the menstrual period, abortion, or labour, is
sufficient to produce inflection. I have frequently thus arrived
at the origin of the disease in females who consult me, and I
am convinced that by examining closely, it will be found that
a large portion of deviations occur in this way.

Effects of displacements. As I have said long since, (see
my clinique, vol. ii, 1840), these deviations alone, are frequently

144 Uterine Displacements. [March,

entirely inoffensive, and a number of women are affected with
them without being aware of it. It is not impossible, however,
for them to produce derangement, and these derangements are
of three kinds 1st, the mechanical inconvenience which the
displaced uterus occasions around it in the pelvis ; 2d, the pul-
ling and stretching of the vascular and nervous filaments which
come from the renal plexus and sides, which is produced by
the descent of its fundus; 3d, to the narrowing of the uterine
isthmus, that is to say, the internal orifice of the neck of the
womb.

Whenever the uterus deviates from its parallelism with the
axis of the pelvis, the functions of the rectum, of the bladder,
and of the nervous and circulatory systems, are in danger of
being disturbed. When the patient complains of a weight
about the fundament, tenesmus, constipation, frequent desire
to urinate, &c, numbness of the whole pelvic cavity, to
such a degree, that some believe that they are rather affect-
ed with disease of the anus or intestine, than of the womb.
Being depressed, the connections between the uterus and great
sympathetic plexus naturally produce certain effects upon the
whole digestive and nervous system ; hence those pains and
uneasiness in the back, weakness, difficulty in walking, &c,
and those thousand other inconveniences which torment both
patient and physician. Free to descend a little lower in the
pelvis, the intestinal mass plays its part in the production of
like symptoms by reacting on the stomach, the liver, and the
spleen. It is with such accidents that physicians have to
contend in females said to labor under engorgement, but who
really suffer from displacement.

It must be evident to any one who will reflect for a moment,
that the canal of a deviated womb must lose its dimensions at
the place of the inflection, especially as this is almost always
opposite the internal orifice, that is to say, the part of the uter-
ine neck, naturally the most narrow. It will be seen at a
glance, that an obstacle will be thus produced to the passage
of the menstrual fluid, or any other matter to be expelled from
the uterine cavity. From this cause, many females complain
of acute pains and colics in the uterine or hypochondriac re-
gions at the approach of the menses, and even during the whole

1850.] Uterine Displacements. 145

menstrual period. The passage of clots then gives rise to suf-
ferings almost equal to those of labor, until they are discharged.
I have seen many such cases. Some who have been in this
condition for years have been relieved by dilatation of the nar-
rowed neck, with bougies or sounds. Such cases point out
the relation which exists between dysmenorrhea and uterine
inflexions.

The narrowing of the uterine canal, though it may arise from
other causes, is equally a cause of sterility with uterine devia-
tions. Besides the greater difficulty with which the seminal
fluid reaches the orifice of the ostincae, this fluid when it has
entered it, is again arrested by the constricted and changed
direction of the uterine cavity, so that under such circumstances
fecundation becomes very difficult.

The subject of sterility is a very delicate one, and I shall there-
fore make but few remarks upon it now. Guided by the pre-
ceding etiology, I have treated a great many cases of sterility
by dilatation of the narrowed uterine orifice : small bougies and
sounds have opened the way for still larger instruments, which
have permitted me to cleanse the uterine cavity by injections,
and even to effect slight cauterisation. Young females who
have been married for two, four, six, and even ten years, with-
out having been impregnated, have conceived as soon as this
treatment has been completed.

Treatment of uterine displacements. The treatment of
uterine displacements, notwithstanding its apparent richness
in remedies, unfortunately leaves much to be desired. Without
any good reason pledgets of various kinds, tonic, astringent,
emollient, etc., introduced into the vagina, have been employed.
For nearly thirty years I have used such applications made of
saw-dust, of tan, or of powdered cinchona. Like others, I have
resorted to sponge, either covered or not with fine silk, and
impregnated with some medicated fluid. By these means,
much relief has often been obtained, but such applications will
not relieve all cases, and moreover they will not correct the dis-
placement of the womb. I have tried all kinds of pessary, with
but little success. It is easy to understand why they generally
prove inefficient. The womb is so mobile, so slightly support-
ed, that an instrument which will not hold it by the fundus will

n. s. VOL. VI. NU. I If. 10

146 Uterine Displacements. [March,

scarcely be able to fix it. When the case is one of anteversion
or retroversion, a well adjusted pessary may possibly be useful.
Once the neck of the womb is engaged in the cavity of the
instrument, and is raised up, and placed in the axis of the cavity,
it will in some instances remain there permanently, and give
much relief. But in cases of inflexion, the value of pessaries
is very questionable. In these cases, the neck of the womb
being still in the centre of the pelvis may be engaged in the
ring of the instrument, without in the least altering the position
of the organ, and moreover is constantly escaping from it upon
the least movement.

Except in a few rare cases, pessaries made thicker on one
side than the other, do not succeed much better, inasmuch as
the organ and the instrument, rarely preserve their proper re-
lations for more than a few moments. If they do give relief in
some cases where there is inflexion, and not simple deviation,
it is because they give support to the uterus, and not a better
direction to the parts.

Being discontented with all known pessaries, about twelve
years ago I invented one which was intended to act directly on
the deviation. It was armed with a stem of gum-elastic, from 5
to 8 centimetres in length, intended to pass up into the womb as
an axis. It formed a portion of a disc, which I turned before in
retroflexions, and behind in anteflexions. I used at the same
time, as a rectifier, an articulated rod, similar to that proposed
by M. M. Tanchou, Pravaz and Leroy d'EtioIIes, for straight-
ening the prostatic region of the urethra. Carried bent, either
through the stem of the pessary, or directly into the cavity of
the uterus, the instrument was then straightened gradually by
a few turns of the screw. Three or four women bore these
attempts very well, but inasmuch as many others were threaten-
ed with metritis or peritonitis, and as I feared ulceration or
penetration of the uterine tissue by the stems of which I have
spoken, I determined to abandon them.

Would we be more successful by introducing foreign bodies
in the anus? A bit of prepared sponge about the size of a
finger, covered or not with fine silk or cloth, and carried dry to
the neck of the womb in anteflexion, and even beyond the fundus
in retroflexion, would produce a decided straightening as soon

1850.] Uterine Displacements. . 147

as it imbibed, and became distended with fluid. It is unfortu-
nate that most females entertain great repugnance to such a
remedy, which in fact is very difficult, and inconvenient in its
application. I ought also to mention as another means, the
introduction of an empty bladder into the bowel, which is then
to be distended with some fluid injected into it.

As all these means occasionally relieve, they may be tried ;
but as none of them really cure, or rectify the inflected organ,
it is clear that we have need of something more efficacious.
The pressure of a pessary or other foreign body on the vagina,
the womb, etc., is liable to so many inconveniences, that I asked
myself twenty years ago, if certain kinds of belts would not
answer better. At first I had one made by Madame Martin ;
afterwards came those of M. Hall, Duvoir de Bechard, Madame
Girard, etc. I did not expect by the aid of such means to rectify
the position of the womb, even where there was only a simple
deviation ; but with the hypogastric plate of some of these belts,
particularly those of Duvoir de Bechard, we may raise up,
and retain the abdominal viscera, whose weight, arrested
above the pelvis, will cease to press upon, and weigh down the
fundus of the womb ; the neighboring organs, the bladder, and
rectum, thus relieved, will perform their functions better, and
the whole abdominal nervous system being no longer irritated,
the digestive functions will be restored, and all the general dis-
turbance of the system obviated. Moreover, we may asso-
ciate these belts with the employment of sponges, or vaginal
pledgets, by means of a strap passing under the pelvis, pro-
vided with a perineal pad. Sustained by this strap, the pad
placed between the anus and vulva, presses up the perineum,
and thus gives a very important support to the uterus.

For twenty years I have prescribed these belts for many hun-
dreds of females, who for the most part were benefitted. Some
could not endure them, and of course were not relieved ; but
in general, the patients who consented to wear them for at least
a week, and who did not reject them on the first unpleasant
sensation which they produced, soon experienced such relief,
that they were neither able or willing to do without them.

When the uterus is let down as well as deviated, the perineal
pad is useful ; also in women who have a very large pelvis.

148 Uterine Displacements. [March,

The belt alone will be sufficient in other cases, especially where
it is employed to elevate a womb made voluminous by some
tumor, or abnormal condition. The belts called hypogastric,
are those which I have so far found best ; I cannot say, howe-
ver, that we need no other remedy.

It is well understood, that all I have said applies only to the
mechanical or local treatment, and does not refer to the advan-
tages that may be obtained from general medications in such
cases.

As I have announced at the beginning of this discussion, it is
only of the body of the uterus that I have spoken in the pre-
ceding argument, when it was a question of engorgement. It
was not because I was disposed, as some appeared to think, to
admit engorgements of the neck without dispute to admit
especially the frequency of that pathological state in the neck,
when I called in question its existence in the body of the organ.
My design was simply not to discuss that which concerned the
neck at first, because I wished to discuss separately, that which
relates to maladies of this part of the organ.

I have been asked if I comprehended engorgements of the
neck in my denunciations. By answering no, but that I would
reserve the question in relation to the neck, for another time, I
did not intend to give my opponents a right to conclude that I
readily admitted the existence of such engorgements.

Now what shall I say of engorgements of the neck of the
uterus? If I do not deny their existence, will it follow that I
admit them ? By no means ; for a fact may not be admitted,
the possibility of which cannot be denied. When chloroform
was accused, I rejected the proofs that were offered, without
denying that the thing was possible. More conclusive obser-
vations have been submitted, and I have admitted the fact. So
with uterine engorgement; tell me what it is let me see it,
and I will admit it. Prove that there exists a chronic, persistent,
pathological state, distinct from chronic phlegmasia, and hyper-
trophy, which is neither the result, nor the complication of any
other malady ; in fine, a pathological state which constitutes a
distinct disease, primitively independent of any other affection
already known under a special name, and I will admit engorge-
ment. Until then, it appears to me logical to remain in doubt,

1850.] Uterine Displacements. 149

and to say, that in the neck, as well as in the body of the uterus,
essential chronic engorgements are as rare, as they are thought
to be frequent, even if they exist at all.

If it is true that the neck is often enlarged, it is equally so
that we may be easily deceived in this respect. The finger
deceives less than the sight. The speculum is a source of
errors which must be guarded against. By its vaginal extremi-
ty, it tends to open the lips of the ostincse, and fully to uncov-
er the apex of the uterus ; the neck often appears much more
voluminous than it really is. Who does not know, moreover,
how numerous are the varieties in the volume of the neck of
the womb presented by different healthy females? Hard and
flattened, or conical in some, soft and swollen in others, it is
sometimes regular, sometimes uneven ; sometimes elongated
in one direction, and shortened in another. It likewise pre-
sents an almost infinite variety of colour, and of length, without
being diseased.

I have no desire to sustain the opinion, that the neck of the
uterus is never more voluminous than it should be, or that dis-
eases may not augment its dimensions ; I only deny, that the
excess of volume, when it is pathological and persistent, merits
the name of engorgement. Then there is either simple hyper-
trophy, which constitutes a deformity rather than a disease, or
a state of congestion, with heat, and even pain, which borders
closely on irritation or sub-inflammation, a state always tran-
sient ; or else, some affection more serious which ought to give
a name to the disease, and should attract the principal attention
of the physician. Shall we then give the name ef engorge-
ment to the disease, merely because the volume of the organ is
augmented, when there exists at the same time either cancer,
tubercles, vegetations, fungosities, granulations, ulcers, etc.?

Admitting, as has been done, that engorgement is a morbid
entity, a distinct malady, you will have a special treatment for
this supposed affection, as you have for pneumonia or intermit-
tent fever. Now I ask, would it not be ridiculous to treat in
the same manner, hypertrophy, sub-inflammation, granulations,
fungosities, ulcerations, cancers, etc., of the neck of the uterus ?
At least until the existence of a real disease, distinct from all
those that I have indicated, shall be demonstrated, I persist in

150 Uterine Displacements. [March,

declaring that it is useless, and even dangerous, to maintain in
theory, or in practice, the idea of a special disease under the
title of engorgement.

One word more. To explain the pretended engorgements
of the uterus, M. Robert has spoken of an affection which he
seems to think new, and to have been discovered by M. Reca-
mier. Jf I understand him correctly, this disease consists of
fungosities, or vegetations of the size of a grain of sand, or the
head of a pin, or even of a hemp or currant seed, which some-
times stud the whole uterine cavity, and bleed upon the slightest
contact, and even without any friction. In this case I must be
permitted to express the same doubt as in cases of engorge-
ment. Setting aside vegetations and cancerous fungosities,
the description of M. Robert can only relate to those granula-
tions that I demonstrate weekly at the Charite, observe daily,
and have described, as well as other practitioners, very fre-
quently during the last fifteen or twenty years. It is then
perfectly useless to create anew designation, since this disease,
which is quite common, is known to, and admitted by every
one. This new name seems to me, moreover, to be danger-
ous, for it has given birth to an operation wThich I believe to
be useless, as well as highly objectionable. This abrasion, this
scraping of the interior of the womb by means of a curette, a
kind of small metalic spoon, of which M. Recamier speaks, will
never be looked upon as an operation free from danger ; its
inutility at least is so manifest, that M. Robert admits that it is
not sufficient alone, but must be associated with injections and
cauterisations. Now, numerous observations and experiments
authorize me to declare, that, with a mop of lint, wet with the
acid nitrate of mercury, and passed once a week into the uterine
cavity, I have almost uniformly removed this granular and
bleeding state of the genital cavities. I will add that some-
times simple emollient, detersive, astringent, or tonic injections,
are sufficient of themselves to effect a cure, or at least to com-
plete it after the slight cauterisation to which I have referred.
This, however, is a subject superadded to the discussion, and
would lead us too far, if we were to examine it thoroughly
at this moment.

I will sum up my remarks.

1850.] Uterine Displacements. 151

1. Engorgement of the neck or body of the uterus as a
distinct malady, a chronic and primitive state, is yet to be de-
monstrated.

2. Supposing that engorgements do exist, they are at least
extremely rare, as rare as they have been thought frequent.

3. This name has been given to a number of diseases which
have an admitted existence, and of which it is but a symptom;
we are especially liable to be deceived by deviations of the
uterus.

4. The deviations which most frequently mislead in this case,
are of two kinds: those with inflexion, and those without inflex-
ion of the organ.

5. These inflexions deceive because in forming a diagnosis
by touching through the vagina or rectum, the examination is
too frequently made when the patient is in the erect position.

6. With the patient lying on her back, and the muscles re-
laxed, we arrive at a correct diagnosis, in a certain sense
mathematical, if the finger is passed into the rectum or vagina,
and the other hand is applied to the hypogastrium, so as to grasp
and force down the uterus, thus enabling us to appreciate cor-
rectly its volume and consistence.

7. Inflexions of the uterus are as frequent, as they are sup-
posed to be rare ; ordinarily simple, they are in general the
cause, and not the effect of the hypertrophy which sometimes
accompanies them.

8. They are not of themselves of a serious nature ; for many
females are thus affected without suspecting it; and general
and internal medications can only remedy their effects, or their
complications.

9. Among the mechanical and palliative means, hypogastric
belts are the most useful, and the least inconvenient.

10. Next to malignant and cancerous diseases, and tumors,
the granular state, either of the os tincae, the neck, body, or
cavity of the uterus is the most frequent affection.

11. The best topical treatment for this condition, is cauteri-
sation with the nitrate of mercury, and nothing indicates that
the method of abrasions are ever necessary for its removal.

Such are my views on this important question, and to these
I shall adhere, until my propositions have been demonstrated
to be erroneous.

152 Mechanical Treatment of Sterility. [March,

I am persuaded that this discussion . will not be useless.
Those who think so, forget, that beyond these walls there is an
immense number of our brethren, who hear us through the
journals, and having no preconceived opinions, will examine
anew in their practice, the questions which are agitated here.
I feel assured that this discussion will dissipate more engorge-
ments than all the iodides and imaginable discutients. It is
scarcely necessary to say that the question of deviations has
been but slightly touched upon, and I shall treat of them in de-
tail elsewhere.

On the Mechanical Treatment of Sterility. By Henry Oldham,
M. D. (Guy's Hospital Reports. Amer. Journ.)

There have been three plans of treatment of a mechanical
kind, for the cure of dysmenorrhcea and sterility, recommended
and practiced ; and it is impossible for any one in practice
in this city [London] as an obstetrician, and who reads the
weekly and monthly journals, to be blind to the fact, that these
means have of late been unsparingly and boldly employed.
They consist, first, of the dilatation by metallic bougies or
sponge tents, or by section of the os uteri internum and
externum ; secondly, of the removal of the front or back dis-
placement of the womb by Dr. Simpson's uterine stem sup-
porter; and, thirdly, by probing the Fallopian tubes. It is im-
possible for me to omit the notice of these expedients ; although,
if the womb be ascertained to be undersized, they would, I
should hope, be abandonded in reference to it. No cutting, or
dilating, or supporting, or probing, can make a small womb
larger : and the amount of uterine stimulus which they would
excite would be considered far too important to justify their
use. I know, however, that the characters of the reduced
womb (if I may so call it) are not always appreciated in their
entirety ; and a source of error may arise from mistaking the
natural and proportionate smallness of its orifice for a contrac-
tion to be removed mechanically. The anteversion I have
noticed would, by some, be regarded as an efficient cause of
sterility and dysmenorrhcea, and the uterine supporter be ap-
plied; while I suppose that Dr. Tyler Smith, if one or both
these plans had been tried and failed, would, pa?* voie d'exclusion,
consider it as coming within the undefined limits of tubal ca-
theterism. The few remarks, however, which I shall make
upon this subject, must be supposed to apply to the mechanical
cure of sterility and dysmenorrhcea generally, without any

1850.] Mechanical Treatment of Sterility. 153

strict application to these disorders as connected with the un-
developed womb.

There are few cases which come before an obstetric practi-
tioner which are so full of perplexity as those of sterility,
especially where it is limited to those cases where the os, and
cervix, and body of the uterus are free from any recognizable
disease. Recent researches have afforded most valuable in-
formation on the composition of the male and female generative
elements, and the physiology of generation ; but our knowledge
of the various causes by which impregnation is intercepted or
prevented is very limited. One of these, no doubt, is any such
partial or complete occlusion of the sexual canals as to prevent
the transmission of the semen. Others are to be found in im-
perfectly developed ova, within a shrunken ovary, or some
defect in the semen, or a want of congruity between the two
elements. These are subtle and concealed causes, difficult,
and, with our present knowledge, almost impossible to detect,
but of infinitely greater importance in their relation to primary
sterility than the mechanical obstacles which have of late so
exclusively engaged attention. It appears to me that the
cases which justify the use of mechanical treatment require the
greatest discrimination, not only on account of the facility
with which they may be confounded with perfectly natural
conditions, but also because these operations are not without
danger. There is scarcely any amount of danger or pain that
women will not go through to obtain the prospect of becoming
mothers. They are notoriously credulous as to success, and
are the ready, and often the costly victims of empiricism ; and
I would venture to say, that obstetricians ought to be nicely
scrupulous in encouraging a plan of treatment of a very doubt-
ful efficacy, and dangerous to life. I cannot imagine a position
more overwhelmingly distressing to any right-minded man than
to have been the means of destroying the life of a woman in
the endeavour to remove sterility. And yet I am sure that, in
these operations, a hazard is run quite disproportioned to the
amount of good accomplished; and I shall recount two fatal
cases which have come to my knowledge: and I cannot but
infer that others of a similar kind have occurred, but have
not been recorded side by side with those of a more fortunate
issue.

I feel great confidence in saying that the true congenital
stricture of the os uteri, externum or internum, or of the Fallo-
pian tubes, sufficient to prevent impregnation, is very rarely to
be met with ; and vet nothing is more easv, with the idea of a
mechanical impediment in the mind, than to be self-persuaded
into the belief that the natural orifice is too small. It is quite

154 Mechanical Treatment of Sterility . [March,

impossible to fix a standard size for the inlet to the womb. It
has often happened to me to feel the virgin os uteri extremely
small, and yet pregnancy to take place. The sound, too, is a
very insecure guide to the measurement of* the os internum ;
and I think it is a most reprehensible practice to allow a neu-
ralgic dysmenorrhcea, whose seat I believe is generally in the
ovary, to be the indication for this meddlesome practice. The
only cases, in my opinion, in which a mechanical dysmenor-
rhcea with sterility can be said to exist, are those in which the
tissue of the cervix is large and firm, and the os uteri is diminu-
tive in comparison with the size of this body; a small, almost
imperceptible, round aperture perforating a bulky cervix.
When the tissue of the cervix is not so condensed, but has its
normal, yielding feel, I doubt altogether the propriety of re-
garding even a very small os uteri as a strictured one. I have
myself successfully treated by dilatation some cases of the kind
above cited, hut they are very few, compared with the large
number which come under my care.

I. I am indebted to my friend Dr. Golding Bird for the fol-
lowing instructive case. On April 7th, 1849, I received from
him the uterus and appendages of a lady w7ho died from perito-
nitis, excited by attempts to cure sterility by mechanical dila-
tation, whose history, as furnished to me by Dr. Bird, is as
follows, and with whose concurrence 1 publish it:

" A lady of dark complexion, aged 36, married several years,
and never pregnant, resided in Jamaica. From youth she suf-
fered intense dysmenorrhcea, and always had pains during sexual
intercourse. She was nervous, hysterical, and excitable to the
last degree, and was supposed to have suffered from every
possible form of inflammation ; these attacks obviously being
neuralgic, so common in hysterical women. In June last, by
the advice of her physician in Jamaica, she came to Lon-
don for the express purpose of having the os uteri dilated,
which had already been attempted by wax dilators. The ob-
stetric physician who was consulted in London coincided in
this opinion, and thought the sterility and dysmenorrhcea
depended on a stricture of the os uteri. He divided the
os uteri with a cutting instrument, and introduced silver dila-
tors. This produced horrible suffering; and, although at first
she fancied the pains of menstruation wTere rather better,
they soon became as bad as ever, and she did not experience
the slightest relief. She left off the treatment for a time, but
was soon again inclined to resume it ; and silver canulse were
passed into the os, and left there. Again she suffered frightful-
ly. On Saturday, March 31st, a gentleman, the assistanj of
the physician, passed in another tube, but the distress was

1850.] Mechanical Treatment of Sterility. 155

intolerable; and sickness and shivering coming on, she urgent-
ly begged her sister to try and remove it, which she succeeded
in doing. Getting worse, a neighboring surgeon was summon-
ed, and he found her laboring under what he regarded as peri-
tonitis masked by hysteria. She had scarcely any fever,
collapse coming on almost immediately, and she continued
sinking until Tuesday, when I (Dr. G. Bird) was summoned to
her. I found her at her sister's residence at T Park, pre-
senting almost the collapse of cholera: pulse 200, and a mere
thread ; distended abdomen ; vomiting of black fluid ; intense
irritability. All treatment was useless, and she soon sunk. On
examining the body, and raising the omentum, no appearance
of disease of any kind was found above a line connecting the
anterior superior spinous processes of the ilia. Below this line
there was intense peritonitis; the convolutions of the intestines
covered with butter-like lymph, and the pelvis filled with pus-
like fluid ; the right ovary and broad ligament covered with
the same butter-like lymph, but so feebly adherent that it wash-
ed away by dipping it in Water; the cavity of the uterus was
filled with bloody mucus. There was no other disease.'"'

The uterus and appendages were examined by Dr. Oldham.

The uterus had been opened by a single oblique division of
the anterior wall, directed from the cervix to the left angle of
the womb. The uterus was larger than usual for the virgin :
it was rounded on its anterior surface, and a bulging convexity
of the posterior wall, which, with the general softness of the
tissue, showed it to have been the seat of recent engorgement.

The blood-vessels over the entire surface of the uterus and
appendages were injected with blood, especially the fimbriated
extremity of the tubes, the ovaries, the broad and round liga-
ments. On the anterior surface of the body of the uterus were
two small projecting fibrous tumours, the size of a large and
small pea; the serous investment of them was highly vascular,
the blood-vessels rising over them just like the calyx of the
ovarian ovum of the bird. There was a similar more flattened
growth in the posterior wall.

The divided surface of the anterior wall showed its proper
structure to be much enlarged (it measured in the body eight
lines) ; the muscular structure was soft, and the veins large, a
probe easily ran through them. The length ef the united cav-
ities was two inches and ten lines, the canal of the cervix being
one inch five lines. The mucous membrane of the cavity of
the body was soft, slightly raised, and of a vermilion hue. Agi-
tation in the water was sufficient to loosen and separate it.

At the os uteri internum, there was a zone of highly-injected
blood-vessels, broken only at one point ; the circumference of

156 Mechanical Treatment of Sterility. [March,

this aperture was eight lines. The os externum had a clean,
smooth edge, without any break or mark of division; its cir-
cumference measured one inch one line. The cervix had its
characteristic markings, and the glands were empty of mucus.
On the right side of the divided cervix, which would have form-
ed the front wall, the ribbings were stretched upwards, enlarg-
ing the mesh-like appearance; and, towards the os internum,
some were lacerated transversely, and from this to the os exter-
num the structure was more ragged than usual.

The right tube. The extremity of this tube was almost en-
tirely closed as a congenital formation, the aperture being very
small. When opened, the fimbriated end showed its charac-
teristic rich folds of mucous membrane, which were much
injected, and were covered with bloody mucus. The remaining
two-thirds of the tube was apparently healthy, not vascular, and
pervious throughout.

The right ovary, which was almost covered with lymph, soft
and large. There was a cyst large enough to hold a small nut
on the uterine end of the ovary. The stroma was gorged with
blood. There was only one puckered Graafian follicle ; the
surface of the ovary was thick and corrugated.

The left ovary was irregular in its shape, a projecting mam-
miliary portion coming out from its outer end. This, on being
cut into, was hard and vascular, like the commencement of
malignant disease ; the ovarian tunic was thick and wrinkled ;
the stroma vascular ; a few remains of Graafian vesicles, with
puckered tunics, and some clots of different colours, black and
brownish.

The left tube vascular at its fimbriae, healthy in its mucous
membrane, and its canal pervious throughout. This tube pass-
ed into the uterus more directly than its fellow, which was
more curved. The veins healthy; arteries healthy; the right
round ligament large and vascular ; vagina healthy.

It is unnecessary to comment at length upon this case. It
affords a most instructive example of the dangerous effects of
dilatation, even in experienced hands, and the great caution
with which it should be undertaken. It is important, too, as
showing the difficulty of detecting the cause of stei ility. I am
sure that there was no kind of morbid contraction in this case,
and that the os and cervix uteri, which were alone treated, had
nothing whatever to do with the dysmenorrhcea or sterility.
Both of these, no doubt, were dependent on the atrophy of the
ovary: and the congenital obliteration of the end of the right
tube would have been sufficient to exclude the corresponding
ovary from any share in the function of reproduction.

II. Another presumed cause of sterility and dysmenorrhcea

1850.] Mechanical Treatment of Sterility. 157

is any deviation in the position of the uterus, and hence an indi-
cation for the cure of these disorders is to replace this organ,
and hold it in its proper axis in the pelvis, by means of Dr.
Simpson's uterine supporter. Dr. Rigby and others have
related cases of this kind. It is not necessary for me to reiter-
ate the objections which I urged in the last number of the
Reports upon this subject ; but I cannot avoid relating the fol-
lowing case, which more than confirms my opinion of the
dangers which may arise from this supporter. I am indebted
to Mr. Bransby Cooper for this case, which, like the preceding
one, ended fatally, and which he has given me his permission to
publish :

A young married lady, of great personal attractions, was at-
tended by Mr. Cooper for a very painful fissure in the anus,
which he divided and speedily cured. She then spoke to him
of what had been to her a very distressing social trouble, name-
ly, her sterility, which she associated with a perfect indifference
to sexual intercourse. Mr. Cooper examined the sexual organs ;
but, as he did not discover any defect which could be remedied
by surgery, he referred her to a physician-accoucheur. This
gentleman detected the uterus in a retroverted state, which he
looked upon as the probable cause of the sterility. For the
cure of this displacement, he introduced a uterine stem support-
er, which set up peritonitis, of which she died in three days.

It is much to be lamented that the warning which such a
case as this imperatively suggests should not have been publish-
ed by the obstetric physician in whose practice it occurrred.
My own opinion is, that mere displacement forwards or back-
wards, if the uterus be not diseased, does not commonly cause
sterility; and I cannot but characterize the practice of fixing
the womb in a definite position by means of a stem supporter,
as rash and hazardous, causing severe irritation and pain, and
even death, to the patient, with, at the best, a very questiona-
ble amount of ultimate good. The anteversion or retroversion
of a small uterus, without other complications, does not, in my
experience, occasion any great distress ; and it is far better to
leave it alone, and improve its tissue with the rest of the organs
of the body, than to prop it up for a time under the feeble pre-
tence of curing it.

III. Dr. T. Smith's adventure of catheterizing the Fallopian
tubes I know of only from his papers. I have the instrument
by me, but at present I have no intention of using it.

158 Apoplexy of the South. [March,

Apoplexy of the South, its pathology and treatment. By
Samuel A. Cartwright, M. D. of New Orleans. (N. O.
Medical and Surgical Journal.)

The apophlegmatic treatment is the most successful in
apoplexy, as met with in this valley ; it is not a disease peculiar
to any climate or season, as it occurs in all the coldest and the
hottest; being most rife in the greatest extremes of heat or
cold, and excessive variations of the weather. The greatest
number of cases occur at the summer solstice and at the
equinoxes, in this country. In cold climates, it is not uncom-
mon at the winter solstice. It would be a great mistake to
suppose, that as apoplexy is found everywhere, and at all
seasons, its treatment should everywhere be the same or even
similiar. Pathologists coincide in the opinion, that every form
and variety of the disease is attended with more or less pressure
on the brain, interrupting the functions of the life of relation,
sensation, muscular motion and intelligence. In a cold climate,
the repletion of the cerebral vessels is often due to a surplus of
arterial blood, and to an excessive action of the heart and
arteries. The respiration of a cold, dense atmosphere tends
to give a greater preponderance to the arterial over the venous
system. Whereas, in a hot, damp climate the reverse is the
case; a hot rarified atmosphere tending to accumulate the
blood in the venous system. The treatment recommended by
practitioners in high latitudes, from Cullen down to the present
day, in apoplexy attended with cerebral pressure from arterial
repletion and increased arterial action, is not the most success-
ful in that form of the disease attended with coldness, torpor,
and plethora of the venous system : Indeed, the standard works
of the present day, in the hands of the profession, although con-
taining many valuable improvements, are calculated to do more
harm than good, as far as apoplexy and some other important
diseases are concerned, to that portion of their readers who
practise in a climate the very opposite of that where the books
are written and the observations made ; because, by directing
attention to the arterial system as the source of danger,
the nervous, the digestive, the glandular, the venous and the
respiratory systems are apt to be overlooked, or to have too
little importance attached to them, in those complaints with us,
where each is more implicated in the morbid actions than the
heart and arteries. Apoplexy from venous repletion is noticed
by the authorities, but many important pathological phenomena,
which occur in other symptoms, both as causes and sequences
of the venous repletion, are left unnoticed. The serous of
or bloody extravasations, sometimes found in the brain, are

1850.] Apoplexy of the South. 159

only accessary ; because, in many apoplectic subjects, no ap-
parent lesion whatever is detected in that organ. ' The effusions
found in the brain are mere effects of the cerebral congestion,
and are nothing more than evidences of misdirected efforts of
nature to relieve the hyperemia of the cerebral vessels. But
there are other very striking phenomena witnessed in apoplexy,
in this latitude, of another expedient adopted by nature to re-
lieve the congestion of the brain, unnoticed by modern authors ;
consisting of copious exudations from the membrane lining the
posterior nares, the tongue, cheeks, palate, uvula, pharynx,
oesophagus, larynx, trachea, and the many cells, ducts and
sinuosities into which the mucous tissue is reflected. In the
healthy state, the pituitary portion of the membrane lining the
internal nares. the maxillary, sphenoidal and frontal sinuses,
and the ethmoid cells, throughout the greater part of its extent,
is studded with glands and follicles, separating a mucilaginous
lymph, called phlegm, or pituita, by the ancients; in apoplexy
this fluid is poured out in much greater abundance than in
health, and is more viscid and tenacious. Besides an increase
of the mucosities, termed phlegm by the ancients, copious
secretions or exudations take place from the glands and
follicles, connected with the respiratory and digestive apparatus
and its mucus lining ; these mucosities are often so abundant
as to impede respiration and obstruct deglutition.

The stertorous breathing is more the effect of collections of
tenacious mucous, impeding respiration, than from paralysis
of the muscles of the larynx, as has been supposed. This is
proved by the fact, that the breathing ceases to be stertorous on
its removal. As nature may be said to commit suicide in
apoplexy, in relieving the cerebral hyperemia by an effusion of
blood or serum, so also, she does the same thing in her efforts to
remove the repletion by exciting so great, a flow of mucosities
from the glands and follicles in the vicinity of the congested
brain, and from the membrane lining the air passages, as actu-
ally to obstruct respiration and hinder the transformation of
venous into arterial blood, unless art be brought in aid, to clear
those important avenues of the offending viscid fluids, by the
proper apophlegmatic remedies. The abundance of mucosities
blocking up those passages in apoplexy, is not a matter of spec-
ulation or conjecture they can be seen and felt, and brought
away, in the shape of tough, viscid ropes of agglutinated
phlegm, by those measures and means called apophlegmatics.
Paul of Agineta used a feather dipped in oil, to bring away the
viscidities obstructing respiration, and assisted the removal
with his fingers; as a preliminary measure to his ulterior
treatment. Indeed, the viscid matter is often so tenacious as

160 Apoplexy of the South. [March,

to admit of being laid hold of, and much of it extracted by
mere manipulations. The celebrated remedy for apoplexy of
the Dominican friars of Rouen, called " Elixir Antapoplexia"
was nothing more than a combination of powerful apophlegm-
atic ingredients, calculated to disembarrass the lining membrane
of the trachea, larynx, fauces and posterior nares of the viscid
mucus obstructing the air passages, and to excite the follicles,
glands, and the membrane itself into active secretion, by direct
medication to those surfaces on which many important nerves
are expanded. The Friar's remedy won a high reputation for
curing the disease; but not greater than its prototype, the ve-
ratrum album, had won all over Southern Europe for curing
the same complaint.

In the Augustan acre, after four centuries of experience of
the curative virtues of the veratrum album, in the treatment of
apoplexy, we find Celsus, (lib. iii, chap. xxvi,)recommending the
same powerful apophlegmatic in the same disease, in conjunc-
tion with blood letting. The nauseous, bitter, acrid taste of
the remedy, the burning sensation it occasions in the mouth
and fauces, the tingling heat it excites in the nostrils, the nau-
sea, vomiting and repeated retchings and the copious discharge
of mucus attending its action, point it out as one of the most
efficient apophlegmatics of the Materia Medica. Tne harsh-
ness of its action led Aretaeus to substitute milder remedies to
remove the obstructing mucosities. Subsequently, Fothergill
introduced the use of the white vitriol, which he gave in doses
of a scruple to half a drachm, to induce active vomiting Sy-
denham, Pitcairn, and a great many eminent names in the
profession, recommended emetics. A large portion of the phy-
sicians of Southern Europe viewed emetics, conjoined with
pungent stimulating substances, almost as specifics in apoplexy.
It wns the high authority of Cullen, who discouraged the use of
emetics and apophlegmatic remedies in the treatment of the
disease. His objections were mostly theoretical, but as apoplexy,
in the 56th parallel of latitude, is more owing to arterial excite-
ment than to venous torpor, his ojections may be founded on
practical observations, applicable to the disease in Scotland,
but wholly inapplicable in Greece, Rome and the United
States. Cullen's theory and practice in apoplexy and Cullen's
prejudices against emetics and apophlegmatics in its treatment,
pervade the works of nearly all the medical writers who have
since treated the subject.

The disease has been defined as a complete or partial sus-
pension of the life of relation. The life of relation has two
orders of functions, the one by which impressions from without
reach the brain, the other by which the brain is exercised on

1850.] Apoplexy of the South. 161

the body. Both these orders of functions are suspended more
or less completely. The brain can neither act nor be acted
upon, except in a very imperfect manner in the complaint
under consideration. Animal life, or the life of relation, is a
mere abstraction, a subtle spirit with a body, when viewed
separately from vegetative or organic life, on which it rests as
a basis. Organic life has also two orders of functions. The
one to assimilate substances to its nourishment by the processes
of digestion, respiration and secretion ; the other to cnrry out
of the* body the particles, which have become effete or
noxious to the economy, by the processes of absorption,
exhalation and secretion. Both these orders of functions, in
the healthy state, are equivalent to each other, and both require
a proper degree of activity in the circulating system for their
due performance. The cause of apoplexy must be looked for,
not in animal life, but in the two orders of functions of organic
life ceasing to be equivalent ; in other words, in superabundant
assimilation or in a delect of the excretory function. The first,
constituting apoplexy from repletion of red and the latter of
black blood, that connected with arterial reaction, as its most
prominent feature, this, with venous congestion. When from
defect of the secretory and excretory functions, as it generally
is in warm weather and in warm climates, the safest and
readiest method of cure is to awaken up all the absorbing,
secretory and excretory organs from their torpor, into in-
creased activity ; particularly those glands and follicles in the
immediate vicinity of the congested brain: the congestion
itself, being the effect of the want of action in the excretory
system. This is the method of cure, which nature points out,
as is evidenced by the copious excretions of viscid mucus that
occur during the apoplectic fit. So abundant is the excretion
of mucus in the nares, fauces, trachea and sesophagus, as to re-
quire the assistance of art to expel it, or this very effort of cure
would itself become the cause of death, by obstructing the due
performance of the respiratory organs.

On the other hand, in that form of the disease arising from a
surplus of assimilated matter, introduced into the system by
vigorous digestive powers, in a cold bracing atmosphere,
depletion of the sanguiferous system by blood letting, would
strike directly at the root of the evil, and restore the balance
between the assimilating and excretory functions, by unloading
the blood vessels, diminishing the morbid heat and quieting the
excessive arterial excitement. Whereas, in apoplexy from
venous congestion, with coldness and torpor, much loss of
blood, or, indeed any, in many cases, would diminish the force
of the circulation too much to be compatible with secretion,

v. s. vol. vi. vo. in. 11

162 Apoplexy of the South. [March,

exhalation and absorption, these requiring so much activity in
the circulatoiy system for their proper performance, as oftener
to need stimulating substances, to excite that system, than the
lancet to quell it. There is pressure on the brain in venous
congestion, equally as in the other form of the disease from
arterial fulness and reaction ; but unloading the larger venous
trunks will not unload the distention of the smaller vessels of
the congested brain, where the danger lies, or do the good it
does in the other form of the disease. Although blood letting
is often serviceable, sooner or later, the main dependence is in
giving energy to the absorbent, excretory and secretory
actions, by addressing remedies directly to as large a surface of
the sensative, nervous expansions as can be reached. Stimu-
lating applications to the cutaneous surface, as mustard, for
instance, to the extremities and over the epigastrium, have
great power in awakening the torpid nervous system ; yet they
are feeble remedial agents in comparison to stimulating applica-
tions to the mucous surface. One of the most effective remedies
for the latter purpose, is a combination of mustard flour, table
salt, ipecac, and tincture of assafcetida. When patients are
utterly unable to swallow water, or the most bland substance,
the mere presence of this combination in contact with the ner-
vous expansions in the mucous membrane (lining the mouth,
tongue, palate, posterior nares and fauces,) will detach the
viscid mucus, which is choaking and suffocating the patient,
restore diglutition and give free egress to the atmospheric air,
so essential to the respiratory system, and to vitality itself. It
not only detaches and throws off the viscid phlegm, already
formed by that low grade of vital action, termed passive
exudation, but by its stimulus on the net work of nerves, it
brings to the rescue of the patient a higher grade of vital ac-
tion in the absorbent and secretory organs of the digestive and
respiratory apparatus ; and thereby unloads as if by enchant-
ment, the repletion of the smaller vessels compressing the
brain. Even the regurgitation of this powerful apophlegmatic
into the posterior nares, when it cannot be swallowed, is not
without its benefit. Its direct application to the membranes on
which the entire olfactory pair of nerves and some important
branches of the fifth are distributed, is well calculated to make
a strong impression upon the sensorium. On the tongue, it
lies in contact with the expansions of the lingual branch of the
fifth, the glossopharyngeal portion of the eighth, and nearly the
whole of the ninth pair. Deep in the throat, it comes in con-
tact with the superior laryngeal and recurrent nerves, branches
of the pneumo-gastric ; awakening the torpid and paralyzed
nervous system into life and promoting absorption, excretion

1850.] Apoplexy of the South. 163

and secretion in the broad expansion of the mucous surfaces,
and the subjacent, as well as the distant organs, subservient to
the important processes of elimination. When it is remem-
bered that a large portion of the mucous membrane acts as a
kind of periosteum, on one of its faces to the bones of the head,
and on the other as an eliminating surface, it can readily be
perceived, how important the mucosities thrown off by it must
be in diminishing the plethora of the cerebral vessels. In
children, whose heads are large, the secretions and excretions
thrown off from the lining membrane of the mouth, throat and
nares are in much greater quantities than in the adult ; thus
proving the importance of such evacuations in preventing
cerebral plethora, by an eliminating process or local depletion,
constantly going on in the healthy state of childhood. In
apoplexy" besides the beneficial efforts of the mere presence
of apophlegmatics in contact with the mucous surface of the
mouth and throat, further advantages are to be derived from
their deglutition, in doses sufficient to cause vomiting. Indeed
vomiting without reference to the substances exciting it, does
some good, but much less than when the substance employed is
both emetic and apo phlegmatic. In substituting simple emetics,
devoid of apophlegmatic properties, for such articles as the
veratum album, possessing both properties in a high degree,
the profession, instead of making progress, made a retrogade
movement, and finally abandoned emetics almost entirely in
the treatment of the disease. Some attention to the patholo-
gical phenomena observed in apoplexy and some other diseases,
from venous congestion, will show the reason why apophleg-
matic remedies cannot be dispensed with in their treatment.
Observations prove that in such affections, the mucous mem-
brane, even into the stomach, intestines, and lungs, is covered
with mucosities of so tenacious a nature, as actually to form,
over a great or less extent of its surface, an additional tunic,
rendering the portion thus coated almost insensible to the or-
dinary medicines. In the lungs, the tenacious mucus obstructs
the inflation of the cellular substance surrounding each of the
extreme ramifications of the bronchial tubes, by stopping up
the small air conduits, opening into the cells, and rilling the cells
themselves, which are lined by a delicate mucous tissue, with
morbid exudations. In the human subject the bronchias end in
cells exceedingly small, scarcely perceptible to the naked eye.
In the alligator, however, Dr. bowler's dissections (witnessed
by the author) show that they are large bladders, equal in size
to the urinary bladder of man. Their inflation brought the
animal to life, after it had been apparently dead for nearly an
hour, and the viscera of the thorax and abdomen had been laid

164 Apoplexy of the South. [March,

open to view by a careful dissection ; so perfect was the re-
storation of \itality, from the simple process of inflating the
air cells of the lungs, that the partially dissected carcass had to
be tied with strong cords to prevent its doing mischief. On
suspending the inflating process, the air cells become flacid, and
a corresponding suspension of animation again occurred, and
was again revived by renewing the inflation.

No better demonstration of the great inportance of the free
expansion of the air cells of the lungs with atmospheric air,
could be desired An emetic, or some remedy capable of dis-
embarrassing the air cells, and the bronchial tubes opening into
them, of all obstructing mucosities, must be of essential service
in the treatment of such a formidable complaint as the one un-
der consideration. But to derive much benefit from it, its ac-
tion should extend further than a mere evacuation of the.
contents of the larger cavities; it should be capable of loosen-
ing and throwing off* the tenncious phlegm coating the mucous
surfaces, and filling the cells and smaller cavities. In other
words, it should be apophlegmatic, a remedy possessing the
virtue of detaching and throwing off phlegm.

The preceding remarks have been deemed necessary to
throw some light on the rationale of the treatment contained
in the following abstract. The merits of the treatment do not,
however, rest on the imperfect reasons above given in support
of it. The theory may be ever so imperfect or erroneous, and
the practice good. The latter was derived from the school of
observation and experience; the former was subsequently pre-
fixed to the practice, and not the practice to the theory. If it
be not a satisfactory explanation, the merits of the practice re-
main the same, wanting nothing but a writer better able to
elucidate and explain it. The truths of a long and extensive
experience, in the treatment of apoplexy, as met with in this
valley, declare the practice to be successful.

Col. Wiley P. Harris, some 20 years ago, in the hot weather
of mid summer, fell in a deep apoplectic fit in the streets of
Natchez, and was among the first triumphs of the practice in
the author's hands a practice which he had derived from the
late Dr. J. A. McPheeters, who himself, recently died of the
disease, but not under the treatment, which he himself
had successfully used for 25 years in Natchez, and had pre-
viously been eminently successful in his hands in the same
disease in St. Louis and vicinity. Thus proving, that the
good results of the treatment are not confined to the southern
portion of the Mississippi Valley. Dr. McPheeters never pub-
lished his experience, and when stricken downby the disease
himself, he derived no benefit from it, but was treated secundum

1850.] Apoplexy of the South. 165

artem, as recommended by northern writers and teachers. In
the hands of the author of this paper, the practice recom-
mended in the following abstract, triumphed over a severe
apoplectic attack in the person of the hero of Chapultepec and
the first American governor of the city of Montezumas, Major
Gen. John A. Quitman, long before he triumphed over the
Mexicans. It cured the historian of the Mississippi Valley,
Dr. J. W. Monett, of a severe attack, connected with hemi-
plegia. It cured both in a very short time. In Capt. Coarse's
family, of Concordia, La., a case occurred, where the first
immediate relief, from impending death, was procured by
extracting the inspissated mucus, obstructing respiration, with
the fingers. In the case of the commander of the Round
Islanders, last summer, Col. W , who fell in his door, in this
city, in a stertorous apoplelic fit, entirely insensible and mo-
tionless, strong and pungent apoplegmatic medicines, conjoined
with a mercurial, (omitting emetic substances.) succeeded in
effecting a prompt cure: camphor, assafcetida, capsicum, quin-
ine, laudanum and mercury, each in a full dose, were mixed
together and inserted into the mouth. The combination was in
part regurgitated into the nares ; deglutition being impossible,
until after the medicine had disencumbered the throat and
fauces of the obstructing mucosities.

In this case, death was so close at hand, that the sphincters
were relaxed. The emetic substances were omitted in conse-
quence of the copious alvine evacuations. Recovery took
place without bleeding, cupping, leeching, vomiting or purging,
by the mere force of apophlegmatics, assisted only by the
mercury to emulge the liver. The same happy result, from
the same combination, used in the Col.'s case, (with the addi-
tion of blood-letting, after re-action took place,) was witnessed
in a case of apoplexy, in a very large, plethoric lady, a native
of the Sandwich Islands, in the prime of life, attacked in the
very hottest weather of last Julv, in this city, at the Planter's
Hotel.

These recent cases, with some others that might be men-
tioned, go to show that the virtues of the following treatment
depend, probably, less upon the emesis occasioned by the
remedies used, and more upon their simple apophlegmatic
action, than was hiterto supposed. The treatment, however,
is given, woid for word, as originally written, a long time ago,
but not until now published to the world.

Treatment of Apoplexy. TwV> teaspoonsful of table salt,
two teaspoonsful of mustard flour, one teaspoonful of ipecac,
and one teaspoonful of tincture of assafaetida, in a tumbler of
warm or cold water.

166 Apoplexy of the South. [March,

The more disgusting the medicine the better, because it
loosens the tenacious phlegm adhering to the throat and air
passages. The pungency of the mustard is all important for
the same purpose. The throat is so choaked up with mucus
and phlegm, that the swallowing of any thing is almost impos-
sible. This mixture does great good without being swallowed.
Its mere presence in the mouth and throat loosens the tenacious
phlegm adhering to the fauces, causes it to pour out of the
mouth, and arrests the stertorous breathing, caused by the
phlegm in the throat, enables the patient to breathe easier,
rouses him in some degree from the stupor, and enables him to
swallow that, or other things. He had better swallow the
mixture, however, until he vomits. It should be forced upon
him until he does vomit, or act on the bowels. The whole
tumbler full should be given in the space of ten or fifteen
minutes, unless it vomits. A second tumbler full is sometimes
necessary, but if it does not vomit, or cannot be got down, the
white vitriol is the best remedy : a teaspoonful in a tumbler of
water, half at one dose, and small portions afterwards The
salt, mustard, ipecac, etc., make the best remedy to begin with,
because it is the best to loosen the phlegm, which is suffocating
the patient ; it should be forced into the throat, by prizing the
mouth open with a spoon, and into this spoon the mixture
should be poured by another spoon ; when it falls down to the
root of the tongue, it causes a heaving, strangling kind of
motion to be made by the patient ; then, he should be turned
a little on his side, to enable the loosen phlegm to run out of the
mouth, but soon replaced on his back again, with head a little
elevated, to get more of the medicine. While this is doing, hot
water, with mustard in it, should be poured, time after time, on
his feet and hands, and a flannel shirt, wrung out of very hot
water, doubled up in a large ball and wrapped in a dry flannel,
should be applied over the stomach and bowels, and frequently
renewed, as hot as the hands can bear it. A great deal of
phlegm, a ropy white-of-egg looking substance, will be thrown
up, and the patient will get relieved. Chamomile tea may be
given to encourage the vomiting. If the head is hot and the
face red, the head and face should be frequently wet with cold
water. When the skin gets hot, and the pulse rises and face
flushed, bleeding from the arm should be resorted to ; but it is
a very dangerous expedient in the opposite state of the system.
After the vomiting, a twenty grain dose of calomel, floating on
a spoonful of water, and a stimulating enema, to move the
bowels, if they have not been already moved. The subsequent
treatment consists of but little more than a light gruel diet, a
little salts, and very small doses of sweet spirits of nitre, to act
on the kidnevs.

1850.] Scrofula. 167

If the patient can be made to vomit, he almost invariably re-
gains his faculties directly. Some physicians have theoretical
fears of vomiting ; it never does mischief to the head in any
case, except where there is great heat of the whole surface,
strong circulation and flushed face ; and not then, if the head
be wet before and at the time of vomiting. Jn the state just
mentioned, bleeding and vomiting at the same time do well
together. Prompt action is as necessary in this complaint, as
in any other kind of strangling or suffocation. The means to
be used should be well fixed in, the mind before hand, and all
the means mentioned should be made act together at the proper
time the vomiting, the hot applications to the extremities and
stomach, and hot or cold to the head.

The Scrofulous Constitution the signs by which it is known
the causes in which it originates its effects upon families
and individuals. By Dr. King. (Prov. Med. Jour. Am.
Jour. Med. Sciences.) '

The scrofulous constitution may be called a defective and
abnormal one, consisting in an imperfect state of the vital pow-
ers ; "the principle of vitality" (whatever that is) causing an
imperfect development of the physical structure, both in form
and substance. There is an imperfect deposit of bony matter
to form the skeleton, and too great a proportion of animal mat-
ter. The bones are therefore too soft to hold their contents,
when that is required, as in the head; and too soft to support
weight and endure force, when that is their office, as in the rest
of the body, the spine, ribs, pelvis, and extremities. All the
cartilaginous parts are increased in size : the extremities of
the long bones are large and soft, and the interstices filled with
serum and jelly instead of earthy matter : and the bones are
either longer or shorter than the average.

The head bones being soft, give way to the pressure of the
brain, which is affected more by the influence of gravity than
its own vitality, and becomes misshapen. When fluid collects
within, the shape is still more affected, and in those who recov-
er, the disfigurement remains for life.

The malar bones are often too prominent, and the lower jaw
too large : the palate is often imperfect, and the dentition is tar-
dy, difficult and irritating: (he teeth imperfectly formed, dis-
coloured, friable, only one half enamelled, and readily decay :
the two middle upper incisors are often unnaturally large and
prominent ; the upper lip partakes of the imperfection of the
palate, and is often fissured. Frequently the ears are deficient,

168 Scrofula. [March,

the cochlea being wanting, and sometimes the internal meatus:
the thorax is deficient in size and deformed in shape: the ribs
bent in, the sternum protruding, and its divisions imperfectly
united. The abdomen is too large and protuberant, from the
flabbiness of internal parts and abnormal size of organs and
mesenterical enlargement. The bones of the spine, partaking
of the deficiency of earthy matter, particularly of the phos-
phates, are too soft to support the head and chest, and yield as
well as their ligaments. The sacrum is often pushed towards
the pubes, producing a narrow, pelvis, and consequently in fe-
males, difficult or impossible parturition: the ilia are often
twisted : the arms too long or too short for the body, the wrists
too swollen, and the hands misshapen. The lower extremities
are too long ox too short, badly supporting the trunk : the knees
larger, the bones badly fitted to each other, forming the knock-
knee, or the reverse; the tibia, sometimes the femur, bending
beneath its weight, and the feet splay-footed, or club-footed, in
various degrees.

The soft, parts partake of the same want of vitality. The
brain is too large or too small, too soft, pulpy, and heavy in its
functions, and liable to effusion from vascular debility : though
sometimes its intellectual functions are more active than com-
mon, this being the exception, not the rule. The nerves are
not so defective in carrying sensations or motions, as the brain
is in its functions. The vascular system is generally relaxed
and weak, and what used to be called (for want of a better
theory) leucophlegmatic : the muscular fibre is weak and relax-
ed, and wanting in tone and vigour; the hair is generally of a
light colour or reddish, and thin in texture, and scanty, and liable
to fall ofi> independent of disease, from a low vitality : the eye
has a peculiar expression, generally heavy, languid, inexpres-
sive; whilst sometimes it has an animated expression of a pe-
culiar kind, known to medical men, and may be called the scro-
fulous eye; at others, it foretells consumption, of itself. As a
contrast to other signs of imperfection, the eyelashes are often
long and beautiful. The stature varies from the dwarf to the
apparent giant, when a boy may be six feet high at fifteen
years of age ; but such excess in height is never accompanied
with corresponding muscular strength and well-developed
limbs and features; they are always puerile and almost effemi-
nate. The appearance of the child is often that of the little
old man : while the appearance of the man is often that of
youth and boyhood without its vigour. Sometimes the child
is fresh and plump, with embonpoint, and to the artist beautiful;
but this hypertrophy of the cellular membrane is delusive and
morbid and often accompanied with organic infirmities, fore-
telling future disease.

1350.] , Scrofula. 169

The deposit of tuberculous matter, from imperfect assimila-
tion, is one of the most obvious and leading erlects of the scro-
fulous constitution, to which some writers have improperly
confined their notion of scrofula. It is only one effect or dis-
ease among many which arises from a common constitution.
Scrofula not only produces specific diseases, but modifies all
which happen in the body in which it exists. Thus, hooping-
cough, small- pox, measles, scarlet fever may he fatal in a scro-
fulous constitution, and harmless in an unscrofulous one.

The specific diseases to which the scrofulous diathesis gives
rise, are hydrocephalus, tumours of the brain, tubercle, abscess,
fungus, epilepsy, insanity, hysteria, amaurosis, cataract, deaf-
ness, otorrhcea, conjunctivitis, lippitudo, lupus, ozsena, coryza;
tubercular glands in the neck ; diseases of the heart and lungs,
of the abdomen, oesophagus, stomach, bowels, pancreas, liver,
kidneys, bladder, uterus, mesentery, scalp, skin, joints. Many
forms of indigestion, dyspepsia, mal-assimilation, anorexia,
general debility, want of tone and power, nervous debility
without organic disease, are modifications of the scrofulous di-
athesis : so is gout.

Scrofula is supposed to affect one-fifth of mankind : of those
who are born scrofulous, one-half perish in infancy; of scrofu-
lous foetuses, one-quarter die in utero. Few scrofulous persons
live to he married : this seems to be the provision of nature to
get rid of the imperfect part of her works. Louis calls phthisis
the most relentless enemy of the human race; but he forgets
that it is the means of preserving purity of blood and vigour of
constitution. Nature does not allow the direct transmission of
scrofula to proceed, as a general rule, beyond three or four gen-
erations. It is then cut short by phthisis, or some other organic
form of scrofula, or by abortion, or by non-conception. The
following principles may belaid down, as true and fundamental
in scrofula, the cases on which they are founded being omitted
for brevity ; but probably every medical man's experience will
assent to their truth

1. The grand source of the scrofulous constitution is the
direct hereditary principle.

2. Scrofula is hereditary in collateral branches, when latent
in the direct line.

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

4. Persons who may have been scrofulous in youth may ap-
pear to have been cured, and to have grown into good health,
but the constitutional taint remains, and the children will be
scrofulous.

170 Scrofula. , [March,

5. Phthisis is the most fatal form of the scrofulous constitu-
tion. Sydenham called it "scrofula of the lungs." Portal con-
sidered that congenital phthisis was scrofulous. Bayle and
Laennec the same. All cachexia is a form of scrofula.

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 eighty-four cases of scrofula in the hos-
pital of St. Louis, at Paris, more than half had phthisical
parents ; all the patients in that hospital who died of various
forms of scrofula, had tubercles in the lungs.

7. Persons who are scrofulous in childhood sometimes be-
come stronger after puberty ; but the taint remains, and the
children are scrofulous. The parents try to conceal the scro-
fula of their youth, which makes it difficult for the physician
to trace the constitution of the child, unless he is clear in his
general principles.

8. Parents who do not appear to be scrofulous themselves,
but whose brothers or sisters are so, have scrofulous children.
The family taint passes through them to the children. .Thus,
scrofula, like gout, is said sometimes to skip a generation.

The scrofulous constitution may be originated independent
of hereditary taint.

1. Syphilis is a cause of scrofula. Astruc says, when scro-
fula is not hereditary, it is invariably caused by syphilis. Scro-
fula attacked the nurse children (foundlings) of Montmorenci,
in France; all the nurses had syphilis; as they were cured the
children got well. Another originating cause of scrofula is ex-
cessive indulgence and abuse of the sexual instinct. The
children of such parents are generally scrofulous. The parent
verifies the expression in Job xx. 2, 11 : " His bones are full of
the sin of his youth." This power of early self-indulgence is
one of the curses of hereditary wealth.

3. Another originating cause of scrofula \s premature indul-
gence of the sexual instinct, and premature marriage. If the
offspring are to be healthy, strong, and vigorous, no man ought
to marry before the age of twenty-five, or woman before the
age of twenty-two or twenty-three. The secretion of the
seminal fluid, like all other secretions, must be subject to laws
which decide its health and vigour. It should not take place
too early or be too frequent, and it should be spontaneous i.e.
the natural result of a healthy organism, not of a mere mental
action, or effort of imagination ; there is a period of life during
which these conditions are complied with, but before and after
which they are not. The ancient Germans held it disgraceful
to indulge the passion before the age of twenty. The laws of
Moses contained particular restrictions on the subject ; and it

1850.] Scrofula, 171

is almost needless to state that the law of Christ inculates
puritv of mind as the grand safeguard against the abuse of this
faculty. If premature marriages have been preceded by in-
dulgence, they are still more unfavourable to the offspring ; and
if by syphilis, still more so. The gradual extinction of the
higher and aristocratic classes, by the want of direct heirs, is
perhaps partly owing to these causes, engendering a scrofulous,
and therefore perishable constitution. On the other hand, the
lower classes marry early, not only from instinct, but also to
obtain the services of a wife and companion ; the physical
strength has been deterioated by low diet and hard labour, and
the premature marriage completes the inability to produce a
healthy, strong, and robust offspring. The labour of the
peasantry is said to be two-thirds too much, and their food two-
thirds too little ; their food, clothing, and habitations are calcu-
culated to a minimum of sufficiency.

4. Another originating cause of scrofula is marriage too late
in life. Debility in early life may, in some degree, be correc-
ted ; .that of old age cannot. The generative power begins to
decline about the age of forty-five. Those who marry late in
life may have one or two children strong, but every child is
weaker than the preceding one, and the youngest are the
weakest. The child of the old man is become a proverb for
visible debility stamped upon its physiognomy. Many of them
die at birth. Some are precocious in childhood, and then sud-
denly fade and become effete and stunted, like the withering
and dropping of fresh fruit in autuman ; they are born out of
due season. The period of weak fecundity in women com-
mences about the age of forty. After this time pregnancy is
often a delusion, or there is an imperfect conception or mis-
carriage, or the child perishes at birth, or, if reared, it is delicate
and scrofulous. When marriage has not been followed by
chidren till after several years, they are generally weak and
scrofulous, agreeing with the age of the parents at the time of
birth. Children born after the expectation of farther increase
of family has ceased, are general scrofulous.

5. Another cause originating scrofula is disproportionate age
and unequal vigour. When the father is younger than the
mother, it may be a cause of scrofula. In all animals, power
is the privilege of the male. The relative superiority of the man
ought to be the foundation of marriage. Upon it depend all
domestic felicity, and often its morality. The constitution of
the children follows that of the father more than that of the
mother. This is the law in the brute creation. The breeders
of cattle set more value upon the male than the female.

6, Another originating cause o^ scrofula is paralysis, and
also epilepsy, lunacy, and other diseases of the brain.

172 Scrofula. [March,

It may be observed that parents may be scrofulous without
apparent signs ; the scrofula may be latent, and the children
scrofulous. Parents may show no signs of scrofula till after
they have had children, when it may begin to appear. In this
way it may be said to skip a generation, when it is latent. Du-
ring the wars of the French Revolution, when the conscription
was at its height, France was so depopulated that every man
capable of bearing arms was enlisted, and even many who
were incapable. None were left at home but the sick, the in-
firm and those who had married at nineteen or earlier, in order
to avoid the conscription. Hence the population was kept up
by persons too infirm and sickly for military service, and too
young to produce strong children. Thus, at the Restoration
in 1814, it was found difficult, out of a levy of 80,000 men, to
find 25,000 to term a corps d* elite, and it was necessary for this
purpose to lower the standard of height. After the peace of
1814, when the conscription was less rigorous, the men were
more robust. But the conscripts of 1836 were an exception,
for they were born in 1816, in which year nine-tenths of the
population suffered severely from famine. These facts are ob-
tained from the reports of the French Secretary at war. The
end of marriage is domestic happiness, and the procreation of
healthy children ; and the former depends much upon the latter.
The law is very particular about the forms of marriage, but
very indifferent about the results. Rational marriages must
rest with the parties themselves. Ignorance of the laws of
constitutional health is one great cause of irrational mar-
riages. The great motives to marriage are rank, property,
fancy ; to these ought to be added, morals, intellect, health,
which are more important for happiness. The moralist has
hitherto been too liitle of a physiologist. Physiology is the
basis of morals as well as of health. The educator ought to be
a physiologist as well as a moralist. It is only by the union of
the two that the young can be judiciously trained, and prepared
for real life. However persons may despise physiological
warnings before marriage, they are too sensible of their value
afterwards. Constitutional diseases not only produce unheal-
thy children, but often also disgust, aversion, and misery be-
tween the parties themselves. Marriage will not strengthen a
weak constitution, as some suppose, but debilitate it still more.
It is a common observation of females, " I have never been well
since I married." Child-bearing and nursing demand more
than a delicate and tainted constitution can bear. The strength
gives way under the heat and burden of the day.

I have* thus endeavored, though too briefly for the importance
of the subject, to trace the history of the scrofulous constitution

1850.] Stricture of the Urethra. 173

in its hereditary principles, direct and indirect, proximate and
remote. Where it exists, it cannot be entirely eradicated.
Where it does not exist, it may be originated by the vices and
follies of men. I have considered it as the source of many dis-
eases not hitherto attributed to it; and that its best antidote
would be a judicious education and training upon physiological
principles. These principles it is the aim and merit of medi-
cine to diffuse among society. The medical voice reaches the
highest and lowest ranks. Her useful and practical truths are
of daily application, and daily disseminated by her faithful dis-
ciples, who in the lower walks of the profession, ever ready by
day or night at the call of distress, find their chief and often
their only reward in the conscious exercise of the duties of
humanity, the mens sibi conscia recti. Finally, the greatest
compliment which has yet been paid to the medical profession,
and its humane and scientific principles, is to see the whole
legislature, and every populous city in the kingdom, resolve to
adopt them as a basis of civil polity, and to carry them out for
the health, benefit, and happiness, of the poorest and largest
class of our fellow-creatures.

Cases of Permanent Stricture of the Urethra, cured by Cutting.
By James Bryan, M. D., of Philadelphia, Professor of Sur-
gery in Geneva Medical College, N. Y. (N. Y. Jour. Med.)

It is well known, that the common modes (dilatation and
caustic) of treating permanent strictures, are to the last degree
unsatisfactory. Patients are relieved temporarily by the forci-
ble introduction of bougies, especially conical ones; by the
judicious use of caustic, &c, but the disease generally remains,
and the patient either returns to the surgeon, or goes to ano-
ther for further temporary relief. Years pass on, and the
stricture becomes gradually worse, until the patient, especially
in cold weather, is in daily danger of a rupture of the bladder,
from retention of the urine, and the impossibility of passing any
instrument through the urethra into the bladder. In other
cases, the patient is doomed to carry with him at all times, a
number of bougies and catheters of "assorted sizes," in order
to relieve himself under the almost certain emergencv. I can-
not, perhaps, better detail my mode of treating these hard
cases, than by referring to one which came under my care
several years ago, with three others which followed. It was
that of Mr. S., a young married man, who had for nine years
suffered from stricture in its worst form. We had gone through
the usual dilating and caustic treatment, with temporary relief

174 Stricture of the Urethra, [March,

from time to time, until the canal had, as far as the introduction
of any instrument went, entirely closed. A very small stream,
or rather dropping of urine, which of course demanded a long
time to evacuate the bladder, was the extent of his power of
urination. He had in fact, several times been in danger of
rupture of the bladder from retention. Having tried a large
number of our most respectable surgeons without permanent
benefit, he despaired of relief. On examination I could dis-
tinctly perceive from without, commencing about h\ inches
from the mouth of the urethra a large cartilaginous stricture,
which seemed to extend 1| or 2 inches along the passage. On
reflection, I came to the conclusion that nothing but a com-
plete division of the strictured part would be of any avail. I
called upon our surgical instrument makers, but found nothing
that I could use, but got Mr. Shively to make me a flexible
metallic catheter, with a stylet, on the distant end of which
was fixed a blade. With this instrument (a full account of
which will be found in the Medical Examiner of 1847), 1 suc-
ceeded in a few sittings in entirely dividing the stricture ; since
when, he has had no difficulty in urination or symptoms of the
disease. The following cases have occurred since that time.

Mr. B., a respectable merchant, from a town in the western
part of New- York, came to Geneva, while I was lecturing there
on surgery ; and consulted me about his case. In my notes,
I find that he applied on the 15th of June, 1849. The stric-
ture was of 12 years' standing. He had consulted many
eminent surgeons in the state and city of New- York ; had had
caustic, dilatation and scarifications tried. In reference to the
latter mode of treatment, my opinion is that, at best, in the
cartilaginous form of the disease, they can but palliate. Mr.
B. supposes there are two strictures, one 5| inches, and the
other 7 from the mouth of the urethra.

June 16th. On examination, I find that the first stricture is
cartilaginous, and at least an inch long. The second is longer,
and in the membranous portion of the passage. Two incisions
were made to-day ; one at 12| o'clock, and the other at 3| P.
M. The instrument advanced more than a quarter of an inch ;
the stricture, after the incision, was distinctly felt to give way
before the point of the instrument.

17th. Two incisions have been made to-day; one at 9,
and the second at 3 o'clock. Mr. B. says that no blood follow-
ed the first incision yesterday, and only a few drops after the
second. That the stream of urine is much freer and larger.
This morning's operation excited a little pain, and produced a
little blood. The afternoon's incision was followed by about
fifteen drops of blood, but very little pain, and an advance of the
instrument of about one inch.

1850.] Steicture of the Ueethra. 175

18th. One incision a few drops of blood no pain.

20th. The bougie passes one and a half inch further. The
first stricture is fully divided and passed. Some soreness, and
a little pus to apply cold water to the perineum, and take a
dose of salts. A good stream of urine.

22d. Quite comfortable ; no discharge of blood or pus ;
continual rest and low diet.

26th. Made an incision, and gained an advance of one-
quarter of an inch on the last.

27th. Advanced another quarter of an inch after an in-
cision.

28th. Made another incision, which was repeated on the
29th and 30th, when the passage was clear to the mouth of
the bladder no difficulty in inducing an ordinary sized ca-
theter.

Having left Geneva the next day, I became anxious to hear
from my patient, but did not until one day last week Novem-
ber 23d. The treatment was successful, and a gentleman from
a neighboring district, who has suffered the disease about three
years, has just been treated in the same way, and discharged.
The gentleman came to Philadelphia to consult me.

Nov. 19th, 1849. Mr. P., aged 23. This stricture was
passable with a small conical bougie, and was located a lit-
tle beyond the curve of the urethra. An incision was made,
and a free cathartic recommended.

20th. A little soreness on passing a small metallic sound at
the point where the incision was made.

21st. An incision made ; the instrument advancing about
half an inch beyond the first point.

22d. No incision thinks the urine flows better than it has
for years.

23d. Cut gained an inch. The operation was repeated on
the 24th and 25th, when the passage was perfectly clear. A
large sized metallic catheter passes readily to the bladder.
The patient remained a few days longer, taking cathartics
several times during the treatment, and living on a vegetable
diet. He was perfectly relieved, and I hope cured.

Case 3. Mr. I., from Georgia, aet. 35, with a stricture of
nine years' standing, having used bougies and caustic again
and again, came to consult me. The first incision was made
October 22d, and repeated five times, the instrument each time
advancing from one-eighth to a quarter of an inch.

No other treatment was resorted to. Only a few drops of
blood were lost and the stream of urine was restored to its
natural size. A full sized bougie can be introduced with the
the greatest facility. The particulars of this case are so much
like those of the first, that it is needless to repeat them.

176 Periscope. [March,

It will be remembered that Civiale has adopted the catting
mode of treating stricture, but that a fatal objection lies against
his instrument, inasmuch as, like those of Amusatand Lallemand.
it must pass the stricture before it can be made to operate, and
then only scarifies. He tells us that he has long been in the habit
of cutting through strictures near the mouth of the urethra,
and that now he cuts them beyond the curve. Mercier's ideas,
in our opinion, are the nearest correct ; viz., that the stricture
must be entirely divided, in each direction.

I think that the use of bougies and dilators of any kind are
prejudicial, and tend to develop strictures rather than cure
them. I recommend no dilatation after cutting, but rely upon
the urine itself keeping the incisions open, and the sides of the
stricture from adhering.

PART III.
JH o n 1 1) I b Periscope.

Movements of the Respiratory Organs in Disease. (Prov. Med. and
Surg. Jour. American Journal.) Dr. Sibson gave an account,
illustrated by diagrams, at the meeting of the South-Eastern Branch
of the "Provincial Med. and Surg. Association," in July last, of his
investigation into the movements of the respiratory organs in dis-
ease :

Tn health, the inspiratory movement of the walls of the chest, du-
ring tranquil breathing, is only from two to six hundredths of an inch;
while that of the abdomen is about three-tenths of an inch.

During a deep inspiration, the expansive motion of the walls of the
chest is, in front, about one inch; and at the side, about-two thirds of
an inch ; and that of the abdomen is about one inch.

The expansion of the two sides of the chest is nearly equal ; the left
side does not, however, expand quite so much as the right side, over
the lower two thirds of the chest, owing to the position of the heart.

In those cases in which there is great obstruction to the entrance
of air, during inspiration, through the outer air passages, as in cases
of extreme narrowing of the larynx or trachea, the walls of the chest,
to a greater or less extent in proportion to the obstruction, instead of
advancing during inspiration, actually fall backwards. The cause
of this remarkable phenomenon is evident: the diaphragm acts with
great power, and lengthens the lung, and, as air can only rush into
the lengthened lung through the larynx, with great difficulty, the
lungs collapse, just as a half-filled bladder collapses when it is length-
ened, and the pressure of the atmosphere forces backwards the anterior
walls of the chest.

In emphysema and bronchitis, in those cases where there is an

1850.] Periscope. 177

obstruction to the entrance of air into the air-cells through the smaller
air tubes, the lower end of the sternum and the adjoining cartilages fall
backwards during inspiration, while the upper part of the chest, ex-
pands, and the diaphragm descends with great power.

In pleuritis, with pleuritic effusion, the inspiratory expansion of the
whole of the affected side of the chest is diminished, abolished, or, in
some cases, even reverse, while that of the opposite side is throughout
exaggerated. The inspiratory motion of the abdomen is also lessened
or abolished in the affected side, while on the opposite side it is in-
creased.

When the whole of the lung is consolidated from gray hepatization,
or tuberculous deposit, or condensed from firm tendinous adhesions fol-
lowing pleuritis, then the expansion of the whole of the affected side is
diminished, arrested, or reversed ; while that of the healthy side is
exaggerated.

When the upper lobe is affected with phthisis, or pneumonia, or any-
other local disease, the expansion of that lobe is interfered with, and
the inspiratory motion of the ribs over the affected lobe is diminished ;
while that of the ribs over the opposite lobe is usually increased.

It is not, however, alone in diseases of the upper lobe, that the
motion of the ribs over that lobe, namely, the five superior ribs, is
diminished, as the respiratory motion is lessened, or even arrested,
when those ribs are injured or diseased, or when the intercostal
muscles moving them are inflamed, or affected with pleurodynia, or
when the motion of those ribs would produce pain or injury in the ad-
joining scapula, shoulder joint, or arm, when they are injured or in-
flamed.

When the lower lobe is the seat of pneumonia, or any other dis-
ease, the motion of the ribs over thnt lobe is usually, but not in every
case, diminished ; and the motion of the abdomen just below the ribs,
on the affected side, is always diminished in these cases.

When the heart is enlarged, and still more when it is adherent,
there is diminished motion of all the ribs on the left side, with the ex-
ception usually of the second and third. If there be pericarditis, the
motion is still more interfered with, and the motion of the abdomen
just below the xiphoid cartilage is also much affected, being in all
cases lessened, and, in some extreme cases, quite interrupted. While
the motion of the centre of the abdomen is diminished, that of the ab-
dominal walls at each side is usually not affected.

In peritonitis, if the disease be general, the abdominal motion is
universally diminished ; if it be partial, the diminution of respiratory
motion is most marked over the immediate seat of the inflammation.

Dr. Sibson concluded by calling attention to the value of the signs
afforded by the modification of the respiratory movements in disease,
and to the aid which those signs give in arriving at an accurate
diagnosis. The nature of the disease cannot be detected by the ob-
servation of the signs just indicated, but its seat is at once pointed out.
In those persons who are really healthy, but who imagine themselves
to be the subjects of chest-disease, the observation of the movements

.v. s. VOL. vi. no. in. 12

178 Periscope. [March,

of respiration will almost always give the satisfactory, conclusive,
and very comfortable knowledge, that the chest is healthy.

In general, the information as to the respiratory movements afforded
by touch and sight is quite sufficient, but, in cases of difficulty, the ob-
servations may be rendered minute and accurate by the aid of the
chest measurer.

On the Comparative Pathology of the Different Races of Men,
(Annales d'Hygiene. Med. Chir. Rev.) M. Boudi^ has for some
considerable time been engaged in furnishing statistical proof of the
erroneousness of the doctrines of acclimatization, which suppose that
long residence habituates men to climates otherwise unfitted tor them.
He has brought forward, in his various communications, of which
this forms one, ample proof of the little success and the great mortal-
ity that have attended the attempts at the colonization of Algeria. In
the same way, the European has always failed in fixing himself in
Egypt, and the French cannot propagate their race in Coisica. He
pays a well-deserved compliment to the British government for having
availed itself of a knowledge of these deleterious influences, in the
more judicious distribution of its troops in recent times. Thus, by
adding to the British troops auxiliaries recruited among races whose
physiological and political aptitudes suited them to the respective cli-
mates, by selecting for the European troops serving in warm climates
the most elevated regions, and by shortening the time of service abroad,
it has effected a remarkable diminution of mortality a diminution
which, in the most unhealthy possessions, has amounted even to fifty
per cent. He contrasts this with the large mortality which still pre-
vails among the French troops serving in analogous regions. The
differences of the comparative mortality of the different races placed
under different circumstances, is seen by examining that of the white
and the negro population. Thus, while at Philadelphia the mortality
of the whites is 24 per 1000, that of the negroes is 47 ; that of the
whites 10 years old and upwards being, at New York, 15 per 1000,
that of the negroes 26. At the Eastern Penitentiary, 20 per 1000
whites and 70 blacks die ; while at Weathersfield, the numbers are
28 and 100 respectively ; and the same enormous disproportion is
observed in other prisons. The great mortality is especially due in
the negro tribes to phthisis and typhus; while the negro is so proof
against malaria, which carries off so many whites, that a due observa-
tion of this fact has enabled the British government to diminish won-
derfully the mortality of their troops employed in the East and West
Indies. In the West Indies, the mortality of the negro soldier, com-
pared to the white one, is but as 40 to 78 per 1000; and in Sierra
Leone, it is 16 times less than that of the white. The latter are 160
times more fatally affected by fevers than the negro ; and it is only
in diseases of the chest that they enjoy a somewhat greater immunity
(4.9 to 6.3 per 1000). Even in the most southern station in Europe,
Gibraltar, however, the negro mortality (62) greatly exceeds that of
the white soldiers (21.4), though these are also strangers to the soil
the diseases of the chest in the negro amounting to 43 per 1000.

1850.] Periscope. 179

In respect to the Sepoys, their mortality, at the different stations, is
three or four times less than that of the English soldier; and they en-
joy a remarkable immunity from diseases of the chest and liver, but
are more prone to dropsies, owing to the endemic prevalence of the
beriberi. The mortality of the Hotientot soldier at the Cape is very
small, half of the deaths arising from diseases of the digestive organs.
They, too, are more prone to diseases of the chest than the white sol-
dier. Many facts tend to show that the Jews, even amidst wide-spread-
ing pestilences, have enjoyed great immunities ; and that they pre-
eminently possess the power of acclimatization.

M. Boudin concludes the present paper with some observations on
the diseases and mortality of the icar-horse. In 1645, of an effective
force of 33,6 IS horses, the French cavalry lost by death 2603, and
by discharge 2511. Of an effective force of 41,793, in 1646, 2679
died, and 3314 were discharged. While the general loss by death
and dismissal, in France, was 143 per 1000, it was in Algeria 240.
In 1636, the mean annual mortality was 197 per 1000 ; 126r in 1841 ;
108 in 1-42: 71 in 18 13: 76 in 1644: 77 in 1645 ; and 66 in 1646
a diminution constituting one of the greatest triumphs achieved by
the application of sound hygienic and administrative measures. How
much yet remains to be done, however, is shown by the fact that the
Prussian cavalry only loses 20 per 1000, and the French gendarmerie
14 per 1000. The largest mortality takes place in the finest quarter
of the year from April to October : while the smallest corresponds
to the cold season of the year a fact chiefly attributable to the sus-
pension of mancevres during the latter period. The most frequent
causes of death, both in France and Algeria, are glanders and dis-
eases of the respiratory organs. The glanders gives rise to ten times
the mortality in Algeria to that produced in France a difference, If*
Boudin thinks, that may be in part explained by the fact of so many
mules (5695, in a force of 16.538) being employed in the former
country the disease almost always attacking these animals in the
acute form. In 1646, the Minister of War consulted 136 army vete-
rinary surgeons, as to whether this disease is contagious. No answer
was returned by 12 : 24 were uncertain ; 36 were non-contagionists ;
and 64 contagionists.

Cases of Inveterate Sciatica, treated by the actual cautery. By Dr.
Payan, of Aix. (Gaz. Medicale.) Case I. A plasterer, 34 years of
age, was admitted to the Hotel-Dieu of Aix, affected with sciatica of
15 years standing. Bearing his pain with great fortitude, he had but
seldom been compelled to relinquish his avocation. The attack which
brought him to the hospital was, however, more severe than heretofore,
and had now lasted six month-. Meet of the usual remedies had
been tried without success. During the day the limb would be pain-
ful and benumbed, but during the night tin.- pain would become in-
tense and lacerating, extending along the entire course of the nerve

180 Periscope. [March,

and its subdivisions, but especially behind the trochanter, in the ham,
and upon the dorsum of the foot. Fifty leeches were twice applied,
followed by turpentine enemata, and blisters and morphine to the de-
nuded surface. The patient was so far relieved as to be able to re-
sume his occupations in 18 days. The pains, however, very soon
returned with increased intensity, and the patient returned to the hos-
pital. Two moxas applied along the course of the nerve near the
trochanter, and frictions with anodyne liniments produced some relief,
yet the pain in the hip and back of the leg remained undiminished.
M. Payan now applied the cautery with a white heat (about 3 centi-
metres long) between the metatarsal bones sustaining the little toe and
that next to it. The relief was complete. The patient slept well the
following night and experienced no more pain whatever. The burn
healed in 28 days. The patient has been frequently seen since and
continues perfectly well. The case wras treated towards the close of
1847.

Case II. A man 45 years of age, had suffered with sciatica six
years, when (in 1848) the pain being increased, he consulted M.
Payan. The pain was located principally along the nerve and its
branches, from the hip to the toes. Cauterization was made between
the metatarsal bones (as in the above case), the wound healed in 31
days, and the cure was complete. The patient had suffered no re-
turn 18 months after the treatment.

Case III. This patient, aged 46 years, had suffered with sciatica
five years. M. Payan saw him on the 22d Nov., 1848, in an attack
of 10 days standing. The pain was seated in the left thigh and leg.
40 leeches were applied behind the trochanter and morphine admin-
istered, with slight relief, which soon subsided. On the 24th Nov.,
the sufferings were as great as ever. Cauterization was now resorted
to as in the above cases. The pains ceased on the instant of its ap-
plication, and had not returned a year after the treatment. This was
35 days in healing.

Case IV. A female, aged 35 years, entered the hospital the 6th
Nov., 1848, with sciatica of the left limb, which had existed since the
January preceding. The pain was felt principally along the external
and posterior surface of the leg, and extended to the toes. Although
somewhat relieved by blisters, it was still very intense. Cauterization
between the metatarsal bones was here also completely successful.

It remains to be determined whether a similar treatment wTould
be successful in cases in which the pain did got extend to the foot
or toes.

1850.] Periscope. 181

Treatment, of Insanity. (Gaz. Medicale.) Mi Brierre-de-Boismont,
of Paris, manager of the Insane Asylum, has just published a memoir
the object of which is to demonstrate from clinical observations, that
all varieties of acute insanity and mania may be cured, in from one
to two weeks, by the use of protracted baths and continued irrigations.

On Nervous or Convulsive Cough. By M. Sandras. (Bulletin
de Therap. Med. Chir. Rev.) There are several species of this :
1. The patient can receive no physical or moral impression, without
suffering from a cough almost convulsive in its character. In exam-
ining the chest of such a person, the physician may be led into griev-
ous error, and the unnecessary fear of incipient phthisis, unless he
examines it on various occasions and under different circumstances.
Patients with incipient phthisis also cough from the slightest cause ;
but it will be generally found that in those cases the impression is
physical, while in those we are alluding to it is oftener moral.

2. Another form of cough, having some analogy to this, is observ-
ed whenever certain functions are brought into play, or when they are
more actively exerted than usual. Thus, it is found in some whose
meals have been too long delayed ; in others, as soon as they have
eaten, especially if rather fully. Other persons cannot take a little
extra-muscular exertion without bringing on a tormenting cough of
this kind. In both this and the preceding form, the cough is dry and
capricious, exhibiting very inconstant physical signs; but this latter
form is somewhat more fixed in character than the first, inasmuch as,
in the same person, it is always when the same function is fulfilled
that it is produced ; and it seems, too, to be more dependent upon dis-
order of the organs in connection with the exercise of whose functions
it appears ; and this should be our chief guide for its treatment.

3. Another cough is observed upon the slightest irritation of the
bronchi being produced ; so that the least cold brings on a convulsive
cough nearly as bad as that of pertussis. Sometimes, and especially
in children and very young adults, it takes on this form at the very
commencement of the cold, and retains it until coction is produced.
Each paroxysm is accompanied by a dry, raucous sound, and attempts
at vomiting. Sometimes it is periodical, the disease only gradually
assuming the characters of an ordinary ripening catarrh. In other
cases, the spasmodic character is only observed as the cough is draw-
ing towards an end. Instead, however, of coction taking place, the
expectoration continues frothy and transparent, and is only ejected by
convulsive efforts and vomiting the paroxysm being brought on by
the slightest cause, and a state of spasmodic suffocation being almost
induced, until a little transparent and frothy matter is expectorated,
when all becomes quiet and normal until a new paroxysm. In some
cases, the cough suddenly ceases, without the expectoration having
undergone any change ; but this is rare. The causes of this pertus-
soid cough are not of easy appreciation. At the commencement, all
is like a common cold ; and it is the reiterated catching cold in an

182 Periscope. [March,

eminently neuropathic subject that seems to induce the aggravation.
The prognosis, as regards immediate danger, is favourable ; but is
more serious in respect to future consequences, owing to the various
evil consequences which may ensue upon the congestions the parox-
ysms give rise to. The destruction of sleep and disturbance of
digestion which it causes are other important circumstances. Among
the more serous results, is the production of hernias and emphysema
pulmonum. The irritation of the glottis and larynx should be re-
lieved by tepid aqueous or narcotic vapours, and by the use of
demulcent emulsions with laurel- water. When the expectoration is
difficult, syrup of poppies, with small doses of tartar emetic, should be
given, the antimony, whether it causes vomiting or not, affording
great relief. So, too, small doses of extract of belladonna every night,
or night and morning, should be given when the expectoration is
somewhat modified, and in a few days the convulsive character of the
cough usually abates. When this drug disagrees with the patient, it
should be used endermically.

4. This variety may be called hysterical, from its occurring in
hysterical patients. In a subject whose respiratory organs are habit-
ually in a good condition, all at once an irregularly paroxysmal cough
comes on, occurring at frequent intervals, and sometimes almost with-
out intermission. It does not terminate with the expulsion of mucosi-
tes, but is either dry and objectless, or is accompanied by a true
phlegmorrhagia. Hysterical phenomena sometimes precede or ac-
company the cough ; while at others it ceases instantly that these ap-
pear. The cough is found to get worse and worse, in proportion to
the development of the hysteria ; and this without any physical expla-
nation of its intensity. The pulse is not febrile, but may be irregu-
lar, and such a one as is found in nervous subjects. The prognosis is
favourable, unless the cough is mistaken for a phlegmasia, and ag-
gravated by maltreatment. The treatment is, in fact, that which is
proper for hysteria; but two means are especially indicated the use
of belladonna, and the employment, of baths." Belladonna, given in
doses of one-seventh of a grain every half hour, is highly efficacious:
and it is rare for five or six doses to be given before improvement is
visible. Baths at from 84 to 89 act as if by enchantment ; but
sometimes it is useful to give them at from 75 to 82 ; and this is the
temperature which will in most cases prove the best, after the patient
has already employed the higher.

Treatment of Nervous Cough with a gargarism of Sal. Ammoniac and
Spirits of Mindererus. (Annales Soc. Med. d'Emulation. Jour, des
Con. Med. Chir.) At the close of catarrhal affections, and especially
of the grippe, there is often a dry and purely nervous cough, excited
by a tickling sensation in the larynx or throat. This cough, in some
instances, ceases for a time, but soon returns with increased intensity.
In such cases, Lceffler advises the frequent application of gargles of

1850.] Periscope. 183

sal. ammoniac dissolved in spirits of mindererus, as a very successful
treatment. Its efficacy was exhibited in the case of a young man,
who, at the close of an intense bronchitis, was troubled with a dry,
fatiguing cough, which resisted both narcotics and derivatives. The
gargarism of Loeffler, with the addition of laudanum, in two days re-
moved this cough which had continued for three weeks. The follow-
ing is the formula :

ft Distilled water, 360 grammes.

Hydro-chlorate of Ammoniac . 15 "
Spirits of Mindererus, ... 24 "
Sydenham's Laudanum, . . 12 "
Syrup of Diacodium, ... 30 "
Make a gargarism.

Conclusions in relation to Angina Pectoris. By Samuel Kneeland,
Jr. (Amer. Jour. Med. Sciences.) 1. From the symptoms and
morbid appearances, angina pectoris is not a disease of the lungs,
heart and its vessels-, or stomach ; but an affection of the nerves sup-
plying these organs.

2. Anatomy, physiology, and pathology would lead us to place the
seat of angina pectoris in the par vagum, and not in the sympathetic
system of nerves.

3. Like other nerves, the par vagum maybe affected with neuralgia
and rheumatism ; with inflammation ; it may be compressed by mor-
bid growths ; its spinal origin may be compressed by hemorrhage,
accidental wounds, and various irritations all of which may cause the
symptoms of angina pectoris.

4. Angina pectoris and asthma are intimately related ; the former
being an affection more especially of the sensitive filaments of the par
vagum ; and the latter an affection of its motor filaments. Both are
generally more or less combined in the same case.

5. Angina pectoris is a disease not necessarily fatal, especially in
young persons, if accurately diagnosticated, and properly treated.

6. In addition to the remedies of the books, special attention should
be given to the inhalation of oxygen, and to the use of electricity.

7. In cases of angina pectoris, attention should be directed to the
examination of the par vagum, from its origin to its terminations,
which, doubtless, on careful examination, \vill exhibit lesions sufficient
to account for a fatal result.

Chronic Articular Rheumatism treated with Applications of the Tinc-
ture of Iodine. (Theses de Strasbourg. Bulletin-Gen. de Therap.)
M. M. Held and Gros, have called the attention of physicians to the
beneficial effects of the application of tincture of iodine to the affected
joints in all stages of chronic rheumatism. The tincture they employ

184 Periscope. [March,

contains one part of Iodine, to ten parts of Alcohol at 33. They re-
port a number of cases in which this treatment was most beneficial.
They state that the local action of the Iodine much resembles that of
vesicatories, tartar emetic, or nitrate of silver. It seems to act on
several elements of the articular affection ; it promptly mitigates the
pain and hastens the absorption of the fluids effused into the articula-
tion, or infiltrated into the adjacent tissues. Moreover this application
produces no pain, but only a slight sense of warmth in the parts upon
which it is made. The first applications sometimes produce some sen-
sation of the integuments, which causes a merely temporary incon-
venience. In some few subjects, vesicles similar to those pro<tuced by
blisters follow the application of the Iodine, but in no instance is there
any considerable inflammation of the skin, or erysipelas. The tinc-
ture as applied by wetting with the tincture of Iodine a pretty long
compress, which is to be wrapped around the diseased joint, and se-
cured by a bandage. The application should be renewed night and
morning. When the skin is very delicate and is vesicated, thj tinc-
ture should be diluted with water, or the application suspended.

Chronic Tonsillitis. (Allgein Med. Central Zeitung. Journ. des
Con. Med. Chir.) Dr. Schallenburg recommends that chronic tonsil-
lar angina should be treated with the application of a tartar emetic
plaster between the shoulders. The pustular eruption usually mani-
fests itself in forty-eight hours, at which time the inflammatory symp-
toms will be found to have diminished. Dr. S. states that he has had
many opportunities for demonstrating the value of this treatment, both
on himself and on other persons.

Cure of Hydrophobia. (London Lancet.) M. Rocher d'Hericourt,
who has lately returned from a journey to Abyssinia, has brought
with him manuscripts of great literary value, and has collected all the
facts calculated to throw light on geology, mineralogy, botany, and
other branches of science. He has likewise brought with him numer-
ous specimens of a plant, the root of which, reduced to powder, is a cure
for hydrophobia, both in men and animals. Of its virtues M. d'Heri-
court had practical proofs. Four dogs and a man having been bitten by
a mad dog, they were, by the application of this remedy, cured of the
hydrophobia which ensued ; whilst the fourth dog, (bitten at the same
time, by the same animal,) to which the remedy was not applied,
perished in all the agony ot that terrible disease. The virtue of the
plant, and the manner of preparing it for use, were explained to the
traveller by a potentate of the country, who assured him that it was
there generally used, and never failed. The specimens brought
over by M. d'Hericourt have been submitted to the Academy of

1850.] Periscope. 185

Sciences of Paris, and a committee has been appointed to test their
efficacy.

Means of arresting the fatal effects of Chloroform. In an article
published in the Bulletin General de Therapeutique, M. Ricord reports
two cases in which the apparently fatal effects of the inhalation of
chloroform were remedied by a very simple process. The first case
was that of a woman from whom some small vegetations were to be
removed. She breathed the chloroform from a sponge, and its anaes-
thetic effects were rapidly produced. Scarce had a cut or two been
made with the scissors, before M. Ricord's assistant informed him that
the pulse was extinct In fact, the pulsations of the heart had ceased,
the lips were livid, the limbs completely relaxed, and the face present-
ed the cadaverous aspect that is the precursor of death. The ordina-
ry treatment was promptly resorted to, but without effect. M. Ricord
then applied his mouth to that of the patient, and insufflated the lungs.
After a few insufflations, the patient sighed, the chest began to dilate,
the visage to resume its natural hue ; the heart and pulse began to
beat in an appreciable manner, and the eyes opened. In another case,
that of a man who was about to undergo circumcision, the same
alarming symptoms were produced, and were promptly removed by
the same means.

Since the publication of M. Ricord's cases, M. Escallier, in the
Revue Medico-Chirurgicale, reports two cases, in which apparently
fatal consequences followed the use of the chloroform, employed to
facilitate the reduction of hernia. In one case, the chloroform was
inhaled from a sponge for three minutes, at which time the pulse and
respiration had entirely ceased. Cold water, titilations of the nostrils,
and ammonia, were tried without effect. M. Escallier then thrust
two of his fingers deep into the throat, even to the openings of the
larynx and oesophagus. Immediately a movement of expiration an-
nounced a restoration of vitality. In the second case, the chloroform
was respired from a fine handkerchief for about five minutes, when
the appearances presented by the patient induced M. Escallier and his
assistants to suppose that death had actually occurred. Two fingers
were at once thrust as deeply into the throat as possible, and suffered
to remain there about a minute, when a strong expiration took place,
and the patient was restored.

A writer in the Boston Medical and Surgical Journal, H. G. Luther,
dentist, reports a case in which electricity very promptly relieved a
female in whom chloroform had produced a most alarming prostration
of the vital powers.

186 Periscope. [March,

On the Therapeutic Properties of Belladonna. By Dr. Debreyne.
The Journal des Connaisances Medico-Chirurgicale for the 1st De-
cember, 1849, contains a lengthy letter from Dr. Debreyne on the
therapeutic properties of the belladonna, in which he speaks most
favorably of its effects in several diseases. He states that he has em-
ployed this remedy almost daily since 1815. We propose to give a
brief abstract of his letter.

Hooping Cough. Dr. D. states that he has employed the belladonna
in hooping cough with great success, especially in a fatal epidemic
which prevailed in 1817 and 1818, at Mortagne (Orne) and its envi-
rons. The dose was generally governed by the age of the child. One
grain for every month of the patient's age was given in the course of
twelve days, which was the ordinary duration of the treatment. For
children over six years, the dose was never carried beyond three
grammes (sixty grains) during the twelve days. The quantities
named were divided inlo twelve equal parts, and one given each day.
The larger doses were again divided into three portions, and taken at
intervals through the day. It must be observed that Dr. D. employs
the root of the belladonna alone.

Epilepsy. Since 1815, Dr. D. has employed the belladonna in
epilepsies, and other convulsive nervous affections, and deems it a
heroic remedy in these diseases. He employs an extract, for which
he has given the formula, and though ordinarily the doses have not
been carried beyond 5 or 6 grains a-day, yet in some of the cases
cited, they were carried to the extent of 13 grains in the twenty-four
hours, and that without any unpleasant effect. In one instance, it
was given daily in 4 grain doses for twenty months, without incon-
venience, and with entire success. He cites numerous cases which
have been successfully treated with the belladonna by his medical
friends. In many of these cases, proper auxiliary treatment was
adopted. Dr. D. however admits that there are epilepsies over which
this medicine exerts no control, and some which are even exasperated
by its use. Yet he suggests that in some of the instances of failure,
the article employed was probably badly prepared.

Hysteria. Dr. D. cites a case of hysteria of six years duration,
attended with convulsions and other distressing symptoms which re.
curred at intervals of a few days. He began the use of the belladon-
na, and the doses were carried to the extent of 7 grains a-day. At
the expiration of six months a cure was effected. He also gives the
history of another case, in which sudden fright was followed by a state
of mental alienation, and a nervous attack, attended by an entire loss

1850.] Periscope. 187

of consciousness every night at a fixed hour. These attacks were
always preceded by the globus hystericus. This patient was subject-
ed to a variety of treatment. Quinine was given for fifteen days with-
out effect. She was put upon the use of Dr. D.'s anti-hysteric pills,
two a-day, each containing two grains of the extract of belladonna.
An immediate amendment followed, and the disease disappeared by
the fourth day, with the exception of slight gaping. The pills were
continued for a month. All the world, and especially the physicians,
says Dr. D. " en etaient dans la stupefaction et V admiration. The
following is the formula for his anti-hysteric pills :

R. Camphor, 12 grammes.

Assafoetida, 12 k<

Ext. Belladonna, 4 "

Watery Ext. Opium, 1 u

Syrup of Gum, q. s.

Divide the mass into 120 pills. Of these, the dose is one on the first
day, two on the second, and thus augmented a pill each day until it
reaches six pills, which are to be taken, two, morning, noon, and night,
two hours before eating.

Chorea. Dr. D. states that he usually treats cases of Chorea with
his anti-hysteric pills, and that the disease readily yields to the reme-
dy. He admits, however, that in many instances it returns when the
medicine is discontinued.

Neuralgias, local nervous pains, etc. Acute neuralgic pains, oc-
cupying all parts of the head, have been successfully treated with a
pomade of belladonna, after all other treatment had failed. Much
relief was afforded by it on the first day, and a cure was effected in a
month. The belladonna was equally successful in an intense neural-
gia of the scrotum, and also in a case of frontal neuralgia with daily
exacerbations, which had continued for eleven years in despite all the
usual remedies. Dr. D. refers to a case of intense facial neuralgia in
which the belladonna proved successful, but from some peculiar idio-
syncracy, or special disposition of the optic nerve, it impaired the
vision, and produced great dilatation of the pupils, which lasted for
several weeks. This is the only instance of any unfavorable effect
which came to his knowledge. The following is the formula for the
pomade that he employs :

R. Extract of Belladonna, 12 grammes.
Hogs lard, .... 12 "

Opium, 2 "

Mix thoroughly, and add a few drops of oil of thyme to aromatise it.

188 Periscope, [March,

A portion of this pomade about the size of a hazelnut is to be rubbed
on the affected parts thrice a-day, and especially when the pain is
most severe. Each friction should be continued for five or six min-
utes. If the sight becomes much disturbed, the frictions should be
discontinued.

Nyctalopia. Dr. Debreyne has employed a collyrium or ointment
of the extract of belladonna with success in many cases of this affec-
tion.

Asthma, etc. For thirty years Dr. D. has treated "nervous asth-
ma," and spasmodic dyspnoea, simulating sternalgia or angina pectoris,
with the powder of the root of the belladonna, combined with expec-
torants, as the squills, kermes, etc. He says, " we have administered
this anti-asthmatic powder more than one hundred times, and never
in vain."

Nervous Coughs. Pills of belladonna have been found useful in all
coughs which were not the result of acute thoracic inflammations.
In these cases, a pill containing one grain of the extract was given
night and morning. In hiccup also, this remedy was generally found
serviceable.

Photophobia. Dr. Debreyne states that he has often employed with
much advantage, a collyrium made with two grammes of extract of
belladonna in 125 grammes of rose-water, in excessive exaltations of
the optic sensibility, and particularly in that of scrofulous ophthalmia.
Dr. D. states, further, that he has found this article of utility in cases
of cataract incontinence of urine, and spasmodic constriction of vari-
ous orifices. He deems it our most valuable remedy in most nervous
derangements. Although highly valued by many, the belladonna is
but seldom employed by others, who from frequent disappointments
are disposed to think its virtues overrated. It is probable that much
of the article in general use is imperfectly prepared.

Belladonna in Incontinence of Urine. (Gazette Medicale.) M.
Cauvin recommends the use of the powder and extract of Belladonna
in incontinence of urine, and especially in that form wrhich proves so
troublesome to children. Administered in small doses, two or three
times a day for a few weeks, he found it often entirely successful.

New Preparation of Opium. By W. M. Cornell. (Boston Med.
and Surg. Journ.) Some three years since, I saw, in the Dublin
Medical Press, a statement from Dr. Nichol, that he had made, and
used in his practice, and also given to some of his friends, who also
had used the same, what he called " Muriate of Opium.''' Their tes-

1850.] Periscope. 189

timony was, that it was far preferable to any other solution or prepara-
tion of opium. Having tried the acetate and sulphate of morphia and
the common tincture of opium, and that prepared by citric, tartaric,
sulphuric, and almost all the other acids, they found all these leave
the patient with headache, constipation, and many other unpleasant
symptoms; but the muriate of opium answered all the indications of
that drug, and left none of the unpleasant sensations. Dr. NichoPs
formula was the following: ft. Pulv. opium, 1 oz. ; muriatic acid, 1
oz. ; distilled water, xx oz. Mix. Macerate (often shaking the liquid)
for fourteen days. Strain and filter. The dose was from twenty to
forty drops, according as circumstances should indicate not varying
much from the tinct. opii.

I tried this preparation, and found it answer the description. Out
of twenty persons who took it, none complained of headache or unpleas-
ant sequences. But it was not of a good color, and soon grew muddy,
and seemed to be decomposed. I therefore made some modifications
of the preparation, until T fixed upon the following formula, which an-
swers admirably, and makes and retains the beautifully red and clear
form of that which 1 herewith send you. I use no other preparation
of opium, except the powdered gum in diseases of the bowels.
R. Pulv. gum opii, i; muriaticacid, %\. ; distilled water, gxvi. ; red
brandy, iv. Mix, &c. It is of nearly the strength of the tincture of
opium, and, I think, much preferable to that of McMunn's elixir.

Lithotomy during Labour. (London Lancet.) Dr. Monad related
the following case at a late meeting of the Surgical Society at Paris :
The patient, forty years of age, was pregnant for the first time, and
had arrived at the natural term of gestation. After the evacuation of
the liquor amnii, the labour did not progress, in spite of very sharp
pains : and it soon became evident that the expulsion of the foetus was
prevented by a large tumour in the vagina, situated in its anterior wall.
The tumour was hard: it closed almost completely the orifice of the
vagina, and it was easy to perceive, by the consistence, form, situa-
tion, and mobility of the swelling, that it was formed by a stone lodged
in the bladder. The diagnosis was rendered still more conclusive by
the introduction of a catheter, which was, however, passed with great
difficulty, owing to the displacement of the urethra. Dr. Monad in-
troduced the index of his left hand under the tumour, with the pulp of
the finger looking towards it, and gliding a common straight bistoury
along this natural director, he made a vertical incision upon the tu-
mour. This incision proved somewhat difficult owing to the inequali-
ties of the calculus. The hasmorrage was rather large, but soon
stopped. The author then tried to seize the stone with forceps, but
finally succeeded in removing it with his fingers only. The stone
weighed almost three ounces, and was very hard. The patient had
been placed under the influence of chloroform, and was delivered by
the forceps while still in an anaesthetic state. The child was alive,
but soon expired, the forceps, as it is feared, having pressed against
a fold of the cord which surrounded the neck of the foetus. The

190 Miscellany. [March,

woman has done very well ; and five days after the operation, the
urine was passing along the urethra, without any trickling through
the wound.

ill e Meal JHiBctllang.

Medical Society of the State of Georgia. The annual meeting of
this Society will be held in the City of Macon, on the second Wed-
nesday (10th) of April next. An .Address will be delivered before
the Society, by Dr. R. D. Arnold, of Savannah. Members of the
Medical profession who may desire to procure copies of the last year's
proceedings, can obtain them by addressing, post-paid, Dr. J. M.
Green, of Macon, the Corresponding Secretary, or the undersigned,
at Roswell, Cobb County. C. T. Quintard, Rec. Sec.

By an oversight of the Secretary of the State Medical Association,
it was announced in our last number that the next annual meeting
would be held on the 20th March. It will be seen, that this meeting
will take place at Macon on the second Wednesday (10th) in April.
We hope there will be a general attendance on that occasion, and
that no one entitled to membership, will fail at least to have his appli-
cation for membership submitted at that time. The advantages to be
derived from an association which will concentrate, and give vigor to
the efforts now being made for the advancement of medical science,
and for the protection of professional rights and interests, are too ob-
vious to have escaped the attention of the most superficial thinker.

We publish, for the information of those physicians in Georgia who
are not members of the Society, the following extracts from the
Constitution :

"Art. III. 1. The Society shall consist of every person now
present as a member of the State Medical Convention who is a
graduate of a respectable Medical College, or who may be authorized
to practice by the legislative act of 1839, re-constituting the Medical
Board of the State, and who shall conform to the regulations of the
Society.

" 2. Any member of the Profession, thus qualified, can hereafter,
on written application to the Society, through the Corresponding Se-
cretary, be admitted to it. by a two-thirds vote of the members present.

"Art. VII. 1. The Society shall hold an annual meeting on
the second Wednesday in the month of April of ea'ch year."

" St. Louis Probe." We have received a new monthly Medical
Journal, bearing this title, and conducted by A. J. Coons, M. D., and

1850.] Miscellany. 191

John R. Atkinson, M. D. We cordially welcome this new laborer
in the field of medical science, and doubt not that it will do credit to its
"two fathers, several wet nurses, and numerous godfathers."

On the action of Chloroform on the Sensitive Plant {Mimosa Pudu
ca.) By Prof. Makcet, of Geneva. (Amer. Jour. Pharm.) When
one or two drops of pure chloroform are placed on the top of the
common petiole of a leaf of the sensitive plant, this petiole is seen
almost immediately to droop, and an instant after the folioles close
successively pair by pair, beginning with those which are situated at
the extremity of each branch.* At the end of one or two minutes,
sometimes more, according as the plant is more or less sensitive, most
of the leaves next to the chloroformed leaf and situated beneath it on
the same stalk, droop one after another, and their folioles contract,
although generally in a less complete manner than those of the leaf
placed in immediate contact with the chloroform. After a rather
long time, varying according to the vigor of the plant, the leaves open
again by degrees ; but on trying to irritate them by touch, it is seen
that they have become nearly insensible to this kind of excitement,
and no longer close as before. They thus remain as torpid for some
time, and generally do not recover their primitive sensitiveness till
after some hours. If, however, when they are in this state of appa-
rent torpidity, they are subjected again to the action of the chloroform,
they close again as they did the first time. It is not till after they
have been chloroformed several times, that they lose all kind of sen-
sitiveness, at least until the next day : sometimes they even fade com-
pletely at the end of too frequent repetitions of the experiment. In
all cases the effects observed are the more marked in proportion to the
purity of the chloroform emplojed and the degree of sensitiveness in
the plant.

Mortality of England. (Bulletin Gen. de Therap.) The mean
mortality in England at this time is 350,000 annually that of London
47,000. As the population of England and Wales is about 1G mil-
lions, and that of London about 1,900,000, it follows that the annual
mortality for the metropolis is 1 in 40, and for the whole kingdom 1
in 45. At the commencement of the eighteenth century, the annual
mortality in England amounted to 1 in 25 ; and towards the middle of
the last century, under the influence of causes not known, it increased
to 1 in 20. Since that period to the present day, the annual mortality
has steadily decreased; in 1801, it was 1 in 35; in 1811, 1 in 38 ;
and now, 1 in 45 ; so that in 40 years the probabilities of life have
been doubled. This result is without parallel in the history of any

* I previously convinced myself by experiment that a drop of water, placed
delicately on a leaf of the sensitive plant, caused no movement.

192

Miscellany. Meteorology.

other people. In Paris, about the middle of the last century, the rate
of mortality was 1 in 25 ; it is now 1 in 32. In Rome, the annual
average is 1 in 25 ; in Amsterdam, 1 in 24 ; in Vienna, 1 in 22. An
inhabitant of London, therefore, has double the chances for life pos-
sessed by a resident of Vienna.

C^The Transactions of the American Medical Association have
been received, but at too late a period to permit us to notice them in
this number. These proceedings make an octavo volume of 956 pages.
To procure this volume, three dollars, in par funds, must be remitted
to Dr. Isaac Hays, Philadelphia, Treasurer of the Association. Every
physician should procure a copy.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet. By Dr. Paul F. Eve.

lor January, J850, at Augusta,
32' west Wash. Altitude above

Sun Rise.
Thkr. Bar.

32
40
46
51
34
43
42
49
42
48
48
50
41
41
38
44
53
62
47
49
46
42
39
48
25, 51
26 60

GO
60
48
37
33

2, P. M.
Ther. Bar.

30 12- 109
30 10-100

29 87-100
" 65-100
" 99-100

30 10-100

29 92-100
75-100
90-100
95-100
44-100
63-100
73-100
90-100

30 11-000,
30

29 84-100
" 60-100
" 80-100
" 93-100
56-100
" 70-100

30

30 7-100,
30

29 94-100
" 77-100
63-100
" 80-100

30 11-100
J30 26-100

46

58
62

60

56

30

46

30

48

29

62

"

54

50

it

70

;<

69

62

(t

54

30

50

30

56

20

73

68

K

62

"

53

ii

50

H

60

((

69

30

72

30

76

29

76

:

63

"

60

1!

63

li

60

30

56

30

17-100
93-100
79-100
78 100
3-100
6-100
71-100
78-100
97-100
78-100
39-100
67-100
66-100
3-100
11-100
92-100
76-100
58-100
90-100
78-100
50-100
81-100
3-100
5-100
95-100
85-100
74-100
57-100
92-100
23-100
26-100

Wind.

w.
s. w.
s. vr.

w.

E.

E.
S. E.
S. W.

W.
N. E.
S. W.

w.

S. E.

s.
s.

N. E.

E.
N E.

W.

E.

S.

S.

s.

s. w.

s.

N. E.
N. E.

Remarks.

Cloudy very white frost.
Cloudy.

Fair, part of afternoon.
Flying clouds strong wind.
Fair, part of afternoon.
Cloudy rainy. [at 1, p.m.

Rain, 45-100 thund. and light.
Cloudy.

Cloudy. ) two nights and one
Rain, $ day, 1 inch 5-100.
Cloudy storm.

ICl'dy afternoon, [light. 40-103,
j.Cl'dy rain at 7, p.m. thun. &
Fair, part of afternoon,
Fair, part of afternoon.
Rain at 2, p.m.
Cloudy sprinkle.
Cloudy rain.

Somewhat cloudy sprinkle.
Rainy.

Rain night and day.
Fair.
Fair.

Fair morning.
Cloudy.

Cl'dy, breeze, rain. ,
CIMy, rainy even'g.J^1^
Rain.
Fair.
Fair.
Cloudy sprinkle.

2 inches.

1 1 *

-(40-]

4 Fair days. Quantity of Rain 5 inches 30-100. Wind East of N. and S.
12 days. West of do. do. 10 days.

Quite a remarkable month. We had no frost in 29 successive days. 1G
rainy days, and only 4 fair days during the whole month.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. APRIL, 1850. [No. 4.

PART FIRST.

Original (Hommunicattons.

ARTICLE VIII.

On the use of Alcoholic Stimulants as articles of Diet and Medi-
cine. By F. M. Robertson, M. D., of Charleston, S. C.

Before entering into the consideration of the nutritive and
medicinal properties of alcoholic stimulants, it will be pro-
per to define the difference between articles of food, properly
speaking, and medicines. The reasons for drawing this dis-
tinction will become apparent as we proceed in the investigation
of our subject.

Aliment, or food, is composed of such substances as, when
taken into the system, contribute to the development and growth
of the corporeal structure, or living tissues ; that is to say, the
substances that contain the elements that enter into the com-
position of the bones, muscles, nerves, bloodvessels, tendons,
and other organs, of which the entire body is composed. A
continual supply of these nourishing substances is necessary to
make up the deficiency in the tissues and organs, occasioned by
the ordinary waste from secretion, absorption, and the wear
and tear of time, mental effort, bodily exertion, and exposure
to the various influences, adverse to health and vigor, with
which we are surrounded.

Under the head of Medicines, we comprehend all those sub-
stances used for the prevention and cure of such diseases as the
human frame is liable to, either functional or structural. They
are derived from the three great kingdoms of nature the

n. s. vol. vi. xo. iv. 13

194 Robertson, on Alcoholic Stimulants. [April

animal, the vegetable and the mineral; and their chemical
composition is as varied as the sources from which they are
derived. Some of them are innocent in their nature, but a
large number possess the most active, acrid, and poisonous
properties, and when improperly administered to the healthy
subject, soon produce derangement of function, structural
disorganization, and death. When used, however, in judi-
cious hands, for the cure and alleviation of those " ills to which
flesh is heir," they become truly valuable instruments of good,
and vindicate the wisdom and benevolence of the great Creator
in endowing finite beings with the power of using them for the
relief and cure of those maladies that often render this life mis-
erable.

Organic Chemistry as the application of this beautiful sci-
ence, to the investigation of the proximate or elementary
constituents of animal and vegetable substances, has been call-
ed has thrown a flood of light upon the composition of those
articles that constitute the largest amount of those elements
essential to vitality and nourishment : that is, the pure pabulum
vitae.

If time would permit, it would be interesting to examine the
process, by which the food is rendered in a fit condition to be
introduced into the circulation ; but, as we do not desire to ex-
tend this article beyond what is reasonable, we must pass over
that truly wonderful process.

* 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
azotised or albuminous compound matter destroyed in twenty-
four hours by life, or organic action, may be taken, on an aver-
age, at two or three ounces." (Dumas' Chimie Physiologique
et Medicate, p. 463.) The blood would rapidly become impov-
erished and unfitted for the purposes of life, unless its losses in
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. Repeated analyses

1850.] Robertson, on Alcoholic Stimulants. 195

have demonstrated that, of the aliment that is adapted to heal-
thy nutrition, one-eighth part only consists of albumen, or its
protein compounds, or their derivative compounds ; and what-
ever is devoid of these substances that is the chemical com-
bination of carbon, hydrogen, nitrogen, and oxygen, in the
proportion to constitute protein (C4 0, H3 0, N5, 012) or albu-
minous compounds cannot perform the offices of food, or be
fitted for nutrition." (Jackson on Tea and Coffee. American
Journ. Med. Sci., vol. xviii., new series, p. 80.) The supply of
the plastic materials necessary to the building up of the tissues
is not the only condition requisite to vitality and life-action.
An uniform and definite temperature, which in man and animals
is from 98 to 100 of Fahrenheit, is also essential to a rigorous
and healthy action of the organization. For this, nature has
made ample provision, by causing it to be abundantly disen-
gaged by the chemical combination of certain elements in the
system. " The mutual action between the elements of the
food and the oxygen conveyed by the circulation of the blood
to every part of the body is the source of animal heat. All liv-
ing creatures, whose existence depends on the absorption of
oxygen, possess within themselves a source of heat indepen-
dent of surrounding objects. The high temperature of the
animal body, or, as it may be called, disengagement of heat, is
uniformly and under all circumstances the result of the com-
bination of a combustible substance with oxygen. In whatever
way carbon may combine with oxygen, the act of combination
cannot take place without the disengagement of heat. It is a
matter of indifference, whether the combination takes place
rapidly or slowly, at a high or a low temperature ; the amount
of heat liberated is a constant quantity." (Liebig's Animal
Chemistry, p. 15.) The carbon and hydrogen which are essen-
tial, by their combination with oxygen, to the production of
animal heat, are introduced into the circulation through the
food, and, consequently, the blood furnishes both these essential
elements to nutritive and life-action.

"The carbon and hydrogen oxidized in the blood," observes
Dr. Jackson, " 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

196 Robertson, on Alcoholic Stimulants. [April,

them a large portion of the food of animals. Not less than
from six-sevenths to seven-eighths of the alimentary substan-
ces 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 and combination with
oxygen introduced into the blood by the process of respiration.
This proposition is demonstrated in the composition of the ali-
mentary 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.''' (Amer. Jour. Med. Sciences,
vol. xviii., new series, p. 81.)

It is from these revelations of organic chemistry, that we
arrive at a precise and accurate knowledge of the nature of
food ; its uses in the economy, and its manner of operating.
We can pronounce with positive certainty as to what substan-
ces do, or do not, constitute appropriate nourishment for the
system, and accurately ascertain the proportionate value of
each article of diet.

From these facts, we also perceive that alimentary substan-
ces, or articles of food, are divided into two distinct classes,
differing from each other essentially in nature, composition, and
mode of action. Under the first division are found the albu-
minous compounds, which, according to the analysis of Liebig,
have nearly the same chemical composition as the tissues them-
selves, and are identical with some of them, and, hence are
specially appropriated to nutrition and repairing the waste in
the solid structures. "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." (Jackson on Tea and Coffee. Amer. Jour.
Med. Sci., vol. xviii., new series, p. 82.) Under the second
head we find those articles of aliment comprehended in those
chemical compounds, called hydro-carbons, that are capable of
prompt decomposition into carbon and hydrogen in the blood.
" No other organic substances," says Dr. Jackson, * though rich
in carbon and hydrogen, are capable of entering into this divis-
ion of aliments."

We shall -now pass to the chemical composition of Alcohol,

1850.] Robertson, on Alcoholic Stimulants. 197

and then examine its claims to be ranked among the nutritive
and life supporting substances. In this examination it shall
have a fair hearing, nor shall "aught be set down in malice."
We shall place it in such a position, and such only, as can be
sustained by scientific facts, well established, from acknowledg-
ed authority.

Turner, than whom there can be no better chemical authori-
ty, calls alcohol a hydrate of oxide of ethyle, represented by
the formula C4 H. O., H.O. " This compound," he observes,
"is formed when ether, which is the oxide of ethyle, and water
meet in a nascent state, as we shall see occurs when some of
the acrid salts of ethyle are heated, or otherwise decomposed.
But, practically, it is produced entirely from sugar by fermenta-
tion. The juice of the grape, or any other saccharine juice,
or an infusion of malt, when exposed to the air for a short time,
and these, from a temperature of from 40 to 85, soon enter
into fermentation, and a large quantity of carbonic acid is given
off, while the sugar totally disappears, and alcohol is found in
its place."

" Alcohol," observes Wood & Bache, "being the product of
the vinous fermentation, necessarily exists in all vinous liquids,
and may be obtained from them by distillation. Formerly it
was supposed, that these liquors did not contain alcohol, but
were merely capable of furnishing it in consequence of a new
arrangement of their ultimate constituents, the result of the heat
applied. Brand, however, disproved this idea, by showing that
alcohol may be obtained from all vinous liquors without the
application of heat, and therefore must pre-exist in them. "His
method consists in precipitating their acid and coloring matter
by sub-acetate of lead, and separating the water by carbonate
of potassa. Guy, Lussac, and Donovan have proved the same
fact." Alcohol, then, is the active principle of all distilled and
fermented liquors whether we call them brandy, gin, whiskev,
rum, champaign, hock, madeira, sherry, port, porter, ale, beer,
cider, &c. ; without the alcohol which they contain they would
be considered utterly worthless, even as beverages, by those
who place so high a value on them. Their different qualities
are due to the different materials from which they are derived.
These are often imitated in the manufacture of spurious liquors

198 Robertson, on Alcoholic Stimulants. [April,

and wines, and if it were necessary we could present an as-
tounding array of the disgusting compounds that are vended
and consumed, under the euphonious brands which are placed
upon them by the unscrupulous manufacturer.

We are now prepared to estimate the value of alcoholic
stimulants as articles of diet. Unfortunately a large number
of those who use distilled and fermented liquors, do so under
the impression that they impart healthful nourishment and
increased energy to the system. By the chemical analysis
which we have given, it will be seen that all articles of food
must contain two chemical compounds one, to build up the
muscular and other tissues, containing an abundance of the
albuminous compounds the other, containing hydro-carbons,
readily decomposed in the circulation, to impart warmth to the
entire system. Upon examining the chemical composition of
alcohol, we find it entirely destitute of the protein compounds
essential to nourishment, and consequently utterly unfit for the
purposes of nutrition. This is a settled point, beyond all dis-
pute or doubt: it exhibits no traces of those elements essential
to the nourishment and growth of the animal tissues, and con-
sequently is utterly unfit for such purposes. Nay, more ; we
shall show, by-and-by, it is positively injurious to the tissues,
and even its moderate use is incompatible with sound health,
and a normal condition of the tissues themselves. This posi-
tion is borne out by the facts disclosed by chemical analysis,
and must stand as a scientific truth until overthrown by new
observations in this department of knowledge.

Although alcohol possesses carbon and hydrogen, yet they
are not in such proportions as to render them available, except
temporarily, under certain conditions of the system, as heat
evolving substances. In his enumeration of the articles fitted
for this process, Liebig ranks wine and spirits as the very low-
est ; and when we remember that there are numerous other
substances in nature admirably adapted to this important end,
and that alcohol as an irritant poison would counteract any
beneficial effects as a heat generating substance, we shall not
hesitate in rejecting it from the list of appropriate aliments.
Moreover, in order to be ranked as one of the * elements of res-
piration?' as Liebig terms these articles of food, it should be

1850.] Robertson, on Alcoholic Stitnulajits. 199

readily andpromptly decomposed, in the circulation, into carbon
and hydrogen. This, however, is not the case with alcoholic
stimulants, and this statement is sustained by a strong array of
scientific testimony. That alcohol is absorbed and conveyed
into the most remote parts of the system, in an unaltered con-
dition, has been abundantly established ; and, that too, upon the
very best authority. If it is readily decomposed in the circula-
tion, how is it that the expired air from the lungs of even the
temperate drinker is redolent with the vapor of alcohol ; and
who that has received in his face the expired air from the lungs
of the confirmed drunkard, can forget the loathsome and sick-
ening combination of the fumes of alcohol and that cadevorous
odor, the mere thought of which is sufficient to inspire disgust.
"That alcohol becomes absorbed is proved by the fact, that
it has been found in the blood, the breath, the fluid of the serous
membranes, the brain, the liver, the bile and the other secretions.
Teidemann and Gmelin recognized the odor of it in the blood
of the splenic vein, though they were unable to detect it in the
chyle. A similar observation is recorded by Magendie. Dr.
Percy* also found it in the blood of the animals to whom he
had administered it. He likewise detected it in the bile, and
other secretions. Moreover, the recognition of the odor of
alcoholic liqors in the breath of individuals who have swallow-
ed them, as well as their detection by their smell in the fluid
contained in the ventricles of the brain, the pericardium, &c,
prove indisputably that alcohol becomes absorbed. Dr. Cook
(Treatise on Nervous Diseases, i., 222. London, 1820) states,
on the authority of Sir A. Carlisle, that, in one case, the fluid of
the ventricles of the brain had the smell, taste, and inflammabili-
ty of gin. Dr. Christison has questioned the correctness of this
observation, on the ground that gin, of sufficient strength to
take fire, could not enter the blood-vessels without coagulating-
the blood. But the objection appears to me to be groundless ;
for I find that a small quantity of undiluted commercial gin may
be adeed to white of egg without causing either coagulation or
the slightest opacity. Dr. Ogston (Edinburgh Med. and Sur<r.

* An Experimental Inquiry concerning the presence of Alcohol in the ventri-
cles of the brain, after poisoning with that liquid, together with experiments
illustrative of the physiological action of alcohol. LondoD, 1839.

200 Robertson, on Alcoholic Stimulants. [April,

Journal, vol. xi.) has confirmed the testimony of Carlisle, and
states, that in one case he found about four ounces of fluid in
the ventricles, having all the physical qualities of alcohol. Dr.
Percy {op. supra cit.) has recently set the question at rest, and
satisfactorily proved the accuracy of the above statements, by
his experiments on animals. He appears to think that some
peculiar affinity exists between the substance of the brain and
the spirit ; more especially as, after analyzing a much larger
quantity of blood than can possibly exist in the cranium, he
could generally obtain much more alcohol from the brain than
from this quantity of blood. He was unable to determine whe-
ther or not the fluid of the ventricles contained any alcohol.
Dr. Percy also detected alcohol in the liver, and has endeavored
to connect this fact with the frequent occurrence of hepatic
diseases in drunkards." (Pereira's Materia Medica and The-
rapeutics, vol. i., p. 328. Philadelphia, 1846.)

Unless it is decomposed promptly, and in sufficient quantities,
that, by the combination of its carbon and hydrogen with oxy-
gen, heat may be produced, it must be unfit for the purpose of
maintaining the animal temperature, and will float through the
system as an irritating poison, perverting and impeding the due
performance of those functions essential to health and life. In
fact, alcohol prevents or retards the performance of those
chemical actions in the animal economy, which are absolutely
necessary to the elimination and ejection of substances, from
the organization unfriendly to life. Of this assertion, we have
abundant proof, both chemical and physiological. * The inges-
tion of alcohol, so far from promoting, checks the oxygenating
process ; and was long since shown by the results of the ex-
periments of Dr. Prout, who invariably found the quantity of
exhaled carbonic acid to exhibit a marked decrease after the
ingestion of alcoholic drinks, other circumstances remaining the
same. Subsequent experimenters upon the respiratory pro-
cess have met with the same results, and they are confirmed by
the facts ascertained by Bouchardat, that where alcohol is
introduced into the system in excess, the blood in the arteries
presents the aspect of venous blood, showing that it has not
undergone the proper eliminating process. Now, although we
may not understand the reason of this, (although it seems to be

1850.] Robertson, on Alcoholic Stimulants. 201

referable to the well known power of alcohol to prevent or re-
tard chemical changes in organic substances,) the fact is of the
utmost importance." {British and Foreign Medical Review,
Amer. Ed., 1 vol., No. vi., p. 526. Philadelphia, Oct. 1847.)

The chemical combination of the oxygen, taken into the cir-
culation through the lungs, with the carbon and hydrogen,
introduced into the same channel by means of the digestive
organs, produces and maintains the temperature of the body ;
and if this combination or combustion does not take place pro-
perly, there will be a corresponding decrease of temperature or
animal heat ; and substances will be retained in the system,
which are positively injurious to the tissues.

Upon a careful review of what has been said upon the com-
position of articles entering into the second class of alimentary
substances, and the chemical unfitness of alcohol to be ranked
in this class, we must at once be convinced of the impropriety
and unreasonableness of resorting to the use of alcoholic stimu-
lants for the purpose of warding off the effects of intense cold.
It would be suicidal, as a dependence upon these articles, to the
neglect of others, which are rich in the heat generating ele-
ments, would be fatal to the desired object, and thus, under the
influence of this common delusion, men often become their
own destroyers. Although the warmest advocate of alcohol,
as a heat imparting substance in winter, and a cooling beverage
in summer, cannot give a shadow of a reason why it possesses
such opposite properties, yet the chemical laws, which have
been brought forward, will show, beyond dispute, that it
performs neither office. In winter it fails, from its very nature
and composition, to impart the elements of heat to the body ;
and, in summer, its property of retarding those chemical ac-
tions essential to the elimination, and removal from the circu-
lation and different organs, substances that are positively inju-
rious, lays the foundation for a train of diseases that have hurried
thousands to untimely graves.

Although the Russians, and most of the Northern nations,
are great consumers of alcoholic stimulants, yet they never
would be able to withstand the intense degree of cold, to which
they are exposed, but for the fact that their accustomed diet
abounds in those substances that are rich in the hydro-carbons.

202 Robertson, on Alcoholic Stimulants. [Apri.,

They use an abundance of animal food and oily substances,
while the inhabitants of the tropical regions confine themselves
mostly to vegetables, fruits, and other light substances. When
we come to understand the chemical process by which the
animal temperature is maintained, we ate no longer surprised
and incredulous upon being informed that the Esquimaux and
Greenlander will feast, with the most perfect gusto, upon enor-
mous quantities of train oil, rancid lard, tallow candles, slush,
and the most offensive articles of this class. These are ail rich
in the hydro-carbons, and are readily decomposed in the system,
imparting an abundance of carbon and hjwogen, which, meet-
ing with the oxygen from the inspired air, combine with it, and
maintain a temperature in the body, which enables it to with-
stand a cold of more than 40 below zero.

In connection with this branch of the subject, we will mention
one fact in relation to the temperature of the body in individu-
als suffering from delirium tremens. In most cases of this
horrible disease, the attack is preceded by a protracted and
excessive indulgence in ardent spirits, and other forms of alco-
holic stimulants, and, usually, an entire abstinence from all
articles of ordinary food arising, either from a want of appe-
tite or an inability in the stomach to retain them when taken.
In the second, and more particularly in the third stage of this
affection, there is a cold and clammy condition of the entire
surface, and even the tongue partakes of this unnatural chilli-
ness. Jn truth, to the touch, it is as chilling and repulsive as
the dewy coldness of a corpse itself. It will generally be found,
that the usual warmth of surface does not return until the stom-
ach becomes tranquil, and some solid and substantial nourish-
ment has been taken into the system.

The fact, that alcohol is absorbed and circulated through the
system in an unchanged condition, affords a ready explanation
of this phenomenon. It is incapable of maintaining the animal
heat, and the more appropriate heat producing, or combustible
articles of food having been refused or rejected by the stomach,
decrease of temperature and coldness of the surface are the
inevitable results ; for the excess of alcohol, in the system, will
retard or prevent the decomposition of the fatty matters of the
organization, which are used up for the purpose of maintaining

1850.] Robertson, on Alcoholic Stimulants. 203

the animal temperature, under circumstances in which the heat-
producing articles of diet are withheld from the circulation.

To show that alcoholic stimulants cannot be relied on to en-
able the system to resist the influence of extreme cold, we shall
refer to a few examples of unquestioned authority.

It is a well known fact, that numerous ships from our own
ports, as well as those of other nations, sail under the " temper-
ance flag;" they furnish no spirits, nor will some of them ship
a man that is not a pledged teetotaler. In lieu of these, coffee
and other articles of wholesome diet are allowed, which, cer-
tainly, while they add to the comfort of the seaman, exert no
influence in leading him to habits of vice and dissipation. And
the combined testimony of all, from the equator to the poles,
establishes the fact that the crews of such ships withstand the
unfriendly influences of extreme heat and pinching cold, better
than those who are allowed to indulge in spirituous beverages.
The following is the testimony of an able English wrriter in the
British and Foreign Medical Review : " The testimony of those
who are exposed to vicissitudes of climate is perhaps even more
valuable than that of those who have to sustain continued heat
or cold ; and under this aspect we regard the evidence of intel-
ligent seamen as of peculiar importance, in addition to the force
it derives from the well-known attachment of this class to
spirituous liquors. That such regard to the total abstinence
principle is at any rate a safe one, may be inferred from the
circumstance that it is now carried into practice in a very con-
siderable part of the merchant service in this country, and in a
still larger proportion of American vessels; and that the adop-
tion of this plan is not known to occasion any difficulty in
obtaining crews for the * temperance ships,7 when a fair com-
pensation is made in the superior quality of the provisions and
allowances, or in the rate of wages, as an equivalent for the
'stoppage of grog;' in fact, such ships are often in positive
request. And it is not a little worthy of note, that lower rates
of insurance are frequently taken upon ' temperance ships,' than
upon those upon whom the usual allowance of spirits is con-
tinued ; it being well known that a large proportion of losses
at sea are due to the intemperance of officers and men."

Dr. Joseph Dalton Hooker, a'distinguished medical officer,

204 Robertson, on Alcoholic Stimulants. [April,

attached to one of the late English Antrctic expeditions, in
answer to a question, whether the abstinence from spirits in
cold climates is attended with positive benefit, writes : " I do
think that the use of spirits in cold weather is generally preju-
dicial. I speak from my own experience. It is very pleasant.
The glass of grog warms the throat, the mouth, and the abdo-
men ; and this, wrhen one is wet and cold, with no fire, and just
before turning into damp blankets, is very enticing, but it ne-
ver did me one atom of good ; the extremities are not warmed
by it; and when a continuance of exertion or endurance is
called for, the spirit does harm, for then you are colder and
more fatigued a quarter or half hour after it than you would
have been without it. Some of the men on board our ship,
and among them some of the best, never touched grog during
one or more of the Antarctic cruises: they were not an whit
the worse for their abstinence, but enjoyed the same perfect
health that all the crew did throughout the four years' voyage.
Many of our men laid in large stocks of coffee, and when prac-
ticable had it made for them after the watch on deck." (British
and Foreign Med. Rev., Oct. 1847, p. 533.)

We shall close this branch of the subject by offering a few
examples, to illustrate the fact that alcoholic stimulants act
injuriously on the system, in warm climates, by interfering with
those chemical actions essential to the elimination, and removal
from, the animal economy, of substances injurious to the system;
and which cannot be retained with safety to health or life.
Those who will take the trouble to examine the reports of the
British Medical officers in the East and West India service,
will see what a fearful mortality is caused by the use of alco-
holic stimulants as an ordinary allowance. Also the great
decrease in mortality and improvement in the condition of the
troops serving in these pestilential regions since the organiza-
tion of temperance societies in the various regiments. "The
return drawn up by the Inspector-General for the first six
months of 1838," observes Dr. Forbes, "show that the average
daily percentage of sick belonging to the temperance society,
(about one-third of the whole strength,) was only 3-f, while the
daily percentage among the remainder was 10j. Even this
result does not give the most favorable view of the case ; for

1850.] Robertson, on Alcoholic Stimulants.

many men joined the temperance society, whose constitutions
had been ruined by previous dissipation, and several such were
habitual tenants of the hospital until invalided. Since that
time the total abstinence principle has been introduced among
Europeans, in India and other tropical countries : and, we are
assured, with the most favorable results. There has been no
want of satisfactory medical testimony in its favour. Indeed,
all our best writers on tropical diseases are explicit on this point.
And we may here give the evidence recently given by Mr.
Gardner, now superintendant of the Botanic gardens in Ceylon,
a well educated surgeon, who spent several years of most ac-
tive exertion in Brazil, and who penetrated into the country
farther than any other scientific European. During three
years' travelling in that climate, under constant fatigue and
exposure to vicissitudes of weather and irregularity of living,
his only beverage, besides water, was tea, of which he had laid
in a large stock previously to "his departure from Pernambuco.
He was told, when he arrived in Brazil, that he would find it
necessary to mix either wine or brandy with the water which
he drank; but a very short experience told him, not only that
they are unnecessary, but that they are decidedly hurtful to
those whose occupations lead them much into the sun. "Who-
ever drinks stimulating liquors," he says, * and travels day after
day in the sun, will certainly suffer from headache ; and in
countries where miasma prevail, he will be far more likely to
be attacked by diseases which are there endemic."

In confirmation of these views, we would refer to another
authentic fact of recent date. Lieut. Lynch, of the U. S. N.,
makes the following remarks in relation to the organization
and results of the expedition to the Dead Sea, in which the
effects of total abstinence, under the most trying exposure to
heat, privation and fatigue, were fairly tried and triumphantly
vindicated. In organizing the expedition," he remarks, "I was
very particular in selecting young, muscular, native-born Ame-
ricans, of sober habits, from each of whom I exacted a pledge
to abstain from all intoxicating drinks. To this stipulation,
under Providence, is principally to be ascribed their final re-
covery from the extreme prostration consequent on the severe
privations and great exposure to which they were unavoidably

206 Quintard, on Ophthalmia. [April,

subjected." {Expedition to the Dead Sea and Jordan, by
W. F. Lynch, U. S.N. Philadelphia, 1849, p. 14.)

The almost universal apology given by those who advocate
the use of alcoholic and other stimulants in warm climates is,
that they increase the appetite, and invigorate the powers of
the digestive organs, at a time when the relaxing and debilitat-
ing effects of high temperature are most felt by the system.
Upon this point, Liebig justly remarks, " the residents of warm
climates, who take stimulants before their meals, in order to
make up for the deficiency of appetite, act upon a most un-
physiological and ultimately injurious system ; forgetting, or
being ignorant, that the real demand for food is much less when
the surrounding temperature is high, and that the diminished
appetite really indicates the diminished wants of the system.
In a large proportion of cases in which the habitual employment
of fermented (and other) liquors has really a show of utility,
we are quite certain that a copious use of cold water external-
ly, and the substitution of it for more stimulating beverages,
will be found in the end to be the most wholesome practice,
tending (as large experience has shown that it does) both to
improve the appetite and invigorate the digestive powers.,,
(Brit, and For. Med. Rev., Oct. 1847, p. 529.)

In a future number we shall discuss the Medicinal properties
and uses of Alcoholic Stimulants.

ARTICLE IX.

The Improper Use of Poultices in Ophthalmia. By C. T.
Quintard, M. D., of Roswell, Geo.

While an assistant physician to the Bellevue Hospital, N. Y.,
my attention was frequently directed to the mal-application of
remedies in the treatment of Ophthalmitis. The eye and its
diseases, have received the attention of so many eminent prac-
titioners, from the days of Avicenna, to the present, that the
treatment, it would seem, should be tolerably well understood ;
but like other diseases, those of the eye have been subjects of
speculation and experiment, from which empirical practice has
resulted. The eye is an organ, so delicate in its structure, as

1850.] Quintard, on Ophthalmia. 207

not to admit of an uncertain practice in the treatment of its
diseases ; and yet practitioners, who have not an opportunity
of investigating the subject by actual observation, do, in a ma-
jority of cases, apply cataplasms, lotions, and unguents, which
increase the existing evil. It is not my intention to enter into
an analysis of the modes adopted to remove the various diseases
of the eye, or even to mention the forms of morbid action
to which the organ is subject, I wish simply to notice, a mode
of treatment which ends often in the destruction of the eve, and
which we have reason to fear is too prevalent. The symptoms
of conjunctival ophthalmia have been so accurately described
by Beer, Fetch, Travers, Lawrence, and a host of writers, that
it is unnecessary to point them out. Beer classifies ophthalmy,
according to the situations in which the inflammation first
originates. He divides it into three forms, viz : inflammation
of the eyelids or blepharophthalmitis ; inflammation of the parts
between the orbit and globe of the eye; and lastly, inflamma-
tion of the eyeball itself, or ophthalmitis. It is not to be
understood, as he remarks, that the extent of an idiopathic
inflammation of the eye is so considerable as to embrace all
the parts indicated by his division, for it is mostly restricted to
particular textures. By neglect, or injudicious treatment, the
inflammation spreads, until it may forever deprive the patient of
vision. There is, according to Scarpa, a period in every case
of ophthalmy, in which the active disturbance ceases, and is
followed by a certain degree of chronic ophthalmy. It follows,
therefore, if the teachings of Scarpa and Richter be true, that
with this altered action, there should be a different treatment
instituted, i.e. in place of emollient relaxing applications, there
should be substituted those that partake of an astringent, cor-
roborant quality, as the former only serve to keep up the tur-
gescence of the vessels and the redness of the conjunctiva.
" Quo major autemfuit injlammationis vehementia, says Rich-
ter, eo major plerumque sequitur par Hum affectarum atonia,
eoque major opus est adstringentiiun et roborantium longo usu,
ut auferantur penitus reliquiae morbi" &c. It is at the period
when the change from an acute to the chronic state takes place
in the inflammation, that the evils of improper practice result.
Some time since, I met with a paper by Dr. Dubois, Sur-

208 Quintard, on Ophthalmia, [April,

geon to the New York Eye and Ear Infirmary, on the impro-
priety of applying warm poultices to inflamed eyes. After
giving the opinion of a number of distinguished surgeons on
the subject, he states that his experience fully agrees with that
of the gentlemen whose opinions he quotes. Poultices, though
for a time they may relieve pain, are generally prejudicial, and
seldom, if ever, so happy in their effects as applications from
which less danger is to be apprehended. Passing for an "old wo-
man's remedy," which is thought " can do no harm even if it do
no good," the poultice is applied, and while the pain is diminish-
ed, the eye is destroyed. It is admitted, by the most eminent
ophthalmic surgeons, that the good effects to be derived
from them may be derived from other means. We conclude,
therefore, that it is generally safer to try other remedies, be-
fore we subject a patient to treatment of such doubtful pro-
priety. I select the two following cases, from those which
have fallen under my observation, to illustrate.

R. McC. came under my care with the lids of the right eye
very much swollen and inflamed ; the cornea bulging between
the lids, with a very copious discharge of lymph. He inform-
ed me that about a week previous he had experienced * a bad
feeling" in the eye, accompanied with frequent shooting pain
through the orbit. That by the advice of a physician he had
applied a warm hop fomentation over the eye, and followed it
with a warm poultice of bread and milk, and although this as-
suaged the pain to a certain extent, the lids nevertheless con-
tinued to swell, and the second or third day after the applica-
tion of the poultices he lost his sight. Finding that nothing
could be done to restore vision for the cornea was destroyed
when he submitted to my treatment I directed my remedies
to the reduction of the chronic inflammation, and the then ex-
isting symptoms.

J. W. came under my care at about the same time, with the
lids of the right eye very much swollen and the cornea present-
ing nearly the same aspect as in the above-mentioned case.
Warm poultices had been applied to the eye, followed by the
results already described. He stated, that after applying the
poultices to the right eye, the left became inflamed, but by the
use of cups, blisters, and a lotion, prescribed by a physician, the
inflammation in the left eve ceased.

1850.] Mayes, on Preparation of Blue Mass. 209

From the history of these cases, I feel confident that the
destruction of the organ, in both instances, resulted from the
inappropriate use of the poultices.

A practice which originated with Dr. Francis Moore, of Mass.,
and which found a distinguished advocate in Prof. Sewall, of
Washington, D. C, has been found very successful in the treat-
ment of ophthalmy. It consists essentially of free depletion,
followed by pressure. So soon as the active symptoms are
subdued by the antiphlogistic regimen, a pad of silk or soft
linen is applied over the eye, then a bat of carded cotton or
scraped lint is confined, by a thin, light bandage, so tight as to
afford gentle and comfortable compression, so as not to afford
pain or uneasiness. This compress is to be removed twice in
the twenty-four hours, and replaced immediately by another of
the same material. During the time the compress is being used,
a minute quantity of cerate is introduced into the eye. It is
prepared after the following formula.

ty. Hydrg. oxyd. rub., grs. xlv.
Lapis Calamin, * xxx.

Cinnabar native, " xv.

Litharge, " xxx.

Axungia pore, i.

Levigate repeatedly and mix.

Prof. Sewell thinks he fulfils the three following indications
by the pad and bandage, viz :

1st. Effectually to exclude the light from the eye.

2d. The globe of the eye is prevented from rolling.

3d. The distended vessels are compressed and disgorged.

article x.

Preparation of Blue Mass. By J. A. Mayes, M. D., of

Bradleyville, So. Ca.

The adulteration of medicines is now so frequently practised
by manufacturers, that it has become exceedingly difficult to
procure the most common chemicals, and manufactured arti-
cles, in a state at all approaching purity. To remedy thi*
enormous evil, the most stringent legislative enactments are

\. s. VOL. vi. no. iv. 1 1

210 Mayes, on Preparation of Blue Mass. [April,

necessary, but are utterly refused by our legislators. Physi-
cians must therefore depend upon their own influence for
checking the evil ; if that fails, they must become, through ne-
cessity, their own manufacturers. That it has already reached
this latter alternative few will deny ; but unfortunately for us,
there are very few in the country who are fully prepared m
all respects for the business. It becomes us, then, to make
Pharmacy a subject of more particular study than heretofore ;
to prepare all powders, tinctures, ointments and officinal com-
pounds in our own offices. In this way. we may become as-
sured that the officinal compounds are prepared correctly, but
for security against imposition in the purchase of the crude ma-
terials, our only safeguard is, an accurate and intimate acquaint-
ance with the pure drug. There are always some respectable
men engaged in the business of selling drugs, who keep on hand
a part of their stock of a quality which they can warrant. It
becomes us to search out these men, and make our purchases
from them. But even then it is necessary that we should make
a personal visit to their establishments, and prove our acquaint-
ance with the articles we wish. Unless this is done, our orders
should be sent only to those in whom we know that confidence
can be placed, with the condition expressed that all articles not
satisfactory are to be returned.

But for pure chemicals we can have no other remedy than
the habit of analysing all parcels we receive, and returning ail
that are impure. When this is habitually done by physicians,
we will soon cease to hear of so much uncertainty in medicine.
It can hardly be expected that every physician should establish
for his own use, an extensive chemical laboratory, but it has
now become a matter of necessity, that every physician should
prepare himself most fully for making accurate analyses. The
expense of the necessary apparatus is not so great as to put
it beyond the power of all to obtain it; but, for economy, clubs
of physicians in every neighborhood might be formed, who
can divide the expense of the outfit and share alike the benefits.
This plan would, if fully carried out, do more to re-instate
medicine in its purity than any laws that can be enacted.

Among the compounds most frequently adulterated, the Pil.
Hydrarg. is most conspicuous. Good Blue Pifl can now be

1850.] Mayes, on Preparation of Blue Mass. 211

very seldom indeed bought at the drug stores. The last pound
jar which the writer purchased was utterly worthless in ordi-
nary doses, requiring from 50 to 60 grains to take as much
effect as 5 grains of that of officinal purity. No other quality
could be conveniently obtained at the time, and the writer was
forced to prepare a few ounces himself. This was found to be
no inconsiderable labor, and led him to try different processes
for more easily effecting the object. Just at this time a short
extract in the Southern Medical and Surgical Journal furnished
him with the desideratum.

It being a matter of not much importance what the substance
is that is used for the division of the mercury, so that the mer-
cury itself is completely extinguished and uniformly mixed in
the mass, the following formula is offered to the profession, as
an easy method of preparing good Blue Pill mass, and which is
entirely free from objection, on account of the materials used
in the formation.

ty. Purified Quicksilver, 2 oz.
Spermacetti, 2 oz.

Olive oil, 2 drs.

Flake manna, 4 oz.

Reduce the spermacetti to powder first; then triturate the
mercury with a heavy pestle in a large iron mortar a few min-
utes, add the olive oil, and continue the trituration until the
globules disappear, which will be in a few minutes ; add the
manna, and beat the mass until it is intimately mixed.

The above will give amass containing one grain of mercury
in four, but the proportion "of ingredients can be arranged by
any one so as to make it stronger if desired.

With the foregoing compound, I am well enough pleased to
continue its preparation for my own use, and never to pur-
chase blue mass from the drug stores. It is offered to the pro-
fession as a resource, when they cannot purchase the pure
article, not at all with any hope of its superseding the officinal
pil. Hydrargyri.

212 King, Case of Disease of the Knee- Joint. [Apr3,

Case of Disease of the Knee-Joint. By Wm. Nephew Kiivg,
M. D., of Roswell, Geo.

Monroe, a negro boy, aged 20, was attacked with pain and
swelling in the left knee-joint, attended with considerable con-
stitutional disturbance. Before he came under our care the 8tb
December last, he had been treated by an accomplished physi-
cian, who was a visitor in the family of the owner. The pre-
cise symptoms of the case, and the treatment, previous to the*
above date, we are unable to give. We were informed by
the gentleman in attendance, that preparations of colchicum
antumnale, cupping and blisters had been employed and reme-
dies used, which are generally indicated by the symptoms of a
diseased joint.

From the complicated structure of the knee-joint, the symp^
toms of morbid action in it are, in the first stages, necessarily
more or less obscure. At the time when the patient came un-
der our care, the following was his condition, viz: extreme
emaciation, loss of appetite, great weakness, wasting of the left
thighy with great swelling of the parts surrounding the knee-
By careful examination the presence of pus was discovered,
and two openings were made to admit of its escape. They
were kept open for two days, when, on a further examination
a sinuous abscess was discovered extending some six inches up
the thigh, beneath the rectus muscle, and one extending down to
the popliteal space, where another opening was made. Through
these incisions the pus was discharged very freely; but the
disease had so far destroyed the joint and prostrated the patient
that there was no hope left for him, except in an amputation,
and though there seemed to be little or no hope even in this,
we determined, on consultation with a friend, to perform tlie
operation.

Accordingly, placing our patient under the influence of Chlo-
roform, we proceeded with the operation. The patient was
drawn down to the foot of the bed, and the limb taken off in
the manner of Liston, (anterior and posterior flaps,) without
the loss of much blood. In place of applying the tourniquet,
pressure was made on the artery by an assistant. After the
ligatures, sutures, and the simple dressings, the patient was

1850.] Transactions of American Medical Association. 213

moved again on his bed, and awoke without being aware of the
operation he had undergone.

Whether this was in the first instance a diffuse cellular in-
flammation, in which the synovial membrane was subsequently-
involved, or whether it was primarily situated in the structure
proper to the joint, we are not of course prepared to say. It
may have been either, for the cellular inflammation may be
followed by an inflammation of the synovial membrane, and
this in its turn may terminate in ulceration of the cartilages.

On examining the joint, after the operation, the abscess was
found even more extensive than we had anticipated, the carti-
lage covering the head of the tibia was destroyed by ulcera-
tion: that of the femur, and the patella, was also to a con-
siderable extent. Pus was found in the joint. For analogous
cases, see Brodie on Diseases of the joints, particularly case
Kill., and Mayo.

At this time our patient is quite recovered, and about on his
erutches.

The case is peculiar, only in the great degree of disorganiza-
tion which had taken place in the joint without a corresponding
intensity of symptoms, and in the success which, by means of
the ehloroform, attended the operation ; for the patient was so
iar reduced that doubts were entertained whether he could
survive during the operation.

PART II.
lUxnr-tDS anir <* tracts.

The Transactions of the American Medical Association. Vol.
II. Philadelphia: Printed for the Association by T. K. and
P. G.Collins. 1849. 1 vol. 8vo., pp. 9S6.

The transactions of the American Medical Association, after
a long and provoking delay, have been presented to the medical
public. For this delay it appears that the Committee of Pub-
lication are not at all responsible, and in justice to themselves,
they have placed the blame where it properly belongs. It
appears that the committees of the Association generally, re-
tained their reports i'ov revision or completion, and did not

214 Transactions of American Medical Association. [April,

forward them until after repeated applications. Moreover, the
authors of some of these reports required that the proof-sheet
should be sent to them for correction, which rendered it neces-
sary to forward proofs to the most distant parts of the Union.
It is to be hoped that in future, reports will be completed before
they are presented to the Association, and so fairly transcribed
as to render the transmission of proof-sheets over the whole
country unnecessary.

The very great size of the volume has rendered it impossible
for us to do more than give it a superficial examination. If all
the committees had kept within their prescribed bounds, the
size of the volume might have been much reduced, without in
any degree impairing its interest or value. This remark ap-
plies in an especial manner to the report of the Committee on
Medical Sciences ; for though their duties were restricted to a
notice of the more important improvements and discoveries in
the sciences " bearing directly on the condition and progress
of medical knowledge in America," they have "followed the
example of their predecessors," and given a retrospect of medi-
cine abroad, as well as at home.

The first forty-eight pages are devoted to the minutes of the
last annual meeting of the Association. t A number of resolu*
tions were reported by the Committee on Medical Education,
and after some discussion were adopted. These resolutions
(see Trans., p. 40-41) approve of those in relation to medical
education adopted by the Convention which met in Philadel-
phia in May,- 1847 ; invite the attention of Medical Colleges to
the resolutions of the Committee on Medical Education adopted
by that body ; advise and request physicians generally to re-
quire of those who desire to become their pupils, evidence of
proper general education ; refuse to sanction or recognise
" college clinics" as substitutes for Hospital Clinical instruction,
and urge the formation of State Medical Societies where they
do not already exist. The Association further recommends
" the various schools of Medicine to meet at Cincinnati, before
the next rnnual meeting of the Association, and present a plan
for elevating the standard of medical education."

Various other matters of interest were brought forward,
and were reierred to the appropriate committees to be report-

1850.] Transactions of American Medical Association. 215

ed upon at the next annual meeting. The Association adjourned
after a session of four days, and it may puzzle some of our read-
ers to understand how so many voluminous reports from
numerous committees, besides discussions, and other business,
could have been gotten through in so short a time. It appears
that the length of the Reports deterred the Association from
hearing them, and that the reading was dispensed with in most
instances.

Report on the Progress of the Medical Sciences. This report
occupies more than eighty pages, a large portion of which is
devoted to abstracts from foreign journals, which, though inter-
esting, certainly did not come within the regulations prescribed
for the committee. It also contains a large amount of interest-
ing matter derived from the American Journals. The great
variety of topics introduced, some of the most important of
which have already been presented to the readers of the Jour-
nal, renders it impossible to make a synopsis of its contents, we
therefore can only recommend it to our readers as worthy of
an attentive perusal.

Report on Practical Medicine. This report is also quite
long, and is mainly devoted to '"the progress of the leading
epidemics of the past year (1848) ; referring as occasion re-
quires to medical topography, and to the character of the pre-
vailing diseases in particular localities, or in the United States
generally," during the same period. The materials of which
this report is composed, the committee have derived mainly
from the medical journals, particularly those of the West and
South.

Typhus fever appears to have prevailed in most of the large
sea-port towns, and in various sections of country, typhoid fever
was epidemic. In some localities where it prevailed extensive-
ly, no suspicion of its introduction, by European emigrants,
existed. Erysipelas appears to have been a frequent disease
in many parts of the country, and in some places was epidemic.
Portions of the Eastern and Western States seemed to have
suffered most severely. In the erysipelatous fever which pre-
vailed at Danberry, Con., peritoneal inflammation was a very
common occurrence. The intimate connection between epi-
demic puerperal fever and erysipelas has often been observed,

216 Transactions of American Medical Association. [April,

and some statistics are brought forward in the report which go
to establish the fact, that those two diseases generally prevail at
the same time and place.

Small-pox appears to have prevailed to some extent in vari-
ous portions of the Middle and Eastern States. Scarlatina of a
malignant character prevailed in many localities, and in Law-
renceburg, Tenn., was very fatal. In many instances persons
died in twenty-four hours: the brain appeared to be the
organ which principally suffered. Measles also prevailed in
many places, but was generally of a mild type.

The report states, that the most widely extended epidemic
of 1848 was dysentery. But few sections of country escaped
bowel affections in some form, and in some places, the mortality
was very considerable. Cerebro-spinal meningitis prevailed
as an epidemic in Montgomery, Ala., and also in some towns
in Massachusetts. In Montgomery, during the months of Feb-
ruary, March and April, 250 cases of the disease occurred.
The cases appear to have been more numerous among the
blacks than the whites. The duration of the disease was vari-
able, but in most instances it terminated on, or before the fourth
day. The mortality was confined to the malignant cases, in
which it was estimated at 60 per cent. In the epidemic at
Sutton and Millbury in Massachusetts, every case, amounting
to 19 or 20, proved fatal. During the pear 1848, yellow fever
was epidemic in New Orleans, the deaths numbering 716. A
mild form of the disease also prevailed at Natchez the deaths
were 42 in about 300 cases. In August, 1848, yellow fever
appeared at the Quarantine ground on Staten Island, N. York.
The cases were not very numerous, and were generally of a
mild type. A committee from the Board of Health investigated
the origin of the disease, and referred it to certain vessels re-
cently arrived from New Orleans with yellow fever on board.

A very considerable portion of this report is devoted to the
subject of Cholera. This disease appeared at the New York
Quarantine ground among the convalescent patients, soon after
the arrival, on the 2d December, of a ship from Havre, on board
of which cholera was prevailing. A ship from Havre, on
which several deaths from cholera had occurred, arrived at New
Orleans on the 11th December. In a few days cases of the

1850.] Transactions of American Medical Association. 217

disease began to occur daily in parts of the city remote from
the infected ship. In New York the disease did not prevail to
any considerable extent, the whole number of cases amounting
to 91, and the deaths to 47; but in New Orleans it soon be-
came epidemic, and in the space of one month carried offmore
than 1200 persons. From New Orleans, the disease was car-
ried by the steam-boats to the towns along the Mississippi, and
Ohio, and into Texas, where it was quite fatal. The committee
have given no opinion as to the contagiousness of the disease,
but they state that u in New Orleans there is no evidence that
the disease spread from individual to individual; on the contra-
ry, it appeared simultaneously in different parts of the city."

To this report are appended communications from Dr. J. F.
Garrison, of Swedesboro', N. J., on the prevalent diseases of his
vicinity ; from Dr. Norrill Wyman, on Dysentery, as it pre-
vailed in Cambridge, Mass., in the years 1847 and 1848; from
Dr. J. Fithian, on Bilious fever, as it prevails in the eastern
portion of New Jersey, and from the same gentleman on Ery-
sipelas.

Report on Surgery. This report occupies but little more
lhan twenty pages, and keeps strictly within its prescribed
bounds. A considerable portion is devoted to the subject of
ana3sthetic agents. The committee, with the exception of
Prof. Knight, prefer the Chloroform to the Sulphuric Ether,
because it is " by far the most powerful anaesthetic agent, and
least annoying in the act of respiration." Prof. Knight prefers
the ether as less powerful and dangerous in its effects ; and to
this opinion many seem strongly inclined since the occurrence
of quite a number of fatal accidents from chloroform. It is
true, that we have comparatively few instances on record, of
the fatal effects of ether, but the committee attribute this great-
er apparent safety of the ether to the fact that it is much more
rarely employed than the chloroform, and its fatal effects are
more remote, and therefore likely to be referred to other causes.
" Sulphuric ether, however, is by no means the innocuous thing
which some have fondly believed it to be." In relation to the
dangers of chloroform, the committee remarks that "he who
fixes his attention exclusively on the fatal cases from chloro-
form, without adverting to the vast number in which it has

218 Transactions of American Medical Association. [April,

been employed, is very naturally filled with alarm. But when
we consider that this agent has probably been administered to
millions of subjects, and that only fifteen cases of death from
its use can be adduced, the individual who subjects himself to
its influence ought to feel no more apprehension, than he who
takes his seat in a rail-road car, and much less than one who
essays a voyage across the Atlantic." The conclusions of the
committee, drawn from the experience of surgeons at home and
abroad, we will present to our readers in another part of this
number.

The report notices some improvements in the treatment of
fractures. Prof. Pope substitutes, with very happy results, the
collodion, for paste and dextrine, in the treatment of the frac-
tures of children. "A strip of lint," he says, " saturated with
it, makes a convenient splint." Prof. P. condemns the appara-
tus of Jarvis, for reducing fractures and dislocations, and in this
the committee fully concur.

Dr. Smith, the chairman, presented to the Association an
apparatus applicable to all fractures of the lower extremities,
from hip to foot, the usefulness of which in a case of fracture of
the neck of the femur is said to have been tested successfully
by Dr. Geddings of Charleston. Dr. Smith also submitted to
the approval of the Association, a method of reducing disloca-
tions of the shoulder, " the peculiarity of which chiefly consists
in the application of the counter-extension to the opposite wrist,
extension being made from the wrist of the dislocated member."
The method of Dr. Smith we will present in another part of
this number. The same gentleman also presented an instru-
ment, not generally made known to the profession, which he
has used in about fifty cases of lithotomy. Dr. Gibson bears
testimony to the value of this new instrument, and deems it the
"best and most complete of all surgical appliances."

The report refers to the gutta percha as a very important
adjuvant in the practice of orthopedic surgery. Dr. Gibson,
of Richmond, in response to the circular of the committee,
urges the importance of after mechanical treatment in cases of
tenotomy for club foot. The chairman referred to an orthope-
dic operation performed by himself on an infant child. This
was the .first section of the tendo Achillis for club foot ever

1850.] Transactions of American Medical Association. 219

made in America, and was successful. " The subject is now a
young lady ; the foot and ancle are perfect in form, position,
and strength."

Dr. Bigelow, of the Massachusetts General Hospital, has pro-
posed the gutta percha in place of wax, or other impressible
materials, for the purpose of ascertaining the form, size, and
direction of strictures of the "urethra. He employs it in the fol-
lowing manner : " A bougie of this material is oiled, then its
point is passed to and fro rapidly, in the flame of a candle till
the nail will indent it. If it be now quickly passed down to the
stricture, and urged against it with a force equal to a pound or
two of weight, and then allowed to cool during three or four
minutes, it will retain, when withdrawn, a perfect impression,
thus furnishing to the operator information which will give
precision to the mechanical means subsequently resorted to."

On the subject of Lithotripsy, the report says, " it has been
generally thought to be ineligible on very young subjects on
account of the narrowness of the canal, and the unmanageable-
ness of the patient. The chairman of this committee, however,
has performed lithotripsy with Jacobson's and Heurteloup's
instrument in infants two years of age, in no less than four
instances, and in several other very young subjects. In one
respect he has found the operation more certain than on adults.
The bladder expels the fragments more promptly."'

The committee refers to a case of traumatic aneurism re-
sulting from the application of the ligature for the cure of
spontaneous aneurism, reported by Prof. Willard Parker, of
New York, in which the efficacy of compression made bv sim-
ply imposing weights upon the part was fully demonstrated.
The mode adopted in this case by the operation is thus de-
scribed. "He prepared a compress of folded adhesive plaster,
the plaster side out, two and a half inches long, and of the size
of the finger. This he placed longitudinally along the artery,
beneath Poupart's ligament, so as not to interfere with the re-
turn of blood by the vein. Another, similar, but flat, and one
and a half inches wide, was superimposed, and prevented the
displacement of the first. Over the whole were placed a com-
press of linen and the spica bandage. A bag of shot, weighing
li\(> pounds, was then placed upon the part, with the effect of

220 Transactions of American Medical Association. [April,

subduing the pulsation completely. After five days this was
replaced by another, weighing two pounds, which was continu-
ed for two days. Complete success crowned this expedient."

Some other cases of interest are referred to, but we must
refer our readers to the Transactions for them. The commit-
tee conclude their report with the declaration that, " in this
department of medicine, the spirit of improvement is abroad in
our country, and that the inventive genius which we claim as a
national characteristic,- is being exercised with signal success
in whatever relates to the science and art of surgery."

Report on Obstetrics. This report was prepared by Dr.
Gilman, owing to the illness of the chairman, Dr. B. R. Wel-
ford, of Virginia. It is quite an able paper, extending to near
twenty pages. It refers to the improvements in our means of
diagnosis, by the speculum and other means, by which many of
the opprobria medicorum among the diseases of females are
now accurately distinguished, and subjected to modes of treat-
ment very generally successful. The subject of retroversion
engages the attention of the committee, and they have brought
to notice the sound, and the stem pessary, proposed by Prof.
Simpson, as means to be employed in such cases. Of the sound
they speak favorably. The employment of the sound as a
means of diagnosis has been denounced by some English ob-
stetricians; but whilst admitting, that in the hands of the igno-
rant and careless it will probably do harm, the committee
asserts that " it can be used without danger." In relation to the
use of the stem pessary, they pronounce no opinion. We -feel
no hesitation in expressing the opinion that the stem pessary
should be entirely proscribed. It may be true, that the evidence
brought forward by Prof. Simpson abundantly proves that the
presence of the stem or shaft, in the uterine cavity, does not
always produce as high a degree of irritation as we might have
expected, yet the observations of others conclusively demon-
strate that it does frequently produce the most alarming effects.
Velpeau, after a fair trial, was forced to abandon its use. Dr.
Meigs approves of the sound, " but condemns the pessary most
unequivocally." Reference is made to an instrument invented
by Dr. Bond, of Philadelphia, for the replacement of the retro-
verted uterus, which has been employed with success in a case

1850.] Transactions of American Medical Association. 221

where Simpson's sound could not be introduced. The commit-
tee are of the opinion that this instrument will " prove a valua-
ble addition to our armamentum obstetricum."

The report refers to some attempts made by Dr. Van Buren,
of Bellevue Hospital, to cure prolapsus uteri, by destroying
some strips of the vaginal wall with the actual cautery, a mode
of treatment originally suggested by Dr. Marshall Hall. These
operations were not perfectly successful, yet the results were
very encouraging, and the committee express the opinion that
the operation deserves more frequent and extended trials than
it has yet received.

The report notices the modification latterly proposed, in the
management of cases of placenta prsevia, which consists in the
detachment of the placenta from the uterine wall, and gives
the grounds upon which the practice is advocated.

( " 1st. The old plan of rupturing the membranes and turning
the child, has been, according to recorded experience, singularly
unsuccessful, one in three of the mothers perishing, and the
proportion of children saved being inconsiderable.

2d. In not a few cases the rigidity of the os and cervix uteri
renders the operation of turning exceedingly difficult indeed
almost impossible ; and when performed under such circum-
stances, it is nearly always, and of necessity, fatal.

3d. The detachment of the placenta, will, in a vast majority
of cases, immediately and effectually check the hemorrhage."

The committee give the principal arguments which have
been adduced in the support of these propositions, and whilst
admitting that the detachment of the placenta is practicable,
and that such detachment will materially check the hemor-
rhage, they look upon it " only as a resource when turning is
impossible, or from the state of extreme exhaustion, likely to
destroy life. In the former category will be found the so-called
cases of rigidity of the os, but in which, as the committee be-
lieve, the difficulty really depends on an undeveloped cervix ;
in such cases the operation is valuable, and iosuch the commit-
tee are disposed to confine it."

A large portion of the report is devoted to the use of anaes-
thetic agents in obstetrical practice. The facts with which the
journals have been teeming for many months have generally

222 Transactions of American Medical Association. [April,

impressed the medical public favorably with regard to the em-
ployment of these agents in midwifery. The committee state
that the practice is gaining ground every where, and that of the
thousands of parturient females who have been subjected to the
influence of anaesthetic agents, no one has lost her life in con-
sequence of the pains of labor having been controlled by ether-
ization. For a solution of the question, why chloroform, which
has been used in obstetrics more frequently than in surgery, is
sometimes followed by fatal consequences in the latter, but ne-
ver in the former, the committee refer to the explanation pro-
posed by Prof. Channing. " In surgical cases, the agent is used
as a preparation to the operation, to prevent pain ; pain is not
present, it has as yet exerted no influence on the nervous sys-
tem, that system as yet has not been exhausted by suffering ;
it is in its integrity, and has of course its greatest capacity of
impression, the greatest amount of sensibility, with the least
power of resistance. The whole nervous power is brought
into relation with the cause affecting it, and yields to the im-
pression. For the most part the mind consents to the same-
thing, and no moral resistance is made. How is it in labor?
Here pain is present, and has been for a long time ; the nervous
system has been greatly taxed ; its power, so to speak, been
used up. Impressions upon it are weaker than they would be
under other circumstances, the system comes rapidly under the
anaesthetic influence, very little ether or chloroform is necessa-
ry, the consciousness need not be destroyed, sensibility need
never be abolished ; neither of these states is desired or aimed
at by the judicious accoucher."

The report invites attention to the reputed prophylactic
powers of Quinine in puerperal fever. This article has been
tried by M. Londet of Rouen, in the endemics of the Hotel
Dieu, in the years 1843, 4, 5 and 6. Of one hundred and four
patients who took no medicine, forty were attacked by the
fever while of forty who took quinine, only two had the dis-
ease. To this report are appended the history of two cases of
retro-flexion of the uterus, one by Dr. A. C. Post, of N. York,
and the other by B. W. McCready, of New York.

Report on Medical Education. This report examines the
general condition of Medical Education in the United States v

1850.] Transactions of American Medical Association. 223

compares it with the state of Medical Education in Great Bri-
tain, France, Germany, and other enlightened European na-
tions ; notices the requirements in the U. S. Army and Navy?
and the legal requirements exacted by the different States of
the Union. Some measures, prospective and established, in
reference to medical education, and the reputable standing of
the profession, and certain matters specially referred to the
committee, are also considered.

The length of this report, and the variety of topics which are
introduced, renders it impossible to do justice to it by any
synopsis which our limits will allow. It appears that the sub-
jects taught in the European schools of medicine, are much
greater than in this country ; the time devoted to their study
is much longer; and the subjects are so arranged, that they
follow each other in a regular order. In the European schools,
satisfactory testimonials of a suitable preliminary education are
required, and examinations are more numerous and compre-
hensive than in this country. In Scotland alone, is punctual
attendance exacted. ' The report gives its approval to the sys-
tem which requires a larger number of teachers, and of subjects
to be taught, but does not deem it essential or expedient, to
adopt the numerous subdivisions which exist in some of the
European schools. From this report, we learn that in the
States of the Union generally, no legal requirements are ex-
acted of medical practitioners. The only exceptions are, New
Jersey, Louisiana, Michigan, and the District of Columbia.

Among the measures of reform in the system of medical
education, the committee recommends that a certain degree of
preparatory education should be required of those who engage
in the study of medicine: they refer approvingly to the action
of the Medical Society of New York, which provides that, " to
be admitted to the offices, of any of the members of the society,
it shall be required that the applicant shall, in addition to a good
English academic education, have made respectable attain-
ments in the Latin and Greek languages.'' They urge the
importance of hospital clinical instruction, and of making at-
tendance upon it, obligatory upon pupils: They condemn
what are called "College clinics," and "concur unanimously in
the opinion, that they present no adequate equivalent to the

224 Transactions of American Medical Association. [April?

student, when resorted to as a substitute for actual hospital
attendance." They also object to the private examination of
students, and recommend that, if not public, they " should be
conducted in the presence of at least a majority of the profes-
sors, and should be in writing, as well as vita voce." The
committee think much would be gained by a division of the
subjects taught, into two classes, and propose that at the end of
each course, the student should be examined, and a certificate
of acquirement given. They also reiterate the recommenda-
tion of the Medical Convention of 1847, that the collegiate
courses should be extended to six months. Other matters of
interest are brought forward which we cannot now notice.

To this report is appended the " views of the Medical Faculty
of Harvard University, relative to the extension of the Lecture
Term," which are adverse to such extension. This paper is
ably written, and some idea may be formed of its character
from the fact that the Association appointed a special commit-
tee to reply to it. This reply is also appended. If our limits
permitted, we would notice these two articles at length.

Report on Medical Literature. The subjects embraced in
this report are 1st. The general character of the Periodical
Medical publications of the United States ; 2d. The more im-
portant articles therein presented to the profession ; 3d. Origin-
al American Medical publications ; 4th. Medical compilations
and compounds by American writers ; 5th. American re-prints
of Foreign Medical works ; and 6th. All such measures as may

be deemed advisable for encouraging and maintaining a national
literature of our own.

a The present aspect presented by medical journalism in our
country is full of auspicious omens of the future progress of
medical science. The first minds of the profession are engaged
both in their editorial management, and in the making up their
original, and review matter. A wise and liberal spirit general-
ly pervades and animates the editorship. No personal abuse
or vindictive feelings are allowed to stain their pages, and dis-
parage the dignity of the science, to the promotion of which
they are devoted."

At the time this report was prepared, there were published
in the United States, twenty original, or native, and four for-

1850.] Transactions of American Medical Aosociation. 225

eign or re-published medical periodicals. Of the former, five
are published quarterly ; six bi-monthly ; six monthly ; one semi-
monthly ; one weekly, and one irregularly, (the Transactions
of the Philadelphia College of Physicians.)

We must pass over the other subjects of this excellent report,
and will only bring to the notice of our readers a measure it
proposes, which we doubt not will receive the approbation of
the profession : " it is the appointment of a Committee or Board
of Publication, at Philadelphia or New York, whose duty it
should be to receive, and carefully read the original 01 transla-
ted works which American writers might offer, and to have
them published under the superintendance of the board or com-
mittee." " This board or committee of publication should have
funds raised by subscription, after the manner of the Sydenham
Society in England, placed in its hands."

Report on Public Hygiene. This report, with its appen-
dices, occupies over 200 pages. It notices the subjects of
drainage, street cleansing, water, building, and ventilation,
nuisances and disinfectants. To the report are appended sani-
tory reports from many of our large cities ; a communication
from Dr. Fenner on the Yellow Fever quarantine at New Or-
leans ; one from Prof. Jackson on the influence upon health
produced by the introduction of Tea and Coffee in large pro-
portion into the Dietary of children and the laboring classes;
one from Prof. Johnson on the introduction of water and gas
into cities ; and one from Dr. Harris on the use of disinfectants
in the Navy.

Report on Adulterated and Sophisticated Drugs. This re-
port is quite short, but it contains many interesting facts, and
some valuable suggestions which we may notice hereafter.

Report on Indigenous Medical Botany. This report is also
short, and is mainly devoted to an examination of two articles,
the Sarracenia, or side-saddle flower, and the Cornus Florida.
Of the former article the report says, "from its physiological
effects, we should confidently expect the remedy to be of very
great value in all those morbid conditions characterized by de-
pression of organic actions, loss of appetite, and deranged diges-
tion, unaccompanied by inflammatory action." In speaking of
the Cornus Florida, the report pays a deserved compliment to

n. s. VOL. VI. no. iv. 15

226 Therapeutic Effects of Aconite. [April,

the article of our esteemed young friend, Dr. D. C. O'Keeflfe,
which originally appeared in this Journal, and draws largely
from it, to illustrate the properties, &c, of this indigenous
medicine.

To this report is appended a long and elaborate report by
Dr. F. P. Porcher, of South Carolina, on the Medicinal plants
of that State, indigenous and introduced, and one by Dr. Ste-
phen W. Williams, of Mass., on the indigenous Medical Botany
of that State.

We hope that the foregoing brief and imperfect synopsis of
the transactions of the American Medical Association, will
induce our readers to purchase the volume. It contains a large
amount of interesting and instructive matter to which we have
not even alluded, and will fully repay any one for its cost, and
the time expended in its careful perusal. A copy may be pro-
cured by remitting to Dr. Issac Hays, Philadelphia, three dollars
in par funds and free of postage.

Therapeutic Effects of Aconite. By Dr. Teissier, of Lyons.
Condensed and translated for this Journal, by J. A. S.
Milligan, M. D.

We find in the Revue Medico-Chirurgicale an article on this
subject by Dr. Teissier, of Lyons. After alluding to the dis-
crepancy in the published opinions of different authors on the
therapeutic value of the preparations of aconite, and explaining
this discrepancy by a want of similarity of cases in which the
remedy was employed, he proceeds to record the results of his
researches, undertaken for the purpose of defining in which
diseases this medicine was indicated.

Dr. T. has examined aconite with reference to its narcotic
and antiphlogistic actions the two modes of action usually
ascribed to it. That this remedy possesses narcotic properties,
he thinks there can be no doubt. Its power, however, was
found to be more feeble than that of opium, belladonna, or the
datura, and the field of its applicability more circumscribed.
It afforded no relief to patients affected with exostosis, cancer,
nephritis, paronychia, etc., but was very efficacious in assuaging
the pains of diseases recognizing for their cause a derangement

1850.] Therapeutic .Effects of Aconite. 2V7

of the functions of the skin, as, for example, rheumatism, angina,
odontalgia caused by cold, etc. Dr. T. concludes, therefore,
that aconite may be of 'ieat service to practitioners as a nar-
cotic, but that this is not its chief property. He has administer-
ed aconite in many diseases for the cure of which blood-letting
is deemed by all practitioners indispensable, such as peritonitis,
apoplexy, and hypertrophy of the heart ; but he has never met
with a single case in which he was convinced that this medi-
cine acted as a useful substitute for venesection, or as a directly
antiphlogistic remedy. He does not wish to be understood as
affirming, however, that aconite never acts as an antiphlogistic ;
for he will show hereafter, that in certain diseases, a in mea-
sles, scarlatina, etc., it may exert a depressive influence on the
circulation : he thinks that it produces this effect, however,
indirectly, and by regulating another function, the derange-
ments of which had caused the disease.

According to Dr. Teissier the action of aconite is directed
chiefly to the skin. Its special property is to eliminate from
the cutaneous tissue all noxious principles, and to re-establish
the disordered functions of this organ. He recommends the
preparations of aconite, therefore, in all diseases caused by a
"derangement of the cutaneous secretion, and consecutively
by a catarrhal j tee on the articulations (articular rheumatism),
on the muscles (muscular rheumatism, lumbago), on the nerves,
(sciatica, odontalgia), on the mucous membranes, (coryza,
angina, bronchitis, grippe, catarrhal fever, etc.)" Dr. T. re-
commends aconite also at the commencement of all eruptive
fevers.

We will notice briefly some of the diseases in which he has
found aconite particularly useful.

Qourbature. This mild disease, caused by a suppression of
perspiration, and characterized by pains in the limbs, shivering,
lassitude, headache, and general aching, says Dr. T., may serve
as a type for the administration of aconite. In this affection
he prescribed from 5 to 10 drops of the tincture during the day.

Catarrhal Fever. Dr. T. found aconite equally serviceable
in catarrhal lever. The therapeutic indications in this lever
are: 1. Tore-establish the functions of the skin ; 2. Tocombat
the local irritation of the nose, throat or bronchi. He affirms

228 Therapeutic Effects, of Aconite. [April,

that aconite fulfils perfectly the former of these indications;
but that in carrying out the latter, it requires the assistance of
other means, such as opiates, vesicatories, etc.

Angina, Acute Bronchitis. " With MM. Tessier (of Paris)
and Gabalda, we have frequently known aconite," says the wri-
ter, "to exert a happy influence in simple angina, and in acute
pulmonary catarrh, mitigating readily the pains of deglutition
in the former, and quieting the severe cough of the latter. We
have found it only necessary in these cases to administer from
5 to 10 drops of the tincture every day."

Grippe. Dr. T. states that in this disease, which bears a
striking resemblance to courbature and catarrhal fever, aconite
is very serviceable: it restores the healthy action of the skin,
relieves the painful sensations of the disease, and abridges its
duration. He considers it worthy of remark, too, that those
patients who made use of this medicine did not retain so long
the feeling of depression and general aching, which so frequent-
ly follows an attack of grippe.

Rheumatism. Dr. T. has not found aconite equally useful in
all cases of rheumatism. He derived the most decided benefit
from it in cases of recent origin, attended neither by swelling
nor fever, or in which these symptoms were but slightly devel-
oped. In these cases he thinks it preferable to blood-letting,
to morphine, and to belladonna: to blood-letting, which only
combats the pain, which does not remove the rheumatic princi-
ple, and which frequently predisposes the part affected to stiff-
ness, swelling, and a recurrence of the evil: to morphine and
belladonna, because they are not so well tolerated by the
stomach, and because they too are merely palliatives. In
acute articular rheumatism, with fever and decided tumefac-
tion, the writer has found aconite less effectual than in the cases
just mentioned. But even in these cases it may be administer-
ed at the commencement, in order to diminish the fluxion to
the joints.

In chronic rheumatism, aconite did not prove so serviceable
as in cases of recent origin. Dr. Teissier has known instances*
however, where obstinate rheumatic pains of several years du-
ration were overcome by the persevering employment of this
remedy. He states, further, that aconite is undoubtedly eflica-

1850.] Therapeutic Effects of Aconite. 229

cious, when its use is continued for several months, in subduing
predispositions to rheumatism. This result it produces by re-
storing the functions of the skin, especially by promoting the
insensible perspiration, and by neutralizing the influence of
atmospheric moisture and of the rheumatic principle.

The dose of aconite, the writer observes, must be much
larger in rheumatism, than in the diseases previously noticed.
We should begin, he says, by giving from 10 to 20 drops of
the tincture, and increase the dose gradually to 4, 6, or even 8
grammes a-day.

Eruptive Fevers. Dr. T. has employed this remedy very
successfully in exanthematous fevers, in rubeola, variola, scar-
latina, urticaria, miliaria, erysipelas, etc. He affirms that in all
these diseases, but especially in the measles of children, aconite
exerted a happy influence on the fever and on the eruption,
which came out with readiness, and ran its course with remark-
able regularity. "But," he adds, " if complications occur, it
will be necessary to combat them by the other means which
experience has sanctioned."

Erysipelas. In this section, the writer treats of the action
of aconite in erysipelas complicating wounds. He has known
aconite to afford very prompt relief in traumatic erysipelas,
attended with fever, rigors, inclination to vomit, temporary
delirium, etc. He remembers, particularly, two patients, who
were affected very seriously with this disease, but who were
relieved, in a manner really surprising, in twenty-four hours.
He recommends very highly the employment of this remedy
in hospitals where traumatic erysipelas is so common.

Pneumonia. Dr. T. has administered aconite in a great
many cases of pneumonia. " On the success which has follow-
ed the employment of aconite in this disease," says he, "the
homceopathists base their assertion, that this medicine may be
usefully substituted for blood-letting." He has found aconite
serviceable in the early stages of pneumonia, before the inflam-
mation had become decided; but when once auscultation had
proved that the tissue of the lung was gorged with blood and
denser than in the normal state, he has found this medicine
insufficient, and has been obliged to resort to antimonials. He
does not think, therefore, that it follows as a natural conse-

230 Therapeutic Effects of Aconite. [April,

quence, because aconite contributes to the moderating of the
febrile symptoms at the commencement of the disease, that it
is for this reason an antiphlogistic remedy, and that it acts like
venesection. He says, further, that he does not believe blood-
letting to be indispensable in the treatment of pneumonia ; that
in fact we may do without it in the majority of cases, excepting
those very rare instances where the oppression is very great.

The writer remarks, that all that he has said respecting
pneumonia, is applicable also to pleurisy. " Aconite," says he,
"may be useful at the commencement of the disease, but when
the effusion is pretty considerable, it becomes only an accessory
element in the treatment, and it then becomes necessary to join
with it purgatives, diuretics, and blisters."

Dr. T. has used the preparations of aconite in typhus, and in
inflammatory fevers, but without success. He is induced to
believe that aconite would be a useful remedy in syphilitic erup-
tions ; but having never administered it in these diseases he is
unable to bring any facts to the support of his opinion.

He cannot say anything of the value of this medicine in
chronic psoric affections.

Dr. T. has had a great desire to try the administration of
aconite, in accordance with the advice of M. Tessier (of Paris),
in the purulent diathesis. He would state, however, that the
purulent diathesis is a disease so terrible, and which carries oft*
patients so rapidly, that he would hardly dare to trust to the
action of aconite, except as an adjuvant, to arrest its progress.

Beside the diseases already enumerated, Dr. T. thinks that
there are many, in the therapeutics of which aconite may enter
as an accessory. As a general rule, he observes, we may de-
rive benefit from its employment whenever we are called upon
to treat a disease, in which the cutaneous action is abnormally
performed.

Mode of Administration. In rheumatism, neuralgia, or in
any other painful disease, where the anodyne effect of aconite
is desired, Dr. T. gives from 10 to 20 drops of the tincture,
increasing the dose gradually to 3, 4, 5, and even 8 grammes
a-day. In courbature, or catarrhal fever, he gives only from
5 to 10 drops of the tincture in the 24 hours : by this means he
reduces the pulse, and lowers all other febrile symptoms, with-

1850.] Ttierapeutic Effects of Aconite. 231

out producing any of the phenomena of intoxication. He
recommends that the medicine be taken some time either
before or after a meal. * Of course," says he, " it must be used
with more reserve in the cases of children, than in those of
adults."

Dr. T. prefers the alcoholic tincture of aconite to the other
preparations of this medicine, considering it as being more relia-
ble than the extract. The dose of the extract, he says, is from
5 to 10 centigrammes, increasing it to 50 centigrammes, or even
to 1 gramme a-day.

We give here the recapitulation of Dr. TVs conclusions.

1. Aconite is a very useful medicine, and is applicable to a
great number of diseases.

2. It is a narcotic less active than opium, belladonna, and the
datura, but which nevertheless may be of great service in pain-
ful diseases, especially in those which recognize for their cause
a serous, catarrhal, or rheumatic fluxion. It is less successful
in the treatment of pains proceeding from diseases decidedly
inflammatorv.

3. The characteristic property of aconite is, to act on the
functions of the skin. It exerts a special eliminatory influence
on this membrane, that renders it useful, either as a principal
or adjuvant remedy in all diseases where disorder of the cuta-
neous action constitutes a prominent part, especially in courba-
ture, catarrhal fever, grippe, angina, and acute pulmonary
catarrh, articular and muscular rheumatism, especially those
cases attended with but little fever, and slightly marked inflam-
matory symptoms, rheumatic neuralgia, etc. ; and in all affec-
tions where a morbific principle is retained in the meshes of
the cutaneous tissue, and alters its normal organization, as in
all the exanthemata (rubeola, variola, scarlatina, miliaria, urti-
caria, erysipelas, etc.)

4. Aconite is never directly antiphlogistic. It cannot re-
place blood-letting. It simply diminishes, in many diseases,
the frequency of the pulse by quieting the pains which occa-
sioned the fever, or by facilitating the elimination of the morbid
principles which kept it up, as in erysipelas and measles.

283 Extraction of Foreign Bodies. [April,

On the Extraction of Foreign Bodies. By Johann Frederich
Dieffenbach. (Excerpta from his Operative Surgery.
Ranking's Abstract.)

I. Removal of foreign bodies from natural cavities, within
reach of the surgeon.

II. Removal of foreign bodies which have penetrated the
textures.

I. The Removal of Foreign Bodies from Natural Cavities,
within reach of the Surgeon.

1st. The removal of foreign bodies from the nasal cavity.
Foreign bodies in this locality are met with most frequently in
children of from three to six years old. Their abstraction is
often very difficult, especially when they have caused swelling,
are firmly fixed, and situate high up. The most common are
leguminous seeds, peas, beans, little stones, glass beads, bits of
wood, pipe-stalks ; in the instance of adults, ends of pipes,
buttons of foils, fragments of pincers, silver wire left behind
after attempts to remove polypus, dossils of lint, blotting-paper,
and compressed sponge, which may have served as plugs, to
check hemorrhage.

In the first place, it is requisite to ascertain the nature of the
foreign body, and also the nostril in which it is lodged. For
this purpose, the patient being seated facing a window, the
surgeon gently introduces a blunt silver probe, curved at the
end, and moistened. The substance, if small, and not wedged
in, may be directly extracted with the probe, insinuating the
concave side of the instrument behind it, and securing it in a
favourable position. Sometimes the irritation excites sneezing
and whenever this can be foreseen from the grimaces of the
patient, sudden pressure is to be made on the opposite nostril,
whereby the body will be expelled through the current of air
and the concussion. This will occasionally follow a pinch of
snuff.

Should the first attempt fail, and the surgeon be aware of the
situation of the foreign body, the head is to be thrown back,
supported by an assistant, while with the left hand he presses
upwards the tip of the nose. If the subject be a child, he takes
a strong silver director, bent at the end like a flat hook, passes
it from below upwards round the extraneous substance, lowers
his hand in order to elevate the point, and withdraws it in that
direction. For infants, an oculist's curette will be found suita-
ble. When the substance is firmly fixed, and cannot be got
away with the above instrument, a small pincer may be em-
ployed, in the manner of a polypus-forceps, one blade being di-

1850.] Extraction of Foreign Bodies. 233

rected upwards, the other downwards. The expanded blades
being made to grasp the body, a few gentle to and fro move-
ments are performed, and the extraction achieved. It is not
sale to exercise much pressure in the instance of glass beads,
lest they break, or even with regard to swollen beans or peas,
lest they be crushed. Residuary fragments often create more
mischief than the original mass. These are best removed
with an ordinary forceps.

The dislodgment of firmly impacted hard substances from
the nostril is frequently difficult. I generally use a straight
polypus-forceps. The manipulations here are the same as for
the torsion or extraction of solid nasal polypus. The hemor-
rharge is oft times considerable ; to be arrrested only by cold
injections and cold applications to the forehead and nose.
Where the foreign body is too large to pass the nasal orifice, or
to be pushed into the throat, it it is necessary to divide the ala
nasi. Bulky substances alone ought to be propelled into the
gullet, because, if small, there is the risk of danger of their
dropping into the windpipe. Bits of sponge, lint, and other
kinds of plugs, are readily withdrawn by the aid of polypus-
forceps, after water has been previously squirted up. To allay
pain and inflammation, tepid injections of decoction of mallows
may be thrown into the nostrils.

2d. The extraction of foreign bodies from the external
auditory passage. This is'often indispensable in the instance
of children who have stuck peas, beads, berries, portions of
chalk or stone in the ears. These are most readily scooped
out with a curved director or a curette ; if in the anterior part
of the auditory tube, with forceps. In adults, the meatus is
sometimes blocked up with dead insects, plugs of cotton, and
other things incrusted with cerumen, or with indurated cerumen
itself. These, the cause of continued deafness for years, are
best extracted with moderate sized polypus-forceps. It is
advisable to drop in beforehand a little almond oil, and allow
the patient to recline upon the opposite side of the head. Great
caution is to be observed, so as not to injure the walls of the
meatus, or the tympanum. Should violent bleeding supervene,
and there be no likelihood of completing the operation at one
sitting, cold, and afterwards warm, applications are to be re-
sorted to, so as to favour suppuration. Subsequently, when
the parts are relaxed, the substance may be extracted. Fa-
bricius Hildanus witnessed hemicrania, debility of the entire
half of the body, obstinate cough, amenorrhcea, epilepsy, and
wasting of the arm ensue from the circumstance of a bead
having been forced into the ear. Restoration to health followed
its abstraction. Sabatier saw typhus fever and death conse-

234 Extraction of Foreign Bodies. [April,

quent upon the pressure of a pellet of paper in this situation.
Power observed protracted salivation and atrophy result from
a dossil of wood. I have noticed, after the removal of foreign
bodies, long impacted in the ear, that the hearing became so
acutely sensitive, as to require the ears to be stopped with cot-
ton. Should a living insect create any distressing symptoms, it
may be picked out by the aid of a tuft of cotton fastened to the
end of a match ; or killed with a drop of oil, and then readily
extricated. Solution of acetate of lead, dilute cherry-laurel
water, and a weak solution of corrosive sublimate have been
used for the same purpose. Comperat destroyed an insect
larva in the meatus auditorius by means of tincture of opium.
Andry states that a round worm crept along the Eustachian
tube into the ear.

3d. The extraction of foreign bodies from betwixt the eyelids
and the eyeball. These are of every variety, mostly grains of
sand, particles of lime, insects, seeds, and the like. They
either lie free between the lids and ball of the eye, or are
imbedded in the surface of the cornea or sclerotica, for ex-
ample, splinters of steel. Foreign bodies, situate beneath the
eyelids, are easily removed, provided these are not inflamed
and can be held apart. If situate, under the lower lid, this is
to be depressed with the left index-finger, held firmly upon the
skin. If under the upper lid, the central eyelashes are to be
seized with the fingers, and the lid gently dragged from the
globe ; then, upon the patient throwing his head backwards,
the operator keeping his eye fixed on the intervening space,
withdraws the mote by the help of a blunt forceps. The
curette answers well when the substance is round ; dust, sand,
and the like are got rid of by a hair pencil, together with
aqueous injections ; acrid matters, as gun-powder, salt, pep-
per, by means of a pencil soaked in almond oil. Irritant
chemical substances are neutralized by appropriate liquids, and
their effects counteracted by a strict antiphlogistic after-treat-
ment ; if the eyelids are greatly swollen, they must be care-
fullv opened, and then syringed with warm milk.

Foreign bodies, which penetrate, and are firmly fixed within
the inner membranes of the lids, are not easily reached,
especially when the eyeball is much inflamed and the eyelids
are closed from inflammatory swelling. When such is the
case, previous resort must be had to local or general blood-let-
ting, cold applications, and, where the substance has remained a
considerable time, to tepid, mucilaginous, and narcotic applica-
tions. The speculum is seldom admissible from the risk of
irritating the eyelids.

If the penetrant body is sharp, angular, and firmly imbedded,

1850.] Extraction of Foreign Bodies.

it must be removed at all hazards, for fear of its perforating the
eyeball. Where it connot be picked out with forceps, and is
endangering sight, the external commissure of the lids ought
to be snipped. The section of the conjunctiva is generally re-
quired from its elimination.

For the removal of minute bodies projected into the mem-
branes of the globe, as tiny splinters of metal, glass, flint, or
points of needles, the forceps of Professor Von Ammon is con-
venient, the eyelids being held asunder with the ordinary
speculum. Very small splinters are most readily extracted
with a cataract needle. The surgeon may occasionally avail
himself of the hooks employed in strabismus operations, for the
purpose of fixing the eye. In the instance of seeds of corn,
which do not perforate the eye, it is generally necessary to
dilate the minute aperature wTith a fine cutting instrument, ere
they can be withdrawn with the forceps.

When the foreign body has remained so long as to have got
incased in a capsule, a slight incision is to be made, after
which it may be picked out with the point of the knife or with
forceps.

4th. The extraction of foreign bodies from the larynx or air-
tubes. (See also some remarks on this subject in our Report
on Surgery, vol. ix.) The extraction of foreign bodies from
the air-tubes is an impracticable operation, partly owing to the
physiological structure of the parts, and partly to the coincident
irritation. The slightest attempt of the kind augments the
jeopardy to life. If it be a pointed body, as a needle or fish-
bone, there is always a chance of its having stuck in the
superior portion of the windpipe. Here, after depressing the
tongue with a spatula, it may be seized with a long forceps.
Small round substances are apt to fall into the windwipe, and
occasion by their ascent and descent, during the act of respira-
tion, the most alarming symptoms. How are they to be
secured? With forceps ? Death would inevitably follow the
experiment. Desault alone proposed the passing of an elastic
catheter from the nostril into the trachea.

As a general rule, the foreign body, if of small dimensions, as
a pea or little bean, after having lodged for a while in the
trachea, drops into bronchus, commonly the right, because
that is shorter and wider than the other. After careful dis-
section, I have always found it in the right, and never in the
left bronchus. It will seldom be evacuated by sneezing,
provoked artificially, by coughing, vomiting, or by inclination
of the head forwards. Only by prompt opening of the larynx
or the trachea can life be saved. All other means are fruitless.
Its exact position can be rarely ascertained by percussion, in-

36 Extraction of Foreign Bodies. [April,

asmuch as it is constantly shifting to and fro during the first
period after the accident, through the movements of respiration
and cough.

5th. The extraction of forign bodies from the cavity of the
mouth and gullet. Foreign bodies become fixed in the mouth
only after having penetrated the mucous membrane, and are
easily removed. When situate in the fauces or gullet, they
create intolerable irritation, and eventually inflammation, if of
a sharp or acrid description. Their immediate removal is
therefore indispensable. Where there is a prospect of this
being accomplished without operative interference, an en-
deavour may be made to provoke vomiting, by thrusting down
the end of a feather, dipped in oil ; if the patient has the power
of swallowing, an emetic may be exhibited by the mouth, or,
under urgent circumstances, injected into a vein. This treat-
ment can apply only to small substances, for. if large and
firmly impacted, the gullet may be ruptured. In all examina-
tions with instruments, the tongue ought to be depressed to
the utmost.

The body in question must either be withdrawn, or hurried
into the stomach. The first course is the best, the last often
dangerous. Venesection is occasionally indicated. Should
everything fail, oesophagotomy is the sole alternative.

The substances which in the fauces are generally small and
pointed, such as fish-bones and needles, most frequently the
former. The patient being seated, is directed to gape and
make a deep inspiration, whereby the velum is elevated, and
the surgeon enabled to detect and extract the bone with a
forceps. A lady, after eating some cake, suddenly shrieked
with pain. I could perceive nothing about the neck, but, on
carrying my forefinger to the back of the tongue, brought
away a long thick bristle, which lay archwise across.

Foreign bodies observe, in their transit, certain stations at
which they halt; thus, in the pharynx, behind the thyroid and
cricoid cartilages, in the begining of the gullet, or at its lower
end, close to the diaphragm or cardia. They seldom stop at
the middle of the gullet. If very large, they may cause
suffocation ; thus, a large piece of meat, a hard-boiled egg, a
pear, a chestnut, have each proved fatal. Guattani witnessed
the most frightful death ensue from a chestnut ; the part of the
gullet at which it stuck was gangrenous. Spiritus saw the
same result follow the swallowing of a five-franc piece, which
perforated the gullet above the cardiac orifice. Needles, in-
advertently swallowed, pierce sometimes the gullet or stomach,
advance by the aid of suppuration, or otherwise, towards the
surface, and either escape spontaneously or through incision.

1850.] Extraction of Foreign Bodies, 237

Lyson observed a case where three needles, that went in at the
mouth, came out at the shoulder ; I have known one issue at
the arm.

The procedure must be modified according to the nature of
the substance. None but a bungler would attempt to disgorge
a piece of meat sticking at the cardiac opening, or urge on a
fragment of glass from the gullet into the stomach. External
pressure will suffice for potatoes or plums when stuck in the
throat.

For the withdrawal of needles, fish-bones, and the like, there
is no better implement than a large goose or swan quill-feather,
with the barbed portion ruffled, and imbued with oil. The
patient sits, with his head leaning upon the breast of an assis-
tant, while the surgeon lowers the tongue, then introduces
the feather, with its concave side downwards, into the throat,
turns it rapidly round, and draws it out. The popular practice
of swallowing a crust of bread is sometimes availing, but may
also increase the peril when arrested above the bone. A sud-
den slap on the back is by no means a bad plan, when the
substance is large and obtuse. It is preferable to that of setting
the patient on his head, as was done in the instance of Mr.
Brunei, to promote the expulsion of the half-sovereign piece.

The principal instruments employed for the present pur-
pose are of the description of forceps. Dupuytren advises, as
a preliminary step, the introduction of a gum elastic tube, sur-
mounted with a silver ball, in order to ascertain the position of
the foreign body. This, however, is superfluous, and will tend,
moreover, to augment irritation. Cooper recommends the
forceps of Weiss. The so-called leaden hammer of earlier
writers consisted of a lead ball attached to a string, which was
let down the throat, and pulled up again. Mesnier's lead
hammer was of an olive shape; Petit's was equipped with a
wire instead of a string. Petit used, besides, a metal noose
fastened to a whalebone stem ; Fabricius Hildanus, a many-
holed silver tube, provided below with a sponge. The double
ring of Graefe, attached to the end of a rod of whalebone, with
a steel spring, is very convenient for taking pieces of money
out of the throat. The customary instrument, termed repous-
soir, or probang, namely, a bit of sponge, as big as a walnut,
stuck to the end of a whalebone rod, is generally useful, either
for entangling fish-bones and the like, or propelling large round
substances. My own procedure is as follows; if the body be
small and sharp, I employ the oiled feather, as above described.
An oiled wax taper, passed down to the cardiac orifice, has
proved serviceable ; for, as soon as withdrawn, the body has
been rejected. If the body be large, as a portion of flesh-meat

238 Extraction of Foreign Bodies. [April,

adherent to a fragment of bone, I use a lithotrite with an
imperforate scoop, and rather straight. The instrument is
introduced with the blades closed, until, it arrives at its destina-
tion, when these are to be separated sufficiently to grasp the
substance, and, after a few gentle turns, withdrawn.

When there is impending suffocation, from the presence of
very large bodies impacted in the throat, Habicot enjoins
tracheotomy before resorting to opening the oesophagus. I
have never been compelled to this extreme measure. The
most difficult thing to deal with are sets of false teeth when
swallowed. I once relieved an old lady in this predicament by
means of my fingers. On several occasions, I have removed,
with curved polypus-forceps, from three to four teeth attached
to a gold plate, and which got accidentally into the throat ;
once, by the aid of an emetic, as a last resort, a seat of four
teeth, very deeply located.

In all these operations, the patient is to be in a sitting posture,
the head properly supported, the mouth rinsed with tepid
water, tepid water mixed with white of egg taken as a drink,
and the instrument smeared with white of egg rather than with
oil.

6th. Of foreign bodies in the stomach and intestines. For-
eign bodies may accumulate to enormous loads in the stomach
before they endanger life. Fournier mentions a galley-slave
who, after swallowing for years all sorts of extraneous sub-
stances, ultimately died of ileus. In his stomach were amassed
twenty-eight bits of wood, a few small pewter spoons, several
nails, buckles, weighing altogether one pound ten ounces.
Bjerlander relates the instance of a man who swallowed a great
many copper coins, a pocket-knife, and a steel for striking fire, all
of which were, however, rejected. Needles, bones offish, and
of small poultry, are sometimes voided with impunity ; at other
times retained, perforate the tunics of the stomach or the in-
testines, and migrate towards the surface, the track which they
permeate, being progressively closed as they advance. Small
pointed bodies are found in the most unaccountable localities.
Heim, the younger, records several instances of fragments of
bone, grains of corn, and the like, which he detected in the
appendix cceci vermiformis. I once met with a fish-bone, half
an inch long, in that situation, while examining the dead body
of an aged female. I have not unfrequently seen fish bones
and sharp osseous spicuise discharged from fistulous openings
about the verge of the anus, which had evidently perforated
the rectum posteriorly to the sphincter, and given rise to fistula.

Leeches occasionally find their way into the stomach, and
fasten themselves to its inner membrane. Numerous minute

1850.] Extraction of Foreign Bodies. 239

leeches were discovered in Egypt by Larrey in the stomachs
of soldiers, who had died in consequence. When this happens,
the patient ought to drink a quantity of strong solution of com-
mon salt to destroy the annelid, and afterwards an aperient
dose of sulphate of magnesia to bring it away from the bowels.

When the substance remains, even after free vomiting has
been induced, large quantities of white of egg ought to be ad-
ministered either directly by the mouth or the stomach-pump,
aided by clysters of the same, anodynes, venesection, and
leeches. Should death not ensue, or the body not pass by the
anus, nature, in some rare cases, favours its escape by the
formation of abscess, and art by incision through the stomach
or intestine.

7th. The extraction oj foreign bodies from the rectum. These
have either traversed the whole intestinal canal, or originated
from hardened feces in the rectum, or entered from without.

The most appropriate instruments for their removal, are
bullet-forceps, polypus-forceps, small lithotomy-forceps, smooth
blunt hooks of the breadth of the finger, and scoops with long
handles. Before operating, the rectum is to be filled with gruel
mixed with one-fourth of olive oil, in order to prevent its coats
from getting into contact with the foreign substance, or dam-
aged by the forceps. The patient is made to lean over the back
of a chair and grasp its front edge, the buttocks being held
apart by an assistant standing to the left side. The anus is
then closed with the left hand, and the forceps, well oiled and
shut, introduced by a gentle movement betwixt the fingers. The
blades are next separated, carried upwards, and then approxi-
mated. The surgeon will soon be sensible whether he has
secured the object of his search: if not, he directs the blades
upwards and downward till he has ; he then drags it out by a
slight rotatory motion, as in the extraction of a stone during
lithotomy. An irresistible call to stool seizes the patient, the
liquid contents gush forth in a full stream, and at that moment
the foreign body is evacuated. I have thus more than once
taken away a mass of incrusted excrement which had been
for years accumulating in the gut. I succeeded, by the aid of
a silver spoon, in relieving an old gentleman throughly of an
infirmity which had troubled him for a long period of time.
He had previously been treated for stricture of the rectum by
means of bougies, and once by dilatation through inpision. He
had annually resorted to Carlsbad to drink the waters, the
radical evil having been overlooked. All loose stools uniformly
swept by the incrusted feces. The extracted lumps possessed
a calcareous crust, and were very voluminous.

Leber failed in removing, by the forceps, a piece of wood

240 Extraction of Foreign Bodies. [April,

one foot long, and one inch thick ; he at length bored it
through, and pulled it out. Marchetti extracted a dried sow's
tail by passing some membrane over it, so as to hinder the
short pickly bristles from irritating the mucous lining. Von
Walther drew away with the forceps, from the rectum of a peas-
ant, a piece of the root of a tree, which measured seven inches;
Von Graefe, in like manner, the end of a stick ; and myself a
shoemaker's pliers from a lad.

Wherever the foreign body, either on account of its magni-
tude, or its being obliquely wedged in, cannot be got away
without violence, it will be expedient to enlarge the orifice of
the anus with a probe- pointed bistoury. In order to insure a
clean incision, the left index-finger, smeared with oil, is to be
inserted with the volar aspect towards the sacrum, as a guide
for the knife, which is made to cut for about an inch in the di-
rection of the os coccygis. This facilitates the extraction, and
the wound readily heals under cold applications, and injections
of gruel into the rectum.

8th. The extraction of foreign bodies from the female parts of
generation. For this purpose the surgeon may commonly use
his fingers or a polypus-forceps ; but if the foreign body be
bulky and wedged in, then bullet or lithotomy-forceps and
broad hooks. The patient being seated upon the edge of a
table, facing the light, with the thighs held widely apart by two
assistants, the surgeon squirts a little oil into the vagina, ex-
amines the nature of the body with the fingers and speculum,
then passes up the forceps, previously oiled, gradually opens
them, insinuating one blade behind the body, and finally with-
draws it in the line of the pelvic axis. This is nowise difficult,
when the body is not very irregular in shape, and the parts are
not inflamed or swollen. Where, on the contrary, the vagina
is contracted, and deprived of elasticity through inflammation
and puriform secretion, and the substance large, it must be
broken up into fragments and taken away piecemeal.

After its removal, the vagina ought to be well syringed, and
the patient put into a warm bath. Mucilaginous decoctions
may be subsequently injected, and the parts fomented with in-
fusion of chamomile and Goulard lotion.

Foreign bodies in this situation are of every variety. If
allowed to remain long, they determine inflammation, suppura-
tion, and napture of the vagina, either into the rectum or the
bladder. Thus communication with these cavities, and effusion
of their contents into the vagina, is the obvious result. Foreign
bodies, if sharp and angular, occasion, now and then, danger-
ous lesions. I once had to remove from a young lady a
number of different sized fragments of a porcelain urinal which

1850.] Foreign Body in the Windpipe. 241

had broken under her. The labia were severely wounded, and
the vagina completely filled with the shred. The hemorrhage
was so excessive as to have caused fainting. I extracted the
whole by means of a polypus-forceps, and inserted a few fine
sutures. The wounds healed promptly. Large, incrusted,
and firmly-adherent sponges were removed by me with
lithotomy-forceps, as also a variety of full-sized wooden pes-
saries, all in like manner covered with a crust. Some of
these 1 was obliged to break, using several forceps, wTith the
aid of assistants, or else cut them in half with Liston's bone-
scissors. Morand withdrew from a lady a silver pessary
through the openings, in which bridles had shot across, and held
it fast. Dupuytren extracted from a nymphomaniac a poma-
tum-pot; on another occasion, an old ring-pessary, which was
wedged in, and caused most urgent symptoms. A girl intro-
duced the cone of a pine into the vagina. The sharp
imbricated scales got lodged in the mucous membrane, and
were picked out one by one after the cone had been cut in
pieces. The vagina was excessively turgid.

The remainder of this article devoted to the subject of " the
removal of foreign bodies which have penetrated the textures,"
will appear in our next number.

A Case of Foreign Body in the Windpipe, By John Popiiam,
A. B., M. B. (Dublin Journal.)

The subject of the present case was a little boy, named John
Casey, aged 4, who was brought to the infirmary to be treated
for supposed croup. His respiration was stridulous, voice
hoarse and at times almost inaudible, and cough dry and hard,
occurring in paroxysms, which threatened suffocation. Du-
ring the fits of coughing, the inspirations, assumed a peculiar
character, becoming shrill and whistling, not, however, so dis-
tinctly sonorous as in hooping-cough ; the expirations were
without any appreciable sound. When the paroxysms ceased,
the child appeared comparatively free from distress, and the
sharp sound of the inspirations became less audible, but did not
quite lose the sibilant character. A circumstance which early
attracted notice in the case was a want of accordance between
the pectoral signs and constitutional symptoms. Thus, the
child suffered very little pain, complaining chiefly of soreness
at the hollow of the neck from constant coughing, the tongue
was clean, the deglutition not affected, there was but little
thirst or heat of skin, and the pulse ranged from 90 to 102 in

x. s. VOL. VI. no. iv. 10

242 Foreign Body in the Windpipe. [April,

the intervals of cough, being slightly intermittent ; the face,
however, was pale, swollen, and anxious, the head thrown
back, so as to extend the larynx; the jugular veins were turgid,
and the child was particularly fidgety and restless. On re-
marking these circumstances to the mother, she stated that on
the previous day the child had been seen playing with a little
ring of brass, an eyelet or stay-eye which he said he had
swallowed, but, from his extreme youth, she did not attach
much importance to the child's assertion; she admitted, how-
ever, that the piece of brass had been sought for and could not
be found. She also observed that a slight cough which the
child had, became suddenly and alarmingly aggravated ac-
companied by a choking sensation so urgent that she took him
to an apothecary in the neighbourhood, who told her that the
child had quinsy, and administered an emetic with temporary
relief. On examination of the chest, the sound on percussion
was found everywhere normal. The respiratory murmur was
heard distinctly in both lungs, and was not accompanied in the
early stage of the case by any rhonchus ; but, though perfect-
ly veiscular all over the lungs, yet it was not as loud as is
usually heard in a child of his age. There was no perceptible
difference in the respiration of the right lung, as is observed to
occur when a foreign body becomes impacted in the right
bronchus or its subdivision. We could thus gather only the
negative evidence that the bronchi were not directly obstruct-
ed, nor the parenchyma of the lungs inflamed. The examina-
tion of the larynx was less conclusive. It was difficult to apply
the stethoscope to the short and uneven neck of the child, and
he was constantly crying and shifting his position. We could,
nevertheless, collect that no evidence of a moveable body ex-
isted either upon coughing or change of posture, even on
inverting the child ; the distress, howTever, produced by this
position, was so great that we did not attempt to repeat it.

The diagnosis of the above case was embarrassing. Wre
had, on the one side, the testimony of the little patient himself
that he had swallowed the piece of brass, but so far dubious,
that when he was pressed further, he got frightened, and de-
nied all knowledge of it ; we had also the sudden appearance
of the suffocation cough and dyspnoea, and the paroxysms of
great distress, alternating with intervals of comparative ease
and remission of febrile symptoms ; these circumstances, taken
in combination with the existing physical signs, rendered the
supposition of a foreign body in the windpipe extremely
probable; on the other hand, cases of croup were at the time
of almost daily occurrence at the infirmary, and, in the present
instance, the signs of temporary or permanent pulmonary ob-

1850.] Foreign Body in the Windpipe. 243

struction were absent. As, however, the evidence in favour
of the presence of a foreign body in the air-tubes predomina-
ted, and the child, in such an event, incurred hourly risk of
suffocation, if not relieved by an operation, it was resolved
to admit him into the hospital with the view of operating
upon the first emergency. On explaining, however, to the
friends the probability of the operation being required, they at
once demurred, and even refused to allow the little patient into
the infirmary, unless a pledge was given that no operation
should be performed. Under these circumstances, nothing
remained but to carry out the medical treatment, explaining to
the parents the risk of failure; accordingly the trachea was
freely leeched, and powders of calomel and ipecacuanha were
given, with the apparent effect of improving all the symptoms,
except the stridulous breathing. The cough lost much of its
hard character, and its exacerbrations were less frequent ; the
expectoration became more free, the only change in the respira-
tion being the addition of slight bronchial murmurs. On the
twenty-first day, from the date of the severe symptoms, the
child after a night of unusual dyspnoea and spasmodic cough,
while sitting up in his mother's arms, where, indeed, he had
continued nearly all the time of his illness, from inability to lie
in bed brought up the piece of brass by a strong expiratory
effort without cough. The little patient was the first to notice
its escape. Upon examination of his chest a short time after,
we found the stridulous breathing and signs of oppressed cir-
culation gone, and the vesicular respiration decidedly louder
over both lungs. In a few days all traces of irritation had dis-
appeared, and the child in the month following passed through
a severe attack of measles without any untoward result.

The piece of brass proved to be, as was suspected, one of
those small rings, with a groved edge and central orifice, used
by stay-makers; it weighed three grains, and its diameter
somewhat exceeded three-tenths of an inch, no doubt greater
than that of a bronchus in so young a person. Hence, and
from the absence of the physical signs of obstruction of the air
passages of either lung, it seems almost certain that the sub-
stance was not impacted in any of the bronchi ; that it was
fixed seems probable, from the absence of pain and of the signs
usually denoting the motion of a foreign body in the trachea;
the weight of the brass and its sharp, jagged edges would also
dispose to this result, but whether it was fixed in the trachea
or in one of the ventricles of the larynx we can only conjec-
ture. The central opening in the eyelet, by affording a facility
for the transit of nir, certainly lessened the danger which
would be incurred from a solid body of equal diameter, and to

244 Periscope. [April,

this was probably owing the feeble vesicular murmur heard
equally in both lungs, as if from a cause common to both. Per-
haps, also, the central orifice in the brass had some connexion
with the whistling sound of the inspiration noticed above, simi-
lar to that which occurred in the case recorded by Professor
Macnamara in the Dublin Hospital Reports, where a distinct
musical note was produced from a perforated cherry-stone
impacted transversely in a boy's larynx.

It is probable that the aggravation of the symptoms upon
the night previous to the expectoration of the eyelet, was oc-
casioned by the loosening or dislodgment of it. Certainly the
happy escape of a body of dimensions so disproportionate to
the opening of the glottis of a child of his age, is a lesson to us
not to despair when, as in the present case, an operation, though
strongly urged, will not be permitted.

PART III.
Jttontljlp ^izvistoyc.

On the Physiological Anatomy of the Spleen. (Medical Times.
American Journal.) Dr. VV. R. Sanders arrives at the following
conclusions, which he gives at present without any details :

I. The Malpighian glandular or sacculi, and the pulp of the spleen,
constitute a true secreting apparatus.

A. The Malpighian sacculi are hollow, spherical membranous bags,
completely closed, and filled with organized contents ; they are at-
tached to the trabecular by an arterial pedicle, and are imbedded in
the pulp.

Saccular membranes. The outer membrane of the sacculi is fibrous,
and contains arterial remifications and numerous capillaries ; their
inner membrane is granular.

Saccular Contents. On the inner surface of the membrane is
applied a complete layer of nucleated cells ; which are clear (not
granular) of about 1.1200th inch diameter, and of a light yellowish
colour, when not altered by the action of water. The rest of the inte-
rior of the sacculus is filled up by free corpuscles (containing nucleoli)
of a light grayish colour, and of about l-4000th inch diameter, corres-
ponding precisely with the nuclei of the cells, and by a homogeneous
or slightly granular plasma.

The perfection of the forms, the constancy and uniformity of appear-
ance of these corpuscular elements, together with their reactions under
water, acetic acid, &c, are extremely characteristic, so that they are
easily and distinctly recognized. There is also evidence of the growth
and maturation of the sacculi. This part, therefore, of the glandular
anatomy of the spleen exhibits characters as perfect and as truly dis-
tinctive as the glandular elements of the liver, kidneys, salivary
glands, &c.

1850.] Periscope. 245

The sacculus is the formative secreting organ, analogous to the
acini of known secreting glands.

B. The splenic pulp consists, like the contents of the sacculi, of
plasma and corpuscles; but the nucleated cells are extremely few,
and mostly glanular hence the reason why they were not detected
by observers who did not examine the sacculi apart from the pulp
with sufficient care the plasma is full of granules, which are distinct,
and infinitely mors abundant, than within the sacculi ; and the cor-
puscles, instead of a regular uniform shape, are mostly angular, de-
formed, with great variety of shape and appearance, and breaking up
into granules. These corpuscles are often, also, of a reddish colour ;
and, besides them, coloured semi-crystalline particles, of a deep red or
yellow hue, and whose true relation is not yet perfectly made out, are
found in the pulp.

The pulp is, therefore, that part of the glandular apparatus where
the corpuscles of the spleen become disintegrated and dissolved into
granules and plasma; and, if the sacculi are analogous to acini, it is
probable that they burst and effuse their contents into the pulp, where
they undergo degenerating changes, becoming thus fit for absorption :
the pulp being a reservoir or duct, in which the secreted product is
lodged for a time, and undergoes the ulterior changes of maturition
and solution.

II. The veins are the absorbent elements of the spleen, and carry
away its secretion.

This is rendered probable by their extraordinary number and size;
by their abundant ramifications in the pulp (while the arteries are
spread over the secreting sacculi) ; by evidence derived from the com-
position of the splenic venous blood, as shewn in Beclard's recent
comparative analysis of splenic and other venous blood (Archives
Generales de Medecine, Oct., Nov., Dec, 1848) ; and by general
analogy in the nature, functions, and relations of the portal circulation
in the adult and in the foetus.

III. The blood circulation within the spleen is peculiar, but the
peculiarities are not confined to the venous circulation, as has been
generally supposed, but are common to it with the arterial. Its gen-
eral principle is, " the sudden and immediate transition from very-
large to very small vessels," which renders the circuit of the blood-
current extremely short. This general rule does away with all the
minor differences of vascular distribution found in the spleens of man,
the horse, dog, &c, compared with those of the sheep, bullock, &c.

The venous cells of the spleen, though, under certain circumstan-
ces, an undoubted appearance, are entirely artificial, and always
produced by methods of preparation, on which no reliance should be
placed.

There is no satisfactory evidence that the lymphatics are the ex-
cretory ducts of the spleen ; nor that its fibrous tunic or tabeculce are
muscular, or anything more than very elastic.

Conclusion. The spleen is a true secreting gland ; and its product,
which is some organized or organizablc albuminous compound, is ab-

246 Periscope. [April,

sorbed into the venous blood of the portal system, and contributes, but
is not essential to nutrition.

The elements here mentioned are constant : they are easily made
out in the spleens of the bullock, sheep, &c, tvhen quite fresh. In the
human spleen, they are in general less easily analyzed ; but the
microscope shows them to be identical, and, further, thus affords the
means of recognizing and establishing the existence of the Malpighian
sacculi, when (as not unfrequently happens in the human spleen) they
are not visible to the naked eye, or, at least, not distinguishable from
the pulp.

Cod lAver Oil in Phthisis. The First Medical Report of the
Hospital for Consumption and Diseases of the Chest, by the Physi-
cians of the Institution. London. (American Journal.) The earliest
trials of this remedy, made on a large scale, were those instituted at
the Brompton Hospital ; where it has now been given in many hun-
dred cases. The results of all these are not given, but its effects are
shown in 542 cases.

Of these 542 cases, 293 were in the first stage of the disease, and
249 in the second and third, or those stages subsequent to softening.
Of those in the first stage, 190 were males, and 103 females ; 72 per
cent, of the males, and 62 per cent, of the females, had their symp-
toms materially improved : in nearly 18 per cent, of the males, and in
28 per cent, of the females, the disease was arrested (the term arrest
implies that all, or nearly all, the symptoms of the disease had disap-
peared, the patients felt themselves well, and able to pursue their
ordinary occupations) ; in 10 per cent, of the males, and in nearly 10
percent, of the females, the disease progressed unchecked. Of the
249 patients in the second stage of the disease, 139 were males, and
110 females ; in 53 per cent, of the males, the symptoms were mate-
rially improved, and in nearly 61 percent, of the females; in a little
more than 14 per cent, of the males, and in nearly 14 per cent, of the
females, the disease was arrested, In a little more than 32 per cent,
of the males, and in 25^ per cent, of the females, the disease was not
arrested. Viewing these results collectively, we find, in about 63 per
cent., the symptoms improved; in 18 per cent., the disease was ar-
rested ; and in 19 per cent., it went on unchecked. When it is
recollected that, of the whole number treated at this hospital, the dis-
ease was arrested in only 5 per cent., the value of this remedy, under
the use of which the disease appears to have been arrested in 18 per
cent, of the cases, must be considered very great.

Different qualities of oil were tried, without exhibiting any marked
difference in their remedial effects; but the offensiveness of some of
the darker kinds rendered their general use impracticable. The oil
now used is straw-coloured, transparent, and free from offensive smell.
Patients in general take it without repugnance. The dose, at first, is
1 drachm three times a-day, for an adult; but it is gradually increas-
ed, in some few cases, to l| oz. for a dose. It is usually administered
in camphor-water, any aromatic water, bitter infusions, milk, or any

1850.] Periscope. 247

other agreeable fluid. When there is great irritability of stomach, it
has been given in mucilage of gum with a few drops of hydrocyanic
acid. In cases where there existed great anaemia and debility, and in
those where the effect of the oil seemed slight, preparations of quinine
and iron, especially the iodide, have been conjoined with advantage.
It has appeared advantageous to intermit its use for a few days, when
nausea and feverishness, from whatever cause produced, are present.
In certain cases, the use of the oil has been continued during the ex-
istence of slight haemoptysis, without producing any injurious results.

Other animal oils (not derived from the liver), and vegetable oils,
were tried with a view of ascertaining how far their operation resem-
bled that of cod-liver oil. The experiments hitherto made have not
shown them to possess the same powers; but they have not been as
yet sufficiently often repeated to warrant decided conclusions.

One of the most striking effects of the use of cod liver oil is an in-
crease in the patient's weight ; with a view of showing the frequency
with which this occurs, the gain or loss of weight was ascertained in
219 cases of consumption treated with the oil.

Taking both stages of the disease, and the sexes collectively, a gain
of weight occurred in 70 percent., a loss of weight in only 21 per
cent., and in about 8 percent, the weight remained stationary. The
amount of the increase varied, being in some patients little more than
one or two pounds during several months ; whilst, in many, the aver-
age increase was from a pound to two pounds weekly, during several
weeks. Some very remarkable instances of great increase of weight
presented themselves thus, in one instance, 41 pounds were gained
in 16 weeks ; in another, 19 pounds were gained in 23 days, and 10
pounds in the succeeding 10 days; in another case, 29 pounds were
added to the patients weight in 31 days. It must be observed, that an
amelioration of the symptoms did not invariably follow an increase of
weight, though the exceptions were rare. An aggravation of the
symptoms and a diminution of weight were almost invariable coinci-
dences. In a few cases, the symptoms improved, though the weight
remained stationary, or even became slightly diminished. In other
cases, where the amelioration was still more considerable, and the
progress of the disease appeared to have been stayed, relapse occur-
red, and was followed by a rapid progress to a fatal issue. That such
cases do occur, requires to be remembered, in order to restrain too
sanguine expectations, and to prevent the remedy from falling into
the discredit which disappointment, after an unlimited confidence, may
induce. On the other hand, without entering into a description of
the successive steps of amelioration experienced by patients, it will
suffice to say, that many of the cases included in the 18 per cent., in
whom the disease is marked arrested, felt themselves as well as they
had been before the attack of the disease.

From these facts, no other conclusion can be drawn than that cod
liver oil possesses the property of controlling the symptoms of pulmo-
nary consumption, if not of arresting the disease, to a greater extent
than any other agent hitherto tried.

248 Periscope. [April,

Treatment of Scarlatina. By Dr. G. W. Brown. (Medical Ex-
aminer.) In the commencement of the epidemic I adopted the treat-
ment usually recommended in the books, viz. : an emetic followed by
calomel, pepper gargles, laxatives, diaphoretics, tepid sponging and
counter-irritation, to the throat ; but this I soon found to be lamenta-
bly deficient, for I lost fully one-half of my cases. About that time,
in conversation with Dr. J. S. Capenter, of Poltsville, I was speaking
of the fatal nature of the epidemic, and of the inefficiency of our,
present mode of treatment, when he suggested a strong solution of the
nitrate of silver to the throat internally by means of zprobang. I
adopted it immediately, with the most happy results, in all of my
cases. Of the last fifty cases treated by it, I scarce lost a patient. I
sometimes used a strong solution of the sulphate of copper, especially
where I desired to vomit the patient at the same time, as was often the
case where the throat was filled with shreds of membrane, foetid mat-
ter, &c,; but I think the nit. argent, preferable in all cases. The
strength of the solution was Si. to the g of water. I applied the nit,
arg. in all my cases as soon as I was called, whether there was
ulceration or not, and repeated it once or twice daily till the patient
was convalescent. In malignant cases I also used the chloride of
soda internally, besides using it as a gargle, and I thought with decided
benefit. Blisters, with few exceptions, did no good, but, on the con-
trary, I thought they did harm by increasing irritation. Liniments,
particularly of iodine, answered better, especially where there was
enlargement of the absorbent glands. My treatment then consisted
in an emetic at the commencement, followed by calomel in doses of
two or three grains every two hours till the .bowels were freely
moved ; then laxatives, to keep up a gentle action on the bowels,
sufficient to remove morbid secretions. A mixture of equal parts of
the syrup of ipecac, and spir. nit. dulc, to keep a gentle action on
the surface, and at any time that it was indicated, pushed snfnciently
to produce full vomiting. Nit. arg. to the throat internally, once or
twice daily, with gargles of the chloride of soda, and internal adminis-
tration of the same, when indicated by malignant symptoms. Lini-
ments to the neck, and tepid affusion to the whole body. Cool air
and cold applications to the head in the shape of evaporating lotions,
so long as the fever continued. I sometimes made use of venesection
with decided benefit, but only in vigorous constitutions, and in the very
early stage of the disease. Dropsy was treated by bleeding freely
and purging, with diuretics and counter-irritation in the latter stages.
Pericarditis was treated by the same means as the dropsical effusion,
only more promptly. Squill, nitre, digitalis and calomel, in combina-
tion, I found to be almost a specific in the second stage of pericarditis,
especially if it purged freely.

Strychnine in Chorea. (L 'Union Med. Ranking's Abstract.)
M. Trosseau treats chorea by the use of a preparation of the sulphate
of strychnine. Of this, they prepare a syrup in the proportion of four-
fifths of a grain of strychnine to three ounces of simple syrup. In

1850.] Periscope. 249

children from six to twelve years of age, he commences with six tea-
spoonfuls during the day ; in more advanced age, the dose is a desert-
spoonful six times a day. The doses are equivalent in the first case
to thirty, and in the second to fifty grammes of the syrup, twenty
grammes of which contain one-seventh of a grain of strychnine.
These doses were increased or diminished according to the effects
produced. Under the use of the remedy, a distinct rigidity of the
jaws, neck, and limbs is produced ; but the author has found that
these physiological symptoms are the forerunners of the yielding of the
the disease, and they therefore advise the continuance of the medicine
until they are induced.

Therapeutic Effects of Gamboge administered in large doses. (Gaz.
des Hop. Bui. Gen. de Therap.) Hitherto regarded as a drastic
purgative, gamboge has been recommended in dropsy, and classed by
the Italians among their contra-stimulants. We, in truth, know but
little in relation to its physiological and therapeutic effects. It has
been recently subjected to experimentation by M. Rayer, who, with-
out determining its precise mode of action, has established its good
effects in Bright's disease. We now have new facts, published by
Dr. Abeille, physician of the Val-de-Graee, which tend to demonstrate
that, like many other substances, this may be given in very large
doses, and be tolerated in certain cases so far as to lose entirely its
cathartic properties and to acquire new ones as the dose is increased.
We will subjoin, briefly, a few of these facts.

Case 1. A. female, 40 years of age, had been eleven months affected
with ascites, which had resisted a great variety of means, and which
must, have been connected with disease of the kidneys. She was
tapped ; then subjected to mercurial frictions, to salivation, and the
internal use of gamboge, beginning with a dose of 30 centigrammes,
which was daily increased 1 decigramme, so that on the eighth day
the patient took 1 gramme. The first two doses provoked numerous
stools, attended with griping ; as the doses were increased, the num-
ber of stools were diminished, and the griping ceased. When the dose
reached 80 centigrammes there were but two stools per day. During
the two first days the swelling of the inferior extremities disappeared,
but the collection in the peritoneal cavity was increased. From the
seventh to the eighteenth day the gamboge was carried to 14 deci-
grammes per day, which occasioned but one stool. From the sixteenth
to the eighteenth day, a real urinary crisis took place, upwards of
fifteen litres being evacuated in forty-eight hours, when the ascites en-
tirely disappeared.

Case 2, A young soldier entered the military hospital of Givet,

250 Periscope. [April,

affected anasarca about ten days, and which M. Abeille attributes to
the existence of pulmonary tubercles, and to a pericarditic effusion.
A large blister was applied to the pericardium, and gamloge pre-
scribed in increasing doses. The first doses, being from 30 to 40
centigrammes, produced brisk catharsis. As the dose was subsequent-
ly increased and tolerance established, the purgative effect diminished,
and finally ceased. In eight days, the gamboge being perfectly toler-
ated in doses of 1 gramme was prescribed only every second day.
On the fifteenth day, when the patient was taking 15 decigrammes
per day, in broken doses, the urine became more abundant. From
the fifteenth to the twenty-second day, the secretion of urine became
so abundant, that on the last mentioned day the patient was reduced
to a mere skeleton by the disappearance of the anasarca.

Case 3. This was a case of Bright's disease. Four issues by
caustic potassa were established over the kidneys, and gamboge ad-
ministered in increasing doses. On the fourth day the remedy was
tolerated, the patient taking 80 centigrammes. The dose was in-
creased gradually to 15 decigrammes. The secretion of urine be-
came abundant, although still albuminous, and gradually lost its
acidity and became alkaline. On the fifteenth day the ascities had
disappeared, and the oedema of the legs was diminished. A repug-
nance to the gamboge compelled its suspension for three weeks, at the
end of which time the ascites had relurned with pain in the pericardial
region an effusion in the pericardium was detected. The gamboge
was again administered in the same way, and a blister applied to the
pericardium. The use of the gamboge was again attended with a
disappearance of the ascites in seventeen or eighteen days. The urine
was still albuminous, though but slightly so. The use of the gamboge
was again suspended for a month, when it was resumed, the ascites
having reappeared. This third time the gamboge provoked more
griping and catharsis: it was never completely tolerated, the patient
having of late two or three stools per day. The secretion of urine was,
nevertheless, increased, and the ascites dissipated for the third time
in twenty-one days.

Case 4. This was a case of ascites consequent upon hypertrophy
and degeneration of the spleen. The patient had been several times
tapped, and the peritonium would fill up again in a few days the
tappings, however, being made at intervals of two months or two and
a half months. The patient was now put on the use of gamboge,
which produced numerous stools during the first days. These di-
minished when the dose was carried to a gramme or more, and tho

1850.] Periscope. 251

secretion of urine became more active than it had ever been. The
abdomen remained three months without being much distended, and
seven months elapsed before it was again necessary to resort to tap-
ping.

If it be borne in mind that gamboge was never prescribed in doses
exceeding from 6 to 12 grains, incorporated with some substance
capable of mitigating its action lest it might give rise to serious gastro-
intestinal irritations, it will be seen, not without surprise, that the dose
has been carried as high as one gramme and a half, not only without
producing emesis nor intestinal inflammation, but even with very little
purgative effect. This is therefore one more fact in evidence of the
modification which large doses produce upon the dynamic action of
certain remedies, and which should lead us to class, in this respect,
gamboge with tartarized antimony, nitrate of potash, &c. It will be
remarked that the gamboge seems to exert its principal influence upon
the kidneys. As to its therapeutic effects, we are 4ed to believe that
they are confined to the elimination of serous collections, without
otherwise influencing the organic lesions which occasion these collec-
tions. But even if the effect of gamboge be thus restricted, it is still
an important remedy, whose effect should be studied by further ex-
periments to determine its real therapeutic value and degree of its
tolerance.

Poisoning with Strychnia relieved by Chloroform. A case of poison-
ing with strychnine in which chloroform was employed with advan-
tage, has been communicated by Dr. Dresbach, in the February
numberofthe Western Lancet. A servant, in the employment of
Dr. D., mistaking a solution of strychnine for brandy, took three
ounces of the strength of one grain to the ounce : twenty minutes after
the ingestion of the poison, the whole muscular system was rigid ; the
muscles of the back and legs so rigidly contracted that it was with
extreme difficulty the patient was able to walk ; face drawn awry,
and articulation extremely difficult ; sense of burning about the stom-
ach ; tightness about the chest, with vertigo and dimness of vision ;
lower extremities cold, and perspiration flowing in a stream from the
head and chest; pulse small and frequent, but regular. None of the
ordinary antidotes being at hand, the chloroform was resorted to in
the dose of two drachms. A few minutes after the administration of
the medicine, the patient said that he felt its effects " to the end of his
toe," and in less than fifteen minutes he was completely relieved of all
symptoms of the poisoning. Although an isolated case like this is not

252 Periscope. [April,

sufficiont to establish the character of chloroform as an antidote to
strychnine, the happy results in this instance, should lead to further
trials in similar cases.

Conclusions of the Committee on Surgery in relation to Chloroform,
(Trans. Amer. Med. Assoc.) 1st. The means of generally render-
ing patients insensible to the pain of surgical operations, so long a
desideratum, have at length been furnished in the anaesthetic agents
sulphuric, ether, chloroform, and chloric ether.

2d. The employment of these agents for obviating pain in most
severe surgical operations is now not only justifiable, but the impera-
tive duty of surgeons ; and, indeed, we may almost adopt the language
of Prof. Miller, before the Medico- Chirurg. Soc. of Edinburgh, that
" no one among his surgical friends, would deem himself justified,
morally or professionally, in now operating upon a patient in a waking
and sensitive state."

3d. Of the anaesthetic agents, chloroform is decidedly the most
efficient and facile of respiration ; but, being most powerful, is, at the
same time, most dangerous, when incautiously employed.

4th. In formidable and painful operations, chloroform not only
obviates pain, but contributes to the safety of the patient, by prevent-
ing shock, and the irritation which is the antecedent, and to a certain
extent, the cause of inflammation.

5th. The use of Chloroform is inadmissible in trivial cases, because
the danger from its use is greater than that from the operation. All
must admit that, of the two objects to be held in view in a surgical
operation, safety and immunity from pain, the former is the more im-
portant.

6th. In regard to circumstances under which chloroform should
be employed, we adopt the conclusions of the French Academy. "It
should not be used when there exists any disease of the heart, any
aneurism near the heart, any threatening dyspnoea, any tendency to
engorgement of lungs or brain. Care must be taken that, during the
inhalation, atmospheric air be sufficiently mixed with the vapour of
chloroform, and that respiration be carried on freely. The inhalation
should be suspended as soon as insensibility is obtained."

7th. The best vehicle for the administration of chloroform or ether,
is a handkerchief or sponge of loose texture, through which the at-
mosphere may be copiously inhaled.

Dr. Smith's mode of Reducing Dislocation of the Shoulder. (Ibid.)
Its peculiarity chiefly consists in the application of the counter-exten-
sion to the opposite wrist, extension being made from the wrist of the
dislocated member. Steady traction from the two wrists, in the hori-
zontal direction, will be observed immediately to erect the head, neck,
and chest, and to restore the symmetry of the two sides of the body.
This at once calls to our aid the action of numerous muscles. The
object of counter-extension is, of course, to fix the scapula of the injur-
ed side. Traction from the opposite side most effectually does this,

1850.] Periscope. 253

first, by erecting the spine, which otherwise yields to the extension,
and, more directly, by communicating support to it through the clavi-
cles which in front fixed the two scapuke together, and behind through
the muscles and tendons, which effect the same on the back. Support
one scapula and you necessarily sustain the other.

We accomplish reduction, in many instances of dislocation into the
axilla, by simple traction, for a few minutes, from the two wrists. In
difficult cases we place the patient on a chair, pass a band (sheet or
towel) over the top of the scapula and tie it beneath the chair. The
knee of the surgeon is then placed in the axilla, and traction is made
steadily from the two wrists, till the muscles are observed to yield,
and the head to be disengaged. Then the surgeon directs the arm to
be depressed, while at the same moment he urges his knee into the
axilla by extending his foot. We have succeeded thus in cases of two
months' standing, and where other methods in judicious hands have
failed. Indeed, we now practice no other method.

A new Operation superseding that of Removal of the Testicle. By
Charles Taylor, Esq., Alfreton, Derbyshire. (London Lancet.)
The castration of animals is an operation which the interests and
necessities of society require, and in the very earliest pages of human
history, we read of the perpetration of the art ; it becomes, therefore,
no longer a question of premediated cruelty, but a possitive necessity,
and which must be generally adopted, so long as man continues to be
carnivorous. The epicure's dainty taste is satiated with the savoury
flesh of the ox, while the capon forms one of the most exquisite dishes
of the wealthy farmer. The horse, rejoicing in his strength, defying
restraint in his search after females, is tamed down to the useful,
docile, noble animal which we now use, and which forms an important
means of commerce, business, or pleasure ; but it is to be regretted
that the operation which renders the horse subservient to our purposes,
should be cruel in the extreme, and should not only deprive him of his
sexual desires, but also of a great portion of strength and power of en-
durance, and should spoil his shape, rendering him, in comparison with
our noble stallions, a sorry piece of horse-flesh ; indeed, so undeniable
is this fact, that the principal draymen in London employ stallions
alone to transmit their burdens, regardless of the extra expense, care,
and attention they require to restrain their penchant for the opposite
sex. On studying the anatomy of the testicle and spermatic cord,
it struck me that an operation might be performed, which would ob-
viate the undesirable effects of the removal of so important an organ,
and which would still destroy desire without affecting the seminal
secretion, and by this means avoid depriving the animal of his mascu-
line characteristics, which, unfortunately, is done by the present
operation, I find that when sows in this neighbourhood, are what is
popularly termed cut, the operation consists, not in the removal of the
ovaries, but in simply dividing the Fallopian tubes, thus preventing
sexual heat, which would otherwise come on in certain months of the
year, and destroying, not only all desire, but all capability of procrea-

254 Periscope. [April,

tion, without unsexing the animal. Now I humble opine that a
similiar division of the vas deferens in the male would, on the same
principle, deprive the animal of desire ; and as the testicle would be
still effectually nourished and retained in situ, it is fair to suppose that
the semen would be secreted as before, and be taken up by the ab-
sorbents into the blood, by this means retaining all the masculine
characteristics of the animal ; but it may be averred by some, that
this operation would not deprive the patient of sexual inclination.
Allowing, as physiologists do, that desire is caused by the irritation
of the semen in the vesiculoe seminales, I believe that this operation
would be quite as effectual as the total removal of the testicle ; as it
is a well acknowledged fact amongst horse-dealers and others, that a
horse old enough for procreation will, after castration, have desire
and power to impregnate one female with the semen which then fills
the vesiculce seminales, though of course not more than one. This, I
think, is a full proof that desire is created by the irritation of the
semen, in the vesiculae seminales, and that division of the vas deferens
would be quite as effectual, far less cruel, and attended with much
better effects, than the ordinary removal of the testicle. Acting un-
der this impression, I placed a dog under the influence of chloroform,
dissected the vas with a ligature, removing an interspace of about
three quarters of an inch ; the animal recovered perfectly ; the
wounds healed by the first intention, and I took the first occasion that
occurred to place him with a bitch in use, when his conduct plainly
showed that all tendency to perpeutate his species was gone.

Preservation of Defective Teeth. (Boston Med. and Surg. Jour.)
Dr. Harwood, a dental operator of celebrity in Boston, is practising a
method in regard to the management of diseased, sensitive, aching
teeth, which promises to revolutionize the whole modern art and mys-
tery of operative dentistry, while the benefit likely to accrue to those
so unfortunate as to suffer from diseased teeth is of incalculable im-
portance. The idea was first suggested by his partner, Dr. Parker.
The old practice consisted, in regard to a carious tooth, too sensitive to
bear gold filling at once, in destroying the vitality of the nerve by the
application of arsenic, nitro-muriatic acid, or even the actual cautery
by introducing into the cavity a red-hot wire. When that had been
accomplished, pressure could be borne and the hollow completely
occupied with gold. In that case, however, the tooth became, by the
laws of chemistry, a foreign substance. It had no longer any vital-
ized connection with the living system, and consequently soon became
partially if not wholly discarded, and gradually rose from the socket
nature never relaxing her efforts to throw off the dead material. To
save the tooth, without severing its connection with the jaw, by the
destruction of the nerve, was the ambition of Dr. Harwood. Those
familiar with the anatomy of the region will appreciate the ingenuity
and success of his plan. With a simply constructed instrument, the
shape and use of which are no secret, the nerve is severed. Instantly
the patient is relieved from the acute and distracting pain sometimes

1850.] Miscellany, 255

characteristic of some kinds of pulp-exposed teeth. Having carefully
removed every speck and point of decayed bone, the tooth is then
plugged artistically, without the least disturbance to the patient. In
the meanwhile a conservative principle is at work. The diseased up-
per and exposed surface of the nerve is divided from the healthy mass
below; but little or no inflammation follows, the air bein? excluded,
as in subcutaneous division of the tendons, and the wound speedily
heals. Nourished, as it always had been, by the arteries at the roots,
and the body of the tooth retaining all its original vital endowments,
no discoloration ensues, and a tooth subjected to this truly philosophi-
cal treatment, may perhaps remain the most enduring and useful of
any in the jaw through life.

We consider this a triumphant achievement of American dental
science, deserving the marked consideratinn of dental surgeons, and
the most extended publicity of the press.

fHeirical fUtscdlang.

Prof. Le Conte and Dr. Bennett Homier. The March number of
the New York Journal of Medicine contains a letter from Prof. Le
Conte, of the University of Georgia, asserting his claim to priority in
the experiments, and the conclusions deduced from them, which have
been published by Dr. Dowler in his "Contributions to Physiology."
Prof. L. very justly expresses his surprise that Dr. Dowler should
have made no allusion to these experiments in his recent article,
more especially as Dr. D., in a review of Solly's work on the brain,
published in the New Orleans Medical and Surgical Journal for July,
1848, quotes them in full, and acknowledges their physiological
bearings.

Prof. Le Conte's experiments were published in the New York
Journal of Medicine for November, 1845, in an article entitled "Ex-
periments illustrating the seat of volition in the Alligator or Crocodilus
Lucius of Cuvier."

The Bulletin General de Therapeutique states, that the French
Government, acting upon the advice of the Council of health and of a
special committee composed of savans and architects, has recently or-
dered the white oxide of zinc to be substituted for the white lead in
painting the public buildings.

We omitted to notice in our last number the receipt of Ranking'*
semi-annual Abstract, richly laden, as usual, with the fruits of the
labor of our transatlantic brethren. No one who desires to keep fullv

^56

Miscellany. Meteorology,

"posted up" in European Medical literature, should be without this
work, and Braithwaite's Retrospect.

Medical College of Georgia. The Annual Commencement of the
Medical College of Georgia was held in this city on Tuesday, March
5th, 1850, on which occasion the degree of M. D. was conferred on
forty-four approved candidates. The honorary degree of M. D. was
conferred upon the Rev. Dr. Boring, now a. missionary to California,
and on Dr. Dudley W. Hammond. A very able and eloquent address
to the Graduating Class was delivered by Dr. Miller, of Rome, and
an interesting valedictory, by Dr. R. B. Nisbet, one of the graduating
class.

The Class, during the course which has just terminated, numbered
one hundred and seventy-nine.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet. By Dr. Paul F. Eve.

lor February, 1850, at Augusta,
32' west Wash. Altitude above

En

Sun
Ther.

Rise.
Bar.

2, 1

Ther.

\ M.
Bar.

Wind.

Remarks.

1

46

30 21-100

72

30 10-100'

s. w.

Cloudy sprinkle.

9

58

29 93-100

63

29 58-100,

s.

lain, 60-100.

9

54

" 65-100

53

" 76-100,

N. W.

Cloudy blow.

4

26

30 12-100

37

30 25-1001

N.W.

'air blow.

8

24

30 30-000

44

30 37-100

N. E.

?air.

6

24

30 29-100

52

30 40-100.

N. E.

?air.

r.

30

30 28-100

60

30 12- 100

N. E.

?air.

8

42

30 3-100,

68

29 89-100!

s.

Jloudy.

9

58

29 46-100

62

" 29-100!

s.

lain, 60-100.

10

38

" 52-100:

57

" 50-l00|

s. w.

^air afternoon.

ll

36

" 82-100

59

" 92-100;

w.

?air.

12

32

30

63

:< 98-100

E.

Fair.

13

48

29 64-100

55

46-100

E.

lain, 55-100.

14

43

" 25-100

40

" 26-100

s. w.

Sprinkle-flakes of snow-storm.

15

38

" 44-100:

46

" 55 100

w.

Cloudy storm.

1G

31

" 85-100

53

<: 95-100

N. W.

Fair.

17

32

" 96-100

56

" 90-100!

s.

Fa i r.

18

36

" 62-100

43

" 45-100'

s. w.

Rain storm, 20-1G0.

19

. 35

" 76-100

52

" 86-100

w.

Fair.

20

3D

" 91-100

65

" 90-100

s.

Fair.

21

43

" 83-100

73

" 81-100

s. w.

Fair.

22

57

" 78-100

49

93-100

N. E.

Cloudy drizzle.

23

36

30 10-100

60

30 10-100

N. E.

Fair.

24

45

29 93-100

52

29 75-100

S. E.

Drizzly rain, 30-100. [&65-100.

25

56

" 62-100

76

" 63-100

S. W.

Some cl'ds rain at 8 p.m., 1 in.

26, 58

" 59-100

78

" 63-100

s. w.

Rain at 7 a.m., 10-100.

27j 57

" 70-100

78

" 66-100

s. w.

Cloudy drizzle.

28

56

" 70-100

71

" 58-100

s.

Cloudy.

12 Fair days. Quantity of Rain 4 inches. Wind East of N. and S. 8 days.
West of do. do. 14 days.

Another very disagreeable month; frequent changes and much wet weather.
We have had but one fair Sunday during the winter.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Yol. 6.] NEW SERIES MAY, 1850. [Xo. 5.

PART FIRST.

Original Communications.

ARTICLE XII.

Report of the Surgical Clinic in the Medical College of Geor-
gia, during the Session of 1849-50. By Paul F. Eve, M.D.,
Professor of Surgery.

Having been requested to furnish a report for the Journal
of the cases and operations presented to the Class during the
course of Lectures just terminated, I do so in the order in which
they occurred, adding just such details of each, as may make
them more satisfactory and of some interest to all.

Case I. Operation for separating the Jaws. This was a
boy, aged 8 years, coming from South Carolina. Cause, pro-
fuse salivation. Anchylosis, apparently complete. Operation :
inhalation of chloroform through the mouth ; effects only par-
tial then free incisions transverse and parallel to both maxil-
lary bones. Some eight or ten teeth, wTith portions of the
alveoli, were removed. Results, fcetor of mouth corrected, and
with Mott's Dilator perseveringly used, patient can now open
the mouth about three-quarters of an inch between the incisors,
the only teeth he has.

II. Removal of foreign body from the Cornea. A negro
man from Elbert Co., has had a portion of fodder blade thrust
through the cornea into the anterior chamber of the eve, where
it has sojourned for two years. It was removed with a cata-
ract needle.

III. Fractured Lc?. A white child, 4 years old. Applied
the immovable or starch apparatus. Cured without deformity.

n. s. VOL. VI. no. v, 17

258 Eve's Report on Surgical Clinic, [May,

IV. Excision of female mamma. Patient from Hall county,
26 years old. Decided schirrous tumor. Under chloroform,
removed by elliptical incisions. She returned home on the
thirteenth day after the operation. Tumors are re-developing
within five months.

I have never yet operated upon a schirrous or cancerous
breast, where the diagnosis was unequivocal, that the affection
did not return.

V. Amputation of toe. Cause, ground itch.

VI. Excision of Tumor lipoma. An aged and lean negro
woman. Situated upon left shoulder. Its removal was fol-
lowed by hemorrhage, after the dressings were applied, which
was arrested by pressure with compress and bandage.

VII. Dislocation of Humerus. Cause, hemiplegia; no treat-
ment.

VIII. Hydrocele 40 ounces. Reported in this Journal, (see
vol. vi., p. 29.)

IX. Incised Wound of Hand with Fracture of Phalanges.
White carpenter ; injuries the result of circular saw moved by
steam power. Portion of thumb cut off and lost, fore-finger
divided through distal articulation, and all the others more or
less incised. Result, a good and useful hand.

X. Fracture of Thigh. An active boat-hand, on our river,
aged about 35 years, fell off the upper on to the lower wharf at
night. Called to him immediately ; no fracture was detected,
but there existed some tumefaction over the anterior middle of
the right thigh. We are positive the trocanter major turned
with the foot and leg, wThen they were rotated, and no crepita-
tion nor artificial mobility could be produced at the seat of
injury ; neither was there any shortening. Moreover the pa-
tient insisted the bone was not broken, and sustained the ex-
tremity upon the heel, the member being drawn up, while lying
upon his back. And yet a fracture must then have existed.
This was made evident in a few days, when he attempted to
walk.

Without entering upon the question of the best position and
treatment of fractured thigh, we simply remark here that, for
what we consider obvious reasons, the bent is selected for frac-
tures of the upper or lower third of this bone, and the straight
for the solutions of the bone occurring in the middle.

1850.] Eve's Report on Surgical Clinic. 259

In the treatment, we apply/oar well padded splints the length
of the thigh, and then place the patient in Prof. Gibson's appa-
ratus. This latter alone will answer in some cases, but when
we consider the very great liability to deformity in all cases of
fractures of the femur, especially in the careless, we make surer
work by applying the two at the same time. We give prefer-
ence to Dr. Gibson's spints over all others for fractures in the
middle of this bone, and for all patients: in the adult it over-
comes the muscles in the child, the hands can be secured to
the foot-piece or inferior extremity of the apparatus. For fifty
cents we have had the two long crutch-like splints with the
foot-piece made, and they can be padded with some four to six
pounds of cotton.

The reason for using the short spint when four are applied,
the one to the outer side of the thigh in addition to Dr. Gib-
son's, is to prevent the angular deformity outwards, so com-
monly met with in the treatment of these fractures.

XI. Excision of Tumor lipoma weighing about 4 pounds.
Patient a fat old lady from South Carolina. She supposed the
tumor was the result of a fall received several years ago. It
was situated over the left false ribs. Placed under chloroform,
it was removed by elliptical incisions. The recovery was good.

XII. Whitlow. Opened.

XIII. Large Abdominal Tumors. Case of a negro woman
about 45 years old. Large tuberculous masses originating in
the abdomen had at last ulcerated and protruded at the umbili-
cus. These had^been removed by the knife, and now there
existed new projecting tumors of a fibrous nature. No opera-
tion was proposed.

XIV. General Exostoses. This wras the case of a boy 5

years old, son of Rev. Mr. C , who likewise presents some

nodosities in certain of his bones. This little patient has osse-
ous tumors, varying in size, in different parts of the system, but
particularly on the tibia, femur, humerus, &c, of both sides.
These enlargements in the bones amount to considerable de-
formity, and are situated near the joints. When the patient
was only three months old he had a convulsion, and these peri-
osteal exostoses were then first noticed. Prescription general
invigoration of the system by hygienic and remedial agents ;

260 Eve's Report on Surgical Clinic. [May,

alteratives, chiefly of iodic preparations the same for local
application, with blistering and firing.

XV. General Anasarca. Presented on account of its im-
mense size, and occurring in a boy : rapidly relieved by the
vapour bath, brisk purgation with cremor tartar and jalap, and
the acetate of iron, made by adding rusty nails to sour cider.

XVI. Large Polypus of the Nose extracted through the Pha-
rynx. This was removed from a young girl of Scriven county,
who had presented symptoms of nasal polypus for two years.
The foreign growth could now be seen projecting in the pha-
rynx, around which a tape was secured, and the mass removed.
In a few days she returned home well, with the senses of smell
and taste completely restored.

XVII. Ankyloblepharon and Symblepharon. This patient
was also a young girl from Scriven county, aged about 13
years. When overheated by work six months ago, she waded
into a pond, which produced inflammation of the skin of the
face, &c. The nature of this could not be ascertained, but she
now has the eye-lids closely agglutinated and the lids adherent
to the ball on both sides. Under chloroform, the eye-lids were
separated and then detached freely from the orbits. Without
great care there is danger of a recurrence of the symblepharon,
if not also of the ankyloblepharon, to some extent.

XVIIL Ulcer of Cornea. Cured by caustic solution.

XIX. Scrofulous Ulcer of Cornea. Cured by hydriodate of
potash with comp. tr. gentian, and caustic to ulcer.

XX. Fractured Thigh. Cause, a fall : direction, transverse,
in a boy 6 years old. Gibson's apparatus cured without de-
formity.

XXI. Ligature to Primitive Carotid. Patient, a negro man
from Putnam county, aged 26. Fell, six years ago, upon a
rock, striking the back of his head, followed by hemorrhage
from the nose and slight delirium. In the course of a short
time epilepsy supervened, and within the past six months total
blindness. Although his master was told the case was exceed-
ingly unpromising, and in all probability nothing could be done
for the man, he insisted that both medical and surgical treat-
ment should be tried. Having exhausted the first, with no
other benefit than to arrest the epilepsy, ligature of the primi-

1850.] Eve's Report on Surgical Clinic. 261

tive carotid to the side (right) most affected of the head was
suggested and acceded to. The ligature came away on the
seventeenth day after its application, and up to the time of his
return home, more than a month afterwards, there had been no
improvement in vision.

XXII. Operation for Artificial Pupil. Failure.

XXIII. " for Cataract. Couching. Result good.

XXIV. " for Pterygium.

XXV. Exsection of three inches of Inferior Maxilla for
Spina Ventosa. This operation was performed on a young
lady from Randolph county, aged 18 years. The cause of the
disease was unknown, probably it was owing to defect of a
molar tooth. It was of six years existence ; the deformity was
great, and pain at times quite acute. Operation: patient under
the effects of chloroform, an incision from beyond the angle of
the inferior maxillary of the right side over the tumor to a
central point under the chin, was then made, and the bone care-
fully denuded. The stomach tooth of the same side extracted,
the bone sawed in two, turned outwards, and again divided be-
yond its angle. Considerable hemorrhage occurred during the
operation ; the patient nevertheless had a good recovery the
line of cicatrix being under the chin is scarcely perceived.

The portion of bone removed included one of its angles, was
greatly enlarged, and when sawed in two presented a central
cavity about the size of a pullet's egg, the walls of it moreover
were more than half an inch thick.

XXVI. Amputation of Thigh. Fungus Haimatodes. Ne-
gro man from South Carolina, aged 50. Had observed a small
round tumor on internal side of knee-joint, more than ten years
ago, which has now acquired the size of the two fists, and has
bled freely, spontaneous and repeatedly from a small projecting
tubercle. The probe here enters without resistance, encoun-
tering nothing solid, but gives pain, and its withdrawal is
followed by hemorrhage. Fungus haematodes is suspected.
Operation : patient under chloroform, tumor laid open by en-
larging the issue at the tubercle, when a large quantity of
brain-like substance, mixed with blood, was turned out. The
thigh was now amputated by the circular method. The pa-
tient had a good recovery, and has yet no return or development
of this malignant disease, five months since the operation.

262 Eve's Report on Surgical Clinic. [May,

XXVII. Compound complicated Fracture of fourth and fifth
Ribs death in nineteen hours. This was the result of an acci-
dent on the rail-road, to a stout, athletic negro man, aged 21,
by a collision of cars loaded with wood. The fourth and fifth
ribs, about their centre, were fractured one in two places, and
both dislocated from the spine ; the intercostal arteries were
ruptured and the thorax laid open, the lung of that side and the
pericardium being fully exposed. There was besides these
injuries a compound fracture of the left tibia. The wounds
were closed, but the oppression and difficulty of breathing were
so great that the patient removed all applications to the chest,
and besides laudanum and hot brandy toddy to produce reac-
tion, he drank large quantities of water. Death put an end to
his sufferings in nineteen hours after the accident.

XXVIII. Fracture of both Malleoli.

XXIX. Compound Fracture of fourth Metacarpal, and other
injury to right hand.

XXX. Concussion of Brain. Case recovered.

XXXI. Compound Fracture of Tibia. Passed into hands of
other physicians.

XXXII. Incised Wound of Scalp,

XXXIII. Amaurosis from blow to head. All treatment failed.

XXXIV. Lacerated Wound to scrotum.

XXXV. Exsection of Female Mamma. In a young negro
woman for schirrous degeneration from neglected milk abscess.
Operation performed under chloroform. Patient well in two
weeks.

XXXVI. Amputation of Leg. This was in a patient who
had served as a volunteer in Mexico, and had returned home
with chronic diarrhoea. Pie had now sustained a compound
fracture of both bones of the left leg at the ankle-joint, from a
loaded wagon passing over it. Amputated just below the knee,
under chloroform.

XXXVII. Operation for Radical cure of Hernia. In a boy
10 years old, with congenital inguinal hernia on the right side.
Performed Bonnet's operation with pins patient under chlo-
roform. Result, a failure.

XXXVIII. Keloidal Tumor in a cicatrix over a Ventral
Hernia. A negro boy, 10 years old, and very unmanageable,

1850.] Eve's Report on Surgical Clinic. 263

had been gored by a cow eighteen months ago in the right
inguinal region. The intestines protruded, a ventral hernia,
size of a turkey egg, has been gradually increasing, and upon
the cicatrix of the skin an oblong keloidal tumor is growing.
While the patient was under chloroform, in cutting out this
tumor, (the hernia having been reduced, as was believed,) the
intestine proved to be adherent to the cicatrix, and was pretty
freely laid open. An artificial anus was the result of this ope-
ration, but which has gradually diminished to a small orifice,
over which the pad of truss is now placed, and the patient is
walking about the Infirmary.

May not this case throw some light on the causation of keloi-
dal or cancroidal tumors, from the fact of the close proximity
of fecal matter to the cicatrix? May. not the want of cleanli-
ness in the skin of the negro account for the frequency with
which this affection is met with in the black, without referring
its production in them exclusively to the peculiar organization
of the cutaneous structure itself?

XXXIX. Necrosis of Femur.

XL. Cancer of Face. In an old man, and of several years'
duration. Chloroform, and excision of the ulceration. Not
cured.

XLI. Hematocele of the Cord. Case reported in the Jour-
nal, vol. vi., p. 114.

XLII. Caries of the Tibia. Patient a negro man in the prime
of life. Cause, obscure, probably scrofulous cachexia. Under
chloroform, the diseased bone was exposed, the crown of the
trephine applied, and the chisel and mallet completed the remo-
val of it. By the use of hydriodate of potash and comp. tinct.
gentian, and then Fowler's solution, the patient has greatly
improved, and seems to be now nearly well.

XLIII. Excision of part of both Tonsils.

XLIV. Radical cure for Hernia. Second attempt in case
referred to (No. xxxvii.), by Mayor's method of invaginatinga
portion of the scrotum. The boy now wears one of Chase's
trusses, and hopes are entertained that the operation will be
successful. Doing now well.

XLV. Amputation partial of the Foot. In a free negro wo-
man, from neglect and filth, resulting in extensive ulceration
and repeated hemorrhage patient under chloroform.

264 Eve's Report on Surgical Clinic. L^ay

XL VI. Excision of Bleeding Tumor from head and neck.
This was an old man from South Carolina, having a large tumor
of a mixed character over the occipital region of the head, and
extending to the neck. While under chloroform, it was ex-
cised by elliptical incisions. The hemorrhage was profuse, and
six arteries were secured. The tumor was not aneurismal,
but had a central hardened portion. It was fibrous, but very-
vascular.

XLVII. Amputation of the Thigh. Case of a negro man,
aged 55, having been burnt on the right knee in infancy. The
cicatrix has now taken on a keloidal degeneration, and bleeds
from slight causes acting upon its large exposed ulceration,
which is very rough, hard, and at times dry. Under chloro-
form, the circular amputation was performed, and the patient .
was out of bed in two weeks, with the stump nearly healed.

XLVIII. Fracture of Thigh. In a boy, 7 years old, pro-
duced by a bale of cotton falling upon him. Treatment, four
spints with Gibson's apparatus.

Besides these cases and operations, there were several pa-
tients presented to the Class with ulcers, hernia, &c. Classi-
fied, we have

Of Fractures of the Thigh, ... 3

' " Leg, .... 3

Of all other Bones, 3

Total, . 9

2 -
1
1
1

Total, . 5

Of Tumors. Lipoma, .... 2

u u Schirrous, Cancer, and Malignant, 5
Other Tumors, 6

Total, . 13
Of the 39 cases operated upon, not one died. Of the whole
number presented, but one only had a fatal termination, and
that within twelve hours after entering the Surgical Infirmary.

Of

u
II

Amputations

u

a

of the

M U

(

Thigh,

Leg,

Foot,

h

M i.

Toe,

1850.] Hammond, on the Calycanthus. 265

ARTICLE XIII.

Calycanthus Floridus its properties and nses. By Dudley
W. Hammond, M. D., of Cullodens, Georgia.

The Calycanthus, or sweet scented shrub, as it is familiarly
called, derives its name from the Greek words xaXug, calyx, and
avdo$, an anther or flower, in reference to the calyx being co-
lored, and appearing like a carolla. It is a shrub from three to
seven feet high, erect, virgate, stoloniferous, the young branches
pubescent, leaves opposite, sometimes acuminate, entire, on
short petioles ; flowers solitary, axillary and terminal, on short
branches ; the petaloid segments of the calyx disposed in two
series, filaments minutely pubescent, the anterior generally
without anthers ; capsule turbinate, seeds oval and large. It
grows in fertile soils, along rivulets, in the upper districts of
South Carolina and Georgia, and is rare in the lower. It flow-
ers in April.

There is a remarkable fact in regard to the Calycanthus,
originally noticed by Mirbel. In the stems of this plant, there
is the usual deposit of concentric circles of wood around the
pith, and in addition four very imperfect centres of deposition
on the outside, next the bark, a very unusual structure.

A good figure of this interesting fact has been given by
Mirbel, in the Annates des Sciences Naturalles, vol. xiv., p. 367.
It is also described by Lindley, Don, de Candolle, and Prof.
Darby, &c. Lemaire has given a description of the Calycan-
thus Floridus in Dictionaire Universel D'Historie Naturelle,
at page 78, and states that Buchoz, in consequence of the de-
lightful aroma exhaled from its branches, being so agreeable
and attractive, or for some other reason, has made it a genus,
dedicated to the "very famous madam Pompadour.

At my particular request, Prof. Darby, of Cullodens, has
analyzed this shrub. He says " I have subjected to analysis
the twigs of the Calycanthus Floridus which you presented to
me, and have obtained the following results. I took 2000
grains for experiment, and obtained in the various products 98
grains. This amount of products would vary very much de-
pending upon the parts of the plant taken. All the essential
products lie in the interior bark, and buds. The wood contains
scarcely any of the following products.

266 Hammond, on the Calycanthus. [May,

Green coloring matter with a resinous substance, . 5.5
Volatile oil, colorless, and highly inflamable, . . 10.4 grs.
Bitter substance, soluble in ether and alcohol, . . 14.6 "
Gummy extract, soluble in water, but not in alcohol

or ether, 57.3 "

A volatile oil, readily miscible in water, with a great-
er specific gravity than the preceding, . . . 2.4
Tannic acid, gallic acid, and a free organic acid,
starch, nitrogenized substances, probably, albumen
and fibrine, 6.8

98.0

The juice does not take on the vinous fermentation, and of
course contains no sugar. It undergoes putrefaction and liber-
ates ammonia."

Out of the 28,000 species of plants in the vegetable kingdom,
we have not more than 1 or 2,000 capable of making sanative
impressions upon the human system; and many of these which
now hold a place in the Materia Medica, if properly tested,
would probably be found so feebly endowed with curative vir-
tues, that on a revision of the Pharmacopoeia many of them
would be discarded. But, on the other hand, there are doubt-
less many, possessing inestimable medicinal qualities, which are
hidden and unknown. It should then be the great and para-
mount duty of every physician to explore the great and inex-
haustible store-house of nature, in search of those hidden
treasures which have been kindly provided for the alleviation
of the innumerable maladies to which flesh is heir.

Man is a constant prey to the ravages of disease in every
clime and place upon the "habitable globe ;" and it is almost a
truism in medical science, that in every inhabited region of the
earth there are to be found medicinal plants, capable of alle-
viating the diseases peculiar to it. As a proof of this, the
inhabitants of warm countries are bountifully supplied with
plants possessing acescent and febrifuge qualities, and others
having virtues suited to the diseases incident to this clime.
Who can contemplate the discovery of the Cinchona without
the most heart-felt gratitude to Him who brought it into exist-
ence. We find also in all the malarious districts of the South

1850.] Hammond, on the Calycanthus. 267

the Cornus Florida and the Liriodendron Tulipifera. And in
the cold and bleak regions of the North, plants grow and flour-
ish suited to its diseases, such as the uva ursi, Lichen, etc., etc.

From these considerations we cannot resist the conclusion,
that, in this, our delightful country, there are, no doubt, hun-
dreds of plants, highly medicinal and whose virtues have not
yet been discovered. It is then the imperative duty of every
medical practitioner, so far as it may be in his power, to use
such p r udent and safe means as may lead to the discovery and
development of those great natural resources of the healing art.

I am not aware that any notice of the medicinal properties
of the Calycanthus has been taken by any writer. I was in-
duced to believe that it was medicinal from its highly pungent
and agreeable odor, its mild and pleasant bitter taste, and its
peculiar effects upon some constitutions. Flowers* and other
odoriferous substances are generally agreeable to the great
majority of mankind. Prof. Dunglison, however, at p. 39 of his
general Therapeutics, states that, the smell of the Calycanthus
Floridus is so disagreeable to some persons as to be almost
intolerable. I also knew a lady who could not inhale its fra-
grance, without being thrown into a violent paroxysm of spas-
modic asthma, often lasting for hours together.

I have found the Calycanthus to be endowed with the follow-
ing medicinal properties : Slightly stimulant, diaphoretic, tonic,
carminative, diuretic, and perhaps anodyne.

In the form of infusion, it is a mild stimulant and diaphoretic,
and may be given in dyspeptic conditions of the stomach, at-
tended with flatulence, cardialgia, griping pains of the stomach
and bowels, neuralgia, etc. When first taken, it soon produces
a slight exaltation of the vital forces, the heart's action is
aroused, and the pulse soon feels the impulse ; the excitation is
quite agreeable, but is evanescent, unless the dose is frequently
repeated. In torpor of the general system, with depression of
the sensorium, I have found it a mild and efficacious remedv.
In abnormal conditions of the stomach, consequent upon an
atonic state, attended with flatulence, and a dry and harsh
skin, it often produces the happiest effects.

From the analysis of the Calycanthus, its modus operandi
* 1 allude to those which exhale a pleasant smell.

268 Hammond, on the Calycanthus. [May,

upon this pathological state of the system is readily compre-
hended. The "bitter substance," acts as a tonic upon the
muscular tissue of this organ, whilst the " volatile oil" exerts a
gentle stimulating effect upon the sentient extremities of the
nervous filaments of its inner coat, bringing into vigorous ac-
tion the great central organ of sympathetic action. The stom-
ach, before painful, has new vigor imparted to it, and soon
becomes quiescent from the expulsion of flatus ; the skin also
is relaxed, and a general diaphoresis follows, together with an
enlivened state of mind, which is generally succeeded by a calm
and quiet slumber.

I have long been in the habit of prescribing a tincture of the
Calycanthus in colicy affections of infants. I consider it supe-
rior to the camphorated tincture of opium, so universally used
both by nurses and physicians. It readily acts as a carmina-
tive, removing the cause of these distressing ailments. It does
not constipate the bowels, as does the camph. tinct. of opium ;
neither does it produce the starting, often caused by this popu-
lar remedy.

In Arthrodynia, it deserves notice. I am well acquainted
with an elderly gentleman in this vicinity, who is in the habit
of drinking a strong; hot infusion of it for Podagra, and he as-
sures me that it is the best remedy he ever tried.

Another affection might be mentioned, in which I have used
it with signal success. In those violent nervous headaches, to
which some females are subject immediately preceding the
regular return of the catamenia, a cup full or two of the infu-
sion, drank warm, soon alleviates the pain, and in many instan-
ces, I am persuaded, hastens the return of the flux.

Although the Calycanthus is a mild stimulant, I have found
its administration contra-indicated in an inflamed condition of
the gastro-enteritic mucous membrane. Is it not wTorthy of
trial in adynamic fevers, attended with asthenic hyperaemia of
the encephalon, when a slight exaltation of the vital powers is
required ?

The Calycanthus is a tonic, very mild in its operation, and
may be properly classed with the sub-tonics. As a general
rule, vegetable tonics are bitter, and disagreeable to the taste,
and sometimes nauseating to the stomach. In this respect, the

1850.] Hammond, on the Cahjcanthus. 269

Calycanthus claims a decided preference over most of them,
as it is not very bitter, neither is it disagreeable to the taste.
When prescribed as a tonic, I direct the cold infusion to be
made strong, and to be drank in small quantities, frequently re-
peated during the day.

As a remedy in Dyspepsia, the great protean malady of the
nineteenth century, whether idiopathic, or the sequence of some
acute disease, it, in a few cases, had no substitute. From my
limited observation of its effects in this distressing disease, I
most respectfully commend it to the favorable consideration of
the profession.

As a remedy in Bilious Remittent and Intermittent fevers, it
is often valuable, especially after the primce vice have been well
cleansed, and the liver emulged by calomel. During the
apyrexia, I direct a strong infusion of the cortical portion to
be drank, which, in most cases, arrests the next paroxysm of
fever. Large draughts of it taken in anticipation of a chill, in
intermittent fever, very often as effectually destroys its periodi-
city, as most other vegetable tonics, the cinchona excepted.

Analysis shows it to contain a large amount of a bitter prin-
ciple, for which I would propose the name of Calycanthine !

Judging from its modus operandi upon the system, I would
suggest it to the profession as a suitable remedy in Leucorrhasa,
a disease which has troubled me more than all others with
which I have had to contend. When the discharge is exces-
sive, the constitution becomes extremely weak and nervous ;
the skin cold and clammy ; stomach feeble and flatulent ; and
the mind, too, sooner or later, becomes involved in this morbid
catenation. The patient often looks upon her case as hopeless ;
"she pines away," and "void of counsel," she becomes "timer-
ous, fearful, and sad." In this pathological state of the system,
I would recommend a trial to be made of the Calycanthus, with
other suitable remedies.

There is one fact in regard to the Calycanthus which it
might be well to mention. I have known it in two instances to
produce ptyalism, after having been used for a few days: the
flow of saliva was immoderate in one of them. j\o soreness of
the gums in either. It is an anodyne, but not in the same sense,
perhaps, in which opium is anodyne. Any remedy which

270 Hammond, on the Calycanthus. [May,

equalizes the circulation, or that excites the stomach, thereby
expelling the flatus, will relieve pain. The Calycanthus, acting
in this way, often produces ease and quiet. I, however, have
frequently observed, that aftei giving a warm draught of the
tea, that the patient soon became sleepy ; and those to whom I
have prescribed it as atonic and alterative, have frequently re-
marked its tendency to produce drowsiness. I consider its
anodyne operation to be the result of its action upon the brain
and nervous system, in the same way that camphor and the
nepeta cataria are anodyne.

As a Diuretic, I have for several years prescribed an infu-
sion of the Calycanthus in dropsical affections, with marked
benefit. I direct a strong, cold infusion of the bark, to be
drank in large quantities, say from 2 to 3 quarts per day; and
should it appear to be tardy in exciting the secretory functions
of the kidneys, I generally give 10 or 15 grs. of the nitrate of
potass., or a drachm of the super-tartrite, two or three times in
the day, in a half tea-cupful of the infusion. This combination
generally brings off large quantities of urine in the course of
thirty-six or forty hours. Notwithstanding it requires, in some
cases, the aid of the nitrate or sup. tart. pot. to direct its action
to the renal apparatus, it is nevertheless a diuretic per se,
almost in every instance causing more or less diuresis; and
this circumstance cannot be considered an exception to the
general rule. Squills, for example, produce more or less diu-
retic action, but its virtues in this respect are greatly heightened
by the addition of the proto-chloride of mercury. Other exam-
ples might be given.

After the kidneys have been aroused to vigorous secretion
from the infusion of the potash the latter may often be
discontinued without diminishing the urinary secretion the
infusion alone, being sufficient to keep up a copious discharge,
when once established by this combination. I have generally
found it necessary to discontinue it after eight or ten days, in
consequence of the anorexia it produces. This ts caused in
part, I imagine, by over-distention of the longitudinal and cir-
cular fibres of the muscular coat of the stomach, and a dilution
of the gastric juice. It will be recollected, when speaking of
it as a tonic, that I recommended it for dyspepsia ; but in that

1850.] Hammond, on the Calycanthus. 211

case, to be drank in small quantities, its action upon the stom-
ach being'governed by the quantity taken into it, and the length
of time it is continued. After suspending it a few days, for the
stomach to regain its tone, it may be resumed again, and in this
way continued throughout the whole course of treatment. To
recommend a remedy for dropsy, without stating what kind, or
without explaining the pathological state of the system, to
which such remedy is applicable, would most certainly be con-
sidered unsatisfactory to the profession, if I had not already
sufficiently explained its modus operandi, and given in detail
the analysis of the remedy under consideration. It will then
be only necessary for me to say, that in all cases where the
hydropic accumulation or diathesis is the result of asthenia,
this remedy may be safely and beneficially prescribed.

When the assimilative process is deranged from a morbid
condition of the stomach and chylopoietic vicera, emaciation and
debility ensue, thereby laying the foundation of dropsy, by
destroying the proper balance between the exhalent and ab-
sorbent systems. It may then be assumed, that in this patholo-
gical state of the organism that " the common predisponent
cause is debility."

In such cases, a mild, stimulating sub-tonic would be proper,
and at the same time, some article would be necessary to
carry off the serous effusion. The Calycanthus will fill
every indication in such a case, or as nearly so as any remedy
with which I am acquainted.

But for fear of extending this essay too far, I might very ap-
propriately detail the history of three cases of dropsy I have
recorded in my note-book, which would more clearly show the
great powers of this remedy in hydropic accumulations. It
must suffice on this occasion to notice them cursorily.

One was a married lady, 22 years of age, who had extensive
anasarca of the whole subcutaneous cellular tissue, produced
by irregular and painful menstruation : she had been afflicted
with it for years, and she had undergone the usual routine of
medical treatment. I put her upon the infusion of the Caly-
canthus, and in two months she was cured. In the meantime,
to the great satisfaction of herself and friends, encyesis took
place for the first time; she carried the lectus to the full period

272 Hammond, on the Calycanthus. [May,

of utero-gestation, and on the first day of October last, was
delivered of a fine healthy male child, since which time she
has been entirely free from any appearance of dropsy.

I will here mention that the patient took, in conjunction with
the infusion, for two or three weeks, the muriated tinct* ferri,
but she had repeatedly taken chalybeates before, with only tem-
porary relief.

The second case, was oedema of the feet and legs in a child
5 years of age, occurring as the sequel of chronic diarrhoea.
The child had been treated with the common remedies without
any abatement of the symptoms. The cold infusion, aided by
a few doses of hydrarg. cum creta, dispelled the disease in fif-
teen days.

The third case, was a lad 14 years of age, in whom extensive
anasarca supervened after the operation of lithotomy, com-
mencing on the seventh day after the extraction of the calcu-
lus.* I prescribed a hydragogue cathartic, which operated
well, causing some diminution of the swelling, and directed Port
wine to be given freely. One bottle was consumed with but
little benefit. I ordered the infusion to be taken every three
or four hours, and in eight days he was convalescent. The
wound healed readily, and the patient had a tedious but com-
plete recovery.

The hot infusion is made by pouring a pint of boiling water
upon an ounce of the bark and buds, covering the vessel for
twenty or thirty minutes. Of this, from two to four fluid
ounces may be administered at one time. The cold infusion
is prepared by adding two ounces to a pint of water, and suffer-
ing it to remain six or eight hours. Dose, from one to two
fluid ounces, three or four times per day.

The Tincture is made, by taking of the bark and tender
twigs, two ounces, bruised ; diluted alcohol, one pint macerate
for seven days, and filter through paper. This tincture pos-
sesses the active properties of the Calycanthus Floridus. The
dose is from one to four fluid drachms.

* The calculus is now in the hands of Prof. A. Means for analysis.

1850.] Production of Sugar in the Human System. 273

ARTICLE XIV.

Experiments and Conclusions of M. Bernard in relation to
the normal and abnormal production of Sugar in the Human
System. By Juriah Harriss, M. D., of Georgia now in
Paris.

Phenomena. Amylaceous materials being the only substan-
ces from which the chemist can manufacture sugar, it might
be inferred that it is also from them that sugar is produced in
the system, or at least in the digestive apparatus. It is indeed
now well established, that sugar is formed during digestion, by
the action of the pancreatic juice upon starchy substances.
This can be easily proved by placing starch in a tube with this
secretion. Saliva will produce the same effect in a tube, but
does not do so in the stomach ; for the acidity of the gastric
juice prevents its action. The pancreatic juice has not an acid
fluid to contend against hence it is unchecked in its action,
and when the aliment containing starch comes in contact with
it in the intestines, sugar is formed. This sugar is called
glucose, or unchrystalizable sugar, resembling very much the
sugar found in grapes. The glucose thus formed in the diges-
tive tube from starchy aliment is absorbed by the veins and
carried into the circulation through the portal system. If, then,
an animal be fed upon food containing starch, sugar will be
found in the blood, which sugar was manufactured in the diges-
tive canal. But will this source alone account for the amount
ordinarily found in the economy ? If so, it will certainly not
account for the enormous amount frequently found in the blood,
urine, and other secretions, during diabetes. It could not be
well imagined that a man could eat sufficiently of starchy food
to supply the excessive quantity of sugar found in the economy
of a diabetic patient. There is an experiment made by M.
Bernard, which furnishes conclusive proof that digestion is not
the only process by which is produced the sugar found in the
circulation. He has frequently taken two dogs, and fed one
indiscriminately upon azotic and non-azotic food, (meat and
bread,) and the other upon azotics alone for months together.
At the end of this time he has taken the blood from the right
auricle of each dog, and found it in each to contain sugar. The

x. s. VOL. vi. no. v. 18

274 Production of Sugar in the Human System, [May,

blood may be taken from the right auricle by passing a cathe-
ter down the jugular vein, taking care, however, that do air
may pass into the circulation. The opinion that aliments are
the only source of sugar, would lead us to believe that no sugar
ought to be present in the blood of the animal that was fed upon
azotics alone ; yet the experiment proved that as much sugar
existed in the blood of one, as in that of the other. One would
suppose that if sugar was derived exclusively from starchy food,
that no sugar ought to be found in the blood of the animal that
had eaten no such food ; but the experiment proves conclusive-
ly that the blood of animals will contain sugar, independently
of the character of their food, whether azotic or non-azotic.
Bernard, seeing this, concluded that sugar must be formed by
some other action, as well as by digestion. He accordingly
instituted a series of experiments, to determine where the sugar
originated. Having ascertained that sugar existed in the blood
taken from the right auricle of animals, it was clear that it came
from above, through the superior vena cava, or from below,
through the inferior cava. He examined the blood contained
in the superior, but found no sugar ; he then examined the
blood of the inferior cava, and detected it here on its way to
the heart. The conclusion was then plain, that it was formed
by some organ or portion of the body, whose venous blood was
carried into the inferior cava. The crural veins were next ex-
amined, and their blood contained no sugar, nor did any exist
in the inferior vena cava, below the liver or below the joint at
which the hepatic veins empty into it. The probability seemed
then that it was formed by some of the abdominal viscera.
This could be determined readily by examining the blood of
the veins of each of these organs. Each vein was examined in
succession, but sugar existed in none of them the viscera
themselves did not escape ; a decoction was made of them by
maceration in boiling water. The search for sugar in their
tissues was equally unsuccessful, save in the liver sugar was
found in abundance in the decoction of its tissue. The result
of the experiments is then, this: that sugar, or glucose, was
found in none of the veins, save in the inferior cava, above the
opening of the hepatic veins. None existed in this vein below
the point at which the hepatic veins open into it, nor in the
vena porta as it enters the liver.

1850.] Production of Sugar in the Human System, 275

In making this experiment, a small opening should first be
made in the abdomen, and the vena porta tied ; for if the abdo-
men be largely opened without this precaution the blood of
the liver will regurgitate and carry the sugar in this vein, be-
cause the pressure of the abdominal walls are obstructed. A
neglect of this precaution might tend to the error that sugar
exists always in the vena porta. This abdominal regurgitation
is seen in paracentisis for ascites.

Sugar was found only in the blood that made its exit from
the liver, and in none of the viscera save this organ. The con-
clusion then, that this substance was formed in the liver was
highly justified by experiments, thus giving to this organ a dou-
ble secretory function, resulting in the production of both bile
and sugar.

Bernard believes sugar to be a veritable secretion. It is
manifestly formed under the influence of the nervous system.
A simple irritation of the pneumogastric nerve, as pinching, will
increase its secretion. If this nerve be cut, the secretion is
immediately arrested. Besides, if in a rabbit, the origin of the
pneumogastric, which is near the fourth ventricle and calamus
scriptorius, be pricked, the increase in the quantity of sugar
formed will be so great as to constitute a real diabetes ; and
sugar will be found in abundance in his blood and urine. The
origin of this nerve may be reached by passing a pointed
instrument between the occiput and the atlas. This artificial
diabetes will cease as soon as the irritation has passed away :
it never lasts over three days in a rabbit, nor more than seven
in the dog.

The opinion that it is a secretion, has been combatted by
some. The objectors urge that the sugar may be manufactured
in digestion, absorbed by the veins and deposited in the liver, this
organ serving as a reservoir. This is by no means a serious
objection, for dogs have been fed for months upon azotised food
alone, and yet sugar existed in their blood. It cannot be easily
imagined that a sufficient quantity could collect in the liver to
supply the purposes of the economy for such a length of time.
The influence of the nervous system is a sufficient answer to
this objection. There is, however, this difference between this
secretion and the others that it has no duct, but is emptied
directly into, or is rather absorbed by the hepatic veins.

276 Production of Sugar in the Human System. |^ay>

Bernard having proved that sugar was manufactured in the
economy and thrown into the circulation, then attempted to
ascertain what becomes of it. He traced it from the liver up
the inferior cava, to the right auricle and ventricle of the heart,
and up the pulmonary arteries to the lungs. But in these or-
gans it disappeared, for none could be found in the pulmonary
veins as they returned the blood from the lungs to the heart.
It was evidently then destroyed in the lungs. How and by
what process? was the next question to be solved. It has
been long known that caustic potash placed in contact with
sugar of glucose would destroy it, disengage carbonic acid, and
leave in the vessel a brown acid. Hence it has been supposed
that the alkalies of the blood destroyed the sugar, and that
when they were not in sufficient quantity to destroy this sub-
stance, it accumulated in the economy and constituted diabetes.
Although glucose may be destroyed in a tube by a strong
alkali, this action certainly does not take place in the economy,
for the chemical action would be so powerful as to destroy the
vitality of the tissues, even admitting that the alkalies were
sufficiently strong, (which is not the case). A simple experi-
ment will prove that its destruction is not due to the alkalies of
the blood. If this fluid be heated to 100 Reaumur, it will no
longer possess the property of destroying sugar, although the
alkalies are not altered by this elevation of temperature. The
blood of a diabetic is no less alkaline than that of a healthy
person ; hence there is no more reason why one person should
be affected with this disease than another. M. Bernard does
not believe its destruction to be effected by the alkalies, but by
a peculiar organic ferment that the blood contains. This fer-
mentation and destruction of the sugar takes place only in the
lungs, because there it meets, or comes in contact with the air,
which is the great promoter of fermentation. The ferment of
the blood is, like all organic ferments, destroyed by concentra-
ted acids and heat. If the blood, as before mentioned, be heated
to 100 R. it can no longer destroy sugar, because the fermenta-
tive principle is rendered inactive, and not because of any
alterations in the alkalies. By this fermentation lactic acid is
formed, which unites with the soda of the blood to form the
lactate of soda, which passes into the circulation, and carbonic

1850.] Production of Sugar in the Human System. 277

acid gas is given off. When the lactic acid unites with the
soda, heat is produced, and this is one of the sources of animal
heat. Sugar then serves two purposes to the economy 1st,
production of animal heat, and 2d, the elimination of carbonic
acid gas. It serves no purpose of nutrition, but is simply a
respiratory aliment. In animals whose liver secretes but little
sugar, their temperature is very low. When the secretion of
sugar is arrested by cutting the pneumogastric nerve, the animal
heat gradually, but very sensibly, diminishes. These two cir-
cumstances add strength to the opinion that sugar assists in the
production of animal heat.

Sugar being secreted by the liver, and destroyed by the
lungs, it may be conceived in what manner diabetes is produced.
This must be done in one of two ways either by a diminution
of the quantity of the fermentative principle of the blood, the
agent of the destruction of the sugar, thereby allowing an ac-
cumulation to take place in the economy, and to pass out
through the secretions; or else the accumulation arises from a
super-secretion of this substance by the liver, to such an amount
that the ferment cannot destroy it. The first opinion, though
admissible, is not at all appreciable, for an estimate of the in-
crease or decrease of this principle cannot be made. M. Ber-
nard inclines to the latter belief that it is the result of a super-
secretion of the liver : he thinks that it is at least the most
frequent cause of this disease. McGregor's experiments (in
Glasgow) would seem to oppose the opinion that it is a result
of the super-secretion of this organ. He gave only meat to a
healthy man, and to a diabetic, and a short time after eating,
he made them both vomit. In the matters vomited by the
healthy person no sugar could be found ; but those of the dia-
betic contained it. He concluded therefore that in this disease
the gastric juice possessed the abnormal property of changing
food into sugar. The presence of sugar in the matters vomit-
ed by the diabetic patient can be easily accounted for ; the
blood of this man was saturated with sugar, and it passed into
the stomach with the gastric juice, where it was secreted, as it
does in the urine. All foreign substances placed in the blood,
the prussiate of potash, for example, will pass into the stomach
with the gastric juice. The frequent association of diseases of

278 Production of Sugar in the Human System. [May,

the lungs with diabetes, can be readily explained by admitting
that the latter is caused by an excessive secretion of the liver.
The secretion being increased, the lungs are forced to take on
an increased action to destroy it and prevent its accumulation
in the economy. Hence the air expired by a diabetic contains
more carbonic acid than that of a healthy person. The lungs,
containing this abnormal activity, gradually becomes fatigued,
exhausted, and finally diseased.

Any acute disease supervening upon diabetes, will arrest its
progress until the acute malady be cured. M. Andral notices
a singular example of this. A diabetic patient, whilst under
his care, was frequently attacked with diarrhoea, and at each
attack the diabetic symptoms were relieved temporarily. It
has been observed, that the blood of a diabetic contained little
or no sugar after death. This is a singular fact, but is doubt-
less owing to the lingering existence and gradual exhaustion of
the nervous system before death. If a person laboring under
diabetes be at the same time affected with phthisis, but little
sugar will be found in his blood after death. If, however, the
patient dies suddenly, sugar will be abundant in his blood.

M. Bernard has as yet proposed no treatment for this disease.
He, however, advises the physician to direct his attention to the
nervous system, and not exclusively to the digestive canal, as
has heretofore been done. Sugar is evidently secreted under
the nervous influence, and diabetes may be styled a nervous
disease ; for any powerful agent that will modify the nervous
system will mitigate this affection. Hence it is that so many
remedies have been proposed, nearly all of which will diminish
its intensity temporarily.

1850.] Influence of the Foetus in Utero, <c. 279

PART II.

TUtvitms anir (Extracts.

On the Fcetus in Utero, as inoculating the Maternal with the
Peculiarities of the Paternal organism : and on the influence
thereby exerted by the Male on the Constitution and the Re-
productive Powers of the Female. By Alexander Harvey,
M. D. (Month. Jour. Med. Sci. American Journal.)

The subject opened in this paper is a very curious one, as
also of great interest in general physiology, and of practical
importance to breeders. Instances are sufficiently common
among the lower animals, where the offspring exhibit, more or
less distinctly, in addition to the characters of the male by
which they were begotten, the peculiarities, also, of a male by
which their mother had at some former period been impregna-
ted, or, as it has been otherwise expressed, where the pecu-
liarities of a male animal, that has once had fruitful inter-
course with a female are more or less distinctly recognized in
the offspring of subsequent connections of that female with
other males. (Alison's Outlines of Phys) It is interesting to
inquire whether this is a general law in animal physiology ;
and, if it be, whether and how far it is modified in its operation
in different animals, and under different circumstances. But
to the human physiologist, and to the physician, it is of more im-
mediate interest to inquire whether or not the fact extends also
to his own species ; and, if it does, to ascertain how far it ap-
plies, and whether it does not admit of illustration by, and
serve itself, in its turn, to illustrate certain known facts in re-
gard to the communication and the constitutional effects of the
syphilitic and other morbific poisons, the scrofulous diathesis,
&c. And, in particular, it can hardly fail to suggest some such
curious questions as the following, viz :

1st. Whether, in the case of a woman who has been twice
married, and borne children to both husbands, the children
born to the second husband ever, or generally, partake of the
peculiarities of the first husband.

2d. Whether, in a family of several children, the younger
children, rather than the elder, are disposed, cater is paribus, to
exhibit the characters of the father.

3d. Whether a woman who has born several children by the
same husband, may not ultimately acquire some of the physical
characters, or at least imbibe and manifest some of the morbid
tendencies, of the latter.

In treating of this subject, Dr. Harvey first states the facts

280 Influence of the Fcetus in Utero, fyc. [May,

at present known regarding it, and second, considers the
theories offered to explain it.

The facts of the subject may be most conveniently noticed,
1st, in relation to the lower animals ; 2d, in relation "to the hu-
man species.

1. In the Brute Creation. A young chestnut mare, seven-
eighths Arabian, belonging to the Earl of Morton, was covered,
in 1815, by a quagga, which is a species of wild ass from Africa,
and marked somewhat after the manner of the zebra. The
mare was covered but once by the quagga; and, after a
pregnancy of eleven months and four days, gave birth to a
hybrid which had distinct marks of the quagga, in the shape of
its head, black bars on the legs and shoulders, &c. In 1817,
1818, and 1821, the same mare (which had, in the mean time,
passed into the possession of Sir Gore Ouseley) was covered
by a very fine black Arabian horse, and produced, successively,
three foals, all of which bore unequivical marks of the quagga.
A mare belonging to Sir Gore Ousley was covered by a zebra,
and gave birth to a striped hybrid. The year following, the
same mare was covered by a through-bread horse, and the
next succeeding year by another horse. Both the foals thus
produced were striped, i. e., partook of the characters of the
zebra.* And it is stated by Haller, and also by Becker, that,
when a mare has had a mule by an ass, and afterwards a foal
by a horse, the foal exhibits traces of the ass.f

In the foregoing cases, the mares were covered, in the first
instance, by animals of a different species from themselves.
But cases are recorded of mares covered in every instance by
horses, but by different horses, on diffent occasions where
the offspring partook of the characters of the horse by which
impregnation was first affected. Of this Mr. M'Gillivray gives
two examples. Thus, in several foals, in the Royal stud at
Hampton Court, got by the horse Actoeon, there were un-
equivocal marks of the horse Colonel, the dams of these foals
were bred from by Colonel the previous year. Again, a colt,
the property of the Earl of Suffield, got by Laurel, so resembled
another horse Camel, " that it was whispered, nay, even as-
serted, at New-Market, that he must have been got by Camel."
It was ascertained, however, that the mother of the colt was
covered, the previous year, by Camel.

It has often been observed, also, that a well-bred bitch, if she
have been impregned by a mongrel-dog, will not, although

M'Gillivray, "Aberdeen Journal," March, 28, 1849. Paintings of these
animals and their skins are said to be preserved in the Museum of the Royal
College of Surgeons of England.

t Haller, Element., Physiol., viii. p. 104; Becker, Physic. Subterran., Lips.
1703. Quoted from Dunglison's Physiology, vol. ii. p. 387.

1850."| Influence of the Foetus in Utero, tyc. 281

lined subsequently by a pure dog, bear thorough-bred puppies in
the next two or three litters.*

The like occurrence has been noticed in respect of the sow.
A sow of the black and white breed (known as Mr. Western's
breed) became pregnant by a boar of the wild breed, of a deep
chestnut colour. The pigs produced were duly mixed, the
colour of the boar being in some very predominant. The sow
being afterwards put to a boar of the same breed with her own,
some of the produce were observed to be stained or marked
with the chestnut colour that prevailed in the former litter.
And, on a subsequent impregnation, the boar being still of the
same breed as the sow, some of the litter were also slightly
marked with the chestnut colour. What adds to the value of
the fact now stated is that, in the course of many years' ob-
servation, the breed in question was never known to produce
progeny having the smallest tinge of the chestnut colour.f

Breeders of cattle are familiar with analogous facts as occur-
ring in the cow. A pure Aberdeenshire heifer was served
with a pure Teeswater bull, to whom she had ^first-cross calf.
The following season, the same cow was served with a pure
Aberdeenshire bull ; the produce was a cross calf, which at two
years old had very long horns, the parents both hummel. J A
pure Aberdeenshire cow was served in 1845, with a cross bull
- i. e., an animal produced betwreen a first-cross cow and a
pure Teeswater bull. To this bull she had a cross calf. Next
season she was served with a pure Arberdeenshire bull, the
calf was quite a cross in shape and colour.

Mr. M'Gillivray, after narrating the whole of the foregoing
examples, says : " Many more instances might be cited, did time
permit. Among cattle and horses, they are of every day occur-
rence."

2. In the Human Species. The facts bearing on this subject
are few, and not to be relied upon, and the following observa-
tions, Dr. Harvey says, intended rather to suggest and direct,
than to satisfy, inquiry.

Dr. Allen Thomson, in his article on generation, in the
"Cyclopaedia, of Anatomy and Physiology,"' remarks: "It is
affirmed that the human female, when twice married, bears
occasionally to the second husband, children resembling the

* Kirke's Handbook of Physiology, p. 613.

t Philosphical Transactions for 1821, p. 23. " Apart from a state of domesti-
cation," says Mr. M'Gillivray, "I do not believe that there is one solitary
instance in which an animal has produced offspring of various colours.
Animals, left entirely to the operation of natural causes, never exhibit this sport-
ing of colours; they are to be distinguished by various and often beautiful
shades of colour; but then each species is true to its own family type, even to a
few hairs or small parts of a leather.

X M'Gillivray, loc. cit. Ibid

282 Influence of the F&tus in Utero, fyc. [May,

first, both in bodily structure and mental powers." And Dr.
George Ogilvie, of this city, informs me of a case which fell
under his own observation, where a woman was twice married,
and had children by both husbands, and where the children by
both marriages were scrofulous, although only the first husband
had marks of that diathesis ; the woman herself, and the second
husband, being, to all appearance, quite healthy.

Dr. Ogilvie's case is clearly beset by so many sources of
fallacy, that we cannot venture at present to regard it as a
case in point. Dr. Thomson does not bring forward any in-
stances, nor offer any proof, in support of his statement ; and,
indeed, he gives it, without saying whether h$ thinks it well or
ill-founded. Any such statement, it is plain, based on observa-
tion of the children of European parent i. c, where the female
and both her husbands and their children are all white must
be comparatively difficult of verification ; but it is equally plain
that means exist for subjecting it to a pretty decisive test.
There are equally distinct breeds of the human family as of
any of the lower animals ; and all that seems requisite in re-
gard to determining the question under consideration is, to ob-
serve accurately, whether the children of European parents,
where the woman has, in the first instance, had offspring by a
negro, exhibit, traces of the latter in the colour of the skin, the
form of the features, &c. ; or vice versa, whether the children
of negro parents, where the woman had, fisrt of all, been im-
pregnated by a Europeon, exhibit the peculiarities of the latter.
Of the former case, a medical friend informs me that he recol-
lects hearing of an instance of the kind as occurring in this
neighbourhood, but cannot vouch for the truth of it. Of the
latter case, if the general fact applies to the human species, in-
stances must abound in our West India colonies, in the United
States of America, and in other parts of the world. My col-
league, Dr. Dyce, tells me that he has certainly known one
instance (if not more,) where a Creole woman bore fair children,
to a white man ; and that the same woman had afterwards to a
Creole man other children, who bore much resemblance to the
white man, both in features and in complexion. But two
very intelligent friends the one a West India proprietor,
the other a medical man both long resident in Jamaica, tell
me that they never noticed, nor ever heard, of an instance of
the kind, although connections of that sort are common there,
and children born under such circumstances very numerous.
It is singular, indeed, if instances of the fact in question do
occur, and still more if they are of frequent occurrence, that
they should not be notorious. It is conceivable, however, and
by no means improbable, that cases do exist, but that they have

1850.] Influence of the Foetus in Utero, Sf-c. 283

been overlooked from the traces of the European being so
minute as to escape ordinary observation, and the fact have re-
mained unknown, from special attention never having been
directed to it.

If the male does exert any such influence as is here in ques-
tion, on the constitution and the reproductive powers of the
female, it is conceivable that, by each successive impregnation
effected by him, that influence may be increased ; and, if so,
the younger children begotten by him, rather than the elder,
might be expected, coeter is paribus, to bear their father's image.
And this more special fact, if ascertained, would establish also
the more general one. I am not aware, however, of any
specific facts, bearing upon it, nor of any popular notions re-
garding it. But my colleague, Dr. Laing, is cognizant of the
case of an English gentleman who had a large family by a
negro woman, in the West Indies, and where the children suc-
cessively exhibited more and more the European features and
complexion.

But, however this may be, there is a popular belief that, in
the course of years, a woman comes to resemble her husband,
and that not merely in respect of temper, disposition, or habits
of thought, but in bodily appearance. But, in so far as the no-
tion may hold good, it may be true only of the features, and of
these only as they indicate or bespeak the inward feelings of
the mind, which, from long and familiar intercourse, may, to a
certain extent, become common to man and wife. In so far
as the notion is true in any other respect, and the parties have
had several children, it may suggest the question, whether the
assimilation is not referable to an influence exerted by the
husband, through the medium of the foetus in utero, on the
constitution of the wife? The question is probably an idle
one, and the notion only a popular error. In so far, however,
as there is anything in it, the explanation suggested gives a
peculiar, and, it may be added, a physiological significancy, to
the language of Scripture relative to man and wife, at least
when their intercourse has been fruitful " They twain shall
be one flesh.'"

It is of more immediate interest, however, and of greater
practical moment, to ascertain whether, through the medium
of the foetus, the husband may impart to his wife either the
syphilitic virus, or the scrofulous diathesis, or any other con-
stitutional morbid tendency (e. g. insanity) which he may pos-
sess. Facts are wanting on this subject ; but it is not unde-
serving of patient inquiry. Dr. Ogilvie's case, formerly re-
ferred to, if it could be relied on, would be an instance of it.
Before the mother could have imparted the scrofulous taint to

284 Influence of the Foetus in Utero, fyc. [May,

her offspring by the second husband, she must herself have im-
bibed it from her first husband through the medium of his off-
spring while in utero. And, although still seemingly free of
the taint, it may have required only the appropriate external
conditions to call it into full activity in her own person. And
with regard to the syphilitic poison, there is no difficulty in un-
derstanding, and it is quite within the bounds of probability,
that the fetus, if contaminated with by its father, it may con-
vey it to the mother. Messrs. Maunsell and Evanson, after
mentioning that they have notes of the case of a syphilitic
child, whose mother had been infected by a former husband
(they do not say in what way) and to all appearance, cured
five years before its birth the father of the child (her second
husband) being in good health, state that their experience would
enable them to adduce many curious facts bearing on the com-
munication of the syphilitic poison.* Perhaps their experience
might furnish an affirmative solution of the question at issue.
It has been affirmed, indeed, that a man who has once had syphi-
lis, but been seemingly cured of it for many years, may yet so
retain the taint of it as to contaminate his offspring, without, at
the same time, tainting his wife. Very possibly. But this
does not prove that he may not contaminate his wife also, and
the observation itself is in that respect fallacious, inasmuch as,
in any given case of the kind, the wife may really have im-
bibed the virus, although in a latent form, and might subse-
quently give proof of the reality of the fact by tainting the
offspring begotten by another and a perfectly healthy husband.
Adopting this view, it may be found of importance, in contem-
plating marriage with a widow, to inquire into the constitu-
tional peculiarities of her deceased husband !

The following additional cases, illustrative of this question,
have recently been communicated to Dr. Harvey; the first
by the Rev. Charles M'Combie, of Tillyfour, minister of
Lumphanan, in Aberdeenshire ; the second by Professor Simp-
son, of Edinburgh ; and the third by Professor Pirrie, of Aber-
deen :

1. Mrs. , a neighbor of Mr. M'Combie, was twice mar-
ried, and had issue by both husbands. The children of the first
marriage were five in number ; of the second, three. One of
these three, a daughter, bears an unmistakable resemblance to
her mother's first husband. What makes the likeness the more
discernible is, that there was the most marked difference, in
their features and general appearance, between the two hus-
bands.

2. A young woman, residing in Edinburgh, and born of white

* On the Management and Diseases of Children, 5th edit., pp. 452, 453.

1850.] Influence of the Foetus in Utero, $c. 285

(Scottish) parents, but whose mother, some time previous to her
marriage, had a natural (mulatto) child, by a negro man-servant,
in Edinburgh, exhibits distinct traces of the negro. Dr. Simp-
son, whose patient the young woman at one time was, has had
no recent opportunities of satisfying himself as to the precise
extent to which the negro character prevails in her features ;
but he recollects being struck with the resemblance, and no-
ticed particularly that the hair had the qualities characteristic
of the negro.

3. Mrs. H , apparently perfectly free from Scrofula,

married a man who died of phthisis. She had one child by him,
which also died of phthisis. She next married a person who
was to all appearance equally healthy as herself, and had two
children by him, one of which died of phthisis, the other of
tubercular mesenteric disease having, at the same time, scro-
fulous ulceration of the under extremity.

Great difficulty has been felt by physiological writers, in re-
gard to the proper explanation of this kind of phenomena.
They have been ascribed by some to a permanent impression
made somehow by the semen of the first male on the genitals,
and more particularly on the ova, of the female ; and by others
to an abiding influence exerted by him on the imagination of the
female, and operating on her mind at the time of her connec-
tion subsequently with other males, and perhaps during her
pregnancy. But they seem to be regarded by most physiolo-
gists as inexplicable.

Very recently, in a paper published in the " Aberdeen Jour-
nal,"* an intelligent veterinary surgeon, Mr. James M'Gillivray,
of Huntly, has offered an explanation, which seems to Dr. H.
to be the true one. His theory is set forth in the following
statements quoted from that paper : " When a pure animal
of any breed has been pregnant to an animal of a different
breed, such pregnant animal is a cross ever after ; the purity
of her blood being lost, in consequence of her connection with
the foreign animal ; and again : " If a cow, say of the pure
Aberdeenshire breed, is in calf to a bull of the short-horn breed
(known as the Teeswater breed), in proportion as this calf par-
takes of the nature and physical characters of the bull, just in
proportion will the blood of the cow become contaminated, and
herself a cross, forever incapable of producing a pure calf of
any breed." " It is maintained, therefore, (Mr. M'Gillivray
adds,) that the great variety of non-descript animals to be met
with are the result of the crossing system: the prevailing evil
of which is, the admission of bulls of various breeds to the same
cow, ichereby the blood is completely vitiated"

" * March 21 and 28, 184D. "

286 Influence of the Fostus in Utero, $c. [May,

Mr. M'Gillivray is probably quite wrong in assuming that
there is a direct vascular connection between the fetus and its
mother ; but this, as Dr. Harvey observes, is not necessary to
establish the theory ; " perhaps," he says, " the best general ex-
pression of the theory is, that the foetus, partaking, as it must,
of the characters or peculiarities of its father, inoculates there-
with the blood, and, generally, the system of its mother."

"In connection with the constitutional influence exerted by
the male, through the medium of the fetus in utero, on the sys-
tem of the female, another and a veiy singular question," says
Dr. H., "may be raised. In the case of an aboriginal woman
of colour, does previous impregnation by a European male
render the female incapable ever after of fruitful intercourse
with a male of her own race ?

" This question is suggested by an observation, made in vari-
ous parts of the world, by the excellent Count de Strzelecki,
relative to the effect of fruitful intercourse between an abori-
ginal female and a European male. * Whenever such intercourse
takes place" says the Count, " the native female is found to
lose the power of conception, on a renewal of intercourse with a
male of her own race, retaining only that of procreating with
the white men.'*

" This, if a general fact, contrasts remarkably with Dr. Simp-
son's case, above-mentioned, (one of fruitful connection between
a white man and a white woman, after previous impregnation
of the latter by a black man,) unless, indeed, this be, which
probably it is not, an exception to an equally general fact of the
same sort. It would limit, also nay, absolutely exclude op-
portunities of observing whether children born of dark parents,
where the mother formerly had issue by a European male, ex-
hibit traces of the latter. But it was before stated, (p. 1135,)
on the authority of two gentlemen long resident in Jamaica,
that, in our West India colonies in Jamaica, at least, fruitful
connections of this kind are of common occurrence (which I
mention at present as in keeping with this) on the authority of
Dr. Boyce, that, in children born under such circumstances,
marks of the European have been observed. Special inquiry,
made recently, has served so far to confirm these statements,
but not to satisfy me that the issue of such connections is nu-
merous.

"The opportunities, however, enjoyed by the Count de
Strzelecki, of making observations as to this point, in most
parts of the New World, have been very great. ' He has lived
much (to use his own words) amongst different races of abori-

* Physical Description of New South Wales and Van Dieman'sLand, p. 347.

1850.] Extraction of Foreign Bodies. 287

gines, the natives of Canada, of the United States, of Califor-
nia, of Mexico, the South American Republics, the Marquesas,
Sandwich, and Society Islands, and those of New Zealand and
Australia.'* And, referring to the statement made by him,
and already quoted, the Count observes ' Hundreds of instan-
ces of this extraordinary fact are on record in the writer's
memoranda, all recurring invariably under the same circum-
stances, amongst the Hurons, Seminoles, Red Indians, Yakies
(Sinaloa), Mendosa Indians, Araucos, South Sea Islanders, and
natives of New Zealand, New South Wales, and Van Dieman's
Land ; and all tending to prove that the Sterility of the female,
which is relative only to one and not to another male, is not
accidental, but follows laws as cogent, though as mysterious, as
the rest of those connected with generation.' "f

On the Extraction of Foreign Bodies. By J oh an n Frede-
rick Dieffenbach. (Concluded.)

The removal of foreign bodies which have penetrated the
textures.

1. The extraction of foreign bodies from wounds, or from
suppurating canals. A vast multitude of instruments have
been contrived for the removal of foreign bodies from the living
organism, a manifest proof of the difficulty and importance of
the procedure. Most of these apply to the removal of bullets,
by far the most momentous. They are chiefly forceps, scoops,
or hooks, and also gimlets, for boring holes into those imbedded
in bone, in order to facilitate extraction. Many are useful,
many superfluous, and others detrimental. The simple are the
best.

The most eligible ball-extractor, according to my experience,
is a straight, uniformly round, strong forceps, fashioned like a
straight polypus-forceps. Its branches and handles must be
longer, and its thickness more than double that of any polypus-
forceps, that it may not break. It must, for the same reason,
be without perforations, its inner edges armed with strong
teeth ; externally, finely polished, so as not to irritate the raw
surface.

In addition to the forceps, the surgeon ought to be provided
with two bullet-scoops, a strong silver probe, a large syringe, a
probe-pointed bistoury and blunt hooks.

The patient ought to be put in the same position as that in
which he received the wound, otherwise muscular fibres, fascia?,

* Physical Description of New South Wales and Van Dieman's Land. p. 315.
t Op. ciU, p. 347.

288 Extraction of Foreign Bodies. [May,

tendons, get misplaced, and tend to perplex the passage through *
which the projectile entered. Should inflammation have as-
sailed the wound, it must be treated in the usual way, and no
operation attempted till its subsidence.

The act of exploration demands the utmost foresight, all noise
being excluded, so that the surgeon may clearly distinguish
what the probe strikes against. If the ball is to be felt plainly,
it is to be extracted. The forceps, smeared with oil, are intro-
duced shut, opened when they reach the ball, made to catch
hold of it, and, with a few gentle turns, gradually withdrawn.
Care must be had not to injure the sides of the wound. Some-
times the ball may seem to be deeply seated when really near
the surface, and vice versa.

The dilatation of the canal or tube formed by the track of
the ball is, in general, highly prejudicial ; but the wound in the
integument may be dilated when it will not admit the forceps.
The position, that a gun-shot wound should be transformed into
an incised wound, is false ; to enlarge the wound is to increase
the danger. Only in the instance of great extravasation, of
loose portions of bone, or of shells, or accumulations of pus, is
dilatation permissible. If the ball has penetrated a bone, and
cannot be got away with forceps, it may be eased out with a
gouge. The suggestion of using quicksilver, to form an
amalgam with the lead, is most objectionable.

If there be no immediate prospect of removing the ball, all
further attempts should be postponed until suppuration is estab-
lished, when they may be renewed with some likehood of suc-
cess. . Frequently, balls heal up within the bone, are overgrown
with osseous deposit, or else encysted in the soft textures.

In other cases, the ball separates of itself and comes away
after the lapse of months, when the tube has been rendered
wider by the process of suppuration, the fat and muscles ab-
sorbed, and the patient has accustomed himself to lie upon the
corresponding side.

Occasionally, the ball cannot be found. It may have de-
viated from its track, swept round a bone, or taken a totally
different course than could have been expected from the direc-
tion of the tube. Under such circumstances all interference is
futile. Are there two openings in a limb ? The lesser is the
inlet ; the greater, the outlet. Of course probing is out of the
question, for the ball is escaped. But yet, despite of two
openings, a ball may be present. I was called in consultation
with Dr. Casper, to a young Russian, who had shot himself.
There was an opening on the chest anteriorly, and another on
the back, both of the same size. At the cadaveric inspection,
a bullet was found in the thoracic cavity. The pistol, therefore,

1850.] Extraction of Foreign Bodies. 289

had been loaded with two balls. Of these, one had passed
through, while the other remained. Should the ball be lying
beneath the integument on the opposite side, all groping in the
tube formed by its track is improper; nothing more is needed
than to make an incision through the skin and extract it.
Bony splinters ought to be left until detached ; otherwise
dangerous bleeding may result. If the bone is fractured, no
search should be made. Wounded arteries must be secured
with ligature a little above the wound, which is not to be dis-
turbed. Portions of wadding are to be removed with hooked
forceps, ball-drawers, or bent hooks. It may be laid down,
however, as a general rule, in all the above cases, that the less
interference the better.

When balls are driven into the surface of the skull, they may
be loosened with a chisel or with Heine's saw ; when the inner
table is perforated, and the bullet wholly or to a great extent
forced inwards, the aid of the trephine will be required for its
withdrawal. The surgeon ought not to go in quest of bullets
lodged within the chest or abdomen ; he may, if accessible,
remove them from the wound, but make no attempt at dilata-
tion. Afterwards, the edges should be carefully brought
together and retained in apposition by strips of adhesive
plaster and a compress, even although other foreign bodies be
infixed.

The extraction of balls, grape, and the like, from the cavity
of a joint or the head of an articulation, is attended with much
difficulty, and only admissible when the ball will readily yield,
as amputation is generally indispensable before the occurrence
of inflammation.

Small pistol-shot, deer and hail-shot, do far less mischief than
those of greater diameter. They either perforate the limb, or
remain and are healed in the flesh. They ought to be removed
only after recent injuries, when they can be easily laid hold of
with dressing or polypus forceps. Hail-shot may be left alone,
if deeply inserted ; but if superficial, picked out with a curette.

Angular fragments, as those of bombs and grenades, chopped
lead and nails, splinters of the carriages of cannon, or of ships
(during sea-fights,) cause the most complicated lacerations, and
their excision by dilatation is as urgently indicated as the op-

fosite, or passive plan, in tHe instance of smooth spherical shot,
n every case, the incision is to be made in the longitudinal
axis of the limb, in the course of the muscles, nerves, and
blood-vesssels, preparatory to the removal of the extraneous
substance, which must be done with extreme circumspection.
Sharp-pointed bodies, as the ends of swords, nails, and the
like, are more readily extracted than bullets, because more

k. s. VOL. VI. no. v. 19

290 Extraction of Foreign Bodies. [May,

freedom may be used in incising the wound, and in tracing
with the probe. For this purpose a dressing forceps is alone
requisite. I have often been at considerable pains in removing
the points of rapiers which had entered the body during duels.
A portion of a two-edged sword, the length of the finger was
once carried with such vehemence into the body of one of the
lumbar vertebras from behind, that, although the broken end
protruded, I was obliged to use great exertion to remove it.
The wound got well without any untoward symptom.

Arrows driven into the body, armed with barbs, barbed
hooks, or other metallic hooked implements, are to be taken
out in the same way as they entered, after previous dilatation
by means of a cutting instrument. If the missile has reached
the opposite side, a counter-opening may be made for its exit.

Needles, whether entire or broken, which have penetrated
the flesh, need no extensive section for their removal. If the
needle is lying lengthwise, I usually force it out by its point
without cutting, namely by simply pressing up the skin with
my fingers against the two ends. So soon as the point makes
its appearance it is grasped with forceps, and the whole
withdrawn. I thus extracted a large needle from a lad, which
had passed through the urethra backwards to the neck of the
bladder. The patient having been placed as in the operation
for lithotomy, I inserted one finger into the rectum, exercised
counter-pressure with the fingers of the left hand upon the gut,
and, having brought the point into view, plucked out the entire
needle with forceps. Should the needle not be discovered after
incising the integument, and careful probing, the wound must
be left to suppurate, and further trials made during the employ-
ment of poultices.

Fragments of glass or porcelain ought to be removed forth-
with by incision. As the external wound is, for the most part,
complicated, incisions cannot do harm. Great delicacy is re-
quired so as not to crush the broken fragment with the forceps
during extraction. Suppuration is to be afterwards promoted,
lest any particle be left and prove a future source of nervous
irritation.

Grains of powder must be picked out with a full-sized
cataract needle, or with the point of a fine scalpel.

In the instance of poisoned wounds excision is the only sure
course. If impracticable, the parts should be bathed with tepid
water, freely scarified, set to suppurate, or covered with poul-
tices medicated with solution of caustic potash. After the
bite of a rabid animal, energetic suppuration ought to be kept
up by the agency of powdered cantharides, applied topically,
ointment of the same, and, subsequently, mild resinous dressing.

1850.] Extraction of Foreign Bodies. 291

The cauterization of poisoned wounds is a most objectionable
practice, inasmuch as the resulting dry eschar serves to retain
the poison in the system.

2. The Removal of foreign substances healed up within the
body. In cases of this kind, where no annoyance is created by
the presence of the foreign body, the best plan is to let it alone.
Where, on the other hand, accidents arise, either from its pres-
sing upon a nerve, or from its approaching a joint and impairing
its mobility, or from its beginning to cause shooting pains,
measures ought to be taken for its removal. A ball often
makes its way to the opposite side to which it entered, and can
be there distinctly felt.

The patient is to be placed in a recumbent posture, and so
adjusted as to relax the muscles of the part implicated, that
the surgeon may be enabled to feel the ball. Should he fail in
doing so, but perceive, on pressing some suspicious spot, that
considerable pain is complained of, let him plunge a pin, such
as is used for transfixing insects, the length of the finger down
through the flesh. If resistance is felt in a situation remote
from bone, and a sound emitted on a gentle tap being given
with a small hammer, he may rest assured the ball is there,
and will not have to operate in vain. I have in this way dis-
covered balls very deeply inbedded.

The patient being properly secured, the incision may be
carried the length of two inches, if the ball be near the surface ;
but, if profoundly lodged, as in the thigh or buttock, it may
extend to three or four inches, always following the course of
the muscular fibres, blood-vessels, nerves, and tendons. In the
proximity of joints, the cut need not be larger than will admit
a straight polypus forceps. It will often prove advantageous
to make, with a small narrow knife, a minute incision several
inches below the articulation and below the ball, thereby form
a punctured channel, and remove the ball according to the sub-
cutaneous method. The utmost caution, however, is necessary
so as not to open the capsule of the joint, or injure the vessels
and nerves.

Should a ball create disturbance after a lapse of several
years, this is probably due to necrosis or caries. Here the sur-
rounding parts will be inflamed and swollen, and the indication
not to disturb the ball, but to further suppuration by means of
hot poultices. When this is established, an incision mav be
made, the ball extracted, and suitable treatment adopted.

A foreign substance which has tarried long in the organism
becomes invested with a tough capsule. This oujjht to be slit
across, and after the withdrawal of the ball its posterior wall
divided, and sides freely scarified, as being little susceptible of

292 Extraction of Foreign Bodies, [May,

inflammation. When these precautions are not attended to, a
cavity is left after the closure of the wound, which may form
a secreting surface, and lead to troublesome consequences, at
any rate, to re-opening of the wound.

I have repeatedly, by the aid of small incisions and forceps,
extracted from the hairy scalp the teeth of horn and tortoise-
shell combs, which had remained fixed beneath the skin for
years, and caused much inconvenience ; in like manner, rusty
needles, from various parts of the body, which had got broken
by the action of the muscles.

Sharp-pointed substances, as fragments of nails or glass,
when infixed in the soles of the feet, the palms of the hands, or
the bends of the fingers, are apt to occasion much distress. I
removed from the sole of the foot of an English officer a long
splinter, of glass, which had been healed in, and caused a deal of
suffering. It is often necessary to excise, at the same time,
hard prominent star-like scars, in order to restore the integrity
of the part, and more efficiently remove the extraneous sub-
stance. A young girl, who was afflicted with epileptic fits,
spasmodic contraction of the arm, with wasting, had a number
of irregular cicatrices in the hand and bend of the fingers,
which were simultaneously drawn together with and through
the spasms. It was stated that she had fallen upon her hand
among glass many years previously. Expecting to find splin-
ters, I dissected out of the cicatrices, and discovered, in the
firmest of the number, a slip of glass resembling a fish scale.
This had evidently determined all her ailments, for the epilepsy
and spasmodic contraction ceased, and she recovered the per-
fect use of the limb.

3. The extraction of fragments of dead hone. The inter-
ference of surgery is seldom required until the necrosed bone is
separated from the adjunct parts by a distinct line of demarca-
tion internally. Much benefit will be derived from judicious
medical treatment. Thus tonic remedies, in conjunction with
phosphoric acid, and also alkaline baths and poultices to favour
exfoliation, and induce liquefaction of the callous integuments,
will be found highly serviceable. When the bony particles get
loose, perforate or project beneath the skin, their removal may
be accomplished by a small incision. More persons, however,
have lost their lives or their limbs by premature attempts to re-
move dead, or partially dead, pieces of bone, than have been
relieved by such operations. The process of necrosis requires,
at least in the instance of the large bones, years for its termina-
tion, as regards unhealthy individuals. All efforts to accelerate
merely tend, to retard, nor are they exempt from danger to
patients reduced by protracted disease. If the sequester held

1850.] Directions for using the Nitrate of Silver. 293

only by the soft parts, keeps up inflammation and abscess,
it will be right to divide the skin, or dilate a pre-existing
aperture, and then seize the bone at one end with forceps and
withdraw it. In general, the necrosed fragments of the super-
ficial layers get uplifted by the granulations at the base, and
compress the skin, which is thereby attenuated and easily
ruptured. During the chronic progress of necrosis of an entire
long bone, of which the articular ends pass into the recent
structure, the old dead portion is so firmly increased, as not to
be readily thrown off. Here patient forbearance is requisite.
The out opening may be dilated with sponge tents, and trials
instituted to bring away piece by piece ; and small bullet
forceps, similiar to polypus forceps, or a gimlet, employed, pro-
vided the fragment is loose. If the osseous cavity be extensive,
the dead portions may be either extracted or crushed by means
of a lithrotrite. I have more than once excavated a sequester,
half as long again as the finger, from its recent bony envelope
in the tibia, without previous dilatation of the cloaca, by the
help of a watchmaker's drill, to which a tubular trephine, of the
size of a swans quill, was attached.

As in the cylindrical bones, so likewise in those of the
cranium, are all manoeuvres to get rid of dead fragments with
saw or chisel contra-indicated. Exposure of the necrosed part
by a linear cut, where the bone is no longer protected extern-
ally by periosteum, is the sole operative procedure to be
sanctioned ; even a crucial incision is too much. Under the
employment of moist warmth, exfoliation is more rapid than in
the case of the long bones.

Directions for using the Nitrate of Silver in the Cure of In-
flammation, Wounds and Ulcers. By Johx Higginbottom,
*F.R. C. S. (London Lancet.)

"Never is Surgery so beautiful, and brilliant, as when obtaining a cure with-
out the destruction of any organ, without plunging the bistoury into quivering
flesh, and without causing the effusion of blood." Lisfranc.

After twenty years' further experience in the application of
the nitrate of silver in the cure of inflammation, wounds and
ulcers, I am desirous of giving full and clear directions for the
use of it, particularly as the proper mode of application is quite
essential to secure its good effect. I have preferred doing
this rather than giving cases in detail, of which I could have
readily produced a volume annually.

There is no form of acute superficial inflammation, arising
from either constitutional or mechanical causes, where the

294 Directions for using the Nitrate of Silver. [May,

nitrate of silver may not be applied with great safety and ad-
vantage.

The observation of the celebrated John Abernethy is true
with respect to the application of the nitrate of silver " Sub-
due local irritation, and regulate the action of the digestive
system, and you control all controllable disease."

The great obstacle to the general and free use of the nitrate
of siver, even at the present day, appears to arise from the im-
pression on the minds of many surgeons that it is a caustic, a
destructive agent. If they could be divested of that idea, and
use it as freely as they would a common blister of cantharides,
their fears would soon subside, from repeatedly observing the
safety of the application, and also its beneficial effects. In my
own practice I have always considered it a safer remedy than
cantharides, as it may be applied freely over a surface, even
where very active inflammation exists, or where there is an
extensive surface denuded of its cuticle. This remedy has also
the advantage of not affecting the bladder, or producing stran-
gury.

The nitrate of silver is not a caustic, in any sense of the
word. It subdues inflammation, and induces resolution and the
healing process. It preserves, and does not destroy, the part
to which it is applied. If wre compare a caustic, as the hydrate
of potassa, with the nitrate of silver, we find that the hydrate of
potassa destroys and induces a slough, and the ulcerative pro-
cess; but if we touch a part with the nitrate of silver, the
eschar remains for a time, and then falls off, leaving the subse-
quent parts healed.

If an ulcerated surface, secreting pus, be touched by the
nitrate of siver, the succeeding discharge is immediately con-
verted into lymph ; it is the property of the hydrate of potassa,
on the contrary, to induce not only ulceration but suppuration.
In short, the peculiar properties of the nitrate of silver have
long been kept unknown to us by the designation of lunar caus-
tic, affording the most striking instance of the influence of a
term, or of a classification, upon the human mind. The nitrate
of silver and the hydrate of potassa (as indeed all caustics) are
as the poles to each other; the first preserves, the second des-
troys ; the first induces cicatrization, the second ulceration.

I have for some years past used the nitrate of silver in solu-
tion, as well as in the solid state, finding the concentrated solu-
tion more convenient for application, where the nitrate of silver
has to be applied on a considerable surface, as in erysipelas, &c.
The following is the formula I have of late used : Nitrate of
silver, four scruples ; distilled water, four drachms. Put the
nitrate of silver into a half-ounce bottle, add the distilled water ;

1 850.] Directions for using the Nitrate of Silver. 295

the nitrate of silver will be dissolved in a short time, and if
rightly prepared the solution will be clear and transparent;
this quantity may be kept conveniently in the pocket of the
surgeon, for daily use. The solution may be. applied with a
small piece of sponge, an inch in length, and one-thiid of an
inch in breadth, stitched on the eye at the end of a common
silver probe ; this makes a most convenient instrument, which
may be kept in the pocket case ; it is not only useful for exter-
nal inflammation, but can be used to internal parts of the throat,
&c. Precaution should be taken to wash the sponge w ell with
water after using it.

When the solid form of the nitrate of silver is used, it is ne-
cessary to moisten the surface to which it is applied, slightly,
with pure water, and apply a long stick of the nitrate of silver
Jiat upon the moistened surface, taking care that it be applied
to every affected part.

It is necessary, for the successful application of the nitrate of
silver, that the surface of the skin be free from any oleaginous
matter, loose cuticle, or any other extraneous substance ; the
parts should be well washed with soap and water, and after-
wards with water alone, to remove any particle of soap re-
maining.

It is essential to know the precise effect of the nitrate of
silver, in the different degrees of its application. If the nitrate
of silver be passed once slightly over the moistened skin of any
part, except the hands or soles of the feet (upon which the cu-
ticle is thicker than elsewThere), it induces an eschar, simply ;
if it be passed over the surface twice or thrice, to the eschar
will be added some vesication ; if more still, there will be vesi-
cation only. In the first place, there will be no pain ; in the
second and last, there will he soreness proportionate to the de-
gree of vesication.

It is essential to the success of this plan of treatment, that
these observations be kept constantly in view.

I shall now describe the mode of application of the nitrate of
silver in the treatment

Of recent Bruised Wounds of the Skin, c. In recent bruis-
ed wounds of the skin, the nitrate of silver should be applied
on the wound, taking care to leave no spot untouched, and
upon the surrounding skin, to the breadth of one-third of an
inch, in such a manner as to induce an eschar, without vesi-
cation. Any moisture which may remain upon the wound is
then to be removed by gently wiping the part with a little linen
or lint, and the skin surrounding that in which the nitrate of
siver was applied is to be moistened, and covered with gold-
beater's skin, so that the whole may be protected from accident ;

296 Directions for using the Nitrate of Silver, [May,

the parts are then to be kept coo), free from covering, and ex-
posed to the air.

This is usually all the treatment required in this kind of in-
jury. It will be generally found, that an adherent eschar is
formed, and that no further application or attention is required,
excepting in old people, in whom the skin is sometimes irritable
from various causes ; in this case, a little fluid will form under
the edges of the eschar, and will require to be evacuated by a
small puncture, the gold-beater's skin being removed for this
purpose, and then re-applied.

If the eschar be removed by accident at any time, the appli-
cation of the nitrate of silver must be repeated as before. If
due care be taken to avoid this kind of accident, it will not in
general be found necessary to enjoin rest.

Of Small Ulcers. The same method of applying the nitrate
of silver may be used in small ulcers as in bruised wTounds, par-
ticularly in exposed situations, as on the face, head and hands ;
in these situations the eschar often becomes adherent from the
first application, but should the first attempt fail, and the eschar
be unadherent, from fluid forming under it, a poultice of bread
and water should be applied, for eighteen or twenty-four hours,
to remove the eschar ; when this is done, it should be treated
as in large ulcers, hereafter directed, which generally effects a
cure with one or two applications.

Of Large Ulcers. I have abandoned the attempt of healing
large ulcers by the unadherent eschar, on account of the incon-
venience and trouble attending the evacuation of the fluid from
beneath the eschar, which is daily necessary to insure an adhe-
rent eschar.

The best treatment is as follows : Apply the nitrate of silver
twice over the ulcer and surrounding skin, then cover the ulcer
with a piece of black lint,* and upon it a plaster of neutral oint-
ment^ spread rather thick on linen, a compress of linen, and a
calico roller lightly applied to secure the whole. This plan is
attended with much less trouble, and requires the attention of
the surgeon only every third or fourth day. The same remark
may be here made of ulcers as in inflammation, which is of
great practical importance respecting the action of the nitrate
of silver, that its influence is exerted for three days in an active

* Black lint: Nitrate of silver, two drachms; distilled water, four ounces.
Mix, and make a solution. Saturate an ounce offinelintin this solution; then
let the lint be exposed in a flat, shallow vessel, to allow it to dry by evaporation.

t Neutral ointment: Lead plaster, eight ounces; olive oil, eight ounces ; pre-
pared chalk, four ounces; distilled vinegar, eight ounces. The acetic acid and
the chalk must be well mixed in a mortar, and the lead plaster and the olive oil,
previously slowly melted together, are to be added. The whole is then to be
birred together until cool.

1850.] Directions for using the Nitrate of Silver. 297

state, and declines on the fourth ; on that account, any inter-
mediate dressings are unnecessary. In small ulcers, a second
application of the nitrate of silver in substance is often not ne-
cessary, as the black lint, by absorbing the moisture, becomes
firmly adherent, and remains on the ulcer until it is healed; if
not healed when the lint comes away, a repeated dressing eve-
ry fourth day, of black lint; neutral ointment is required.

Of old Ulcers of the Legs. Old ulcers of the legs have long
been the opprobrium of surgery, and I recollect the following
remark made in one of our periodical works soon after the pub-
lication of my essay on the Use of the Nitrate of Silver, that
"Old ulcers of the legs in 1830, would be old ulcers of the legs
in 1840;"' that no improvement would be made in the surgical
treatment.

After the lapse of nearly twenty years, I am led to conclude
that there has been a very manifest improvement in that de-
partment of surgery not so much by the permanent cure of
old ulcers of the legs by the use of the nitrate of silver as I an-
ticipated, but by what is far better the prevention by the early
use of that remedy.

I have no doubt that if these directions for the treatment of
external inflammation, in bruised wounds, and also that of re-
cent ulcers, with the occasional assistance of graduated pres-
sure, were followed, we should seldom have severe cases of old
ulcers of the legs.

From my own observation and inquiry, I am led to believe
that they have materially decreased in number in this locality,
both in hospital and private practice ; indeed, so much so, that
if I were to commence my treatment as I did twenty-four years
ago, I should have great difficulty in finding one half the cases
I then readily obtained, notwithstanding there is an increase of
one-third more of inhabitants.

Of Ulcers attended with Inflammation. If ulcers attended
wriih inflammation should occasion constitutional disorder, I
would prescribe the patient an emetic of ipecacuanha, a calomel
pill, followed by an active saline purgative; to apply a bread-
and-water poultice, every eight hours, on the ulcer ; and cloths,
moistened with cold water, constantly over it and the inflamed
part, as an evaporating lotion ; and to keep in bed for twenty-
four or thirty-six hours.

After this period, the treatment as directed for ulcers, with
the nitrate of silver, black lint and neutral ointment, &c, may
be generally pursued. Should there still be swelling or oedema
arising from the ulcer, it will be necessary to enjoin absolute
rest in bed, or under such circumstances the ulcer will not heal.

Of Punctured Wounds, Bites and Stings. In recent punc-

298 Directions for using the Nitrate of Silver. [May,

tured wounds the orifice must be first examined. If there be
any extraneous body within it, or loose skin surrounding it,they
should be first removed. A drop of water should be put on the
puncture, and the surrounding skin slightly moistened. The
nitrate of silver is to be applied to the former, until some pain
be experienced ; and over the latter lightly, so as not to induce
vesication. It should be applied to the skin for an inch round
the puncture, and to a greater extent, if the swelling exceeds
this space. The part is then to be exposed to the air.

These cases are generally adherent from the first application
of the nitrate of silver ; but I have sometimes found the eschar
to separate from the wound before it has quite healed, owing to
its conical form ; it is then only necessary to repeat the appli-
cation of the nitrate of silver slightly to complete the cure.

Ata later period of punctured wounds, inflammation is usual-
ly present; the punctured orifice is nearly closed by the swel-
ling, and a little pus or fluid has generally formed within. A
slight pressure is to be applied to evacuate this fluid, a drop of
water should be put on the orifice, and the nitrate of silver is
then to be well applied within the puncture and upon and a
little beyond the surrounding inflamed skin, as before directed,
and the parts are to be exposed to dry. In this manner an ad-
herent eschar is formed, and the inflammation subsides. If
there be any vesication it may be simply left to nature ; the
fluid is soon absorbed or evaporated.

If there be reason to suppose that an abscess has formed
deeply, it must be opened freely with the lancet, and the nitrate'
of silver is then to be applied on the cavity and on the sur-
rounding inflamed or swelled skin. A poultice of bread and*
water and cold water as a lotion is then to be applied over the
whole. The application of the nitrate of silver may be repeat-
ed every second or third day if the swelling or inflammation
require it, and the cold poultice may be renewed every eight
hours.

I have several times applied the nitrate of silver over an in-
flamed surface when I was not aware that suppuration had
taken place. Even in these instances an immediate check was
given to the surrounding inflammation, and relief to the pain ;
but two or three days afterwards there was increase of swel-
ling attended by some pain, which is not usual, excepting when
there is matter or some extraneous body underneath.

In these cases a free incision must be made with the lancet,
and afterwards apply the nitrate of silver and cold poultice.

In doubtful cases, where suppuration may be expected, it is-
advisable to apply a poultice after the nitrate of silver, as the
part may be in a fitter state, to detect any matter, than if a hard
eschar be over it.

1850.] Directions Jor using the Nitrate of Silver. 299

The bites of animals and the stings of insects have a speedy-
remedy in the nitrate of silver, if applied as directed in punc-
tured wounds.

Of Wounds received in Dissection. Previous to a post-mor-
tem examination, as a precautionary measure, any sores or
scratches on the fingers or hands should have the nitrate of
silver applied to them to form an eschar.

After a post-mortem examination, wash the hands well in
tepid water, then bathe them in salt and water, so that any
small wound or abrasion may be detected by the smarting pain
occasioned by its application : this is especially desirable after
a. post-mortem examination of abdominal inflammation and of
puerperal patients, as a number of fatal cases have occurred
from very slight wounds unobserved at the time. Every sus-
picious spot should be then moistened with a little water, and
the nitrate of silver freely applied on the affected parts, and
over the surrounding skin, to form an eschar. This plan will
be a most effectual preventive of mischief in recent injuries.

If the puncture be deep it will be necessary to suck the part
well first, then put a drop of pure water on the orifice of the
puncture, and apply the nitrate of silver well, so as to occasion
a smarting pain within the wound, and apply it lightly on the
surrounding skin.

In the second stage, when the wound becomes painful or
inflamed, and there is a tumor or elevation of the skin, the re-
moval of the small tumor with the lancet, or a crucial incision
must be made through it, and then apply the nitrate of silver on
the wound, and on, and beyond, the inflamed and swollen parts ;
if on the following or subsequent days the inflammation spreads,
the application of the nitrate of silver should be repeated; an
ipecacuanha emetic, followed by a purgative, would be desira-
ble, if the digestive organs are affected.

In the third stage, inflammation is rapidly spreading, violent
constitutional symptoms are present, and the violent knocking
pain in the head peculiar to this stage. Venesection, ipecacu-
anha emetic, followed by a purgative, two grains of calomel
with two grains of James's powder, every three or four hours,
till the mouth is affected, appear to be the best treatment. The
nitrate of silver should be applied freely on all the inflamed
surface, and along the inflamed absorbents.

Wounds from the Bites of Rabid Animals. I read a paper
some time ago, in a work on veterinary surgery, where the
writer mentions his entire confidence in the application of the
nitrate of silver to the bites of rabid animals.

An objection has been made to the excision of the part alone,
on account of the danger of the virus from the bitten wound

300 Directions for using the Nitrate of Silver. [May,

being conveyed to the recent wound made with the scalpel.
To avoid this, the parts may first be well washed with warm
water, with the assistance of Read's, or any powerful syringe,
to remove the saliva away from the wound ; the nitrate of sil-
ver should be then freely applied within the wound, after that
the bitten part should be removed with the scalpel, and after-
wards apply the nitrate of silver again to the wound, making
doubly sure of having the poisoned parts removed. The sores
to be healed by eschar.

Of Lacerated Wounds. After the wound has been well
cleansed, and foreign matters removed, the nitrate of silver must
be applied close upon the irregular edges of the wound, but not
within the wound, and on the surrounding skfn ; afterwards the
parts should be brought into approximation by straps of adhe-
sive plaster, to be healed by the first intention. Should the
laceration be considerable, the interrupted suture may be used
with the same success and safety as in an incised wound, but
the suture must be applied before the application of the nitrate
of silver; the nitrate of silver should be applied on the edges
of the wound, on the line of the wound, and on the surrounding
skin ; the parts should be supported by adhesive straps, without
any other covering ; the ligature may be removed about the
third day, and the nitrate of silver applied to the small orifices
left, to prevent any ulceration.

Great advantages are derived from healing wounds, particu-
larly on the face, by the aid of the nitrate of silver.

1. It prevents the irritation arising from the irregular edges
of a lacerated wound ; adhesive inflammation takes place, and
the wound is healed by the first intention, as in an incised wound.

2. The inflammation, swelling and irritative fever, consequent
on lacerated wounds, are in a great degree prevented, and there
being no ulcerative process, there is no loss of substance, so
that unsightly scars and raised cicatrices are prevented.

To arwst the Hemorrhage from Leech-bites. Apply the
point of a stick of the nitrate of silver firmly within the little
orifice for a short time ; then a small piece of black lint must
be firmly pressed on the part with the finger for two or three
minutes ; by this means the bleeding is effectually stopped ;
the black lint becomes firmly adherent; adhesive inflammation
is produced, and the lint does not separate till the leech-mark is
healed.

Incised Wounds. Apply the nitrate of silver slightly on the
skin surrounding the wound, not within the wound, and bring
the edges of the wound together with adhesive plaster, or un-
interrupted sutures ; by this means any subsequent inflammation
or swelling of the skin is prevented, and the wound heals by

1850.] Directions for using the Nitrate of Silver. 801

the first intention. In the operation for hare-lip, or in wounds
on the face, adhesive inflammation is immediately produced by
this treatment, and the cure safely effected. When the liga-
tures are removed, the small orifices remaining should be
touched with the nitrate of silver, to prevent any ulceration.

Of Erysipelas. In very slight attacks of erysipelas, some-
times an active purgative and low diet will be sufficient to
remove the disease without the application of the nitrate of
silver ; but if constitutional symptoms are present, it is the
safest plan to use both constitutional remedies and the nitrate
of silver simultaneously.

The constitutional remedies, as the case may require, are
venesection, emetic, purgative, and repeated doses of chloride
of mercury and James's powder. The nitrate of silver to be
applied as follows : Wash the affected parts well with soap
and water, then with water alone, to remove any particle of
soap remaining, afterwards wipe the parts dry with a soft cloth ;
then apply the concentrated solution of the nitrate of silver
two or three times over the whole inflamed surface, and be-
yond it on the surrounding healthy skin, to the extent of two
or three inches. In about twelve hours it will be seen if the
solution has been well applied. If any inflamed part be unaf-
fected by it, it must be immediately re-applied to it. Some-
times even after the most decided application of the nitrate of
silver, the inflammation may spread, but it is then generally
much less severe, and it may be eventually checked by the re-
peated application of this remedy.

It is desirable to visit the patient every twelve hours, till the
inflammation is subdued.

By this means we have a complete control over the disease.
If the erysipelas is attended by vesication, the vesicles should
be broken and the nitrate of silver applied on the denuded,
inflamed parts ; but if the vesicles arise from the use of the
nitrate of silver, they may be allowed to remain undisturbed.

In erysipelas of the face, when it is spreading on the fore-
head, or at all on the scalp, the head should be shaved as early
as possible, that the extent of inflammation may be traced on
the scalp, which often can only be detected by pain, or by
oedema being felt on pressure with the finger. The solution
requires to be applied very freely all over the scalp, where it
scarcely or never produces vesication.

When the inflammation has been subdued by an early use of
the nitrate of silver, the constitutional symptoms have been
immediately relieved ; the constitutional disturbance is directly
aggravated by the least increase of local inflammation, and in a
few hours, after a decided application of the nitrate of silver,

302 Directions for using the Nitrate of Silver. [May,

the inflammation has been arrested, and gradually subdued, and
with it the constitutional symptoms cease.

Even in idiopathic erysipelas, there is no period of the dis-
ease when I would not apply the nitrate of silver : I have never
in any case seen metastasis or any other bad effect from the
use of this important remedy ; on the contrary, I think it the
best local remedy to prevent such mischief.

On Phlegmonous Erysipelas. An early application of the
solution of the nitrate of silver alone will sometimes be sufficient
to check the progress of the inflammation.

If the inflammation be severe, attended with swelling, and
the subcutaneous cellular tissue be much affected, a number of
leeches should be applied on the inflamed part, or small incis-
ions made with a lancet ; a bread-and- water poultice applied,
until the bleeding has ceased, then the concentrated solution to
be applied freely upon and beyond the inflamed parts, and
afterwards covered with a plaster of the neutral ointment, if
suppuration be anticipated; if not, the parts should be exposed
to the air, to form an eschar.

If the leech-marks or incisions afterwards become painful or
irritable, a slight application of the nitrate of silver will be re-
quired.

By the above method of treatment, the inflammation is ar-
rested and subdued, the suppurative process often prevented,
and long incisions unnecessary. Should the system be affected,
ipecacuanha emetics, saline purgatives, and repeated doses of
calomel with James's powder.

On Inflammation of the Absorbents. Constitutional remedies
are often required, as venesection, emetics, purgatives, &c, and
an immediate attention to the origin of the disease. If from a
foreign substance, it must be removed ; if from an abscess, it
must be freely opened ; or from an irritable ulcer, the nitrate of
silver should be applied to destroy the irritation. The nitrate
of silver should then be applied, either in substance or the con-
centrated solution, freely upon the whole of the inflamed and
swelled surface, along the lines of inflammation, and beyond
them on the surrounding skin. By these means, in twenty-four
hours, the disease is generally most effectually arrested in its
progress, and the numerous abscesses, often occasioned by this
kind of inflammation, prevented.

Phlegmonous Inflammation. Pure phlegmonous inflamma-
tion will be often arrested and subdued by the early application
of the nitrate of silver, without any other remedy; but if it has
proceeded so far as to be doubtful whether suppuration has ta-
ken place or not, the inflammation will be arrested, and the
suppuration more circumscribed and limited in its extent.

1850.] Directions for using the Nitrate of Silver. 303

If the tumefaction and inflammation are not subdued in four
days after the application, it \vill be found that suppuration has
taken place, and that the use of the lancet will be required to
open the abscess, after which the wound will more rapidly
heal than if the nitrate had not been used. The cold poultice
may be applied every eight hours, and the nitrate of silver every
second or third day, as required.

Small Imtable Ulcers icith Varicose Veins. Fill the small
ulcers lightly with scrapings of the black lint, and cover them
with a plaster of the neutral ointment, and apply graduated
pressure with a bandage on the leg ; it often happens that an
adherent eschar is formed after the first application ; but if not,
the remedy must be repeated every third or fourth day. A
bandage or laced-stocking should be continued.

Burns or Scalds. In the first class of burns or scalds, where
there is superficial inflammation, and in the second where there
is simple vesication without destruction of the cutis, the appli-
cation of the nitrate of silver as directed in erysipelas, often
effects a speedy cure ; the vesicles should be removed, and the
nitrate of silver be applied on the exposed cutis, to form an
eschar. If future dressings are required, the black lint and
neutral ointment may be applied every third or fourth day.
Should the burn or scald be exposed to friction on any part of
the body, a plaster of the neutral ointment applied, with a light
bandage over it, will be necessary.

In burns from the explosion of gunpowder, particularly on
the face, the mode of healing by eschar with the nitrate of silver
is very successful.

Gangrcena Senilis. An early application of the nitrate of
silver is indispensable to give a chance of checking the pro-
gress of this dreadful disease. It has been used with decided
success when the toes have assumed a dark color, and become
a little swollen with purple vesications on the lower and outer
part of the leg. The solid nitrate of silver may be applied (the
affected parts being previously moistened with water) freely
on the affected toes, and lightly on the surrounding healthy
skin ; and also on the denuded skin after the vesicles have been
removed, so as to form an eschar. If successful, the eschar
becomes adherent, the inflammation is subdued, and all further
mischief prevented. In due time the eschar will be thrown
oft* leaving the parts underneath healed.

It will be desirable to give purgatives, and adhere to an anti-
phlogistic regimen during the cure.

304 Chloroform. [May,

Contributions to the value of Chloroform. By R. P. Stevens,
M. D. (N. Y. J6urn. of Med.)

In the July number of the Journal I published a contribution
to the value of chloroform in -natural cases of midwifery.
When a new agent is introduced to the notice of the medical
profession, one naturally wishes to test the range of its capa-
bilities to subserve the interests of that profession. If it pro-
fesses to be the friend of the physician in alleviating the suffer-
ings which he is called to minister unto, to test how far its
friendship extends, and where it ends.

The first disease which I propose to report its favorable use
in, is a case of Nervous Dyspepsia, of some eighteen months
standing. Mrs. S., of a nervous temperament, set. 33, had
frequently suffered from this ennui-engendering disease. Her
last attack was peculiarly obstinate, resisting the usual reme-
dies, which in former attacks had procured relief; and the usual
round of anodynes, antispasmodics, and tonics, either separate
or combined. Hydrocyanic acid, of the strength of Scheele's
formulas, in large doses, would give some temporary relief.
Her life was rendered miserable ; her spirits much depressed,
and this depression made her dyspepsia worse. Immediately
upon the republication of Prof. Simpson's pamplet, in Boston, I
procured from that city some chloroform, and administered
by inhalation about fifteen drops, upon a linen handkerchief,
folded for the purpose. It produced but partial anaesthesia, but
the dyspepsia disappeared from that time, and has not returned,
a period now of nearly two years.

Three cases, of Furuncula cured by the application of a
dosil of lint saturated with chloroform. One of these diminu-
tive, but exquisitely painful tumors, was situated within the
nasal orifice. It was speedily discussed, much to the delight of
the modern Job.

Three cases of Asthma. One of a child, aet. four years.
The sufferings of this little girl were truly terrific. She was
stretched upon the floor ; her head supported, countenance
livid, eyes staring and glassy, the chest heaving laboriously, her
brow bathed in a cold perspiration ; her whole powers of body
and mind seemed absorbed in laboring for her breath. I im-
mediately exhibited eight drops by inhalation, which gave
instant relief, equally as much to the surprise of the delighted
mother, as to the comfort of the little sufferer.

The other two cases, were Mr. C, set. 37, a confirmed
wheezing asthmatic. Half his nights are spent in an arm-chair.
A feather-bed is suffocation to him. The first trial of chloro-
form was in one of his ordinary attacks. The inhalation of

1850.] Chloroform. 305

fifteen drops procured almost immediate relief, and in a few
moments he was in a sweet sleep : he inhaled in a reclining
posture, almost suffocated with his recumbent position. The
second trial was when the attack was unusually severe, being
increased in severity by taking a full dose of opium. It requir-
ed thirty drops, thrice repeated, while sitting in his chair, to
entirely relieve his respiration; soon after the secona1 dose it
became easier, more natural and fuller. The pulse denoted the
effect of the chloroform upon the heart and arterial system,
and he soon fell asleep, the first he had had in three days and
nights. We gently bore him to his couch, and he had a sound
sleep of nearly four hours, and awoke in the morning refreshed,
leaped aboard a raft, and piloted it to Pittsburgh.

I have found it useful in Ondontalgia, by applying it to the
cleaned cavities of the carious teeth, in irritable corns and bun-
ions, and in chilblains.

In Neuralgia of the supra-orbital nerves, applied over the
foramen by a saturated dossil of lint, covered with oiled silk, it
procures instant ease.

In six cases of Cholera Morbus, attended with cramp of the
muscles of the extremities and abdomen, chloroform, with cam-
phor dissolved in it, has succeeded like a charm in arresting the
convulsions, and relieving the pain.

It has sometimes needed to be repeated. It is a powerful
solvent of camphor, and prevents this gum from distressing the
stomach.

In one case of stercoraceous vomiting, in doses of thirty
drops, thrice exhibited internally, it restored the peristaltio
motion of the alimentary canal to its normal state, imparted
new life to the circulation, heat to the extremities, and warmth
and moisture to the surface. When received into the stomach
it is an exciter to the heart and arteries, equally as prompt and
decided as it is a depresser when inhaled. In the last case
mentioned, the pulse rose from 32 beats in a minute, up to 70
from being feeble and flickering, to full, soft, and strong.

One case of sick head-ache. Mrs. S., subject to frequent
attacks, oftentimes assuming a neuralgic character ; vomiting
gives no relief, but increases the pain ; counter-irritation along
the affected nerves also increases the pain. Morphine gives re-
lief at the expense of a sick day following. Sleep, though but
for a few moments in the initiatory symptoms, often allays the
attack. Cave fifteen d\x>\>* by inhalation ; not producing the
desired effect, through imperfect application of the napkin to
her mouth; the dose was repeated. In a few moments, as soon
as the pulse indicated the influence of the chloroform; she fell
asleep, and awoke perfectly cm

VI. v

306 Periscope. [May,

PART HI.
ill o n 1 1) 1 g IjizxxstQyG.

Effects of Bloodletting and Mercury' in Pericarditis. By Dr. lorn*
Taylor. (Med. Gazette. Braithwaite's Retros.)

I. Bloodletting. The conclusions arrived at are the following.

I. The duration of pericarditis increases in proportion as the time
is longer between the commencement of the disease and the first
bleeding. 2. The duration of the cases bled' after the first four days
is greater by one-half than of those bled within the first four days from
the invasion of the' disease. 3. The influence of bleeding was more
marked in the case in which it was copiously and repeatedly, as well
as early, practised,- than in those in which blood was drawn less fre-
quently and more sparingly. 4. Pericarditis is never extinguished at
once by bleeding, however early er however copiously practised.-
5. In several cases the pericarditis was suspended for a limited time*
The suspension in every instance wras immediately consequent upon
the local abstraction of blood. 6. It is probable that renal has a long-
er duration than rheumatic pericarditis. 7. Bloodletting must be less-
copious, and is more frequently inadmissible, in renal, than in rheu-
matic pericarditis. 8. Bloodletting probably lessens the mortality,,
inasmuch as it lessens the duration of pericarditis ; but direct proof
of the reduction of mortality is not to be obtained from these cases.
9. The abstraction of blood by venesection, cupping or leeches, al-
most invariably relieved the pain at once, but not permanently. There
is no reason to believe that any one form of bleeding relieved pain
more effectually than another. 10. Bloodletting never lessened the
frequency of the pulse, except when there were signs of the inflamma-
tion having abated. 11. The tendency to syncope in some cases of
pericarditis, renders it necessary to be very careful in abstracting
blood by venesection. 12. Free venesection for pericarditis does not
always prevent the subsequent appearance of serious inflammation in<
other internal organs.

II. Mercury.

1. The cases in which mercury was given within the first four day s$
had an average duration less by five days than those in which it was
given later. 2. The cases- in which salivation was produced within
the first four days had an average duration less by two days than those
in which it had occurred later. 3'. Iris difficult to determine how
much of the benefit was due to the mercury, because all the patients
who took mercury were likewise bled,, and in almost every instance
the two remedies were first employed on the same day. 4. The au-
thor is inclined to the conclusion, that the benefit' was due in greater
measure to the bleeding than to the mercury partly because the du-
ration of the disease was more abbreviated in those who simply began'
to take mercury than in those in whom salivation was produced with*
in the first four days. The administration of mercury coincided with
vhe bleeding, but the salivation did' not, and the results are just wha

1850. \ Periscope. $0i

might be looked for upon the supposition that the benefit was due to
the bleeding, and not to the mercury. 5. If the production of saliva-
tion had anything like the marked influence in arresting inflammation,
arid in promoting the removal of its products, which it is currently
believed to possess, the duration of the cases of pericarditis after sali-
vation ought to have been much less than it really was. This is
proved by a detail of the cases, (a.) Salivation was not followed by
ariv speedy abatement of pericarditis in sixteen cases, (b.) Salivation
was followed by pericarditis in five cases, (c.) Salivation was follow-
ed by an increase in the extent and intensity of the pericarditis in three
cases, (d.) Friction-sound ceased two days before the mouth became
sore in two cases, (e.) Salivation was followed by a speedy diminu-
tion of the friction-sound in two cases; it did not cease, however, for
some days after, (f.) The pericarditis ceased soon after salivation in
two cases; in one of them, however, it had been declining for some
days before, (g.) Mercury was given, Ink no salivation was produced
in seven cases. (/*.)' No' mercury was given, nor other treatment
adopted in eight cases, (i.) Cases are detailed exhibiting the occur-
rence of various internal inflammations during the time that salivation
was proceeding. The cases comprise examples of endocarditis, pleuro-
pneumonia, pneumonia, pleuritis, erysipelas, and rheumatism.

A conclusion rather adverse to the antiphlogistic powers of mercury
having been drawn from the facts narrated, the author next examines
the evidence upon which the contrary and more prevalent opinions is
based,* and infers that the evidence is not satisfaetorv.

Treatment of Scarlatina by hot-water applications. By F. A. Bul-
ley, Esq. (Med. Times. Braithwaite's Retros.) Mr. Bulley de-
scribes a mode of treatment which he has adopted and found successful
not only in scarlatina, but in every instance of febrile disturbance that
has come under his observation within the last few years. He gives
as an illustration the case of a farmer, who, after several days of pre-
monitory symptoms, became covered with a rash. The next day Mr.-
Bulley was sent for, and found his patient labouring under an attack'
of scarlatina, which he (Mr. B.) believed would prove a very severe
one. The following treatment was adopted :

The patient was placed upon a bed, on which, the sheets having
been removed, two blankets had been laid, tiicn a flannel pad, compos-
ed of four thicknesses of coarse household flannel, sixteen inches long
by ten inches wide, stitcl>ed round the margin to keep it together, and
wrung out of hot water till almost dry, was laid as hot as he could bear
it upon the pit of the stomach and over the region' of the heart ; and
while it was still warm, the blankets, one by one, were carefully
folded round his body, so' as to completely confine the perspiration and
heat, which might be generated by this process ; at the same time,
another pad of two thicknesses only of the course flannel, wrung out
of boiling vinegar and water, was placed round the throat for the relief
of the local inflammation. After he had remained enveloped in the
Wrappings a little more than half an hour, during which time the &

308 Periscope. [May,

brile excitement had been somewhat increasing, he burst into a pro-
fuse and general perspiration, in which he was allowed to remain for
two or three hours longer, with an evident abatement of the symptoms,
when the blankets were carefully removed, and the flannel pad with-
drawn ; after this, he had some refreshing sleep, and but little return
of the burning fever; he was now ordered to take half a drachm of
Dr. Stevens's saline powder in a mixture every four hours, and to use
the following gargle to the throat : R. Armenian bole ; burnt alum
powdered, aa. gr. 40; brown sugar, gr. 60; water 3 viij. Mix.

This plan of treatment was so successful that on the seventh day
from the first appearance of the eruption, the patient was going about
h^s farm. Mr. Bulley makes the following remarks upon the treat-
ment:

I have had the satisfaction to observe, that the simple method which
I have adopted in the treatment of fever, and which I practised in the
foregoing case, has never, in any trial which I have made of it, failed
in its object. I have now used it in a great number of cases, some of
them of the worst description, and in every instance where the process
has been judiciously managed, it has either at once annihilated the
fever, mitigated its severity, or diminished its duration. I have also
found it extremely useful in cases of small-pox, in constitutions where
the circulating power has been naturally so feeble as to be insufficient
of itself to throw out the morbid elements from the blood by the skin.

Employment of Manganese in Ancemic and other affections. By M.
Hannon. (London Jour, of Med. Braithwaite's Retros.) Manga-
nese and iron are almost constantly found united in the same minerals,
and can be separated with difficulty. Again, iron is not always
efficacious in chlorosis, and fails in curing anaemia arising from can-
cers, from tubercles, from prolonged and abundant suppuration, &e.
In these cases, it cannot be the iron that is deficient in the blood, but
some other ingredient ; and it is probable that iron is united to man-
ganese in the blood ; and that cases of anaemia, unsuccessfully treated
by iron, might be cured by manganese. M. Hannon first tried the
effects of this agent on himself. He took at first a grain of the car-
bonate of manganese daily, increasing the dose to four grains by the
end of the first week, and to eight grains by the end of the second.
At the end of a fortnight, he experienced symptoms of plethora ; tho
appetite increased, the pulse became stronger, and the colour of the
interior of the eyelids was heightened. He then administered man-
ganese to some anaemic patients ; some of them experienced nausea
for two or three days, after which the medicine was tolerated. In a
short time, its beneficial effects became manifest in the increase of
colour, in the fuller and more frequent pulse, in the energetic move-
ments and general improvement of the functions.

The presence of manganese in the blood was discovered by M.
Millon, who presented a memoir on the subject to the Academic des
Sciences of Paris. His observations have been confirmed by M,
Hannon.

1850.] Periscope. 309

Several illustrative cases arc given. The first mentioned is one of
extreme chlorosis, in which the patient was sent into country air, and
took iron for some time, without benefit. We are told that

The patient was then directed to take one of the following pills daily
before breakfast, and another before dinner: Extract of cinchona,
carbonate of manganese, of each a drachm. Mix and divide into four
grain pills. After she had used these pills for a fortnight, the cheeks
and conjunctiva? regained their colour, and the swelling of the feet
disappeared. The following pills were then ordered. Sulphate of
manganese, carbonate of soda, of each a drachm; fresh charcoal, ho-
ney, of each a sufficient quantity to make a mass, to be divided into
four-grain pills. A fortnight after the employment of this medicine,
the bellows-sound had disappeared; the pulsations of the heart were
strong and loud ; and an energetic impulse was felt on applying the
hand. There was no syncope ; and the appetite had returned. The
dose of the pills was increased; and a month after, menstruation oc-
curred, and the patient became plump, and able to bear much exertion.
She digested and slept well in a word, was cured.

Another case is that of a young lady affected with phthisis :

Iron with opium was prescribed ; but it increased the cough, and
brought on obstinate constipation. Syrup of the phosphate of manga-
nese was then given, with cod-liver oil ; the latter being added rather
to prevent the contact of air with the manganese, than from any ex-
pectation of its producing good effects. The constipation ceased ; and
the cou^h became more bearable, and ceased in a fortnight. The
patient then began to recover embonpoint. A month after the knuc-
kles assumed a very remarkable brick-red colour, which has continued
up to the present time a period of nearly a year and half. This
patient took three gros (216 grains) of phosphate of manganese, in
doses of three grains daily.

Madame R. was affected with cancer of the uterus. She complain-
ed of remittent pain in the hypogastric region, and suffered much
while at stool. In the evening, she was troubled with severe lancin-
ating pains, which often continued through the night. She was ex-
cessively weak, and of a pale yellow hue. She was troubled with
palpitation, and a hruit was heard in the carotid. The feet frequent-
ly swelled. Syrup of the iodide of manganese was given with syrup
of horse-radish, for several months. The pains did not leave her, but
the amemic appearance completely disappeared. To calm the pains,
opium, with extract of hemlock, was prescribed; and the patient be-
came apparently cured.

Mademoiselle M., aged 14, of a scrofulous constitution, had glandu-
lar enlargement in the neck, ulceration of the transparent cornea of
the left eye, and caries of the first phalangeal bone of the index finger
of the right hand. Being the dau^htcrof a peasant, she had lived ex-
clusively on vegetable fo< id ; bul was ordered to take meat, and to drink
beer. Syrup of the iodide of manganese was given in doses-oCa
spoonful two or three times a-day. Under the influence of this, and
her improved diet, she became lesa lean; soon alter, the cornea re.

$1Q Periscope. [May,

gained its transparency, having been washed with a lotion containing
gr. ss. of nitrate of silver to an ounce of distilled water. The suppu-
ration of the carious bone ceased, and the finger was cured.

M. G. B., aged 28, had been treated with mercury for some years,
for constitutional syphilis. The bones were sound ; the skin was af-
fected with all kinds of eruptions; the tongue had long been the seat
of an obstinate tumour ; and there were syphilitic ophthalmia and
iritis. Fumigation and iodide of potassium were persevered in for
several months, but without effect. Iodide of manganese was then
given, with syrup of sarsaparilla ; and in a month, the patient was
completely healed. He was directed to continue the use of the jnan-
ganese ; and, as he has not since applied for relief, it is probable that
he has had no relapse.

These cases have been selected from a number of similar ones,
and shew the efficacy of the new remedy proposed. Manganese has
in all cases produced a more rapid effect than iron, in cases of simple
anaemia. In the forms of anaemia cited, all the cases had resisted
iron, and all yielded to manganese. The other cases are respective-
ly of phthisis, cancer, scrofula, and syphilis:- all inducing almost
jrremidiable cachexia, and all rapidly alleviated by manganese. The
effects of the manganese, as observed in one case, (phthisis) are re-
markable. Iron seldom produces a similar result; if it improves the
state of the blood, it increases the cough; so much so, that many
practitioners abstain from its use in phthisical cases. In all the scro-
fulous cases, the iodide of manganese, by its salutary and rapid
influence, was proved superior to the iodide of potassium? The per-
sistence of the cures obtained by manganese, in comparison with those
produced by iron, is very remarkable: no cases of relapse have tjeen
observed by M. Hannon. The quantity required to be taken, in or-
der to produce the desired result, is far from being so great as that of
iron.

Qn the Treatment of Hooping Cough. By M. 'J'bousseau. (Journ.
ties Connais. Medico-Chirurg.) M. Trousseau thinks favorably of
the emetic treatment recommended by Lsennec for the commencement
of the disease; but for its subsequent stages he prefers belladonna to
all other remedies. We give his views on this subject.

The belladonna should be given from the first in full doses, M.
Bretonneau, says he, has remarked that a large dose of cinphona acts
much more energetically when given at one time, than when double
the quantity is taken in five or six doses. The same is true of bella-
donna. Experience has shown, moreover, that, as is the case with
the datura, digitalis, etc., the powder of this plant is preferable to both
the tincture and extract, even when these latter are prepared in the
best manner. The powder of the root should be employed therefore,
or if that cannot be obtained, the powder of the flowers, in the dose qf

i-850. J Periscope. 31 1

one centigramme, to a child from two to six years of age, according to
the following formula:

Powder of the root, or .flowers, of belladonna, 1 centigramme.
Pulverised sugar, '... 25 "

Triturate carefully. This dose is to be administered at one time,
morning or evening, according as the cough is observed to be most
troublesome in the night or during the day. After having kept up
this treatment for two or three days, if there is any marked amend-
ment, the belladonna is to be continued in the same dose ; but if there
is no improvement, the dose is to be doubled, and two centigrammes
are to be given during three days. The dose may be even increased
to three centigrammes, to be given always at one time. Moreover,
the belladonna should fee continued for twelve or fifteen days at least
after the cessation of the cough ; otherwise it might return with des-
perate obstinacy, and then the remedy, after having been suspended,
would ot yield the same advantages as in the first instance.

Here opium sometimes succeeds where the belladonna has failed.
One drop of Rousseau's laudanum every day for three days might
then be found serviceable.

After opium, digitalis may be used, in the dcse of one centigramme
of the powder, or one milligramme of digitalin. It will seldom be ne-
cessary to quintreple these doses ; if these means fail, recourse must
be had to antispasmodics, such as gum ammoniac, the sub-nitrate of
bismuth, and the oxide of zinc.

A blister, or frictions, with croton oil, may be of service during the
latter stages of the disease, or when it is protracted in duration.

Hemorrhages constitute a frequent and sometimes a very serious
complication of hooping-cough. M. Trousseau has lately seen a child
with hGoping-cough sink under haemoptysis : this is of rare occur-
rence ; but epistaxis, and sub-cutaneous and sub-mucous ecchymosis
are more common. Children have been known to weep tears o
blood. Epistaxis may be repeated so frequently as to cause in the
little patient a state of anaemia. There is no better remedy in these
eases than the Peruvian bark, given in doses of two or three grammes
&-day. This remedy is equally successful in the epistaxis of adult?.
Rhatany is far from being equally useful. We may also use the dry
extract of this article topically, or we may inject into the nostrils a
solution of the sulphate of zinc or of copper. We may begin with a
solution of five centigrammes of the salt to thirty grammes of distilled
water, and increase the former gradually to ademigramme or even to
one gramme.

312 Periscope. [May.

Sulphate of Iron in Diabetes of Children. (Joum. des Connais.
Med. Chirurg.) Dr. Heine, of Berlin, reports two cases of diabetes
mellitus in young children, treated successfully with the sulphate of
iron. The first case was a child of nine years. At the age of four
years he had measles, and from that time was unhealthy. He was
badly fed and clothed ; feeble, emaciated, and melancholy. His ap-
petite was irregular, and his bowels costive. He was attacked with
fever every night, but received no medical treatment until the diabetes
made its appearance, when his step-mother, annoyed by his urinating
ten times in the night, applied to Dr. H., who detected sugar in a con-
siderable quantity in his urine. Small doses of calomel, rhubarb, and
magnesia, were given, and in the intervals, phosphate of soda, com-
bined with ipecacuanha. All the symptoms were mitigated with the
exception of the excessive secretion of urine. The calomel wTas dis-
continued, and the patient put upon the use of the sulphate of iron.
He had not taken this medicine more than two days, when a decided
improvement was observed. He urinated but twice in the night, and
the urine presented no traces of sugar. The sulphate was continued
five or six weeks, and the health of the child was completely restored.

The other case was a child of seven years, who had been in a state
of utter destitution. He was much emaciated, his bowels constipated,
without appetite, and a prey to continued fever. He also labored
under a profuse saccharine diabetes. Dr. H. gave him the sulphate
of iron in half grain doses, combined with rhubarb. A rapid ameliora-
tion took place. In about five days the urine was much diminished,
and at the end of eight days, it contained no sugar. The cure was
perfected in four weeks.

Sulphuric Ether topically applied to atonic ulcers. (Bulletin do
Therap.) Prof. Bouisson recommends the topical application of sul-
phuric ether as a valuable means in the treatment of atonic ulcers.
Employed in this mode, the ether, independently of its sedative pro-
perties, produces a tonic effect, due to the refrigeration which results
from its rapid evaporation ; it also dries the humid surfaces with which
it is brought into contact. Prof. B. has recently treated two cases, the
one for an ulcer of the thigh, resulting from a bruise, and of two
months standing the other from an ulcer in the abdominal region,
primitively of a venereal origin, which had resisted all external and
internal treatment. The application of lint wet with the sulphuric
ether, three times a-day, effected a cure in fifteen days. This treat-
ment is very simple, raid should be tried when the ordinary treatment
p-roves unsuccessful.

1^50.] Periscope. 318

The Bark of the Khaya Senegalensis as a substitute for Cinchona.
The Journal des Connaissanccs Mc-dico-Chirurgicales, for January,
contains the following description of the Khaya Senegalensis, com-
monly known as the Cinchona of Senegal, by M. Cavento.

The Khaya Senegalensis, (Switenia Senegalensis,) one of the
largest and most beautiful of the trees which adorn the banks of the
Gambia, and the Peninsula of Cape Verde, belongs to the family of
Meliacex.

The febrifuge properties of the bark of this tree, noticed some time
ago by MM. Merat and De Lens, and also by M. Guibourt, have ob-
tained for it the name of the Cinchona of the Senegal.

The bark of the Khaya Senegalensis is about 15 millimetres in
thickness; grayish, rough and hard, externally; under the epidermis
it is o^ reddish, yellow colour, which becomes lighter in proceeding
from without inwards. It developes, when chewed, a decided bitter-
ness, has a clean fracture, is close grained, and presents in its longi-
tudinal direction white lines, which become more close and numerous
as we proceed from the bark toward the centre.

M. Cavcntou has analyzed this bark, and has obtained .from it a
new organic principle to which he has given the name of cail-cedrin.
This is a yellowish, opaque, non-chrystalline body, of a resinous ap-
pearance, of a bitter aromatic taste, and is but slightly soluble in water.

A trial of this article, made at the Hotel-Dieu, by MM. Moutard,
Martin and Chomel, seemed favorable to its employment in intermit-
tent fcver. M. Caventou himself admits, however, that it demands
further examination.

But as those who live on the banks of the Senegal cure themselves
when most violently attacked with fever, by using the decoction of
Khaya bark, it is to this that the first clinical researches should be
directed.

Vegetable Charcoal. (Journ. des Connais. Med. Chir.) M. Patis-
sier, oil the part of MM. Becamicr, Caventou, and for himself, read the
following additional conclusions of a report previously communicated
to the Academy on a memoir concerning the use of vegetable carbon
in gastro-intestinal nervous affections, both idiopathic and symptoma-
tic, by Dr. Belloc, surgeon-major to the 6th regiment of hussars.

These results, said he, from the chemical facts mentioned in the
memoir of M. Belloc, and from those which your committee have been
able to gather, arc :

1st. That pulverised charcoal prepared from the common poplar,

314 Periscope. \ [May,

may be used with advantage in the treatment of nervous affections of
the stomach and intestines ; that its therapeutic effects do not differ
materially from those of charcoal obtained from light and porous wood
(white willow, fir, larch, etc).

2d. That these powders are only really valuable when administered
in large doses, four or five tea-spoonsful a-day, to be taken before or
after meals.

The committee think that M. Belloc has rendered a service to prac-
tical medicine, by directing the attention of physicians to the thera-
peutic value of vegetable charcoal. Your committee propose that
you address a letter of thanks to this excellent brother, and place this
memoir in the archives.

Anti-asthmatic pills de M. D'Avonie. (Journ. de Med, Connais.
Med. Chirurg.) M. D'Avonie recommends pills made according to
the following formula, as uniformly efficacious in asthma, whether
idiopathic or symptomatic:

ft. Venice soap, , , , 4 grammes.

Gum ammoniac, i

Fresh squills, >

Socatorine aloes, ) aa 2 grammes.

Bals. copaiba, q. s.
Make into pills of four grains each. One pill to be taken every two
hours.

For Alopecia. (Bulletin de Therap.)
Ointment of cocoa, (cocoa butter 2 parts, olive oil 1 part,) 60 grammes.

Tannin, ,..,,, 80 centigr.

Quinine, ..,,,,, 40 "

Dissolve in aromatic alcohol, (alcoolat aromatique,) . 8 grammes.

Make an ointment. To be used night and morning.

New Febrifuge Pills. (Journ. de Med. de Toulouse. Bulletin
de Therap.)

ft. Willow bark, .,,..,.... 10 parts.
Capsules of common lilac (syringa vul.) "j

?entian' , I each 2

Lesser centaury, j

Wild endive, J

Exhaust by means of boiling water, concentrate the liquors, reduce

to the consistence of an extract ; and add, one half-part of crude

1850.] Periscope. 315

quinine, dissolved in three times its weight of lactic acid. Incorpo-
rate intimately, thicken with a sufficient quantity of powdered Colombo
root, and divide the mass into pills of 15 centigrammes, (3 grs.)

From one to three pills to be given a-day, and to be continued some
days after the cessation of febrile symptoms.

Position of the Foetus in Utero, and the causes of Preternatural Pre-
sentations. By Dr. J. Y. Simpson, Edinburgh. (Monthly Journal.
JSraithwaite's Retros.) Dr. Simpson endeavors to establish the follow-
ing propositions relative to the common or natural position of the foetus
jji utero :

1. The usual position of the fostus, with the head lowest, and pre-
senting over the os uteri, is not assumed till about the sixth month of
intra-uterine life, and becomes more frequent and rnore certain from
that time onwards to the full term of utero-gestatiqn.

2. Both the assumption and maintenance of this position, are vital
and not physical acts, for they are found to be dependent on the exist-
ence and continuance of vitality in the child : concurring with its
life, but being lost by its death.

3. In human physiology we do not know or recognize any vital
power or actk>Q, except muscular action, .capable of producing mo-
tions calculated to alter or regulate the position, either of the body, or
any of its parts ; and further, the motory muscular actions of the fcetus
are not spontaneous or voluntary, but reflex or excito-mstory in their
nature, causation, and effects.

4. The position of the foetus, with the head placed over the os uteri,
is that position in which the physical shape of the normal and fully
developed foetus is best, adapted to the physical shape of the normal
and fully developed cavity of the uterus.

5. This adaptive position of the contained body to the containing
cavity is l.be aggregate resuli of reflex or excito-motory movements
on the part of the foetus, by which it keeps its cutaneous surface with-
drawn as far as possible from the causes of irritation that may act
upon it as excitants, or that happen to restrain its freedom of position
or motion,

Proceeding to speak of preternatural positions and presentations of
the foetus, as originating in the derangement of one or other of these
normal conditions, Dr. Simpson states them to be referrible to the fol-
lowing causes:

First. Prematurity of the labour; parturition occurring before the
natural position of the foetus is established.

Secondly. Death of the child in utero; or in other words, the loss
of the adaptive vital reflex actions of the foetus.

Thirdly. Causes altering the normal shape of the foetus or contain-
ed body, or causes altering the normal shape of the uterus or containing
body, and thus forcing the foetus to assume, in its reflex movements,
an unusual position in order to adapt itself to the unusual circum-
stances in which it happens to be placed.

316 Periscope. [May,

And, lastly. Preternatural presentations are occasionally the result
of causes physically displacing either the whole foetus or its presenting
part, during the latter periods of utero-gestatiou, or at the commence-
ment of labour.

Prematurity of the labour is a cause of mal-presentation in this re-
stricted sense, that the position of the fcetus with the head lowest, and
presenting over the os uteri, is not generally assumed till the sixth
month ; and that from this period such position is taken and kept with
a certainty and frequency which increase in proportion to the dura-
tion of the pregnancy. Thus, Dr. Simpson states, that while the per-
centage of head presentations in children born at the end of the sixth
month is only about 52 in 100, it increases during the seventh month
to 68 in 100, and to 76 in 100 during the eighth and ninth months ;
and rises at the full period, as high as 96 or 97 in 100. He says :

It is hence evident that if, from any causes, parturition happens to
come on prematurely, the child is much more liable to present preter-
naturally, than if pregnancy had gone on to the full time ; or, in other
words, the prematurity of the labour, is, in this sense, a cause of the
malpresentation of the fcetus.

From an examination of statistics published by various authors, Dr.
Simpson adduces also the following conclusions :

1. That while presentations of the head occur in 96 per-cent. in
common obstetric practice at the full time, the same presentations oc-
cur only in 70 per-cent. among premature labours ; 2. that pelvic
presentations* are nearly eight times more frequent among prema-
ture labours than among labours at the full time; and, 3. That
transverse presentations are nearly ten times more frequent among
premature labours than among labours at the end of the usual time of
pregnancy.

On the subject of the death of a child, as a cause of abnormal pre-
sentation, Dr. Simpson says :

The child not unfrequently dies in utero, and before labour begins.
In cases in which the death of the fcetus is induced from any cause,
during its intra-uterine life, the child, when labour at last supervenes,
is apt to be found presenting pretcrnaturally. The maintenance as
well as the assumption of the usual position of the fcetus with the head
downwards and over the os uteri, is an excito-motory, and consequent-
ly a vital act ; and hence, when the vitality of the fcetus is lost, its
position, as a result of that vitality, is liable to be lost also. In other
words, the death of the child thus becomes a cause of* its malpresenta-
tion at the time of birth.

The difference between the liability to cephalic, pelvic, and trans-
verse presentations between children who have died before labour,
and those bom alive, may be expressed as follows: 1. Head pre-
sentations are 16 per-cent. less frequent among dead than among living
infants ; 2. Pelvic presentations are five times more frequent among
dead than among living children ; and 3. Transverse presentations
are four times more frequent among the former than the latter.

1850.] Periscope. Miscellany. 317

Chlorosis in Pregnant Females. (Gazette Medicale.) It a meeting
of the Academy of Medicine of Paris on the 19th of February, M.
Cazeaux read an essay, the object of which was to show that the
functional derangements so common among pregnant females, such as
cephalalgia, vertigo, tinnitus aurium, palpitations, dyspncea, &c, gen-
erally attributed to plethora, are more frequently the results of chloro-
anemia. In pregnant women sanguine plethora is rare, but serous
plethora is quite common. M. Cazeaux founds his opinions upon a
chemical analysis of the blood, upon the symptoms, and upon the hap-
py effects of the ferruginous preparations : he concludes, from the
chemical results, that the principal elements of the blood, during preg-
nancy, undergo modifications analogous to those of chlorosis. The
functional disorders are also similar. Moreover, an animal diet, and
the administration of chalybeates, have always been found equally
efficacious in the treatment of the functional disorders of pregnancy,
as in chlorosis. He now does not resort to bloodletting for the relief
of palpitations, and he has never found them to resist the employment
of chalybeates when continued for some days.

ill t it i c a I ill i s c 1 1 a n jj .

Medical Society of the State of Georgia. An accident which hap-
pened to the train on the Macon Rail-road prevented the attendance of
our delegates at the late meeting of the State Society. But we have
been favored with an account of some of the proceedings of the late
meeting, in the following letter from the Recording Secretary, Dr.
Nottingham :

Macon, Ga, April 18th, 1850.
Dr. I. P. Garvin, Editor, &c.

Dear Sir, Pursuant to a resolution adopted at the last annual
meeting, the Medical Society of the State of Georgia assembled in
Macon, on Wednesday, the 10th inst., and continued in session two
days. The meeting, although not a full one, was sufficiently numer-
ous for the transaction of business. Many important subjects con-
nected with the advancement and elevation of the Profession, were
deliberated upon in a spirit of harmony, high toned feeling and liberal
sentiment, that augurs well for the future usefulness of the Institution.
The officers elected lor the present year, were

Charles West, M. 1). of Houston, President ;

R. D. Aknold, M. D., of Chatham, 1st Vice-President ;

I. E. Dupbee, M. D., of Twiggs, 2d Vice-President ;

318 Miscellany. [May,

J. M. Green, M. D., Of Bibb, Correspond'g Secretary ;
C. B. Nottingham, M. D., of Bibb, Record'ng Secretary ;
S. W. Burney, M. D., of Monroe, 'Treasurer.
The following gentlemen were duly elected Delegates to the next
meeting of the "American Medical Association," which will convene
in Cincinnati, on the 2d Tuesday in May, viz :

s L. D. Ford, M. Dm of Richmond; l^-
W. M. F'rasier, M, D., of Pulaski ;
I. E. Dupree, M. D., of Twiggs ;
T. F. Green, M. D., of Baldwin ;
Charles Thompson, M. D., of Bibb ;
T. L. Rives, M. D., of Troup;
J. N. Simmons, M. D., of Butts ;
R. L. Roddey, M. D., of Monroe ;
J. H. Oliver, M. D., of Laurens.
A number of committees, composed of much of the medical talent
of the State", were appointed to prepare Essays and Reports, upon
various subjects pertaining to Medical Science, to be presented af the
next annual meeting of the Society which will be held at Atlanta,
Dr. Arnold of Chatham, with Dr. LeConte of Bibb, as his alternate,
was selected as Orator for the occasion.

A summary of the Proceedings will be published in pamphlet form
at as early a day as practicable.

Very respectfully, C. B. Nottingham.

New Orleans Medical and Surgical Journal.-^-We were much grati-
fied a few days since, to receive the March number of our valued New
Orleans COtemporary, which has been delayed by the disastrous fire
that consumed the office, with all its books, printing material, etc., and'
reduced to ashes* all the profits which had accrued from several years'
incessant labors. Whilst we deeply sympathize with our esteemed-
brother, we can but admire the indomitable spirit which he exhibits.
"If we have heen unfortunate," he says,- "we are not despondent ; but
gathering additional energy from our recent losses, we shall push for-
ward the work with all that zeal and resolution which can alone guar-
antee ultimate success in any undertaking." Fortuna opes auferre,
iwn animum, potest.

Extract of a Letter from James H. Oliver, #1.D., of Laurens Co., Ga.

I was, on 22d January, 1849, called to see a gentleman whom 1

found it necessary to cup. His wife, who was some four months ad-

1850. J Miscellany. 319

vanced in pregnancy, was sitting near me whilst 1 was operating upon
his temples. Nothing worth noticing transpired at the time of oper-
ating or daring the latter months of pregnancy. At the expiration of
the usual term, she was delivered of a fine, and apparently healthy
child. There were found twelve scars in each temple of the child,
arranged so uniformly that they resembled the cicatrices made by the
action of the scarificator in actual cupping. These cicatrices, as I term
them, gradually disappeared as the child advanced in life. The last
time that I examined the temporal region they were entirely invisible.
How the impressions made upon the mother caused this physical evo-
lution to take place upon the foetus whilst in utero, is wonderfully
mysterious. I had always doubted that any such impressions could
be made, but I am now constrained to believe it possible.

Percussion. (Gaz. Medicale.) M. Poirson, Interne at la Saltpe-
triere, has communicated a new mode of percussion, that consists in
striking after the usual manner, without a plessimeter, and with the
index or middle finger furnished with a polished thimble, adjusted in
such a manner as to confine a certain quantity of air between its upper
extremity and the end of the finger. This instrument without alter-
ing in anywise the character of the sounds, communicates to them,
according to the author, a remarkable clearness and intensity which
enables the physician to perform the percussion, and yet to spare the
patient almost entirely the suffering occasioned by a shock that is often
very painful.

Northern Lancet, and Gazette of Legal Medicine. A new Medical
Journal, under this title,- has been received. It is published ai Pitts-
burgh, N. Y., in monthly numbers of 32 pages each, and is edited by
Drs. Francis J. D' Avignon and Horace Nelson. A considerable por-
tion of the work will be devoted to Legal Medicine, a subject which has
hitherto been too much neglected by the profession. We wish the
enterprising editors great success in t'heir honorable undertaking.

A Foetus discharged by tlic mouth. We find in the Gazette Medicale
of the 23d February, a very singular case (if true), derived from the
Spanish journals. Maria de la Cruz, aged 18 years, in the second-
stage of yellow fever, was attacked with vomiting, during which she
threw up, with much difficulty, a substance which proved to be a per-
&cily developed fcetus of four months. The female died next Jv-.

320

Miscellany. Meteorology.

On an examination of the body, the uterus was found augmented in vo-
lume, and between that organ and the vagina, an abnormal cavity
communicating with the intestine by an opening four inches in diameter.

Mortality of Providence, R. I. We learn from a communication,
made by Charles W. Parsons, M. D., to the Boston Medical and Sur-
gical Journal, that the deaths in Providence for the last eight years,
among the white population, including the still-born, amounted to 6146,
or 1 in 39.42. During the same period, among the black population,
which numbers 1476, the deaths were 457, or 1 in 25.89.

METEOROLOGICAL OBSERVATIONS, for March, 1850, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above

tide, 152 feet. By Dr. Paul F. Eve. ,

P.M.

Sun Rise.
Ther. Bar.

70
53
62
48
48
57
51
42
47
56
51
37
54
65
59
60
57
57
44
49
46
46
52
36
43
45
56
38
35
49
45

2,
Ther.

29 43-100
" 72-100
" 54-100
" 97-100

30 12-000

29 79-100
" 41-100
86-100
" 92-100,
" 84-100
" 91-100
11 97-400
" 94-100
" 74-100
" 82-100
" 85-100
" 77-100
" 59-100
" 85-100

30 10-100
29 35-100

" 70-100
" 41-100
91-100
" 76-100
" 53-100
" 32-100
" 52-100:
" 87-100
" 74-100
" 72-100

Bar.

(*) From E. to N. E,

29 47-100
67-100
58-100

30 5-100
30 5-100
29 31-100

50-100
91-100
94-100
83-100
92-100
30

29 84-100
:' 77-100
" 74-100
" 78-100
65-100!
" 62-100
" 90-100

;o lo-ioo

29 88-100
60-100
59-100
88-100
69-100
44-100
31-100
63-100
82-100
66-100
79-100
all around the

Wind.

w.

S. E.
E.
S.

w.
w.

s. w.
w.

N. E.

N. E.
E.
W.

w.

()

s.

s. w.

w.

E.
S. E.
S. E.
N. W.
N. W.

S.

S.
N. E.

N.

E.

E.
N. W.

compass.

Remarks.

Fair Wow.

Cloudy.

Fair afternoon gale.

Fair.

Cloudy. [85-100.

Cloud)' violent storm rain,

Fair.

Fair.

Cloudy.

Fair afternoon.

Rainy hail breeze.

Fair afternoon.

|Rain all night, 1 inch 10-100.

Fair afternoon.

Storm at 2 p.m., 90-100.

Storm all afternoon 1 in. 30-100.

Storm at 4 p.m. \ two nights, 1

Cloudy. $ inch 30-100.

Fair.

Cloudy rainy.

Rain, "l inch i. 3-1 00.

Cloudy rain, 95-100.

Fair heavy blow.

Fair.

Cloudy.

Somewhat hazy rain at 8 p.m.

IRain, 25-100.

!Fair afternoon blow.

'Some clouds.

,Cloudy rain at 3 p.m., 55-100.

Fair breeze.

8 Fair days. Quantity of Rain
11 days. West of do. do. 13 days.
Another most disagreeable month-

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

cold, wet. and tempestuous

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. JUNE, 1850. [No. 6.

PART FIRST.
r i 3 1 n a I (ttotrurutntcattons.

ARTICLE XV.

An Essay on the Influence of Dentition in producing Disease.
By Henry F. Campbell, M.D., Demonstrator of Anatomy
in the Medical College of Georgia.

The period of Dentition has ever been regarded one of pecu-
liar interest, as well to the pathologist as to the practitioner.
That certain diseases are more apt to occur during this season,
few pretend to deny ; but the amount of the symptoms, due to
the irritation of teething, has been variously estimated, some
attributing to this cause nearly all the ills to which infancy is
liable, while others ridicule the idea that a process .in itself so
purely physiological and natural should be regarded ever a
cause of disease.

The object of our essay is to investigate impartially this
important subject with the view of determining, as nearly as
possible, to what extent the organism is affected by the evolu-
tion of the teeth. In doing so, it appears to us most rational,
as a primary step in the investigation, to review briefly the
phenomena of both normal and anormal dentition, with the
view of finding the foundation of the pathogenic theory, if such
exists, in the physiology of this process.

The phenomena observed during easy or normal dentition
may be briefly summed up as follows : The salivary secretion
is increased, the gums are swollen, the mouth hot, and the child
evinces a disposition to press every substance within its reach

N. 3. VCL. VI. no. vi. 21

322 Campbell, on the Influence of Dentition [June,

upon the gums, in order to relieve the irritation it here suffers.
Later the gums become more swollen and softer, the irritation
more distressing, and, under certain circumstances, the mouth
dry and slightly inflamed. The child becomes fretful; its
sleep is disturbed and feverish, its bowels become loose, which
latter symptom we frequently observe accompanied by nausea
and vomiting. There is also described by some authors an
irritation of the schneiderian membrane, with increased secre-
tion, marked by the child's rubbing its nose.

Cases of anormal dentition are brought more frequently under
the cognizance of physicians, and their phenomena are hence
familiar to every one. The above symptoms become exagger-
ated some, which in normal dentition were of trivial import-
ance, becoming so severe as to threaten the life of the patient.
Thus the gently relaxed condition of the bowels, which in easy
dentition was even beneficial, is now changed to diarrhoea with
distressing tormina and alarming emaciation. The salivary
glands, which in easy dentition manifested their implication
only by increased secretion, now become inflamed and swollen
till finally their secretion is altogether arrested, leaving the
mouth and tongue dry, parched and painful ; and the nervous
fretfulness of the normal process is often replaced by actual
fever, sometimes attended by the most terrific convulsions.

We have here sketched hastily some of the more prominent
phenomena of both easy and severe dentition, as we each daily
observe in practice, and find reported by authors, and we do
not adduce them at present as the direct results or consequen-
ces of the process, but only as its pretty constant concomitants.
In referring to those symptoms hereafter in the course of our
essay, we will necessarily enlarge upon and develope more fully
some of their characteristics. Let us now, with a little atten-
tion, enter into an analysis of these concomitants of dentition,
and endeavor to ascertain whether or not their origin may be
found in the process itself. To this end, we will consider briefly
the anatomy and physiology of the parts concerned in this im-
portant and often perilous process of evolution. Dentition
begins early in foetal life by the formation of minute pulps in
the maxillae, the deposition of calcareous matter upon these pulps
afterwards occurs, and finally these rudimentary bodies, becom-

1850.] in producing Disease. 823

ing more and more perfect, emerge from the fibrous capsules
that envelope them, and finally by the absorptive process make
their appearance through the gum, and the child is said to have
cut its teeth. This process is not at once uninterruptedly
completed, but is from time to time resumed with but short
intermissions, till, successively, all the teeth are through, the
whole process occupying a period varying from fifteen to thirty
months. The parts in which this slow and tedious evolution
takes place soon become better supplied with blood, the vessels
enlarging for this purpose, and moreover it is not unimportant
to recollect they are supplied by sensitive branches of the
trifacial or fifth nerve, a nerve the irritation of which is ever
made evident% the most painful manifestations. Add to the
above the inordinate development of the nervous system, par-
ticularly the spinal, at this period, and we have the most import-
ant physiological peculiarities which bear upon the question
under consideration.

That pain frequently exists during dentition is a fact that
needs no argument to substantiate ; the uneasiness, fretfulness,
biting and other symptoms, are all unmistakable manifestations
of pain in the child, and further, we know that in the adult the
appearance of the wisdom teeth is often attended with pain of
the most acute character. The following case will illustrate
this fact : Some time since we were requested to extract a
tooth, the young man complaining of intense pain in the lower
jaw ; on examination no decayed tooth could be discovered to
which to refer his distress, but behind the last molar tooth on
the right side there were much tumefaction and tenderness; on
scarifying the part deeply the wisdom tooth was felt to grate
under the lancet. He was instantly relieved of the pain, which
did not return, and the tooth has since made its appearance
without causing further trouble. His pain had been caused, no
doubt, by the pressure of the growing tooth upon the branches
of the fifth nerve distributed to the gum in which it was embed-
ded ; and in the same manner does the emergence of each
successive tooth in the infant cause pain, varying in degree
according to the susceptibility of the subject and number of the
teeth simultaneously emerging.

Ill children* as in the above adult case, we constantly observe

324 Campbell, on the Influence of Dentition [June,

instant relief from free incision of the gums ; indeed, we could
report many cases wherein the relief was so marked that the
children seemed aware of it themselves, and would make no
resistance whatever to the operation, but would bear up against
the cutting edge of the lancet, the pressure of it affording relief.

In addition to the local results of pressure upon the nerves,
as pain, heat, tumefaction, and other symptoms of inflammation
in the mouth and its vicinity, we have general symptoms of a
graver and more important bearing upon the welfare of the
individual, a train of phenomena denominated by some authors
the sympathetic disorders of dentition, and by others denied,
as having little or nothing to do with the process, but treated
of as merely coincident diseases, occurring at this period be-
cause the system is more irritable, and consequently more liable
to disease, thus we may say evading the question and virtually
acknowledging their true origin. Thus Dr. West, in his recent
admirable course of " lectures on the Diseases of Infancy and
Childhood," writes, " the time of teething is in reality one of
more than ordinary peril to the child, though why ft should be
so, is not always rightly understood." And he goes on to ac-
count for it. by saying that "it rs a time of the most active
development of the organism a time of transition from one
mode of being to another, in respect of all those important
functions by whose performance the body is nourished and
built up. Statistics embracing the largest numbers, prove the
dangers of this period, and warrant us in regarding the comple-
tion of this process as a fair subject of congratulation.""

Among the diseases to which the system is at this time liable,
we will enumerate as most important, first, those of a convul-
sive or spasmodic nature, and secondly, and almost as im-
portant and dangerous, those that affect the gastro-intestinal
canal. That the convulsions occurring during dentition de-
pend upon the irritation of the process for their production,
we have every reason to believe, that high authority, ob-
servation and careful induction can afford. We are all aware
that irritation occurring in one portion of the nervous system,
is adequate to the production of sympathetic irritation in ano-
ther portion, sometimes indeed very remote from the exciting
cause. Thus an irritation of the nervous plexuses supplying

3850.] in producing Disease. 32o

the womb, often gives rise to puerperal convulsions, by the
reflex action of the nerves transmitting this irritation through
a nervous centre, the spinal marrow, to certain muscles, many
of them very distant from the primary seat of the irritation.
Or, as another familiar illustration, we adduce the irritation of
the fauces in the production of vomition : here the irritation,
being made in the branches of an exciter nerve, the glossopha-
ryngeal, distributed upon the mucous membrane of this region,
is transmitted to the medulla oblongata, the nervous centre
common to this and a motor nerve, the pneumogastric supply-
ing certain muscles of the pharynx, oesophagus and stomach,
and vomiting is produced. That this is true, there can be no
doubt ; for whenever the fauces are in a condition to obtund
the sensibility of the glossopharyngeal nerve, whether from
tumefaction or the deposition of false membranes, it is with
great difficulty that vomition is effected, because then we are
deprived of the action of the chief excitor to the act. Since,
then, we must admit that dentition gives rise to much local
irritation, and also that local irritations can, under certain cir-
cumstances, be productive of sympathetic phenomena, through
the reflex agency of the nervous system, the conclusion is
inevitable that some at least of the convulsions occurring
during this period are directly referable to such local irritation,
for here the analogy is as perfect and entire as could reasonably
be required for such a deduction. Here the sensitive branches
of the fifth pair of nerves itself almost a spinal nerve, become
excitor to the motor filaments of the spinal nerves, by transmit-
ting to the medulla oblongata the irritation caused by the pres-
sure of the growing tooth, this irritation is thence reflected
through the spinal marrow and motor nerves arising therefrom
to the muscles, and the convulsions are thus produced.* This
theory of the origin of this irritation receives further corrobora-
tion, if we observe that the reflected irritation is first transmit-
ted through the nerves that arise successively from the nervous
centre, thus, first the motor branches of the fifth nerve itself
are excited, and those muscles moving the inferior maxilla are
convulsed; then the sixth, and the eye is rolled outward in its
orbit; thirdly, the seventh is excited, and the superficial mus-

* Todd's article on Sympathy, in the Encyclopedia of Anat. and Phys.

326 Campbell, on the Influence of Dentition [June,

cles of the face, the muscles of expression, distract the features
by their convulsive actions. Then in rapid succession the
other nerves ; the pneumogastric causing dyspnoea by closure
of the glottis from spasm. Then the hypoglossal protruding
the tongue ; and we think it is owing to the position of the
origin of this nerve that this organ is so frequently lacerated,
the mascatory muscles are already in action, and on the excita-
tion of the ninth pair the tongue is thrust between the teeth
before the patient has made noise enough \o attract the atten-
tion of the attendants, for it is only after the excitation of the
phrenic nerve, which arises much lower down, that the dia-
phragm is convulsed, and the crowing inspirations are pro-
duced. But to resume : shortly after the ninth, we observe the
action of the spinal accessory nerve of Willis is excited through
the common nervous centre, and the head is drawn forcibly
backwards upon the neck by the action of the sterno-mastoid
and trapezius. Now in rapid succession all the spinal motor
nerves are excited and the convulsion is general.

The above, with very little variation, will be found to con-
stitute the order of phenomena of those convulsions that occur
during dentition. The successive excitation of the nerves
above-mentioned is so rapid that it is difficult to mark the exact
time of its recurrence, but that it is successive is plain and per-
fectly observable to any one who has awaited in dread, as we
have done, the advent or return of this most terrific of the many
scourges that affect mild and innocent, yet too fragile childhood.

From the above considerations we are induced to conclude
that convulsions are often produced by the irritation of denti-
tion, and can be directly referred to this as the sole cause.

We arrive now at a point in this somewhat obscure and
much disputed question which perhaps affords more ground for
doubt than any of the foregoing, viz., a consideration of the
pathogenic influence of dentition in the cholera infantum or
diarrhoea so uniformly co-existant with this process. Unlike
the convulsions, the analogy between which and certain known
and established phenomena of the excito-motory system, which
it is only necessary to refer to, and their operation is plain and
intelligible, this new set of symptoms, if we refer them to the
process of dentition, requires us to look yet deeper into the

1850.] in producing Disease. 327

mysteries of our nervous organization, and to venture still one
step further on the terra incerta of sympathetic interpretation.

In order to apply our arguments, let us hastily review the
foregoing investigation, that they may bear more fully upon
this part of our question; and, firstly, we have seen that in-
flammation, pain, and irritation are produced locally by the
process of dentition, evinced by restlessness, biting, &c. Se-
condly, we have seen that this local irritation can be transmitted
by excito-motory influence to other and distant parts of the
body manifested by convulsions. We have also endeavored
to corroborate this latter opinion by a reference to the order of
succession in the nerves in which this irritation occurs, and also
by a comparison of these phenomena with other well under-
stood and established analogous phenomena. Heretofore we
have had to deal entirely with functions of the cerebro-spinal
system of nerves ; but to account for this second and more ob-
scure part of our problem, we must look in vain to any direct
anatomical connection between the fifth pair and the rest of
this system of nerves. We are forced to seek out other con-
nections, indeed somewhat more intricate and indirect, but
fortunately no less legitimate and definable. We have now to
consider a sett of organs that, unlike the voluntary muscles, have
no connection, or rather, we would say, emphatically, they
have a connection, though indirectly, with the cerebro-spinal
system. We mean the abdominal viscera, which we know are
almost altogether supplied from the great sympathetic system
of nerves. Now, in the prosecution of our inquiry it becomes
necessary, to the elucidation of the question, to trace out the
same connection between the fifth pair and the sympathetic or
secretory, as we did between the fifth pair and the cerebro-spinal
or motory nerves, and then, should we succeed, we will briefly
inquire into the bearing which this connection and its possible
results may have upon our question.

The connections between the fifth pair, the rest of the cere-
bro-spinal system of nerves and the great sympathetic, are so
abundant and universal that it is only necessary to enumerate
a few of them to illustrate the fact. Firstly, we have a con-
nection in the ophthalmic or first division, by its nasal branch
communicating with the ciliary ganglion ; then in the superior

*J28 Campbell, on the Influence of Dentition [June,

maxillary, or second division, are branches of communication
with Meckels ganglion ; again, in the sub-maxillary ganglion,
with the inferior maxillary or third division. So much for the
fifth itself. Then we know that every one of the spinal nerves
throughout the entire chord are connected to each sympathetic
ganglion of the system, thus establishing communications the
most abundant and intimate between these two systems of
nerves. We know also that these ganglia distribute numerous
branches to all the splanchnic viscera by plexuses which ac-
company the arterial trunks into the minute structure of these
organs.

Thus connected and distributed, this nerve presides over the
important functions of nutrition and secretion, which office so
characterizes it as to give it the name of the secretory system.
In the physiology of the nervous system, there is no fact bet-
ter established by anatomy and pathology, as well as by ex-
periments on the lower animals, than this, that the sympathetic
nerve, whatever else may be its functions, always forms a
necessary element in the nutrient and secretory apparatus of
all the splanchnic viscera ; and further, that upon its sanity
depends the due administration of these two great functions.
It is the nerve for the bloodvessels ; '' and," remarks Todd and
Bowman, "as secretion is mainly dependant on the normal
nutrition of glands, it is reasonable to suppose that that func-
tion would be to a certain extent controlled by these nerves."
And as early as the year 1732, Pourfour du Petit found that the
division of the trunk of the sympathetic, opposite the fourth or
fifth cervical vertebra in dogs, was followed very rapidly by
great disturbance of the circulation of the eye-ball, producing
inflammation, flattening of the cornea, and finally destruction
of this organ.

The experiments of Dupuy upen the horse, wherein he
severed this nerve at the superior cervical ganglion, also cor-
roborate this statement ; general emaciation here ensued, with
an anasarcous condition of the limbs and an eruption over the
whole cutaneous surface.

In some experiments made by Dr. J. Reid, and reported by
Todd & Bowman, in reference to the sympathetic branches
supplying the eye, it was found that a section of this nerve was

I860.] in producing Disease. SUM

to produce an immediate injection of the conjunctiva. In one
case, he observes, the redness of the conjunctiva took place in
a few minutes after the section. It has been already stated,
continue these great authors, that a section of the branches of
the fifth nerve which supply the eye, is followed by ulceration
and other signs of impaired nutrition in the eye-ball. But these
changes do not take place for some time after the section of
the nerve generally many days elapse and they are attributa-
ble to the presence of irritating particles which, owing to the
insensible state of the conjunctiva, are suffered to remain in
contact with the surface of the eye, giving rise to inflammation
and ulceration of its textures. The effects of section of the
sympathetic are immediate, and are probably due to a change
produced in the blood-vessels, in consequence of the with-
drawal of the accustomed nervous influence.*

We have now glanced sufficiently, we think, at the anatomy
and physiology of the sympathetic system of nerves, to make
the application of such points as are pertinent in the solution of
our pathological problem. In its anatomy, we have seen its
connections with all three of the divisions of the fifth nerve by
ganglia, the connexion of these various ganglia with each other,
as well as with the cerebro-spinal axis ; and lastly, the distribu-

* In the Medico-Chirurgical Review for January, 1845, this view of the func-
tion of the sympathetic nerve is ably elucidated in an article by Dr. T. Proctor.

" After alluding to the proofs derived from the experiments of Philip, Flourens,
and others, oi the non-dependence ot the circulation upon the cerebro-spinal
system, Dr. P., in another part of his work, thus expresses himself.

-' 'It is self-evident, then, that it is to the sympathetic, and that alone, that we
must look for regulating the arterial system. And it will be observed that, in all
parts of the animal body, where large and sudden supplies of blood are required,
such as the heart, stomach, bowels, and organs of generation, we have the gan-
glionic or sympathetic system very fully developed, and, as far as I can judge,
in ratio to the amount of blood supplied to the several organs: on the contrary,
in some parts of the body, and in the extremities where the flow of blood is more
regular, and not subjected to those sudden calls for large supplies of blood at
irregular periods, we find this nerve manifestly decreasing in size: and, indeed,
as far as we can judge with the naked eye, ceasing altogether in some parts.
Still I perfectly agree with Sir Charles Bell that it is distributed all over the bo-
dy; but whether its influence is confined to regulating the small arteries which
supply the coats of the vessels, or whether the same influence is continued by it
over the whole circulating medium of the extremities and other parts that it
manifestly has over the abdominal viscera, must, I fear, be left to a more en-
larged enquiry.' "

The whole article is full of interest and valuable suggestions, and its perusal
will add much to the clearness of our pathology in many points that have here-
tofore been exceedingly embarrassing to practitioners.

330 Campbell, on the Influence of Dentition [June,

tion of branches from these ganglia, which are conducted by
the arteries into every part of every one of the splanchnic
viscera. In its physiology, we find it in entire charge of the
important functions of nutrition and secretion, and that where
ever these processes are effected it is by the agency of this
nerve alone upon the blood-vessels. And further, we have
seen that pathology and experiments on lower animals establish
its indispensableness to the due performance of these functions,
and that whenever the supply of its innervation has been cut
off from a particular part of the organism, that part immediate-
ly manifests symptoms of impaired nutrition and altered secre-
tion.

Now we are all aware that nearly the whole of the intestinal
canal, or rather that portion between the stomach and lower
part of the colon, receives no direct innervation from the cere-
brospinal axis, but is entirely dependant upon the sympathetic
nerve for its supply of nervous influence of whatever kind it
may enjoy, whether motory, sensory, or secretory, and conse-*
quently an impairment of the function of this nerve must neces-
sarily correspondently alter its condition so far as regards all
those functions with which this nerve endows it. The altera-
tion in these functions would, of course, depend, in a great
degree, upon the amount of impairment in the source of irrita-
tion ; thus, as we have seen, if the supply is entirely cut off, the
functions of the arteries seem in a great measure to cease, pas-
sive congestions occur, and the parts inflame and ulcerate.
Now we can also very naturally conceive of a condition of
these nerves somewhat analogous to the above, yet intermedi-
ate between the entire interruption caused by section, and
perfect health: a condition of embarrassed or of exalted
innervation. Now this intermediate condition is exactly the
state which, from the developments of the foregoing investiga-
tion, we feel that we are authorized to affirm is that which
occurs in severe dentition, and that upon it is dependant the
whole train of intestinal morbid phenomena observable during
this process.

That this, so far, is legitimately inferable, we do not think
any one will deny. Now let us enquire how far these phe-
nomena are dependant upon dentition; and analogy with the

1850.] in producing Disease. 331

excito-motary system will much assist us in our argument.
We have seen that local irritations can, through this system,
produce convulsions by the reflex function of the nerves, the
sensitive branches of the fifth pair becoming excitor to the
motory spinal nerves ; and so may we justly infer do these
same branches, under certain circumstances, become excitor to
the secretory filaments of the sympathetic, distributed so abund-
antly to the intestinal canal, by a transmission of this irritation
through the various ganglia with which it is connected. Thus
the irritation at first produces simply an exaltation of the inner-
vation of these secretory surfaces, and consequently secretion
is more active than normal, producing simple diarrhcea. A
continuance of the irritation, alters the character of the secre-
tion, and we have the various morbid discharges observable
during this period. This increase and change in the secretion
are effected by the agency of the altered function of the nerve
upon the arteries from which these secretions are eliminated.
Now when the innervation of these arteries is still further em-
barrassed by the long continuance of the reflected irritation,
the state of things nearly approaches that observed in Dupuy's,
Reids's and Pourfour du Petit's experiments of actual destruc-
tion of the nerve, and we have ulceration of the intestinal
mucous membrane: all these phenomena being the result of
various degrees of injury sustained by the sympathetic nerve.

It may here be asked, why should the branches supplying the
intestinal mucous membrane become more implicated than any
other portion of the sympathetic system? and why do not
similar irritations of the fifth nerve produce like results in the
adult ? To the first of these questions we answer, that most
probably the other portions are implicated, but the manifesta-
tions of such, implication are greater and graver here than
elsewhere, because these are the sole sources of innervation to
the viscus. The other branches are in all probability implica-
ted, but receiving a certain amount of innervation from other
sources, most of their functions not being entirely secretory,
are still, though imperfectly, carried on. But in the intestinal
canal the case is far different ; the requisitions made upon \i are
of a nature that it has need for no other innervation than that
of the sympathetic system. Its functions are secretion and

332 Campbell, on the Influence of Dentition [June,

nutrition for the whole animal organism, and when these are
impaired, its primary, indeed its only intents are altered or
completely nullified. The second question is answered by the
greater development of this system in the growing than in the
adult individual, for the purpose of supplying the more active
nutrition and secretion at that time necessary. We know that
disease is more apt to occur in many parts of the body during
this period; this is the general admission. Thus, according to
many authors, among whom are West, Churchill, &c, pneumo-
nia and bronchitis are more apt to attack children during
dentition, than at any previous or subsequent period. Cutane-
ous eruptions, and many other aberrations of secretion occur-
ring during this period, but serve to corroborate our theory of
the origin of the morbid intestinal secretion. The increased
vermicular action and tormina attending this affection, find a
ready explanation in the fact, now well established, that the
sympathetic receives both motor and sensitive filaments from
the anterior and posterior roots of the spinal nerves, endowing
the organs of their distribution, to a certain degree, with cor-
responding susceptibilities.

In conclusion, let us define the position which, at the end of
our investigation, we feel warranted in assuming. They are
the following: that in the anatomy and physiology, as well as
in the dependant analogies of the process of dentition, we find
ample ground for the opinion that the diseases pertaining to
this period, may be dependant, and in many instances are en-
tirely so, upon the local irritation attending the process being
transmitted through either the cerebro-spinal system of nerves,
producing convulsive diseases in the motory apparatus, or
through the sympathetic, causing derangements in the secreto-
ry organs, particularly the alimentary canal, by the sway which
it exercises over the arterial system, from which these secre-
tions are eliminated. And the practical deductions to be drawn
from these conclusions are, that we should not be remiss in
taking every measure to arrest or lessen this local irritation,
either by free and repeated incisions of the gums, or by the
judicious administration of appropriate remedies, among which
we have found opiates to prove most safe and efficient.

It would indeed be an improving, and not an unpleasing ex-

1850.] in producing Disease. 333

ercise, to trace out more fully the connexions between the local
irritation and the various diseases occurring during the period
of dentition, to take more extended views of the abundant
analogies and comparisons afforded by this truly prolific sub-
ject ; but time and the special object of our essay, do not war-
rant the indulgence in speculations so general and discursive.

Our object has been to trace the connexion between this
process and diseases in general, only in so far as it has a bearing
upon the establishment of one principal question in reference
to the diarrhoea of this period. The subject has been only
glanced at, and deserves a fuller and more extended treatise ;
wherein all the concomitant diseases of dentition, as dropsy,
eruptions, and the many infantile neuroses, should be fully and
carefully discussed. Such views, we would earnestly invite
from some abler and more philosophic member of the profession.

ARTICLE XVI.

Veratrum Viride. By Wesley C. Norwood, ofCokesbury, S.C.

American Hellebore. There is no science or art that suffers
more, for want of reflection and investigation, than the science
of medicine and the art of administering remedial agents to
diseased animal bodies. When we reflect on the important
responsibility that rests on the physician, this fact is truly a
source of profound regret. It is truly surprising, how little is
known and understood of the powers and properties of many
remedial agents, to say nothing of the same want and deficien-
cy in much that pertains to the grand circle of medical science
in its most general and extensive import or widest range. The
circumstances leading to this much to be deplored condition,
would afford abundant matter for a dissertation, alone.

The powers and properties of Veratrum Viride are but little
known, and the little that is known is rather taken for granted
or supposed from analogy : it is certainly a powerful and
efficient agent, and can be as easily and as safely managed as
any other equally active and energetic remedy. We have first
employed it in July, 1841. It was in the case of Mrs. T.,that

334 Norwood, on Veratrum Viride. [June,

our attention was more particularly called to some of its pecu-
liarly striking effects. She was ordered full doses in the morn-
ing. In the afternoon we were sent for in haste, as it was
operating drastically: we found the skin cold; considerable
moisture of the surface ; paleness extreme ; vomiting every
fifteen minutes or oftener ; the pulse beating not more than
sixty, but full and distinct. The pulse in the morning, before
the administration of the veratrum viride, was one hundred and
thirty in the minute. The emesis, coldness and extreme pale-
ness of the surface, great despondency, or sense of sinking and
dissolution, and the great reduction in the frequency of the
heart's action, led us to observe more carefully its effects from
that period. The disease in which we have used it most fre-
quently is Pneumonitis, and its varieties. Its remedial proper-
ties or powers are acrid, narcotic, expectorant, diaphoretic, emet-
ic, and lastly, sedative, eminently reducing the frequency of the
pulse, and rendering it slow, full and distinct. Its occasional
effects are slight and pleasant delirium, hysteria or symptoms
approximating hysteria, preternatural wakefulness, &c. We
have enumerated its powers, beginning with that which is least
prominent, and so on till we have reached the last, and as we
believe the most energetic and valuable. It possesses a suffi-
ciency of the powers called Acrid to relieve very moderate
cases of torpor and where not sufficient for extreme cases, it
renders a much less quantity necessary of such articles as gin-
ger, grains of paradise and capsicum, than would be requisite,
if veratrum viride was not administered, and by virtue of this
property, it obviates any torpor that might be the result or
follow from its own narcotic powers, and also counteracts some
of the troublesome effects of Papaver, such as general torpor of
the whole system, or of the bladder in particular. The next
property in order, is its Narcotic, or if we had any appro-
priate term between a nervine and narcotic, we would use it ;
but as it is not a pure nervine, nor an intense narcotic, but
more of the latter than the former, we must retain it. We
have found a much smaller quantity of opium and its prepara-
tions necessary, and many of its inconvenient effects obviated,
under the administration of this article, such as, starting, fright-
ful dreams, and a continual muttering while dosing or sleeping,

1850.] Norwood, on Veratrum Yiride. 335

which symptoms or effects are distressing to the patient, and
sometimes alarming to the friends. By allaying pain, inducing
more or less quiet, or even sleep, and not being accompanied
with the above named disagreeable symptoms or effects, it
proves itself a valuable agent in the treatment of disease. In
the third place, it is Expectorant, and as decidedly so as any
article with which we are acquainted, not only increasing, but
materially changing the matter expectorated. When adminis-
tering it we rarely find any other expectorant indicated. Under
its ordinary effects, the surface is nearly always sufficiently soft
or moist, and at times drenched with perspiration or if there
is no moisture, the heat is reduced sufficiently low to render
any additional remedy for its diaphoretic effects unnecessary.
This brings us to the more active powers of the article; and,
first, it is actively and drastically emetic, when administered in
single full doses, but sufficiently mild and moderate in its
operation when given in small doses at short intervals, for the
young, delicate or feeble to take it with perfect safety. It
operates on the stomach, and produces but a small discharge of
bile, but a considerable quantity of mucous or watery fluid, or
perhaps both. It excites a great degree of nausea, and an un-
usual paleness or a contraction of the capillaries, thereby pro-
ducing more or less coolness of the surface, with a feeling of
sinking or exhaustion. It alone answers all the purposes that
can be obtained from emetics in pneumonitis. The last and
most prominent effect is a certain extensive and permanent
reduction of the frequency of the pulse. It is the only article
with which we are acquainted, that certainly and invariably
lessens the frequency of the pulsations of the heart and arteries,
and it possesses this power in a greater degree than any one,
and perhaps all the articles combined for which this quality or
effect is claimed. It so constantly produces this effect, that it
may be administered without any fear or dread of disappoint-
ment. In Pneumonitis Typhoides the frequency and rapidity
with which the blood is sent through the lungs is certainly one
of the most difficult circumstances belonging to the disease to
control permanently. This frequency of action or pulsation of
the heart and arteries aggravates, and is more liable to keep up
persistent pain and inflammation than perhaps all others em-

336 Norwood, on Veratrum Viride. [June,

bodied and combined. The hurried^motion of the lungs, from
the rapid circulation through them, must be detrimental to an
organ whose functions are so essential, and whose office is so
important to the animal economy. From the great variety of
remedies recommended, the conclusion is forced on us, that
these motions and actions are of difficult control, or the state
and condition of the system exciting them, are not counteract-
ed by ordinary agents. But to be able to control these morbid
actions and motions, or to manage or change the morbid state or
condition from which they result, with a single article, that can
be administered without difficulty that is not inconvenient
from bulk, nor disagreeable to the taste, nor of offensive odour
or smell, is certainly not a minor consideration, and should be
taken into strict account in healing this scourge of the human
race. If a multitude of remedies have been found absolutely
necessary to control and subdue the above motions and actions,
under the usual and ordinary mode of treatment, upon what
does the cure depend? Does it rest on the fact of their
controlling the action of the heart and arteries and the mo-
tions of the lungs, thereby giving the vis medicatrix an oppor-
tunity of relieving the state or condition on which they
depend ? Or does it result from their counteracting this state
and condition, the motions and actions ceasing, as a necessa-
ry consequence of this counter-agency ? Or do they unitedly
effect this desirable object ? We know that calomel, emetics,
blisters, expectorants, are resorted to in the treatment of
this disease ; and notwithstanding the powerand activity of
many of these articles, we often find it absolutely pecessary
to call into full requisition the whole catalogue, and after
using them as skilfully and efficiently as we may, we often
get along badly with many cases. But further, as all reme-
dial agents are more or less poisonous and detrimental to a
purely physiological state of the system, and if administered
in health, will destroy that nicely adjusted balance of action in
the various organs so essentially necessary to health, their suc-
cess or power of removing disease must depend on their ex-
citing a new disease, or a series of impressions and actions of
an opposite character to the disease, and as their actions and
effects are not persistent, unless frequently repeated, we have

1850.] Norwood, on Veratrum Viride. 337

often to continue them for some time to subdue the disease: or
perhaps while the disease proper, and the disease incident, or
the effects of the remedies are contending for the mastery, the
great principle vitality, or instinct, if you please, resumes its
place, and health is restored. By vital principle, instinct, nature,
or the vis medicatrix naturse, we understand that state, condi-
tion, or principle, as expressed by Dr. Good, which tends to
preserve, perpetuate and re-produce a part or parts, or a being
of like powers and properties. We believe that the veratrum
viride embodies as many or more powers than any one, and
perhaps all the other articles used in pneumonitis, combined ;
and that it is superior to all others, from the fact that it not
only counteracts and excites a new series of actions, but from
its possessing, in an eminent degree, the peculiar power of les-
sening the frequency of the pulse, and consequently the motion
of the lungs and frequency of respiration, thereby giving time
and opportunity to the diseased organ to restore itself.

We wish to call the attention of the profession, particularly,
to this peculiarity in the effects of this article. In inflamma-
tion, there are all the symptoms that go to make up fever, and
in addition, there is pain in the organ or part inflamed, and
congestion and relaxation in the capillaries of the diseased part.
That a cure may be consummated, the pyrectic symptoms must
be subdued the pain, with other inflammatory attendants, re-
lieved. To effect this object, that is, to subdue pain, to remove
the heat or pyrectic symptoms, to control the frequency of
the action of the heart and arteries, to relieve the hurried and
laborious respiration, to moderate the continued motion of the
lungs, and to assist the relaxed and congested capillaries in
unloading themselves, are the great ends sought to be accom-
plished in the cure of pneumonitis. The great duty of the
physician is to subdue all diseased action speedily and with
safety to the patient. We know of no article capable of meet-
ing these indications with so much ease, certainty and safety
to the patient, as the veratrum viride. By its narcotic powers,
the pain and irritability are greatly moderated, if not relieved ;
by virtue of its emetic powers a sudden shock and impression is
made on the system, and if a resolution or crisis is not produced
the pyrectic symptoms are greatly abated, and in addition

n. s. VOL. VI. NO. vi. 22

338 Norwood, on Veratrum Viride. [June

to the general shock, there is a series of new actions and im-
pressions excited which are of great service in counteracting
the disease and changing the secretions and excretions. It is
powerfully nauseant, thereby aiding expectoration, which, in
an eminent degree, assists the capillaries in relieving them-
selves of their engorged condition. But, as has been already
stated, its power of reducing the frequency of the dilitations and
contractions of the heart and arteries, and consequently lessen-
ing the frequency of inspiration and expiration, and the con-
tinued motion of the lungs, which effects being accomplished,
gives an opportunity to the relaxed and engorged capillaries to
unload themselves of the unusual quantity of blood they contain,
and gives, justly, to veratrum viride, the prominent position it is
justly entitled to in the list of remedial agents. It does not
possess the properties of colchicum. Colchicum is a chylo-
gogue cathartic, more or less emetic, and possesses very con-
siderable nervine powers. Veratrum Album is an emetic, and
hydragogue cathartic. It usually produces more or less of a
burning glow of the surface and flush of the face. The active
principle of the colchicum and veratrum album, therefore, seem
to differ from each other; but however unlike they may be, it
does not follow that they are not adapted to, and useful, in over-
coming the same disease.

We will now repeat, or give, rather, a condensed description
of some of the leading powers of veratrum viride ; and as its
powers and properties are, or have been supposed to be, the
same as those of veratrum album, we will contrast their effects,
that others may judge of the similarity of their powers. It is
actively emetic, but does not occasion a great secretion of bile,
but produces free mucous or serous discharges. It induces an
unusual degree of paleness and coolness, or, strictly speaking,
coldness ; more or less moisture of the surface ; a sense of
great exhaustion and dissolution; occasionally a slight and
pleasant delirium ; occasionally a paroxysm of hysteria, or an
approximation to hysteria. During all this emesis, nausea,
coldness, paleness, and delirium or hysteria, the pulse is slow,
full, and distinct, and so far as it is concerned, the person would
be considered in good health, if it were not for other accompa-
nying symptoms.

1830.] Norwood,, on Veratrum Viride. 339

We will contrast the effects of Veratrum Album and Vera-
trum Viride. The V. album is emetic and cathartic, whilst
the V. viride is emetic, but never cathartic. The V. album
excites a peculiar burning glow and flush of the face, but
the V. viride produces no such symptoms. The V. album does
not produce a sense or feeling of dissolution, nor delirium, nor
paroxysms of hysteria, nor an approximation to it under its
ordinary operative effects, whilst the V. viride does produce
these symptoms in its ordinary operation. The effects of the
V. album do not excite in the minds of bystanders a belief in
the rapid and speedy dissolution of the patient, but the action
of the V. viride usually creates such an impression. The V.
album does not lessen materially and permanently the frequen-
cy of the pulse, but the V. viride does produce this change in
the heart's action. The V. album does not produce paleness and
coldness, nor diaphoresis, whilst the V. viride produces such
symptoms in an unusual degree. The difference in the effects
produced by these articles prove that they are each entitled to
a separate and distinct place.

We trust enough has been said,' to satisfy any reasonable
mind that the powers and properties of the article under con-'
sideration are but little known, and that, instead of possessing
powers and properties similar to other articles, as stated in the
books, that it possesses properties and principles quite dissimilar
and peculiar. Its virtues should therefore be more fully tested.

As already stated, we have used it mostly in pneumonitis of
the typhoid type ; but we would also use it in other tvpes, pre-
mising venesection. Once for all, we state that we would feel
as awkwardly situated and as much unprovided for the treat-
ment of pneumonitis without this article, as we would if we
were deprived of cinchona and its preparations in the treatment
of intermittent and remittent fevers. We are of opinion that
it will prove to be a valuable agent in the treatment of many
inflammatory affections, as gout, rheumatism, peritonitis, 6cc.

It may be prepared for use, by digesting eight ounces ef the
bruised root in one pint of alcohol. We generally commence
with ten drops, and increase the portion from one to five drops
each time, repeating the dose every two or three hours, until
nausea, emesis, or a reduction in the frequency of the pulse

340 Dugas, on Quinine in Singultus and Tetanus, [Jane,

takes place. We then lessen the quantity, or extend the inter-
val, so that nausea and emesis are not excited ; but take care
that sufficient is given to maintain the required redaction in
the frequency of the pulse. We often omit the article for the
space of one day, when the pulsations fall in number under fifty
or sixty per minute. For a child, from three to five years of
age, we begin with two or three drops every three hours, but
do not increase it at each dose beyond one or two drops, unless
the symptoms are or should become so urgent as to require
that the system be brought more speedily under its influence.
A tea-spoonful will often operate drastically, and will scarcely
have need, at farthest, to be repeated beyond the second or
third portion every half hour, before its full effects will be ex-
perienced. The small dose, gradually increased, and often
repeated, we have found the most efficacious. To relieve its
unpleasant efFects, a mustard plaster to the spine and extremi-
ties, and a little syrup of morphine and tincture of ginger or
seeds of paradise, together with a suspension of the article, will
be all that is necessary.

We have not exaggerated the effects produced by veratrum
viride, and wTe are confident that we can demonstrate them at
the bedside to the satisfaction of any and every one.

We could extend this article much further, but we have
already spun it out much beyond what we intended,

ARTICLE XVII.

Observations on the use of the Sulphate of Quinine in Singultus
and Tetanus. By L. A. Dug as, M. D., Professor in the
Medical College of Georgia.

Aware of the evil consequences of generalizing from isolated
facts, and also of the tendency to over-estimate the value of
new remedial agents, the cases now submitted have been thus
long withheld from the press in the hope that other opportuni-
ties might be presented for repeating the treatment detailed.
The writer has not since had the management of similar cases,
and feels it a duty no longer to remain silent, but to lay before
the profession the following facts in relation to two forms of

1850.] Dugas, on Quinine in Singultus and Tetanus. SHI

disease, whose usual obstinacy and fatality should plead his
apology for suggesting a fair trial of the plan of treatment which
in these two instances proved successful.

Case of Singultus. On the 17th of February. 1848, Judith,
a negro woman of apparently good constitution and about 25
years of age, (the property of Mr. J. R.,) was taken with
labour and placed in charge of a midwife. The pains pro-
gressed regularly, and seemed to be effective ; yet after the
lapse of twenty-four hours without delivery, I was requested
to see her. Finding that the head presented, but was still in
the superior strait, no active measures were recommended.
On the 19th, however, the same state of things continuing, the
pains having lost their intensity, and the patient being much
fatigued, wine of ergot was administered, with the effect of
bringing the head to the inferior strait. The patient during
this day suffered occasionally with hiccough, without any other
symptom of prostration. During the night the singultus be-
came persistent, and continued so without intermission, even
during sleep, for seven days and nights. On the 20th, the
child's head being firmly fixed in the inferior strait and the
prostration of the mother being imminent, the forceps were
used in vain, and delivery was finally effected by emptying the
cranium. The child had hydrocephalus. Puerperal peritonitis
very soon ensued with great intensity ; the posterior walls of
the vagina sloughed away with a portion of the rectum, giving
a free passage to the faeces through the vagina ; the pulse was
reduced to a mere thread ; the surface was bathed in a cold,
clammy sweat ; the abdomen was very much enlarged, and the
case presented every appearance of utter hopelessness. The
patient, however, recovered !

The peritonitis was principally treated by extensive blister-
ing over the abdomen and large doses of spirits of turpentine.
As this affection yielded, attention was directed to the persistent
hiccough. The usual antispasmodics, opium, camphor, assa-
fcetida, brandy, &c, were used ineffectually; chloroform was
inhaled repeatedly until the induction of coma and insensibility,
without arresting the hiccough for a moment. The precipita-
ted carbonate of iron, which I had used in several other cases

342 Dugas, on Quinine in Singultus and Tetanus. [June.

of obstinate singultus with marked success, was unavailing
here. On the fifth and sixth days after delivery the pulse had
become full and of good character; the patient seemed to be
doing well, with the exception of the hiccough and a daily ex-
acerbation of the febrile symptoms. Despairing of being able
to arrest by remedial agents the hiccough, I prescribed, on the
25th February, quinine for the purpose of averting the next
febrile exacerbation, directing 10 grs. to be given at once, and
5 grs. more two hours afterwards. The first dose had been
taken only half an hour, when the hiccough ceased entirely :
nor did it return until the following morning, when another dose
of 10 grs. promptly arrested it again, and permanently.

The suggestion naturally presents itself, that there was per-
haps a mere accidental coincidence between the administration
of the quinine and the cessation of the spasmodic affection.
But the repetition of the same circumstances would incline us
to a different conclusion. The result was as unexpected as it
was gratifying, for the prescription was made for another end.
The fact, however, is valuable, and may incite others to test
the same remedy more directly.

Case of Tetanus. Sophia, a negro girl about 10 years of age,
(the property of Mr. J. B. C.,) became affected with tetanic
symptoms on the 10th of April, 1848, some eight or nine days
after having stuck a nail in her heel. Having been called to
see the case about twelve hours after its invasion, I found it in
charge of Dr. Hammond, who had examined and opened the
wound without giving issue to any pus ordered an alkaline
poultice to it, and morphine internally. The jaws were not
" locked," for the mouth could be opened about half the usual
extent ; the head was drawn back ; there existed a fixed rigidi-
ty of the muscles back of the neck, along the spinal column and
over the abdomen, which were attended with distinct spas-
modic jerks at intervals of about five or ten minutes. The ex-
pression of the countenance was anxious and the pulse some-
what accelerated. The use of morphine was ordered to be
carried as far as possible, and extensive counter-irritation ap-
plied to the spine. She was kept in a state of narcotic sleep
. during the remainder cf the day and night, and until noon

1850.] Prevention of Constipation. 343

following (11th April). The symptoms still progressing, not-
withstanding our efforts to control them by counter-irritants
and narcosis, I stated to Dr. H. the effect produced by quinine
id the case of singultus first related, and suggested its use in the
present instance. Not feeling warranted in omitting the
morphine, we combined the quinine with it, so as to administer
every three, four or five hours, according to effect, 10 grs.
sulphate quinine with \ gr. sulph. morphine, in solution. This
treatment was soon attended with a prolongation of the inter-
vals between the paroxysmal spasms, and a diminution in their
violence. The cold sweat usually induced by excessive doses
of quinine showed itself several times to a moderate degree,
and in the course of forty-eight hours the spasms had entirely
ceased, although the rigidity persisted and gradually wore away
in the course of a week. The doses of quinine and morphine
were now gradually lessened and finally entirely omitted. On
the 21st of April the patient was dismissed, entirely restored.

Inasmuch as the treatment did not modify the disease until
the use of quinine, we may without impropriety attribute to
this agent a very important part in the successful termination
of the case. If upon trial in other cases it be found entitled to
confidence in the management of so formidable a disease as
tetanus, it is hoped that the fact will be made known.

PART II.
UtvxtvoB ft n i <xtvatis .

On the Prevention of Constipation. By Johx C. \Varrex,
M. D. (American Journal of the Medical Sciences.)

" It remains, therefore, that the people at large be entrusted with the deliberative
and judicial powers of government, because the members of assemblies, senates,
and courts of justice, acting not individually, but collectively, prove mutually as-
sisting to each other. In such popular tribunals, virtue and passion, reason
and sentiment, courage and wisdom, are harmoniously blended into one saluta-
ry composition, in which even the grossest ingredients are not without their
use ; for experience teaches, that the purest nourishment is not alvaus the best, but

that FINE FLOUR IS MOST WBOLBSOMK WHEN RIlXBD WITH THE COARSE." A

Politics, book iii., Gillies' translation, third edition, page 216. London, 1813.

This extract from Aristotle, which I have lately met with,
comes to the support of a practice, adopted, by me many years
before I had seen the passage. It consists in the use of un-

344 Prevention of Constipation. [June,

bolted wheat meal, and of a very coarsely ground wheat, for the
preventure and cure of a constipated state of the bowels.

The retention of any of the habitual excretions produces de-
rangement of the animal economy. The suppression of the
cutaneous exhalations is followed by local imflammation. The
suppression and retention of urine bring on a sudden paralysis
of the nervous system ; and the suppression and retention of
the contents of the alimentary canal produce indigestion,
foul breath, hemorrhoids, chronic headache, cutaneous affec-
tions, and, in fact, a vast number of diseases, which though
not all arising directly from the source, may be traced to its re-
mote and gradual influence.

Constipation of the bowels is frequent in persons of sedentary
habits, especially those called by profession to constant mental
occupation ; while bodily activity and a correspondent incep-
tion of food protect the cultivator of the soil. The most
common cause of this evil would therefore seem to be an inert
state of the bowels, from want of exercise and want of sufficient
stimulus from food. Weakness of the bowels, a wTant of suffi-
cient mucous secretion, and, above all, a want of a sufficient
quantity of healthy bile, are also common causes. The bile be-
ing the natural purgative, its deficiency will, of course, leave
the intestines in a torpid condition, and thence it happens that,
in persons constitutionally costive, the liver is found to be in
many cases unnaturally small. Dry atmosphere predisposes
to this affection, and we find, therefore, that the inhabitants of
the eastern parts of the United States are more disposed to it
than those of the damper climates of England and Holland.
For this reason it is, no doubt, that the latter are able to make
great use of astringent wines with less consequent incon-
venience than the former. Our constitutions cannot tolerate
them.

The use of improper articles of food is a frequent cause of
constipation. Food is composed of two kinds of substance,
possessing different properties ; one soluble and nutritious, the
other insoluble and non-nutritious. The former is taken up, in
a great measure, by the absorbent vessels, and conveyed into
the blood. The latter, the non-nutritious, remains in the in-
testines, stimulates their action, and is subsequently expelled.
One of the most remarkable of the nutritious substances is fine
flour, a very common article of food. This, in its varied pre-
parations, unless contracted by some other article, is an indi-
rect cause of costiveness; and the reason is, that its particles
are in great measure absorbed. The same is true of other sub-
stances containing a considerable proportion of nutritious mat-
ter. Such are jelly, arrow-root, starch, milk, and its prepara-

1850.] Prevention of Constipation. JM5

tions. I knew a learned gentleman troubled with dyspepsia,
who had come to a conclusion to live wholly on nutritious sub-
stances, which, being easily absorbed, he thought might be
taken without inconvenience. After he had employed this
kind of food for some weeks, the intestines ceased to act with
sufficient energy. It was even difficult to excite them by
medicinal substances, and he came near losing his life.

The insoluble part of the food is of no use for the purpose of
nutrition, since every substance to be taken up by the absorb-
ent vessels must be in a state of solution. Such are the cover-
ings of seeds and fruits, woody fibre, etc. Skins of fruits,
especially dried fruits, which have been eaten, are constantly
seen in the evacuations. Seeds, as those of mustard, etc., are
well known to pass through the whole intestinal tract in an un-
changed state, in consequence of the insolubility of their outer
coats. Hence it happened, when these articles were medi-
cinally employed, some thirty years ago, that the intestines
became ultimately filled with insoluble matter, actually plug-
ged by them, in such a way that nothing but mechanical means
were sufficient to remove the obstacle and save the patients'
lives. In these instances, I relieved them, not without much
suffering on their part and much trouble on mine, by breaking
down the concreted substances with small pokers and extract-
ing them with scoops and forceps. The same kind of obstruc-
tion is said to have been produced by accumulation in the in-
testines of the remains of undigested nuts and raisins.

A great alarm has been excited in regard to magnesia, be-
cause some persons have died from its excessive use, and the
intestines, it is stated, have been found paved with it. This
is all very natural. Magnesia is an earth, insoluble in the
human stomach to any considerable extent. When it is taken
in small quantities, and of the best quality, it unites with, and is
neutralized by, the acids it meets with in the digestive tube
hydrochloric, carbonic, lactic, etc, and salts more or less
soluble are produced. But when the quality of the magnesia
is bad, and the quantity great, the acids of the digestive canal
are inadequate to its conversion into a salt, and, mass being
thrown in upon mass, the intestines will ultimately be clogged
and sometimes wholly blocked up.

The immediate consequence of the retention of excrementi-
tious matters is the absorption and passage of part of them
into the blood. For, although there seems to be a natural
repugnance in the intestinal lacteals to the absorption ofex-
crementitious matter, this repugnance may ultimately be over-
come and absorption of the lecal contents of the intestines
take place. The consequences will be offensive breath, dys-

340 Prevention of Constipation. [June,

pepsia, cutaneous eruptions, etc., as stated above, and an im-
pure state of the whole mass of blood.

On the Remedies for Chronic Costiueness. The principal of
these are either medicinal or alimentary. Of the former, I
shall mention only three, aloes, magnesia, and the wine of
senna produced by fermentation. The bitter quality of aloes
seems to render it a proper substitute for the natural purgative,
bile. A few grains of the substance of this gum in the state of
powder are a mild and effectual purgative. The watery ex-
tract, or inspissated solution, in the dose of from five to ten
grains, combined with an aromatic, such as a drop of oil of
anise or oil of nutmeg, taken fasting, is one of the mildest laxa-
tives I know of.

It is the common practice to take a laxative medicine at
night. There are objections to this, because the stomach
usually contains a quantity of food, and the medicine being in-
termixed with this is sometimes too much diluted, sometimes
altogether buried in the alimentary mass, and thus becomes
ineffectual. Another objection to taking medicine at night is
its having the effect of disturbing the repose, especially if the
patient be of a nervous temperament. The proper time, there-
fore, is when the stomach is empty, as before dinner or before
breakfast.

The mildest, thou not the most certain, of all laxatives is
pure magnesia. This useful preparation, as made by English
chemists, may be taken in the dose of a teaspoonful in two-
thirds of a wineglass of water, with the addition of four or five
drops of tincture of peppermint, at night being therefore an ex-
ception in this respect to other laxatives. It is so mild that it
does not disturb the night's sleep, and, combining, as it does,
with the acids- which have been generated in the stomach
during the day, it is likely to be more completely neutralized
under this circumstance, and to have a more certain effect.
When the stomach is not acid, the juice of half an orange will
aid its operation.

The third substance, which I have employed lately with
much satisfaction, is the wine of senna, produced by the fermen-
tation of infusion of senna with sugar, according to the process
of Dr. Butler Lane. The dose of this for an adult is from half
an ounce to two ounces ; being slightly stimulating, it may be
taken for an oppressed stomach at night. If used in the morn-
ing on an empty stomach, it should be diluted with an equal
quantity of water.

Injections. It would not be proper to pass over injections,
so generally employed abroad and so little in this country.
Their application is to be preferred, when it answers, to any

.1850.] Prevention of Constipation. 347

cathartic. A valuable use of this remedy has been introduced
by the followers of the much extolled and much denounced
Broussais, on the supposition that it would extinguish inflam-
mation of the intestinal mucous membrane. Cold injections
into the rectum were proposed by them, and it was shown that
cold water might be thus employed without alarming conse-
quences. For the relief of the bowels, the prevention and cure
of hemorrhoides, the mitigation of urinary and uterine de-
rangements, cold water, in quantity from a gill to a quart, is
most valuable. Fifty years ago, I first heard of a distinguished
lady who was in the habit of dashing the abdomen with cold
water for the relief of the bowels. This fact, considered so
wonderful at the time, made a deep impression on my mind,
and led me to recommend for this purpose, with excellent ef-
fect, a sponge with cold water or the hip-bath, and finally gen-
eral shower-baths.

Articles of Food. The most important of the remedies ap-
plicable to this case are to be found in articles of food. A few
individuals have, discovered something of this kind which suits
the exigencies of their constitution, and carries them comforta-
bly through life. The greater part of those subject to this
derangement are obliged to temporize with their trouble and
employ different substances under different conditions.

Fruits are among the most useful and agreeable of these.
Fresh fruits are preferable to dried, because a large portion of
the latter consists of a skin, which is with difficulty attacked by
the gastric fluid. Whether fresh or dried, fruits, if used to aid
the bowels, should be taken when the stomach is free from
other food, especially before breakfast and before dinner. The
use of fruit after a regular satisfactory meal of meat and vege-
tables is a common cause of cholera, and other disorders of the
bowels, by bringing on the acetous fermentation. Fruits and
vegetables produce their laxative effect by their acid and sac-
charine qualities, and also by the bulk of their effete or insoluble
portions. The laxative vegetables are not very easily digested
by patients who have weak stomachs, and they are often
obliged to abandon them, on account of the distressing flatu-
lence which follows their use. On the other hand, I have seen
a beneficial effect from acids in some peculiar cases. Some
children, after weaning, become excessively costive. I have
knowTn this state to be altered by an infusion of cranberries
slightly sweetened. It is likely that any other smart acid
would have the same effect. Some individuals find great ad-
vantage in drinking a glass of cold water before breakfast, and
it is a practice of others to drink a cup of strong coffee, before
rising in the morning. The use of these drinks must be accom-
modated to different constitutions.

348 Prevention of Constipation. [Junef

Animal food has rather a laxative effect than the reverse,
perhaps by the animal oil intermixed with its fibres. Fatty
substances are uniformly laxative, but they are also uniformly
unmanageable by weak stomachs. The Laplanders, and other
inhabitants of very cold regions, as well as a certain number of
individuals elsewhere, are able to take, in large quantities, the
fat of various animals, without exciting a revolt in the stomach.

I have known individuals to use great quantities of wine, un-
der the belief that the bowels would not move without. The
laxative effect in such a case would arise from the pressure
made on the intestines by the bulk of the liquid. Perhaps,
again, the wine taken in this way exerts a tonic influence, which
causes the bowels to throw it off; and this notion is confirmed
by the fact that this practice, so far as I have seen, has uniformly
terminated in dropsy, or some other chronic affection. Most of
the wines I am acquainted with, when taken in moderate quan-
tities, constrict the fibres of the intestines, and produce costive-
ness. This is certainly the effect of sherry, Madeira, and other
strong white wines ; and still more "so of brandy and every
form of alcohol. The use of such articles, in the way last men-
tioned, having a stimulating effect, is followed by indirect
debility and constipation.

The cerealia were perhaps the earliest, the most general,
and the most valuable articles of human food. Wheat, rye,
barley, oats, and maize are employed in different countries, ac-
cording to the properties of the soil and the taste of the inhab-
itants. Wheat seems to be more extensively used than either
of the others, and is, perhaps, the most palatable and the most
digestible, This grain is not used entire. It consists of, prin-
cipally, two substances; the coverings, or part containing, and
the flour, or part contained. In the early ages of the world,
these were probably employed together; but art has been di-
rected to their separation, and has reduced the flour, as nearly
as possible, to the state of an impalpable powder.

Flour, taken apart from its coverings, has a most constipating
property. Its great use by the inhabitants of towns and cities
will, therefore, go far to explain why constipation is so general.
The separation of the coverings from the flour, as usually prac-
tised, seems to counteract the intentions of nature, which un-
doubtedly destined them to be employed together.

The external skin of the grain, thus throwu away, contains
various important properties ; and, in stead of being in a great
measure rejected, it should be altogether preserved and ground
up with, the flour. This substance, which is known by the
name of bran, is the part which prevents the flour from pro-
ducing costiveness.

3850.] Prevention of Constipation. 319

About the year 1825, I began to use bread in which the bran
was retained; and, after having employed it a considerable
time in my own family, I ventured to recommend it to others.
For some time it was ridiculed under the name of saw-dust
bread ; but finally, in a very slow way, it came to be employed
by a large number of persons, its valuable properties were
ascertained and admitted, and it has now come into general use.
In a tour through Europe, about twelve years since, I found that
this same bread was becoming an article of food for the upper
classes in London, Paris, and Rome. Among poor people a
brown bread is employed in most countries of Europe; and,
probably, has been from time immemorial. In Germany,
horses are advantageously fed on it while travelling.

Some years ago, it occurred to me that, as the brown wheat
bread was beneficial on account of its coarseness, but was not
sufficiently active in all cases, it might be wrell to use the wheat
in a coarser state, and without making it into bread. 1 there-
fore directed some wheat to be ground in a cofTee-mill, and
after boiling three or four hours, a little salt having been pre-
viously added, it was found very palatable. This substance
has abetter effect in preventing constipation of the bowels than
any article I have ever met with, after a great number of years
of observation and inquiry. When the stomach is very weak,
it will not bear it in sufficient quantity to answer the purpose.
But for costive people in general it will produce quite a remark-
able revolution, and a consequent favorable change, in the ap-
petite and general health, when taken in the right quantity ;
and this I consider to be about twelve ounces for an adult. It
maybe used at breakfast as a part, or, when the case requires
a large quantity, as the whole, of a meal, and at dinner as a
substitute for puddings and vegetables. For the evening meal,
I have rarely recommended it. By those who require some
addition to render it savory, the substances which are employ-
ed with hominy for the same purpose, may be used, such as
milk, butter, cream, or molasses. The sweet articles are not
well borne by a weak stomach, especially molasses ; but when
they can be used without inconvenience, they add to the effica-
cy of the wheat.

The preparation of it consists in washing clean in cold
water, then in boiling from three to four hours, adding water,
from time to time, sufficient to bring it out with about the con-
sistence of hominy or boiled rice. The longer it is boiled, the
more agreeoble it is, but less effectual. A moderate degree of
fluidity, that is, less than that of boiled rice or hominy, renders
it more laxtive.

The principles on which the coarse wheat operates as a laxa-

350 Prevention of Constipation. [June,

tive are not very obvious. M. Millon has reported to the
Academy of Sciences that the bran of wheat possesses various
valuable properties, not before known. Whether any of these
are calculated to have a purgative effect, we know not ; but
such may possibly be the fact. I have been led to believe,
however, that the wheaten bran operates in two ways; first,
by the stimulus of the edges of its-branny particles ; second, by
mere bulk. It may be supposed to operate in the first mode by
the undissolved portions of bran acting on the mucous coat of
the intestines, exciting thereby the nervous energies of the
parts, and producing contractions of the muscular fibres. Se-
condly, bulk is necessary to keep up the action of the bowels,
as has been already shown in the allusion to the effect of highly
nutritious substances, which, being in a great measure taken
up by the lacteals, leave no mass of insoluble matter to fill the
calibre and excite the action of the intestines. People who eat
much food are more regular in the bowels than those who eat
little ; though they may be obliged to pay for this advantage
by the injury done to the overburdened stomach. These ideas
are supported by the fact already mentioned, that seeds and
other insoluble matters have the effect of urging on the torpid
peristaltic action.

Superfine flour bread, as has been stated above, is not a
healthy article of food for man nor animals. Dr. Truman,* in
his "Rules for Diet," says: " The French plan of eating enor-
mous quantities of bread at dinner is unwholesome for most
people, unless they take very violent exercise ; a very liberal
allowance of bread is always apt to induce headache, and a
confined state of the bow'els." Animals, so far as I have ob-
served, do not like, and, for the most part, cannot live upon fine
bread ; whereas many animals, even carnivorous, can subsist
on coarse wheat bread. Dogs, according to the French physi-
ologists, die after feeding about three weeks on fine bread, but
will live on coarse bread an indefinite time. Birds are very
fond of coarse bread and of cracked wheat hominy, which they
eat with avidity ; and it agrees with them. There is reason to
believe that the vertebrated animals generally can be subsisted
on coarse bread, but not on fine. Many persons object to
coarse bread, that it is not so agreeable as fine. This sentiment
is the result of habit, for those who have been accustomed to
use the coarse bread, for a reasonable time, find it sweeter to
the taste, and more satisfying to the stomach, than the other.
It seems then unfortunate that an article of food, which is de-
ficient in some principle necessary to its healthy action on the
animal economy, should have been so long employed, and so

* Truman on Food, p. 161. London, 1842.

1850.] Effects of Indigenous and Naturalized Plants. 351

widely spread among the population of cities, and, in truth,
among a great mass of people elsewhere.

My authorities for these experiments, I am unable, at this time,
to quote, many years having elapsed since I read them ; but,
as they were published in the popular journals, they are proba-
bly wTell known to the profession generally.

Since I have made use of the coarse wheat, I have had fre-
quent communications on the subject with professional friends,
as well as with a great number of other individuals, and find
that they are satisfied of its valuable effects. This being so, it
may be thought that the subject should have been brought be-
fore the public at an earlier period. The reason why I did not
do this was, that it seemed too simple a matter to trouble the
public with ; and I also thought it very probable that a sub-
stance which I had found so efficacious, I mean the wheat
hominy, and which must have been employed as food from the
earliest ages, might have been recommended in some work I
had not met with. The long period during which I have seen
its effects not having enabled me to discover that it had any
where been formally and distinctly advised, it has appeared
more proper to give the public* a distinct knowledge of its use,
than to hold it back because it may have been recommended by
other people.

I cannot conclude without repeating that, of all the articles
of food which, in the course of fifty years practice, I have had
occasion to recommend for the prevention of a constipated
state of bowels, and its consecutive evils, this cracked wheat is
incomparably the most effectual.

Medical Experience with Indigenous and Naturalized Plants,
officinal and unofficinal, by the United States Phar?Jiacopceia.
By R. P. Stevens, M. D., of Ceres, Pa. (New York Journ.
of Medicine.)

Artimesia absinthium. (Wormwood.) A useful tonic of
considerable power in the cure of ague and fever of miasmatic
districts. It has in a number of cases, and once in my own,
succeeded, where sulph. quinine failed.

Cochlearia armoracia. (Horseradish.) A grateful stimu-
lant in atonic dyspepsia. In this disease I have used it with
the most pleasing effects. I have also used it as tonic, in the
cure of intermittent fever. In my own person, I prefer it to
cinchona, or its alkaloid quiniu.

352 Effects of Indigenous and Naturalized Plants. [June,

Calamus aromaticus. (Sweet Flag.) After many years'
experience with this highly useful stimulant, I give it the pre-
ference over all other carminatives. I use it in catarrhal
coughs, after the following formula : ^. Fresh calamus sliced,
5j; sugar-house molasses, Oj ; boil sufficiently to candy; then
pour into shallow moulds. This medicated candy is far supe-
rior to Pease's, Jervis's, and all 'J other cough candies" that I
have used.

Cimcifuga racemosa. (Black Cohosh.) I make great use
of this piant in the treatment of articular rheumatism. I con-
sider it especially useful where the joints are swollen. My
preference is for the saturated tincture. Its powers are much
increased by the combined use of iodide of potassium. I have
known cases to yield to this combination, which had resisted
all other treatment, and where calomel and opium, with guiac-
um, had been pushed to the repeated constitutional effect of the
mercury. In neuralgia of the uterus, after repeated experi-
ments, I give it a high rank, fully equal to the tinct. of guiacum
of the Dewees formula.

Eupatorium perfoliatum. (Boneset.) I should not speak too
highly of this plant, if I should say that I hold it in greater
esteem than any other of our indigenous plants. In the com-
mencement of common colds, it rarely fails, when given in full
doses of the decoction, to break up the complaint ; and the half
frozen, trembling, coughing, sneezing patient, finds himself hap-
pily relieved from one night's dosing, and the next day ready
for his accustomed business.

In epidemic influenza, when combined with Pulvis Doveri, I
hardly use any other remedy. This present season, during the
prevalence of an influenza, I have prescribed it in over one
hundred cases, with the most happy effect.

In the influenza of 1841, '42, (Tyler Grippes, as it was face-
tiously termed,) I used it with the same happy effect. I con-
sider it especially useful in removing the deep-seated pains and
internal soreness, and pain in the bones, which the patient so
loudly complains of. In this disease, its diaphoretic and sudo-
rific powers are preferred to its emetic power.

In the first stages of miasmatic fever, I frequently exhibited
it, to full emesis, using the decoction, and adding ipecac, if its
emetic powrers are not speedily enough developed.

In that slight congestion of the hepatic system, which will
precede for days, oftentimes, an attack of miasmatic fever, a
congestion, frequently attended with acid eructations, and a
sense of fulness in the epigastrium, and tenderness on pressure
in the right hypochondrium, full emesis will often restore the

1850.] Effects of Indigenous and Naturalized Plants. 253

function of the liver to a healthy state. During ten years' resi-
dence in a malarious district, where at first I trusted to calomel
and blue mass to relieve myself of these hepatic congestions,
I afterwards learned to' trust to the virtues of this plant, and
almost to consider it for myself a specific.

A cold infusion of it is a useful tonic, and corroborant to the
stomach in its debilitated state, during convalescence from remit-
tent and intermittent fevers. A prolonged use of the infusion,
has, in a number of instances, succeeded in the cure of Ptyriasis.

To my regard for this plant, full justice would require an
article, and that is not my present intention.

Frasera Walteri. (Col umbo.) In the summer and fall of
1838, emphatically "the sickly season," of the Valley of the
St. Joseph's of Michigan, owing to the depreciation of western
funds cinchona and quinia were not to be obtained, and many
practitioners wTere driven to the forests for their tonics and
febrifuges. In the powdered root of the frasera, combined
with capsicum, I found a highly useful combination, in the
treatment of the fevers of that season. Owing to its bulk, I
neglected it in after years, and have not since made trial of it.
A cold infusion of it is a grateful tonic in dyspepsia, and debili-
ty of the stomach after fevers.

Geranium maculatum. (Cranesbill.) In the treatment of
salivation, this is one of the best astringents. From its af-
foiding so immediate and decided relief to the severe pain and
high irritation attending mercurial ptyalism, I am inclined to
consider it as having a sedative action. In chronic diarrhoea,
where a vegetable astringent is demanded, it rarely disappoints
my expectations. In compounding pulvis cretae compos, I
always use the root of this plant.

Inula Helenicum. (Elecampane.) In some cases of pro-
fuse catarrhal expectoration from the lungs, I have used a
decoction of this plant with benefit.

Juglans cinerea. (Butternut.) The watery extract of the
inner bark of the root has proved to be a valuable article in
the treatment of chronic constipation of the bowels.

Magnolia glauca. (Cucumber tree.) The fruit of this no-
ble tree, chewed, and the juice thus expressed, I have known to
cure the summer complaint; and the dried fruit pulverized, I
frequently give to children with diarrhoea, with benefit.

Podophyllum peltatum. (Mandrake.) The root of this
plant in powder, combined with calomel, I have long used as a

n. s. VOL. VI. NO. vi. 23

354 Effects of Indigenous and Naturalized Plants. [June,

powerful cathartic, in cases of cerebral apoplexy or paralysis,
arising from, or attendant with congestion of the liver. My
formula is 40 grs. of the finely powdered root, with 10 grs. of
calomel. I have known a full bounding pulse, 120 beats in the
minute, and demanding, in the opinion of three physicians at-
tending as counsel, immediate and efficient venesection I say
I have known such a pulse, from one dose of this combination,
reduced to 80 strokes in the minute, and to be soft, easily com-
pressed, and gradually go down to the usual standard, much to
the surprise of the intelligent counsel.

Sanguinaria canadensis. (Bloodroot.) I have derived more
benefit from this medicine in the treatment of scarlatina
maligna, than any other disease ; and I have used it in phthysis
pulmonalis, pertussis, pneumonia, bronchitis, haemoptysis, and
rheumatism.

In scarlatina, I exhibit it in full emetic doses, preferring for
this purpose a strong decoction. It acts more promptly than
ipecac, and is not so depressing as antimony.-

It removes the morbid secretions of the mucous membrane,
not only of the stomach, but also of the oesophagus and fauces.
By its action in this particular, it prepares the system for the
exhibition of other remedies, and goes far towards breaking up
the morbific impressions of the virus, which causes this fatal
malady. In haemoptysis I have received some marked benefit
from it. In phthisis, I have never seen any good effects. In
bronchitis, where the secretions are opaque and viscid, it pro-
motes the secretion of mucus ; renders it thinner, less opaque,
and easier to expectorate.

In catarrh of the mucous membrane of the nares and frontal
sinus, in combination with cloves and gum camphor it is a use-
ful errhine. It promotes the discharge of the highly offensive
mucus, imparts a pleasing sense of warmth to the whole head,
and gives strength to the wTeak and watery eyes attending this
truly distressing malady. It does not possess sternutatory
powers in so great degree as hellebore, and is therefore more
pleasant to use.

In all diseases of the chest, where I think best to exhibit this
plant, I give preference to the tincture after the formula of
Prof. Tully.

Unofficinal Plants.
Bahtisia tinctoria. (Wild Indigo.) The action of this plant
in full doses, is that of an emeto-eathartic, producing slight
vertigo. In small doses it is laxative and sedative, leaving
after its operation a soothing influence upon the bowels. In
epidemic dysentery, I have used it in small doses, with a happy

1850.] Tartar Emetic in Inflammation of Cellular Tissue. 355

effect. Yet, from its being so disagreeable to the taste of
patients, I have not made any very extended trials with it.

In the treatment of Epidemics, most practitioners have
found some one medicine on which they place more reliance
than others; and they have also found, that in treating the
same epidemic diseases, but in different seasons, they have had
to change their favorite remedies. Old ones failing and new
ones succeeding. Agreeably to this experience I found that in
an epidemic dysentery of the summer of 1839, arising from
miasmatic causes, a decoction of the root of the babtisia suc-
ceeded when all other remedies failed ; since then I have used
it in the same epidemic disease, and evidently having a malari-
ous origin too, but without the same pleasing effect. .

Cucumis melo. (Muskmelon.) I have to record one case
of that body-distressing, spirit-depressing, and ennui-engender-
ing disease dyspepsia, as cured by the eating of this delicious
summer fruit. It was the patient's only diet the only diet his
stomach would retain for many weeks.

Cypripedium parviflorum. (Yellow ladies' slipper.) This
is the "nervine" of the Botanic and Thompsonian Physicians.
There are two other varieties of the* cypripedium, C. ancale and
C. spectabile. I do not Consider them equal to the parviflorum
in useful medicinal qualities; certainly they are not equally
safe. I have found them, especially when growing in dark
swamps, to possess a narcotic quality, which has deterred me
from their use, and which has alarmed some of my patients.
But the parviflorum, when growing upon a light sandy soil,
the oak openings of Michigan for instance has never exhibit-
ed this quality.

In full doses, it is a gentle stimulant, with a decided tendency
to the nervous system, and harmonizing its disordered action.

In hysteria it is a valuable remedy. In pains of the joints
following scarlatina, it has proved itself a valuable remedy : I
consider it fully equal to the valerian officinalis.

On the use of Tartar Emetic in Inflammation of the Cellular
Tissue. By John L. Milton, M. K. C. S*E. (London
Lancet.)

My attention was first drawn to this remedy by the difficul-
ty I experienced in treating, with the means more generally
used, certain forms of diffuse inflammation of the cellular tissue.
It is well known to many practitioners that the tanners are sub-
ject to a form of inflammation in the hand, closely akin to dis-
section wounds, and which arises from the skin being broken,

356 Tartar Emetic in Inflammation of Cellular Tissue. [June,

and the open surface getting inoculated from some putrid hides,
&c. The men subject to this are generally cachetic or pletho-
ric, and the inflammation very rapidly runs into extensive sup-
puration, requiring incisions for its evacuation. The results of
the most active treatment by calomel and black draught, in
very large doses, a free use of opium, cold lotions, and starva-
tion, were not always so satisfactory as I could have wished;
and thinking that if the tartar-emetic can cure pneumonia,
which is a diffuse inflammation of the cellular tissue, it would
in all probability be serviceable here, I resolved on trying it,
and, to my great satisfaction, the first case succeeded very
well. Since then I have used it some hundreds of times in
nearly every possible form of inflammation of the cellular tis-
sue, as well where this was the only structure invaded as where
it was one of several attacked, and in nearly every case with
the greatest success ; and that I have not succeeded in more
was owing First, to the cases being too far advanced towards
suppuration; but even here it proved of signal value, by pre-
venting all further extension, and arresting the inflammation in
those parts which had not gone on to suppuration, by hastening
the separation of the pus, &c. Secondly, to neglect on the
part of the patients themselves; their not taking the medicine
from its nauseating them, or their being of a suppurative diathe-
sis, &c.

With a view of illustrating this more fully, I have selected
the following cases, which are not to be looked on as the most
striking examples in favor of what I have asserted, because I
think that when tried it will be found that I have in no way
exaggerated the success of this treatment, but because the dis-
eases given in these cases are often scattered widely apart in
books, and not to be found under the same heading or in the
same chapter ; nor is it from not having cases which exemplify
many other forms of inflammation that I restrict myself to
these; for I have accumulated and carefully recorded a large
number, and the forms are so common and so easily recog-
nized that more might have been obtained every day, but I am
in full hopes that what I have selected will be found sufficient
for the purpose.

Syphilitic Bubo.
Case 1. Mr. J. B., aged twenty-four. This gentleman came
to me this morning (August 8, 1849) for advice regarding a
severe pain in his groin. On examination I found the follow-
ing symptoms : A chancre is gnawing away the fraenum. In
the right groin there is a large bubo ; the surface is dusky red,
and the swelling and pain have reached such a height, that he

1850.] Tartar Emetic in Inflammation of Cellular Tissue. 357

can no longer go to business, and he is worn and jaded. The
case is unfavorable, as three weeks ago, while in Dublin, he
had a bubo from chancre, which, in spite of rest, starvation,
and other rigorous means taken by the surgeon, burst, and is
not yet healed. His health has given way very much latterly ;
his tongue is foul, and his head disturbed. The fraenum was
divided, the sore dressed, and he returned home. To take one
grain of tartar-emetic every three hours, apply seven leeches,
followed by ice, and to rest in bed.

Aug. 10th. Great improvement. The tartar-emetic to be
continued in doses of a grain and a half every two hours.

12th. Further improvement: the tongue is beginning to
clean ; appetite restored ; his head is better, and the pain and
swelling rapidly giving way. The ice to be discontinued, and
the bubo covered with caustic.

14th. The skin is now greatly shrivelled, which appeared
to me one of the first and most incontestable signs of diminu-
tion of a swelling ; the bubo smaller and almost painless. He
is now able, for the first time, to leave his bed for an hour or
two. To resume the use of the tartar-emetic, which he had
partly given up, in doses of two grains every three hours.
Every time it was thus omitted the sickness returned on its
being resumed, but subsided after vomiting once or twice.

16th. Rapid diminution of the swelling ; pain gone ; the
health improving; appetite better. He sits up nearly all day.
To take forty drops of the liquor potassse three times a day in
milk.

20th. Returned to business, almost well.

25th. Called to show me the chancre, which, from a hard
day's work, and a good deal of wine, had partially re-opened.
To be touched with caustic. The bubo, which was once so
large, has now almost totally disappeared ; his general health
greatly improved, and this continued, for the ultimate result of
the case was satisfactory.

Bubo ; return, but in a less aggravated form, from suspension
of the treatment.

Case 2. Charlotte S , a middle aged woman, applied,

Aug. 16th, 1849, with a bubo and sores. The bubo evidently
arises from the sores, which are of syphilitic origin. She suf-
fered much pain from it, and it is rapidly going on to suppura-
tion ; the bowels are confined. To take half an ounce of
castor oil immediately, and repeat it in a short time, if the bow-
els are not relieved ; then to begin with the tartar-emetic,
three-quarters of a grain every two hours.

23d. The severity of all the symptoms is diminished ; the
lump is much smaller

358 Tartar Emetic in Inflammation of Cellular Tissue. [June,

26th. After her last visit she thought herself so much better,
that she went out, left off taking her medicine, and walked a
great deal ; the bubo, which had nearly gone, now rapidly in-
creased again ; but she continued to work, and poulticed the
swelling, which soon burst, when a small quantity of pus, not
amounting to a tea-spoonful came out. To resume the tartar-
emetic.

30th. Rapidly improving. To take the liquor potassae,
thirtv drops, twice a day.

Sept. 20th. Well.

Diffuse Inflammation in and about the Elbow.

Case 3. B. F , of Gray's-inn-road, Oct. 25th, applied,

to-day, at the Royal Free Hospital, for advice. From the ap-
pearance of the arm, suppuration seemed unavoidable, if not
already established ; the patient also seemed to think so, and,
with a view of promoting this, had diligently poulticed it. The
inflammation was extensive; the pain and swelling very great,
and extending for a considerable distance above and below the
elbow-joint. It had been some time coming on, but had in-
creased very much latterly; still it was evidently not in an
acute form. To take a grain of tartar-emetic, and ten drops of
tincture of opium, every three hours, and to apply a blister to
the part.

Oct. 30th. She is very much better. To take three grains
of iodide of potassium, and an ounce of infusion of calumbo,
three times a day. The blistered surface to be dressed with
zinc ointment.

Nov. 6th. Much better. Continue the iodide of potassium
and the ointment.

13th. Same report. Continue the iodide of potassium.

20th. Blistered surface entirely healed. Continue.

27th. Every trace of the disease gone.

Phlegmonous Swelling in the right Groin, and Erysipelas in

the Leg.

Case 4. G. C, of Camden-town, applied for relief, Aug. 14,
1849. The skin is of a deep fiery red, and the pain is very
<rreat ; the blush over the swelling in his groin seems to be
taking on the characters of erysipelas. He was put upon a
grain^and a half of the tartar-emetic every three hours; the
dose to be increased so soon as the sickness yielded.

Aug. 23d. He is better; the redness is disappearing ; both
the swelling and the erysipelas have yielded. To continue the
medicine.

I went to Camden-town, to see what had become of this

1850.] Tartar Emetic in Inflammation of Cellular Tissue. 359

man, as he suddenly discontinued his visits ; but all the people,
had left, and the new-comers knew nothing of him.

Whitlow, and results of it.

Case 5. Miss Y., aged twenty-four. The case of this pa-
tient shows strikingly the effect of the tartar-emetic. Some
months ago she had rheumatic fever, which was followed by
some pericarditis, and symptoms of both threaten her now from
time to time. Soon after her recovery, and about the begin-
ning of October last, a whitlow formed on the third finger of
the right hand, which went on to suppuration, though she
placed herself under the surgeon's hands for it ; and after a
month's continued suffering, came to London, soon after which
she came under my care. I found the cellular tissue almost all
suppurated and sloughed away ; the extremities of the tendons
loose, the third phalanx reduced to a mere shell ; and detached,
and the extremity of the second bare. After the third phalanx
was removed, I made a vain attempt to heal the sore, by wash-
ing it well with zinc lotion, and bringing the sides together ;
but finding I was only losing time, I persuaded her to let me
remove the whole of the diseased portion with the knife. Three
days after, and while the new wound was healing kindly, she
was attacked by symptoms of thecal abscess, in this finger and
in the palm of the hand. Half a grain of tartar-emetic was
given every two hours, the finger, as far as the palm, freely
rubbed with nitrate of silver, and an ether lotion constantly
applied. The medicine produced five hours' nausea and some
sickness, but the relief was speedy and effectual.

From this time no bad symptom showed itself. The tartar-
emetic, persevered in for some time, was followed up by the
iodide of potass., and she soon after went to the country com-
pletely cured.

Cerebral Congestion.

Case 6. I append the following case, because, though not
considered within the range of surgical practice, it is yet essen-
tially the same as the cerebral congestion, passing often into
inflammation, which follows upon concussion.

W. T., aged sixteen, applied, Aug. 23d, 1849. He had been
ill fourteen days, being seized at the commencement with se-
vere pain in the head and bowels ; the latter soon gave way,
but the former increased, and now presents all the symptoms of
cerebral congestion, and commencing inflammation. The face
and eye are flushed ; the pulse is strong ; some confusion of
ideas, &c. To take half a grain of tartar-emetic every two
hours.

3G0 Tartar Emetic in Inflammation of Cellular Tissue. [June,

Aug. 28th. He is very much better ; the pulse has fallen to
96 ; the tongue clean ; headache relieved, but still present. To
continue the tartar-emetic, and apply a blister to the neck.

I afterwards learned that he completely recovered, and is
now in perfect health.

I must again remark, that these few cases are only a frag-
ment of what I have collected, but in these it will be seen that
the tartar-emetic was the chief, if not the sole agent, which is
the point most in question.

It has been objected to this plan by some, that the tartar-
emetic is a violent and most. unpleasant remedy, and that anti-
phlogistic treatment, with purgatives, mercury, salines, &c,
relieve the patient just as soon ; that the plan of poulticing, and
then opening the abscesses or collections of pus is preferable ;
or that, as resolution is the natural termination in most of
such cases, the expectant treatment is preferable. To this I
reply

1st. That the tartar-emetic is a violent and most unpleasant
remedy? That, so far as I have been able to learn from the
statements of the patients themselves, the sickness and nausea
seldom lasted beyond the third dose, except with children ; that,
severe as it was, many preferred exposing themselves to it a
second time to suffering the pain of a second inflammation,
wThen they had, from carelessness, or the pressure of unavoida-
ble circumstances, suspended the treatment, and the disease
was, in consequence, once more making headway. In children,
the sickness often occurred after each dose, but the good done
was more than commensurate with the evil inflicted; their
sickness is attended with less suffering than that of men ; I
have never had occasion to regret using the tartar-emetic very
freely with them.

2dly. That antiphlogistic treatment relieves the patient just
as fast ? The method of deciding this would be to institute a
complete series of experiments, and compare the results, a thing
I should infinitely prefer leaving to some indifferent person to
undertaking myself; for whatever the results might show, the
attempt could only appear invidious. I can merely say, that
in my hands this treatment was not so successful as that with
tartar-emetic, for which reason I have adopted the latter, and
wish now to propagate its use as much as I can. I think every
practitioner will admit, that many cases of this kind go on to
suppuration in spite of every effort on his part. Moreover, I
have seen purgatives and mercury producing their full effect
without, in any material degree, checking the advance of in-
flammation and suppuration, which has not appeared to be the

1850.] Tartar Emetic in Inflammation of Cellular Tissue. 361

case with tartar-emetic, for as it established its influence, the
inflammation seemed to give way, excepting always such parts
as had already gone on to suppuration, or where a cause exist-
ed bevond the reach of the medicine, such as a foreign body,
&c. Starvation, which figures among these remedies,, is one
of those things which patients, outside the hospital, will not
practise.

3dly. That the plan by poulticing and evacuating the morbid
matter is better ? In numberless instances, this morbid product,
once formed, is not so easily evacuated ; witness the cases
where it accumulates in spots, which the boldest surgeon hesi-
tates to invade with the knife ; and again, the destructive effects
of suppuration among the tendons and sheaths of the muscles
form an additional objection to this plan. Lastly, patients,
young and old, rich and poor, have a deeply-rooted objection
to having knives plunged into them for any purpose whatever,
answering all arguments in favor of the practice with the pow-
erful engine of passive resistance: this may be a prejudice on
their part, but it is one which the surgeon sometimes finds it
difficult enough to overcome.

,4thly. The expectant treatment best, resolution being the na-
tural termination, fyc. ? That the expectant treatment is
homicidal in pneumonia, I believe the majority of practitioners
will admit, and why it should be admissible in these less im-
portant, but strictly analogous cases, I am at a loss to conceive.
Nor can I understand how resolution can ever be the natural
termination of inflammation ; it certainly is the most fortunate,
but that is a different matter. I should as soon think of taking
up the idea, that if the earth were driven from its orbit it would
naturally re-enter it, no impulse being communicated to it by
any other body ; and I would oppose this opinion on the fol-
lowing grounds :

1. Resolution cannot be the natural termination in those
cases which spontaneously go on to suppuration.

2. Resolution follows in many cases where medicine has
been freely administered, and where the body being in a non-
natural state, suppuration, and not resolution, ought to have
been looked for according to such a theory.

3. In spite of all the errors of medicine and surgery, the
calumnies of homceopathists. and the national taste for quacke-
ry, the far greater portion of mankind here know that such
cases get on more favorably under the doctor's hands than
when left to nature, and to the surgeon they will turn for help
and relief, excepting-, of course, those whose intellects are so
muddy, that the owners of them put themselves under the
hands of homceopathists, horse-doctors, quacks, and old wo-

3G2 Tartar Emetic in Inflammation of Cellular Tissue. [June,

men a piece of fanatical delusion for which they often pay a
heavy penalty.

4. That it is more natural to suppose that the cause which
produced an inflammation capable of going on to suppuration
would carry on that inflammation to suppuration, no check
being interposed by art, nor the cause removed. I believe we
may conclude that one or both of these have occurred in those
cases where resolution has seemed to arise solely from the
powers of nature overcoming the suppurative tendency of the
disease.

5. If nature were capable of checking the progress of a dis-
ease, how is it that she cannoi check its first advances, the
body then being much sounder, and necessarily more capable
of resisting a malign influence ?

Before summing up this paper, I may as well say a few words
on the way in whice I have given the tartar-emetic. To full-
grown persons I have never given less than half a grain; to
men, three-quarters or a full grain every two hours, and in-
creasing the dose so soon as the sickness gives way. Where
the bowels are confined, it may be combined with drachm doses
of tartrate of soda; and when relaxed, with a few minims.of
tincture of opium ; where neither of these, but much pain, with
tincture of hyoscyamus ; but I always think it acts best uncom-
bined. With children it is apt to be very violent, yet one-
eighth of a grain may be safely given at the commencement,
and even those of tender age soon bear a dose of half a grain to
two-thirds of a grain. A carminative, or minute dose of Prus-
sic acid, which may be given to children more freely than is
generally done, will assist in abating the vomiting. Placing
the patient with the head lower than the hip will almost totally
prevent any vomiting, but the position is difficult to enforce.
The ether lotion in the acute, and painting with tincture of iodine,
and blistering, in chronic cases, are most useful auxiliaries ; for
if patients are left to get ice, baths with cold water, &c, it is
not very often they will do it. Now, in the introduction or
extension of any remedy, it is always necessary to attend to
three points

1. To discover that remedy which shall most certainly cure
the greatest number of cases.

2. Of two remedies of equal value, to choose that which will
cure most pleasantly and safely.

3. To endeavor to deduce from its application and opera-
tion some law, or to illustrate some known principle.

1. The first point has already been discussed in the answers
to the objections raised against its use.

2. Here there can be little doubt that every voice will be

1850.] Causes and Management of difficult Parturition. 303

raised against the tartar-emetic : for perhaps if one method
could be found more unpleasant than another, it would be this ;
but the annoyance, great as it is, is but trifling compared with
the sufferings produced by inflammation, and may, with care,
be very much shortened, complete toleration being established
in many cases in from five to seven hours. Those patients who
have had one inflammation go on to suppuration will take, and
continue to take, almost any remedy whatever rather than have
a second ; and those who have taken tartar-emetic once will
freely take it the next time they find the inflammation coming
on.

3. Let me now ask, if the' facts detailed above bear out the
following conclusions :

That phlegmon and diffuse inflammation have their heat
essentially and in the cellular tissue.

That they are essentially the same, whether appearing un-
der the form of a whitlow or a pneumonia ; in an abscess of the
brain, liver, or limbs.

That tartar-emetic is the best of the antagonist remedies that
can be arrayed against them.

It is only by referring back to laws, and basing laws on facts,
that the one can be explained, and the other supported ; it is
only thus that the philosophy of medicine can acquire that
strength which will enable it to resist successfully the scathing
fang and destructive claw of old Time himself, and to battle
with those agencies which blot out an art, subvert a dynasty,
or sweep away a mighty nation from the records of man, and
from the face of the earth.

Observations on the Causes and Management of difficult Par-
turition. By J. Hall Davis, M. D., Physician to the Royal
Maternity Charity, and to the St. Pancras Infirmary. (Lon-
don Lancet.)

To ensure to the fairest portion of the Creator's works the
greatest amount of safety, the least possible degree of suffering
in her hour of trial, is the high object of our pursuit as obstet-
ric practitioners and no department of the practice of medicine
and surgery can involve more trying responsibility, demand a
sounder judgment, more firmness of conduct, more profound
reflection. It is my propose, in the following series of com-
munications, to review, in a concise manner, and upon the
plan of my lectures, the different kinds of difficult parturition in
its more extensive signification, comprehending all deviations
from ' natural labour." Difficult parturition may be traced to
two principal sources :

364 Causes and Management of difficult Parturition. [June,

1. Any circumstance in a labour impairing or rendering
abortive the due exercise of the powers of parturition.

2. Some attendant circumstance or complication of the
function of parturition, calculated to compromise the safety of
the mother or her offspring, or both.

Arid be conveniently distributed into four classes, as fol-
lows:

I. Protracted labours or impeded labours in the first degree.

II. Preternatural labours.

III. Complicated labours.

IV. Instrumental labours.

I. In Protracted Labours, the presentation of the foetus is
natural viz., by the head, but the delivery, although difficult,
requiring more time, a longer endurance of pain for its com-
pletion than in easy parturition, is nevertheless safely accom-
plished without manual or instrumental proceedings, medical
treatment in some cases being required.

In the above definition, I have purposely excluded the idea
of time, having met with many exceptions to the rule adopted,
after Denman, by some teachers and practitioners, where easy
and safe labours have exceeded the assigned limit of twenty-
four hours, and difficult labours, have occupied a shorter period.

In calculating the possibility of injury occurring from the
length of a labour, we should not form our estimate from itsentire
duration, as I have elsewhere observed, (Contributions to the
Practice of Midwifery, The Lancet, 1845,) but from the period
occupied by the second stage of the process, when, the liquor
amnii being discharged, more forcible efforts come into play,
and the soft maternal tissues, with the child's frame, are exposed
to a direct and unprotected pressure. Considerable allowances
must also be made for differences of constitution in our pa-
tients.

The causes of protracted or impeded labours in the first de-
gree are various, and so accordingly must be the method of
management. They may be arranged under two heads viz.,
defective parturient action, and inordinate resistance to the
agents of labour.

Defective parturient action may arise from the following
causes:

1. Constitutional Debility, in which the uterus and its acces-
sory powers participate, is one of the most frequent causes of
loss protracted labours. This may result from previous disease,
of blood, excessive discharges of any kind, extreme poverty and
its attendants, impairment of the health by intemperance, or the
patient having previously borne many children. Phthisis, al-
though an exhausting disease, is not attended by that en-

1850.] Causes and Management of difficult Parturition. 365

feebled uterine action which might, a priori, have been ex-
pected ; but then the actions of pregnancy most frequently
have the effect of suspending for the time the progressive en-
croachments of consumption upon the powers of the consti-
tution ; and the state of the parts, as Denman has truly ob-
served, which in a common way might require the exer-
tion of much force to dilate, corresponds with the strength
such women are able to exert. The debility may further pro-
ceed from ill-adapted age (early or late) for parturition, and
from a languid, indolent, phlegmatic temperament, or a nervous
irritable habit.

Treatment, The energies of the system and uterus must be
susained by suitable nourishment, as gruel, arrow-root, beef-tea,
jelly. In some cases, stimulants, as brandy, wine, or ammonia,
especially if the pulse is feeble and slow, and the surface colder
than natural, should be administered, but with discretion, so as
not to excite fever or inflammation. At the same time, the
temperature of the room, and its due ventilation, and also the
proper amount of bed clothing, should be attended to. The
patient's mind must be encouraged, and assured of a favoura-
ble termination. An occasional change of posture is sometimes
useful and also gentle friction of the abdomen with a warm
hand. If there has been little or no sleep for several hours or
days, the patient may, with advantage, be left quiet for a re-
freshing sleep, should there be any disposition ; otherwise we
should try to promote rest by a half-grain dose of morphia, its
acetate or muriate. The bladder and rectum must be relieved,
if necessary. Should these means fail in rousing the dormant
powers of the uterus, we may then, as I shall presently explain,
administer the ergot of rye.

2. Plethora. The uterus may be feeble from the effect of a
gorged state of its bloodvessels partaking in a similiar condition
of the entire system. There are present, the general symp-
toms of plethora ; besides headach, a pulse full and resistant, or
oppressed and labouring; the injected face, eyes, and skin;
the patient sleeps not, or but little in some cases, is drowsy in
others ; and tension, with a sense of weight in the uterine
region, is frequently complained of: I have also met with
puffiness of the hands and feet in these patients, with a swollen
state of the os uteri and vagina, as also a varicose state of the
os externum and labia, and haemorrhoidal vessels ; mostly thirst
is absent, or not remarkable ; bowels usually costive.

Treatment. Much may be done before labour to prevent
this state, by a spare diet, cooling regimen, walking exercise,
and gentle aperients. During labour, the room should be kept
well ventilated, and not-overheated ; simply diluents taken ;

306 Causes and Management of difficult Parturition. [June,

everything which would promote plethora excluded, and these
measures failing, a few ounces, from fourteen to eighteen
ounces, of blood must be abstracted from the arm.

3. Afebrile condition of the system may produce a sluggish
action of the system, recognised by its more obvious characters
of a hot, dry skin, thirst, scanty and high-coloured urine. The
patient should be kept quiet, the bladder and bowels attended
to, the room cool, and nothing be given to the patient but the
thinnest cold drinks, as wTater, thin barley-water, or toast-and-
water. I have frequently found all that was necessary for its
removal, a better ventilation, removing excess of bedclothing,
and preventing the repetition of stimulants given for supposed
weakness of the patient. But sometimes the removal of blood
from the arm will be requisite and the best judgment of the
practitioner, his knowledge of his patient's constitutitution, must
regulate the quantity. It will seldom be necessary to exceed
sixteen ounces, but it should be rapidly withdrawn. The
labour will after that proceed in its due course, a striking
change will take place in its character, and a speedy favoura-
ble termination be the issue.

A Depressing Emotions of the Mind. I have witnessed
many instances of the influence of the mind over parturient ac-
tion. The arrival of the accoucheur, especially if sudden, and
he is a stranger, his manners embarrassed, or rough, is sufficient
to arrest, or much enfeeble, the action of the uterus. The
mention, and discussion, of unfortunate confinements, or any
indiscreet intelligence, in which foolish attendants and nurses
sometimes thoughtlessly indulge, is an occasional cause of the
patient's depressed spirits, and their reaction on the labour ; as
well as the preconceived notions some women have formed of
the probable event of their labours. The obvious treatment is
to support the patients's spirits during her pregnancy and
labour by a cheerful unembarrassed manner, and by every
kind of encouragement and assurance of a safe delivery ; at
the same time, however, do not run the risk of disappointing
her, and so increasing her depression by fixing any precise
period for the duration of her labour. Enjoin the same con-
duct on the nurse and attendants.

5. Irregular Action of the Uterus. The muscular fibres of
that organ act spasmodically, and in a wrong direction, bearing
inefficiently, or not at all, upon the os uteri. This condition
most frequently arises, through an excito-reflex action, irom
faecal accumulations, some cause of intestinal irritation; and in
the second stage of labour I have met with it as a result of re-
tention of urine.

Treatment. An enema and the removal of any scybalse

1850.] Causes and Management of difficult Parturition. 367

from the rectum, the exhibition of castor oil, or a laxative dose
of sulphate of magnesia with tincture of hyoscyamus, will be
requisite for the former, and the catheter must be introduced
for the latter cause. The spirits of the patient, if disposed to
flag, must be sustained. In many cases, nothing more will be
required, in addition, than time and patience : but in a few in-
stances opium will be necessary to subdue the spasmodic action,
and thus to allow free course to the proper parturient powers,
as also to secure rest, when that has been much disturbed.
But this remedy should not be given till the bowels have been
moved, and is rarely needed except in the first stage of labour.
Chloroform by inhalation might be given with advantage in
some of these cases, especially where opium disagrees as an
antispasmodic ; and I have derived benefit in three cases of pro-
tracted labour from its use in this way ; but this remedy cannot
be had recourse to in all habits, and must be used with circum-
spection. From analogy of its favourable action internally, in
doses of ten and twenty drops in two cases of severe spasms in
English cholera lately, and in others of Asiatic cholera men-
tioned to me by Dr. Clutterbuck, I should be disposed to
administer it thus in spasmodic action ot the uterus in pro-
tracted labour, as also in that attending some forms of
dysmenorrhea, especially where opium disagrees with the pa-
tient.

6. Over-distention of the Uterus by excess of Liquor Amnii.
The uterus may be thus distended beyond its power of effective
action. It is not a frequent cause of lingering labour. The
average amount of liquor amnii in a single birth, is, I have ob-
served, about a pint, but several pints have in certain cases been
discharged. In some instances there are two distinct discharges
of water, separated by an interval of several hours or days ; in
these, I attribute the first to a distinct collection now and then
formed between the amnion and chorion. Very large collec-
tions within the amnion have been supposed to arise from an
inflammation of that membrane, and a dropsy of the same.
The head being presumed to present, the obvious remedy is to
rupture the membranes ; the os uteri should first be fully dila-
ted, and we should have satisfied ourselves that this (on due
deliberation, and adequate time allowed,) from the large size
and tense state of the uterus, and the absence of all other pro-
bable causes is the cause of delay, since a premature rupture
of the membranes may of itself protract a labour for many
hours.

7. Impediment to the Action of the accessory powers of partu-
rition. Thus the due filling of the chest preparatory so those
expulsive efforts, so important as aids in the paturient act, may

368 Causes and Management of difficult Parturition. [June,

be interfered with &by disease of the heart, lungs, or pleura?.
The contraction of the abdominal muscles may avail but little,
or be but freely exerted, as accessory agents to the uterus, more
especially during the second stage of labour, by disease within
the abdomen, as ascites, enlarged liver, an ovarian tumour.
Distention of the bladder, which I have mentioned under the
last head, will also retard a labour in this way. Much time
and patience will be required in these labours, and we must
meet the different indications which present, in accordance
with directions under their respective heads. Sometimes the
support of the constitutional powers will be our special care ;
in other instances, a moderate depletive treatment will be
essential to the patient's welfare ; and occasionally, as I shall
hereafter specify, a recourse to instrumental delivery will be
required.

8. Feeble uterine action cannot always be explained upon
any known principles. The pains will fail in strength, indeed,
become entirely suspended, for several hours, without any ob-
vious reason, and yet, after a period of repose, be resumed
without any interference, and all end satisfactorily. Should,
however, this not happen, what is to be done ? We have
changed our patient's posture from time to time ; advised mod-
erate movement about the room, when not fatiguing; hot
diluents : we have attended to the bladder and rectum ; there
is no want of confidence and courage in our patient; and yet
there is no amendment. Here we may exhibit that undoubted
excitant of uterine action, the ergot of rye, under certain con-
ditions, however, which I shall here mention. I prefer its ad-
ministration in the form of fresh powder, in half-drachm doses,
given in infusion every quarter of an hour or twenty minutes,
according to its effects. A single dose will sometimes suffice ;
but from two to five doses may be necessary. Sometimes the
stomach rejects the whole, yet retains it sufficiently long for the
intended object. The infusion may be exhibited in the form of
enema when the stomach is usually irritable. The following
are the conditions for its safe employment:

1. The head should present. In breech and footling cases,
it is, in my opinion, objectionable, on account of the very
gradual descent of the presenting parts required for the subse-
quent passage of the head, without risk to the child from pres-
sure on its funis. It is improper, obviously, in transverse
presentations, and also when the cord, hand, or foot, prolapse
by the side of the head, unless, when feasible, they are first
returned.

2. The os uteri should be fully dilated, or at the least soft and
dilatable, therefore it is contra-indicated in the first stage of

J 850.] Causes and Management of difficult Parturition. 360

labour ; the vagina relaxed also, and, mostly, the perinaeum
likewise; tor sometimes the ergot is cautiously, and with ad-
vantage, given to promote the descent of the head into gentle
bearing on the perinaeum, and then withdrawn, to allow that
part a safe time for relaxation, and yielding, aided or not by
medicines, as may be advisable.

3. A small pelvis, from whatever cause, and disproportionate
size of the child, and consequently impaction of the head, forbid
its use.

4. Very rarely, indeed, should it be given to primaparae, and,
excepting in a recent case, in which I was consulted, I have
refrained from exhibiting the ergot in first labours, much time
and a slower action of the parturient powers bein^ required in
these labours than is consistent with the effects of the medicine.
In that instance there was an ample pelvis, a relaxed and capa-
cious soft passage ; the hand could be passed freely around the
head : the case had been lingering several hours ; the patient
was weary ; nothing was found wanting but efficient action of
the uterus to finish the labour.

5. All previously mentioned causes of uterine inertia should
be absent. Where these were present, it has sometimes been
usefully administered after their removal, of which I have given
examples in The Lancet.

As I shall explain bv-and-by, the ergot is of great service
also in accidental uterine haemorrhage and attendant inertia,
after the liquor amnii has been discharged ; in some premature
labours and abortions : in the delivery of the second of twins ;
in anticipation of haemorrhage habitual to certain patients,
from inaction of the uterus after the birth of the child.

The peculiarity of its action is, that when fully developed, it
is without intermission, and much more powerful than the na-
tural contractions of the uterus ; it is therefore, when improper-
ly exhibited, capable of doing much mischief. The violent
respiratory movements which it calls into play may, in predis-
posed persons, and when its action is strongly resisted by an
obstruction, seriously disturb the functions of the lungs, heart
and brain. The violent contractions of the uterus, when
strongly apposed by a resisting impediment, may destrov the
child by arrest of the utero-fcetal circulation from an inordinate
and continued pressure ; and rupture of the uterus, vagina, or
bladder, exhaustion from long-continued and fruitless pains,
may be, and have been, the consequence of its abuse. To The
Lancet I have communicated illustrations of its action in pro-
perly selected cases. This medicine has been very much used
in America, and Dr. Traske, who approves of its careful em-
ployment, cites several cases of rupture of the uterus. (A Sta-

n. e. vol. vi. no. vi. 24

370 Bibliographical. [June,

tistical Enquiry on Rupture of the Uterus, American Journal
of Medical Sciences, vol. xv.,) seemingly induced by its action
under improper circumstances.

Dr. Robert Lee refers to a case of rupture of the uterus
which occurred under the use of the ergot, the difficulty in the
labour having depended on hydrocephalus of the fcetus, (Medi-
cal Gazette, April 7th, 1843.) About two years ago, I was
informed of a recently ruptured uterus having been brought
under the notice, for discussion, of the members of one of our
societies, where the accident was stated to have occurred un-
der the action of the ergot, given by an ignorant midwife in
deformity of the pelvis.

Another method of exciting contractions of the uterus is that
suggested and practised by Dr. Radford, of Manchester,
namely, by transmitting galvanic shocks through the uterus, so
as to stimulate directly its muscular structure. And, lastly, I
may allude to the use of stimulating enemata, as of culinary
salt and water, of turpentine, in rousing, by reflex spinal action,
the torpid powers of the uterus. The rectum should previous-
ly be cleared of faecal contents by warm water or soap-and-
water. injections, which sometimes of themselves serve as a
sufficient excitant of parturient action.

BIBLIOGRAPHICAL NOTICES.

1. A Universal Formulary, containing the methods of 'preparing and
administering officinal and other Medicines ; the whole adapted to
physicians and pharmaceutists. By R. Eglesfield Griffith, M.D.
Philadelphia: Lea &Blanchard. 1850. 1 vol. 8vo., pp. 567.

Some difference of opinion prevails among medical men as to the
value of formularies beyond those of the recognized Pharmacopoeias.
We are of the number of those who deem a well arranged and judi-
cious selection of forms for the preparation and administration of
medicines as highly valuable to the physician, and especially to such
as are just entering upon their professional career. The advantage
of such works must be obvious when it is considered how few enter
upon the practice of medicine wilh any knowledge of the art of com-
pounding medicines. Dr. Griffith's Formulary we think decidedly
the best of its kind, and should be in the hands of every young practi-
tioner. The value of the work is much enhanced by the addition of
much valuable information in other points of a practical nature. The
"Introduction contains full tables of weights and measures of the
specific gravities of some of the preparations of the Pharmacopoeias, of

1850.] Bibliographical 371

hygrometrical equivalents, an explanation of the principal abbrevia-
tions occurring in pharmaceutical formulee, and some very judicious
observations on the management of the sick room. Appended to that
part of the work devoted to formulae, are full directions for preparing
the diet of the sick ; a list of incompatibles ; a posological table of the
most important remedies ; a table of pharmaceutical names which
differ in the United States, London, Edinburgh, and Dublin pharma-
copoeias ; some remarks on officinal preparations and directions ; a
list of Poisons with the symptoms they produce, the morbid appear-
ances, tests and antidotes, arid a full index of diseases and their
remedies.

There is a peculiarity in Dr. Griffith's work which we most cor-
dially approve. "In each formula the English appellations for the
articles composing it are used, and the quantities of these ingredients
are expressed in words, and not in the usual pharmaceutical signs."
This plan should be generally adopted as much less liable to error.
A slight change in the pharmaceutic sign for a drachm makes it
indicate an ounce. Such a change in a formula in Ellis' formulary,
(in a formula for hydrocyanate of potassium we believe it was.) result-
ed in the death of a distinguished physician of Macon. A notice was
sent by the publishers of the work to the various Journals, requesting
the necessary correction to be made in that formula, but the correc-
tion came too late for the unfortunate Dr. Baber.

The typographical execution of the work is good, as indeed is the
case with all the medical books published by Messrs. Lea & Blanchard.

2. The Diseases of Females, including those of Pregnancy and Child-
bed. By Fleetwood Churchill, M. D., author of the Theory
and Practice of Midwifery," " Diseases of Infants," &c, a new
American edition, revised by the author. With the Notes of Rob-
ert M. Huston, M. D., Prof, of Materia Medica and General
Therapeutics, and formerly of Obstetrics and Diseases of Women
and Children, in the Jefferson Medical College of Philadelphia ;
President of the Philadelphia Medical Society ; etc, etc. Philadel-
phia : Lea & Blanchard. 1850. 1 vol. 8vo., pp.032.

The works of Dr. Churchill are now so well known and so general-
ly esteemed In this country, that any commendation would be super-
fluous. That they are received with equal favor by our transatlantic
brethren is proved by the fact that the work now before us has reached
a fifth edition. The work has been enlarged by considerable ad-
ditions to the text, and notes. Dr. Huston's notes add value to tho
book.

372 Bibliographical Periscope. [June,

3. Surgical Anatomy. By Joseph Maclise, Surgeon. With colored
Plates. Philadelphia : Lea & Blandiard. 1850. Part II.

In a former number of the Journal we took occasion to express a
favorable opinion of this work, and to recommend it to our readers,
particularly to such as were unable to resort regularly to actual dis-
sections. The second number contains twelve large finely executed
and well colored engravings of the Hand and Wrist ; the cranial,
nasal, oral, and pharyngeal cavities ; the superficial organs of the
thorax and abdomen ; the deeper seated organs of the thorax and abdo-
men; the principal bloodvessels of the viscera of the thoracico-abdom-
inal cavity ; the relation of the principal bloodvessels of the thorax
and abdomen to the osseous skeleton, &c. ; the relation of the internal
parts to the external surface of the body ; the superficial bloodvessels,
&c.,ofthe inguino- femoral region ; and the surgical dissection of the
first, second, third and fourth layers of the inguinal region in connec-
tion with those of the thigh. We have met with no work of the kind
which we think equal to this, either in its scientific or artistic execu-
tion.

PART III. .
, ftt o n 1 1) I g periscope.

Pharmaceutical Preparations of Manganese. (American Journ.)
In our preceding number, p. 193, we gave a brief notice of the views
of Mr. Hannon relative to the use of manganese as a succedaoeum to
steel. The Revue Medico- Chirurgicale de Paris for June last, con-
tains an interesting paper by this author, on the therapeutic uses of
this substance, and on its pharmaceutical preparations. The latter
portion of the paper we shall here present.

Oxide of Manganese. This is a very good preparation, especially
when obtained by the humid method ; it should therefore be made only
when it is wanted for use. The best mode of prescribing it is, to add
to an ounce of simple syrup, half a drachm or a drachm of the hydrated
oxide, with some oily emulsion, to prevent the contact of the air.

Carbonate of Manganese is best prepared by dissolving seventeen
ounces of pure crystallized sulphate of manganese, and nineteen
ounces of carbonate of soda, in a sufficient quantity of water. Double
decomposition takes place ; an ounce of syrup is added to every seven-
teen ounces of the liquid, and the precipitate is allowed to settle, in a
well-stopped bottle. The supernatant fluid is then decanted off; the
precipitate is washed with sugared water, and allowed to drain on a
cloth saturated with simple syrup ; it is then expressed, mixed with
ten ounces of honey, and rapidly evaporated (the access of air being

1850.] Periscope. 273

prevented) to a proper consistence for making pills. The sugar and
honey oppose the transformation of carbonate of the protoxide of
manganese (carbonate manganeux) into carbonate of the peroxide
(carbonate manganique,) which is but little soluble in the acids of
the stomach. The dose is from four to ten pills, each four grains,
every day in chlorotic cases, where iron has not succeeded. The
hyperoxidation of the carbonate of manganese may be prevented by
adding freshly prepared vegetable charcoal to the pills ; it absorbs
the carbonic acid, which is disengaged by a partial decomposition,
and enables the pharmaceutist to dispense with the use of mucilage,
which only increases the hardness of the mass.

Neutral Malate of Manganese. This is procured by treating car-
bonate of manganese with malic acid. It is an eligible preparation,
as the base of the salt is in the form of protoxide, and the acid is easily
digested. The dose is from two to four grains, in pills.

The prepartions of manganese have this immense advantage over
those of iron, that they can be combined with vegetable tonics and
astringents, namely tannin, and the substances which contain it, as
gall-nuts, rhatany, catechu, dragon's blood, kino, monesia, canella,
and cinchona. These can all be combined with malate of manganese.
Syrup of malate of manganese consists of, simple syrup gxvi ;
malate of manganese gi ; essence of lemon 5ij ; an ounce of syrup
contains twenty-nine grains of malate of manganese. Pills of malate
of manganese. Malate of manganese gr. xv ; powder of cinchona
gr. xv : honey, a sufficient quantity to make twenty pills. Lozenges
of malate of manganese. Malate of manganese si ; sugar |xi ;
mucilage of tragacanth a sufficient quantity. To be formed into
lozenges, each twelve grains in wreight ; each of which contains a
grain of the salt.

Tartrate of Manganese is prepared in the same way as the malate,
tartaric acid being used. It may be substituted for the malate in all
the above-mentioned formulae; and is used to prepare the following
highly tonic syrup. Syrup of tolu "xvii ; extract of rhatany 3iiss;
tartrate of manganese 3iiss. Dose, from four to five spoonfuls daily.

Phosphate of Manganese is best prepared by dropping a solution of
phosphate of soda into a solution of sulphate of manganese. The
precipitate is collected after nitration, dried, and preserved in well-
stopped bottles. This preparation may be employed, like the phos-
phate of iron, in cancerous affections. Pills of phosphate of manganese.
Phosphate of manganese 3iss; powder of cinchona 3ss: syrup of
catechu a sufficient quantity. To be divided into four-grain pills.
Syrup of phosphate of manganese. Phosphate of manganese 3ss;
syrup of tolu iii, 3iii; syrup of cinchona 3V ; essence of lemon
3iss; powder of tragacanth gr. x. This preparation must be made
quickly, and preserved in awell-stopped bottle. Lozenges of phosphate
of manganese. Phosphate of manganese %\ ; sugar :,xu. .Mix and
divide into twelve-grain lozenges, each containing one grain of the
phosphate.

Iodide of Manganese is prepared by digesting recently precipitated

374 Periscope. [June,

carbonate of manganese with fresh hydriodic acid ; then filtering, and
evaporating, the access of air being prevented. It may more con-
veniently be prepared extemporaneously, by mixing together an ounce
of iodide of potassium, and the same quantity of sulphate of manganese,
perfectly dried, and in the state of powder. It is then made into a
pill-mass with honey, and divided into pills, each containing four
grains of the iodide ; which should be kept in a well-stopped bottle.
The dose is at first, one pill daily, gradually increased every three
days, to six pills ; the medicine is then omitted for eight days, after
which it is resumed. Syrup of iodide of manganese is prepared by
adding concentrated hydriodic acid to a drachm of perfectly pure
hydrated carbonate of manganese, until it be entirely dissolved ; then
mixing with the solution seventeen ounces of a syrup ofguaiacum and
sarsaparilla. Doses, from two to six spoonfuls daily.

In cases where iron has not succeeded, it is desirable not to make a
sudden transition to manganese, but to combine the two remedies, as
in the following formula. Pure crystallized sulphate of iron gxiii ;
pure sulphate of manganese giiiss; pure carbonate of soda gxviiss;
honey gx ; syrup, as much as may be sufficient to make a mass, to
be divided into four-grain pills. Dose, from two to ten pills daily.
The insoluble preparations of manganese should be first used, as the
carbonate, phosphate, and oxide ; then the more soluble preparations,
the tartrate, malate, etc., may be employed. The use of this medi-
cine should not be persevered in so long as that of iron, as its prepara-
tions are more rapidly assimilated. Manganese is not, like iron,
found in the excrements of persons who take it at least it is in very
small quantity.

In the depraved state of the blood which succeeds intermittent
fevers manganese is useful ; it is the most certain remedy for prevent-
ing a return of the attacks. Leucophlegmasia and engorged spleen,
of long duration, are rapidly reduced by the use of iodide of manga-
nese with syrup of cinchona. The preparation of manganese should
also be used in urethro-vaginal catarrh in chlorotic patients, and in
chronic blennorrhcea, especially in individuals weakened and rendered
anaemic by excess. The salts of manganese, with which we are
acquainted, are powerfully astringent, and may be used as external
applications, in all cases where other astringents are not indicated.
In this respect, they possess no other peculiarity.

Good effects of repeated Blistering in acute Endo- Carditis. (Bui. de
Therapeutique.) We have witnessed in the service of M. Becquerel,
the good effects to be obtained by the repeated application of vesica-
tions. Seven patients laboring under this affection have been under
our observation, and we found that on the day after the application of
the blister the blowing sound lost its intensity, the pulsations of the
heart became more regular, and the respiration less disturbed. This
change was perceptible to the patients themselves. In proportion ai

1850.] Periscope. 375

the blistered surface became dry, the morbid phenomena slightly-
increased, but after two, three, or four applications, the blowing
sounds became weaker and disappeared, the pulse became perfectly
regular, and the respiration easy. The endo-carditis was pursued
with vesicatories, until not only these sounds, but even the prolonga-
tion of the first bruit, which is the beginning of the blowing sound,
entirely disappeared. This medication does not prevent the employ-
ment of a tonic and substantial alimentation to sustain the strength of
the patient after the fever has disappeared, but we have remarked
that the resolution of the disease was more slow under the use of such
means.

Mode of depriving Quinine of its bitterness. Dr. Richard H.
Thomas, of Baltimore, in a letter to the Editor of the American Jour-
nal of Medical Sciences, recommends a combination of tannic acid
with quinine, as a means of destroying its bitterness, without in the
least impairing its efficacy. The following is his formula for the
combination :

B. Sulphate of Quinine, - ten grains.
Tannic Acid, - - - two grains.
Syrup of Orange, - - two drachms.

Water, six drachms. Mix.

In a letter from James V. D. Stewart, of Baltimore, to Dr. Thomas,
it is suggested that the proper proportion of the tannic acid is one and
a half grains to ten grains of the quinine.

Traumatic Tetanus. In the April No. of the Western Journal of
Medicine and Surgery, Dr. Emison reports a case successfully treated
with the Sulphate of Quinine. The subject was a healthy and athletic
young man who was accidentally wounded near the external malleolus
of the left leg, by the discharge of a pistol loaded with tow. The wound
did well until some three weeks afterwards, when upon exposure to bad
weather, and a long horseback ride, tetanic symptoms were induced.
A large poultice of hops was applied to the wound, which was nearlv
healed, but with dry, everted edges, and a large dose of calomel with
two grains of ipecac was administered, followed by a full dose of cas-
tor oil. After the operation of these medicines, half a grain of the
sulphate of morphine was given every half hour for two hours, and
afterwards sixty drops of laudanum every hour. Three portions of
the laudanum were given, when it was suspended. The spasms con-
tinued, and the anodyne was more freely administered, and a blister

376 Periscope. [June,

substituted for the poultice. The condition of the patient had now be-
come distressing, and on the evening of the second day thirty grains
of quinine were given and the anodynes continued. There was a
decided remission at midnight. A cathartic was given, followed by
anodynes. On third day, at 6 o'clock P. M., one drachm of quinine
was administered. Symptoms much mitigated, and at 6 o'clock P. M.,
on the fourth day, the quinine was repeated in a dose of thirty grains.
The tetanic symptoms gradually yielded, and in four or five days en-
tirely disappeared.

On the use of the Tincture of Iodine in Variolous Eruptions. By
Prof. Diez Benito. Gaceta Medica. (London Lancet.) I do not
recollect where, but not long since I read of this as being used, in order
to avoid the the cicatrices which remain after small-pox. I had oc-
casion to try it in civil practice ; but fearing lest the cases might not ter-
minate favourably, I was induced to suspend its use until my hospital
experience might justify its adoption, and the following are the results I
have obtained. 1 have ordered the whole of the cheek to be painted with
the tincture, during the period of eruption. The regular development
of the pustule has not been checked by this. After the pustules have
maturated, I have perceived that from within 24 to 30 hours they become
dry, if the pustule were confluent, and the whole of the cheek covered
with a scab. On its falling off, the cutis appeared red and delicate.
When the pustules were distinct, it was perceived that instead of leav-
ing a depressed irregular spot, they were detached with a little epider-
mic scale, and not with that cutaneous erosion which is observed in other
cases. But if the patient scratched himself, or if the scabs were re.
moved by adhering to the linen, the result was not so satisfactory.
The face has not appeared the same in all cases, since in some
irregular cicatrices have remained, but not to the extent they would
have been, had the tincture not been used.

The tincture of iodine is indeed a most useful remedy in such
cases, but it does not completely fulfil the object sought for. I have
never observed any ill results from its use.

On the use of Chloroform in Ophthalmia. (Ibid.) In a soldier who
suffered from chronic inflammation of the palpebral, accompanied by
great intolerance of light, and epiphora, which had resisted, with re-
markable pertinacity, the usual treatment recommended in such
cases, the idea occurred to me of dropping into each eye a drop of
chloroform, and from the first day he obtained so much relief, that he
could look steadily at the light for some moments when for two months
before, a variety of remedies had been uselessly applied. I have not
effected a complete cure, as the patient could not be persuaded to
remain sufficiently long in the hospital ; but I hope that the professors
who may have many ophthalmic cases under their care, will adopt
this treatment in such as they may deem opportune, especially in those
cases of extreme sensibility of the retina.

1850.] Periscope. 377

Treatment of Gleet. By C. Johnsox/M. D. (American Jour.)
Having for several years used a solution of nitrate of strychnia
with excellent success as a topical application, in chronic ophthal-
mic catarrh, I was induced to apply the same remedy by injection to
the urethral lining. I discovered that its efFect was singularly benefi-
cial in gleet not depending upon stricture, accompanied or not by
disease of the prostate gland, which, if neglected, terminates in hyper-
trophic enlargement. Farther experiment proved to me the efficacy
of the internal administration of nux vomica in arresting the morbid
urethral or prostatic discharge. Quinine was used with it as an
adjuvant, and hyoscyamus added with a view of soothing irritation of
the vesical neck, although that agent has been supposed to control the
action of strychnia. The effect of this treatment has been such as to
rob vexatiously enduring gleets of their annoying persistence, and to
create the hope that others may derive equal pleasure from its em-
ployment.

R. Strychnia, gr. ij ;

Acid. nit. fort. gtt. iv ;

Aquas gij. Ft. sol.
S. Inject one drachm thrice a day after urination.
BL Ext. nucis vomicae, gr. xij ;

Sulph. quinia^,

Ext. hyoscyaimi, aa gr. xxiv. M.
In pil. No. xxiv. divid. S. Two pills to be taken an hour before each
meal.

I also recommend the use of lean meats, and abstinence for a fort-
night from salted and smoked meats, and from saccharine articles of
diet in the usual proportion.

Radical Cure of Corns. In the number of L'Abeille Medicale of
the 15th April, M. B. Matton proposes a mode of curing corns with-
out a resort to cutting instruments. He advises that the feet be soaked
in water for a short time, and the most projecting part of the corn be
taken off with a penknife, or with the fingers; a stick of nitrate of
silver moistened at the free extremity is then to be pressed slightly
over the whole surface of hardened cuticle, and even a little beyond
on the sound skin. The part to which the caustic is applied should
then be well dried, and let alone for ten days. A very slight and
hardly perceptible vesication takes place, which however is soon. ab-
sorbed. At the end of eight or ten days, by making some slight
tractions with the fingers, or a pair of dissecting forceps, from the
circumference to the centre of the eschar, we may remove, without
the slightest pain, the hardened epidermis, so completely as to leave
no trace behind. M. Matton pledges himself that those who try his
plan will be certainly and radically cured.

378 Periscope. [June,

Concentrated Tincture of Capsicum, a remedy for Chilblains and
Toothache. By A. Turnbtjll, M. D. (American Journal of Phar-
macy.) My plan of treatment is simply to saturate apiece of sponge
or flannel with the concentrated tincture of capsicum, and to rub well
over the seat of the chilblains until such time as a strong tingling or
electrical feeling is produced. This medicine possesses an extraor-
dinary power in removing congestion by its action upon the nerves
and circulation.

This application ought to be continued daily until the disease is re-
moved ; relief will be experienced on the very first application, and
frequently there will be a total removal of the disease after the second
or third. This of course depends upon the severity of the case. This
embrocation when rubbed, never produces excoriation if the skin is not
broken.

The manner of using it for toothache, is by putting a drop or two of
the tincture on cotton, and applying it to the part affected the relief
will be immediate. The following is the formula :
Tinctura Capcici Concentrata.
R. Capcici Baccarum, . . . iv.
Spiritus Vini Rect., . . . gxij.
Macerate per dies septem et cola.

It may also be made with advantage by displacement.

[The fluid oleo resinous extract obtained by acting on capsicum with ether,
and evaporating the elher, must possess yet stronger claims as a remedy in tooth-
ache, inasmuch as it is much stronger than capsicum weight for weight. Edt.
Am. Jour. Pharm.J

New Adhesive Agent. M. Mellez, in an article published in the
Bulletin de Therapeutique of March 30th, recommends very strongly
an adhesive preparation made of Shell lac dissolved in alcohol by
the aid of a moderate heat. The relative quantities of the articles
should be sufficient to give the preparation the consistence of jelly or
something approaching to it. It should be kept in a broad-mouthed
bottle, corked, to prevent desiccation. When wanted for use, it is to
be spread upon strips of cloth of suitable size and form. M. Mellez
enumerates as its merits, contraction during its evaporation ; imper-
meability to air ; absence of all irritant action on the wound or skin ;
intimate adherence to the skin ; resistance to the action of water,
greasjr matters, or the secretions from the wound ; and absence of any
need of heat. In all these respects he asserts that it is superior to the
collodion. It does not dry quite so quickly as the latter article, but it
dries with sufficient rapidity to avoid any tax upon the patience of the
surgeon. It does not require that the parts to which it is to be applied
should be so thoroughly dried as does the collodion. It is also a much
cheaper article. He asserts that from his observation he feels au-

1850.] Periscope. 379

thorized to state that it is the most reliable and easy to manage of all
the adhesive agents ; that its agglutinative power resists the action of
liquids, and the moderate movements of patients, even when its appli-
cation lasts for weeks ; that in drying it approximates the edges of the
wound submitted to its action ; that the short time which elapses be-
fore the wound begins to cicatrize gives ground for a suspicion that it
does something more than afford a mechanical protection ; and that
in the treatment of fractures, especially such as are complicated with
wounds, it is in every respect preferable to dextrine.

Chloride of Sodium in diseases of the eyes. (Journ. desConnais.
Medico-Chirurgicales.) Dr. Berroit, Professor in the Faculty of
Montpellier, has reported two very interesting cases of ulceration of
the cornea in which this article was successfully employed. In one
case ulceration of the cornea existed on both sides, which were treat-
ed with calomel, general bleeding, and frictions with mercury and
belladonna, without benefit. Three applications of solid lunar caustic
were made at intervals of seven days, but the effects were rather inju-
rious than otherwise. On the twelfth day the use of a collyrium of
chloride of sodium was begun, and on the morrow, the photophobia
had disappeared, which permitted a full examination of the ulcers.
The collyrium was continued until the twenty. fourth day, at which
time the ulcers had cicatrized. In the other case, which wTas of a
scrofulous character, the ordinary treatment had been pursued for
three months, without efFect. Under the use of the chloride of sodium,
a cure was effected by the twenty-first day. Dr. B. refers to many
other analogous cases, and adds moreover, that he has employed this
remedy with satisfactory results in chronic inflammation of the lach-
rymal sac, complicated with engorgement.

Treatment of Puerperal Mania. By F.Churchill, M. D. (Dub-
lin Journal.) The treatment of puerperal mania is very simple as
regards the materials, yet requiring calmness and judgment in their
application.

1. Those who regard it as any modification of phrenitis, of course
recommend blood-letting, with more or less liberality. Now, from
what I have said as to the nature of the disease, it will be clear that
for these cases it is inadmissible, or, if ever used, it must be with ex-
traordinary caution, and by means of leeches, in cases where there is
strength and quickness of pulse, and flushing of the head and face. I
have, however, never found it advisable ; and Esquirol, Haslam,
Gooch, Burrowes, and Pritchard, are all opposed to it. The last
named author remarks: "If we consider that the greatest danger to

380 Periscope. [June,

be apprehended for patients laboring under puerperal madness arises
from a state of extreme exhaustion, that many women die from this
cause within a short interval from the commencement of the disease,
and that, if they survive this period, the healthy state of the mind is in
most instances restored, it will be evident that our chief endeavours
must be directed to the present support of life." " Blood-letting, as a
general remedy for puerperal madness, is condemned by ail practical
writers, on whose judgment much reliance ought to be placed."*

2. When the stomaeh is overloaded, when indigestible food has
been taken, or even for the purpose of lowering the pulse by the shock
cf vomiting, emetics have been found useful. They must, however, be
used with caution, when the face is pale, the skin cold, and the pulse
quick and weak. Dr. Gooch prefers ipecacuanha to antimonials.
Dr. Burrowes recommends nauseating doses of tartar emetic, with
the saline mixture and digitalis, for the purpose of reducing the vio-
lence and fury of the patient ; and Dr. Beatty informs me that he has
derived great advantage from tartar emetic.

3. From the almost universally disordered state of the bowels,
great relief is afForded by one or two brisk purgatives of calomel, fol-
lowed by castor oil or Gregory's powder. The stools are dark-colored,
and highly offensive ; and in addition to the advantage of clearing out
the bowels, purgatives act admirably as derivatives from the head.

4. After the bowels have been freed, the greatest benefit will be de-
rived from narcotics. Denman prefers small and repeated doses of
opiates, but Gooch, Burrowes, and Pritchard recommend full doses,
and with this I concur : ten grains of Dover's powder, twelve drops of
black drop, or an equivalent of the other preparations of opium. If
opium disagrees, hyoscyamus may be given ; and should sleep be
induced, repeated small doses may be administered ; when the head
is very hot, and face flushed, we should postpone the exhibition of
opium, and we must guard against constipation.

5. The head may be shaved, and a cold lotion applied; if the
delirium continue, a blister may be applied, but it is not generally
necesssary.

6. In protracted cases, or when the patient is exhausted, nourishing
diet, broths, &c, and even tonics, must be allowed ; ammonia, with
cinchona ; oil ofturpentine, &c.

7. As uterine inflammation not uncommonly arises in the course of,
or follows puerperal mania, a close watch should be kept for the earli-
est symptoms, and if they appear, calomel in small and repeated doses,
or mercurial inunction, should be added to the other remedies, with
such other local applications as may be deemed advisable.

8. It will be necessary to keep the most careful watch upon the
patient ; the nurse, who ought, if possible, to be one familiar with
such attacks, should never leave the room ; friends ought to be abso-
lutely rel'used admission ; the apartment kept slightly darkened, and
the entire house perfectly quiet.

9. When the mania disappears and the patient is convalescent, a
change of air and scene is most advisable.

* On Insanity, p. 313.

1850.] Miscellany. 381

Ultiual itttacdlantt.

American Medical Association. The third anniversary meeting
of the American Medical Association was held at Cincinnatti on Tues-
day, the 7th May. We learn from Prof. P. F. Eve, who represented]
the Medical College of Georgia on that occasion, that the meeting was
highly interesting, and that the delegates were cordially welcomed and
hospitably entertained by their Western brethren. The meeting was
organized by the election of Dr. R. D. Mussey, of Ohio, President;
and Drs. Johnson of Mississippi, Lopez of Alabama, Norris of Penn-
sylvania, and Brainard of Illinois, Vice-Presidents ; Dr. Hays of
Philadelphia, Treasurer, and Drs. Stille and Dessaussure, Secretaries.
More than five hundred delegates and other members were in at-
tendance, and twenty-five States were represented.

On Thursday evening, the 9th, a splendid supper was given to the
Association by the physicians of Cincinnatti, at which over five hun-
dred guests were seated.

The following named gentlemen have been appointed Chairmen of
the several Standing Committees for the ensuing year :
Dr. Dowler, of La., on Medical Science.
" Flint, " N.Y., " Practice.

V--" P.F.Eve," Ga. " Surgery.

" Hooker, " Ct. " Medical Education.
" Storer, " Mass. " Obstetrics.
" Reyburn, " Mi. " Medical Literature.
" Hays, " Pa. Publication.

" Frost, " S. C. " Arrangements.

The next meeting of the Association will be held in Charleston, S.C.,
on the first Tuesday of May, 1851.

National Medical Convention for revising the Phannacopceia of the
United States. The fourth decennial convention for revising our
national pharmacopoeia, met in Washington City on Monday, 6th May.
Delegates from a number of colleges and societies were present.
We perceive that no society or college South of Washington, or from
the West, was represented. Dr. G. B. Wood, of Pennsylvania, was
elected President ; Dr. Joseph Mauran, of Rhode Island, and Dr
Simons, of S. Carolina, Vice-Presidents; and Drs. Lindsay and Fore
man of the District of Columbia, Secretaries. A committee appoint
ed to prepare a plan for the revision and publication of the pharmaco
pceia, recommended the appointment of a committee of revision, con

382 Miscellany. [June,

sisting of nine members, of which three should form a quorum, to
meet in Philadelphia as soon as practicable, and to publish the work
after revision. This plan was adopted. Dr. Wood was added to the
committee, and appointed its chairman. A dinner was given to the
Convention by the medical gentlemen of Georgetown and Washington.

Demonstrative Midwifery. We are surprised to learn, that an
effort made by the Professor of Obstetrics in the Buffalo University to
give his class clinical obstetrical instruction has been denounced by
certain physicians of Buffalo as u wholly unnecessary for the purposes
of teaching, UNprofessional in manner, and grossly offensive, alike to
morality and common decency." The plan adopted by the Professor,
which has elicited this rebuke, was to introduce a parturient female
into the apartments of the Janitor of the College, and to permit each
member of the graduating class separately to examine the case. This
was done in the presence of the Professor and of the wife of the Jani-
tor. If this course violates decency and outrages virtue, then the
practice of midwifery should at once be surrendered by medical men.
This we presume is not desired by the fastidiously decent and virtuous
gentlemen whose sensibilities have been so much shocked. That
unprofessional persons should make objections to obstetrical demon-
strations is no more surprising than that they should object to dissec-
tions, but that medical men could be found ready to arouse or minister
to popular prejudice against an important means of imparting profes-
sional knowledge, admitted to be indispensable in every other depart-
ment of practical medicine, must be a subject of profound regret to
every one who has the usefulness of his profession at heart. Obstet-
rical demonstrations may be a novelty in this country, but in France
they are common, and though conducted in a manner far more repul-
sive than that of the Professor at Buffalo, they are encouraged for the
valuable instruction they afford.

On the proportion of Graduates to the Population By Prof. Geo.
Tucker. (Medical Examiner.) On the first of June 1848, the popu-
lation of the United States adding to the ordinary increase a
reasonable allowance for the accessions from the acquired territories
of Texas, California and New Mexico, and an unprecedented number
of immigrants since 1840 was probably not less than 22,000,000.
Let us, however, suppose it to be 21,500,000. With this population,
what is the probable number of physicians ? I have been in the habit
of estimating one for every 800 persons. Dr. Mitchell, guided by the
number in Philadelphia, supposes one for 700 ; but the proportion is

1850.] Miscellany. 383

always greater in the cities than in the country. Taking then the
former ratio, the whole number of practising physicians in the United
States is 26,875. On comparing the number of free white adults in
the census of 1830, with that of 1840, and deducting from the latter
the intervening gain from immigration, it would seem that the annual
diminution by death in that class is about 2 per cent. For reasons
with which I will not trouble you, I suppose the proportion of deaths
in your profession to be greater than the average. Let us, however,
assume it to be the same, and the annual reduction from this cause
will be 537.

But the annuul addition to the population requires a correspondent
addition to the number of physicians. The yearly increase by natural
multiplication appears to be about 2. 8 per cent., which in a population
of 21,500,000 amounted in 1848 to 602,000, to which 200,000 may
be added for immigration. That year, indeed, the number of immi-
grants was considerably larger. The whole addition to the population
being thus 802,000, would consequently require 1002 physicians.

Further deductions must be made for those who quit the profession
for other occupations, or because they are weary of it ; for those who
have obtained the degree of doctor of medicine but have never
practiced; and for a small number who, having graduated in two
schools, have been reckoned twice. I do not add to this list, those who
practice in foreign countries, since the number of physicians who mi-
grate to this country is probably equal to those who leave it. I have
no data for estimating this class of deductions ; but Dr. Mitchell reck-
ons it at 2 per cent., and you think that estimate not too high. This
would take off 537 more, or at 1 per cent. 268.

The additional number of physicians annually required to supply
the wants of the country was then as follows :

From deaths, 537

From increase of population, 1002

From withdrawals, ic, at 2 per cent, 537

2076
If, however, we reduce the last head to only 1 per cent., the num-
ber would be 1807, so that if the annual number of medical graduates
had not exceeded 1500, as the report of that committee assumed, we find
that after allowing the widest range for possible error, the annual supply
is from 20 to 35 per cent, less than the annual demand. This de-
ficiency, which has since increased, was of course supplied from
the large class of uneducated and half-educated practitioners who
are still suffered to sport with the health and lives of the credulous
multitude.

Resignation of Prof. Chapman. The venerable and distinguished
Professor Chapman has resigned his professorship in the University of
Pennsylvania. He has been connected with the medical department
of the University for more than thirty years.

384

Miscellany. Meteorology.

[June,

Dr. Samuel Henry Dickson has resigned his professorship in the
University of New York, and has been elected to the professorship of
the Institutes and Practice in the Medical College of South Carolina.
Prof. Geddings has been transferred to the Chair of Surgery in the
same institution.

Female Medical Schools. At the late session of the Pennsylvania
Legislature a Female Medical College was chartered, which is to go
into operation next October. A Female Medical School was to have
been opened in Boston during the present spring.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet. By Dr. Paul F. Eve.

for April, 1850, at Augusta,
32' west Wash. Altitude above

Sur
Ther.

i Rise.
Bar.

3,1

Ther.

P.M.
Bar.

Wind.

Remarks.

1

40

30

70

30

S. E.

Fair.

2

51

29 92-100

60

29 76-100

S.

Rain all night, 40-100.

3

60

" 43-100

74

" 29-100

s. w.

Pair afternoon heavy blow.
[d'y afternoon-blow-r. at 7 p.m:

4

56

44-100

75

" 46-100

s. w.

5

58

" 27-100

68

" 19-100

s. w.

Cl'y-blow-r. last night, 45-100.

6

47

" 32-100

58

" 50-100

w.

Cloudy rain storm at 7 p.m.

7

44

" 75-100

63

" 80-100

w.

Fair breeze.

8

48

" 83-100

67

" 80-100

s. w.

Cloudy rain.

9

46

" 85-100

7t

" 82-100

Fair morning.

10

59

74-100

63

" 71-100

s. w.

Rain, 90-100.

11

58

" 70-400

57

" 69-100

N. E.

Rain, 65-100.

12

' 52

" 61-100

59

" 56-100;

N. E.

Rain.

13

51

" 57-100

65

:' 62-100

w.

Fair blow.

14

48

" 85-100

68

" 86-100

w.

Fair breeze.

15

46

" 89-100

82

" 88-100'

s. w.

Fair. [night.

16

53

" 89-100

80

11 85.100'

S. W.

Cloudv rain last evening and

17

56

" 63-100

70

" 69-100

w.

Rain, 30-100.

18

46

30

66

30 3-lOOi

E.

Fair gale last night.

19

49

30 3-100

64

29 97-100;

S.

Cloudy slight rain.

20

57

29 83-100

81

" 71-100

s. w.

Cloudy breeze.

21

63

" 77-100

81

" 84-100'

N. E.

Cloudy.

22

62

" 87-100

82

" 81-100'

S. E.

Fair afternoon breeze.

23

65

" 84-100

87

" 83-100

S. W.

Cloudy breeze.

24

64

30 3-100

79

30 2-100

N. E.

Cloudy.

25

60

29 94-100

77

29 82-100

E.

1 Moudy breeze 40-100.

2G

68

81-100

78

" 79- 10(

S. W.

Rain, 1 inch.

27

64

" 84-100

74

" 78-100

s. w.

Cloudy,

28

63

" 75-100

73

" 71-100

s. w.

Fair.

29

60

" 64-100

76

" 75-100,

w.

Fair.

30

50

" 97-100

84

11 93-100

s. -w.

Fair.

12 Fair days. Quantity of Rain 5 inches 20-100.
8 days. West of do. do. 9 days.

Wind East of N. and.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL..

Yol. 6.] NEW SERIES. JULY, 1S50. [No. 7.

PART FIRST.
(Original Communications.

ARTICLE XVIII.

Remarks on the Causes which diminish the Prophylactic powers
of the Vaccine Virus. By Reuben B. Nisbet, M. D., of
Macon, Ga.

It is unfortunate that such a subject for investigation should
present itself to the attention of the profession ; but it is impos-
sible to deny, however unwilling we may be to do so, that it is
one which opens a wide field for inquiry and examination, and
that we still need clear wad. practical deductions upon this im-
portant subject. Each one who has investigated the subject
seems to have been, as is very common and very natural, blinded
by the beauties of his own theory, and has drawn conclusions
better adapted to its support, than to the clear and impartial
elucidation of the subject.

Nearly fifty years since, Jenner, in the pride of success, an-
nounced, in his report to the British Parliament, that he had
discovered "a disease attended with the singular beneficial
result of rendering, through life, the person inoculated with it,
perfectly free from the contagion of Small-pox." For some
time, this opinion, after successful experiment, was generally
admitted, and many, whose professional opinions have much
weight, still entertain the hope that this severe scourge will
finally become entirely eradicated. The success of vaccination
in the beginning gave much encouragement to these sanguine
hopes; but the experience which time has collected, (that best

n. s. VOL. VI. no. vi. 25

386 Nisbet, on the Causes which diminish the [July,

of all authorities upon subjects of doubt,) together with stub-
born facts in the form of statistics, have much destroyed the
confidence of the professional, and still more of the public mind,
in the total and thorough prophylactic powers of the Vaccine
Virus ; and we are compelled to admit, nolens volens, that there
is too much reason for the encouragement of this belief, and
that there are but few exceptiens to the general rule, and these
becoming more and more rare ; that vaccination, as it is at
present practiced, is not a sure and perfect preventive ; nor, if
it does prevent, does it "through life," protect against the con-
tagion of Small-pox

Perhaps this opinion is too confidently and sweepingly ex-
pressed, but we believe that it is more generally believed than
admitted. It is by the careful study of the tedious teachings of
experience, and by the collection of clear statistical facts, that
any permanent truth in any science can be definitely arrived
at ; and if the practice of medicine is to become a perfect as
well as a noble science, it is in this way that its study must be
pursued. It is in this manner that its fundamental doctrines
have been proven, and it is in this manner alone that much
which is now doubtful must be permanently and perfectly
established. Let us glance then at the statistics, and their re-
sults, upon this point.

First, then, in England, where this subject has been most
thoroughly and patiently investigated, it is ascertained that
Small-pox is as common as it was sixty years ago, and that in
the city of London, the mortality is undiminished. This last
assertion will not hold good as regards the other cities, and
many of the counties of England. This gives us little reason
to agree in the opinion of Jenner, formerly, and of Sir Gilbert
Blane, more lately, concerning the final extirpation of the dis-
ease. In British India, this disease, as a yearly epidemic, is
as regular in its approach, duration and cessation, as the chan-
ges of the seasons themselves : nor is the mortality in any
degree lessened. So much with regard to its eradication so far.
Time, we hope, and yearly improvements in vaccination, and
all of its associate circumstances may greatly modify these
facts.

Now, with regard to the success of vaccination as a prophj-

1850.] Prophylactic power of the Vaccine Virus. 387

lactic, we have the statistics of the London Small-pox Hospital
during the epidemics of 1838, and 1844. During the first year,
there were admitted, 38G patients unprotected by vaccination,
298 patients protected by vaccination ; and it is probable that
the proportion of the vaccinated received into the hospital bear
about the same proportion to the unvaccinated, as is the pro-
portion of the vaccinated to the unvaccinated in the general
population subject to the care of that institution. During the
year 1844, there were as many patients admitted as before the
invention of vaccination ; one half of these had been vaccinated.
Seven per cent. died.

From these facts, we ascertain that in London, the birthplace
of vaccination, fifty percent, of the operations proved fruitless,
as a prophylactic.

Secondly, that among those vaccinated, seven per cent. died.
Thus we see that vaccination by no means prevents the occur-
rence of Small-pox, though it modifies its character, and lessens
its mortality. These statistics from Bhglish authority, are pre-
ferred, because they are most certainly ascertained.. Perhaps,
however, the inefficiency of the vaccine virus as a perfect pro-
phylactic against Small-pox, and its efficacy in modifying the
disease, might have been admitted, without this tedious collec-
tion of facts.

Let us now inquire into some of the causes which may dimin-
ish some of the prophylactic powers of the Vaccine Virus.

It is impossible, within the limits of this essay, to inquire into
all those points which may be mostly of investigation, and we
will therefore restrict our remarks to the consideration of a
few, which seem to promise more advantage and more practi-
cal utility from a thorough examination, and which, although of
much importance, do not seem to have received that attention
which, is justly their due.

The points we propose briefly to notice, are : 1st. Impurity
of the vaccine matter; 2d. The method and time of vaccina-
tion; 3d. Constitutional influence; 4th. Atmospheric, or the
influence of climate and seasons; and lastly, the necessity of
re-vaccination, and the efficacy and success of inoculation.

It was strenuously contended by Jenner, and still is bv a
large and respectable portion of the profession at the present

388 Nisbet, on the Causes which diminish the [July,

time, that good vaccine never deteriorated from its original
purity and strength. So strongly was this belief inculcated by
Jenner,.that in the Royal Jennerian Institute the same virus is
used as in the year J 806. We all know that exposure to light
and air impairs the efficacy of a vaccine scab. There is much
carelessness in its preservation : so much so, that whenever an
epidemic occurs in one of our rural districts, it is impossible to
succeed in one operation out of ten. This was strikingly illus-
trated in the Small-pox which occurred in our own State dur-
ing the last spring: the whole population were forced to remain
under the influence of that terror which the disease always
inspires where it seldom appears, until one successful pustule
gave to the profession this much needed article.

The lymph, and not the scab, should be used. It is most ac-
tive and successful when taken from the pustule during its full
maturity. Experience has taught us that the lymph, when
used on the eighth or ninth day, seldom fails; but if taken be-
fore or after that period^ is more or less defective. How weak
then must be the power of the scab, obtained, as it is, on or
after the twentieth day. It is then so dry and hard that it must
necessarily lose some of its vitality, and present a serious obsta-
cle to absorption. It is useless to multiply arguments to prove
what all know, that most of the vaccine matter preserved in
this country is decidedly worthless.

How shall we remedy this ? Go back to the original source
the cow. But it is argued that this can seldom be done with
success, that there is great difficulty in obtaining the right kind
of virus, and that it is difficult to distinguish it from the other
varieties of virus found upon the animal. These objections
speak little for the profession, for they virtually admit their
ignorance of that which has been used by all for almost half a
century: carefully examine, analyze, and failure is next to im-
possible. There have been frequent recurrences to the cow,
and always with success.

Again, it is urged, that the operation of vaccination with
fresh virus developes vaccinia as severe almost as the disease it
prevents. Did Jennerin his first experiment find this to be so?
In the American Medical Intelligencer of 1838-9, it is stated
that the fresh virus was used by many of our first men, among

1850.] Prophylactic power of the Vaccine Virus. 369

whom are found Drs. Meigs and Huston, of the Jefferson Medi-
cal College; and that although few were disposed to object to
it on account of the severity of its operation, all acknowledge
that the virus was most active : the vaccinations were as suc-
cessful ; the lymph of the pustule retained its activity even after
the ninth day. The argument in favor of seems to more than
counterbalance those against using fresh virus.

In relation to the mode of vaccination, the first great desid-
eratum is carefulness. The ease of the operation lessens our
sense of its importance. The virus should be so introduced
to secure it in situ, without being kept in position by artificial
coverings. The application of sticking plaster, for instance,
prevents " taking1' often by the matters adhering to its surface.

The best time for vaccination is a more important considera-
tion. The profession generally admit, that the most successful
age is infancy, and that the patient should be free from disease,
in a state of perfect health. If there is at the time any disor-
der at all of the system it may give rise to inaptitude, if from
no other reason than the old Hunterian doctrine, that two dis-
eases cannot exist at the same time. Now, what diseases
which from their constitutional peculiarities, would be most apt
to prevent " taking 1" It would appear to be most reasonable
that it would be those which in any way derange the healthy
condition of the integument, as it is by this entrance the virus
must pass into the system. Measles, Scarlatina, and in fact all
of the exanthematous affections run their course before the
pustule will begin its developments, with the single exception
of Varicella Lymphatica, (London Medical Gazette,) which will
run its course, and not at all interfere with the phenomena of
vaccination. This exception arises perhaps from the similari-
ty of the two diseases : the same condition of the system which
is favorable to the development of the one, is appropriate also
to the success of the other. A dry, harsh condition of the skin,
is also an obstacle to the successful influence of the virus; any
affection which interferes with the absorption of the virus a
weak, debilitated, and dropsical condition of the patient, anae-
mia, &c, &c.

From the observations of Legender, it seems that vaccina-
tion, after exposure, appears to favor the receiving of the disease,

390 Nisbet, on the Causes irhich diminish the [July,

though frequently of a modified form, and also that vaccination,
after the appearance of variola, does not, although the vesicle
goes on to maturity, modify the character or violence of the
disease. The practical deduction- from these statements are of
great importance. First, after the exposure of young and deli-
cate subjects, the danger of receiving the disease is increased
by vaccination. Secondly, that the practice of vaccination
during the stage of incubation demands a more thorough inves-
tigation.

As for the time of the year, the winter is the best season:
warm weather weakens the powers of the vaccine. The hu-
man system is generally less vigorous, and the perfect operation
of its vital functions are more or less altered during the warm-
er part of the year. These facts are annually proven in India,
where, from March to October, vaccination is perfectly useless.

We now come to a part of this subject which is more in the
dark, and which, it seems strange, has attracted so little of the
attention of the profession. We allude to the constitutional
influence, or, more correctly, the changes which must be devel-
oped, and the alterations which it seems almost impossible to
doubt must take place in the virus from passing through the
systems of hundreds, each one possessing its own peculiarities,
each one different from the other ; the one plethoric, another
anaemic ; one scrofulous, another syphilitic. Indeed, it is al-
most impossible to find two persons whose functions are per-
formed with the same degree of healthful perfection, or possess-
ing the same peculiar idiosyncracy. What is there in the
vaccine virus which exempts it from changes which effect,
more or less, every thing organic or inorganic, vegetable or
animal ? We do not expect to present any thing upon this
subject new or interesting. We simply believe, from all that
we can gather upon this subject, that the virus does become less
and less active, and that the continual use, and that for years,
of the same article, diminishes not only its prophylactic influ-
ence, but also its power of producing a complete and perfect
form of vaccinia. In comparing cases of vaccination from the
old matter, still used in the Jennerian Institute, with that of later
date, used in the London Small-pox Hospital, we find a marked
difference in favor of the article used in the latter institution.

1850.] Prophylactic power of the Vaccine Virus. 391

The development of the vesicle is of a more complete charac-
ter, it runs its course more surely, the constitutional symptoms
are more clearly marked, and its success as a prophylactic far
more certain. We have this from Dr. Gregory, of London,
whose inquiries upon this subject have commanded much atten-
tion. Dr. Fiard, of Paris, a strong believer in the degeneracy
of the virus by transmission, advances the same conclusions :
" A diminution in the deviation of the eruption, a difference in
the development of the pustule, &c." We also know that
there are many persons whose peculiar idiosyncracy complete-
ly modifies or entirely prevents the action of the vaccine.
What is there in the constitution of these individuals which
produce this result/ Admitting the influence of transmission
in deteriorating vaccine virus, what is there in the human sys-
tem which effects this change? This is a subject worthy of
investigation. One, and only one probable cause we would
suggest, and that is the influence of the blood. We all know
that exposure to light and atmospheric air destroys the strength
of a vaccine scab. Are there not some constituent or constitu-
ents common both to the blood and atmosphere which may be
most instrumental in producing an analogous result? We have
not the opportunity to pursue this subject by experiment, chemi-
cal actions, analysis, &c, &c. ; but merely present it to the
consideration of some one who may do it justice, and handle it
in the manner that its interest demands.

Small-pox not only seems to be no respecter of persons, but
to be independent of all climes : now desolating one of the
clean cities of northern Europe, or the still neater and better
ventilated ones of our own country then depopulating the far
distant villages of some Indian province, surrounded by its
rich, luxuriant, but noisome jungles. But although it respects
no country, yet by a kind Providence some nations are for a
season annually free from its ravages. In India it is seen at
the departure of summer steadily and regularly approaching:
like the Eastern locust, it settles upon the land a heavv scourge,
until nothing seems left whereon to prey ; but at the approach
of summer, migratory like, it departs, and for one half of the
year it is not found. This is the lint season, and as small-pox
is prevented during this season, so is the influence of vaccine
vims.

392 Nisbet, on the Causes which diminish the [July,

Dr. Stuart, on Small-pox in India, affirms " that at certain
seasons, and throughout the country, the vaccine virus becomes
deteriorated, the vesicle assumes an altered appearance, and
vaccine often cannot be perpetuated at all."

At Turin, in August of 1829, when a similar condition of
atmosphere maintained, as is common in India during the sum-
mer months, the same facts were observed. Now what is it
that destroys the susceptibility of the population to small-pox
or vaccinia ? Does the peculiar constitutional idiosyncracy of
every individual change? or is it the influence of atmospheric
changes ? It can hardly be the first, because the same persons,
a few months after, will again become liable to an attack ; it
must be the influence of the atmosphere peculiar to the season.
Now what is peculiar about this is the fact that the susceptibili-
ty to vaccinia returns at the commencement of winter. It
would seem from this that both the power of the vaccine is
destroyed, and the susceptibility of the human system, so as to
produce a temporary freedom from small-pox, as well as from
the operation of its virus. Now the condition of the atmos-
phere which produces this result is as during the rainy season
in tropical climates, both exceedingly hot, and at the same time
very mild and damp the population breathing as it were steam.
This fact has been noticed in our own country. In an epidemic
during the last spring, synchronous with the appearance of the
small-pox, the whole State was visited by weather which
was more unseasonable than had ever before been known :
a cold, snowy day, followed by a succession of cOol, dry, and
frosty days, for the period of a fortnight or more. The small-
pox steadily increased during the continuance of this weather,
and as soon as our customary and more seasonable weather re-
turned, there was an instantaneous cessation of the disease in
every place ; not a single new case occurred, and in six weeks
from its commencement it completely disappeared. These facts,
which govern, as by fixed laws, this fatal disease, hold good as
regards vaccinia, the similarity of the two diseases subjecting
them to the same influence.

Jenner admitted that time restored the susceptibility of the
system to vaccinia. This is also admitted by all the candidates
for the prize offered by the French Institute for the best essay

1850.] Prophylactic power of the Vaccine Virus. 393

upon this subject; and these last agreed upon the time also for
its practice, and "that it was rare we meet a second attack of
small-pox before the age of sixteen, and after this period it be-
comes more and more frequent until the age of thirty-five,
when the system becomes free from liability to another attack.
In the monarchial and more despotic governments of Europe,
where these things can be more correctly ascertained, Re-
vaccination is commanded in their army regulations. In the
Prussian, Hanoverian, and Russian armies, it is practiced with
uniform success, so that it has much diminished the confidence
of the profession in these countries in its prophylactic influence.
If there is no good, certainly there is no pain, in re-vaccina-
tion. Why not then, immediately after the first pustule is
healed, try again, and not consider the patient safe, until he is
not susceptible at all ? Do not declare, after the first effort,
that his cnnstitution does not admit of it does not kindly
"take;" but repeatedly try : error must then be on the safe
side. When is the influence of the first operation lost ? how
long does it take the system to throw off (as it were) its influ-
ence ? and how does it do so ? Is it according to the idea of
the old physiologist, that after the lapse of so many years we
become new men ? It wrould seem that if a man attacked by a
well defined small-pox, is free from another attack of the same
disease, that a man once subjected to vaccinia will never lose
its prophylactic influence against itself. This most natural de-
duction we dislike to doubt, but experience forces us to do so.
The period of puberty, with its peculiarities, exerts a marked
influence, almost destroying the effect of former vaccination.
So great are the changes of that age that we literally become
new beings, and we must be subjected to former influences
again if wre wish to retain their advantages. After puberty,
there is certainly as great a necessity for vaccination as before ;
and also the modifying influence of vaccination is governed by
the lapse of time, and is almost lost by the time we reach an
age when we become most liable to exposure ; and ergo, we
should vaccinate them freely once before and once after puber-
ty at least. We should reap all the advantage which it is
capable of producing.

Thus we have briefly and lightly glanced over some of

394 Prophylactic power of the Vaccine Vims. July,

the causes which tends to diminish the prophylactic influence
of vaccine virus : many others present themselves which need
not be discussed here. We have, from the comparison of sta-
tistics and well ascertained facts, found that there is much to be
improved in the use of this great preventive and useful remedy.
We have seen, first, that for want of care in obtainining and
preserving of vaccine virus, we are forced often to use an im-
pure article, thus preventing its good results, disappointing and
vexing ourselves, and, worse still, producing with regard to its
efficacy, a feeling of skepticism in the public mind, which, if it
increases, will necessarily subject us to contempt, and nullify
all the advantages which has been derived from this important
discovery. Secondly, that there is need of more definite rules
as regards the method and time of vaccination. Thirdly, that
there are some unknown influences exerted upon the inoculated
virus, which lessen and diminish its strength ; and, fourthly,
that the peculiarities of atmospheric changes aftect the success
of vaccination, either by producing a change in the vaccination
or by predisposing the system to reject its influence.

Perhaps it may not be out of place here to present the inquiry,
whether inoculation of small-pox virus could be so managed as
to supersede the use of vaccination? Its complete success de-
mands attention. Dr.Gregory tells us, that only one in five
hundred take the disease after inoculation. We find, too, that
in the East, it is regularly and safely practiced. Most of
our information, as regards its practice, must come from the
East. " TheJBrahmins practice inoculation in such a manner
as to render the disease mild, and with but little eruption ;" and
they do this by using virus deteriorated by time. Could not
then the system be so prepared by treatment, by preparation t
by selecting a favorable time, a proper state of health, of weath-
er, &c, &c, so as without danger to bear the comparatively
mild disease, produced by inoculation, and beome "forever and
through life perfectly exempt from small-pox contagion ?"

18M).] Bignon, on Treatment of Dysmenorrhea. 305

ARTICLE XIX.

Treatment of Dysmenorrhoea by Qyinine and Prussiate of Iron.
By H. A. Bignon, M, D., of August?., Ga.

The frequent occurrence of Dysmenorrhea, and its pamful
and intractable character, render it a subject of deep interest
to the physician. As the most approved modes of treatment
often effect little more than a slight palliation, I am induced to
report a few cases treated with Quinine and Prussiate of Iron,
in the hope that others may be induced to test these remedies
in similar cases.

Case 1. About the first of July, 1848, I was called to see
Celia, a negro woman about 28 years of age, and of very deli-
cate constitution : she was then laboring under Dysmenorrhcea,
and on enquiry I found that she had been affected with it for
some nine vears, during which time she had been under the
treatment of several physicians, and as far as I could learn, had
been put on the use of purgatives, tinct. of guiacum, and all the
usual remedies, with only slight relief, if any. I immediately
prescribed a warm hip bath with mustard, and 10 grs. of Do-
ver's powder, under the influence of which she was not long
in falling to sleep, and got a good night's rest. On my visit
the next day, I found that the pains had returned, and she
was suffering very much. I suspected the existence of a clot,
from the character of the pains, (resembling those of labour,)
and immediately gave her a tea-spoonful of wine of ergot, and
repeated the dose about every ten minutes, until she had taken
three spoonsful, after which she passed a clot about the size and
shape of an almond, to the entire relief of all her suffering. I
prescribed another hip bath and 10 grs. of Dover's powder for
the night, and left her.

I did not see my patient again until about two weeks after,
when she came to see if I could not give her something to
prevent her suffering so much at the next approach of the
catamenia. I put her on the use of pills, consisting of 3 grs.
of Quinine and 3 grs. of Prussiate of Iron, of which she was to
take one three times a day, and gave her a mixture of camphor
(De wees') to take, in case she suffered much at the next period,
and did not see her again until about one week after she had

396 Dr. Drake's New Work. [July,

had a return of the discharge, (making about three weeks since
my last interview with her,) when she came to get more of the
pills, saying that she thought they had helped her a good deal,
but not cured her. I made another box of the pills, and kept
her on the use of them for the space of about six months, when
she came to me quite another looking woman, and entirely free
from the disease. I have seen her frequently since, and she
continues well.

Case 2. Maria, a negro woman, aged about 32 years, and
of slight frame, applied to me in the month of September, 1848,
for the relief of Dysmenorrhea, which she had had since a cold
caught after confinement about seven years previous. As the
case was very similar to the preceding one, I will not go into a
detail of it, but merely say that I put her upon the same treat-
ment, and in the space of about seven months I had the gratifi-
cation of seeing her quite well again.

Case 3. Ann, a negro woman, aged about 20 years, well
made and of large stature, applied to me in the month of No-
vember, 1849, for the relief of Dysmenorrhea. The case was
similar to the others, excepting that Ann was then nursing a
child of three years of age, and also complained more of pain
in the back than did the others. I put her upon the same treat-
ment as the other cases, with the addition of a blister to the sa-
crum, and made her wean the child. This case is under my care
at this time, and at the last period she says that the discharge
was quite natural, and that the pain was scarcely to be felt.

PART II.
HHtvitms anir (Extracts.

A Systematic Treatise Historical, Etiological, and Practical,
on the Principal Diseases of the Interior Valley of North
America, as they appear in the Caucasian, African, Indian,
and Esquimaux varieties of its population. Bv Daniel
Drake, M. D. Cincinnati : W. B. Smith & Co. 1850.
Pp. 878.

The comprehensiveness of the above title sufficiently indi-
cates the vastness of the author's undertaking, and the well
established reputation of Doctor Drake insures its execution in
a manner creditable to American medical literature. The

1850.] Dr. Drake's New Work 397

volume before us is full of valuable information to the Natural-
ist as well as to the Physician, and evinces an amount of labori-
ous investigation rarely met with in our country, occupying the
author's attention for forty years, and extending over the
greatest valley of the earth. The following extract will conveyr
some idea of the motives and design of the work.

' There are diseases which occur independently of all
known external influences, which affect individuals of all
races, and present in all cases substantially the same symp-
toms and lesions of structure; of which cancer, fungus nema-
todes, melanosis, wens, cataract, ossifications, apoplexy, and
various chronic affections of the skin, may be cited as examples.
There are others, depending on known and common causes to
which man is exposed in all countries, climates, and states of
society ; such as inflammations from mechanical injuries, burns,
or the ingestion of acrid poisons, which respectively present
nearly the same charteristics, wherever or in whatever race
they occur. Others, again, result from specific causes which
are reproduced in the bodies of the sick, whereby they spread,
with great uniformity of symptoms, to all who are exposed ;
such as small pox, cow pox, measles, and hooping cough. In
reference to all these, and other diseases which might be men-
tioned, it may be said, that the observations made in one coun-
try are, in the main, equally applicable to every other. The
maladies are the common scourge of our race; and the know-
ledge of their symptoms, lesions, and treatment, the common
heritage of our profession.

"On the other hand, there are diseases which scarcely ever
occur but in certain climates, localities, or states of society ; of
which we may select for illustration, yellow fever, autumnal
intermittent and remittent fever, plague, pneumonia, goitre and
cretinism, gout, scurvey, and mania, most of which, moreover,
in different countries, ages, and races exhibit some variety of
type, and demand some peculiarity of treatment. Here then
is the foundation of local medical history and practice ; a basis
which does not support the whole nosology, and yet is broad
enough for a large superstructure, whenever an extended region
constitutes the field of inquiry.

"That many physicians overrate the degree of variation
from a common standard which the diseases of different coun-
tries present, I am quite convinced ; but feel equally assured,
that if the maladies of each country were studied and described,
without a reference to those of any other, it would be found, if
the state of medical science were equal in thein: that the works

31)8 Dr. Drakes New Work. [July,

thus produced would not be commutable, but that each would be
better adapted, as a book of etiology, diagnosis, and practice,
to the profession and people among which it was written, than
to any other. How much better, would depend on the various
identities and discrepancies which might exist between the
countries thus compared. If their geological, hydrographical,
topographical, climatic, social, and physiological conditions
were nearly the same, of course their medical histories would
be much alike; but if they differed widely in one or several of
these conditions, a corresponding diversity would appear in the
respective histories ot all the diseases, which admit of modifica-
tion from causes referable to those heads.

"The work on which we are entering, is an attempt to
present an account, etiological, symptomatica!, and therapeutic,
of the most important diseases of a particular portion of the
earth; not of a state or political division, for it is indirectly,
and to a very limited extent only, that civil divisions can
originate varieties in the character of disease. Physical causes
lie at the bottom of whatever differences the maladies of
different portions of the earth may present; and hence the region
which a medical historian selects, should have well-defined
natural, and not merely conventional boundaries." (p. 1.)

The region subjected to examination is thus briefly defined :

<; The Interior Valley op North America begins within
the tropics, and terminates within the polar circle ; travers-
ing the continent from south to north, and passing through
the entire northern, temperate zone. In the south it rests
upon, and is deeply indented bv, the Gulf of Mexico ; in the
north it bears a similiar relation to the Polar Sea and Hud-
son Bay ; the latter penetrating it so deeply, as to come within
twenty-two degrees of latitude of the Gulf of Mexico. On
the east its limits are the Appalachian Mountains, which ex-
tend from the thirty-third to the fifty-third degree of latitude,
each end terminating in a low water shed.. On the west, the
immense chains of Rocky and Sea-side Mountains, beginning
within the torrid zone and ending beyond the polar circle,
seclude it from the Pacific Ocean. These mountain borders,
as may be seen on the map (PL i), diverge from each other as
they cross the continent, and thus the Valley regularly widens
as it passes from south to north."

"Of the area of this great intermontane region it is not
easy to speak with much precision. To the south its lati-
tudes vary from the eighteenth to the thirtieth parallels ; in
the north, from the fiftieth to the seventieth. Ln the south,

1850. J Dr. Drake's Xtir Work. 309

its eastern margin is found near the eighty-first meridian; its
western, in the one hundred and fifth ; but in the fifty-third
degree of latitude, it advances east to. the fifty-sixth meridian,
and west to the one hundred and sixteenth ; finally, in the sixty-
eighth parallel, its western margin is found in the one hundred
and thirty-sixth degree of longitude.

"If we assume eight millions of square miles as the area of
North America, the Valley cannot be estimated at less than
six millions, or three-fourths of the whole continental surface.
Its northern half, however, is rendered nearly uninhabitable
by the state of its surface and its climate; and, therefore, the
portion which presents objects of immediate interest to the
medical etiologist, does not exceed three millions of square
miles, of which, as yet, not more than one-third has acquired
even a sparse civilized population." (p. 5.]

The author has devoted no less than 446 pages to the study
of Topographical and Hydrographical Etiology, and accompa-
nied his interesting descriptions with beautiful plates of the
most important localities. Dividing the vast Interior valley
into three Basins, the Southern comprehends the Gulf of Mexi-
co, the Delta of the Mississippi, the Bottoms and Bluffs of this
river above its delta, the Regions west and east of the Gulf
and of the Mississippi, and the Ohio basin; the Eastern basin
includes the great Lakes and their estuary the St. Lawrence;
and the last is constituted by the Hudson Bay and arctic re-
gions.

The quantity and quality of materials suspended and dissolv-
ed in the water of our rivers must necessarily vary exceedinglv
and be modified by the extent and geological formations of the
regions which they drain, as well as by the density of the popu-
lation inhabiting them. The Mississippi river, deriving its
waters from almost every kind of geological formation, must
therefore contain not only most of the soluble principles of our
earth, mineral, vegetable and animal, but also the comminuted
particles of such portions of matter as may be carried by the
current in a state of suspension. The latter will especially
vary, however, at different points of the river according to the
facility with which they may gravitate to the bottom ; the more
ponderous being carried only a short distance, whilst the lighter
may be readily conveyed thousands of miles. According to
Professor Bailey the water of the Mississippi abounds in micro-

400 Dr. Drake's New Work. [July,

scopic infusoria. In the water at St. Louis he detected no less
than twenty species, all living and active ! The proportion of
suspended matter in the Mississippi water at New Orleans has
been found to be TVo m bulk, or about T in weight. One
hundred parts of the sediment deposited by the water opposite
St. Louis yielded the following results :

"Silica, . - . 48.00

Alumina, - 18.50

Oxide of iron, - - - 14.00

Carbonate of lime, - - 8.00

Phosphates of alumina and iron, 1.00

Vegetable mold, or geine, - 3.00

Undecomposed organic matter, 7.50

* 100.00 "

and the elements held in solution in 100 parts of the same water
were found to be

"Sulphate of soda, with a trace of the chlorides of) _..

lime and magnesia, \

Organic matter, with a trace of Silica, - - 32.45

100.00

Yet the Mississippi water is held to be rather beneficial than
injurious to health !

"The salubrity of the Mississippi water, or that of the Mis-
souri, which imparts the character of turbidness, is not an open
question. From St. Louis to New Orleans, the testimony of
the population on its banks, and of those who spend a great
part of their lives upon it as watermen, is unequivocally in its
favor. Many persons drink it before its suspended materials
have subsided, and seem to prefer it to that which has been
rendered transparent by time or art. That it produces some
effects on the system, which transparent water, from wells and
springs, and our other rivers, does not, is an established popu-
lar opinion. It is even regarded by many persons as being, to
a certain extent, medicinal, and especially adapted to the cure
of chronic functional disorders of the stomach, bowels, and liv-
er an opinion in which I am disposed to concur. That its
daily use averts some forms of disease, may be admitted as

* Note, by Dr. Raymond. In this analysis all the precipitates were dried to
212 Fahrenheit; at this temperature the alumina, oxide of iron, and carbonate
oi lime would retain water equal to about one half of their weight.

1850.1 Dr. Drake's New Work. 401

probable ; but precise observations on all these points are want-
ing ; and I shall dismiss the subject with the presentation of
two facts, in which, I trust, the reader will take a pleasant
interest. First : Professor Bailey, after observing its numer-
ous shoals of microscopic animalcules, expresses the opinion,
that they are sufficiently abundant to render the water some-
what nutritious. Second: In his Letters on Louisiana, written
in the year 1751, Captain Boissu informs us that the Mississippi
water has the propertv of contributing to the 'fecondite des
femmes /' * (p. 72.)

Part II. of the work occupies about 190 pages, and embraces
under the head of Climatic Etiology an elaborate investigation
of the temperature of the Interior Valley, its atmospheric pres-
sure, winds, aqueous meteors, electrical phenomena, plants and
animals.

The General table of mean temperatures furnished by the
author, comprises 82 places extending from South to North.
We subjoin a few of the most important points. The mean tem-
perature of Havanna, is - - 77.34
" Key-West, " - - 76.48
" New Orleans, " - - 71.32
" Pensacola Bay, " - - 68.16
Mobile, " - - 70.29
" Natchez, " - - 66.86
" Huntsville, Ala. " - - 59.73
" Nashville, Tenn. u - - 58.46
" Louisville, Ky. ** - - 55.00
" St. Louis, Mi. " - - 55.55
" Cincinnati, " - - 53.36
Detroit, Mich. " - - 47.43
" Fort Gratiot, Mich. " - - 46.83
" Rochester, N. Y. " - - 46.68
" Montreal, - - 44.57
u Quebec, " - - 37.66
The following observations will correct an error very gen-
erally entertained :

"Alleged greater Heat of the Middle Latitudes of
the Interior Valley, than op the Atlantic Plain. In
1783, Mr. Jefferson published, that the Basin of the Ohio was
warmer, by the amount of three degrees of latitude, than <>he

N. s. VOL. VI. no. vi. 26

402 Dr. Drake's New Work. [July,

maritime belt east of the mountains;* and about twenty years
afterward, M. Volney,f on returning from his travels through
this country, adopted the same conclusion. In 1815, I endea-
vored to show,J that the opinion to which those distinguished
writers had given currency was erroneous. At that time, the
number of reliable observations was small, compared with the
present ; yet the error into which Mr. Jefferson had fallen, by
a premature generalization, was correctly pointed out ; as nu-
merous observations on both sides of the mountains, have since
shown. As it is not in the plan of this work to institute com-
parisons between the climate and diseases of the Interior Val-
ley, and the regions beyond the mountains, which bound it to
the east and west, I shall limit myself to the assertion which has
been made, leaving it with others to compare the observations,
which show that in the same latitudes the temperature of the
climates on the opposite sides of the Appalachian range, is sub-
stantially the same. The physician, then, of Maryland or
Pennsylvania, who would advise his patient to emigrate to a
milder climate, must not point out the State of Ohio ; nor must
the invalid of Virginia, expect a warmer climate by removing
to Kentucky. Much of the popular perpetuation of this error,
has come from the direction of the great current of immigration
into the the middle latitudes of the Mexican, and the southern
portion of the St. Lawrence Basin. It has been largely from
higher to lower latitudes, and yet it was all, in the phraseology
of the people and the profession, to the West. They reached a
warmer climate, by going south, and without investigation pro-
nounced it the consequence of travelling westwardly." (p. 476.)

The variations of season in different latitudes are thus
summed up.

"In the equatorial regions, the seasons present but little varia-
tion ; and the difference between winter and summer, is not as
great, as that between one hour and the next, in the temperate
zone. In advancing to the north, the curves which indicate the
temperatures of those seasons, immediately begin to diverge,
and continue to separate wider from each other, until we reach
the fifty-third parallel of latitude. This divergence another
expression for the difference between winter and summer
proceeds pari passu with the decrease of mean annual heat;
so that the individual who travels from south to north, is con-
stantly subjected to a climate of less mean heat, and greater
extremes of summer and winter temperature, than that he left
behind. He cannot anywhere in the Valley enjoy a temperate

* Notes on Virginia. t View of the Soil and Climate of the TJ. S.

t Picture of Cincinnati, by Daniel Drake. 1815.

1850.] Dr. Drake's New Work. 403

summer, without encountering a rigorous winter and a low
annual heat ; nor a mild winter, without a hot summer, and
high annual heat." (p. 491.)

In the Table (p. 588) representing the average quantity of
rain and snow per annum at 52 places, we find it to be

At

New Orleans,

51.204 inches.

Mobile,

66.915 "

Natchez,

60.120

St. Louis, -

39.670 "

Huntsville, Ala. - .

54.878 "

Nashville -

55.002

Cincinnati, -

35.332 *

Rochester, N. Y.

34.920 "

Toronto,

32.798 "

The author, after dwelling upon the heterogeneous charac-
ter of the population of the great valley, derived as it is from
the various nations of Europe, from the Atlantic States of the
Union, from the African and from the Aboriginal tribes, all of
which are undergoing a regular process of amalgamation, ar-
rives at the conclusion that we cannot as yet define any physio-
logical peculiarities as characteristic of this vast region. He
thinks it probable, however, that as the population assumes a
fixed character, u Autumnal fever will decrease, and typhus
and typhoid fevers become more prevalent ; gout will occur
oftener than at present ; the diseases produced by the intem-
perate use of ardent spirits will diminish ; consumption and
scrofula will increase; apoplexy, palsy, and epilepsy will be-
come more frequent ; diseases of the liver will become less, and
those of the mucous membrane of the bowels, more prevalent ;
and lastly, mental alienation will be more frequent."

We regret that, from the statistical nature of the work, we
cannot furnish even a summary of the facts so industriously and
judiciously accumulated. We must therefore be content with
recommending their attentive perusal to all who may wish to
study the subject. The portion of the volume devoted to spe-
cial diseases comprehends about 165 pages, in which we find
treated Intermittent and Remittent fevers, each being subdi-
vided into simple, inflammatory, and malignant. The remarks,

404 Dr. Drake's New Work. [July,

upon their geographical limits and causes are exceedingly judi-
cious and instructive, and, we think, conclusively demonstrate
the futility of any attempt to discover a special morbific agent,
instead of regarding (as we have done for many years) a varie-
ty of circumstances connected with soil, temperature, moisture,
electricity, animal and vegetable decomposition, the growth of
forests and agricultural products, the evolution of animalculae
and fungi, &c, as concurring in greater or less numbers in the
causation of autumnal fevers. Yet the author concludes the
subject by stating that, " Ignorant, however, of any definite,
efficient cause for autumal fever, I am a full believer in its ex-
istence, and shall speak of it as a specific agent, known only by
its effects on the living body."

The treatment recommended by Prof. Drake for " Simple
Intermittent fever," is very much the same as that formerly in
vogue on the atlantic slope. Whether or no this form of fever
differs upon the eastern and western declivities of the Appala-
chian heights, we are not able positively to determine, as we
have not had an opportunity to make personal observations.
Were we left, however, to form an opinion from the work be-
fore us, we would acknowledge that we can perceive no differ-
ence. We therefore feel confident that the vast improvements
made in this section of the country in the treatment of, not only
* Simple Intermittent," but also of every other form of Inter-
mittent and Remittent fever, might be adopted with advantage
in the great " Interior Valley." Those amongst us who have
so long adopted the plan of never permitting the patient to have
another paroxysm after seeing him, would feel restive under a
system of "preparative treatment," consisting of " blood-let-
ting," " emetics," and " cathartics." Desiring to do full justice
to the author, we quote his own words.

"Bloodletting. In the beginning of simple intermittents,
we often find much vascular fullness, and during the hot
stage, a considerable resistance in the pulse, with great heat,
thirst, jactation, headache, backache, and pains in the perios-
teum of the long bones. Such a concourse of symptoms,
would seem to indicate a phlogistic diathesis ; but in reality
they are the expression of a febrile condition only, and in
a few hours will entirely cease, to be renewed the next day,
or the next but one. Shall we admit that in this condition

1850.] Dr. Drake's New Work. 403

the lancet is demanded ? The answer, I think, should be, that
whenever the constitution is vigorous, and the physician is
called to an early paroxysm, bloodletting is not only safe,
but will both mitigate the symptoms, and prepare the system
of the patient for other remedies ; which, in many cases fail,
or succeed but imperfectly, from the tone and fullness of the
vascular system, (p. 743.)

" My own experience, with that of many others, leads me to
commend emetics in this form of fever. When the circum-
stances already recognized as suggesting venesection exist, let
it be first employed when they do not, an emetic may be the
first remedy. A free and full evacuation of the stomach is
followed by a decided improvement in its condition, by a ten-
dency to sleep, and an abatement of the dryness of the skin, if
not an actual perspiration. The emetic may be given during
the hot stage, if the arterial system should not be plethoric ; or
it may be administered in the intermission, or at the access of
the chill, which it often shortens, and sometimes averts. In
fact, when the disease has lasted for a while, a powerful vomit
just before the shake, is one of the successful modes which the
people adopt, for arresting the disease. It carries into the sys-
tem a perturbation, in which the paroxysmal tendency is lost.
As a preparatory remedy, an emetic empties the stomach of
undigested food, and the acids resulting from indigestion or
morbid secretion. Very commonly, however, instead of acids,
a liberal quantity of regurgitated bile is thrown up, from the
beginning, or at the close of the operation. Great comfort,
and much abatement of all manifestations of disease, generally
follow such an operation, and the stomach is prepared for the
favorable action of other remedies.

"Cathartics. In the commencement of simple intermittent
fever, the bowels are generally sluggish, if not torpid, and
charged with feculent matters and bile. A cathartic is, there-
fore, indispensable, whether an emetic be first administered or
not. Of this cathartic calomel should always be an ingredient,
as a complete emulgence of the hepatic ducts, is a desideratum.
The old-fashioned dose of ten grains of calomel with ten of
jalap, with or without one grain of tartarized antimony, is
equal to any other formula ; but calomel, in a dose of ten, fif-
teen, or twenty grains may be given alone; and after its
alterant action has been exerted on the liver, its cathartic
effect may be quickened by an infusion of senna, with or with-
out sulphate of magnesia. The best time for the operation to
take place is in the decline of the hot stage. If that stage
should be intense or prolonged, the bowels may not be obedient

406 Dr. Drake's New Work. - [July,

to the impress of the medicine, when a liberal bleeding will
bring on free and full purging. Jn some cases the liver is in
a high state of functional excitement ; and there is an un-
common development of the elements of the bile. Such a
condition is indicated by yellowness of the eyes, a sallow
complexion, and a tongue covered with a heavy yellowish fur,
large quantities of bile being at the same time brought away by
the operation of cathartic medicines. It is quite possible, how-
ever to attach too much importance to the removal of these
symptoms, and to be over anxious for a clear and healthy tongue
before proceeding to other measures. In short, I can see no
sufficient reason, for a continuance, through many days, of a
treatment which, carried to any extent, will seldom arrest the
disease. Indeed, I suppose it would be better to leave the
patient to himself, than by the daily repetition of drastic
evacuants, to reduce his strength, and irritate, if not inflame,
the mucous membrane of his stomach and bowels; for, if
brought into such a condition, he would not be prepared, but
rendered unfit, for the treatment which is essentially remedial.*'
(p. 744.)

It is manifest from the following paragraph that the author
is acquainted with our plan of treatment and pathological
views :

"Omission of Preparatory Treatment. At the outset it
may be asked, whether the sulphate of quinine will cure inter-
mittent fever without the preparatory treatment which has
been recommended ? The answer must be that it will ; for in
the south, it has of late, been frequently administered, as the
first medicine, and found successful. This may seem incredi-
ble to those, who, adhering rigorously to old ideas, regard
evacuation, revulsion, and time, as curative; and the sulphate
as a tonic, maintaining and carrying on what they had com-
menced ; but those who see in that medicine, a power of es-
tablishing in the system a peculiar action, incompatible with
the febrile will have little difficulty in believing the report that
it has often succeeded, without preparative treatment. Re-
garding the morbid state of the secretions, as the effect and not
the cause of the disease, they will consistently suppose, that
the best corrective for that state must be the agent which can
supersede the febrile action by one of its own. Nevertheless, I
believe the preliminary treatment, which has been pointed out,
generally advisable, and in many cases indispensable. This
remark, however, applies chiefly to the early stages of the
disease ; for in relapses, no treatment preparatory to the ad-
ministration of the sulphate, is in general required." (p. 747.)

1850.] Dr. Drake's New Work. 407

Arsenious acid, although once famous in intermittents, has
lost much of its celebrity since the introduction of Quinine. It
is still however a valuable remedy, and may enable us very
often to dispense with the use of the more costly interloper.
The following formula is that recommended by Dr. Drake :

" Ff . Arsenious acid, grs. j.

Finely powdered opium, grs.iv.

Mix intimately, and divide into sixteen pillls.

Three or four of these pills, in the course of twenty-four
hours, are as much as can be long borne. If the disease should
not yield, by the time the stomach becomes irritable, with some
degree of epigastric tenderness, or the face exhibits an incipient
oedema, it is not advisable to continue the medicine any longer.
Sixteen grains of sulphate of quine, added to this formula, will
make it as effective in obstinate agues, as any other remedy
with which I am acquainted." (p. 751.)

We cannot refrain from re-producing a passage well calcu-
lated to account for the popular tendency in favor of homoeopa-
thy. We do not think that any practitioner in our section of
country has ever used such rash medication ; but it cannot be
denied that our people have taken, and still take much more
physic of all kinds than can be necessary or useful.

"The Purging Practice (in Remittent fevers). At all
times, and with all our physicians (except those who adopted the
opinions of Broussais,) purging, as we have seen, has been an
important part of our methodus medendi ; but it required a
peculiar hypothesis, to resolve the whole treatment into that
operation. This was at length supplied, in congestion of the
portal circle and the vena cava ascendens. The removal of
this congestion constituted the sole indication of cure, and
was to be accomplished, by increasing secretion from the liver,
and the mucous membrane of the stomach and bowels. Those
who adopted this hypothesis, as simple as the gastro-enteritis
of the French school (but suggesting in the opinion of its ad-
vocates, a totally different practice), built their hopes on drastic
purging, and, consistently made calomel the governing article
of their prescriptions. Thus the mercurial and cathartic treat-
ment became united into one method, which in its application
substituted, for the discriminating skill of the physician, the
relentless punctuality of the apothecary and the nurse. Calo-
mel, in doses which the world had not hitherto known, was
given to excite the liver and mucous membrane into increased
secretion, and drastics, in corresponding doses, to drain the

408 Dr. Drake's New Work. [July,

bowels, as fast as those fluids were poured into them. The
object was not to supersede the febrile action, by a mercurial
irritation of the general system ; but to rouse the liver and
gastro-enteric membrane into secretory excitement ; and thus
transform the blood of the portal viscera into bile and liquor-
intestinalis. To this end, scruple doses of calomel were
regarded as sufficient for the mildest cases only; and drachm
doses, at short intervals, became a familiar prescription, in or-
dinary epidemics ; while, in those of greater violence, portions
of half an ounce, an ounce, or an ounce and a half, were swal-
lowed by the patient several times a day ; till in some instances,
a pound, or a pound and a half, was administered to a single pa-
tient, and gave to his excretions the appearance of chalk ! I am
not at liberty to doubt the testimony collected in the south, on
which I make this statement. In the State of Mississippi, a
physician assured me, that he had given a patient, one thousand
grains for three successive days ! As the purgative effects of
calomel do not increase wTith the dose, and yet purging was an
essential part of the cure, medicines better calculated to excite
it, were either alternated or combined with the calomel ; and
these were very commonly given in vast doses. A respecta-
planter, in the same state, assured me, that he had given, by
order of his physician, such quantities as I thought incredible ;
till I met with a neighboring physician, who declared that he
had administered, in a single case, six hundred grains of a
triple compound of aloes, rhubarb, and calomel, in equal quanti-
ties, for six consecutive days! Such instances, I am happy
to think, embrace the extremest abuses of this method ; and the
number who reached these criminal limits, was perhaps not
very great. It cannot be denied, however, that the practice,
here reprobated, was for several years, that on which numer-
ous physicians of the west and south rested their hopes; and
although in general they stopped short of the recklessness of a
few, they carried their single idea to an excess, which at length
produced a revulsion in the public mind ; and in numerous in-
stances led to their being superseded by empiricsjwho declaimed
equally against the judicious, and the headlong administration
of calomel. Under this reaction, it became, at least, difficult
to exhibit that medicine in any dose, and the blue pill is now
often substituted, when calomel would be preferable."* (p. 785.)

* Some years before the visits of which I have spoken, a physician of Louis-
iana, flippantly andhyperbolically, wrote me, that in a certain epidemic, he had
drawn " blood enough to float, and given calomel enough to freight, the steam-
boat General Jackson !" During my first visit, another who had given it by the
ounce, said his object was. to load dmen the irritable stomach, so as to prevent
vomiting! "While multitudes believed, that when they did not obtain bilious
discharges, by ounce doses, it was because they were too timid in the adminis*
tration ! (p. 804.)

1850.] Southern Medical Reports. 409

In the treatment of the malignant forms of fever, our author
is in advance of those who have preceded him in systematic
treatises, although he does not insist sufficiently npon the jugu-
lating method to meet our entire approbation.

In conclusion, we cheerfully accord to Prof. Drake the credit
of having furnished the profession with a work entirely original,
containing a vast store of useful information, and written wifh
a simplicity of style characteristic of good scholarship and cor-
rect taste. The diction is chaste, to the point, and entirely
devoid of that redundancy so common in the light literature of
the day, and so much out of place in works of science. We
earnestly hope that the learned author may soon be able to
complete a work so successfully commenced. D.

Southern Medical Reports ; consisting of general and special
reports on the Medical Topograghy, Meteorology, and preva-
lent diseases of the following States: Louisiana, Alabama,
Georgia, Mississippi, South Carolina, Florida, Texas, Ar-
kansas and Tennessee ; to be published annually. Edited by
E. D. Fewer. M. D., of New Orleans, Visiting Physician to
the Charity Hospital, &c., &c. Vol. 1. 1849. New Or-
leans : B. M. Norman, 16 Camp-street ; New York : Samuel
S. and William Wood, 261 Pearl-street. 1849. 1 vol. 8vo.,
pp. 448.

We have been kindly furnished, by the Editor, with the
sheets of this work, which is now passing through the press,
and their perusal has afforded us much pleasure as well as pro-
fit. The volume contains a large collection of facts bearing
upon many subjects of great interest to the medical profession,
and especially to those who practice in the South. The work,
as its title imports, is made up of reports from physicians in
several of the States upon the topography, diseases, &c., of
their sections. We propose to bring some of these reports to
the notice of our readers, premising that, from the character of
such a work, it will be impossible for us to do more tban give
a brief summary of some of its most important contents.

A large portion of the volume (255 pages) is occupied bv
reports from Louisiana. The first of these is on the Medical
Topography and Meteorology of New Orleans, with an account

410 Southern Medical Reports. U^Y*

of the prevalent diseases during the year 1849, by Dr. Fermer.
We learn from this report that there are two rainy seasons in
New Orleans, and the adjacent country ; one in summer, and
the other in winter; and that the quantity of rain which falls
in each season is about the same. The annual average of rain
for the last ten years was 69.632. The mean annual tempera-
ture during the same period was 70.6.

There are some interesting remarks on the subject of accli-
mation. The views of Dr. Fenner are embodied in the following
extract:

* 1. That persons coming from more northern latitudes to
this, have to undergo an acclimation or seasoning, before they
become secure in the enjoyment of good health.

"2. That this acclimation may be attained without sickness ;
but that, most generally, it requires the endurance of one or
more spells of the customary endemic fevers.

" 3. That an attack of the endemic yellow fever effects great-
er security against subsequent attacks, than any form of fever
seen in the country ; but that the remark is applicable, in some
degree, to all of them, excepting the ordinary mild intermit-
tents.

"4. That persons may have yellow fever more than once,
though it is evident that those who have had one plain attack,
usually have little or nothing to dread from subsequent attacks.

" 5. That Creoles, or natives of New Orleans., may have yellow
fever though generally, they have it in very mild form."

Cholera made its appearance in New Orleans in the latter
part of the year 1848, but soon subsided. In the early part of
1849, the city was visited by a second epidemic of Cholera,
which continued its ravages with more or less severity until
July. During the first six months of the year, the deaths from
Cholera were 2608, and of all other diseases 2794. In the
month of May, the back part of the city was inundated by the
Mississippi, and remained under water until the 18th of June, a
period of about forty days. Many persons felt much alarm,
lest the subsidence of the flood should be followed by a sickly
season. The remainder of the year, however, was unusually
healthy. This, we learn from Article Second, on the subject
of the inundation in 1816, was the case during that year, as

1850.] Southern Medical Reports. 411

also after the inundations in 1785 and 1791. During the sum-
mer it is true that a few cases of yellow fever occurred, but it
is worthy of remark, that the deaths from this disease were
almost exclusively confined to the cases in the Charity Hospi-
tal, those occurring in private practice almost all recovering.
Dr. F. attributes this fact to the mildness cf the disease which
led the laboring class, who are usually ignorant or reckless, to
neglect their cases, under the belief that the fever under which
they labored was not of a serious character. During the lat-
ter part of the year, diarrhea and dysenteries were somewhat
prevalent. The dysenteries were easily relieved, if taken in
time, by a combination of quinine, blue mass and morphine.

Article Third is devoted to the Hydrography of the Missis-
sippi river. It has been carefully prepared by Caleb G. Forshay,
A. M., Civil Engineer, and is accompanied by a diagram exhib-
iting the rise and fall of the river during the year 1849, and also
its mean height for thirty years in groups of ten years.

Article Fourth, is an elaborate report of the Board of Health
of New Orleans, prepared by Dr. Barton. The first part is
devoted to "the condition of the city as to health during the
year 1849," and the remaining part to "the suggestion of such
means as are advisable for improving the same." The report
complains of the imperfection of the data in relation to fevers,
and indeed all special diseases, yet it expresses a belief that
fevers have diminished "in numbers, intensity and mortality,"'
owing probably to the improvements which have been made,
and particularly to draining in the rear of the city. The num-
ber of deaths from Phthisis is remarkably small, especially if
we take into account the number of consumptives from north-
ern regions, who resort to New Orleans during the winter
months, and die there. The proportion which the deaths from
Consumption bore to the whole mortality for 1849, was only
9.37 per cent., whilst in Havanna it was 19.50, and in Charles-
ton, 18.27. Exclusive of the deaths from Cholera, and causes
other than disease, the mortality in New Orleans for 1849,
amounted to 6314, being at the ratio of 1 in 16.67, the stationa-
ry population being estimated at about 105,000. A very con-
siderable portion of this heavy mortality was of course derived
from the floating population, which is very large during a part

412 . Southern Medical Reports. [Juty>

of the year, and is made up of persons not only unacclimated,
but many of them of broken down constitutions, and given to
various kinds of excess. That a large part of the mortality is
thus derived, is proven by the fact that of the deaths by fevers,
870 were foreigners, and but 85 citizens of the United States.
Notwithstanding that a part of the great annual mortality of
New Orleans can thus be accounted for, it cannot be denied
that until a great sanitary reform is effected, the chances of
human life are much less in that city than in most other cities
of the Union. Appended to this report are several mortuary
and meteorological tables, which sustain the various positions
of the writer.

The fifth Article is "a special report on the fevers of New
Orleans, particularly the Yellow fever of 1849, by Dr. Fenner.
This is an interesting paper, though some of its positions will
not be generally admitted : we allude more particularly to the
writer's opinions on the nature of Yellow fever. He advocates
the opinion that this disease is but a modification of the ordina-
ry remittent and intermittent fevers of that locality. But we
will let him speak for himself. He says, " Cases are seen every
sickly year, commencing as intermittent or mild remittent, and
wanting those strongly marked diagnostic symptoms which
have been said to distinguish yellow fever ; yet which, if neg-
lected or maltreated, terminate in hemorrhage and black vomit.
In these cases, the advocates of the specific character of yellow
fever contend that the patients contract a new and different dis*
ease; but we think improperly. We believe it is all the same
disease ; differing only in grade and stage." He further goes
on to say, "A vast majority of cases in their mild forms, and
the early stages of the more grave, are just such as are seen all
over the southern country. The more malignant forms, and
the advanced stages of the mild, have a decided tendency to
terminate by hemorrhage. This makes what is called yellow
fever, and is the main feature that distinguishes it from the
endemic fevers of the country. Physicians may say what they
please about being able to distinguish a case of yellow fever
as soon as they examine it : we don't believe it possible, ac-
cording to their ideas." We are not prepared to give our
assent to these views. Our opportunities for observing inter-

1850.] Southern Medical Reports. 413

mittent and remittent fevers have been by no means inconsid-
erable, and the frightful epidemic Yellow fever which ravaged
our city in 1839, gave us ample opportunity to learn something
of the character of the latter disease, and we feel no hesitation
in expressing the firm conviction that these do differ in some-
thing more than " grade and stage." And this we believe is
the opinion generally entertained by those who have had op-
portunities for clinical observation of these diseases. In our
own section we sometimes meet with remittent or "bilious
fevers," as fierce, and as rapidly fatal as yellow fever, but never
presenting the peculiar features of this latter disease. In some
sections of Georgia and South Carolina, the mortality from
febrile diseases, among unacclimated individuals, will exceed
that of New Orleans. In some localities, to sleep one night is
almost certain death. Yet in such places we hear of no yel-
low fever. Besides, it is known that second attacks from yellow
fever are comparatively rare, indeed so rare that by many,
persons who have once passed through the disease, are deemed
almost as secure from its future visitations, as small-pox sub-
jects are from a second attack of variola. This we know is not
the fact in relation to our ordinary malarious fevers. An at-
tack of intermittent fever renders an individual more liable to
be re-attacked ; and remittents, though not so apt to be followed
by a severe return, often attack the same individual frequently
during a period of years, though usually in a mitigated form.
But we are not disposed to discuss the question, and will leave
it for those whose familiarity with yellow fever will enable
them to speak more reliably upon this subject.

It appears from this report that there were admitted into the
Charity Hospital during the year 1849, 7575 cases of fever, of
which number 4439 were intermittents; 10G0 yellow fever;
824 remittents ; 891 typhus ; and 130 " bilious/' The remain-
der were cases af typhoid, continued, &c, &c. In the treat-
ment of yellow fever, Dr. Fenner recommends the " abortive
method by quinine." He states, that when called to a case
within twenty-four to thirty-six hours after the attack, he sel-
dom failed to cut short the disease by large doses of quinine in
combination with opium or morphine, frequently followed by a
little blue mass or calomel. He says : " Our usual mode of pro*

414 Southern Medical Reports. July,

ceeding in this stage is, to order at first a hot, mustard foot-bath
and a purgative enema then give to an adult 20 or 30 grains
of quinine with 25 or 30 drops of laudanum, or 1 or 2 grains of
opium, or the fourth of a grain of sulphate morphiae, at one dose.
This would generally reduce the vascular and nervous excite-
ment completely in the course of a few hours, throw the patient
into a profuse perspiration, relieve all pain and produce sleep.
The bowels were kept open by some gentle means, and more
or less quinine was repeated as occasion required. We recol-
lected but one fever patient that required cupping, and we did
not have a single one bled from the arm." Dr. Fenner looks
upon blood-letting as of great value in persons of a plethoric
habit. He deems it applicable to that stage in which the quin-
ine is so useful. Dr. Fenner's views of the treatment of yellow
fever have found many advocates among them was the late
Prof. Harrison.

Article Sixth, contains statistics of Yellow fever, and of all
diseases in the Charity Hospital of New Orleans, for thirty
years, from 1820 to 1849, inclusive, prepared by J. C. Simonds,
M. D. During this period, 130,000 patients have been admit-
ted, of whom nearly 13,000 were laboring under yellow fever.
From the manner in which the records have been kept, no very
important conclusions can be drawn from them.

Article Seventh, is a report on epidemic Cholera in the city
of New Orleans, 1848-'49, by Dr. Fenner. It contains many
facts in relation to the epidemic, but we do not find any which
throw new light upon the subject. In relation to the conta-
giousness of the disease, Dr. Fenner says, "although there are
on record some well authenticated, and apparently indubitable
instances in which cholera was conveyed and communicated
from person to person, yet this is neither its only, nor its prin-
cipal method of extension." Dr. Fenner defends the profession
against the charge so often made by the unprofessional, and
strengthened by the admission of some physicians, that medi-
cal men "know nothing about cholera or its remedies." He
very justly contends that we do know a great deal about both.
He says : " There can be but little doubt that at least eight-
tenths of the victims of cholera in New Orleans have died unne-
cessarily ; i. e.} they have been lost on account of their neglect

1850.] Southern Medical Reports. 415

of the plainest dictates of prudence and common sense. Ought
this to be charged to the discredit of the medical faculty? Or
ought we to confess that so many people have died of cholera
because we did not know how to treat the disease ? Certainly
not. We do know how to treat it ; and as the best evidence of
the fact, we have seldom failed to cure our patients, if called in
before they are beyond the curable stage. We had as well be
expected to raise the dead as to cure patients in articulo mortis. "

A remarkable feature in the history of the year 1849, was
the prevalence in New Orleans of an epidemic Colic after the
subsidence of the cholera in the spring. The eighth Article is
on this subject, and is from Dr. Fenner. This disease has gen-
erally been seen every summer, and on one or two occasions
prevailed to some extent. During the past year it prevailed
during the months of July, August and September, chiefly
amongst the laboring class of whites, but to some extent among
the negroes. " The prominent symptoms of the complaint
were a constant and severe griping pain in the abdomen, at-
tended with but little tenderness and no fulness, eructations,
vomiting of bile, and obstinate costiveness." Prof. Hunt and
Dr. Stone look upon the disease as a neuralgic affection. The
treatment generally consisted in the use of mercury, purgatives,
anodynes, &c, &c, and was generally successful. Dr. Fen-
ner saw one fatal case in the Charity Hospital, and was told of
three others that occurred in private practice.

We have neither time nor space to notice the remaining re-
ports contained in the volume, further than to recite their titles,
and thereby give our readers some idea of the character of the
remaining part of the work. Article Ninth, is by James B.
Duncan, M. D., on the Topography, Climate, and Diseases of
the parish of St. Mary's, La. Article Tenth, by Wm. A. Booth
M. D., on the Cholera of Lafourche Interior. Article Eleventh,
is a report on the origin and sanitary condition of the Orphan
Asylums of New Orleans and Lafayette, by J. Rhodes, M. D.,
O. Carey, M. D., and U. P. Sunderland, M. D. Article Twelfth,
gives a number of interesting statistics of the New Orleans
Charity Hospital.

From Alabama, there are four reports : the first on the To-
pography, Climate, and Diseases of Madison county, by J. Y.

41 G Southern Medical Reports. [July,

Bassett, M. D., of Huntsville. This is quite an interesting arti-
cle, written with considerable spirit and humor, and will doubt-
less be appreciated by all who peruse it. Article Second,
consists of contributions to the vital statistics of Mobile, by
George A. Ketchum, M. D. Article Third, is an abstract of
the proceedings of the Mobile Medical Society, which contains
a number of interesting facts which have been brought to the
notice of the society by its members. The last Article from
Alabama is by T. A. Bates, M. D., on the prevailing diseases
of a part of Dallas county, originally read before the Alabama
State Medical Association in May, 1849.

From Georgia, there are two reports one on the Topogra-
phy, Climate, and Diseases of Middle Georgia, by E. M. Pen-
dleton, M. D. This is a well written article which will repay
the time spent in its perusal. A portion of it has heretofore
appeared in the Southern Medical and Surgical Journal. The
other Article is a case of Insanity, by J. C. C. Blackburn, M. D.

From Mississippi, we have five reports : the first on the To-
pography, Climate, and Diseases of Jackson, the Gapital of
Mississippi, by S. C. Farrar, M. D. ; the second, on epidemic
Cholera in the vicinity of Natchez, by C. H. Stone, M. D. ; the
third, from C. S. Magoun, M. D., of Natchez, on epidemic Cho-
lera and its preventive treatment ; the fourth, a case of Disar-
ticulation and removal of one half of the inferior Maxilla for
Osteo-sarcoma, by A. M. Clemens, M. D. ; and the fifth, on the
Medicinal Waters of Mississippi the Artesian springs of Madi-
son county.

From Tennessee, there is a report on the commencement,
prevalence, treatment, &c, of pestilential Cholera in Memphis
and its vicinity; with the prominent facts bearing upon the
unsettled question of its imported or domestic origin, by Lewis
Shanks, M. D.

From South Carolina, there is an Article by Thos. T.
Simons, M. D., on the fever which is developed in the city of
Charleston, after exposure to the country air during the summer
and autumn, and known there as Country fever ; an Article on
the Yellow fever of 1849, by the Editor of the Charleston
Medical Journal, and extracted from that journal ;' and some
cases in private practice, by W. F. Holmes, M. D.

1850-1 Identity of Erysipelas and Puerperal fever. 417

From Texas, there are two reports, both mainly devoted to
the subject of Cholera, the one by J. J. B. Wright, M. D., Sur-
geon U. S. A., and the other by N. S. Jarvis, M. D., of the
U. S. A.

We have now given our readers a brief and imperfect out-
line of Dr. Fenner's work, but sufficient, we hope, to impress
them favorably with its character. It is a new undertaking,
and has cost the Editor much labor and expense, which we
trust will not go unrewarded. We hope our readers will mani-
fest their appreciation of Dr. Fenner's efforts in the cause of
medical science by purchasing a copy of his work, and giving
to it a careful perusal. By so doing, they will reap profit for
themselves, and will enable him to prosecute his laudable un-
dertaking with energy and success. Upon the patronage
which the work receives its continuance depends.

On the Identity of Erysipelas and a certain form of Puerperal
Fever, and its Contagiousness. By Ezra P. Bennett, M.D.,
of Danbury, Conn. (American Journal of Med. Sciences.)

On this subject there appears to be, at the present time, great
diversity of opinion. Some maintain I think correctly that
the two diseases are identical in their character, and that both
under certain circumstances, are contagious ; and that the mor-
bid principle of either may, under favorable circumstances,
produce the other. Others contend that they are totally and
essentially distinct, and incapable of producing and reproducing
each other, under any possible conditions.

In view of this divided state of the profession in regard to a
disease of so much importance, I have thought it might be use-
ful, or at least interesting, to send you for publication the histo-
ry of eleven cases of puerperal disease, which occurred in my
practice in the winter of 1847-8, extending into the summer
months ; giving, at the same time, my own opinion in regard
to its true nature, its identity with erysipelas, its communica-
bility from one patient to another, by the accoucheur, and by
other modes of propagation. In doing this, I am well aware
that I am arraying myself in opposition to some of the profes-
sion in this country, whose opinions, in consequence of age,
experience, talents, and position, are entitled to the utmost re-
spect and deference. But after all, facts are facts, no matter
by whom observed. Facts make up all that is useful in medical

n. s. VOL. VI. NO. VI. '27

418 Identity of Erysipelas and Puerperal fever. [July,

science. We know, for instance, that it is a fact that cinchona
will cure an ague and mercury syphilis, yet no theorizing
could ever have arrived at these facts, and no theorizing can
make them any thing less than facts.

In the fall of J 847 and 1848, a disease of a new character
made its appearance among us. It appeared to break out
simultaneously in both parishes of the town, viz., Danbury pro-
per and Bethel, which proved to be an epidemic erysipelas of
a wide-spread and fatal character: Previous to this time, cases
of ordinary erysipelas had become much more than usually
prevalent, so much so that, from being a very rare, it had be-
come a very common complaint. Many of the cases were
severe, but none were fatal. In November, it assumed an
epidemic character, of a malignant grade. This form of the
disease has been well described by my nephew, Dr. H. N. Ben-
nett, of Bethel, in the New York Journal of Medicine. A very
accurate account of it has also been given by Dr. Charles Hall,
of Burlington, Vt., and Dr. George Dexter, of Lancaster, N. H.,
in the American Journal of the Medical Sciences for January,
1844. The disease, as it occurred here, was, with a very few
and slight exceptions, a fac simile of the complaint as it occur-
red in the above-mentioned places.

My object in this paper is to prove the connection and iden-
tity of this disease with a peculiar form of puerperal inflamma-
tion, which commenced in January, 1848, when the erysipelas
was at its height, and which went hand in hand with it during
its stay in this place. I think I shall be able to prove that the
two diseases are not mere coincidences, but that they were
identically and specifically the same ; differing only in their
location and the peculiarities of the child-bed state. In the first
place, I became perfectly satisfied, during the prevalence of
this epidemic, both by observation during the life of the patient,
and by post-mortem examinations, that erysipelas is not exclu-
sively a dermoid disease. The evidence was indubitable, that
not only the skin, but the mucous membranes, cellular tissue
(primarily, and not by extension), and the serous tissues of the
pleura and peritoneum, were the seat of this disease.

The very first case of this affection to which I was called,
was an erysipelatous inflammation of the pleura. It commenced
(as I was informed by the friends) with sore throat, which was
treated for a few days by a Thompsonian. When I saw the
patient, she had a train of symptoms which were of an entirely
different character from any thing I had ever seen in a practice
of over twenty years. She had no pain in the side, or catching
in respiration, but her breathing was excessively hurried, as
was, of course, the circulation; her face was cadaverous; look

1850.] Identity of Erysipelas and Puerperal fever. 419

anxious ; said she was in no pain, but was very tired ; no rale ;
chest sounded clear ; she died within twenty-four hours ; and
left rne perplexed in regard to the true nature of her case.
Two or three days after this, I was called to see a precisely
similar case of disease, in a patient of my nephew, in Bethel.
This case was a fac simile of the other in symptoms, and ter-
minated fatally in about three days; when a post-mortem
examination revealed a case of erysipelatous pleuritis, of a most
unmistakable character. The whole pleura costalis and pulmo-
nalis of both sides was affected with a diffuse inflammation ; on
one side there was an effusion of a sero-purulent character, with
some few albuminous flocculi, on the other there was scarcely
any effusion, but some very slight adhesions. The parenchy-
matous texture of the lungs, together with their lining mem-
brane, was free from disease.

Now this was not an ordinary case of pleuritis ; there was
not the pulse of pleuritis ; there was no pain in the side in fact,
there was no pain anywhere ; her only complaint was of being
tired; the effusion was not sufficient to cause death, and that
effusion was not of a sero-albuminous character, as is the case
in pleuritis. Death was produced by excessive irritation of
the nervous system.

Again, in many cases this disease commenced in, and was in
a great measure confined to, the cellular tissue (the skin suffer-
ing but slightly and secondarily), producing diffuse cellular
inflammation of a most virulent and extensive character; in
one instance, affecting the whole trunk from the pelvis to the
chin. This was the case of a young physician, of much prom-
ise, and terminated fatally, of course. In another case, that of
a robust mechanic, the whole cellular tissue of the thigh was
affected, which terminated in gangrene and death. In a small
boy, the cellular tissue of the thigh also was affected, without
the skin participating in the affection in the least. He was
treated with poultices ; translation to the brain took place, and
he died of meningitis. Jn some cases, again, the disease attack-
ed the stomach and bowels, producing gastritis or peritonitis ;
and, in many cases, it attacked the womb and its peritoneal
covering, producing metritis and puerperal peritonitis. I am
aware that this view of the disease is directly opposed to that
of Dr. jViiigs and others. Dr. Meigs says that it is as impossi-
ble for a woman to have erysipelatous inflammation of the peri-
toneum, as to have iritis in the pylorus; a very strange remark,
by the way, and one the force of which I am totally unable to
perceive.

So far as my experience goes, the same kinds of inflammation
may occur in tissues wholly different, and that it is the effects

420 Identity of Erysipelas and Puerperal fever. [July,

of the inflammation, which are so much modified by difference
of structure. Now inflammation may take place in the iris or
in the pylorus, and that inflammation may be of the ordinary
or diffuse character ; and this is all I contend for in the present
case. A woman may have inflammation of the skin, of the
cellular tissue, of the mucous membrane, of the pleura, or of
the peritoneum, and that inflammation maybe ordinary healthy
inflammation, the disposition of which is to limit itself by con-
densation of surrounding cellular tissue, and by its disposition
to form pus in cellular textures, or in the serous tissues, by an
effusion of sero-albuminous fluid with a tendency to adhesion ;
or it may be of an unhealthy inflammation of a diffuse charac-
ter, with a disposition to spread and disorganize, according to
the cause which produced it, or the state of constitution and
general health of the patient in whom the disease occurs. Dr.
M. admits the cellular tissue may become the seat of erysipelas.
Now, if this is so, then why may not the serous tissues, as the
one is but a modification and condensation of the other? One
thing certainly must be admitted, and that is this, that erysipe-
las is not a local, but a general disease, produced by a morbid
state of the fluids, and that these diseased fluid's may produce
this peculiar form of puerperal inflammation when brought in
contact with an absorbing surface of a female recently deliver-
ed. Very many cases of a reliable character are on record,
where practitioners have communicated the disease to puerpe-
ral females, after dressing erysipelas ulcers, when due attention
has not been paid to cleanliness. Now is it not a general rule
that, when vitiated animal fluids are capable of producing dis-
ease in a healthy person, I say is it not a fact that the disease
produced is of a similar character to the one which produced
it? Most certainly it is: there may be slight modifications,
but the general characters of the disease remain the same.
Variola never produces rubeola, nor syphilis variola ; but like
produces like. Now is it at all probable that the disease in
question is an exception to this general rule ? Is it to be sup-
posed that inoculation of a puerperal patient with the morbid
matter of erysipelas, should produce any thing but erysipelas?
Certainly not.

Again, it is a well established and acknowledged fact that,
when any malignant disease is prevailing epidemically in a cer-
tain portion of country, all the diseases of that district are more
or less modified by and assimilated to the prevailing epidemic.
Now, if this is so (and I trust there are very few who will deny
it), what effect would an epidemic erysipelas be likely to pro-
duce on an inflammation of the peritoneum in a. child-bed wo-
man"? Would it not so modify it as to produce an erysipelatous

1850.] Identity of Erysipelas and Puerperal fever. 421

instead of an ordinary inflammation? This certainly cannot
be denied. Thus it is that the same miasmatic state of atmos-
phere may produce erysipelas of the skin in one, of the cellular
tissue in another, of the mucous membrane in another, of the
pleura in another, and, most of all, would it be likely to pro-
duce metritis or peritonitis in a woman recently delivered, as
her situation would be such as particularly to invite the disease
to locate in that region. When erysipelas prevails in hospitals,
wounded patients, from accidents or operations, are always sure
to be attacked with it. Xow a woman just delivered is in a
similar condition to a wounded man, in more respects than one.
She may have lost an undue quantity of blood, which renders
the system- peculiarly liable to this kind of disease ; besides,
that portion of the wornb from which the placenta has been
separated, is not in a very dissimilar condition from that of a
wounded person from other causes. I do not pretend to say
that it is exactly similar, but there certainly is something analo-
gous in the two conditions. If the disease attacks the mucous
membrane of the uterus, and spreads from thence to the perito-
neum, it proves just as conclusively that the peritoneum is sus-
ceptible to this kind of disease as if it had originally commenced
there. All I want to prove is that the peritoneum may take
on erysipelatous inflammation, of which fact I myself have not
the least doubt. When this is once fairly established, the con-
troversy in regard to the identity of the two diseases is at an
end, and the point established that they are identically one and
the same disease.

Again, if it can be proved that the mucous membrane of the
uterus may be, and sometimes is, the seat of erysipelas (a fact
which I believe is conceded by Dr. Meigs himself), then what
objection in saying that a certain form of puerperal fever is
identical with erysipelas ? yea, more, that it is erysipelas itself?
In most of the cases which occurred here, the disease evidently
commenced in the uterus, and sometimes confined its ravages
entirely to that organ ; in other cases, it evidently extended
to the peritoneum in a gradual and progressive manner: its
progress could be traced as easily up the peritoneum as it could
be traced upon the external surface.

Another powerful reason for considering this affection as
erysipelatous, is the fact that many of the children born of these
women died within a few days with erysipelas of the scalp.
Now if these females did not die with erysipelas, how happens
it that so many of their children should happen to be attacked,
whilst no other infant born at the same time suffered? To say
the least of it, it is a remarkable coincidence.

Remote Cause. The remote cause of this complaint was

422 Identity of Erysipelas and Puerperal fever. [July*

undoubtedly a vitiated, miasmatic state of atmosphere. What
the peculiar poison contained in the atmosphere at this time
was, no one can say with any degree of certainty. It was pro-
bably of such a character as to produce a defibrinating effect
upon the blood to a certain degree, but its greatest influence
was exerted upon the brain and nervous system, prostrating
the vital energies and preventing healthy reaction.

Predisposing Causes. There seemed to be but one predis-
posing cause, and that was a want of stamina in the constitution.
It was confined almost exclusively to the anemic ; so much so
was this the case, that I could generally predict with certainty
who would be attacked and who would not. Not one healthy,
red-faced woman was attacked. If my patient was florid in
the face, and did not flood, I usually felt that she was secure ;
if, on the contrary, she was pale and weak, or flooded much,
my apprehensions were always excited.

Exciting Causes. These were the peculiar condition of the
system induced by labour, exposure to cold, and the abuse of
stimulating drinks, and, in some cases, excessive purgation.

Prevention. There are only two modes of prevention ; one
is to give the patient, before parturition, such a hygienic and
therapeutic course as to improve her general health to such a
degree as to enable her to resist the poisonous influence of the
disease. She should take regularly as much exercise in the
open air as she can possibly bear without fatigue ; her diet
should consist principally of bread and lean meat, with oysters,
eggs, &c, and with her meals she should take moderately of
good, sound porter, or good wTine ; her bowels should be moved,
if costive, by enemata of moderately cool water, to which, if
necessary, a little salt may be added. Purgatives should be
sedulously avoided. The body should be sponged daily with
water, not cold or warm, but of such a temperature as to feel
slightly cool, after which it should be well rubbed with a coarse
towel. In regard to medicines, I should place the most reliance
upon some of the acidulated preparations of iron and cinchona ;
they should be used for at least two months, if possible, before
delivery, and continued after delivery until the danger is past.
The only sure preventive, however, is removal from the infect-
ed district; this I believe will never fail; every woman who
went abroad to be confined did well.

To write out the history of the eleven cases in detail, would
extend this communication too far ; I shall therefore give a
brief synopsis of the symptoms, treatment, peculiarities, ter-
minations, &c, from which as correct deductions can be drawn
as from a detail of each case separately. Of the eleven cases
attacked, ten died ; nine were attacked in just about forty-eight

1850.] Identity of "Erysipelas and Puerperal fever. 423

hours after delivery ; two were attacked in twenty-four hours
after delivery.

The disease commenced invariably with a chill, which was
usually slight ; there was pain in the head and hack, and, in
ahout half the cases, pain also in the bowels ; but this was not
constant, and, except in two cases, was slight. The most that
they complained of was a sense of weariness; they were very
tired, was the usual reply, I feel quite comfortable if I was not
so tired. In the commencement, in every case, the uterus
could be felt just above the pubis a little enlarged and tender,
but this tenderness did not extend beyond the uterus. The
belly was soft and flaccid ; the milk was usually suppressed, but
not always the lochia, but its character was changed to a dirty
sanies. By degrees, in some cases, the bowels became gradu-
ally distended and resonant, but not to that degree that we ob-
serve in ordinary peritonitis ; they wrere not hard and rigid, but
had a soft and doughy feel ; but in the majority of the cases
the bowels were not distended during any part of the disease,
but remained soft and flaccid to the last. Immediately after
the chill, the pulse rose rapidly up to 160, which was its maxi-
mum ; it was weak and easily compressed. The tongue was
covered with a thin, white coat ; the urine scanty and high
colored ; skin cool, preternaturally moist and sticky ; counten-
ance leaden, look anxious ; slight disposition to diarrhoea, so
that purgatives operated quickly, powerfully, and, in most
cases, injuriously prostrating the powers of the patient without
at all relieving the disease. The intellect could hardly be said
to be clear, although there was no delirium, except in the last
stage of the disease ; yet there was this peculiar hebetude of
mind and peculiar indifference to their condition, which we
often see in fatal disease of the bowels. In only two cases did
the patients seem to be fully aware of their real condition; they
did not generally consider themselves as very sick, or that there
was danger of death ; towards the close'ofthe disease the mind
usually wandered.

Two cases only terminated in gangrene ; the rest died from
the exhausting effects of the disease, or the poison of the disease
acting on the nervous system. In regard to treatment various
plans were adopted. The first cases which occurred, were
treated with calomel and opium, fomentations and blisters to
abdomen, with saline diaphoretics and mercurial inunctions,
with a view, if possible, to produce a very gentle mercurializa-
tion ; then, as the cases continued to prove fatal, other remedies
were given either separately or conjointly, as spirits of turpen-
tine, externally and internally, camphor, serpentaria, nitre,
quinine, ammonia, &c. Toward the close of the epidemic, I

424 Identity of Erysipelas and Puerperal fever. [July,

bled three ; the loss of blood was soon followed by symptoms
of syncope, so that in neither case was there taken more than
eight ounces of blood, and this was not repeated ; the blood
was buffy and cupped. I bled at the very outset of the disease,
as soon as the chill was felt ; one of these cases recovered, one
lived about two weeks, and at one time her pulse fell to 110 ;
she had had mercurial injection rubbed into the abdomen and
thighs, and was slightly mercurialized. This produced, in my
opinion, the mitigation of the symptoms as they occurred simul-
taneously, but a change for the worse soon took place and she
died. In one case (the last case which occurred), the bleeding
did not appear to have any effect. In the patient which recov-
ered, in addition to the bleeding, I put her upon full doses of
opium and digitalis, and blistered the abdomen; purgatives
were invariably hurtful. Moving the bowels by injections,
was productive of the most benefit. The time of death varied
in different cases, from twenty-two hours to fourteen days;
mean duration of the disease was about five days ; those who
were bled survived the longest.

Can this disease be communicated from one person to another
by the practitioner ?

This is a very important question, a correct answer to which
would be exceedingly desirable, as it affects seriously both
practitioner and patient. That it can be conveyed from one
patient to another, is probably correct, where due attention to
cleanliness is not observed ; but if ordinary attention be paid
to person and clothes, I do not believe it will ever be thus pro-
pagated. In this epidemic, I am quite sure that it was not thus
caused in a single instance ; for had it been so caused, it would
not have attacked one and then passed over five or six to ano-
ther ; but it would have attacked in succession, all the females
where I attended, wrhich was by no means the case. Only one
out of five were sufferers from it. Moreover, in three or four
of the cases, before attending them, I washed my whole person
with soap and water, then with a solution of chloride of lime,
and then with alcohol, changing every article of dress, and
putting on clothes which were entirely clean. Yet, notwith-
standing this precaution, they were attacked and died. I did
this in the last case that occurred ; I then was satisfied that the
disease was not propagated by the hands or clothes of the phy-
sician ; and I went from her dying bed and attended two ladies,
without using any precaution, and they both escaped. My
nephew in Bethel had three or four scattered cases ; he took
no precaution, but had no more cases.

The next question is, can the practitioner convey it in his
own system, and communicate it by his breath, or by his cuta-

1850.] Puerperal Convulsions. 425

neous transpiration? This question I will not attempt to an-
swer. I was constantly in the erysipelas from its beginning,
was very much fatigued and worn down by constant riding
and attendance on the sick, and in May, I had an attack of
erysipelas of the face, which confined me for two weeks and
over. Now about half of these cases occurred before I was
taken with the disease and about half after I recovered and
resumed my professional labours. Every case of this disease
occurred in my practice ; however, it must be born in mind
that, at the time of its commencement, I was doing nearly all
of the obstetrical practice of the town, being the oldest and
only married physician in the place.

Pueperal Convulsions succsssfully treated by Chloroform. By
John Senior Turner, Esq., M.R.C.S., Mansfield. (London
Lancet.)

I was called, about eight P. M., on the 25th of September

last, to attend Elizabeth F , aged twenty -two, who was in

labour of her first child. I found everything natural, and a
living child was born about half-past nine, the placenta follow-
ing in a few minutes. Having left an anodyne draught, with
orders for its being given when- the patient was in bed, I re-
turned home.

At three A. M. of the 26th, I was summoned in great haste
to the patient, whom I found labouring under puerperal con-
vulsions. She having already had three fits, I immediately pro-
posed bleeding. As the friends strongly opposed this step, I
reluctantly consented to defer it for a short time, and mustard
plasters were applied to the legs and feet; but another fit
supervening, I determined to wait no longer, and I bled the
patient to twenty ounces, without any alleviation of the attacks,
either in intensity or duration. She continued insensible be-
tween the fits. I then ordered a turpentine injection ; the
head to be shaved, and cold applied to it ; and a mixture con-
taining sulphuric ether, ticture of cardamom, and camphor
julep, to be taken every hour. I also gave two* drops ofcroton
oil, which operated freely in about an hour. The pupils were
generally dilated, and the retina showed very slight sensibility ;
the eyelids were half-closed ; the breathing was stertorous, ex-
cept just previously to the accession of a fit. Matters con-
tinued in this way the fits coming on about every fifteen or
twenty minutes till twelve o'clock, when a consultation was
proposed.

I felt a strong desire to administer chloroform, from having

426 Puerperal Convulsions. [July,

read of its good effects in some cases of tetanus and hydro-
phobia, and believing that there was some analogy between the
cases: but feeling the responsibility of trying so powerful an
agent without a second opinion, my friend Mr. Cooper was
sent for. He not being at home, I waited until half-past two
o'clock, but the attacks continuing with the same frequency,
and each successive fit leaving the patient in a more profoundly
comatose state, I resolved on applying the chloroform.

A few minutes before the usual time for the accession of a
fit, I put her under the influence of this agent, and repeated its
application when any restlessness (which always preceded a
fit) was apparent. No fits recurred after the application, till
after three o'clock, when the period for three attacks having
elapsed, I resolved to discontinue the remedy, and await the
result. At a quarter past three a fit again came on. I then
resumed the use of the chloroform, with the same results as be-
fore. On one occasion, the patient not having been brought
under its influence with sufficient promptitude, a slight convul-
sive movement of the right hand was visible, but of no other
part of the body. Mr. Cooper arrived about half-past four, and
coincided with me in the propriety of continuing the treatment.
Another fit, as violent as before, and attended witb episthotonos,
occurred just at this juncture, I having again omitted the use of
the remedy. The next fit came on at half-past six, our chloro-
form being exhausted, and a fresh supply not arriving in time.
About this time a full dose (seventy drops) of laudanum was
given. The cloroform was again assiduously applied as before,
till half-past eight, when, not expecting any return, and having
neglected to watch the premonitory symptoms, another fit
occurred, and I am happy to say, that from that time there was
no recurrence of the fits. I left the house soon after, but visit-
ed the patient again about eleven, when I found her in a com-
fortable sleep, and perspiring freely.

Sept. 27th. At our visit this morning we found conscious-
ness had partially returned. The patient had passed a quiet
night, without any convulsions. She was sufficiently sensible
to put out her tongue when requested to do so. She continu-
ed to improve during the day, and convalescence was gradual
and uninterrupted. She is at this time in good health.

The only subject of complaint afterwards was some pain in
the head, which was relieved by anodyne medicine. The
lochial discharge had continued unaffected from the first.

I think it is evident, that in the above well-marked case of
puerperal convulsions, the administration of chloroform had a
powerful effect in controlling and postponing the fits, and I also
think that its influence was manifestly beneficial in conducting

1850,] Remarks on Vermifuges. 427

to a favourable termination one of the most formidable diseases
with which we have to contend. Doubtless the bleeding, and
probably the full dose of opium, were of service, but neither
had so obvious a good effect in arresting the convulsions as the
chloroform, which succeeded in the direct ratio of its digilent
employment.

Remarks on Vermifuges. By M. Cazin. (Dublin Journal,
from Jour, de Med. et de Chir.)

Dr. Cazin, of Boulogne-sur-Mer, having had the opportunity
of treating a large number of worm cases, has published the
following interesting account of his experience. He states that
he has frequently employed the common Spigelia or worm-
grass. He administers it in the form of decoction, prepared by
boiling two drachms of the herb in a quart of water to one half.
The decoction is then expressed, strained, and flavored with a
little lemon-juice and a sufficient quantity of sugar. The dose
for an adult is two wine-glassfuls, followed by a wine-glassful
every six hours until the desired effect is produced. To chil-
dren and delicate persons a smaller quantity is to be given.

Wormwood (Absinthium) is an excellent indigenous anthel-
mintic; it is also a powerful tonic and stimulant, the use of
which, continued after the expulsion of the worms, prevents
their reproduction. M. Cazin often uses a wine prepared by
digesting an ounce of wormwood, with an equal quantity of
garlic, in a bottle of white wine, of which he gives from one to
three ounces every morning. This wine is well adapted for
poor lymphatic subjects, wasted by wretchedness, and suffering
from the influence of a marshy soil. The Absinthium mariti-
mum is likewise a very good anthelmintic. M. Cazin gives it
to the extent of one or two drachms boiled in four or five ounces
of water, with the addition of some white sugar, or of any an-
thelmintic syrup. This is quite a popular remedy in the mari-
time districts, and almost always succeeds with children affected
with worms.

Although a case of poisoning by Cevadilla has been reported,
M. Cazin has administered this vermifuge with success in cases
in which ordinary anthelmintics had but little effect; but he
has always commenced with a very small dose, in order to
ascertain how far it would be borne by the digestive organs.
For children the dose of this plant is from a grain and a half to
four or five grains of the powder of the seeds, mixed with syrup
of rhubarb; for adults eight or nine grains, with the addition of
a little sugar and a few drops of oil of fennel. In each case the

428 Remarks on Vermifuges. [July,

dose is to be repeated daily for four days, after which the infu-
sion of chamomile is to be given.

Assafcetida possesses acknowledged anthelmintic properties,
and is suitable for cases of sympathetic nervous affections pro-
duced by the existence of worms. It thus, like valerian, fulfils
a twofold indication. In a case of nervous affection, which M.
Cazin believed to be idiopathic, the administration of assafcetida
both determined the disease and revealed its true cause, by
effecting the expulsion of a number of lumbrici. This result has,
in three cases of chorea and in two of epilepsy, enabled him to
recognise that sympathetic irritation, depending on the presence
of intestinal worms, was the sole cause of disease in these in-
stances. Under ordinary circumstances M. Cazin frequently
combines assafcetida with calomel in pills. This combination,
of all those that he has employed, succeeds best in expelling
lumbrici. He has also combined it with black oxide of iron,
particularly in anemic patients. Assafcetida may be given in
powder, in doses of from four grains to half a drachm.

The essential oil of turpentine is jiot merely useful in cases
of taenia, it is also decidedly efficacious in expelling the lum-
brici. M. Cazin has sometimes, in cases of lumbrici and
ascarides, administered with advantage turpentine enemata,
prepared by suspending, by means of yolk of egg, from one
drachm to half an ounce of the oil in decoction of tansy, absin-
thium worm-seed, (semen-contra), or Corsican moss.

Common salt is very destructive to worms ; it is given alone
in large doses dissolved in water ; it should be taken on an
empty stomach. M. Cazin also frequently administers it in the
form of enema, with brown sugar, linseed or poppy oil, and a
sufficient quantity of water. With children it almost always
succeeds.

Like all tonics, iron has the advantage of destroying worms,
at the same time that, by imparting tone to the intestines, it
prevents their reproduction. From six to eight grains of iron
filings, mixed with an equal quantity of rhubarb, and taken
twice or three times a day, have often been sufficient to expel
the worms contained in the intestines. M. Cazin succeeded in
rapidly curing a boy nine years of age, emaciated and pale,
whose sleep was disturbed, and who was suffering from spas-
modic movements similar to those which characterize chorea,
by the exhibition of pills of sulphate of iron, combined, accord-
ing to Fuller's formula, with aloes, senna, &c, under which
treatment he voided twenty-three lumbrici in four days. He
has also used with remarkable success Bosen's mixture, con-
taining extract of black hellebore and sulphate of iron. But
what he chiefly gives to children, as well as to adults, is the

1850.] Remarks on Vermifuges. 429

syrup of citrate of iron (four parts of citrate to sixty of simple
syrup, and one of essence of lemon), in doses of from two
drachms to half an ounce to children, and from half an ounce
to two ounces to adults.

M. Cazin remarks that calomel, so efficacious as an anthel-
mintic, ought never to be combined with an alkaline chloride,
as the formation of corrosive sublimate would probably ensue
from their admixture. In like manner, the combination of
calomel with cherry-laurel water, or emulsion of bitter almonds,
would give rise to the development of two formidable poisons,
corrosive sublimate and cyanide of mercury.

The effects of the male fern, tin, pomegranate bark, hellebore,
&c, require merely to be noticed ; and the properties of the
pomegranate root bark are so well known that they need not
be dwelt upon. M. Cazin has remarked nothing particular re-
specting other anthelmintics. He merely says that cod-liver
oil has succeeded with him in the cases of two females, one of
whom passed twelve lumbrici the same day that she had taken
in the morning three table-spoonfuls at intervals of an hour.

But, whatever be the medicine selected, we must not, like
routine practitioners, be content, when the worms are killed
and dislodged, with this merely palliative cure. A very im-
portant indication remains to be fulfilled, viz., to prevent their
reproduction. This object is attained, according to M. Cazin,
by the adoption of a tonic and stimulant regimen, which must
be long continued, and, above all, by the employment of bitter
and chalybeate preparations. He has found the ferruginous
chocolate to be sufficient, in the case of children, to prevent
the relapses which are for many years very apt to occur.
Wine taken while fasting has succeeded with the poor inhabit-
ants of the marshes, accustomed to live only on vegetables and
milk ; and he has also remarked its efficacy as a preventive of
worn affections in other instances.

To these observations of M. Cazin, the editor of the Journal
de Medicine has appended the following practical remarks.
The number of experiments tried by M. Cazin leaves no room
for doubt respecting the enormous amount of worm affections
which he must have met with. Such a result may appear
strange to Parisian physicians, who attribute to the presence
of worms in the intestines only a very trifling influence over
the symptoms formerly ascribed to them. But if worm affec-
tions are rare among the inhabitants of large towns, the\ are
frequent and generally more serious among the peasantry, and
particularly among those who are poor and placed in unfavora-
ble hygienic circumstances. We shall, therefore, take the
present opportunity of mentioning the efficacy of brown sunto-

430 Remarks on Vermifuges. [July,

nine, lately brought under the notice of the readers of the
Bulletin de Therapeutique, by M. Gaffard, an apothecary at Au-
r iliac.

The difficulty experienced in procuring pure santonine, both
on account of its high price, and for other reasons, has induced
M. Gaffard to endeavor to obtain from worm-seed, a product
which may possess the advantages of the former, and at the
same time be free from the objections to the use of the latter.
This product he calls brown or impure santonine ; it is obtain-
ed in the following manner :.

Take of Aleppo worm-seed, three ounces ; carbonate of pot-
ash, one ounce ; slacked lime, sifted, half an ounce ; water, from
three pints to three pints and a half. Place the mixture on the
fire, stirring occasionally with a wooden spatula; let it boil for
an hour ; on removing it from the fire pass it with expression
through a linen cloth, let it settle, decant, and add hydrochloric
or nitric acid until it reddens litmus without being sensibly acid
to the tongue. Allow it to rest, pass it through a filter previous-
ly moistened, or through apiece of close canvass, and allow the
product which remains on the filter to dry in the open air until
it acquires the consistence of firm butter. This product, which
is a mixture of santonine, resin, and essential oil, will answer
for the various pharmaceutic forms in which the practitioner
may wish to exhibit it. M. Gaffard gives it in the form of loz-
enges composed as follows:

Brown santonine, three drachms ; powdered sugar, thirteen
ounces ; powdered gum, one ounce and a half, essential oil of
lemon, twenty-five drops. Place the brown santonine in a mar-
ble mortar ; add by degrees, and with constant trituration, the
sugar mixed wTith the essential oil and the gum, so as to make
a homogeneous powder. Form with a sufficient quantity of
water a mass of the desired consistence, and divide it into loz-
enges, each of which shall weigh, when dried, fifteen grains;
each lozenge will then contain somewhat more than one-third
of a grain of brown santonine.

For infants under six months the dose will be one lozenge
night and morning; from six months to a year, two lozenges
night and morning ; from one to two years, three, and from two
to four years, four night and morning ; for children of five years
and upwards a lozenge for each year of the child's age should
be given night and morning. The medicine to be continued
until the desired effects are no longer produced.

A remedy for tape-worm, which has been for some time em-
ployed in France under the name of kousso, has been recently
tried in King's College Hospital, London, with marked success.
It is an infusion of the dried flowers of Bravera anthelmintics,

1850.] Urethral Hemorrhage. 431

a native of Abyssinia, in which country it is a popular remedy
for this worm, which is very prevalent amongst the inhabitants.
A single dose, which is prepared by macerating for a quarter of
an hour half an ounce of the dried flowers powdered in half a
pint of hike-warm water, is taken at a draught, the suspended
powder being all swallowed. Lemon juice may be taken be-
fore and after the dose. It usually brings away the worm in an
hour or two after it has been taken. Those who have tried
this remedy state that it is equally safe as effectual; and the
only objection to its employment is its high price at present.

Clinical Observations on the Treatment of Urethral Hemor-
rhage. By James S. Hughes, M. D., F. R. C. S. I., Surgeon
to Jervais-street Hospital. (Dublin Journal.)

There is, perhaps, no form of hemorrhage, which, when
profuse, causes more alarm to the patient, or proves more trou-
blesome to the surgeon, than that arising from the urethra,
especially if it resist the ordinary modes of treatment; and as
great difficulty is at times experienced in arresting the bleeding,
when it springs from a part of the urethra beyond the influence
of pressure, we cannot be too well prepared to meet such cases
by prompt and effectual treatment.

The causes of hemorrhage from the urethra are very numer-
ous ; amongst the most, frequent, however, may be mentioned
those arising from the acute stage of gonorrhoea, rupture of the
urethra from falls on the perineum, and the improper use of
instruments. When the hemorrhage does not arise from any
distinct accidental cause, it may be difficult to find out from
whence it proceeds; but experience tells us that, under these
circumstances it is occasionally the consequence of malignant
disease of either the kidney or bladder.

Of all the sources of obstinate bleeding from the urethra, the
most fruitful, perhaps, is that caused by the rough handling of
the catheter, either by the patient himself or by an inexperi-
enced practitioner, in cases of diseased prostate gland ; examples
of which most surgeons have met with, and which, unfortunate-
ly, often tend to shorten life. But the most alarming form of
urethral hemorrhage I ever saw, occurred lately in the person
of a man who presented himself at Jervis-street Hospital, caused
by the giving way of some vessels in the urethra during the
venereal orgasm. As it is a rare and complicated case, I shall
give it in detail.

- Mullens, a3t. .35, a very delicate looking man, a hatter

by trade, presented himself at the Dispensary of the Hospital

432 Urethral Hemorrhage. [July,

on May 8th, 1849. The patient was perfectly anemic in ap-
pearance, being quite blanched in the face ; his pulse was rapid
and feeble, and the extremilies were cold. He stated that at 4
o'clock on that morning, immediately after sexual intercourse,
he felt the lower part of his night-dress quite wet, and that on
inspection he observed a stream of florid blood flowing from the
urethra. He left his bed, and, having dressed himself, attempted
to stop the bleeding with cloths wrung out of cold water, but
without effect, the blood continuing to pour out until his arrival
at the Hospital at nine o'clock, A. M. On examination, I found
his shirt and several folds of rags saturated with blood ; I then
removed some clots of blood from the penis, when a stream of
florid blood poured out from the orifice of the urethra. The
fraenum exhibited no appearance of injury, and there was no-
thing external to account for the hemorrhage ; there was
neither fulness nor pain on pressure along the penis, or in the
perineum ; and the patient had passed water three or four
times since the accident.

On questioning him he stated that he had been married for
the last eight years, but that previously to his marriage he had
suffered several times from gonorrhoea, and that he had been
labouring under a frequency of calls, and difficulty in expelling
his urine, for about ten years, for which he had not consulted
any surgeon.

A middle-sized catheter was now passed four inches and a
half into the urethra, where it met with an obstruction ; a
smaller- sized gum-elastic catheter was then, with some difficulty,
passed through a long cartilaginous stricture, a distance about
seven inches, when it was suddenly arrested in its course.
Other instruments were then cautiously tried, and as they appar-
ently took the direction of a breach in the canal, as the patient
had passed water seveial times since the accident, and as there
was no evidence of extravasation, it was not deemed advisable
by Dr. Power (my colleague on duty) or myself to have re-
course to violence in attempting to introduce an instrument
into the bladder. A full-sized catheter was then passed down
to the obstruction, the patient was put to bed, and proper pres-
sure was applied to both the perineum and penis ; but although
the pressure was assiduously kept up for a considerable time,
the bleeding evidently continued, flowing backwards into the
bladder, the patient having frequent and urgent calls to make
water, which contained much blood and some coagula. Ex-
perience having taught me the value of gallic acid as a styptic
in affections of the urinary organs,* I ordered in the following

In the the third volume of the New Series of this Journal I have published a
case illustrating its effects in hematuria from injury.

1850.] Urethral Hemorrhage. 433

form : Gallic acid, eighteen grains, and extract of gentian,
eight grains : to be divided into six pills, one to be taken every
second hour.

Before the patient had taken more than twelve doses of the
gallic acid, the hemorrhage had completely ceased, at which
time the presence of the acid in the urine was detected by the
addition of the tincture of the muriate of iron. The patient
left the hospital of his own accord on the second day, there
being no return of the bleeding ; and he promised to return in
a few days in order to have an instrument passed.

Laceration of the urethra, followed by profuse hemorrhage,
as a result of the venereal orgasm is a very rare occurrence,
there being few cases of the kind on record, but, although rare
it may lead to very serious results, as we learn from the follow-
ing case, related by South, in his edition of Chelius' Surgery, f

" I may here mention, that I once saw a case under my
colleague, Mr. M'Murdo's, care, in which there was enormous
extravasation of blood from the bursting of some vessels in the
penis during the act of coition, and the result of which was,
that the penis especially, and the perineum, were greatly dis-
tended, and he was unable to pass his urine without extreme
pain, in consequence of which a catheter was introduced. In
the course of two or three days extravasation of urine ensued,
and the bladder was punctured through the rectum. Conside-
rable sloughing, not only in the perineum, but also up into the
groins, took place, into which incisions were made as needed
and he ultimately, though slowly, recovered."

With regard to the application of pressure to the perineum
in cases of hemorrhage from the urethra, there does not now
exist in the minds of surgeons that prejudice against it, which
Sir Everard Home and others improperly entertained on the
subject. Sir Everard Home's objection to it was, that, although
it arrested the flow of blood externally, it directed it backwards
into the bladder, thereby converting, as he said, a case of sim-
ple bleeding into one of danger, by the filling up of the bladder
with coagulated blood, and probably inducing retention of
urine. No doubt the filling up of the bladder with coagula-
ted blood in these cases is a most unpleasant complication ;
and numerous cases of urethral hemorrhage have been publish-
ed by Guthrie, Brodie, and others, in which pressure on the
perineum, whilst it arrested the bleeding from the orifice of the
urethra, appeared to have directed it backwards into the bladder,
yet the filling up of which viscus, although attended with much
annoyance to both patient and medical attendant, was not, m
itself \ productive of serious consequences. The proper mode

~ t Vol. i. \\ 1 J7.
N. I. VOL. VI. NO. VI. 38

434 Reconstruction of an Entire Phalanx. [July,

of treatment to be adopted, in cases of profuse hemorrhage,
when it proceeds from the urethra anterior to the triangular
ligament, is obviously that by pressure ; and if the rules iaid
down so clearly by the best authorities on the subject especial-
ly those by Mr." Guthrie, be strictly followed, the bleeding
point will be soon arrived at, and hemorrhage, either anteriorly,
or backwards into the bladder, will be, in most cases, complete-
ly arrested. But, on the other hand, in cases of profuse
hemorrhage springing from the membraneous or prostatic
portions of the urethra, posterior to the triangular ligament,
where pressure can exert but little, if any, beneficial influence,
the surgeon should, I think, rely chiefly on the immediate
exhibition of gallic acid internally. In it he may place the
greatest confidence, its rapid and powerfully styptic action on
the urinary organs rendering it peculiarly suitable to such
cases. Its timely administration will, in all probability, pre-
vent the distention of the bladder with blood, the necessity for
having recourse to instruments for the purpose of withdrawing
the contents of the bladder, and the subsequent injection of
that viscus with tepid water, with the intention of breaking up
the coagula; which operations must, in all cases, tend more or
less to induce a recurrence of the hemorrhage by the additional
infliction of mechanical violence or irritation thereby. The
gallic acid may be administered, in these cases, in doses of from
three to ten grains, but my experience has led me to prefer
giving it in three-grain doses every second hour, to giving it
in maximum doses at long periods. The stomach will, in some
cases, reject the large doses, when frequently repeated, whereas
I have never known it to disagree in three or four grain doses
repeated at short intervals, by which means its influence on the
urinary organs is steadily maintained. The acid may be or-
dered either in the form of pill, or suspended in water by means
ofmucilafre.

'O

Reconstruction of an Entire Phalanx. Reported by Frank
H. Hamilton, one of the atending Surgeons of the Buffalo
Hospital of the Sisters of Charity. (Buffalo Journal.)

Catharine Dolen, aged 24 ; admitted Dec. 25, 1849. Thumb :
The bone was necrosed, and on the 29th I extracted the
phalanx entire. The inflammation having considerably sub-
sided by the third of January, five days after the operation, I
applied a tape roller the whole length of the thumb, and mod-
erately tight. This was continued with occasional intermissions
during two months, when a new phalanx was found to have

1850.] Periscope. 435

been formed, of the same length and breadth, and form, as
the original phalanx ; the articulating snrface was also re-
formed, and the flexor and exterior tendons so attached as that
the motions of the joint were perfect.

This result is not now the first time discovered. More than
a )Tear since, Prof. Dudley, of Lexington, informed me in a
private communication, that he had been able to reconstruct a
phalanx, where the bone had been entirely removed, by the
continued application of the roller. To Dr. Dudley, therefore,
is the profession indebted for this interesting pathological dis-
covery.

We have many times seen the bone reconstructed, where a
portion only of the whole was removed ; as when the bone
was partially destroyed by necrosis or caries and exfoliated, the
deficiency has sooon been supplied, so that the form, size, and
functions were again restored. Especially has this happened
when the process of necrosis was slow. Nor ought we to have
been surprised to find the entire phalanx reformed after a slow
destruction of the original, since the new phalanx might have
been commenced before the complete death of the old, and
thus serve as a nucleus for a reformation. This may have
happened often, and may have been noticed, but it is the com-
plete reconstruction of a bone when it has been removed in its
totality by extraction, that excites our surprise, and which we
have marked as a novelty, for I am not informed that after Dr.
Dudley, any one except mvself has demonstrated its practica-
bility.

PART III.
ill o n 1 1) hj Periscope.

On Blood-Jetting in the Pneumonia of Children, By Dr. Mauth-
ner, (Monthly Jour. Osterreich. Med. Wochen. Amer. Jour.)
It is only in the genuine lobar pneumonia of children that Mauthner re-
commend venesection. This form of disease usually occurs without
any lengthened premonitory stage, after alternate exposure to extreme
heat or cold, sometimes apparently in connexion with depraved
digestion, often as one of the sequela of scarlatina, measles, or small-
pox.

Its prominent symptoms are, difficult breathing, with oppression at
the chest, short sharp cough, (a symptom which, in the severe forms
of the disease, is at first wanting.) heat of surface, i^cver, head affec-
tions, and sometimes vomiting.

Over the seat of the disease, which is usually the back of the right
lung, the j>ercussion sound becomes dull ; and, on auscutlation in the

436 Periscope. [J^ty"?

early state, fine dry crepitation is audible ; afterwards bronchial re-
spiration. The child usually lies on the right side ; and, if it can
speak, complains of pain in the chest ; the pulse is small, hard, and
frequent; the secretions and excretions are dimished in quantity.
These severe attacks are most common in children above a year old,
but infants are not exempt from them.

The anatomical characters of the first stage consist in extensive
congestion (stasis) of the pulmonary parenchyma; of the second, in
alteration of structure, with effusion of plastic exudation in the form of
red hepatization ; of the third (the so-called suppurative stage), in
effusion of pus, sometimes diffused throughout the parenchyma, more
rarely in children constituting true abscesses.

In the cases treated during the first stage, Mauthner has obtained
the very best effects from blood-letting. He has often bled the little
patients who have been brought for his advice to the hospital, permit-
ted them to be carried home, had been subsequently astonished to find
how completely this single remedy had obviated the urgent symptoms.
On the other hand, he has too often seen the bad effects of neglecting this
heroic remedy at the outset of the inflammation. In using the lancet, re-
gard must be had to the age and constitution of the patient, and to the
intensity of the disease. The depletion should not stop till the child
turns pale, becomes sick, vomits, or seems exhausted. When the
operation is properly performed, Mauthner thinks all other remedies,
such as leeches, cataplasms, and internal physic, may be dispensed
with, and in a few days the child is well.

In cases in which the disease has reached its second stage, the im-
mediate effect of venesection is not so remarkable ; but some benefit is
usually speedily experienced, and within three days the bronchial re-
spiration ceases, and the morbid process is removed, usually upon the
appearance of some critical evacuation from the skin or kidneys.

Even when there was reason to suspect suppuration, Mauthner has
often let blood after mature deliberation, and has had no occasion to
repent the adoption of the practice. Thus, he believes that he suc-
ceeded in saving a boy six years of age, who, after a neglected pneu-
monia of three weeks' standing, fell under his care, suffering from
hectic fever, emaciation, and purulent expectoration. After in vain
attempting a cure with digitalis and acetat. plumbr, Mauthner ordered
venesection, and the boy recovered. Where, however, as is often the
case, an unresolved pneumonia seems to have gone on to tuberculosis,
bleeding can do no good.

The indications for venesection are derived, first, from an accurate
physical exploration of the chest. It must, however, be noted, that,
when the cough and general symptoms indicate the existence of
pneumonia, the absence of physical signs does not justify the neglect of
proper remedies. For, even when extensive congestion of the pul-
monary tissue is present, if a certain quantity of air be still included
in its interstices, the percussion sound and respiratory murmur may
not be sensibly affected. Besides, the inflammation may be situated
in a part of the lung which cannot be satisfactorily explored ; or the

1850.] Periscope. 437

child may be so restless and timid as to render the use of the stetho-
scope impossible.

The second indication is derived from the age and individual con-
stitution of the child. Strong plump children above a year old may be
bled without scruple ; those who are delicate will still bear depletion,
if it be ascertained that their previous health has been good ; even in-
fants under one year of age, labouring under severe pneumonia, suffer
less from venesection than from the application of three or four leeches.

The stage of the disease affords the third indication. In the con-
gestive period, the remedy is quick and sure. When hepatization
has already taken place, the detraction of blood is never hurtful ; but,
when the suppurative period has arrived, the lancet must be used
cautiously and seldom.

The operation of opening a vein in the arm of a fat restless child
is not easy, and for its proper performance requires some previous
experience for the feel of the vein must, more than the eye, guide
the lancet. The ribbon must at first be drawn rather tightly, until
the vein be felt and opened, when it must immediately be slackened
again. While the blood trickles out (a full jet is seldom obtained
from a child), the arm should be left quite still, for, on the slightest
movement, the fat mobile integuments lap over and close the orifice.
There is no difficulty in stopping the bleeding, either with a cross of
sticking plaster, or by a single turn of a bandage.

The amount of blood drawn must be chiefly regulated by the age
of the child. Considerable effect may be expected in infants, from
the detraction of a single ounce. Children from two to three years of
of age require a blood-letting of from two to three ounces, and older
children more in proportion.

The usual relative proportion of serum and cruor in cases of
pneumonia, in children, Mauthner states to be one part of the former
to two of the latter. He has not unfrequently observed the buffy
coat, but attaches very little importance, in a therapeutic point of view,
to its presence or absence. In the case of a boy, two years old,
whom he had occasioned to bleed to three ounces for severe pneu-
monia, which had been in vain treated by leeching, he found a bufTy
coat of two lines in thickness upon the blood, after it had stood for
some time in a conical-shaped vessel. In this case, there was no oc-
casion to repeat the operation, but rapid convalescence followed.

Treatment of Chorea. (London Lancet.) M. Faivre d'Esnans
mentions in the Journal de Medecine et de Chirurgie Pratiques, that
he has obtained the happiest results from the prussiate of iron in
chorea and epilepsy, and he gives several cases where the cure was
obtained in between four and eight days. He uses the following
formula: Prussiate of iron, fifteen grains ; extract of valerian, forty-
five grains ; make twenty-four pills. One pill to be taken three times
a day, at six hours' interval, each pill to be iollowed by a wine-glass
of infusion of valerian. The author was induced to try the prussiate
of iron, from having seen M. Jourdes use it, at the Military Hospital

438 Periscope. . [July,

of Strasburg, for intermittent fever. Ashe considers that both dis-
eases (chorea and ague) have their seat in the medullary spinals, he
thought that the same remedies would prove efficacious in both com-
plaints, in which supposition, according to his statements, he was not
deceived.

On AncEsthesia hy Inhalation of Ether or Chloroform. (Ibid) M.
Velpeau read, at the annual meeting of the Academy of Sciences, a
paper on the Inhalation of Ether or Chloroform, in which he embo-
dies the history of anaesthetic agents, their introduction into practice,
the results obtained, and his own opinions on the subject. In the
historical sketch we find the following passages. The so-called
Memphis-stone, dissolved in vinegar, after having been reduced to
powder, was used as an anesthetic agent amongst the Greeks and
Romans, and mandrake was extensively known as possessing anaesthe-
tic properties. Dodonaeus says, in his history of plants, that the
vinous decoction of mandragora causes sleep, and allays pain ; and
that it was therefore administered to those who were to have part of
their body burnt or sawn off. The surgeons of the middle ages were
well acquainted with the employment of certain anaesthetic agents.
Hugh, of Lucca, a celebrated practitioner of the thirteenth century,
speaks very distinctly on the subject. A sponge dipped in the juice of
morel, or nightshade, hyoscyamus, cicuta, lactuca, mandragora, or
opium, was put under the nose of patients, and made them sleep during
operations ; they were then roused by being presented another sponge
soaked with vinegar, or by putting the juice of rue into their ears.
From M. Jullien's communication to the Academy of Sciences, it may
be seen that the Chinese, some centuries ago, were aware of means
for rendering patients insensible during operations. Boccaccio men-
tions, in the Decamerone, 39th tale, that Mazet de la Montagne used
to operate on his patients after having put them to sleep with a water
of his composition. Formulae have been transmitted from father to
son among malefactors, by which their intended victims might be
plunged into sleep. Prisoners, towards the revival of letters, knew
how to procure certain drugs with which they could bear torture
without feeling the pain. Is it not likewise said that the Turks pos-
sess the means of plunging into anaesthesia those upon whom circum-
cision is to be performed ? In our own times we find Sir Humphrey
Davy stating, after having used the nitrous oxide gas upon himself to
allay toothache, that this gas might probably be of use in surgical
operations. Mr. Wells, of Hartford, used this gas in 1842, for ex-
tracting teeth without pain. Mr. Hickman announced in Paris, in
1821, that he was able to render patients insensible to pain by making
them breathe a gaseous substance, the name of which he did not make
public. Messrs. Orfila and Christison had found that animals might
be rendered insensible by giving ether internally. M. Merat used ether
inhalations for allaying pain, and Mr. Faraday observes {Quarterly
Journal of Sciences, 1818) that ether acts upon man like the nitrous
oxide gas, and that the action of the former, at first exhilarating, soon
becomes stupefying.

1850.] Periscope. 430

M. Velpeau, after refuting the objections of those who represent the
inhalations of ether or chloroform as dangerous, says: The use of
these agents does not seem prudent in operations to be performed on
the mouth or throat, in the nasal fossae, the larynx, or trachea, on ac-
count of the necessity for patients to expel, by coughing, the blood
which tends to invade the bronchi. Without proscribing chloform, I
however do not advise it when operations are to be performed on the
eyes, lids, or lips, when in aneurism an artery is sought for, or in oper-
ations upon individuals much enfeebled, either by disease or old age.
It is a mistake to believe that chloroform facilitates the surgeon's task,
for it would be often advantageous to make the patient change his posi-
tion, answer questions, &c ; and the operator is likely to get nervous
and flushed when the chloroform is kept on for a long time, as fears of
ultimate unpleasant results will disturb his mind. Yet painless opera-
tions by means of chloroform must be reckoned among the most bril-
liant discoveries of the nineteenth century; and so great is the desire
to tike advantage of it among the public, that the surgeon is more
frequently obliged to refuse giving the chloroform than to induce the
patients to inhale it. Many people who would have gone to their
grave without even disclosing the nature of their affection, from their
horror of operations, will now have a chance of a prolonged life.

Finally, M. Velpeau thinks that the administration of anaesthetic
agents ought to be regulated more by the nervousness and fear of the
patient than by the importance of the operation. Terror and dread
are very detrimental, and though the cases be slight, anaesthetics
should be had recourse to when the patient's mind is disturbed by
lively apprehensions of pain.

Intercostal Neuralgia as a sign of Phthisis. By M. Beau.
(L'Union Medicale. Braithwaite's Retrospect.) Intercostal neuritis
is an affection which habitually coincides with inflammation of the
.pleura, whether simple or combined with pulmonary inflammation.
The explanation of this coincidence is found in the anatomical rela-
tions of the pleura and intercostal nerves which are in immediate
contact at the posterior part of the thorax. According to the author,
the stitch in the side, which attends affections of the pleurae, and most'
severe pulmonary affections in which the pleurae are involved, is
owing to inflammation of the intercostal nerves, which are found en-
larged to two or three times their normal size, adherent to the
pleurae or to the cellular tissue in which they lie, and, in acute cases,
much injected. The degree to which the nerves are affected bears
an exact relation to the amount of affection of the pleurae, and is
therefore evidently secondary to it.

When the lung is attacked by tubercles, it almost invariably hap-
pens that adhesions of the pleurae take place in their neighborhood.
The adhesions, like that tubercles, are at first confined to the summit
of the lung, and are attended by the same change in the intercostal
nerves as in the case of acute affections, only that the lesion is
chronic in its development, and not generally characterized by in-
creased vascularity.

440 Periscope. [July,

Thus the author explains the dull pains which occur at the summit
of the thorax in phthisical persons. Sometimes these pains are suffi-
ciently distinctly marked, and even neuralgic in character; they
radiate into the neck and supra spinous fossa, or even along the arm,
as in angina pectoris ; this divergence being due to the inosculations
between the intercostal nerves and those of the cervical and brachial
plexuses. But it is not always so, nor can these pains be said to be
an habitual symptom of phthisis. Nevertheless the lesion of the in-
tercostal nerves is almost always found after death from this disease.

In seeking to explain this contradiction, M. Beau has discovered a
symptom, to which he attaches considerable importance in the
diagnosis of doubtful cases of phthisis. Even where no pain is mani-
fested under ordinary circumstances, he finds that this symptom may
be almost constantly produced by moderate pressure with the finger
on the anterior or sternal extremity of the intercostal spaces. In
early cases it is limited to the upper part of the chest, and is, generally
speaking, more severe in the first space than in the second, in the
second than in the third, &c. It varies in intensity, but sometimes is
so considerable as to cause an involuntary shrinking on the part of
the patient. It is more severe and effects the greatest number of
spaces, on the side in which the tuberculization has advanced farthest.

This symptom is almost constant in phthisis pulmonalis. Among
fifteen causes under M. Beau's observation at the time of writing, it
was not absent in more than one ; and only one of these cases pre-
sented the symptom of one spontaneous pain. The author, therefore,
thinks it will prove a useful diagnostic mark in cases where the physi-
cal signs of phthisis are marked by bronchitis. "The predominance of
the pain in the anterior part of the spaces, where the alteration of the
nerves is least considerable, is ascribed by M. Beau to the circum-
stance that, when a nerve is diseased, in any part of its course, the
morbid sensibility is always referred to its peripheric extremity.

Another form of the intercostal neuralgia of phthisical patients is
the pain between the shoulders which has been so frequently described
as characteristic of phthisis. In these cases the author has always
found that the pain may be traced along the intercostal spaces to the
anterior part of the chest. M. Beau had previously endeavoured to
demonstrate the connection between intercostal neuralgia and dys-
pepsia : he now considers both these symptoms as related to phthisis,
of which disease dyspepsia, as is well known, is a frequent accom-
paniment.

Use of Coffee in Hooping -Covgh. (Lon. Jour. Med. Braithwaite's
Retrospect.) Various medicines have from time to time been brought
forward as specifics in hooping-cough ; and some of them we have
tried. To quinine, salicine, arsenic, and oxide of silver, we have given
a fair trial in a considerable number of cases ; and the result of this ex-
perience is, our belief that all of them, except the last named, possesses
some power in checking the disease, when it has gone on for some
time, and is marked by periodicity. When the hour of the recurrence

1850."| PefHscope. 441

of the fits comes to be accurately foretold, all of the above-named
drugs given in full doses in anticipation of the attack, postpone, or
entirely prevent it. In the early stages or latter, where there is some
amount of bronchitis, the free use of stimulating embrocations, with
occasional expectorants, 4and stomachics, and alteratives, (such as a
powder composed of cusparia, trisnitrate of bismuth, and rhubarb, are
the means we trust to. When the cough assumes a distinctly
periodic character, we recommend a trial of antiperiodic remedies
and chauge of air, both of which measures, in many cases, prove of
signal and speedy benefit.

From Pereira's summary of the therapeutic uses of coffee, it is not
unlikely, however, to exercise some control in hooping-cough. " It
has," says Pereira, "been employed as a febrifuge in intennittents ;
as a stomachic in some forms of dyspepsia ; as an astringent in
diarrhoea ; and as a stimulant to the cerebro-spinal system in some
nervous disorders." Floyer, Dr. Percival, and others, have used it
in spasmodic asthma ; and Laennec says, " I have seen several
cases in which coffee was really useful."

The recommendation of coffee, in hooping-cough, seems decidedly
to merit attention. Dr. Jules Guyot, who advocates the use of the reme-
dy, writes thus in the Union Medicale for 24th April, 1849 : " Cafe
a Veau, hot, and well sugared, in suitable doses, taken four times or
oftener, daily, will cure, in from two to four days, the most obstinate
cases. For a child of two years, the dose is a teaspoonful ; for a
child of four years, a desert spoonful ; and for an elder patient a
tablespoonfuh To obtain a rapid and permanent cure, it is necessary
to conjoin with the coffee treatment a diet of fried and roast meat,
taking care to mince it, if the child cannot masticate it sufficiently.
The quantity of milk used, ought' to be diminished ; and farinaceous
food, confectionaries, and fruits, must be entirely prohibited."

The alledged specific power of coffee in hooping-cough, was ac-
cidentally discovered by observing the following case :

A child of four years old, under rigid dietetic treatment for measles,
was seized with congestion of the lungs, against which energetic anti-
phlogistict treatment was put in force. When Dr. Guyot was called
in, death seemed imminent from violent paroxysms of cough, which in-
duced such alarming suffocation and syncope, as to cause the patient
to appear to be actually dead. Some spoonfuls of strong beef-tea, with
some spoonfuls of sweet and hot infusion of the lime-tree, were pre-
scribed. The child passed the night without tainting. On the fol-
lowing day, the same infusions were continued, and in addition, there
was given a little bit of grilled and finely minced mutton, with the
view of restoring strength as rapidly as possible : but a severe fit of
coughing came on, which terminating in vomiting, caused ejection of
the food ; recourse was again had to to the beef-tea, which provoked a
similiar fit of coughing, and was ejected. In these circumstances,
with death apparently impending, a tea-spoonful of coffee was given
after each tea-spoonful of beef-tea. Not only was the beef-tea
retained; but, to my great surprise, the cough likewise ceased. Two

412 Periscope. [July,

hours afterwards, the child took with relish, a little bit of hashed
cutlet, followed by a teaspoonfulof the coffee; the food was not. ejected,
digestion went on naturally, the night was passed in comfortable
sleep, there was no more cough : and in truth the child was saved.
On the following day, the treatment was continued, and there was a
continuance of a like satisfactory state. On the third day, however,
the relations omitted the coffee, when the cough returned after the first
meal, with all the characteristic violence of well-formed hooping-
cough ; and this state continued during the day. On the fourth day
when the coffee was resumed, the cou^h disappeared. During forty-
seven days the coffee was persisted in, when the cure was distinctly
complete. The little patient was the only daughter of M. Haquin, a
master boot-maker of Argenteuil.

This case was furnishing subject of serious reflection, when Dr.
Guyot met in a public conveyance M. Bouju, ex-notary of Francon-
ville, he told him that he had been obliged to have double doors for
his study, to keep out the terrible and incessant noise caused by his
two children with the hooping-cough.

Dr. Guyot detailed the case above narrated : and he cured both
his children in four days by means of coffee. He has since tried the
remedy successfully in above sixty cases. The efficacy of coffee in
hooping-cough seems to show that the seat of the disease is not in the
bronchial tubes or larynx nor in their vascular or nervous network
but exclusively in the digestive organs, and especially in the pharynx
and stomach. The cough and convulsive movements ofthelarjnx
are excited by a pruriginous irritation of the pharynx; which, again,
probably depends on some special affection of the stomach.

Formula employed by M. Ricohd in the Treatment of the various
forms of Syphilis. (Gaz. des Hop. Dublin Journal.)

Non-malignant Varieties. 1. Inflammation of the glans penis
and prepuce : Injections of the following solution are to be made three
times a day between the prepuce and the glans : Nitrate of silver,
twelve grains ; distilled water, one ounce. 2. Abortive treatment of
gonorrhoea : A single injection is to be made with the following solu-
tion : distilled water, one ounce; nitrate of silver, eight grains ; and
this powder to be taken three times daily : cubebs, two drachms and
a-half, and powdered alum fifteen grains; mix. 3. Injection for gon-
orrhoea when the period for the abortive treatment is past : Rose
water, six ounces ; sulphate of zinc and acetate of lead, of each twelve
grains ; to be used three times a-day. 4. Internal treatment of gon-
orrhoea : Balsam of copaiba, syrup of tolu, syrup of poppies, of each
one ounce ; mint water, two ounces ; gum Arabic, as much as may
be sufficient ; orange-flower water, half an ounce; to be made into an
emulsion, of which a table-spoonful is to be taken three times a-day.
5. Acute stage of gonorrhoea: Twenty leeches to the perineum, fol-
lowed by a warm bath, cooling drinks, confinement to bed, low diet ;
to use a suspensory bandage, and to take four times a day one of the
following pills : Lactucarium and camphor, of each two scruples, to

1850.] Periscope. 443

be made into twenty pills. 6. Gleet (goutte militaire) : The following
injection to be used three times daily : Rose water and red wine, of
each six ounces ; alum and tannin, of each eight grains.

Malignant Varieties. Primary Symptoms. 1. Abortive treat-
ment of chancre : During the first five days after contagion, destroy
the chancre with Vienna paste. 2. True chancre not indurated :
Frequent dressings with aromatic wine ; extreme cleanliness ; occa-
sional light cauterization with nitrate of silver ; rest ; emollient drinks.
When inflammation exists, antiphlogistics, purgatives, emollient ap-
plications. (No mercury). 3. Phagedenic chancre : complete cau-
terization with nitrate of silver, acid nitrate of mercury, potassa cum
calce, or the actual cautery, according to circumstances. In a more
advanced stage, lotions composed of aromatic wine, three ounces and
a-half, and extract of opium, two grains and a-half ; or aromatic wine,
eight ounces, and tannin, twenty-four grains; or, in the scrofulous
diathesis, distilled water, three ounces and a-half, and tincture of
iodine, one drachm ; or the application of sulphur ointment, and the
use of sulphurous baths. Internally : Tartrate of iron and potash, one
ounce dissolved in eight ounces of distilled water, of which one ounce
is to be taken three times a-day. 4. Indurated chancre : Three dress-
ings daily with the following ointment ; Calomel, one drachm, and
lard, one ounce ; mercury to be given internally. 5. Abortive treat-
ment of bubo consequent on the absorption of the virus of a non-indu-
rated chancre : Deep cauterization with potassa cum calce, to be
continued for ten minutes ; the separation of the eschar is to be pro-
moted. 6. Bubo consequent on indurated chancre : Antiphlogistics
are to be employed according to circumstances, and vents must be
given to the purulent matter by cauterization with caustic potash ; the
glandular mass situated at the bottom of the opened bubo is subse-
quently to be gradually destroyed by caustics ; an ointment composed
of equal parts of extract of belladonna and mercurial ointment may be
added to the poultices after cauterization. 7. Horse-shoe bubo, and
gangrene : For the former the same treatment is to be adopted : for
gangrene, lotions with the following mixture : Chloride of lime, one
ounce ; distilled water, three ounces and a-half; or the application of
a powder composed of equal parts of prepared charcoal and powdered
cinchona bark.

Secondary Syphilitic Symptoms. A spoonful of compound syrup
of sarsaparilla to be taken three times a-day in a glass of decoction of
soapwort leaves ; one of the following pills to be taken daily : Proto-
iodide of mercury and lactucarium, of each thirty-five grains; extract
of opium, twelve grains ; extract of hemlock, one drachm and a-half;
to be divided into sixty pills.

Tertiary Syphilitic Symptoms. A spoonful of the following syrup
to be taken three times a-day, in a glass of decoction of soapwort:
Syrup of sarsaparilla, thirty ounces, and iodide of potassium, one
ounce.

Scrofulous Complications. The following emulsion is to be giv-
en in three doses : Iodine, two grains and a-half; oil of sweet almonds,

444 Periscope, [July,

one ounce; gum Arabic as much as may be sufficient; almond emul-
sion, three ounces and a-half.

Mercurial Stomatitis. Decoction of lactuca sativa, five ounces;
honey, half an ounce ; hydrochloric acid, fifteen drops ; to be made
into a gargle to be used three times a-day.

Salivation. One drachm of flowers of sulphur, mixed with honey,
to be taken daily ; water acidified with nitric acid, and sweetened, to
be used as ordinary drink. The following gargle to be used three
times a-day : Decoction of lactuca sativa, five ounces; honey, one
ounce ; and hydrochloric acid, fifteen drops.

Aphtha ix the Mouth. Decoction of hemlock, six ounces and
a-half, and bichloride of mercury, two grains and a-half; to be used
as a gargle three times a-day

Warts are to be sprinkled twice a-day with a powder composed of
equal parts of savin, oxide of iron, and burned alum.

Sumbul (London Lancet.) In recently attending the medical wards
of this (King's College) hospital, we perceived that Dr. Todd was pre-
scribing, in a case of epilepsy, a medicine, the name of which we
heard for the first time. On inquiry, we find that this root, called
Sumbul, is being introduced into practice as an anti-spasmodic by Mr.
Savory, of Bond street. It appears that Dr. Granville, on a recent
return from the Continent, mentioned sumbul to Mr. Savory as a root
employed with great success in Germany and Russia, against cholera :
wondering that it had not yet found its way into this country. Mr.
Savory immediately set about procuring it, but his correspondent in
Russia had much trouble in getting this root ; he, however, sent over
specimens of it. A little later, another parcel of the sumbul was ob-
tained, by the same house, from Hamburg ; and on comparing the
two samples, Mr. Savory came to the conclusion that the German one
was decidedly the firmest, least damaged, and in the best condition of
the two. We were shown these specimens, and find that they resem-
ble much the circular pieces in which calumba is generally seen, ex.
cept that they are considerably larger, of a more spongy texture, and
resembling huge bungs. They are of a yellowish grey, whitish in
the centre, with a thin, pellicular bark surrounding them. The most
striking feature of the root is its very strong odour, which very much
approaches that of musk, being almost as pleasant and powerful. The
pieces are very light, and seem to be formed of a condensed and har-
dened pithy substance. From this imperfect description, it may at
once be gathered that the sumbul promised to be useful as an anti-
spasmodic, and Mr. Savory first thought of combining it with the coty-
ledon umbilicus, and using it. against epilepsy. It is, however, being
tried by itself, and though Dr. Todd cannot as yet state anything posi-
tive as to results, we were told that the little boy who is taking ten
minims of the tincture thrice a day, and who, when admitted, had an
epileptic fit once or twice a week, has had no attack since he has been
in the hospital. Mr. Savory has likewise prepared on extract of the
root, and further trials are of course necessary to judge of the efficacy

1850.] Miscellany, 115

of the medicine. Musk being, however, very expensive, it would be
a great boon to the public were this root found as efficacious. No-
thing is yet known of the botanical origin of the plant; efforts are,
however, being made to ascertain its natural history, and we shall
have much pleasure in communicating to our readers the details
which may transpire both in the latter respect, and with regard to the
trials which are being made as to the therapeutical virtues of the root.

Supplementary Mamma. (Archives Generales.) M. Marotte read
the notice of a case of supplementary mammee, occurring in a young
woman 17 years of age. The glands of the axilla were the seat,
every month, of painful sensations at the menstrual periods. This
sensation began to be experienced at the age of 12, during menstrua-
tion. These two tumours, especially the one on the left side, attained,
in this young woman, a considerable development during pregnancy,
and two days after her delivery they discharged spontaneously a fluid
having all the appearances of milk. The normal breasts were devel-
oped, but were not of unusual size.

Vicarious Menstruation. In the June number of the Western Lan-
cet, Dr. B. F. Richardson, of Cincinnati, reports a case in which at
each regular menstrual period the discharge takes place from the anus
instead of the vagina, and continues about as long, and in quantity is
about the same as the normal menstrual discharge. The fluid does
not coagulate. Its discharge is usually preceded by pain and uneasi-
ness in the lower part of the bowels. From careful and minute
enquiry, Dr. R. is satisfied that the discharge was not hemorrhoidal,
and that there was no reason to suspect a recto-vaginal communication.
A very singular case of vicarious menstruation was brought to the
notice of the Westminster Medical Society by Dr. Rogers, last year,
in which blood oozed from the tips of the fingers.

itUMcal ill i s c c 1 1 a n tj -

Compensation of Physicians for Post-mortem examinations hefore
Coroner's Inquests. Until a short time since, we have had no oppor-
tunity to examine the Act, passed at the last session of the Legislature
of Georgia, whicli provides for the compensation of medical men who
may be required to attend professionally upon Coroner's inquests.
This act provides that " it shall be lawful for every Physician or Sur-
geon who shall be summoned by the Coroner or Sheriff of the county
to make a post-mortem examination for the information of juries of

446 Miscellany. [July,

inquest, to charge and receive from the Treasurer of the county, the
sums following, to wit : For each post-mortem examination, when
death has resulted from external violence, where no dissection is re-
quired, the sum of Ten dollars ; for the same, where dissection is
necessary, and where no interment of the body has been made, Twen-
ty dollars ; for the same, after one or more days interment, Thirty
dollars ; for the same, when any chemical analysis is required, the
sum of Fifty dollars, and the expense of such analysis : Provided, that
the compensation allowed in this act, shall not extend to more than
one physician, for each post-mortem examination."

We are pleased that this tardy act of justice to the medical profes-
sion has been done ; but at the same time we are constrained to say
that the compensation for post-mortem examinations, where chemical
analysis is required, is entirely inadequate. In almost every case of
this kind, the entire responsibility is thrown upon the physician.
Upon the correctness of his analysis, the reputation and life of the
accused depends. His opinion alone determines the question whe-
ther or not a crime has been committed. To place a man under such
a weight of responsibility, and then to offer to compensate him for
fifty dollars, shows a very low appreciation of the profession, or a very
extravagant estimate of the value of money. We hope that this part
of the law will be hereafter amended, and a more adequate compen-
sation allowed. We are, however, much gratified that the obligation
of the community to compensate physicians for services rendered the
public has been thus recognised. This recognition is doubtless due to
the organization of the profession which has been going on throughout
this country for the last three or four years. The same means, if
properly used, will procure a further recognition of the obligations
which the public are under to physicians.

Medical Society in Cobb county. We learn from a medical friend
that a Medical Society has been formed in Cobb county, Georgia, and
that Dr. Elliott has been elected its President, Dr. Quintard, Vice-
President, and Dr. Dun woody, Secretary. The next meeting of the
Society will be held on the first Saturday in August, at which time
an address is expected from Dr. Slaughter, of Marietta.

The Postmaster-General has decided that the " African Reposito-
ry, a monthly periodical of 32 pages, printed in Washington and
stitched in a cover, is entitled to pass through the mails at newspaper
postage. The Boston Medical and Surgical Journal, an unstitched

1850.] Miscellany. 447

weekly journal, is charged with pamphlet postage. Is it that the af-
fairs of Africa, and the interests of the African race, are deemed of
more importance than the physical welfare of our own people ?

University of Pennsylvania. Prof. George B. Wood, has been
transferred to the Chair of Practice, vacated by the resignation of the
venerable Professor Chapman, and Joseph Carson, M. D., has been
elected to the Chair of Materia Medica and Therapeutics.

American Medical Association. The following resolution, append-
ed to the Report of the Committee on Medical Literature, was adopted
by the Association at the meeting at Cincinnati in May last.

Resolved, That the sum of one hundred dollars, raised by
voluntary contribution, be offered by this Association for the best
experimental essay on a subject connected either with physiology, or
medical chemistry, and that a committee of seven be appointed to
carry out the objects of this resolution : said committee to receive the
competing memoirs until the first day of March, 1851 ; the authors'
names to be concealed from the committee ; and the name of the suc-
cessful competitor alone to be announced after the publication of the
decision.

Dr. Francis G. Smith, Philada., Chairman.
" Alfred StillS, Philadelphia.
" Franklin Bache, "
" L. P. Yandell, Louisville, Ky.
" James Moultrie, Charleston, S. C.
" Robert Bridges, Philadelphia.
" Washington L. Atlee, Philadelphia.
In accordance with the above resolution, the Chairman gives notice
that the sum of one hundred dollars is secured, and will be paid over
to the successful competitor, or, if preferred, a gold medal of equal
value, bearing a suitable inscription.

The competing memoirs must be transmitted to the Chairman, free
of expense, and should be designated by some appropriate motto ; the
author's name accompanying it in a sealed packet, designated in like
manner. The successful essay will become the property of the Asso-
ciation, and in case no paper of sufficient merit is offered, the time will
be extended for another year.

After the decision of the committee, the sealed packet containing

the author's name will be opened in the presence of the Association.

Medical Journals throughout the country are requested to give pub-

icity to the above Notice, and to aid in furthering the wishes of the

Association in this respect.

Francis G. Smith, M. D., Philada., Chairman.

418

Miscellany. Meteorology.

Great Longevity. The Boston Medical and Surgical Journal states
that among the members of a religious congregation in Suffolk county,
Long Island, N. Y., there are five persons over one hundred years
old ; eighteen over ninety j fifty-one over eighty ; and forty-five over
seventy. If this report is correct, it speaks well for the morality of
the congregation, for " a conscience void of offence1' is certainly one
of the most important means of procuring long life.

Deaths. M. Makjolin, one of the oldest and ablest of the surgeons
of France, died on the 4th March, in the seventieth year of his age.
A large concourse of medical men, students, deputations from hospi-
tals, &c, followed his remains to the tomb.

Doctor Capurox, a distinguished professor of Midwifery, died re-
cently in Paris, at the advanced age of eighty-three years.

METEOROLOGICAL OBSERVATIONS,
Ga. Latitude 33 27' north Longitude 4
tide, 152 feet. By Dr. Paul F. Eve.

for May, 1850, at Augusta,
32' west Wash. Altitude above

<

Sun
Ther.

Rise. II
Bar. j

3, I

Ther.

\ M. !
Bar.

Wind.

Remarks.

1

58

29 91-100'

85

29 87-100

s. w.

Fair.

2

60

t: 95-100

84

" 90-100

w.

Fair.

3

62

" 95-100

75

" 87-100

S. E.

Cloud)' breeze.

4

68

" 80-100

81

" 65-100

E.

Cloudy.

5

70

" 47-100

82

" 61-100

S. E.

Fair.

6

60

" G3-100

76

" 74-100

W.

Fair.

7

56

" 90-100

75

" 96-100

E.

Fair.

8

62

" 74-100

77

" 51-100

S. E.

Rain, stormy, hail, I in. 25-100,

0

60

" 55-100

76

65-100

W.

Fair.

10

56

" 70-100

81

" 64-100

S. E.

Fair.

11

66

" 62-400

81

" 56-100

s. w.

Fair.

1-2

58

" 72-100

73

" 76-100

z.

Fair.

13

50

80-100

77

M 80-100

E.

Fair.

14

68

" 50-100

78

" 44-100

s. w.

St0rm~rain'l 5(M00'

15

65

" 38-100

74

" 35-100

S. E.

If,

64

" 39-100

76

54-100

s. w.

Fair.

17

63

" 40-100

78

a 51-100

s. w.

Fair.

18

66

" 62-100

73

" 62-100

S. W.

Cloudy,

19

57

" 70-100

77

72-100

w.

Fair.

20

57

" 80-100

76

" 79-100

w.

Fair.

21

60

!( 80-100

80

" 80-100

N. W.

Fair.

2-3

63

" 91-100

81

" 91-100

s w.

Fair.

23

69

" 93-100

80

91-100

w.

Fair.

21

66

83-100

72

" 81-100

E.

Cloudy.

25

87

'' 76-100

76

" 76-100;

E.

Cloudy all the morning.

or.

60

" 75-100

86

" 74-100

N.W.

Fair.

37

63

" 75-100

90

" 74-100

N. \V.

Fair blow sprinkle at 7 p.5'<

28

68

" 72-100

91

" 68-100

X. w.

Fair storm w wind at 8 p.m.

29

68

" 64-100

95

58-100

w.

Fair morning blow at 8 p.m.

30

71

58-100

79

" 58-100

N.W.

Cloudy rain, 80-100.

31

67

" 56-100

70

" 51-100i

N. E.

Rain, 45-100.

20 Fair days. Quantity of Rain 3 inches Wind East of N. and S. 12 dayc
West of do. do. 19 days.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES AUGUST, 1550. LNo. 8.

PART FIRST,
rtginal am muni cat ions.

ARTICLE XX.

Counter-irritants. By T. C. Quixtard, M. X)., of RosWell, Ga.

Although our subject may seem to be "hackney'd and worn
out to the last faint thread," it is nevertheless one of too great
importance to be passed heedlessly over by the medical prac-
titioner. Speculation' in philosophy, particularly in medical
philosophy, is carried to such an extent that it amounts to a
positive evil, in our times : it frequently takes the place of
scientific facts which bear directly upon natural phenomena,
and leads the mind from the contemplation of mere agents, to
the grander subject of systems and laws. It is pleasanter to give
loose reins to the imagination, to study the poetry of science, to
deal in the abstract conditions of matter, of the principles of
natural bodies, or of the motion, place, and time of natural
bodies, than to curb the fancy down to the stern reality of fact
and experience, or the consideration of those things which lie
before us in daily life. We do not hope to present any thing
new, probably nothing that has not been known since the days
of Hippocrates, and yet we hope our subject will find favor
from its intrinsic importance. Aristotle has said, "they who
demonstrate plain things, light a candle to see the sun." This
is very true ; but there are some fnen who would never know
the sun rose at all unless they were told it, and there are some
men of exuberant intellects who like to have common subjects
brought before them without the bother of thinking.

Jf. 8, VOL. VI. NO. VII!. CD

450 Quintard, on Counter-Irritants. [August,

Counter-irritants may be defined agents, whether natural,
mechanical or medicinal, by which we endeavor to remove or
diminish the morbid condition of a particular structure by pro-
ducing an abnormal state in some part more or less remote
from the seat of disease. Counter-irritants have two distinct
modes of operation, the one derivative, the other stimulant t'o
the general system or to some susceptible organ in particular ;
and a knowledge of this distinction must guide us in their ap-
plication. The principal object to be gained by the use of
counter-irritants, is the withdrawal of morbid action from an
inaccessible and more or less vital organ, to a part immediately
within our power of control. In their application, both skill
and judgment are needed ; for in the hands of the inexperienced
they may work mischief. About the middle of the last century,
when epispastics were far more popular than at present, coun-
ter-irritation was the pet practice in the treatment of gout.
Hillary gives us a case of " gout at the stomach, with some pain
in the head, for which a large vesicatory was applied to the
head, which soon brought the gouty humor thither, and caused
it to swell in an extraordinary manner,, and killed the patient
in thirty hours; whereas," he continues, " if it had been applied
to the feet or ancles, and other proper methods used at the same
time, it would have drawn the gout thither, and have saved the
life of the patient/'* The experience of every man who has
seen much of disease, might be introduced to prove the necessity
of discrimination iu the use of counter-irritants, especially in
those diseases affecting the respiratory organs. Mr. Porter
protests against the use of blisters in acute laryngitis, especially
in the earlier stages.f A case is also related where, in acute
pneumonia, the application of a blister was followed by an
aggravation of the symptoms, and death was the consequence.
On dissection, a portion of the surface of the lung, exactly cor-
responding to the size and shape of the blister, was found in a
more advanced stage of inflammation than the remaining pul-
monary tissue. So, also, tartar-emetic may become so violent
in its action as to increase rather than remove the difficulty for

* Hil. Med. Knowl., p. 353. See also Boerhaave, Aphorisms, Febris and
Bagliv de Usu et Abusu vesicant.
t Surg. Obs. on Dis. of the Larynx and Trachea

1850.] Quintard, on Counter- Irritants. 451

which it is applied, and a case will be given, when we come to
speak of croton oil, in which twelve drops of that article appli-
ed over the chest for a bronchial affection, produced an eruption
over the surface of the whole body. Counter-irritants have
been more or less popular with the profession from a very-
early period in the history of medicine, and were doubtless first
"suggested to the attentive observer by the occurrence of spon-
taneous translations of disease from one part to another, and by
the obvious and frequent relief afforded by them: as, for exam-
ple, in the subsidence of pulmonary and gastric irritation on the
appearance of a cutaneous eruption." It is this simple process
of enquiring into the causes of natural or morbid appearances,
which has assisted materially in placing medicine among the
certain sciences; and it is by accurate observation, after all
our reading, with true inductive reasoning, from certain estab-
lished facts, that we are enabled to perfect the ars divina.
Such observation and reasoning will conduct us right and
prove truly satisfactory to the judicious physician. With these
few desultory remarks, we proceed to the consideration of
Cantharides.

Cantharides, cantharis vesicatoria Geoffroy ; meloe vesica-'
toria Lin. ; lytta vesicatoria-~Fab. ; belonging to the family
of the trachelides. They are common in Spain, Italy and
France, where they are found in great numbers on the ash,
lilac, viburnum, &c. Their body is from six to eight lines long;
the feelers are black, retaceous, composed of twelve articula-
tions ; the elytra, long, flexible, of a shining golden green, and
the tarses of a deep brown. Their odour is strong, penetrating,
peculiar and unpleasant; their taste extremely acrid; their
powder is of a brownish gray, intermixed with shining particles
of a metallic green color.* According to Robiquet, they con-
tain, with several other ingredients, a peculiar substance, called
cantharadin. They were first used internally, as a diuretic, by
Hippocrates,f while to AretaeusCappadox, who lived probably
about the time of Domitian, towards the latter end of the first
century, is due to the credit of first applying them externally as
vesicatories.

* Encyc. Am. et Gen. crust, et Insect., torn, ii., p, 220. (Latreille.)
i Hippoc. de Intern, affeciionibus.

452 Quintard, on Counter-irritants. [August,

By the application of cantharides to the surface of the body,
the extreme vessels take on an inflammatory action, the inten-
sity of which depends on the strength of the plaster and the
length of its application. It follows, therefore, that the benefit
derived is by different modes of operation. As a rubefacient it
is advantageously applied in low fevers to increase the vigor of
the circulation and to impart tone to the nervous system ; as
evacuants, by getting up a determination to the surface, and
by withdrawing blood from the engorged capillaries to supply
the discharge of serum or pus; as derivatives, by producing a
diversion of the circulation from the neighboring organs; as
antispasmodics, relieving pain through the medium of sympa-
thy. " A blistered surface may be considered in the light of a
new excretory organ, the fomentation of which requires the
establishment of a new current of blood."* In whatever way
blisters may operate whether as evacuants, rubefacients, de-
rivatives, or direct stimulants, whether as " cordial and exhilira-
ting" remedies or depletories, as in erysipelas, experience has
proved their utility in a great variety of cases, in affections
differing as widely in their anatomical character, as in their
location.

The effect of a blister on the cuticle is worthy of notice. It
at once destroys its connection with the cutis, and the perspira-
tory apparatus is broken up. If a blister be applied to a sweat-
ing surface, so soon as it produces sufficient inflammation to
bring on effusion of serum, the cuticle separates from the cutis,,
and becomes impervious. Whether, therefore, this be a dis-
tinct papillary structure, as Gaultier contends, or possessed of
an infinite number of minute pores or, as M. Chevalier
thought, permeable by means of a velaminous structure, its
vitality is at once destroyed by being separated from the parent
cutis, and is never again reunited to that structure. The more
powerful rubefacients will produce vesication ; but of them and
their effects we shall speak hereafter. If a plaster of canthari-
des here be applied for two or three hours only, its effect is
merely rubefacient ; but if allowed to remain on the surface of
the body from five to ten hours, as the circumstances of indi-
vidual cases will indicate, a quantity of yellowish serum will be
Eb. Therap., v. 2, p. 216.

1850.] Quintard, on Counter-irritants. 453

found beneath the cuticle, which, being poured out more pro-
fusely after the removal of the plaster, fills the. separated cuticle.
Unless local depletion is used, cantharides has a stimulating
effect, until vesication is completed, or rather until the engorg-
ed capillaries are about to throw out serum, when their evacu-
ant power is developed, and frequently to such a degree as to
decrease the frequency of the pulse, and having thus an indirect
sedative action, induce sleep.

Frequently the active property, the cantharadin, is absorbed
into the system, causing a considerable degree of general irrita-
tion, producing priapism, strangury, bloody urine, &c. This
is more peculiarly liable to occur where the system is uncom-
monly irritable, where the blister is large, or where it is appli-
ed to a newly abraded surface, as to the head, when recently
shaved. (Murray.) It was once contended that the canthari-
des contained an "alkaline semi-volatile salt," "which passing
into the blood, attenuated, dissolved, and hastened and increas-
ed its putrefaction," and this conclusion was confirmed by "the
putrid alkaline acrimony which it produced in the urine."*
Modern research has given us a clearer and .more satisfactory
explanation of the modus operandi of this agent, and the man-
ner in which strangury arises.f An analysis of cantharides
was attempted, by Thonvenal, in 1773, and by Dr. Beaupoil,
in 1803, but no result of value was obtained until 1810, when
Robiquet discovered in them a crystalline substance, which ap-
pears to be the vesicating principle. It is owing to the absorp-
tion of this active principle, which is one of the most troublesome
attendants upon their operation, that many practitioners hesi-
tate in prescribing them where they are indicated. To prevent
the occurrence of strangury, as well as unnecessary irritation
from the adhesion of particles of fly to the surface, it is well to
adopt the expedient recommended by M. Bretonneau, that of
interposing a piece of thin gauze, or paper, well soaked in oil,
between the blister and the skin. The oil, according to the
experiments of M. Robiquet, being a solvent of the vesicatory

* Hiliary Med Know]., p. 35G.

t The student should consult Marshall Hall's Memoirs on the Nervous Sys-
tem. (Lond., 1837.)

454 Quintard, on Counter-irritants. [August,

principle,* transfers its effects, without any diminution to the
skin. (Paris.) When strangury does occur, it is better to
have recourse to small injections of oil and laudanum, rather
than to allow the patient to drink freely of mucillaginous com-
pounds as is often recommended ; for there are instances in
which the quantity of fluid taken has entirely desti oyed the
influence of the blister. Liquids must be absorbed in the cir-
culating fluids, and thus may counterbalance the evacuant
power of the vesicatory and render it a simple counter-irritant.
Dr. Williams says, " we are convinced, by experience, of the
advantages of abstinence from any bulk of liquids, and would,
therefore, look for other means to avoid the irritating effects of
absorption from a blister."f

As all local diseases are more or less connected with the
general health, wre should beware, lest, in applying blisters for
slight local diseases, we produce too great general disturbance.
Abernethy, in speaking of this subject, says, "You need not
apply a blister a foot square in order to derive benefit from it.
Oh ! no. But blister a small part of the surface of a large
swelling at a time. Quiz it as they like, it is a very useful pro-
cedure." Again,. in speaking of counter-irritants generally, he
says, ' Blisters may be considered one of the mildest of them ;
yet a blister, oh! a blister is a horrible thing in an irritable
system, and disturbs the general health more than you would
suppose.rJ

The powerful impression made by blisters on the system is
sufficient, in many instances, to destroy morbid action : hence
their use in the treatment of remittent and intermittent fevers.
In those cases of intermittent fever, where quinine will " break
the chill" for a while, by giving tone to the vis nervosa, with-
out a corresponding effect on the muscular fibre, a blister ap-
plied to the spine will generally break up the morbid action
completely, when so employed as to be in full operation at the

* This fact shows how erroneous was the opinion formerly entertained viz..
that oil was an antidote in cases of poisoning by canth. It assists its action.
Emetics should be employed, and afterwards draughts containing camphor or
opium, with mucillaginous injections into the bladder.

t Cyc. Prac. Med.

t Vide Marshall Hall, on the true spinal marrow and excito-motory system
of nerves.

1850.] Quintard, on Counter-irritants. 455

period for the recurrence of the paroxysm. By carefully
guarding against too great arterial excitement, blisters may be
used in nearly every disease attended with irritation or inflam-
mation of internal organs. Substituting their own action in
the part to which they are applied for one of a morbid nature,
they are useful in tinea capitis, herpes, and a variety of cutane-
ous eruptions. As local stimulants, they are of use in cases of
threatened gangrene, partial paralysis, &c. Some five year*
since, the writer was attacked with paralysis of the portio-duraB
on the right side. The most delicate, and the most powerful
remedies were applied, without success, by Prof. Pattison, of
New York. The use of an electro-magnet was persevered in
for a length of time; but all agents, both internal and external,
failed, except cantharides. Blisters were applied repeatedly,
as stimulants, and so soon as the effect of one wore off, the
application was renewed, each application producing a marked
benefit in giving tone to the muscles of the face. The serous
discharge they produce renders them useful in cases of local
inflammation, where they can be applied in the vicinity of the
disease, as in erysipelas, &c. On some constitutions canthari-
des produces a poisonous impression, when externally applied,
attended with dryness of the fauces, subsultus tendinum, and
even convulsions : the instances are, however, rare, and should
not deter a physician from prescribing the remedy as often as
his judgment dictates. It is impossible to determine what is
the condition of the system, or peculiarity of constitution in
which this is liable to occur.

Few authors recommend a more general adoption of blisters
than Broussais, and although his treatment was based upon his
favorite theory of disease, the student will find very much
valuable information in his writings, with reference to the sub-
ject of blisters. There is one point, too often lost sight of in
the management of pleurisy, viz., after the application of a
blister to a case of pleuritic phlogosis, the pain being removed,
and a partial cessation of the fever, and other general symp-
toms, the uneasiness and slight dyspnoea are regarded as the
effect of a disease removed, rather than symptoms of a disease
continuing. On this point, M. Broussais, after noticing the
universality and appropriateness af the application of blisters in

450 Le Conte, on the Science of Medicine, tyc. [August,

this disease, remarks : " We usually observe, in fact, that the
pain disappears in consequence of their action ; but I have
several times noticed that this disappearance did not offer the
physician a guarantee sufficient to remove all his fears as to
the sequelae of the phlegmasia. I have seen several pleuritic
patients die, previously to the term assigned to acute diseases,
in whom the blister had removed the pain from the first day,
and dissection proved that the inflammation of the pleura had
not been dissipated." In hospital practice, where, from multi-
plicity of engagements, the physician is unable to give the
requisite attention to all his cases, this is more apt to occur than
in private. It often happens that a pleuritic patient will, in
common parlance, "get well." The physician, losing sight of
his patient, has no opportunity of judging of the after effects of
the disease. Says the distinguished author just quoted, " I lay
great stress on this point, being intimately persuaded that a host
of practitioners have habitually under their care, consumptions
arising from pleurisies, the formation of which they have seen
and misunderstood.

Brown,'in his system, condemns the use of blisters, without
reserve, in all sthenic diseases. The humoralists use them to
evacuate "the humors;" the vitalists propose to establish by
them an innocent external phlogosis in place of an internal
one so that as system succeeds system, this remedy is adopted
by each, for various reasons and explanations, differing widely
in theory and fact, given to justify their use.

With this imperfect sketch of our subject we are obliged to
close for the present. In our next we shall take up Tartar-
emetic and Croton oil, as counter-irritants.

ARTICLE XXI.

On the Science of Medicine and the causes which have retarded
its progress. By Joseph LeCont, M. D Macon, Ga.

It is the remark of one of the most profound writers and
thinkers of the present day, that the prevalance of quacks and
quackery in any age marks the decay of old institutions and the
loss of public confidence in existing formulae and modes of

1850.] Le Conte, on the Science of Medicine, fyc. 457

thought; and that affairs can in no wise progress or improve,
until some radical change is effected and a new basis of faith
established.

Let us apply this truth to the existing state of medicine.
Never in the whole history of our science did quackery
abound to the same extent as it now does. The variety and
speciousness of its forms are so great as to elude the vigil-
ance and deceive the judgment of the most penetrating. Now,
if we seek the- cause of this growing evil, is it not evident that
it takes its rise in the want of entire public confidence in the
so-called orthodox system of medicine, and the notorious fact
that the frequency of recoveries from disease is nearly the same
under every system of treatment? Is it not because, while
general intelligence, civilization and science in every other
department, is advancing with a rapid and constantly increasing
rate of progression ; medicine is slowly halting after, at an
almost telescopic distance. The public are not to blame. The
origin as well as the cure of this disease rests with ourselves.
The evil will continue to increase, acts of legislation and reso-
lutions of medical societies to the contrary not withstanding,
unless we shake off the lethargy which has seized upon the pro-
fession, and with it all orthodoxy or prejudice in favor of
existing systems, all petty jealousies and selfishness, and ap-
proach the subject with an open, candid mind, full of the love
of truth, fired with zeal and confidence, but tempered with the
awe which should characterize the true devotee at the shrine
of nature.

If, then, we have rightly stated the origin of the evil of which
so much complaint is heard (as we think every candid mind
must admit we have), it behoves us to waste no more time in
vainly attempting to put down quackery, by memorials to the
Legislature or any other forcible means. As the science now
exists, the evil is necessarily and inseparably connected with
the practice of medicine under every system, and the only
possible way of eradicating it, is to direct all our energies to
the accomplishment of two objects, vjz., the advancement of
the science of medicine and a proper system of medical educa-
tion.

Of these two grand objects of medical organization, we pro-

458 Le Conte, on the Science of Medicine, fyc. [August,

pose on the present occasion, to speak only of the former,
particularly as the latter is now engaging the attention of
medical societies throughout the country. And here, lest we
should be charged with presumption, we would premise by
remarking, that it is not our intention to attempt a complete
solution of the problem of medical advancement to point out
the best plan of medical organization. to show the means to be
used, and the manner in which they must be used in other
words, to construct the whole complicated machinery by which
the principles of Inductive Philosophy may be best applied to
medicine ; but simply by glancing slightly into the philosophy
of our science and pointing out the causes which have retarded
its progress, to show that statistics are the most direct and
powerful means of fulfilling the object which, it is hoped, we all
have in view that it is indeed the only means of applying
induction to a large portion of our science.

Among the causes which have retarded the progress of the
science, we might mention its necessary connection with, and
consequent dependence upon, the profession of medicine.
The result of this connection is, that petty selfishness is often
opposed to the best interests of truth. Hence, when we look
for union and concerted action, we find disunion, wrangling and
jealousy, until the very word "physician" is proverbially as-
sociated with illiberality and prejudice. But, we will not dwell
upon these humiliating facts, for the existence of medical asso-
ciations in every part of the country, and the increasing
interest which is felt in them, are evidences, not to be mistaken,
of the dawn of a better state of things.

Another, and perhaps more important, cause, is the great
prevalence, both in, and out of, the profession, of the belief that
there is a natural antagonism between profound scientific
knowledge and great practical skill that there is a practical
knowledge and a practical skill found thereupon, which is vastly
superior to, and has no connection with, theoretical knowledge
that, in short, the study of the science, unfits a man for the
practice, of medicine. Now, although there is probably a germ
of truth in this notion, yet it is evident that those who entertain
it, take but a superficial view of the subject and by hasty and
unphilosophical generalization strike a blow at the very life of
medicine as a science.

1650.] LeConte, on the Science of Medicine, tj-c. 4f>9

It is readily admitted that there is a knowledge which cannot
be learned from books which science has not yet attempted
to brin^ under her dominion a knowledge which is essentially
unscientific in its character which is more or less vague and
indefinite, and which therefore can only be expressed vaguely
and indefinitely ; but which is nevertheless of the utmost
importance in the practice of medicine. It is to be learned by
close observation and constant attendance at the bedside of the
sick. It requires the exquisite sense of touch, the keen ear,
and, above all, that delicate constitution of the perceptive pow-
ers which quickly and accurately responds to the senses, the
strong intuitive mind which easily look through the external
features or physiognomy of a disease and sees its true nature
and tendency, and the decision, promptness and energy necessa-
ry to overcome the foe whose nature and place of concealment
we have discovered. It is also admitted that there are many
profoundly versed in the science of medicine, as it now
exists, and who, for the want of knowledge of which we
have spoken or perhaps of the proper constitution of mind and
body, are nevertheless unsuccessful in practice, and others
who are comparatively successful and yet trust so evidently to
the delicacy of their senses, the intuitive quickness of their per-
ceptive powers and the promptness and accuracy of their judg-
ments, as to affect a contempt of the science of medicine. But
it is evidently a " non sequilur" to conclude that the superiority
of the latter is due to his want of scientific or theoretical know-
ledge.

All practice, however strictly practical it may be, is founded
upon general notions or theories of some kind. Even in the
most common acts of practical life, we are invariably (when we
act rationally) guided by such general notions. Indeed this
faculty of theorizing and forming general rules of conduct
seems to be one of the most important of those which separate
us from the brute creation. The only difference then between
the so-called practical and the scientific physician, is that the
rules by which the former is guided are based upon crude ill-
constructed theories drawn from hasty observation and limited
experience, and wanting in scientific distinctness and accuracy,
and therefore can only be applied with more or less vagueness

460 Le Conte, on the Science of Medicine, <J*c. [August,

and uncertainty ; while the theories of the latter are founded
upon whatever is most worthy of confidence in the observations
of the whole civilized world. They are not arrived at hastily,
but by careful induction, and are therefore capable of infinitely
more certain application. Other things being equal, therefore,
the scientific practitioner is always the most successful. For
since all are governed by theories of some kind, the more ex-
tensive, fixed and definite, they are, the more certainly will
they guide us correctly. When the more fixed and firmly es-
tablished principles of our science fail to .serve us as a guide,
(and this will frequently be the case,) then those vague and
uncertain principles which we have provisionally established in
our own minds, as the results of our own individual observation,
but have not yet been brought under the dominion of science
which frequently we cannot express distinctly in words, and
sometimes exist, scarcely distinguishable, like shadows in the
mind ; even these flickering and uncertain lights must be our
guides through the chaos of doubt and darkness which too
often surrounds the most intelligent. Alas ! how small a pro-
vince is cheered by the light of science, and how illimitable
the kingdom of darkness and ignorance by which it is sur-
rounded. This kingdom it is the glorious destiny of science
to conquer and reclaim.

The causes which we have mentioned above are not neces-
sarily connected with medicine. They are rather connected
with the present state of the science. We may therefore rea-
sonably indulge the hope that time will remove them. But
there are other causes of the slow progress of medicine, con-
nected with the nature of the subject itself obstacles which
therefore it is impossible for us to remove, but which, by patient
and persevering industry, we may surmount. The necessity of
understanding and fully appreciating these causes, in all our
attempts to advance the science of medicine, renders it neces-
sary to dwell a little moje fully.

And here, in order to avoid confusion, I find it necessary to
define in what sense I use the phrase, "the Science of Medi-
cine." This I do, not to change the views of any one on this
subject, but simply that I may not be misunderstood in what
follows. This definition is the more necessary, as this phrase

1 850. ] Le Conte, on the Science of Medicine, fyc. 4G 1

has been very loosely used and the limits of our science seldom
carefully marked. I shall speak of medicine in its widest sense,
in the only sense in which it can lay any claim to the rank of a
science, and define it to be the science of Life or Biology, as it
has been very properly called. It includes physiology and
pathology, but excludes hygiene and therapeutics ; these last
being but systems of practical rules, deducible from the laws of
life, for the preservation or restoration of health. Its province
is quite distinct from, though intimately connected with, organic
chemistry and the science of organization or natural history,
in its highest sense. Chemistry deals with organic matter, the
science of organization with organized bodies, biology with
living beings. The chemist, it is true, often deals with organ-
ized bodies, but their organization is of no importance to him.
Between the provinces of the biologist and the naturalist, how-
ever, it is more difficult, nay, even impossible, to draw the line
of distinction; yet they are by no means identical. The pre-
sent state of Paleontology proves that the naturalist is not
entirely dependent upon the phenomena of life for the successful
cultivation of his science. Other departments, as generation,
embryology, development, &c, where life is a necessary ele-
ment, are claimed by both sciences. These subjects, however,
have been principally pursued, and the most general and im-
portant laws established by naturalists. I shall therefore speak
of these laws as a part of our indebtedness to the science of
organization. Biology deals entirely with phenomena of life,
particularly as manifested in the highest order of animals. It
is evident, therefore, that both organic chemistry and the sci-
ence of organization are subordinate to biology, which, there-
fore, is the highest and most complex of all sciences. In this
very elevation consists the difficulty of which we propose first
to speak.

If we take a rapid glance at the history of the inductive
sciences, we find, that though at first all rest upon simple ob-
servation and experiment, yet at a certain stage, the progress
of the more complex may be impeded for want of sufficient
development of the more elementary. Thus, for instance, we
find the science of Astronomy advancing with great rapidity
under the Alexandrian school, and again under the powerful

462 Le Conte, on the Science of Medicine, fyc. [August,

influence of Copernicus, Tycho Brahe, and Galileo, until this
inductive epoch was finally crowned by the three great phe-
nomenal laws of Repler. Thus far, all was the result of simple
observation, aided by mathematical calculation. But now, ob-
servation had done all it could do : it had established the highest
laws of phenomenal astronomy. Here, therefore, the science
would have remained forever fixed, no higher inductive step
been taken, and physical astronomy had no existence, if the
development of mechanical philosophy, about this time, had not
given Newton the means of establishing the grand law of
universal gravitation, and thus communicating an impulse to
astronomy which has not only brought it forward to its present
enviable position, but will yet carry it onward for many suc-
cessive ages, without the assistance of any higher generalization.
As we rise in the scale of sciences, we need not be surprised to
find these connexions and dependencies becoming more com-
plex, until the greatest degree of complexity is attained in the
science of life.

Biology is intimately connected with, and necessarily, in a
measure, dependent upon, all the principal departments of
science, viz., the mechanical sciences, including the physical
sciences strictly so-called ; the chemical, including also electri-
city, magnetism, &c. ; and the organical sciences, including the
anatomy, physiology, and classification of organized beings, or
natural history in its noblest sense. Its connection with the
mechanical sciences, though comparatively slight, is not unim-
portant : without their aid we could not fully understand the
phasnomena of vision and hearing; the physiology of locomo-
tion, respiration, circulation, &c. But it would seem that the
physical sciences have already done all that they can for us, or
at least the rapid advance of these sciences for many years past
has not materially affected ours. It is to developments in the
chemical sciences that the attention of the medical world has
been directed with perhaps the greatest expectation of assist-
ance. We cannot too highly estimate the effect which the
progress of these sciences are destined to produce upon our
own. Every function of vegetable life is more or less subject
to the laws of chemical affinity. Respiration, calorification,
digestion, nutrition, secretion and excretion, are daily brought

1850.] Le Conte, on the Science of Medicine, fyc. 463

more and more under the dominion of these laws. Meanwhile,
there are not wanting those who hold that many of the func-
tions of animal life, as muscular contraction, sensation, &c, are
equally referrible to the laws of electricity. Thus the time-
honored empire of vital force, attacked on both sides, has been
gradually contracting its domain, until, to many, it seems
doubtful whether it will not vanish altogether whether vital
force, chemical affinity and electricity, are not indeed modifi-
cations of one and the same force. Hypotheses of this kind
may be useful in the investigation of truth, but must not be
mistaken for truth itself: they stimulate enquiry and point the
direction to be pursued, but cannot safely be used as a founda-
tion upon which to build. Hypotheses are provisional: they
may be confirmed or disproved. Truth, inductively establish-
ed, is eternal. The true, inductive philosopher, neither affirms
nor denies what is involved in the smallest degree of doubt;
but fearlessly investigates every subject, calmly awaits the
gradual development of facts, and earnestly embraces the truth
brought to light. To him, old prejudices may be sacred, but
truth infinitely more sacred.

Aside, however, from all hypotheses, nothing can be more
certain and important than the intimate connection which ex-
ists between the sciences of biology and chemistry. This con-
nection has given a new dignity to the latter science, new
vigor and energy to its prosecution, and a corresponding im-
pulse to its rate of progression. The reaction of this impulse
upon the former will doubtless be attended with the happiest
effects, and henceforth these two sciences will advance with
equal pace, each throwing light on the other, gradually ap-
proaching and partially merging into one.

The connection of biology with, and consequent dependence
upon, the science of organization, is perhaps less generally felt
and acknowledged, but even more important. The object and
tendency of chemistry, in its present state, is to explain in de-
tail and reduce to the laws of chemical affinity, many subordin-
ate and non-essential functions of life, and to prove that these
functions are regulated by the same laws which we recognize
every where around us in inorganic nature. Natural history,
rising one step higher, lays hold of the essential functions of

464 LeConte, on the Science of Medicine, <$-c. [August,

life, which are beyond the grasp of chemistry, and establishes
their faws. Chemistry reduces many phaenomena of life to
their physical or causal laws. Natural history knows no cause
but the great first cause, and is content to reduce to phenome-
nal laws the operations of that cause, as revealed in organiza-
tion. The cultivator of this science devotes his life to estab-
lishing that perfect unity which binds the whole animal and
vegetable kingdoms into one organic whole. He feels that
this must be done before we can discover the causal law which
will add this link also to the chain which shall surround the
universe.

Those who have studied natural history, under the Linnsean
system of classification only, will perhaps be surprized at the
elevated position which I would assign to that science. But
since the days of Linnaeus, natural history has undergone a
wonderful change so great that the end and object of the sci-
ence is different and infinitely more elevated. The true end of
the Linnaean system is to recognise and distinguish objects of
nature. The collection of these into genera, orders, classes,
&c, was intended to facilitate the labor of description, as well
as for the convenience of the learner, who would know the
names arid find the places, in this artificial system, of the differ-
ent objects of nature, and thus often miserably delude himself
with the conviction that he is intimately acquainted with the
profoundest secrets of nature. Classification was therefore
founded upon a few external and very marked features, works
of natural history little more than dictionaries in which objects
bearing a resemblance in certain arbitrary particulars, like
words having the same initial letter, were placed in juxtaposi-
tion ; and naturalists were mostly laborious collectors of im-
mense museums of dried specimens accumulators of what
Professor Schluden, perhaps too severely, characterizes as no
better than so much "hay/1 On the other hand, the end of
natural history, as now pursued, is to understand the real and
natural relations of organized bodies, to discover, as it were,
the plan of the creator himself, and thus to recognise the perfect
unity and beautiful harmony which reigns throughout all or-
ganized nature ; and classification is the simple expression of
these relations so far as we are able to discover them.

1850.] Le Conte, on the Science of Medicine , c$*c. 465

It is evident, however, that the artificial system was a neces-
sary stage in the progress of the natural sciences. It was
necessary for many ages, to study, recognise and know famil-
iarly, individuals, before we could unite them according to their
natural affinities. Linnaeus himself was perfectly aware that
his system was temporary, and must be superseded by a more
natural one. If it had not been so superseded, the true end of
natural history would never have been attained, and biology
never felt the powerful influence of this department of science.
This influence is only now beginning to be fully recognised,
and already the most important revelations have been made,
and at least one grand, universal law of life established, viz., the
law of cell-developement. The effect of this law is already
felt in every department of physiology, and points, the most
obscure, and hitherto believed to be beyond the reach of human
intellect, have been rendered perfectly clear and intelligible.
It teaches us that the phenomena of development and growth
are the same in every tissue, and in all organized beings, from
the highest vertebrate to the lowest cryptogam : its essential
nature being in fact the spontaneous division and subdivision of
primary nucleated cells, and differing only in the fact that in the
higher animals these self-multiplying cells are carried by a specific
circulation to the tissues, and assume different forms, according
to definite laws corresponding to the tissue by which they are ap-
propriated. It teaches that generation by fission and gemmation,
is but an extension of the law of development ; that, by fission be-
ing perfectly analogous to the spontaneous division of cells, and
that by gemmation to the reproduction of limbs in the lower, and
of tissues in the higher animals ; and that even the mysterious,
process of sexual generation differs but little from that of de-
velopment : that it consists essentially in the separation by a
sort of spontaneous fission of one cell (instead of many, as in
the fissiparous and gemmiparous variety) from the organism of
each parent, which then unite to form the germ ; that therefore
the separation by spontaneous fission of one or more cells from
the parent organism, according to the simple law of "cell-devel-
opment," is the invariable, and therefore the essential element
of all generation. How universal, simply expressed and beau-
tiful, are these laws ! ! In the words of one of the most eloquent

x. s. vol. vi. no. vm. 30

466 Le Conte, on the Science of Medicine, tyc. [Augxrst,

writers and profound physiologists of the present day "If ever
we are to escape from the obscurities and uncertainties of our
art, it must be through the study of those highest laws of our
science, which are expressed in the simplest terms in the lives
of the lowest orders of creation.5'*

There are many other problems of the highest importance, for
the solution of which we are now looking to the development of
the science of organization. If the study of organized beings,
both vegetable and animal, has thrown so much light on those
functions which are common to both, may we not hope that
the study of animal organisms, with reference particularly to
those still more mysterious functions which are peculiar to
animals, will be productive of equally important results. Al-
ready there has been something done on this subject. The
attentive study of the anatomy of the lower, and particularly
the invertebrate animals, in connection with the phenomena of
muscular motion in these animals, have already greatly modifi-
ed the "reflex theory" of Marshall Hall. As we proceed down
the scale of animal existence, we find that first one and then
another portion of the nervous centres disappear. First the
cerebrum, and probably cerebellum, dwindle and vanish with
the vertebrate type ; then the ganglia, at the base of the brain,
dwindle in the same way, and vanish with the articulate and
molluscous type ; in like manner, what seems to be the homo-
logue of the spinal chord disappears, until finally we have nothing
but simple nervous chords. Here, then, we have the conditions
varied by nature in almost precisely the same manner as we
attempt to vary them in vivisection-experiments, and we have
moreover the important advantage of observing the phenome-
na in healthy, unmutilated subjects. Thus, nature prepares the
experiments, if wre will only take the trouble to observe. Surely
nothing can be more important to the physician than the study
of this science. It has been called the noblest of all sciences:
and certainly, until biology shall assume the form of a distinct
science, it deserves that rank ; for in the whole range of sci-
ences, there is none which opens so rich, varied, and extensive
a field to the enquirer after truth so ennobles, elevates, and

* Mr. Paget's Introductory Lecture at the Royal College of Physicians and
Surgeons.

1850.] Le Conte, on the Science of Medicine, tyc. 467

purifies the mind so plainly unfolds the beautiful harmony and
unity which pervades the universe so deeply impresses us
with the wisdom and goodness of the Creator so leads from
the finite to the infinite, shewing thereby that, to the rightly
constituted mind, science is the purest and most exalted reli-
gion, as the science of organization. And here, I cannot forbear
participating in the enthusiasm, and adopting the language of
one who thus combined science and religion ; who, after pass-
ing in review all the inductive sciences, thus concludes the
history of that of which we are now speaking : " We have been
lingering long amid the harmonies of law and sympathy, con-
stancy and developement; and these notes, though their music
was sweet and deep, must too often have sounded to the ear of
our moral nature, as vague and unmeaning melodies, floating in
the air around us, but conveying no definite thought, moulded
into no intelligible announcement. But one passage which we
have again and again caught by snatches, though sometimes
interrupted and lost, at last swells in our ears, full, clear and
decided; and the religious 'hymn in honor of the Creator? to
which Galen so gladly lent his voice, and in which the best
physiologists of succeeding times have ever joined, is filled into
a richer and deeper harmony, by the greatest philosophers of
these latter days, and will roll on hereafter the 'perpetual song1
of the temple of science."*

But, however important the sciences we have mentioned
are, to the progress of our own, there are many phenomena of
life, patticularly as manifested in its most complicated form in
man, which they do not in their present state, in the least degree,
explain, and the laws of which we may never know, unless we
arrive at them in some other w7ay. The laws established by
other sciences, when all the conditions under which they act
are fully understood, may be deductively applied to explain the
phenomena of life ; but when these conditions are not under-
stood, we cannot arrive at their proper explanation by deduction.
We must take up biology as a distinct science- We must dis-
card all attempts to explain the phenomena of life, by loosely
extending the laws which govern other phenomena of nature,
and which have been established by other departments of sci-

* Whewell's History of the Inductive Sciences, 2d edition, vol. 3, p. 5*21.

468 Le Conte, on the Science of Medicine, fyc. [August,

ence ; and commence with simple observation of facts, and thus
establish laws by strict induction. The science of organiza-
tion teaches us the highest and most universal laws of life.
But the phenomena of life in the higher animals, and particu-
larly in man, in health, and especially in disease, are so compli-
cated, that we cannot refer them to these general laws. In the
same manner, although doubtless the laws of chemical affinity
govern, more or less, all the phenomena of life, both healthy
and diseased, yet the conditions, under which these general
laws act, are so little understood, that we cannot refer the
phenomena to them. As an illustration of the fact, that we
may be acquainted with the forces, and even the more general
laws, which govern certain natural phenomena, and yet be so
ignorant of the conditions under which they act, that these
phenomena shall appear the result of mere chance, we will
mention the science of meteorology. All the phenomena of
this science, such as, winds, rains, formation of clouds, atmos-
pheric moisture, weight and electrical condition, are subject
to the already known laws of chemistry, electricity and me-
chanics. Winds, for instance, are subject to the simple law of
equilibrium of fluids; and yet what can be apparently more
fortuitous than their occurrence ? Just so with the irreducible
phenomena of life, of which we are now speaking. Though
they are, doubtless, subject to already known chemical and
organical laws, we cannot reduce them to those laws they
seem to happen fortuitously : the subordinate laws which gov-
ern them, and by which alone we can reduce them to the
general laws, we do not understand, and never will, unless we
arrive at them by the strictest induction.

Inductive philosophy, as we all know, is founded upon simple
observation of the operations of the forces of nature. If the
subject admits of it, we vary, in every conceivable manner, the
conditions under which the forces act, and again observe the
effects. This, we call experiment. After a sufficient number
of careful observations, under various conditions, we perceive
the law by which the phenomena are governed. If the law
so discovered may be expressed algebraically, in terms of
number and quantity, then this most powerful agent of the
human mind is brought to bear on the subject, and the law is

1850.] Le Conte, on the Science of Medicine, $c. 409

applied with the utmost rapidity and certainty in the explana-
tion of phenomena, which were before irreducible. Calcula-
tion develops new laws, and the subject advances with the
utmost rapidity.

Perhaps the best illustration of the principle of induction, and
example of its triumph, is contained in the history and present
position of the science of astronomy. The inductive steps are
plain and distinct; the progress uninterruptedly onward, from
the simplest observation of isolated facts, to the highest state of
perfection to wThich science has yet attained ; from the collec-
tion of shapeless and apparently useless materials, to the present
state of that stupendous edifice, which we cannot view without
wonder and astonishment.

If we turn now to the history of medicine, we find the con-
trast humiliating in the extreme. Commencing, like astronomy,
at a period of which we have no authentic account cultivated
in every age by a larger number of intelligent men than any
other department of knowledge superior to all others in the
intrinsic interest of its subjects, and their intimate practical
connection with the happiness of the human race, medicine has
just commenced to take rank among the inductively progressive
sciences.

Let us inquire into the cause of this amazing difference, and
point out the obstacles which have opposed the successful ap-
plication of induction to our science.

Of these, the first and most important which we will mention,
is the fact, that some of the most powerful agents of inductive
progress, which we have noticed above, are either altogether or
to a great extent inadmissible in our science. The conditions
of life are so nicely balanced, that in attempting to modify, we
destroy the cords of life, so highly strung, and so delicate,
that in attempting to make music with our rude fingers, thev
snap. In other words, we cannot, except to a very limited
extent, make use of experiment. Even vivisections, which
seemed to promise more than any other, have failed to answer
the expectation of those most sanguine of their success. In-
deed, so remarkably has this been the case, that manv have
condemned such experiments as useless cruelty, hardening the
best feelings of the experimenter without effecting any useful

470 LeConte, on the Science of Medicine, fyc. [August,

results. But it is evident that this is an error on the other
extreme; for.it is certain that vivisections of the lower ani-
mals, and particularly of the cold-blooded vertebrata, have
already revealed important truths concerning the functions of
the nervous system especially, and are capable of rendering
still more important service, now that we have been taught so
many useful lessons concerning the fallacies to which we are
liable, in experiments of this kind fallacies which, by caution,
we may avoid, but whose sources we cannot remove. The
difficulties in the way of drawing correct conclusions from
physiological experiments, must therefore always remain very
great. In pathology, these difficulties are still greater, as will
at once appear to any one who will reflect a moment on this
subject. Again, when we attempt to apply mathematics, we
find that the phenomena of life, though subject to the laws of
number, are altogether irreducible to those of quantity. We
may, by statistics, ascertain the number of each kind of phe-
nomenon which may occur in any given time, their relative
frequency, and therefore, to some extent, their value, compared
with one another, but the quantitative value of each fact, we
have no means of measuring. Hence it is that the subordinate
phenomenal laws of life, established by what is called the nu-
merical method, must be only approximatives, (the degree of
approximation being in the direct ratio of the amount of accu-
mulated facts,) and the empyrical rules of practice based upon
them, must still want the mathematical accuracy of expression
and certainty of application, which belongs to the practical
rules of the physical sciences.

Another serious obstacle to the inductive progress of biology,
is the extreme multiplicity and complexity of the phenomena,
the laws of which it is its object to discover. In the microcosm
of the animal body, all the forces of nature are, apparently, at
war, and contending for mastery. The mechanical, chemical
and electrical, against a peculiar force,* which we call vital.
This contention is, doubtless, only apparent, and the result of
our ignorance, which cannot as yet see the beautiful and per-

+ I call this a distinct force, for the same reason that gravitation or chemical
affinity is called so, viz., because its essential phenomena cannot yet be referred
to any other force.

1850.] Le Conte, on the Science of Medicine, fyc. 471

feet harmony which pervades nature. But in no other way
can we, in the present state of our knowledge, account for the
unexpected and, often, apparently inconsistent results, which
attend the operations of vital force. It is a convenient form of
expression, which well represents the character of vital phe-
nomena, and renders their occurrence conceivable. Where,
then, there are so many forces contending, and disturbing the
normal action of each other where we neither fully under-
stand these disturbing forces, nor appreciate the conditions
under which they act, the multiplicity and complexity of the
resultant phenomena must necessarily appear almost infinite.
Of all problems presented to the human mind, for solution, there
are none so complicated and difficult as those of biology.

It is easily inferred, from what we have said, that the most
important means of remedying the difficulties of which we have
spoken, and thus advancing the science of medicine, are the
extension of the chemical and organical sciences, and the
establishing of an organized system of observations ; which
observations must be recorded in the form of regular statistics,
physiological and pathological. We might say much on the
importance, to the medical man, of the pursuit of the chemical
and organical science ; but we will not, at this time, dwell on
this point not because it is an unimportant one, but because
the progress of these sciences is altogether independent of our
exertions. They have already enlisted in their cause, zeal,
industry and intellect, of the highest order. In the hands of
such men as Agassiz and Prof. Owen, Ralfs and Prof. Schleidru,
Leibig and Boussingault, they must and will progress, in spite
of the ignorance and prejudice of the conceited empyric, who,
in self-sufficient reliance on what he calls his practical skill,
sneers at and rejects, because he cannot comprehend, the won-
derful truths which they continually reveal.

But there is a class of biological phenomena, and these the
most important of all to the physician, upon which, as we have
already remarked, these sciences throw no light, and whose
laws we must arrive at by a different road. Here is true field
of activity for the medical profession; and here we must look
for aid, only from statistics from systematically recorded ob-
servation. The difficulties of the subject are so great, that the

472 Le Conte, on the Science of Medicine, fyc, [August,

ordinary mode of observation, though continued through many
centuries, has resulted in very little inductive progress. The
object of statistics is to render these observations more full,
definite and accurate ; and the conclusions drawn from, and
practice founded upon them, correspondingly definite and cer-
tain. It is a common opinion, both in and out of the profession,
that many of the phenomena of which we are speaking, are
either subject to no law, or else that the laws by which they
are governed are not discoverable. This is the universal ex-
pression of ignorance, with reference to every subject, but one
which ill becomes the members of a liberal profession in
the nineteenth century. To the ignorant, all nature is chaos
and confusion. To the man of science, the most perfect har-
mony and unity pervades the universe, to him, nature is a
"book of revelations," in which the character of God is writ-
ten in symbolical language ; and one of the chief duties of man
in his probationary state, is the interpretation of these symbols.
But we will not resort to argument to prove this point. It is
easy to bring forward undeniable facts to shew that the most
important laws physiological and pathological, have in this
manner been determined. The laws which govern marriages,
births, deaths, &c, have in this way been submitted to investi-
gation, and to some extent established. The influence upon
these, of age, sex, season of year, locality, occupation, &c,
are to a great extent established. The influence of the above-
named agents together with atmospheric heat, moisture and
electrical condition, upon general health and prevalence of dis-
ease the influence of all these agents upon the prevalence of
each particular disease the frequency and, consequently, value,
prognostic and diagnostic, of each symptom of each disease ;
and even the value of therapeutic remedies, may thus be sub-
mitted to statistical investigation, and positively determined.
All these points have already been made the subject of statisti-
cal investigation, and the most important results elicited ; and
but for the limited nature of the statistics, it is impossible to
estimate the impulse which must have been communicated to
the science of medicine. The tables of France, Belgium and
Geneva, have been most useful in determining physiological
laws, such as those of marriages, births, deaths, the mean and

1S50.] Le Conte, on the Science of Medicine, $c. 473

probable life, the value of life at every age, longevity, &c.
Pathological statistics have been much more limited. The
difficulties in the way of keeping these in private practice are
very great, but should not be considered insurmountable. They
have heretofore been kept, principally, by army surgeons and
physicians of hospitals. Dr. Walshe's statistical investigations
of cancer and pulmonary phthisis, are probably the best exam-
ples we have of this mode of interrogating nature, and as such,
should be carefully studied by every cultivator of our science.
He subjects to separate investigation every individual symptom,
and determines its nature ; and if his observations were more
extensive, and made under a greater variety of condition, these
points might be considered as absolutely determined.

It has been objected to statistics, that the rules of practice
derived therefrom, are, of all others, the most grossly empyri-
cal that the mind is diverted from the causes of diseases and
symptoms, to the frequency of their occurrence, and conse-
quently practice becomes a mere calculation of chances. But
it is evident that all observation is subject to this abuse. Yet
even here the superiority of statistics over the ordinary mode
of observation is very decided, inasmuch as the empyrical rules
derived therefrom are much more definite in expression, and
certain in their application. Statistics differ in no respect from
other modes of observation, except in being more extensive
and accurate, and also in being systematically recorded. The
prime object of all observation is to determine laws first the
subordinate, and then the more general ; and thus to establish
a certain basis of practice. If this high object is lost sight of
in the search after empyrical, and, therefore, more uncertain
rules of practice, the fault lies not in the method of observation,
but in the observer who would thus reduce our art to its lowest
condition.

We would remark, in conclusion, that we should not be sur-
prised, nor discouraged by the meagre results, in establishing
the more general laws of life, which have so far attended the
keeping of statistics, compared with the rapid strides with
which many other sciences are advancing. All inductive
sciences commence from small beginnings. The most subor-
dinate phenomenal laws are first established, then the more

474 Harriss, on the Renal Circulation, [August,

general, and, finally, the causal laws. And with every new
law an impulse is communicated and the progress accelerated.
Many of these phenomenal laws of life have already been estab-
lished by means of statistics, and already the effect is seen in
the rapidly increasing zeal and interest excited. Let us see to
it, that we are not left behind in this glorious race. But let us
also be careful that, in our attempts to advance the science,
we be not governed by purely selfish motives and feelings.
Let us connect with it all that is high, noble and generous in
our nature. Science, inductively pursued, is eminently reli-
gious in its tendency. It is a river which commences from
small and insignificant fountains : these presently unite to form
mighty streams, on whose broad bosoms float the industry and
happiness of nations, and which, still farther explored, are found
to unite and lose themselves in the ocean of one infinite truth,
which is God.

ARTICLE XXII.

An, Exposition of M. Bernard's Discovery of the Renal Cir-
culation. By Juriah Harriss, M. D., of Georgia now in
Paris.

The novelty and importance of the discoveries and experi-
ments of M. Bernard have again induced me to report a few
of the beautiful results he has obtained, and some of the facts
he has established. He has been for several years placing
stone after stone upon the great edifice of medicine, of which
he is destined to become one of the pillars of support.

The knowledge of the excessive rapidity with which certain
substances, when taken internally, pass out of the economy with
the urine, and the ascertained fact that many of them when
administered could not be found in the blood, but were identifi-
ed in the urine, have heretofore been unexplained or have led
some into the regions of absurd hypothesis. The mystery was
attempted to be explained by supposing that a hidden commu-
nication existed between the stomach and kidneys, by which
these substances could pass directly from the one to the other.
This, it is needless to say, is unphysiological and untrue.

1850.] Harri&s, on the Renal Circulation. 475

M. Bernard has attempted to solve the mystery, and has
done so by direct experimentation.

The portal circulation is entirely independent of the pulsa-
tions of the heart, and differs from all other venous circulations
in the fact that there is an intervening organ between the vein
and the heart. The blood, instead of passing directly from the
portal vein to the heart, is forced to traverse an organ seated
upon its course to the centre of circulation. The portal, and
indeed the circulation in all the abdominal viscera, is under the
direct influence of the pressure of the abdominal walls. This
pressure is essential and indispensable to the circulation of the
blood through the abdominal organs, and particularly so to its
passage through the portal system. If a small opening be made
in the abdomen of an animal, a portion of intestine be with-
drawn, a hydrometer be placed in one of the veins and the
intestine returned into the abdomen, an oscillation will be ob-
served in the tube at each inspiration. The blood is elevated
in the tube because at each inspiration the abdominal' cavity is
diminished by the descent of the diaphragm and the contrac-
tions of the muscles. A notable pressure is thus applied to the
contents of the cavity, which is in some degree measured by
the elevation in the tube. The pressure is increased or dimin-
ished in proportion to the depth of the inspiration. If, after
the introduction of the instrument the walls be largely opened,
the oscillations will cease, because the pressure is obstracted.
In this case the elevation will not only cease, but there will be
a counter-current or regurgitation from the inferior vena cava
and liver into the vena porta and mesenteric veins. If prussiate
of potash be placed in the inferior cava, by means of a tube,
and the abdomen opened, it will regurgitate with the current
of blood into the vena porta. This regurgitation occurs in
paracentisis abdominis for ascites ; the pressure is removed,
and hence the syncope. The portal circulation is then entirely
dependent upon the abdominal pressure, which last is dependent
upon respiration.

During digestion, the quantity of blood in the vena porta and
liver is much increased, by the considerable absorption (of albu-
minous and saccharine principles) which takes place by means
of the mesenteric veins. While this act is being accomplished,

476 Harriss, on the Renal Circulation. [August,

the blood accumulates in the liver, and distends it, in conse-
quence of the increased supply to the portal system. At this
time, either the capillaries must take on an immense increase of
activity to relieve this organ, or the quantity of circulating fluid
in the vena porta must be diminished, before reaching it.
There is, in fact, a system of vessels that perform this function.
Bernard made this beautiful anatomical discovery in the horse*
where it is in reality very manifest. He has there demonstrated
that there is a direct communication of blood-vessels between
the vena porta and the inferior vena cava, distinct from the
communication that exists between the portal and hepatic veins
in the liver. During digestion, when the portal system is en-
gorged with blood, a portion passes through these collateral
branches into the vena cava, thereby greatly facilitating the
flow from the portal vein. These branches are but small, and
ramify upon the vena cava, as do the vasca vasorum upon the
intestines, and open abruptly into it, by several of them uniting
and forming a kind of sinus.

There are in some animals muscular fibres in the walls of the
vena cava : they are particularly well marked in the horse.
These fibres commence at the diaphragm, and extend down as
far as the renal veins some of them are circular, and others
longitudinal. In full digestion, then, the portal system is filled,
the liver is increased in volume, and the inferior vena cava and
right auricle of the heart, are largely distended by the great
increase in the quantity of blood absorbed from the food, by
the mesenteric veins. The distension of the vena cava is easily
seen in the rabbit. A kind of stagnation occurs in these or-
gans, because the amount of blood is too great to circulate with
facility through them. It is at this time that the collateral
branches become of great utility, and disgorge the portal
system, at the same time that the fibres of the cava contract
and force the blood down to the renal veins, and through them
into the kidneys. When these fibres contract, the blood cannot
pass up to the heart, because there is already a surplus and
stagnation in the right auricle, and must consequently descend.
But it may be asked, why does not the blood continue down
the iliac and crural veins ? It is because, as Bernard has de-
monstrated, there exists at the opening of the renal veins a

1850.] Harriss, on the Renal Circulation. 477

valve, which will permit the blood to pass up the vena cava;
but when the current is downwards, as in digestion, it closes
this vein, and the blood is compelled to pass through the renal
\eins to the kidneys. At the moment of the downward cur-
rent, the inferior cava and renal veins can be distinctly seen to
pulsate under the influence of the contractions of the muscular
fibres. The blood then goes directly to the kidneys for the
secretion of urine. Thus, there are many substances absorbed
and passed into the portal vein, and from thence to the kidneys,
without going around the general circulation. The obscurity
in which the profession has been involved is thus beautifully
dispelled. The rapidity with which certain matters were
thrown out of the economy with the urine, and the fact that
they could not be identified in the blood, is now easily under-
stood and satisfactorily explained. If prussiate of potash be
given to a dog, upon an empty stomach, it will be absorbed and
carried through the liver, to the heart, and thence to the kid-
neys. It will be found in the renal arteries, but not in the renal
veins. If, on the contrary, it be administered to him during
digestion, the stagnation in the vena porta and vena cava, will
necessitate the aid of the collateral anastomoses, and the con-
tractions of the vena cava will force it down with the current
of blood to the kidneys, where it will be secreted with the or-
dinary constituents of urine. In this case the prussiate will be
found in the renal veins, and but little, if any, in the renal arte-
ries. If an animal drink a large quantity of liquids, a portion
will pass directly to the kidneys, without going around the gen-
eral circulation. This vein, then, resembles the portal in its
distribution. N

But there is another important question to be answered.
How is it that, when there is a stagnation of blood in the supe-
rior part of the inferior vena cava, and a descending current in
the lower portion, that the blood can circulate from the inferior
extremities? By what route does it reach the heart ? Patholo-
gy has already, in a measure at least, elucidated this point. It
has been observed, and reported, that in cases of obliteration of
the superior or inferior vena cava, by a tumour or other cause,
that the vena azygos was much distended, and performed the
function of the obliterated vein. Though this circulation

478 Harriss, on the Renal Circulation. [August,

occurred under a pathological cause, in all cases heretofore
reported, the discovery of the renal circulation demonstrates
that it takes place physiologically. The stagnation of blood
in the inferior cava is but a physiological obstruction to the
circulation through it to the heart, and, as in the case of the
pathological cause, the vena azygos undertakes the work, and
conducts the blood to the central organ of circulation. Prior
to this time, this was thought to be but an incidental use,
arising from an abnormal cause; now, however, it is demon-
strated to be a natural and physiological function, that this
vein daily performs. The office of this vein is then to carry
on the circulation between the inferior extremities and the
heart, during digestion.

During full digestion, there is no circulation in the kidneys.
The blood is carried on by both veins and arteries, and conse-
quently has no means of exit. It is at this moment that the
urine changes its character according to the nature of the food
taken. If the food be azotized, the urine will be acid, and if non-
azotized, it will be alkaline. In an animal fasting (a rabbit) the
blood reaches the kidneys alone by the arteries, and the urine
will be clear and acid. But if ordinary food (non-azotized) be
given him, the blood will reach the kidneys, both by the veins
and arteries, and the urine will be turbid and alkaline. The
phosphate of soda, that exists in abundance in the urine of a
rabbit, after digestion, does not exist in the blood, but is formed
in the pelvis of the kidneys, in consequence of the combination
of the two kinds of urine that meet at this point. The acids of
the one, unite with the alkaline principles of the other.

If medicine be administered during digestion, a great portion
of it at least will pass down the renal veins to the kidneys, and
be thrown off with the urine ; and thus it is that a dose of poison,
which, during abstinence, would probably prove fatal, may be
thrown out of the economy, during digestion, without producing
serious accidents. Belladonna, or its active principle, atro-
phine, will not readily kill an animal during digestion, but will
do so speedily when fasting. Hence we can conceive the
reason why a rabbit is not killed by these strong narcotics,
when the same dose will be fatal to a dog. It is because a rab-
bit is really always digesting; his stomach may almost be said

1850.] Longstreet's Case of Dislocation. 479

never to be empty, even when made to fast for several days.
If this animal be kept from eating a long time, he will be killed
as readily as the dog. A dose of poison, to kill an animal, must
be much larger during digestion, than during abstinence.

In reptiles, there is a peculiar arrangement of the vena porta.
There exists in them two venae portee : the one that is found in
other animals and distributed to the liver, and the other that
passes to the kidneys, and may be styled the renal vena porta.
This arrangement in man is similated by the renal circulation.

ARTICLE XXIII.

Reduction of a Dislocation at the Knee-Joint, of nine weeks
persistance. By A. P. Longstreet, M.D., of Augusta, Ga.

On the 20th of May, 1850, Mr. K., aged 27 years, consulted
me, in the absence of Prof. P. F. Eve, respecting an accident
he had recently sustained, leaving him quite lame^ His case
was this: On the 13th of March, in getting out of his buggy,
he received a kick from the horse on the inner and upper part
of the left tibia. The leg was semi-flexed at the time, and con-
sequently the soft parts about the knee-joint were Telaxed. He
obtained medical aid within twenty-four hours after the blow ;
but owing to the great tumefaction, the attending physician did
not recognize the nature and extent of the injury. Refrigerant
lotions were applied, and continued with splints up to the time
of his visit to Augusta.

I found the knee enlarged, the leg semi-flexed upon the thigh,
and the external condyle of the femur resting upon the inner
articular surface of the tibia, the external portion of the articular
surface of this bone at the same time projecting outwards. The
ligamentum patellae passed diagonally downwards and out-
wards, and if the lateral ligaments escaped being ruptured, we
think it was evident, from the great displacement, the crucial
ligaments must necessarily have yielded to the force applied
when the patient was injured.

With the assistance of professional friends, Jarvis' Adjuster
was secured to the perineum and leg, and while the patient was
under the effects of chloroform, by steady and gradual exten-

480 Passage of an Iron Bar through the Head. [August,

sion the dislocation was fortunately successfully reduced. A
long splint to the back of the member, with bandages, and dis-
cutient lotions continued for two weeks, and then passive motion
in the joint, enabled the patient to leave on a steamboat, with
flattering prospects of a good and useful joint.

PART II.
HBt*tt)0 anir (Extracts.

Dr. Harlow's Case of Recovery from the passage of an Iron
Bar through the Head. By Henry J. Bigelow, M. D.,
Professor of Surgery in Harvard University. -(American
Journal of Medical Sciences.)

The following case, perhaps unparalleled in the annals of
surgery, and of which some interesting details have already
been published, occurred in the practice of Dr. J. M. Harlow,
of Cavendish, Vermont. Having received a verbal account of
the accident, a few days after its occurrence, from a medical
gentleman who had examined the patient, I thus became inci-
dentally interested ; and having since had an opportunity,
through the politeness of Dr. Harlow, of observing the patient,
who remained in Boston a number of weeks under my charge,
I have been able to satisfy myself as well of the occurrence and
extent of the injury as of the manner of its infliction. I am also
indebted to the same gentleman for procuring at my request
the testimony of a number of persons who were cognizant of
the accident or its sequel.

Those who are skeptical in admitting the co-existence of a
lesion so grave, with an inconsiderable disturbance of function,
will be interested in further details connected with the case ;
while it is due to science that a more complete record should
be made of the history of so remarkable an injury.

The accident occurred upon the line of the Rutland and
Burlington Railroad, on the 13th of September, 1848. The
subject of it, Phineas P. Gage, is of middle stature, twenty-
five years of age, shrewd and intelligent. According to his
own statement, he was charging with powder a hole drilled in a
rock, for the purpose of blasting. It appears that it is cus-
tomary in filling the hole to cover the powder with sand. In
this case, the charge having been adjusted, Mr. Gage drected
his assistant to pour in the sand ; and at the interval of a few
seconds, his head being averted, and supposing the sand to have

1848.] Passage of an Iron Bar through the Head. 481

been properly placed, he dropped the head of the iron as usual
upon the charge, to consolidate or, u tamp it in.v The assis-
tant had failed to obey the order, and the iron striking fire upon
the rock, the uncovered powder was ignited and the explosion
took place. Mr. Gage was at this time standing above the
hole, leaning forward with his face slightly averted ; and the
bar of iron was projected directly upwards in a line of its axis,
passing completely through his head and high into the air.
The wound thus received, and which is more fully described
in the sequel, was oblique, traversing the cranium in a straight
line from the angle of the lower jaw on one side to the centre
of the frontal bone above, near sagittal suture, where the mis-
sile emerged; and the iron thus forcibly thrown into the air
was picked up at a distance of some rods from the patient,
smeared with brains and blood.

From this extraordinary lesion, the patient has quite recover-
ed in his faculties of body and mind, with the loss only of the
sight of the injured eye.

The iron which thus traversed the skull weighs thirteen and
a quarter pounds. It is three feet seven inches in length, and
one and a quarter inches in diameter. The end which entered
first is pointed; the taper being seven inches long, and the
diameter of the point one quarter of an inch ; circumstances
to which the patient perhaps owes his life. The iron is unlike
any other, and was made by a neighboring blacksmith to please
the fancy of the owner.

Dr. Harlow, in the graphic account above alluded to, states
that " immediately after the explosion the patient was thrown
upon his back, and gave a few convulsive motions of the ex-
tremities, but spoke in a few minutes. His men (with whom
he was a great favourite) took him in their arms and carried him
to the road, only a few rods distant, and sat him into an ox cart,
in which he rode, sitting erect, full three quarters of a mile, to
the Hotel of Mr. Joseph Adams, in this village. He got out
of the cart himself, and with a little assistance walked up along
flight of stairs, into the hall, where he was dressed."

Mr. Joseph Adams, here spoken of, has furnished the follow-
ing interesting statement :

This is to certify that P. P. Gage had boarded in my house
for several weeks previous to his being injured upon the rail-
road, and that I saw him and conversed with him soon after the
accident, and am of opinion that he was perfectly conscious of
what was passing around him. He rode to the house, three
quarters of a mile, sitting in a cart, and walked from the cart
into the piazza, and thence up stairs, with hut little assistance.
I noticed the state of the left eye, and know, from experiment,

K, S. VOL. VI. NO. VIII. 31

482 Passage of an Iron Bar through the Head. [August,

that he could see with it for several days, though not distinctly.
In regard to the elevated appearance of the wound, and the
introduction of the finger into it, I can fully confirm the certi-
ficate of my nephew, Washington Adams, and others, and
would add that I repeatly saw him eject matter from the mouth
similar in appearance to that discharged from the head. The
morning subsequent to the accident I went in quest of the bar,
and found it at a smith's shop, near the pit in which he was en-
gaged.

The men in his pit asserted that "they found the iron, cov-
ered with blood and brains," several rods behind where Mr,
Gage stood, and that they washed it in the brook, and returned
it with the other tools; which representation was fully corrob-
orated by the greasy feel and look of the iron, and the fragments
of brain which I saw upon the rock where it fell.

(Signed) JOSEPH ADAMS,

Cavendish, Dec. 14, 1849. Justice of the Peace.

The Rev. Joseph Freeman, whose letter follows, informed
himself of the circumstances soon after the accident.

Cavendish, Dec. 5, 1849.

Dear Sir I was at home on the day Mr. Gage was hurt ;
and seeeing an Irishman ride rapidly up to your door, I stepped
over to ascertain the cause, and then went immediately to meet
those who I was informed were bringing him to our village.

I found him in a cart, sitting up without aid, with his back
against the fore-board. When we reached his quarters, he rose
to his feet without aid, and walked quick, though with an un-
steady step, to the hind end of the cart, when two of his men
came forward and aided him out, and walked with him, sup-
porting him to the house.

I then asked his men how he came to be hurt ? The reply
was, " The blast went off when he was tamping it, and the
tarn ping-iron passed through his head/' I said, " That is im-
possible."

Soon after this, I went to the place where the accident hap-
pened. I found upon the rocks, where I supposed he had
fallen, a small quantity of brains. There being no person at
this place, I passed on to a blacksmith's shop a few rods be-
yond, in and about which a number of Irishmen were collected.
As I came up to them, they pointed me to the iron, which has
since attracted so much attention, standing outside the shop-
door. They said they found it covered with brains and dirt,
and had washed it in the brook. The appearance of the iron
corresponded with this story. It had a greasy appearance, and
was so to the touch.

1850.] Passage of an Iron Bar through the Head. 483

After hearing their statement, as there was no assignable
motive for misrepresentation, and finding the appearance of the
iron to agree with it, I was compelled to believe, though the re-
sult of your examination of the wound was not then known
to me.

I think of nothing further relating to this affair which cannot
be more minutely stated by others.

Very respectfully, yours,

(Signed) " JOSEPH FREEMAN.

Dr. J. M. Harlow.

Dr. Williams first saw the patient, and makes the following
statement in relation to the circumstances:

. Northfteld, Vermont, Dec. 4, 1849.

Dr. Bigelow : Dear Sir Dr. Harlow having requested me
to transmit to you a description of the appearance of Mr. Gage
at the time I first saw him after the accident, which happened
to him in September, 1848, 1 now hasten to do so with pleasure.

Dr. Harlow being absent at the time of the accident, I was
sent for, and was the first physician who saw Mr. G., some
twenty-five or thirty minutes after he received the injury; he
at that time was sitting in a chair upon the piazza of Mr. Adams'
hotel, in Cavendish. When I drove up, he said, u Doctor, here
is business enough for you." I first noticed the wound upon
the head before I alighted from my carriage, the pulsations of
the brain being very distinct ; there was also an appearance
which, before I examined the head, I could not account for : the
top of the head appeared somewhat like an inverted funnel ;
this was owing, I discovered, to the bone being fractured about
the opening for a distance of about two inches in every direc-
tion. I ought to have mentioned above that the opening
through the skull and integuments was not far from one and a
half inch in diameter; the edges of this opening were everted,
and the whole wound appeared as if some wedged-shaped body
had passed from below upward. Mr. Gage, during the time'l
was examining this wound was relating the manner in which
he was injured to the bystanders; he talked so rationally and
was so willing to answer questions, that I directed my inquiries
to him in preference to the men who were with him at the time
of the accident, and who were standing about at this time.
Mr. G. then related to me some of the circumstances, as he
has since done ; and I can safely say that neither at that time
nor on any subsequent occasion, save once, did I consider him
to be other than perfectly rational. The one time to which I
allude was about a fortnight after the accident, and then he
persisted in calling me John Kirwin ; yet he answered all my
questions correctly.

484 Passage of an Iron Bar through the Head. [August,

I did not believe Mr. Gage's statement at that time, but
thought he was deceived ; I asked him where the bar entered,
and he pointed to the wound on his cheek, which I had not be-
fore discovered; this was a slit running from the angle of the
jaw forward about one and a half inch ; it was very much
stretched laterally, and was discolored by powder and iron
rust, or at least appeared so. Mr. Gage persisted in saying
that the bar went through his head : an Irishman standing by
said, " Sure it was so, sir, for the bar is lying in the road below,
all blood and brains/' The man also said he would have
brought it up with him, but he' thought there would be an in-
quest, and it would not do.

About this time, Mr. G. got up and vomited a large quantity
of blood, together with some of his food : the effort of vomit-
ing pressed out about half a teacupful of the brain, which fell
upon the floor, together with the blood, which was forced out
at the same time. The left eye appeared more dull and glassy
than the right. Mr. G. said he could merely distinguish light
with it.

Soon after Dr. Harlow arrived, Mr.' Gage walked up
stairs, with little or no assistance, and laid down upon a bed,
wThen Dr. H. made a thorough examination of the wounds,
passing the whole length of his forefinger into the superior
opening without difficulty ; and my impression is that he did
the same with the inferior one, but of that I am not absolutely
certain: after this we proceeded to dress the wounds in the
manner described by Dr. H. in the Journal. During the time
occupied in dressing, Mr. G. vomited two or three times fully
as freely as before. All of this time Mr. G. was perfectly
conscious, answering all questions, and calling his friends by
name as they came into the room.

I did not see the bar that night, but saw it the next day after
it was washed.

Hoping vou will excuse this hastv sketch, I remain vours,&c.
(Signed) EDWARD H. WILLIAMS, M. D.

Dr. Harlow's account of his first visit to the patient, and of
the subsequent symptoms, is here appended.

" Being absent, I did not arrive at the scene of the accident
until near 6 o'clock, P. M. You will excuse me for remarking
here that the picture presented was, to one unaccustomed to
military surgery, truly terrific ; but the patient bore his suffer-
ings with the most heroic firmness. He recognized me at once
and said he hoped he wTas not much hurt. He seemed to be
perfectly conscious, but was getting exhausted from the hemor-
rhage, which was very profuse both externally and internally,

1850.] Passage of an Iron Bar through the Head. 485

the blood finding its way into the stomach; which rejected it as
often as e\ ery fifte en or twenty minutes. Pulse 60. and regular,
ersonand the bed on which he was laid were literally one
gore of blood. Assisted by my friend, Dr. Williams, of Proc-
ille, who was first called to the patient, we proceeded to
dress the wounds. From their appearance, the fragments of
bone being uplifted and the brain protruding, it was evident
that the fracture was occasioned by some force acting from
below upward. The scalp was shaven, the coagula removed,
together with three small triangular pieces of the cranium, and
in searching to ascertain if there were other foreign bodies
there, I passed in the index finger its whole length, without the
least resistance, in the direction of the wound in the cheek,
which received the other finger in like manner. A portion of
the anterior superior angle of each parietal bone, and a semi-
circular piece of the frontal bone, were fractured, leaving a
circular opening of about three and a half inches in diameter.
This examination, and the appearance of the iron which was
found some rods distant, smeared with brain, together with the
testimony of the workmen, and of the patient himself, who was
still sufficiently concious to say that 'the iron struck his head
and passed through,' was considered at the time sufficiently
conclusive to show not only the nature of the accident, but the
manner in which it occurred.

" I have been asked why I did not pass a probe through the
entire extent of the wound at the time. I think no surgeon of
discretion would have upheld me in the trial of such a foolhardy
experiment, in the risk of disturbing lacerated vessels, from
which the hemorrhage was near being staunched, and thereby
rupturing the attenuated thread, by which the sufferer still held
to life. You will excuse me for being thus particular, inasmuch
as I am aware that the nature of the injury has been seriously
questioned by many medical men for whom T entertain a very
high respect.

"The spiculse of bone having been taken away, a portion of
the brain, which hung by a pedicle, was removed, the larger
pieces of bone replaced, the lacerated scalp was brought toge-
ther as near as possible, and retained by adhesive straps, ex-
cepting at the posterior angle, and over this a simple dressing
compress, nightcap and roller. The wound in the face was left
patulous, covered only by a simple dressing. The hands and
forearms were both deeply burned nearly to the elbows, which
were dressed, and the patient was left with the head elevated,
and the attendants requested to keep him in that position.

M 10 P. M., same evening. The dressings are saturated with
blood, but the hemorrhage appears to be abating. Has vomit-

486 Passage of an Iron Bar through the Head. [August,

ed twice only since being dressed. Sensorial powers remain
as yet unimpaired. Says he does not wish to see his friends, as
he shall be at work in a day or two. Tells where they live,
their names, &c. Pulse 65 ; constant agitation of the lower
extremities.

* 14th, 7 A. M. Has slept some ; appears to be in pain ;
speaks with difficulty ; tumefaction of face considerable, and
increasing ; pulse 70; knows his friends, and is rational. Asks
who is foreman in his pit. Hemorrhage internally continues
slightly. Has not vomited since 12 P. M.

" 15th, 9 A. M. Has slept well half the night. Sees objects
indistinctly with the left eye, when the lids are separated.
Hemorrhage has ceased. Pulse 75. 8 P. M. Restless and de-
lirious; talks much, but disconnected and incoherent. Pulse
84, and full. Prescribed vin. colchicum, f 3ss every six hours,
until it purges him. Removed the nightcap.

"16th, 8 A. M. Patient appears more quiet. Pulse 70.
Dressed the wounds, which in the head have a fetid sero-puru-
lent discharge, with particles of brain intermingled. No dis-
charge from bowels. Ordered sulph. magnesia, 3j, repeated
every four hours until it operates. Iced water to the head and
eye. A fungus appears at the external canthus of the left eye.
Says 'the left side of his head is banked up.'

"17th, 8 A.M. Pulse 84. Purged freely. Rational, and
knows his friends. Discharge from the brain profuse, very
fetid and sanious. Wounds in face healing.

" 18th, 9 A. M. Slept well all night, and lies upon his right
side. Pulse 72; tongue red and dry ; breath fetid. Removed
the dressings, and passed a probe to the base of the cranium,
without giving pain. Ordered a cathartic, which operated free-
ly. Cold to the head. Patient says he shall recover. He is
delirious, with lucid intervals.

" 19th, 8 P. M. Has been very restless during the day ; skin
hot and dry ; tongue red ; excessive thirst ; delirious, talking
incoherently with himself, and directing his men.

"20th and 21st. Has remained much the same.

" 22d, 8 A. M. Patient has had a very restless night. Throws
his hands and feet about, and tries to get out of bed. Head
hot. Says ' he shall not live long so.' Ordered a cathartic of
calomel and rhubarb, to be followed by castor oil, if it does
not operate in six hours. 4 P. M. Purged freely twice and
inclines to sleep.

"23d. Rested well most of the night, and appears stronger
and more rational. Pulse 80. Shaved the scalp a second time,
and brought the edges of the wound in position, the previous
edges having sloughed away. Discharge less in quantity and
less fetid. Loss of vision of left eye.

1830.] Passage of an Iron Bar through the Head. 48*

''From this time until the 3d of October, he lay in a semi-
comatose state, seldom speaking unless spoken to, and then
answering only in monosyllables. During this period, fungi
started from the brain, and increased rapidly from the orbit.
To these was applied nitrate of silver cryst., and cold to the
head generally. The dressings were renewed three times in
every twenty-lour hours ; and in addition to this, laxatives,
combined with an occasional dose of calomel, constituted the
treatment. The pulse varied from 70 to 96 generally very
soft. During this time an abscess formed under the frontalis
muscle, which was opened on the 27th, and has been very
difficult to heal. iJischarged nearly 5 viij at the time it was
punctured. %

"Oct. 5th and 6th. Patient improving. Discharge from the
wound and sinus, laudable pus. Calls for his pants, and wishes
to get out of bed, though he is unable to raise his head from the
pillow.

"7th. Has succeeded in raising himself up, and took one
step to his chair, and sat about five minutes.

"11th. Pulse 72. Intellectual faculties brightening. When
I asked him how long since he was injured, he replied, ' four
weeks this afternoon, at half-past four o'clock.' Relates the
manner in which it occurred, and how he came to the house.
He keeps the day of the week and time of day in his mind.
Says he knows more than half of those who inquire after him.
Does not estimate size or money accurately, though he has
memory as perfect as ever. He would not take one thousand
dollars for a few pebbles which he took from an ancient river
bed where he was at work. The fungus is giving way under
the use of the cryst. nitrate of silver. During all of this time
there has been a discharge of pus into the fauces, a part of
which passed into the stomach, the remainder being ejected
from the mouth.

"20th. Improving. Gets out and into bed with but little
assistance. Sits up thirty minutes twice in twenty-four hours.
Is very childish ; wishes to go home to Lebanon, N. H. The
wound in the scalp is healing rapidly.

" Nov. 8th. Improving in every particular, and sits up most
of the time during the day. Appetite good, though he is still
kept upon a low diet. Pulse 65. Sleeps well, and says he has
no pain in the head. Food digests easily, bowels regular, and
nutrition is going on well. The sinus under the frontalis mus-
cle has nearly healed. He walks up and down stairs, and about
the house, into the piazza, and I am informed this evening that
he has been in the street to-day. I leave him for a week, with
strict injunctions to avoid excitement and exposure.

488 Passage of an Iron Bar through the Head. [August,

" 15th. I learn, on inquiry, that Gage has been in the street
every day except Sunday, during my absence. His desire to
be out and to go home to Lebanon has been uncontrollable by
his friends, and he has been making arrangements to that effect.
Yesterday he walked half a mile, and purchased some small
articles at the store. The atmosphere was cold and damp, the
ground wet, and he went without an overcoat, and with thin
boots. He got wet feet and a chill. I find him in bed, de-
pressed and very irritable. Hot and dry skin ; thirst, tongue
coated; pulse 110: lancinating pain in left side of head and
face; rigors, and bowels constipated. Ordered cold to the
head and face, and a black dose to be repeated in six hours, if
it does not operate. He has had spiculae of bone pass into the
fauces, which he expelled from the mouth within a few days.

" 16th, A. M. No better. Cathartic has operated freely.
Pulse 120 ; skin hot and dry ; thirst and pain remain the same.
Has been very restless during the night. Venesection f *xvj.
Ordered calomel, gr. x, and ipecac, gr. ij, followed in four hours
by castor oil.

" 8 P. M., same day. Purged freely ; pulse less frequent ;
pain in head moderated; skin moist. $. Antim. et potassa
tart., gr. iij ; syr. simplex, f 5 vj. Dose, a desert-spoonful every
four hours.

"17th. Improving. Expresses himself as 'feeling better
in every respect;' has no pain in the head.

" 18th. Is walking about the house again ; says he feels no
pain in the head, and appears to be in a way of recovering, if
he can be controlled."

Remarks. The leading feature of this case is its improba-
bility. A physician who holds in his hand a crowbar, three
feet and a half long, and more than thirteen pounds in weight,
will not readily believe that it has been driven with a crash
through the brain of a man who is still able to walk off, talking
with composure and equanimity of the hole in his head. This
is the sort of accident that happens in the pantomime at the
theatre, but not elsewhere. Yet there is every reason for sup-
posing it in this case literally true. Being at first wholly scep-
tical, I have been personally convinced ; and this has been the
experience of many medical gentlemen who, having first heard
of the circumstances, have had a subsequent opportunity to
examine the evidence.

This evidence is comprised in the testimony of individuals,
and in the anatomical and physiological character of the lesion
itself.

The above accounts from different individuals, concur in as-

1850.] Passage of an Iron Bar through the Head. 489

signing to the accident a common cause. They are selected
as the most complete among about a dozen of similar documents
forwarded to me bv Dr. Harlow, who was kind enough to pro-
cure them at my request ; and which bear the signature of
many respectable persons in and about the town of Cavendish,
and all corroborative of the circumstances as here detailed.
The accident occurred in open day, in a quarry in which a con-
siderable number of men were at work, many of whom were
witnesses of it, and all of whom were attracted by it. Suffice
it to say. that in a thickly populated country neighborhood, to
which all facts were matter of daily discussion at the time of
their occunence, there is no difference of belief, nor has there
been at any time doubt that the iron was actually driven through
the brain. A considerable number of medical gentlemen also
visited the case at various times to satisfy their incredulity.

Assuming the point that the wound was the result of a mis-
sile projected from below upwards, it may be asked whether
the wound might not have been made by a stone, while the bar
was at the same moment thrown into the air. It may be re-
plied in answer, that the rock was not split, nor, as far as could
be learned, disintegrated. Besides, an angular bit of stone
would have been likely to have produced as much laceration as
the bar of iron : and it is in fact possible that the tapering point
of the latter divided and repelled the soft parts, especially the
brain, in a way that enabled the smooth surface of the iron to
glide through with less injury. And assuming the only possible
hypothesis, that the round bar followed exactly the direction of
its axis, the missile may be considered as a sphere of one and
a quarter inches diameter, preceded by a conical and polished
wedge.

The patient visited Boston in January, 1850, and remained
some time under my observation, during which he was pre-
sented at a meetingof the Boston Society for Medical Improve-
ment, and also to the medical class at the hospital. His head,
now perfectly healed, exhibits the following appearances.

A linear cicatrix of an inch in length occupies the left ramus
of the jaw near its angle. A little thickening of the soft tis-
sues is discovered about the corresponding malar bone. The
eyelid of this side is shut, and the patient unable to open it.
The eye considerably more prominent than the other, offers a
singular confirmation of the points illustrated by the prepared
skull described below. It will be there seen that the parts of
the orbit necessarily cut away are those occupied by the leva-
tor palpebrae superioris, the levator oculi, and the abducens
muscles. In addition to a ptosis of the lid, the eye is found to
be incapable of executing either the outward or upward mo-

490 Passage of an Iron Bar through the Head. [August,

tion ; while the other muscles animated by the motor communis
are unimpaired. Upon the head, and covered by hair, is a large
unequal depression and elevation. A portrait of the cast of the
shaved head is given in the plate ; and it will be there seen that
a piece of cranium of about the size of the palm of the hand,
its posterior border lying near the coronal suture, its anterior
edge low upon the forehead, was raised upon the latter as a
hinge to allow the egress of the bar; and that it still remains
raised and prominent. Behind it is an irregular and deep sulcus
several inches in length, beneath which the pulsations of the
brain can be perceived.

In order to ascertain how far it might be possible for this bar
of an inch and a quarter diameter to traverse the skull in the
track assigned to it, I procured a common skull, in which the
zygomatic arches are barely visible from above ; and having
entered a drill near the left angle of the lower jaw, passed it
obliquely upwards to the median line of the cranium just in
front of the junction of the sagittal and coronal sutures. This
aperture was then enlarged until it allowed the passage of the
bar in question, and the loss of substance strikingly corresponds
with the lesion said to have been received by the patient.
From the coronoid process of the lower jaw is removed a frag-
ment measuring about three-quarters of an inch in length.
This fragment in the patient's case might have been fractured
and subsequently reunited.

The hole now enters obliquely beneath the zygomatic arch,
encroaching equally upon all its walls. In fact, it entirely oc-
cupies this cavity; the posterior wall of the antrum being par-
tially excavated at the front of the hole, the whole orbitar portion
of the sphenoid bone being removed behind, as also the anterior
part of the sqamous portion of the temporal bone, and the inter-
nal surface of the zygoma and malar bone laterally. In the
orbit the sphenoid bone, part of the superior maxillary below,
and a large part of the frontal above, are cut away, and with
these fragments much of the spheno-maxillary fissure ; leaving,
however, the optic foramen intact about a quarter of an inch
to the inside of the track of the bar..

The base of the skull upon the inside of the cranium presents
a cylindrical hole of an inch and a quarter diameter, and such as
may be described by a pair of compasses, one leg of which is
placed upon the lesser wing of the sphenoid bone at an eighth
of an inch from its extremity, cutting the frontal, temporal and
sphenoid bones ; the other, half an inch outside the internal op-
tic foramen.

The calvaria is traversed by a hole, two-thirds of which is
upon the left, and one-third upon the right of the median line,

1850.] Passage of an Iron Bar through the Head. 491

its posterior border being quite near the coronal suture. The
iron freely traverses the oblique hole thus described.

It is obvious that a considerable portion of the brain must
have been carried away ; that while a portion of its lateral sub-
stance may have remained intact, the whole central part of the
left anterior lobe, and the front of the sphenoidal or middle lobe
must have been lacerated and destroyed. This loss of sub-
stance would also lay open the anterior extremity of the left
lateral ventricle; and the iron, in emerging from above, must
have largely impinged upon the right cerebral lobe, lacerating
the falx and the longitudinal sinus. Yet the optic nerve re-
mained unbroken in the narrow interval between the iron and
the inner wTall of the orbit. The eye, forcibly thrust forward
at the moment of the passage, might have again receded into
its socket, from which it was again somewhat protruded during
the subsequent inflammation.

It is fair to suppose that the polished conical extremity of the
iron which first entered the cavity of the cranium prepared the
passage for the thick cylindrical bar which followed ; and that
the point, in reaching and largely breaking open the vault of the
cranium, afforded an ample egress for the cerebral substance,
thus preventing compression of the remainder.

Yet it is difficult to admit that the aperture could have been
thus violently forced through without a certain comminution
of the base of the cranium driven inwards upon the cerebral
cavity.

Little need be said of the physiological possibility of this his-
tory. It is well known that a considerable portion of the brain
has been in some cases abstracted without impairing its func-
tions. Atrophy of an entire cerebral hemisphere has also been
recorded.

But the remarkable features of the present case lie not only
in the loss of cerebral substance, but also in the singular chance
which exempted the brain from either concussion or compres-
sion; which guided the enormous missile exactly in the direc-
tion of its axis, and which averted the dangers of subsequent
inflammation. An entire lung is often disabled by disease ; but
I believe there is no parallel to the case in the Hunterian col-
lection of a lung and thorax violently transfixed by the shaft of
a carriage.

Taking all the circumstances into consideration, it may be
doubted whether the present is not the most remarkable history
of injury to the brain which has been recorded.*

* The iron bar has been deposited in the museum of the Massachusetts Medi-
cal College, where it may be seen, together with a cast of the patient's head.

492 Operation for Removal of Ovarian Tumor, [August,

Account of an operation for the removal of an Ovarian Tumor.
By Alden March, M.D., President, and Professor of Surgery
in the Albany Medical College. (Trans. New York State
Medical Society.)

On Friday, the 7th of December, 1849, the wife of Mr. W.
J. P., of Granby, Mass., aged 49 years, was brought to me in
company with her husband and her family physician, Dr. Alex-
ander Le Baron Munroe, of the same place, for consultation and
advice in what was supposed to be an Ovarian Tumor.

Mrs. P. was the mother of five children, the youngest of
whom was about seven years of age, in person rather spare, of
a good constitution, intelligent, firm, and morally courageous.

The tumor was of three years' growth or more, having been
accidentally discovered when it was about the size of a turkey's
egg, in crowding between a bed-post and the wall of the room.
For a year or two after, it gave her no alarm, or scarcely any
anxiety ; since it was neither painful nor tender, nor was its
moderate increase in size calculated to excite serious appre-
hensions for the future ; so that its existence was not made
known to her physician until within eight or nine months of the
day of the operation. During the last three or four months the
tumor had increased so rapidly that she appeared like a woman
far advanced in pregnancy. At last she was so much incom-
moded as to be entirely prevented from sleeping in the hori-
zontal position.

Alter inquiring into the history of the case, and making a
careful examination of the tumor, the general health and con-
dition of the patient, as to the existence or non-existence of
any other disease, Dr. Munroe and myself agreed that it was
a favorable case for the operation of extirpation. However,
before proceeding in a matter of such vast importance to the
patient and her friends, to say nothing of my own professional
reputation, and that of the practice of the surgical art, I deemed
it prudent to solicit a general consultation on Saturday, at
which were present Dr. Munroe, Prof. E. Emmons, Prof. J.
McNoughton, Prof. J. H. Armsby and Prof. Thos. Hun, my
colleagues in the Albany Medical College, who came to the
unanimous conclusion, after each had' made a critical examina-
tion, that if an operation for an attempt at removal was ever
warrantable in cases of this kind, this was a peculiarly favora-
ble one.

The tumor was in the main smooth, though apparently lobu-
lated, or having in one or two places a strictured or depressed
line; and most of the bulk of it seemed to be made up of fluid,
although there were one or two points apparently as large as

1850.] Operation for Removal of Ovarian Tumor. 493

the fist, which felt like a. soft solid. In the abdominal wall there
did not appear to be any tenderness or soreness to the sense of
touch, nor had the patient ever experienced any pain in the
swelling or abdomen, excepting an uneasiness for a few weeks,
which was the result of pressure and over-distension of the ab-
dominal walls.

The bowels were thoroughly evacuated on Sunday, by a
calomel purgative, and on Monday, December 10th, 1849, at
one o'clock, the operation was performed in the presence, and
by the aid and assistance of the gentlemen who have already
been named as council in the case, as well as several medical
students.

An incision was commenced about four inches above the
umbilicus and carried in the line of the linea alba to near the
pubis. The abdominal wall at the upper part was extremely
thin, and by two or three strokes of trie knife the tumor was
readily brought into view. The wound was so extensive, be-
ing about 12 inches, and the tumor so much exposed, that it was
readily discovered by the eye and hands to lie almost loose in
the abdomen. To facilitate its extraction, a puncture was
made in the front and lower part of it, by which nearly, or all
of the water from the cyst was evacuated. The collapsed sac
was followed down to its attachment to the right angle of the
uterus, by which it was discovered that the ovarium had been
dilated into a monolocular, or single sac, attached to the uterus
only by the broad ligament and Fallopian tube, which, when
twristed upon itself, or gathered together, was not larger than
the little finger; around which, in mass, a three-threaded liga-
ture was very tightly applied, not merely by the strength of a
strong man, but by one of my own hands superadded. This
was applied very near to the substance of the uterus; and next,
all the substance included in the ligature, was severed about
half an inch from the point of its application. In using the
sponge to cleanse out a trifle of blood that had fallen into the
abdomen, the ligature was detached, when a brisk, or rather an
alarming hemorrhage ensued. The uterus was seized upon,
drawn up, and the part containing the severed vessel, which
was of the size of a crow's quill, or larger, was secured between
the thumb and finger of my assistant, Dr. Armsby, until I could
pass an armed needle with double ligature, the four ends of
which I tied each way. The first did not prove effective in
completely arresting the flow of blood. Another needle was
passed in the same manner, and secured as before, which an-
swered the purpose. The patient must have lost nearly a pint
of arterial blood, most of which fell into the cavity of the abdo-
men, and after having been properly removed, the wound in the

494 Operation for Removal of Ovarian Tumor. [August,

abdominal wall was closed by eight interrupted sutures, and
the ligatures brought out at the lower part of the wound. The
abdomen was supported with long adhesive straps, a large
sheet folded for a compress, and over the whole a towel or
swathe applied after the manner of its use in obstetrical prac-
tice.

The shock of the operation, and the loss of blood being so
severe for the patient, it was difficult to keep life in her for sev-
eral hours. However, at the end of six hours, reaction began
to take place. Although she was in the horizontal position
during the operation, yet she became faint; which rendered it
necessary for an assistant to make pressure with his hands on
the bowels, to aid in keeping up the circulation. She also ex-
perienced a degree of nausea, which I was then rather disposed
to attribute to the use of chloroform. Some four or five days
after, there was a disposition to retch, but not sufficient to
amount to much vomiting. This I attributed to the sympa-
thetic irritation existing between the uterus and stomach. I
believe this was all quieled by a little infusion of columbo.

In the management of the case, I constantly and regularly
used morphine, for some ten or twelve days, and did not attempt
to disturb the bowels with physic for eight or nine days. In
the mean time, the bladder became distended with urine, and
the bowels with air. The former was relieved by the use of the
catheter, and the latter, by passing up the rectum, a large gum-
elastic tube. By the adoption of these measures, the patient
obtained great relief, and continued to improve from day to
day in a very satisfactory manner.

I think the sutures were removed on the eighth day, when
union by the first intention was complete, at every point, except
at the lower angle of the wound occupied by the ligatures, with
which the divided arteries were severed. There was no red-
ness, nor scarcely any tenderness, in any part of the abdomen,
except at the lower part or in the region of the uterus. The
ligatures had all come away, and the patient had so far recov-
ered her health and strength, as to be able to make a journey of
over a hundred miles in one day, on the thirty-fourth day after
the operation.

The sac, when distended with its fluid, weighed 18 pounds.

In conclusion, I would say that I am apprehensive that a
successful case or two, may encourage us to operate too often ;
when the favorable prospect, to say the least, might be but little
encouraging. A monolocular hydatid, or fluid tumor, is re-
garded as the most favorable for removal.

There should be no adhesions between the cyst and the wall
of the abdomen, omentum, or intestines. The foot stalk or

1850.] Cases Illustrating the Pathology of Cancer. 495

pedicle of the tumor should be small. I should prefer not to
have the patient tapped at all, except as an exploring operation
just as extirpation was about to take place. I would recom-
mend to the surgeon to place his finger beneath the broad liga-
ment or pedicle of the tumor, and divide with the knife upon it
such part as would include the blood-vessels, and as they bleed
secure them .by a small ligature. After these are properly
secured, I would then divide the Fallopian tube and the re-
mainder of the folds of the peritoneum, which make up the
broad ligament, as far from the angle of the uterus as practica-
ble, and instead of fetching the ligatures out through the ab-
dominal wall, I would suggest to have them threaded into a
long sail-makers needle, and conveyed by the aid of one finger
in the vagina, carried high up, either in front or back of the
uterus; and with the fingers of the other hand dipping down
in the brim and cavity of the pel vis, through the pelvic partition,
transfixing it into the vagina, and out at the os externum.

By this procedure a less direct communication would be left
with the peritoneal cavity; and if any serum or blood should
remain in the lower part of the peritoneal cavity, it would in
the course of a few days readily find an exit by the side of the
ligatures, " per vaginam." In my case I do not think there was
the least peritoneal inflammation, except that which was caused
by and situated immediately around the ligatures, where they
had their exit from the abdominal wall. Why I would apply
the ligature to the insulated blood-vessels, and as far as possi-
ble from the uterus, would be to avoid irritation and inflamma-
tion of that organ, and the fold of the peritoneal membrane,
which forms the broad ligament. By this means the Fallopian
tube needs not be in the least irritated by coming in contact
with a foreign substance.

Cases Illustrating the Pathology of Cancer. By J. A. Swett,
M. D. (New York Journal of Medicine.)

Case 1. Carcinoma of the Stomach. An Irishman, aged
50 years, entered the New-York Hospital, Feb 9th. He had
been complaining five weeks, and principally of pain in the
epigastric region. He was pale, emaciated, but free from fever.
He had vomited occasionally ; his appetite and digestion were
tolerable; bowels constipated. On examination, a tumor was
felt in the left epigastric region, convex edge, sharp, hard, and
well defined, and granular ; this edge could neither be traced
under the false ribs, nor beyond the median line ; the centre
of the epigastrium was full and tense, with a good deal of ten-
derness.

496 Cases Illustrating the Pathology of Cancer. [August,

The patient died about three weeks after admission. He
hardly vomited at all, and digested simple food tolerable well.
The pain in the epigastrium continued, and was at times lan-
cinating.

On post-mortem examination, the right of the stomach
was found degenerated into cancer, involving the whole sub-
stance ; internally along the lesser curvature, a blackish
slough was seen, extending to the muscular coat ; pylorus not
contracted.

Cancerous tubercles in the liver, lungs, spleen, lymphatic
glands of abdomen, and under the peritoneum.

Case 2. Carcinoma of Stomach. A German sailor, aged
53, admitted to the New 'York Hospital, Oct. 13, 1849. Was
attacked, three and a half months ago, with pain in epigastrium,
and vomiting soon after eating, which was followed by relief.
For some time past, has retained nothing on his stomach longer
than twenty or thirty minutes. Lancinating pain, extending
from the right portion of the epigastrium, and radiating over
the whole abdomen ; pain occasionally in right shoulder. Is
much emaciated ; countenance pale, sallow, pinched ; no fever ;
abdomen contracted, except in epigastrium, where it is full and
tense ; no distinct tumor. Bowels very constipated ; vomits
every thing he swallows, and besides this, a large quantity of
dark brown acid, bad smelling, grumous, pasty matter. He
died on the 28th. The pyloric extremity of the stomach
adhered firmly to the liver. The coats of the stomach, for a
considerable extent above the pylorous, had undergone the
cancerous degeneration. The orifice was contracted, so as
hardly to admit the end of the little finger. The liver contained
numerous cancerous masses ; other organs healthy.

Case 3. Cancerous Testicle. This case and specimen was
presented to the New York Hospital Museum, by Dr. Trask,
of White Plains. A German, 30 years, laborer, received a
blow on the testicle with a crow-bar. This was followed by a
swelling, which in two weeks had attained the size of a young
child's head. Surface irregular, lobulated, varicose veins run-
ning over it ; sense of fluctuation in portions, and in one spot a
feeling of gurgling; the surface hot and painful; skin in por-
tions red ; spermatic cord not affected. The tumor was first
examined on 10th Aug., 1849.

About the last of Aug., symptoms of pneumonia, affecting
the lower portion of the left lung, ensued, followed by hemor-
rhage. The patient sank more rapidly after this occurrence,
and died on the 5th of October.

The tumor weighed 6 lbs. 6 oz. It was the encephaloid de-
generation. The mesenteric glands were affected. The

1850.] Poisoning by Colored Confectionary. 497

whole left lung, except a small portion at the summit, had
undergone the cancerous degeneration ; encephaloid, and nu-
merous deposits were found in the right lung.

Case 4. Carcinoma of the Tongue. A German, aged 22,
clerk, entered the New York Hospital, Oct. 14, 1849. Four
months before this, a small indurated ulcer appeared on the
left side of the tongue, about halfway between the apex and
base ; it was not attended by much pain, but continued to en-
large. Other small indurated tumours appeared on the tongue,
and the organ increased in size. It is now ulcerated entirely
around the left margin, and to a considerable extent anteriorly,
and to the right. Deglutition and articulation are considera-
bly interfered with. The ulceration continued to extend, and
the ulcerated surface assumed the appearance of wet crumbs
of bread ; submaxillary and lymphatic glands of neck enlarged.
Repeated hemorrhages ensued, coming from a source beyond
the range of vision. The patient died suddenly, about seven
and a half months after the disease was first noticed.

The anterior \ of the tongue was destroyed by the cancer-
ous degeneration, and the disease had burrowed downwards
and backwards to a considerable extent. The parts diseased
resembled in appearance a boiled cauliflower. The entrance
to the larynx was much contracted, and this may have been
connected as a cause, with the sudden death.

Cases of Poisoning by Coloured Confectionary, with Remarks.
By H. Letheby, M. B., Lecturer on Chemistry in the Lon-
don Hospital. (Medical Examiner, from London Medical
Times.)

Hannah Martin, aged 4| years, Jane Embden, aged 10 years,
and Amelia Leir, also aged 10 years, were admitted into the
London Hospital on Sunday, April 28th ult., suffering from
violent sickness and great prostration of strength.

It appeared that they had bought some sugared ornaments
and colored confectionary from a Jew in Petticoat-lane; and
that soon after they had partaken of these sweetmeats, they
became very sick; complained of a burning sensation in the
mouth, fauces, and oesophagus, of great pain in the stomach and
abdomen, and were seized with violent retching, which was at-
tended, after a few hours, with profuse purging. When they
were admitted into the hospital they were seriously ill, for the
features looked pale and shrunk, the extremities were deathly
cold, the pulse was, in each case, small and feeble, and the sur-
face of the body, especially of the last named child, was covered
with a clammy perspiration. Emetics of sulphate of zinc were

n. s. von. vi. no. viir. 32

498 Poisoning by Colored Confectionary. [August,

instantly administered, and the vomited matters were saved
for analysis. Antidotes of milk, white of egg, and demulcents,
were also given in great abundance ; and, after the sickness had
subsided, they were permitted to sleep, from which state they
awoke considerably revived.

The vomited matters were evaporated to dryness, and the
solid residue, not amounting to two drachms in weight, yielded
abundant evidence of the presence of arsenic, copper, lead,
iron, and zinc, all of which metals, excepting the last named,
had, doubtless, been derived from the confectionary of which
the children had partaken.

On making inquiry into the matter, we were informed that
between thirty and forty children had been attacked in a
similiar way, and that they had all purchased sweetmeats from
the Jew in question ; but it does not appear that he was ac-
quainted with the poisonous nature of his merchandize, for he
had purchased it (so he stated) as the refuse stock of a large
and very respectable firm in the city.

It is not generally known that the ornamental kinds of con-
fectionary are frequently tinted with poisonous pigments ; that
the greens for example, are commonly produced by means of
arsenite of copper, (Scheele's green,) verdigris, or a mixture of
chrome and prussian blue ; the yellow, by chromate of lead ;
the red, by vermillion, (bisulphuret of mercury,) or oxide of
iron; and the whites, by carbonate of lead, oxide, or carbonate
of zinc, chalk, or sulphate of baryta; and that frequently, the
fine frosting which covers the commoner kinds of twelfth-cakes,
and the hard white sugar of comfits, contain from 10 to 30 per
cent, of plaster of Paris or of whiting.

I have been induced to record the preceding cases, not so
much for the purpose of exhibiting the nature of the symptoms
observed, as with the the view of showing the necessity for
some legislative interference in a matter of what may truly be
termed wholesale poisoning ; for, without such evidence be-
fore the mind, it would not be credited by the great bulk of the
community, that many of the prettiest and daintiest looking
confections of the dessert-table are like the choice luxury of the
Queen-mother, but too often the source of danger to those who
partake of them.

Within the last three years no less than seventy cases of
poisoning have been traced to this source ; and how many,
may we ask, have escaped discovery? In the month of Sep-
tember, 1847, Mr. Hetley, who is the visiting surgeon of St.
Marylebone Infirmary, reported in the Pharmaceutical Journal,
that he was requested, on the 14th of that month, to go as
quickly as he could to the relief of some persons who had been

1850.] Poisoning by Colored Confectionary. 499

taken suddenly and dangerously ill. He found three adults and
eight children severely affected with vomiting and retching;
the angles of their mouth and linen being colored green by the
ejections. On seeking into the cause of this, he was told that
one of the children had bought two pennyworth of some
colored confectionary ornament, of which they had all partaken.
Some of the offending article, (a thin cake of sugar and Paris
plaster, covered with a layer of bright green) was, however,
found, and it at once made the case clear.

In commenting on the above, Dr. Guy states, that "an ac-
cident on a larger scale, but happily unattended by any fatal
result, occurred in our own experience, one of the .patients
having been brought to the King's College Hospital on the day
after the accident. An ornamental green basket, after having
been used at an evening party, was given to one of the atten-
dants, who distributed the fragments among the inmates of a
large workshop. Severe vomiting and purging was the result.
On inquiry at several confectionaries, we. ascertained that
arsenite of copper is commonly used to give a green color to
confectionary, and an analysis of a fragment of the basket con-
firmed this statement." Banking's Abstract, Vol. VII., p. 347.

At the very time that the preceding article was going
through the press, an inquiry was being instituted at North-
ampton before the county coroner, Mr. Hicks, respecting the
death of Mr. William Cowfieid, who, with twenty others, was
poisoned at a public dinner given in that town, on the 7th of
June, 1848, when it appeared that deceased had partaken of a
blanc-mange, the top of which was colored with emerald green,
(arsenite of copper.) and of which he died.

In the month of February, 1849, Dr. W. Fergus published the
case of three children, who were poisoned bv eating the green-
sugared ornaments from a twelfth-cake. (Med. Gaz., p. 304.)
And, in the month of June following, Professor Christison ex-
hibited to the members of the Edinburg Medico-Chirurgical
Society, a green powder which he had purchased at a confec-
tioner's in that city. It was a portion of the stock employed to
color jellies, &c. ; and, on examination, he found that it
consisted of sugar mixed with verdigris and arsenite of copper.
His attention was drawn to it by the severe illness of two
maid-servants who had partaken of some jelly colored with it.
London Journal of Medicine, Vol. 1., p. 702.

Two years since, professor Louyet, of Brussels, wrote to in-
form and caution us concerning the fact, that bon-bons, colored
with an unusual quantity of ehromate of lead, were being
manufactured largely in London, and exported thence to
Belgium. The bon-bons in question consisted of a species of

500 Bibliographical. [August,

aromatized sugar, colored yellow throughout its mass, exhibit-
ing the scent and flavor of lemon, and encrusted with a species
of transparent red-currant shell. Very recently some cheap
almond and caraway and comfits have been sold at the grocers'
and confectioner's in many parts of London, which are colored
yellow by means of this pigment, for I have detected as much
as half a grain of chromate of lead in three of these comfits.

This dangerous practice of coloring sweetmeats, &c, with
poisonous substances is, unhappily, not peculiar to the English ;
ibr very recently some cases have been reported by MM.
Houze and Jaubert, in which four persons were seriously at-
tacked after having partaken of some bon-bons which were
colored with arsenite of copper. One of the patients (a child
aged six years) died from the effects of the poison, after an
illness of two days; and a second chlid was brought so near
to the grave that she did not recover for two years after the ac-
cident. So, again, it is recorded by Chevalier, that at a
breakfast given on a festive occasion by an eminent Parisian
lawyer, a boar's head was decorated in a very artistic matter
with masses of fat, which were colored of a lively red and green
tint. One of the guests, who was well acquainted writh
chemistry, suspecting that the pigment might be poisonous, re-
tained a portion of the fat for further examination, and he
found that it contained about two per cent, of arsenite of
copper. Jour, de Chirur. Med., Jan. 1847.

All these facts, and there are many others of alike character
which relate to the trade of the pickle-merchant, are sufficient
to show that however difficult it may be for the Home Sec-
retary to give a correct definition of a poison, or even a com-
plete list of poisonous substances, it is high -time that the
Government should take some steps to protect the lives of the
community from danger, by imposing a sufficient check upon
the present unrestricted sale and use of these, and such as these,
the commoner poisons.

BIBLIOGRAPHICAL NOTICES.

1. Medical Jurisprudence. By Alfred Taylor, F.R.S., Licentiate
of the Royal College of Physicians ; Member of the Royal College
of Surgeons; and Professor of Medical Jurisprudence and Chem-
istry in Guy's Hospital. Second American, from the third London
edition, with notes and additions by R. Eglesfielu Griffith, M.
D., &c. Philada.: Lea & Blanchard. 1850. 1 vol. 8vo., pp. 670.

No work upon Medical Jurisprudence has been more favorably
received by the medical and legal professions, than Taylor's. In
England, several thousand copies have been sold in the few years

1850.] Bibliographical. 501

which have elapsed since the appearance of the work. This fact not
only proves the high estimate placed upon the labors of Mr. Taylor,
but evinces a growing interest in the important subjects of which he
treats. We are gratified to find that in our own country, also, Medical
Jurisprudence attracts a much greater degree of attention than it did
a few years ago, and that it is now taught in most of our medical
colleges.

This new edition of Taylor's Medical Jurisprudence has been en-
larged by the addition of more than one hundred pages, and contains
the newly observed facts which bear upon the subject. '' Many legal
cases have been added which have given rise to new questions re-
quiring the aid of a medical jurist for their solution." The subject
of poisons has been abridged, in consequence of the publication by
Mr. Taylor of a separate work on that subject, but it still contains
what is necessary for practical purposes. Large additions have been
made to the sections on wounds, and infanticide. A number of notes
and observations have been added by the American editor, Dr. Grif-
fith, which give additional value to the work.

We cordially recommend this new edition of Mr. Taylor's work to
our readers, as the very best work on Medical Jurisprudence in our
language, and one fully "on a level with the advanced state of
science."

2. A Theoretical and Practical Treatise on Midwifery ; including
the Diseases of Pregnancy and Parturition. By P. Cazeaux,
Adjunct Professor in the. Faculty of Medicine of Paris, etc., etc.
(Adopted by the Royal Council of Instruction.) Translated from
the second French edition, with occasional notes and a copious
index by Robert P. Thomas, M. I)., Member of the Philadelphia
County Medical Society, &c. With one hundred and seventeen
illustrations. Philadelphia: Lindsay & Blakiston. 1850. 1vol.
8vo., pp. 785.

This is not a new system of Midwifery, but a translation and re-
publication of the second edition of an excellent work which was first
published in 1840, in Paris.

Almost as soon as the first edition issued from the press, wc
were fortunate enough to receive a copy we approved very highly
of it, made frequent reference to it in our lectures, and would have
gladly adopted it as a text-book, had it been translated into our own
language; indeed we contemplated, and might have ourself under,
taken the task of translating it, had not more pressing engagements
prevented. Since 1840, many excellent treatises have appeared,

502 Bibliographical. [August,

rendering a translation of Cazeaux's work less necessary ; but it is
by no means altogether superseded ; for although there are some,
taken as a whole fully as good, we would consider this treatise, in
some respects, superior to all the rest.

The profession is indebted to the translator for the labor he has so
ably performed.

The fact that, as early as 1841, one year after its first publication,
M. P. Cazeaux's Treatise on Midwifery was adopted by the Royal
Council of Public Instruction, is a sufficient guaranty of its excellence
and of the high reputation it had even then acquired in France. The
second edition is much more comprehensive and complete than the
first. Without undertaking to set forth the merits or point out the
defects of this work, we believe it has as many of the former and as
kw of the latter as any system of obstetrics extant. Perhaps the
greatest imperfection is that observed in the American Journal of the
Medical Sciences, the silence of both author and translator on the
employment of anaesthetic agents in obstetric practice : for whether
their use be proper or improper, safe or dangerous, to be commended
or condemned, it is a subject altogether too important to pass by with-
out comment. J. a. e.

3. A Practical Treatise : on Inflammation of the Uterus, and its
appendages, and on Ulceration and Induration of the neck of the
Uterus, By James Henry Bennett, M. D., Member of the
Royal College of Physicians, &c, &c. Second American from
the second London edition. Philadelphia : Lea and Blanchard.
1850. 1 vol. 8vo., pp, 355.

The first edition, or, more correctly, Dr. Bennett's first work was
re-printed in the United States in 1847. In the volume of this Journal
for the same year, we noticed this publication at some length, and in
the most favorable terms: subsequent experience has fully confirmed
the high opinion, then expressed, of the views entertained by Dr. Ben-
nett on the pathology and treatment of diseases of the uterus. We
believe this little work has done as much, or more than any ever pub-
lished, to modify and improve this department of practice. We have
no hesitation in acknowleging our indebtedness to it ; we believe that
we, as well as our patients, though in different respects, have profited
by it.

The author very correctly remarks in his preface : " Although
nominally a second edition, the present is in reality a new work. It
will be found to contain, not only a faithful history of the various

1850.] Bibliographical. 503

pathological changes produced by inflammation in the uterus and its
annexed organs in the different phAs of female life, but also an ac-
curate analysis of the influence exercised by inflammation in the
production of the various morbid conditions of the uterine system,
hitherto described and treated as functional."

This is a much more comprehensive work than the former, not only
including a fuller treatise on the same, but comprising many import-
ant subjects not embraced in that.

The author is sometimes a little too exclusive ; he doubtless attri-
butes too much to inflammation, considering all cases of displacement
of the uterus to depend on increased volume and gravity consequent
on inflammation; he is perhaps correct in a large majority of cases,
but we believe there are some altogether independent of it, and to be
remedied on an entirely different principle and plan of treatment.
We would not claim perfection for any human performance, but we
do regard this a most excellent and valuable work, which cannot fail
to do a large amount of good. j. a. e.

4. Essays on the Puerperal Fever and other diseases peculiar to
women ; selected from the writings of British authors previous to the
close of the eighteenth century. By Fleetwood Churchill, M. D.,
M.R.i.A., &c, &c. Philadelphia: Lea and Blanchard. 1850.

This excellent collection of essajs constitutes an octavo volume of
464 pages.

The first part comprises An historical sketch of the epidemics of
Puerperal Fever, by the Editor. Dr. Denman on the Puerperal Fe-
ver. Dr. Hulme on the Puerperal Fever. Dr. Leake on the Child-
bed Fever. Mr. Charles White on Pregnant and Lying-in Women.
Dr. Kirkland on Childbed Fevers. Dr. Butter on the Puerperal
Remittent Fever. Dr. Joseph Clarke on the Puerperal Fever. Dr.
John Clarke on the management of Pregnancy and Labour. Dr.
Gordon on the Epidemic Puerperal Fever.

The second part consists of miscellaneous essays, to wit: I. Dr.
Fothergill on the Management proper at the Cessation of the Menses.
II. Dr. Macbride's Cases of Tumefaction of the Labium after Delive-
ry. III. Dr. Clarke on Cauliflower Excrescence from the Os Uteri.
IV. Dr. Clarke's two Cases of Tumour of the Uterus. V. Dr. Den-
man's Account of an Excrescence from the Womb.

Dr. Churchill is so favorably known to the profession in the United
States, that his name alone would be a sufficient recommendation to
any book he might edit. But the authors of these essays themselves

504 Periscope. [August,

stand too high in credit to require the endorsement of Dr. Churchill
to give them currency. Whoew desires to inform himself thorough-
ly on the subject of puerperal fever could not turn to a better source
for information. The miscellaneous essays are very good treatises
upon the subjects to which they refer. j. a. e.

5. The Doctrine of the Unity of the Human Race examined on the.
Principles of Science. By John Bachman, D. D., Prof. Natural
History* College of Charleston, &c, &c, &c. pp. 312. Charles-
ton, S.'C. 1850.

It is not our purpose to review the work, the title of which is given
above: but though this may not fall strictly and legitimately within
the province of a Journal restricted to medicine and surgery, we can
with propriety give it a passing notice. We are aware that, for the
past few years, a controversy has been carried on in the city whence
this publication emanates, on' the subject of the unity of the human
race, and an attempt made to present it as the question of the age in
which we live. In this discussion, we regret to find our profession
opposed to the Clergy the M. D.'s have taken the negative side,
while the D. D.'s advocate the affirmative.

J)r. Bachman has certainly written a most able argument, and done
much to convince the most sceptical of the position that all mankind
sprang from one race, an original pair. For ourself, we are not
ashamed of the doctrine of the Bible, and feel under much obligation
to the author for this deeply interesting book. We commend it to
the careful perusal not only of the scientific, but to all classes of read-
ers, especially disbelievers in the Mosaic account of the peopling of the
world by the Adamic race. p. f. e.

PART III.
ill o n 1 1) 1 2 |3 c v x 5 c o p c .

On the Existence of two new kinds of Anatomical Elements in the
Medullary Canals of Bones. By M. Ch. Roijin. (Brit, and For.
Medico-Chirurgical Review, from Gazette Medicale de Paris.) In
all bones, whether short, flat, or long, the medullary tissue contains,
besides the adipose cells, the vessels, and the finely granular amor-
phous matter, a peculiar kind of cells, which may be termed medulla-
ry cells ; these are spherical, or slightly polyhedric, transparent, with
defined borders, and generally include a spherical, regular, transparent,
sharply-defined nucleus. Between the nucleus and the cell-wall,
and especially around the former, there exists a variable quantity of
molecular granules. These cells are more abundant in young sub-

1650.] Periscope. 50i

jects than in adults, and towards the end of the period of gestation
ihey occupy nearly the whole of the medullary cavity, to the exclu-
sion of the adipose cells.

Another kind of cell is met with in long and short bones, but nor-
maliy in less amount : the knowledge of these cells, however, is im-
portant, because it is in an unusual development of them that some
diseases of bones originate. Certain tumours of bone, considered
by pathologists as cancerous, are not truly so, but are made up of
large plates or flattened lamellas, sometimes polygonal, sometimes
irregular circularly, having a diameter of at least from l-20th 1q l-12th
of a millimetre (or from 2 to 3-100ths of an inch), finely granular in
their texture, and containing from six to ten large oval nuclei, which
are embedded in the thickness of the plates. The author states that
he has met with these bodies as the principal components of several
osseous tumours ; and that such tumours owe their origin to an unusual
local development of a normal element of bone. For these peculiar
bodies are found in the medullary tissue of even healthy bone ; being
much less numerous, however, than either the true medullary or the
adipose cells; but being, like the preceding, more abundant in the
bones of young subjects than in those of adults. #

Researches on the Physiology of Medulla Oblongata. By M.
Browtn-Sequard. (Gazette Medicale.) The following are the re-
sults of the author's experimental inquiries, made upon fifty-four
species of animals, belonging to the five classes of Vertebrata :
1. The life of Batrachia does not seem (o be considerably shortened
after the removal of the medulla oblongata alone, or with the rest of
the encephalon, so long as the animals remain in air of a temperature
below 46 (Fahr.) Many individuals have lived, in these condiiions,
more than three months. 2. The sanguiferous and lymphatic circu-
lation, the cutaneous respiration, the digestion, the mucous, epidermic,
and urinary secretions, the nutritive operations, the reflex power, and
the properties of nerves and muscles, continue in Batrachia, deprived
of the medulla oblongata, with as much rapidity and energy as in
those which remain uninjured, and which are exposed to the same
temperature. 3. All animals, even adult Mammalia, may survive
the removal of the medulla oblongata during from ten to twenty min-
utes, when their temperature has been reduced below from 86 to 92.
For this result pulmonary insufflation is not requisite. 4. The most
remarkable differences present themselves in the duration of life, in
the different individuals of the same species, after the removal of the
medulla oblongata, these being in exact accordance wi.h the temper-
ature. Thus the duration of life in the Batrachia may be reckoned
by months, between the temperatures of 32 and 4G ; by weeks, be-
tween 41 and 54 ; by days, between .r)() and 61 ; by hours, between
66 and 77 ; and by 'minutes, between 80 and 104.

Remarkable Case of Retention of Urine after Delivery. By M.
Malgaigne. (Med. Chir. Rev.) M. Malgaigne was called to a

r>00 Periscope. [August,

woman on the fourth day after her delivery, in consequence of the
various attempts at relieving retention of urine by catheterism having
failed. The abdomen was as much swollen as prior to delivery, and
the woman was in a state of dreadful suffering. On inquiring, M.
M. Malgaigne learned that both she and one of her daughters urinated
in a different manner from other females the jet passing upwards and
in front ; and he concluded that the urethra mounted higher up in front
of the pubis than usual, and that this bone had prevented the passage
of the catheter. By directing the instrument first from above- down-
ward, then turning it, and pushing it upwards and backwards, he
easily reached the bladder. He was perfectly astonished at the enor-
mous quantity of urine that came away this far exceeding any thing
he had ever witnessed before. By weight, it amounted to 3300
grammes, and by measure to three Hires; that is, between eight and
nine apothecaries pounds, or between five and six imperial pints.

Scrofulous affections treated with preparations of the leaves of the
Juglansregia, or English Walnut. The April number of the Archives
Generales contains an article on this subject by Dr. Negrier, of An-
gers. The article i* devoted mainly to an analysis of a memoir on
this subject by Dr. Borgiali, an Italian physician, which appeared in
1846. A number of cases of scrofulous disease are detailed, and the
following conclusions drawn by Dr. Negrier : 1st, that scrofulous
affections are, in general, radically cured by the preparations of the
leaves of the walnut ; 2d, that the action of this remedy on the econo-
my is sufficienly constant to enable us to count on the cure of the
greater number of the cases submitted to its influence ; 3d, that its
influence is slow, innocent and durable ; 4th, that its first effects are
general, and subsequently, local ; 5th, that scrofulous affections of the
skin, of the mucous surfaces, of the system of vessels and lymphatic
ganglia, are cured as certainly and as promptly by the preparations of
the leaves of the walnut, as by any other known method ; 6th, that
affections of osseous, cartilaginous, and ligamentous systems of a scro-
fulous origin, are sometimes radically cured by this means, lymphatic
subjects always experiencing good effects, and nervous subjects find-
ing but little benefit ; 7th, that scrofulous ophthalmias are effectually
and promptly cured by a treatment having for its basis, the leaves of
the walnut.

The use of the remedy must be long continued, to the extent of
several months, even in recent or slight cases, and for a still longer
time in old and obstinate cases. Dr. Borgiali employs an infusion of
the leaves, either green or dried in the shade from two or three leaves,
to eight or more, infused in a half a cup of water. He also employs
a decoction of the fruit with the envelope of the fruit, recently boiled,

1850.] Periscope. 50'

and an extract made of the leaves and hull of the fruit. Of the ex-
tract which is the most feeble preparation, and which he only employs
in the winter, he gives from ten to sixty grains. The decoction and
infusion is usually given once a-day, on an empty stomach, though in
some instances the doses has been carried to the extent of one or
two pounds a-day. It usually acts powerfully as a diuretic, and pro-
duces some purging, especially when first taken. Under its use the
digestion improves, the appetite returns, and the patient, before
gloomy, recovers his former vivacity.

Solution of Gutta Percha in Chloroform in the Treatment of Eczema
Rubrum. The Journal desConnaissances Medico-Chirurgicales con-
tains an interesting case of Eczema, successfully treated with a solution
of gutta percha in chloroform, reported originally in the Gazette Medi-
cale de Strasburg, by Dr. Robert. About a year ago a female, aged
about 46 years, wTas suddenly attacked with urticaria, complicated
with eczema and prurigo. The prurigo spread over the entire sur-
face, but the eczema concentrated itself almost exclusively on one of
the limbs, where it attained a high degree of inflammation. As soon
as the vesicles emptied themselves, the limb would again swell, and a
new infusion of ichorous fluid would plunge the patient into an indes-
cribable state of excitement and agony. Dr. R. resolved to employ
the gutta percha, to protect the diseased surface from the contact of the
air, and to dissolve it in a fluid which might favorably modify the
vitality of the skin. To eflect these purposes he prepared a solution,
made with five grammes of gutta percha in thirty grammes of chloro-
form. This fluid was then spread upon the diseased surface, and at
first produced a very marked burning sensation. In a few minutes it
became solid, and formed a perfect coat. On the next day, the vitali-
ty of the skin seemed to have been favorably modified ; the patient
suffered less itching, and the vesicles had nearly all disappeared.
Every day the portions of the varnish which were detached from the
surface by the exudations from the skin were removed, and the solu-
tion again applied. Under this treatment, in seventeen days the dis-
ease was reduced to more than three-fourths of its original dimensions,
and Dr. K. supposed that in eight days more, it would entirely disap-
pear. No internal means were employed except a tonic decoction.

The Journal des Connaissances suggests that Dr. R. should have
awaited the completion of the cure before reporting the case, but sup-
noses that his haste was induced by a fear that some one would take
irom him the honor of priority in the use of this new remedy for ecze-

508 Periscope, [August,

ma. Dr. R., however, cannot claim the honor, of being the first to
apply a varnish to diseased surfaces to protect and modify them, for
his preparation is but another form of collodion, and this, Mr. Mitchell
of Dublin has employed successfully in psoriasis, and others have since
been equally successful with it in other diseases.

On the febrifuge and anti-periodic properties of Chloroform. (Ar-
chives Generales de Medecine.) At the meeting of the Academy of
Medicine of the 23d March, Dr. Delioux, Professor of the Normal
School at Rochetbrt, presented a communication on the febrifuge
and anti-periodic properties of chloroform, given internally, in cases of
intermittent fever. He employed it at first in old and obstinate cases,
in which cinchona, chalybeates and bitter tonics, had only succeded
in suspending the attacks for a time. In many instances the chloro-
form succeeded in checking the disease ; in others it failed, or at least,
only suspended it for a short time. From his observations, Dr. D.
concludes that independently of its antispasmodic and sedative proper-
ties, chloroform possesses antiperiodic and febrifuge properties, inferi-
or probably to quinine and arsenic, yet positive, and deserving a trial
in intermittent affections. The mode of administration is similar to
that of the cinchona, that is to say in divided doses, taken some hours
before the time of access. In tertians, and obstinate quartans, Dr. D.
gives the medicine every day, increasing the dose on the day of the
access, and continues it for some days after the disease is arrested, in
decreasing doses. On the seventh and fourteenth days he renews the
use of the chloroform.

We are much disposed to doubt whether chloroform has any proper
febrifuge property, though it will probably be found competent to ar-
rest a paroxysm of intermittent, as indeed are all the diffusible stimu-
lants, if their action is properly timed. The suggestion to renew the
use of the remedy on the seventh and fourteenth days after the subsi-
dence of the disease is a most valuable one, when applied to the use of
the quinine and other periodics. We are fully persuaded that if this
plan was generally adopted, we would seldom fail in effecting a per-
manent cure.

Strychnia in Intermittent Fever. (Medical Examiner.) Dr. Mc-
Kinley, of Tenn., states that he has employed the strychnia with the
most marked and happy effects in a great many cases of intermittent
fever in which quinine, combined with other acknowledged tonics, had
been given without success. He gives one-sixteenth to one-eighth of
a grain of strychnia every three hours, gradually augmenting the

1850.] Periscope. 509

dose in proportion to the lost susceptibility, until in some cases a grain
may be given three or four times a-day, without the production of any
toxical effect whatever. It may be given in a pill of bread-crumb.
Dr. McK. asserts that no other remedy has proved so potent in his
hands.

We have been for some time aware of the value of the strychnia in
the treatment of obstinate intermittents, but we would caution those
who may not be in the habit of prescribing this powerful article,
against the use of grain doses, as suggested by Dr. McK., even though
such doses in his hands may have failed to do injury. The small doses
will usually be found quite efficient, and certainly free from danger.

Chronic Inflammation of the Bladder cured, by injections of a solution
of JS Urate of Silver. (British American Medical and Physical Jour-
nal.) Dr. R. L. Macdonnell reports a case of chronic cyetitis treated
by Dr. Belin, with injections of nitrate of silver into the bladder.
The patient was an unmarried female aged twenty-seven, and had
labored for eight years under pain in the pelvic region, suppression of
the menses, frequent micturition, heat and smarting of the private
parts. By treatment the menses was partially restored, and the or-
dinary remedies for cystitis gave some relief. Subsequently the
patient became much worse ; she had pain in the loins and hypogas-
trium, frequent desire to urinate, inability to remain long in the sitting
position, with great restlessness, and tendency to chilliness and perspi-
ration. The urine, under microscopic examinatien, exhibited pus
globules, and chrystals of triple phosphate. An injection of four grains
of nitrate of silver dissolved in four ounces of water was thrown into
the bladder, and retained for fifteen minutes. Eight days after, eight
grains were injected, and retained ten minutes. Two days after, a
solution containing twelve grains was thrown up. These applica-
tions, however, seemed to afford but little relief. The strength of the
solution was then increased to four grains of the nitrate to the ounce
of water, when the symptoms yielded promptly.

Abortive method of treating Coryza. (Bulletin Gen. de Therapeu-
tique.) M. St. Martin suggests the application of the vapor of acetic
acid as a valuable remedy in cases of coryza, in their incipient stage.
A flask containing a small portion of the acid is held to the nostrils,
and deep and slow inspirations made for about five minutes. The
vapor penetrates the whole olfactory cavity, and impresses on the mu-
cous membrane a modification slightly phlogistic, yet sufficient to dry

510 Periscope. [August,

up the nasal flux. This mode of treatment has been repeatedly em-
ployed with success by M. St. Martin, not only on himself, but in
numerous other cases.

Neutral Citrate of Soda. (Gaz. Med. de Lyon. Journal des Con-
naissances Med. Chirurg.) A few years since M. Roge proposed the
citrate of magnesia as a new purgative, more agreeable to the taste
than other saline articles, and equally efficient. Its high price, how-
ever, has prevented its general use. Since then, M. Guichen, of
Lyons, has sought for another medicine of analogous properties, which
would not be liable to this objection, and now proposes the citrate of
soda, as an article possessing the same therapeutic properties as the
citrate of magnesia, having no disagreeable taste, and being far cheap-
er than that salt.

The neutral citrate of soda chrystallizes in six sided pyramids ; it
is white, without odour, slightly acid, and effloresces slightly in the
air. By the addition of a sufficient quantity of lemon syrup, it fur-
nishes a very agreeable purgative drink.

Citrate of Iron and Magnesia (London Journal of Medicine, from
Journnl des Connaissances Med. Chirurg.) The citrate of iron and
magnesia appears, to M. Van der Cofput, likely to come into general
use among ferruginous preparations, being easy of administration, and
not liable to produce constipation. It is prepared by dissolving two
parts, by weight, of recently precipitated hydrated oxide of iron in a
solution of three parts of citric acid; the liquor is then saturated
with carbonate of magnesia, and evaporated to dryness.- The salt
is in the form of shining brown scales: the taste is sweetish, very
slightly inky, and not at all disagreeable. It is perfectly soluble in
water: it is not deliquescent, so that it may be given in the form of
powder. It may be prescribed in doses of 15, 30, or 60 centigrammes-
(2, 5, or 10 grains).

Syrup of Citrate of Iron and Magnesia is prepared by dissolving 8
grammes in 15 grammes of orange-flower water, with 180 grammes
of simple syrup. This is one of the most agreaable preparations of
iron.

Saccharine Confection of Citrate of Iron and Magnesia.

Take of citrate of iron and magnesia 1 drachm

Powdered sugar 7^ drachms

Powder of canella 1 drachm

Mix, and divide into powders, each containing twelve grains.
Lozenges of Citrate of Iron and Magnesia.
Take of citrate of iron and magnesia .... drachm

Powdered sugar 7 drachms

Saccarine confection of vanilla, . . . | drachm
Mucilage of tragacanth, a sufficient quantity.
Mix, and divide into lozenges of twelve grains.

1850.] Miscellany. 511

ftteMrcil ill i s c c 1 1 a n rj .

New Medical Journal. We have received the first number of the
New York Medical Gazette and Journal of Health, published weekly,
under the editorship of D. M. Reese, M. D. The Journal will be
specially devoted to " the vindication of rational medicine and conser-
vative surgery, in contradistinction from the follies and fancies of the
times ; and to the guardianship of the public health from the mis-
chiefs of popular ignorance and delusion." The well-known ability
of the editor will doubtless" make the journal a valuable work to the
profession, and we know of no one more competent to combat " popu-
lar ignorance and delusion."

University of New York. The recent election of Dr. Detmold to
the chair of Theory and Practice in this Institution, appears to have so
much dissatisfied Dr. Valentine Mott as to induce him to resign the
chair of Surgery. Whereupon Dr. D . nold also resigned his Pro-
fessorship. Both resignations have been accepted. There are now
two vacancies to be filled.

Still Born and Premature Births in the City of New York. The
New York Medical Gazette contains the following extract from the
report of the City Inspector for the year 1849, by which it will be seen
that the infant mortality in that city is of a most startling character :

"In three years we have a mortality from premature births of 400 ;
and from still-lorn of 3,139 ; making a total of 3,539 (!) human beings
that never breathed.

11 Since 1805, when returns were first made to this office, the num-
ber of these accidents have steadily and rapidly augmented. With a
population at that time of 76,770, the number of still-born and prema-
ture births were 47 ; in 1849, with a population estimated at 450,000,
the number swells up to 1,320 ! Thus, while the population has in-
creased nearly six times since 1805, the annual number of still-born
and premature births has multiplied over twenty-seven times! !

11 To show the rapidity of this increase, I Have prepared the follow-
ing table :

"In 1805 the ratio to population was as

1810

14

14

1815

14

tt

1820

44

a

1825

M

tt

1830

14

tt

1835

14

M

1840

a

U

1845

It

a

1849

tt

(estimated)

as

as ]

. to

1612.12

14

it

14

1025.24

M

u

(i

986.46

tt

14

M

654.52

%l

14

44

680.68

N

14

14

597.60

(4

14

14

569.88

II

14

14

516.02

44

14

[ *'

384.68

((

14

tt

340.90

512

Miscellany. Meteorology .

" This is a state of mortality from these accidents truly alarming,
which, while no remedy in this connection can be advised, demands
our most serious consideration. What of crime and recklessness there
is in this sum dare not be expressed, for we cannot reter such a heca-
tomb of human offspring to natural causes. " An honest and fearless
expression of the causes or circumstances attending these events, on the
part of the medical attendant, would bring into this department an
amount of valuable knowledge that might be useful in checking this hor-
rible and increasing icaste of life.,}

Medical Officers in New York. The N: Y. Medical Gazette gives
a list of the paid medical officers in that city holding appointments from
the State, City, and from the governments of the several institutions.
They are twenty in number, with an aggregate annual compensation
of 851,600. The Health officer has a salary (supposed) of $15,000 ;
Coroner $10,000 ; Physician to the Marine Hospital $6,000 ; Health

Commissioner $3500.
per annum.

The other salaries ranges from $500 to $2000

METEOROLOGICAL OBSERVATIONS, for June. 1850, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet. Bv Dr. Paul F. Eve.

V

Sun

-

Thf.r.

1

60

2

56

3

60

4

60

5

61

6

61

/

62 i

8

69 1

9

70

10

70 |

11

69 |

12

58 1

13

58

14

64

lb

65

16

67

17

71

1^

70

19

68

'20

71

21

71

22

71

23

71

24

72

25

72

26

73

27

74

28

72

29

75

30

76

29 54
" 78
88

30 2
30 3
30 8
30
29 84

72
67
89
30
30

29 95
95
91
84
91
99
30

29 90
" 88
': 85
11 78
" 75

4,
Ther.

100
100
100
100
100
100

100
100
100
400

100
100

70
75
81
83
85
95
87
91
90
86
87
83
86
86
87
B3

-100

-100 85

100 87

100 87

91

-100 91

100 90

100 91

-100 94

-100 82

-100 88

100 i 86

100 89

1001 89

80-
81-

83-
80-100' 85

P. M,

Bar.

29 65-100

Wind.

Remarks.

N\ E.

Fair afternoon rain last night

" 82-10(1

E.

Fair. [and morn'g. 50-100.

" 91-10(1

w.

Fair.

30 4-lOCl

s.

Fair.

30 7-100;

E.

Fair.

30 5-100

W.

Fair.

29 92-100

N. W.

Fair.

" 94 100

w.

Fair.

" 70-100,

s. W.

Fair.

" 73-100

N.W.

Fair morning.

" 91-100

N. E.

Fair.

30 5-100

S.

Fair blow at 2 a. m.

29 91-100

E.

Fair.

" 92-100

S.

Fair.

" 91-100

s.

Fair.

" 89 100

E.

Cloudv.

83-100

8.

Fair sprinkle at 3 a, m.

92. j 00

s.

Fair afternoon.

97-100

s.

Fair.

" 91-100

s.

Fair.

" 85-100

s.

Fair.

84-100

s.

iFair.

(: 75-100

Fair. [rain, 10-100.

<: 68.100

s.

[Fair thunderstorm at 7 p. m.,

" 78-100

S'

Cloudy thunder.

74-100
" 75-100

I:

Cloudv thunder sprinkle.
Showery, 20-100.

<: 78-100

8. E.

Fair breeze.

" 86-100

s. w.

Fair afternoon.

75-100

s. w.

Showerv, 10-100.

20 Fair days. Quantity of Rain 90-100.
West of do. do. 8 da vs.

Wind East of N. and S. 6 days,

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES SEPTEMBER, 1850, [No. 9.

PART FIRST.
r i g i n a I ( o m m n n u a 1 1 0 n $ .

ARTICLE XXIV.

Observations on Chlorosis, with a Case. By J. A. Mayes, M.D.,
of Sumter District, So. Ca.

In an article on the use of " Sulphate of Iron in Chlorosis,"
by R. Jarrott, M. D., of Florida, published in the September
number of the Charleston Medical Journal and Review, there
occurs the following remark : " perhaps there is not a practi-
tioner in the United States, who is not in the habit of treating
it frequently." The disease is, indeed, one of such frequent
occurrence, that it has appeared to lose the importance which
it merits; and from the scarcity of publications in the journals
on the subject, we would be naturally led to suppose that it is
a disease so very manageable that none require further instruc-
tion concerning it. The experience of the writer, however, has
satisfied him, that one, at least, of the profession, finds chlorosis
to be a disease exceedingly difficult of management. Tempo-
rary relief can in all cases be soon afforded ; but how common
is it, that the same case requires our attention after the lapse of
a month or two from the time when we had dismissed the pa-
tient as cured. This shows us, that our usual treatment is not
radical, but only palliative, and, that the disease is one which
ought to engage seriously the attention of the profession.

11 ( /hlorosis occurs principally in female youth ; but frequent-
ly in married women, both young and old ; and occasionally in
the young and sedentary of the male sex, and even in men of

N. S. VOL. VI. NO. IX. 33

514 Mayes, on Chlorosis. [September,

adult age, from the influence of sedentary habits and mental
anxiety." In the section of country in which the writer resides,
the foregoing observation of Marshall Hall will strictly apply ;
for the male youth are as often subjects of the disease as the
female; and, perhaps, an accurate census of chlorotic individu-
als, in the middle districts of South Carolina, would show that
the males are more subject to it than the females. What the
cause is that gives rise to its very great prevalence, we are at
a loss to determine, but suppose that it may be owing to defi-
ciency of wholesome food, sleeping in crowded and ill ventila-
ted apartments, as, so far as our observations have extended,,
the disease is confined to the poorer classes, who have not all
the comforts and conveniences around them which the rich
have. This remark will, however, apply only to the whites ;
for the disease is by no means prevalent amongst the negroes.
The subjects of chlorosis are often unjustly charged with dirt-
eating, and it is no uncommon thing to see them severely pun-
ished for an imaginary oflfence ; as if the castigation would
correct that depraved appetite which impels them to eat such
articles. We think it highly probable that the disease exists
before the appetite for clay is formed, and that it would be more
rational to attempt the correction of a disordered appetite by
medicinal means, than to force the abandonment of the habit
by corporeal punishment. Indeed, we have never seen a dirt-
eater broken of the habit by punishment, but have, in numerous
cases, seen that appetite give way before a judicious course of
treatment. It has also, no doubt, fallen under the observation
of numerous physicians, to see hale and strong persons in ad-
vanced life who have eaten clay daily as far back as they can
remember ; and who will assure you, that without this indul-
gence, they never felt well. Their appetites called for the
clay as a necessary article of diet, or as a necessary medicine.
This latter supposition,, may perhaps be the correct one, and
the clay be taken for the relief which it affords to the undefined
symptoms of gastric uneasiness, of wrhich they often complain.
With this view, we feel much more charitable to those unfortu-
nates who form this habit ; for bad it is, most unquestionably,
when carried to that excess to which they invariably arrive.
How the clay acts in confirming the disease we cannot deter-

1850.] Mayes, on Chlorosis. 515

mine, unless it be explained on the principle that, being a palia-
tive only of a certain set of symptoms, the disease is progressing
unchecked and gathering new strength with its duration ; that
the palliative efFect of the clay is sufficient to keep the sufferer
ignorant of the actual disease for a long time, and finding the
remedy always at hand, and in great abundance, no complaint
of indisposition is heard for years, perhaps, after the disease is
actually set in. We are, then, ready to admit that the disease
is seldom or never aggravated by the clay, in consequence of
any inherent poisonous property in itself; but rather incline
to the opinion that it does harm only by accumulating in the
bowels.

It has been supposed, with some appearance of probability,
that the disease is brought on by a deficiency of salt in articles
of diet; but my observations have not led me to adopt this opin-
ion. I have recommended the use of highly salted articles of
food in families in which the disease was prevalent, and have
every reason to believe that my advice was adopted and carri-
ed out fully, but with no good result, as the younger members
as they grew up successively, all exhibited the same appear-
ances. I have also tried salt freely upon horses, which had ac-
quired the habit of dirt-eating, but in these cases, there was a
very manifest repugnance to salt, and the unfortunate "stump
suckers," as they are called, could find no relief from anything
except clay, rotten wood, or some other absorbent. Having
once owned a " stump sucker," I have seen the great strength
of that impulse which leads them to such articles, and I am
convinced that horses eat dirt only for relief and not from
choice. I have kept the horse mentioned above stabled for
some days, and every precaution used to prevent his eating dirt,
and confining him during that time to the best provisions and
purest water. On being turned out of the stable, he would rush
to the bank of a ditch, and with the most unmistakable si^ns of
gratification commence devouring the clay. Such horses are
always poor, have little or no appetite, are constipated, and
very feeble. The disease is identical with that which we call
chlorosis in the human, and for the relief of the gastric uneasi-
ness which they suffer, they resort to clay, the same remedy to
which the human sufferers apply.

516 Mayes, on Chlorosis. [September

I cannot, therefore, regard the habit of dirt-eating, and the
deficiency of salt in articles of food, as causes of this malady ;
but at the same time, I confess my inability to point distinctly
to any cause. Several circumstances must, no doubt, conspire
to produce this result, and we have seen ft in some families,
offering stronger proofs of the hereditary transmission of dis-
ease, than either insanity or tubercular consumption. Its causes
are obscure, and through the obscurity, we think, we can dis-
cern, with sufficient clearness, the sleeping in crowded and iU
ventilated apartments, filthy clothing, and badly cooked food,
as very prominent. These may not be sufficient of themselves
to produce the disease, as we are satisfied by actual observa-
tion, that the reverse will not cure it when once established.
However difficult.it may be to determine the causes of chloro-
sis, the same difficulty does not occur in its diagnosis, for the
unprofessional recognize it with the utmost facility. It is,
however, peculiarly the province of the physician to notice the
varieties and stages of the malady, these points never being no-
ticed by the unprofessional, who look upon all cases as being
exactly alike, and requiring the same "Copperas Pill" for its
relief. The distinctions made by Marshall Hall are founded
upon close observation, and, though attended with no great
practical importance so far as the treatment is concerned, yet
they are important in making up our prognosis. By determin-
ing the stage of the disease, we are better enabled to say with
certainty what result may be expected, and not render our-
selves liable to imputations of ignorance, by having our progno-
sis falsified. Hall considers the symptoms as indicative of
three forms or stages -the Incipient, the Confirmed, and the
Inveterate. The symptoms peculiar to each stage are detailed
at length in his work on the Diagnosis of Diseases, which every
practitioner should have as a book for reference. To that
work, we will refer our readers, for an accurate description of
the disease, and instead of any remarks of our own on the pa-
thology of chlorosis, we will extract from the same work the
following, which embraces all that is probably known of its
pathology : :: There is occasionally a remarkable state appa-
rently of the capillary system, giving rise to a hemorrhagic
tendency, to epistaxis, melcena, ha3matemesis, menorrhagia,

1850.] Mayes, on Chlorosis. 517

and even purpura. Still more generally, the blood discharged
from the nose, or taken from the arm, and the catamenia, be-
come almost aqueous and colorless ; so that this affection pre-
sents an instance in which the vital fluid undergoes considerable
change. I have seen the blood scarcely tinge the sheets, and
I have seen it resolve itself almost entirely into serum with
scarcely any crassamentum." The leading symptom is, then,
impoverishment of the blood, and this must proceed from a
want of energy in the digestive system ; in other words, from
an aggravated dyspepsia, but without the local inflammatory
symptoms of that disease.

The facility of diagnosticating the disease, and the very plain
indications to be fulfilled in the treatment, makes it unnecessary
for us to enter more minutely into the consideration of this por-
tion of the subject, and after giving a quotation from that
admirable work, Bell and Stokes' Practice, we will enter at
once upon the practical part of the subject.

" We fulfil this (the indications of treatment) by the regular
and prolonged use of chalybeates, generally combined with
purgatives, often with vegetable bitters. Bearing in mind
the possibility of some important organ suffering under conges-
tion or chronic inflammation at the same time, we shall not
refuse to remove this local disease by the customory remedies,
a few leeches or scarifying cups, and, unless there be phlogo-
sis of the digestive mucous membrane itself, by free purging:
but these measures are not to interrupt, or more than very
temporarily suspend, the main treatment by chalybeates ; nor
must you be misled by the troubled circulation, the immense
throbbing and noise in the large arteries, and the hurried and
panting respiration, the frequent pulse, the hot and dried skin,
into a belief that these are symptoms of phlegmasia, or of febrile
state with inflammation, calling of themselves for depleting re-
medies."

The foregoing gives us, in a few words, the rules for the treat-
ment of chlorosis ; but the warning against the adoption of
antiphlogistic treatment, however, good as a general rule, must
sometimes be disregarded. We presume there are few prac-
titioners who have not found it necessary to stop all tonic treat-
ment and depend upon a strictly antiphlogistic course in some

518 Mayes, on Chlorosis. [September,

of their cases. For the benefit of young practitioners, who
may otherwise be at a loss how to treat cases like those referred
to above, I will transcribe, in full, the notes of a very severe
case of confirmed chlorosis, believing that the detailed history
of a case may convey more practical information than the sys-
tem of generalization usually found in books.

Case. A. D., aged about 12 years, had been chlorotic for
several years; was usually relieved by chalybeates ; but sub-
ject every spring to an aggravation of the disease. April 18th.
Represented to be rather worse than he had ever been ; con-
fined entirely to bed, and vomits every thing taken on his
stomach. Did not visit him, but sent the following prescription :
Aloetic purgative pills, to unload the bowels, and after their
operation to take a tea-spoonful of the following powder three
times a-day : Pulv. columbo, Uoz.; carb. iron, \ oz. Mix.

30th. Being informed A. D. was no better, visited him to-day
for the first. Found him in an anaemic condition much greater
than anticipated ; pulse very feeble and frequent ; action of
heart rather labored; skin dry, hot and glossy white; lips and
tongue very white, the latter covered with a white fur and
having the appearance of being swollen, the teeth indenting its
sides and tip ; great prostration of strength ; inability to walk,
an attempt bringing on palpitation of the heart; considerable
tumefaction of the face, with constant pain over the right eye;
no appetite; vomits every thing, whether nourishment or medi-
cine ; bowels not costive ; but no disposition to diarrhoea ; ab-
domen enlarged considerably, but not ascitic ; burning sensation
in the stomach, but no tenderness under pressure ; frequent and
protracted attacks of nausea ; lower and upper extremities
very lean.

This case was diagnosed to be one of confirmed chlorosis,
and as the indications were, very strongly, for tonics, the tinct.
ferri. mur. was substituted for the powder before used, in doses
of 20 drops, three times a-day; recommending light nourish-
ment and an epispastic liniment rubbed over the whole abdo-
men.

May 4th. No improvement whatever; but symptoms strong-
ly indicate the necessity of stopping the tonic plan of treatment.

1850.] Mayes, on Chlorosis. 519

The vomiting comes on oftener and the burning sensation in
the stomach rather increased. Appearances in all other re-
spects the same. Directed him to take freely of mucilage of
slippery elm, and to take nothing else upon his stomach, either
as nourishment, drink or medicine. The epigastrium to be
vesicated by frequently rubbing with this ointment.

^. Mercurial ointment, 5i.

Iodine and Iodide Potassium, aa 20 grs.
Mix in a mortar, and apply a half drachm every three hours,
until the skin is inflamed.

7th. Condition very little improved ; has not vomited so often
since the vesication of the epigastrium, but still much troubled
with nausea; pulse very feeble and quick, 100 to the minute.
Continue same treatment.

11th. Has vomited but three times since last visit, and the
nausea and burning sensation in the stomach have almost disap-
peared ; pulse a little fuller and not so quick ; bowels not cos-
tive; dejections very foetid; abdomen shrinking rapidly; face
much swollen, and the pain over the right eve persistent : is
anxious to eat, but is allowed only a little rice gruel once or
twice a-day. Continue the elm mucilage as before, and also
the inunctions with the ioduretted mere, ointment, once a-day,
so as to keep the surface continually sore; also 2 grs. sub-nitrate
of bismuth, three times a-day.

15th. Appearance of the abdomen much changed, being now
emaciated ; face more swollen, and the pain over the eye ra-
ther worse ; nausea entirely absent, has not vomited since last
visit, and has felt little or none of the burning sensation in the
stomach. Directed the bismuth to be continued as before; the
diet to be improved by allowing a little tender well boiled
chicken once or twice a-day, with rice or hominy, well cooked :
5 grs. pil. hydrargyri every other night; the hair to be shaved
from the right temple and the part vesicated by the iod. mere,
ointment.

20th. Much relieved of the distressing symptoms with which
he had been troubled ; no pain over the eye ; no nausea or
burning sensation in the stomach ; tumefaction of the face near-
ly subsided ; keen appetite, and begs to be allowed the privilege
of eating whatever he pleases ; slight soreness of the gums, with

520 Mayes, on Chlorosis. [September,

mercurial foetor of the breath ; pulse 96 to the minute, and
feeble ; has a little more strength of body than before. Discon-
tinue the blue pill; continue the bismuth as before, and directed
a more nourishing diet ; but cautioned his parents against
overloading his stomach, as his digestive powers were still very
wreak. Continue the vesicating ointment to the temple and
pit of the stomach.

27th, Has not suffered from headache since last visit, and
complains of no pain anywhere ; has had one or two slight
attacks of nausea ; is stronger and has a good appetite ; bowels
been rather loose a day or two ; general appearance much the
same as hitherto, except a very perceptible falling off in flesh ;
has a quick pulse, rather frequent, 132. Continue the bismuth,
and take 5 grs. blue pill every third night ; diet to be improved,
and fried bacon allowed him in limited quantities this latter
article he has craved very much ; vesication to be continued
as before.

31st. Very little change in any respect. Omitted the bis-
muth, and take 20 drops tincture of iron three times a-day.
Continue the vesication.

June 5th, General appearance the same in all respects, but
has now an entire freedom from pain, nausea, or any other
unpleasant symptoms, except it may be too much looseness of
the bowels. His appetite is good, and digestion improving
fast, as he can now eat almost any article of diet without the
slightest inconvenience; has not much strength, and is still
confined to bed the most of the time. Omit the blue pill and
tincture of iron : take 2 grs. sulphate of iron three times a-day
a minute portion of opium was added to the iron to check the
disposition to diarrhoea. Diet to be nourishing.

11th. Evidently improved since last visit; lies on the bed
but little through the day ; disposition to diarrhoea checked ;
appetite very good, and digests almost every thing he eats
without any unpleasant symptoms. Still very pale and lean.
Directed the discontinuance of all other treatment, and to use
for the future the following prescription, unless some symptoms
should arise forbidding its use :

Prescription. ^ Sulph. Iron, . . 3i,
Pulv. Capsici, . 3ss.
Pulv. Seneka, . 3ss.

1850.] Mayes, on Chlorosis. 521

Make into a mass with a little mucilage of slippery elm, and
roll into thirty pills. Take one of these three times a-day,
with two tea-spoonfuls of the saturated tincture of Burr Arti-
choke leaves with each pill. Diet to be generous, but guarded
against eating too much.

21st. Improving rapidly; regaining his strength, and has
walked a considerable distance without fatigue; regaining co-
lor in the cheeks, and with the exception of a little too much
whiteness would appear to be in good health; appetite and
digestion very good. Prescribed the continuance of the pills
and tincture until his health may be completely restored. .

During the treatment of the foregoing case, it will be seen
that there was a positive necessity for the discontinuance of all
tonics, and that these could not be resumed with safety for a
considerable period; and that the sub-nitrate of bismuth agreed
very well at a time when more active tonics might have done
positive harm. The preparations of iron are admitted by all
to be of the first importance in the treatment of chlorosis, but
cases, like the foregoing, do sometimes occur when they are
utterly inadmissible. It is important, then, that we should have
a substitute which will be more acceptable to the irritable
stomach ; and the writer of this can speak, from much experi-
ence, in favor of the sub-nitrate of bismuth. It is applicable
to all dyspeptic affections, so far as my experience has gone,
and for that particular form of the disease, attended with vom-
iting of the ingesta an hour or two after each meal, I regard it
as a specific. In those cases, 3 to 4 grs. should be taken imme-
diately after eating. Another article, in the treatment of
chlorosis, well worthy the attention of the profession, is the
Burr Artichoke, in the form of tincture of the leaves. With
the Botanical name of this plant, I am not now acquainted, but
may, in some subsequent communication, make more particu-
lar mention of its medical properties and uses. Sufficient for
present purposes it is, to say that it is a valuable tonic, with a
decided tendency to stimulate the kidneys, and it is to this lat-
ter effect, that 1 attribute its great value in chlorotic affections.

In the journals, lately, some very favorable accounts of the
efficacy of manganese have been published, but not being sup-

522 Gordon, on Chronic Mammary Tumor. [September,

plied with any of the preparations of manganese, I have, so far,
made no use of them in this class of diseases. But should an
opportunity occur soon, I may give it a trial, and communi-
cate the result.

ARTICLE XXV.

Chronic Mammary Tumor: a case of development in each
Mammary gland, and their removal by operation. By James
M. Gordon, M. D., of Lawrenceville, Ga.

The normal structure and healthy functions of the female
mammae are indispensable to the propagation and perpetuity of
the human species. These functions, when healthfully per-
formed, are in the strictest accordance with a wise provision of
Nature, that whilst the changes necessary for the formation of
a new being are taking place in the uterus during foetal growth,
that a supply of nourishment should be prepared, sufficient for
its sustenance, so soon as it has entered into a new state of
existence. It is for this most important purpose that the
mammary glands are formed extremely complicated in their
organization, acutely painful when in a state of inflammation,
and frequently the seat of the most loathsome diseases that can
possibly afflict suffering humanity.

The female breast is not only subject to nearly all the forms
of disease incident to the other structures of the human body,
but also to others which belong to it exclusively.

The almost uniform fatality that attends the malignant dis-
eases of the breast, has the effect to produce, in every case of
a tumor developing itself within its structure, the fearful appre-
hension of the surgeon, and the most anxious solicitude on the
part of the patient; and in these, as in all other cases, whether
requiring medical or surgical treatment, accuracy in diagnosis
is of vital importance: thereby, the surgeon may be enabled
to discriminate between cases that are curable, and those that
are incurable. Such discrimination may not only prove con-
soling to him, but will also enable him to quiet the anxious fears
of his patient. Every tumor of the breast naturally excites
suspicion, and demands a careful examination, since they are all

1850.] Gordon, on Chronic Mammary Tumor. 523

liable to be called cancerous, and treated as such, thus subject-
ing the patient to unnecessary and severe operations. It is
nevertheless true, that a large majority of tumors of the breast
are not cancerous.

The diseases of the breast have been divided, by Sir Astley
Cooper, into two classes viz : Malignant and Non-malignant.

The latter class are agaiu sub-divided. First, into those dis-
eases which are the result of common inflammation, whether of
acute or chronic character; and, secondly, into complaints
which are the result of specific and peculiar action, which are
not malignant, and do not destroy the adjacent tissues, by in-
volving them in the same degeneration of structure with them-
selves, but simply displace and transform them into a kind of
enveloping cyst, or sac, which, when entirely removed, has no
disposition to return, and leaves no constitutional traces of dis-
ease behind.

Those of a malignant character, on the contrary, are not only
the result of a specific local action, but are also connected with
an unhealthy constitution. They not only affect the parts in
which they may be situated, but ever seek to destroy the sur-
rounding textures in their extension, by metamorphosing them
into their own degenerated nature. In their progress, the con-
stitution becomes more and yet more contaminated, so that
local disease of analogous character is frequently produced in
other, and remote, parts of the body. When removed, there
can be no guaranty that they will not again return ; and as a
general rule, they are reproduced. Operation, only stays the
progress of the malady for an indefinite time, when it returns
with redoubled energy to the attack, and ceases only with the
termination of the earthly career of the unfortunate victim.

According to the classification of Sir Astley, the first sub-
division of the second class of diseases of the breast is compre-
hended in those which involve the organ in acute inflammation,
as milk abscess, or a more chronic form of inflammation, which
remains stationary for a considerable time, and finally termin-
ates in an indolent abscess; and lastly, inflammation followed
by an obstruction of one or more of the lactiferous tubes, pro-
ducing a lacteal tumor.

The second division of the second class comprises much the

524 Gordon, on Chronic Mcnnmary Tumor. [September,

largest number of diseases of that organ, embracing the several

varieties of tumor, as follows :

1st. The Hydatid. 5th. Large and pendulous Breast.

2d. The Chronic Mammary. 6th. The Scrofulous.

3d. The Ossific. 7th. The Irritable Breast.

4th. The Adipose. 8th. Ecchymosis of the Breast.

In the first class, but two diseases are enumerated, viz., those
of Fungoid character and Carcinoma.

It is not designed, in the present article, to notice in detail
the peculiarities of these several species of the different classes,
but the remainder will be devoted to the description of the
second variety mentioned in the second sub-division of the
second class or,

Chronic Mammary Tumor.

This disease is incident to females in early life, and those of
the most robust and healthy constitutions. It rarely appears
earlier than the fifteenth, or later than the thirtieth year of age.
It occurs principally in unmarried women, and those who have
not borne children. The constitution does not generally suffer,
either at the commencement, during the progress, or at the
termination of the disease, unless from the tormenting anxiety
of the patient's mind, as to whether or not it is of schirrhous
nature.

The cause of the disease, in the opinion of Sir A. Cooper,*
"is the result of the sympathetic influence of the uterus, the
excitement of the one organ, -leading to an increased deter-
mination and action in the other, and thus a new growth is
produced."

The symptoms which mark the invasion of this disease are
as follows : The growth of the tumor is external to the true
mammary structure, beginning at the surface, and extending
internally as it increases in size. Sometimes, however, it arises
from the posterior surface of the breast, and is there deeply
situated, and the distinguishing marks are less apparent. It is
of a rounded, lobulated form, possessing considerable mobility,
and is not attached either to the skin or subjacent tissues. In
the earlier stages, there is entire freedom from pain or incon-
venience of any kind, without redness, or the least disposition
* Work on Anatomy and Diseases of Breast, and Surg. Papers.

1850.] Gordon, o?i Chronic Mammary Tumor. o'25

to ulceration. But, after progressing for some time, it does
occasionally become painful, the pain extending up the side to
the shoulder of the affected side, and is described as being of a
dull, aching character. The tumor may also become tender to
the touch, and more painful at the approach of each catamenial
period. Thus it may continue for months, and even years,
slowly increasing, without ever attaining a very great size.
Generally there is no constitutional disturbance, the patient's
health remaining unaffected. Occasionally there is enlarge-
ment of one or more of the axillary glands, the effect of simple
irritations, and not productive of any formidable disease.

The more important diagnostic marks may be reduced to the
following: The early age at which it occurs, almost uniform-
ly prior to thirty, while those of great malignancy are rarely
manifested till a later period. It may also be distinguished
from malignant disease by the freedom from pain, except after
its existence for a considerable length of time, and the general
health continuing unimpaired. In this affection, the superficial
position of the tumor, together with its great mobility, and the
tardiness of increase in swelling, from a striking contrast with
those of malignancy. Lastly, it is more peculiarly distinguish-
ed by the lobulated feel to the touch, being formed of a number
of distinct lobes connected together, with intervening depres-
sions between them, and whatever size it may attain, it still
maintains the same character. The increase in bulk, obtains
by a corresponding increase in number of lobules.

By dissection, it is observed that the whole tumor is encyst-
ed by a membrane of fibro-tendinous character, analogous to
that enclosing, dividing, and occupying the interstices of the
true glandular stricture, and to which it is attached, but at the
same time so imperfectly as to admit of its free motion on the
breast. When first divested of the enveloping sac, it appears
to be made up of large lobes, but these are, when divided, again
susceptible of sub-division to an almost indefinite extent, and
when thus divided, have very much the resemblance of the
glandular arrangement of the breast, with the exception of the
absence of the lactiferous ducts.

But little benefit is to be derived in the treatment of this
malady, cither from therapeutical remedies, or the observance

526 Gordon, on Chronic Mammary Tumor. [September,

of hygienic rules; for, as previously observed, the patient is
most commonly in the enjoyment of perfect health, each organ
enjoying a state of healthful exercise, and performing its func-
tions regularly, and naturally. If, however, any of the func-
tions of the body are disordered, it is important that they be
restored to their normal condition : if there exists habitual con-
stipation, attended with imperfect hepatic secretion, or the
catamenial function is imperfectly performed, they will demand
appropriate treatment.

Iodine, and its different preparations, have been recommend-
ed to discuss the tumor, by increasing the activity of absorp-
tion, but they have not proven of much value in the attainment
of the desired object.

As these are growths of long continuance, as might therefore
be reasonably supposed, considerable length of time is required
for their removal by absorption : they not unfrequently gradu-
ally disappear upon the cessation of the peculiar uterine excite-
ment upon which they depend. The most speedy, and effectual
cure, is produced by pregnancy. The tumor frequently entire-
ly vanishes during the period of utero-gestation, and if not then,
with almost absolute certainty, during the subsequent lactation.

When the disease is progressively on the increase, and has
become painful, with danger from a loss of substance of the
breast, from the size and weight of the tumor, and there is
no probability of the occurrence of conception, it is advisable
to remove it with the knife an operation neither formidable
nor dangerous, and which, since the discovery and use of anaes-
thetic agents, has been disarmed of all its terrors.

Case. Mary, a favorite yellow servant girl, 17 years of age,
the property of Mr. A., about eighteen months previous, disco-
vered a small tumor occupying a space near the external margin
of the areola of the right breast, which has regularly increased,
till about the size of a turkey's egg. Twelve months afterwards,
a small tumor of similar character appeared over the superior
border of the right mammas, which also increased regularly
until it had attained the size of a pigeon's egg. For the last
few months, she has complained of a dull aching pain in the
right breast, extending to the shoulder. There has been no

1850.] Gordon, on Chronic Mammary Tumor. 527

pain whatever in the left breast. The history and symptoms
rendered the diagnosis so obvious, as to admit of no doubt as
to the true nature of the disease.

As there was but little probability of conception taking
place, (she had been living with a husband two years unfruit-
fully,) it was, in consultation, determined to remove the tumors
by operation. On the 16th of July, 1849, assisted by Drs.
Russell and Lowe, we proceeded to their extirpation in the
following manner : The patient was placed under the influ-
ence of chloroform, when a rectilenear incision, four inches in
length, was made over that of the right breast, in the direction
of the fibres of the pectoralis major muscle, and after the com-
plete division of the skin and subcutaneous cellular tissue had
been effected, the remainder of the dissection was easily accom-
plished by means of the fingers and handle of the scalpel, the
knife being used only for the purpose of the division of the
aponeurotic attachments to the breast. Two small arterial
branches only, required the ligature.

The smaller tumor of the left breast was removed by a trans-
verse incision in the direction of the longitudinal diameter :
no ligature required. The operations required but a very short
time, the patient being perfectly tranquil. The largest tumor,
together with its appendages, weighed 3|, the smaller ljozs.
The wounds united in part by the first intention. The recove-
ry was rapid, and she is now perfectly well.

In conclusion, it is proper to state, that Mary's health had
always been good. Menstruation was established at thirteen
years of age, and has since been regularly and naturally per-
formed. The most remarkable fact in her case, was the devel-
opment of a second tumor, in the opposite breast, a year after
the appearance of the first a circumstance that has not been
mentioned either by Mr. Travers, Sir Astley Cooper, or Dr.
Warren, comprising those of the most extended observations,
and who have written most extensively on the subject.

528 Jones, on the relations between the Climate [September,

ARTICLE XXVI,

On the relations between the Climate and Diseases of our State.
By W. L. Jones, M. D., of Athens, Georgia.

It is generally believed, that a large proportion of the abnor-
mal conditions of the human system are referable to external
influences. We speak of the diseases of northern and southern
latitudes, of mountainous and marshy districts, and every one
recognizes the distinctions; but their convictions are based
upon general considerations, and not upon accurate examina-
tions of the relations between organized beings, and the physi-
cal agents which surround them. It is a subject, however,
worthy of the most careful investigation, and there is not one*
perhaps, to which the attention of the Physicians of Georgia
could he more profitably directed than the relations between
the climate and diseases in our State. The excess or diminu-
tion of the supporters of animal life, oxygen, heat, light, &c.,&c,
are each capable of disturbing the natural functions of the body.
Now these physical agents are not only different for separate
portions of the earth's surface, but are constantly varying1 an-
nually and diurnally in the same locality : the first, producing
the forms of disease incident to different regions; the second,
the forms prevalent during the different seasons; the last,
effecting changes in our sensations, and acting as exciting
causes of disease. These general propositions strike every re-
flecting mind is it possible to trace out these relations accu-
rately and in detail ? Considering the proverbial changeability
of the weather, men are not generally disposed to believe that
the influences of climate upon the human system are capable
of being reduced to laws. But he who has taken one step in
the investigation of the works of nature with the true spirit of
a philosopher, cannot resist the conviction, that one of the most
essential characteristics of all the phenomena which surround
us, is a never-varying observance of law and order. Even the
" capricious minds" do not escape the universal rule, as modern
researches most beautifully show. The thermometer, it is true,
indicates various degrees of temperature, during the different,
months of the year, at the same locality ; but if the averages of
a series of years be compared with each other, the differences

1850.] and Diseases of Georgia. 529

would be scarcely appreciable. Not only the mean tempera-
tures, but the maximas and minimas also coincide in like man-
ner. Knowing these constants, therefore, for any locality, it
would be easy to trace the relations between them and the dis-
eases incident to it. The same is true of all other physical
agents, numerous observations indicating a like invariability
with reference to them all. Admitting, therefore, the possibili-
ty of obtaining " physical constants," and consequently of
tracing the relations between them and diseases, how shall we
proceed? Just as in all other purely observational sciences:
we must observe the phenomena carefully, and extensively
enough, to eliminate accidental or temporary perturbations.
The phenomena in question are, the intensity of climatic agents
on the one hand, and coincident diseases <jn the other.

What are the physical agents which, taken together, consti-
tute climate ? ' It is not known what are all of its elements, nor
is the relative importance of those recognized, accurately estab-
lished. The influence of temperature is decided, as is clearly
manifested by the different forms of disease which prevail in
summer and winter, in low and high latitudes. From the great
influence which Light is known to exert over vegetable life, it
is possible, and even extremely probable, that it also modifies
animal life: we must regard it, therefore, as an element of cli-
mate, until proved to be inoperative. Atmospheric Electricity
is probably another influential agent, but unfortunately our
knowledge in reference to it is extremely limited. The amount
of Oxygen present in the atmosphere is an important circum-
stance. It is probable, from the analysis of air collected in a
great variety of places, that the relative proportions of nitrogen
and oxygen are the same under all circumstances, but their
absolute quantities in any locality are subject to considerable
variations. Thus a cubic foot of air would contain a larger
quantity of both of its constituent? when the thermometer
stands at zero, than when it is at 90. Agam: supposing the
barometer to remain at the same height, there would be more
air, and consequently more oxygen present, if the atmosphere
is dry, than if it is damp ; for in the latter case, the column of
mercury is sustained by the weight of the vapour plus, that of
the air the latter, therefore, must exist in diminished quantity.

n. s. VOL. VI. no. ix. 31

530 Jones, on the relations between the Climate [September,

It would appear, also, that the amount of moisture in the atmos-
phere exerts another very decided influence, by affecting the
function of the skin. Experiments, recently performed by
Becquerel and Breschet, show that the prevention of evapora-
tion and exhalation from the surfaces of rabbits, by coatings
imperviable to water, caused the animals to die of cold. Now,
it is obvious that a damp atmosphere would tend to produce the
same effect, since evaporation goes on rapidly when it is dry,
and slowly when it is moist. This is confirmed by every oneTs
experience of the depressing influence of damp weather.

Heat, Light, Electricity, Oxygen and Moisture, are probably
the most important physical agents ; but as it is yet so uncertain
what may, or may not affect the human system, it is desirable
to have accurate descriptions of the localities where records
are kept, whether cleared or not, level or hilly, having stag-
nant or running waters, the nature of the soil, character of
vegetation, &c. ; also the number of fair and cloudy days, the
amount of rain, the direction and force of the wind. It is very
desirable to obtain records of these things in all parts of the
State, through a series of years, together with records of the
diseases prevailing through the same period. It is easy to anti-
cipate what useful and important results might be obtained
from such materials; among other things, the cause of mala-
rious diseases would in all probability be discovered. Of course,
these materials can only be obtained from the co-operation of
all the physicians in the State, and we would respectfully and
earnestly request them to.unite in this great undertaking.

In making observations and keeping records, there are seve-
ral particulars to be observed, the neglect of which would very
much diminish their value. It has been found that, during the
day, the air is warmer near the surface of the earth than it is
above, but just the reverse is true in the night. At the latter
time, as much as 10 difference has been observed between a
thermometer on the ground and one a few feet above. In
making observations, therefore, which are to be compared with
each other, it becomes necessary for all the thermometers to
be situated at the same elevation, and we would suggest 10 feet
from the surface as a convenient height, upon which all obser-
vations might agree. Again, care should be taken that no

1850.] and Diseases of Georgia. 531

direct or directly reflected rays of the sun should fall upon the
instrument : the latter point is often neglected. It is difficult
to determine the intensity of light by direct observation, but
we know that, as a general rule, it varies inversely as the
square of the cosine of latitude, and can therefore avail our-
selves of this formula. It is also very difficult to make obser-
vations on the electrical state of the atmosphere ; but here also
we can take advantage of some general laws relating to it,
already established. It is known that there are two daily
maxima and minima of positive electricity, the latter occurring
just before sunrise, and about 3 o'clock, P. M., the former be-
tween these points. There is also an annual maximum and
minimum, the former in winter, the latter in summer. Obser-
vations on the amount of moisture in the atmosphere, are the
most difficult and require the greatest care. The method
almost universally adopted to determine it is to ascertain the
dew-point. This is the temperature of the air at the moment
the moisture in it cannot exist as vapour, but begins to be de-
posited in the form of water. It is obtained by cooling a body,
a silver cup filled with water, for instance, and noting the height
of a thermometer in the water at the instant moisture is de-
posited on the outside. Daniell's hygrometer is a beautiful
instrument, constructed on this principle, and in a moist cli-
mate, where the requisite amount of cold can be produced by
the evaporatien of ether, it is the most convenient instrument
which can be used. Experience has shown, however, that it
is unsuited to the high and dry portions of our State, as a suffi-
cient reduction of temperature cannot be produced there with-
out ice. Another method of determining the dew-point, which
is practicable in any climate, is by the Wetbulb hygrometer.
This consists of two similar thermometers placed near each
other, the bulb of one surrounded by muslin and kept constant-
ly wet by a thread passing from a cup of water upon it. Evap-
oration of the water would depress this thermometer, and the
difference between the two instruments would indicate the rate
of evaporation. Now the rate of evaporation is necessarily
affected by the amount of moisture in the atmosphere. Know-
ing the former, therefore, we can determine the latter. If.
August has constructed a formula for the Wetbulb hygrometer,

532 Brandon's Case of Gun-shot Wound. [September,

which is regarded by meteorologists generally as affording the
surest indications of all the methods proposed. It is E=e'
0.000 748 (t t') b, in which E represents the tension of the
vapour in the air at the temperature of the dry thermometer (t) ;
e' its tension at the temperature of the wet thermometer (f) ;
b the height of the barometer. A centigrade thermometer is
supposed to be employed, and a barometer whose scale is divided
into millimetres ; but it would be easy to convert Fahrenheit's
scale into the centigrade and inches into millimetres. Having
obtained the tension of the vapour in the air, we have only to re-
fer to tables constructed for the purpose, to find the correspond-
ing-dew-point. It will be observed that the height of the barome-
ter enters into this formula, and this method therefore can only be
employed where daily observations of this instrument are made.
In making records of diseases and deaths, it is necessary to
mention several things which have been discovered to modify
the influence of external agents. Sex is> one of these ; thus
numerous tables collected in different parts of Europe, show
that the mortality of boys is much greater than that of girls
during the first five years of life ; also between the ages of 20
and 25, when- 'the passions reach their greatest intensity, the
mortality of the male preponderates. Again, of calculus pa-
tients there are about 21 males to one female. Age also is an
important circumstance, the number of deaths being regularly
on the decrease from birth to the age of 15, and increasing
regularly afterwards. Occupation is another disturbing cause,
mortality being greatest among physicians and teachers, and
least among agriculturists and theologians. The task proposed
is difficult and laborious the incentive to action the relief of
suffering humanity.

ARTICLE XXVTI.

Extensive Gun-skot Wound of the Knee- joint Amputation on
the third day under Chloroform Death of the patient soon
after the operation. By D. S. Brandon, M. D., of Thomas-
ville, Georgia.

Mr. V., a young man about 25 years of age, of good consti-
tution, sanguineo-nervous temperament, was thrown from his

1850.] Brandon's Case of Gun-shot Wound. 533

horse on the 15th of June last, on returning to the house of the
gentleman with whom he lived, in Decatur county, and in the
fall one barrel of his gun was discharged, the kne< receiving
the whole load about two inches above the joint. He was re-
moved to the house, and Dr. Holland was immediately called.
He examined the wound, and decided that the limb would
have to be removed. On the next day, Dr. Adama of this
place was sent for to assist in the operation. He could
not leave his family, and requested me to attend.

I arrived at the house where Mr. V. was, early on the morn-
ing of the 17th. He had considerable fever ; pulse 120, full ;
somewhat irritable, with a countenance plainly indicating great
suffering. Dr. Holland and myself again examined the wound,
and determined upon the operation. He very kindly proposed
that I should operate, which I consented to do.

The patient being placed upon the table, the circular opera-
tion was performed at 11 o'clock, A. M., under the influence of
chloroform. I poured about a table-spoonful of the liquid on a
bit of sponge, and the patient was allowed to inhale it for about
a minute, when the sponge was again wet with about half the
quantity first used. Complete insensibility being produced, the
operation was performed and the arteries tied (two in number)
in about two minutes. When the first cut was made, the mus-
cles of the face were noticed to corrugate, and the limb was
slightly drawn up, the only evidences of pain observed during
the operation. About fifteen minutes were allowed, in order
that other vessels might be tied if they should spring, during
which time nothing unusual was observed in the appearance of
the patient ; after which the stump was dressed. He was pale,
having lost a considerable quantity of blood, though his respira-
tion was observed to be perfectly free and easy at the same
time. About the close of this period, his color was thought to
improve, and sensibility was evidently returning : pulse feeble,
but not irregular ; asked some pertinent questions, such as,
" How are you getting on with the operation ? will you boon
be done?" &c. At this moment all was thought to be well;
but in a very short time the mind was lost a kind of spasmo-
dic writhing came on, partaking apparently both of a voluntary
and involuntary character. Three or four persons were now

534 Practical Views on Medical Education. [September,

requested to hold him on the table, from which he had not been
removed. At times, it required almost my entire weight to con-
trol the stump of the amputated thigh. In this condition, he died
in about an hour and a half after the removal of the limb, breath-
ing apparently with perfect ease up to the last few minutes.

On examining the knee-joint, the femur was found broken
about two inches above the joint, and the condyles driven
asunder, the inner and under portion of the internal one being
completely shot away. Powder, wadding, and a portion of the
shot were found in the popliteal space, the remaining portion
having ranged down, and lodged in the calf of the leg, as it was
half flexed upon the thigh at the time the gun was discharged.

Dr. Reeves, who was present at the operation, related the
case of a man in South Carolina, who took chloroform as a
mere matter of experiment. A convulsive movement of the
whole system soon came on, of which he died the next day.
The death was attributed to the chloroform. Was it that
agent, or the powerful shock the nervous system received from
the discharge of the gun, followed on the third day by the am-
putation, that caused the death of Mr. V. ? What experienced
man, in the use of chloroform, will say ? I am sure I cannot.
Were I the subject of just such a misfortune, I would take that
powerful agent under the same circumstances, though I would
not administer it unless specially requested.

PART II.
HHzviztds anir (Extracts.

Practical Views on Medical Education, submitted to the mem-
bers of the American Medical Association, by the Medical
Faculty of Harvard University.*

The undecided state of public opinion in regard to some of the
fundamental points in a course of medical education, including
among other things the portion of the term of pupilage proper
to be spent in attendance on lectures, is thought, by the under-
signed, to justify a further consideration of the subject. In

* We have published this article, not only because we have been requested
to do so, but for its own intrinsic merit. These views of the Medical Faculty of
Harvard University, upon some of the leading questions now under general
discussion, are entitled to a fair examination, and most of them, we doubt not,
will eventually meet the approval of the medical public [Edt.

1850.] Practical Views on Medical Education. 535

some of its relations, this subject has already been discussed, in
the Transactions of the American Medical Association for
1849, in two reports, pages 353 and 359, to which the reader is
particularly referred. The following condensed, but more
general view of the subject of medical education, is now re-
spectfully submitted to the members of the Association.
Boston July 10, 1850.

1. Medical instruction should be adapted to the power of
students to receive and retain what is communicated to them,
and should be confined to what is important to them in their
subsequent life.

2. In modern times the constituent branches of medical
science are so expanded, that they are not acquired by any
physician in a life-time, and still less by a student during his
pupilage. The same is true even of many individual branches.
It is not, therefore, to be conceded that " a scheme of scientific
instruction should embrace the whole science, and no part
should be omitted ;" nor that "a well-digested plan of lectures
embraces all that is to be known and taught." Medical science
has at this day become so unwieldy, and contains so much that
is unnecessary, at least to beginners, that the attempt to ex-
plain to students the whole, is likely to involve the result of their
learning: but little.

3. In Chemistry, at the present time, a thorough adept is un-
known. No man living knows all the recorded facts, or all
that is to be known and taught, in that science. Organic
chemistry alone fills large volumes, though yet in its infancy.

4. In Materia Medica there are some thousands of substances
and their compounds, which possess what is called a medicinal
power. Yet it is not probable that any physician effectively
reads the one half, or remembers one quarter, or employs in
his yearly practice one tenth, of the contents of the common dis-
pensatories.

5. In Pathology, so complicated and various are the condi-
tions attendant on the individual forms of disease, and their
relations with idiosyncracy, temporary condition and external
agency, with organic lesions and functional disturbances, that
few of the most experienced pathologists can be said to under-
stand their whole science, or to be always competent to its
successful application.

6. In Etiology, the theoretical literature of causes has spread
itself out to an extent, which is burdensome and unprofitable.
It is true, that "man, from his nature, is subject to suffering, dis-
ease and death ;'' but it is equally apparent, that "the causes by
which these conditions are produced, are ascertainable." We

536 Practical Views on Medical Education. [September,

know nothing of the vehicle of cholera or influenza, nor is it
probably in the power of any physician, by any art, or appli-
cation of his knowledge, to produce in a given healthy man, a
case of common pneumonia, or of acute rheumatism, of
diabetes or Bright's kidney, of hypertrophy or of cancer, or
even of a common boil, or wart.

7. In Therapeutics, many hundred volumes exist, such as
would not have existed, could a knowledge of the cure of dis-
eases be made so easily tangible that it could be spread before
the student in the three or five years of his pupilage.

8. In Anatomy, general and special, microscopic and trans-
cendental ; in Physiology, with its intricate ramifications ; in
Surgery, of which several subordinate specialities constitute
distinct living professions ; it is not to be admitted that the
means or time of any ordinary course of lectures, can furnish
full and complete instruction. Certainly it must be difficult to
arrange a course of lectures on any of the extensive sciences
which now constitute medicine, if it be indeed true, that "the
teachers are not justifiable in suppressing any portion."

9. It is the business of lecturers in medical schools, to con-
dense and abridge the sciences which they respectively teach,
to distinguish their essential and elementary principles, to sift
carefully the useful from the superfluous, and to confine the
scope of their teachings, as far as possible, to what is true and
profitable, and likely to be remembered and used by their
hearers. It is unfortunately too true that, "in an extended
system of instruction, there is much that the student will not
master, much that will have escaped his attention, much which
he ought to know, that he has not learned." The remedy ap-
peal's to be, to teach him well what he can and should master,
and briefly to point out to him the sources, fortunately abundant,
from which he may obtain the rest.

10. Much injuiry is done to the cause of true learning by
medical assumption, amplification and exaggeration, by prema-

I ture adoption of novelties, and by tenacity of theories, personal
or espoused. Students, in all former years, have expended
much time in learning, what it afterwards cost them both time
and trouble to unlearn ; in acquiring, not merely the truths of
science, but the crude announcements and plausible doctrines
of sanguine or ingenious men. How much time has been
wasted in some of our distinguished seminaries in acquiring the
visionary, and now neglected, theories of Rush and Broussais !

11. The most commonly exaggerated branch of medical sci-
ence is therapeutics. Enlightened physicians well know, that
many diseases are incurable, and that others are subject to laws
of duration, which cannot be interrupted by art. Yet students

1850.] Practical Views on Medical Education. 537

sometimes return from medical schools persuaded that their in-
structed know how to cure a large part of these diseases, and that
if others are less fortunate, it is attributable to their own fault.

12. Medical teachers should keep peace with the progress of
their respective sciences. Yet in their haste for the promulga-
tion of novelties, they should not omit to give the proper con-
sideration to the older and more settled principles of science.
Medical men are liable to commit the error of adopting
premature opinions, unsound practice and inconvenient changes
of language and nomenclature, sometimes from a love of dis-
play, and sometimes from a want of self reliance, and a fear
of being thought behind the literature of their time.

13. The length of a course cf lectures'is not the measure of
its value to the student. A course of lectures should not out-
last the curiosity of its hearers, nor their average pecuniary
ability to attend. Custom in this country has generally fixed
the limits of these things at about four months. A compre-
hensive and judicious course, confined to the enforcing of
necessary points, is far more profitable than a more discursive
course to a wearied and diminishing audience.

14. Lectures are chiefly wanted to impress by demonstra-
tion the practical branches of science, and they are most effec-
tive in places where the facilities for such demonstrations can
be commanded. Anatomy requires extensive exhibitions by
the teacher, and personal dissections by the student. Chemis-
try and Materia Medica require illustrations by specimens and
experiments. Pathology needs the aid of autopsies, museums
and the clinical demonstrations of large hospitals. A know-
ledge of Obstetrics is not perfected without apparatus and
practice. Surgery is acquired by witnessing numerous opera-
tions, surgical diseases, illustrated explanations, and by personal
practice on the dead body. Physical exploration is wholly de-
monstrative. A knowledge of auscultation can no more be
acquired from books, or abstract lectures, than a knowledge of
music, or of individual physiognomv.

15. The intermediate period between lectures, should be
spent by students in active and original study, approved and
confirmed by regular recitations, and by such opportunities as
can be commanded, for practical, personal experience. Private
schools for small classes, and the private teachings of individu-
als, who are suitably qualified and situated, are more advan-
tageous for two-thirds of the year, than either the fatiguing
jostle of overcrowded rooms, or the listless routine kept up by
the survivors of a passive class.

16. The usefulness of a medical school depends not so much
on the length of its session, as upon the amount of education,

538 Ascending or Inter muscular Hernia. [September,

preliminary and ultimate, which it requires, the fidelity with
which it exacts its own professed requisitions, and the train of
healthy exertion, active inquiry, and rigid, methodical, self-
regulating study, to which it introduces its pupils. The
longest lectures are of little use to students who want a com-
mon education, and whose medical education does not qualify
them afterwards to observe, to inquire and to discriminate. The
exacted evidence of three years of well conducted study, is bet-
ter than the exhibited ticket of a six months course.

17. The subjects most important to be well taught in medical
schools, are the elementary principles which constitute the
frame- work of medical sciences, and the mode of thought and
inquiry which leads to just reasoning upon them. After these,
most attention should be given to selecting and enforcing such
practical truths, as will most certainly be wanted by the young
practitioner in his future career of responsibility.

18. The things to be avoided by medical teachers, are
technicalities which are unintelligible to beginners, gratui-
tous assumptions and citations of doubtful authorities, prolix
dissertations on speculative topics, excessive minuteness in
regard to subjects, which are intricate and but little used, and
therefore destined to be speedily forgotten. To these may be
added controversies, superfluous personal eulogiums and crim-
inations, and all self-exaggeration, personal or local.

JACOB BIGELOW, Prof, of Materia Medicaand Clinical Medicine.
WALTER CHANNING, Prof, of Midwifery and Med. Jurisprudence.
JOHN WARE, Prof, of Theory and Practice of Medicine.
JOHN B. S. JACKSON, Prof/of Pathological Anatomy.
OLIVER W. HOLMES, Prof, of Anatomy and Physiology
HENRY J. BIGELOW, Prof of Surgery.
E. N. HORSFORD, Prof, of Chemistry.

Ascending or Intermuscular Hernia. By James Luke, Esq.,
Surgeon to the London Hospital. (London Medical Gazette.
N. Y. Journ. of Medicine.)

There is a variety of inguinal hernia apparently not generally
known to surgeons, which I venture to designate as Ascending
or intermuscular, (for reasons which will appear in the sequel,)
to which I am anxious to draw attention from the circumstance
that it is liable to cause some difficulty in diagnosis, and when
strangulated to become a matter of more than usual interest
and occasional embarrassment.

To illustrate the subject, it is proposed to relate a few cases,
which partake of the same general character, although they
exhibit modifications of sufficient interest to be noticed in the
description. Before relating those cases, I propose to give

1850.] Ascending or Intermuscular Her ri\a. 539

some account of the form of hernia to which they relate, that
a clearer understanding of its mode of formation may be ob-
tained. In doing so, it will be needful to recall to the recollec-
tion of the reader the relations which a hernia, in the most com-
mon forms, bears to the inguinal rings and canal through which
it descends, because the immediate subjects of this communica-
tion are examples merely of deviations from those relations.

It will be remembered that an inguinal hernia of the ordinary
kind, after issuing from the abdomen through the internal ring,
descends in the inguinal canal in front of the spermatic cord in
the male, and of the round ligament in the female, from whence
it passes through the external ring to the scrotum in the for-
mer, and to the pubis in the latter.

A hernia, however, at its exit from its abdomen, is liable to
be pushed aside, or have its course altered, by any opposing
obstacle ; for its tendency is always to pass in that direction in
which it meets with least impediment to its course. In the
cases before us, such impediments do occasionally arise, and
more particularly in the female a circumstance attributable to
the lesser anatomical development of the canal and external
ring in that sex, from which probably proceeds the more fre-
quent occurrence of the form of hernia mentioned below. In
the male sex, the canal and rings are sufficiently large to allow
of a hernial descent, so that we continually observe that the
direction of an inguinal hernia in the male is downwards, unless
it be turned aside, or its direction altered by artificial means,
and especially by the pressure of a truss. In the female, howr-
ever, natural obstacles occur in the downward direction ; it
therefore sometimes happens that the lesser impediments to the
progress of a hernia lie in an upward or outward direction ; in
which case the tumor, after passing from the internal ring,
turns towards the ileum, and becomes interposed between the
layers of abdominal muscles above and on the outside of the
ring. Such hernia are covered anteriorly by the internal
oblique muscle, and bear nearly the same relation to the tegu-
mentary surface as an ordinary hernia confined to the inguinal
canal, but differ materially from it in its relation to the internal
ring. The tumor lies nearer to the ileum in this form of hernia,
in a position which, being not usually occupied by hernia, may
give rise to some difficulty in diagnosis, and may, through inad-
vertence, be mistaken for some other disease, either of the
caecum on the right, or colon on the left side. It also lies
somewhat buried, when small, under a covering of muscular
structure, and occasionally under an accumulation of adipose
tissue, and may, on that account, be passed over altogether
without notice. In its position it constitutes the kind of hernia

540 Ascending or Intermuscular Hernia. [September,

which I have named above. It is important that such cases
should be well understood ; and the relation of the following
cases will probably help this matter. Although not the first,
the most perfect specimen of the kind of case referred to in the
foregoing observations, occurred to a person about 60 years of
age, residing in the neighborhood of Bethnal Green. She was
of thin, spare habit, and when I first saw her, had suffered
during four days from obstruction of the bowels and sickness
the symptoms having increased in severity up to the time of
my visit. On the day previous, a fulness had been observed
a little to the inside of the right spine of the ileum, which had
not been noticed during the two first days of her illness, and
was supposed to be connected with the caecum, from the cir-
cumstance of its position and apparent depth. When I exam-
ined the part very carefully, it appeared to contain an ill-defined
tumor, lying deeply, but within the walls of the abdomen, and
not within the abdomen itself. Its position was to the outside
of the situation of the internal ring, with its inner side resting
upon the ring. It was somewhat rounded in form, and painful
on pressure. Connecting it with the existing symptoms of in-
testinal obstruction, I concluded that it was a hernial tumor in
a state of strangulation, and advised an operation, in the per-
formance of which the integuments were incised perpendicu-
larly over the tumor, and, consequently, on the outside of the
internal ring. The abdominal tendon being divided, the tumor
was brought into view, covered by the lower border of the
internal oblique muscle. It was about the size of a pullet's egg,
and had the ordinary characteristics of a strangulated hernia,
but with its neck of communication with the abdominal cavity
at its lowest part, this being at the internal ring, where the
stricture upon the contents was found, apparently produced by
its margins. These were divided without opening the sac,
and the hernia reduced within the abdomen. Relief to the
symptoms of obstruction speedily followed this proceeding, and
recovery gradually, though slowly, took place it being delay-
ed by circumstances unconnected with the hernia.

The next case came under my notice in consultation with
Mr. Bvles, in a female between 50 and 60 years of age, suffer-
ing from acute symptoms of intestinal obstruction, attended by
peritoneal inflammation and abdominal tension. She was the
subject of a moderate-sized umbilical hernia, which was irredu-
cible, without impulse, and inflamed. On examining the lower
part of the abdomen, there was discovered a small tumor on
the left side, lying deeply under a thick covering of fat, and
exteriorly to the usual seat of an inguinal hernia. It was pain-
ful when pressed. It was considered to be a hernia, and in a

1850.] Ascending or Intermuscular Hernia. 541

state of strangulation, although some doubts were entertained
whether the umbilical hernia was not really the one strangula-
ted. An incision was made through the abdominal tendon,
which exposed to view a small tumor lying as in the former
case, exteriorly to the internal ring. When the sac was laid
open, its communication with the abdomen was found to be at
its lowest part, and the intestine so tilted upwards over the
upper and outer margin of the internal ring which formed the
stricture, that some difficulty was experienced in getting at the
part which is usually divided for its relief. This division being
accomplished, the hernial contents were reduced into the ab-
domen, and the wound closed. This patient had a good
recovery. At a distance of five weeks fiom the operation she
was seized with apoplexy, and died.

A modified form of the same kind of hernia came under my
notice, in a post-mortem examination of a patient who had been
operated on by the late Mr. R. C. Headington, formerly an up-
right and distinguished surgeon to the London Hospital. The
subject was a female, about 60 years of age, and the operation
was performed in the London Hospital. The hernia, I was in-
formed, presented the ordinary appearance of an inguinal hernia
of the left side, descending upon the pubis through the external
ring. The requisite incisions were made over the tumor, and
the lower part of the sacjaid freely open. Of the seat of stric-
ture, I was not informed. When efforts at reducing the hernial
contents were made, they were attended with apparent success ;
but, on remitting the effort, the contents returned to their former
place in the sac. Renewed efforts were attended by the same
results ; and, after being several times repeated, with each time
a recurrence of the descent, were finally abandoned, and the
contents were allowed to remain unreduced the wound being
closed over them. The patient shortly died.

On dissecting the integuments from the lower part of the
abdomen, the opened hernial tumor presented below the exter-
nal ring in the usual manner, and was readily traced to its
communication with the abdomen at the internal ring, but it
also extended in a direction towards the spine of the ileum
beyond the ring, and between the layers of the abdominal mus-
cles. Thus the sac was found to be far more capacious than
was suspected before death ; and the circumstances attending
its relations to the abdominal aperture explained the difficulty
which had occurred during the operation. The hernial con-
tents, when apparently reduced into the abdomen, had not been
so in reality, but had been transposed from one part of the sac,
and that the lowest, to the other or upper, which lay above and
to the outside of the internal ring. No difficulty could arise in

542 Ascending or Intermuscular Hernia. [September,

such a case in respect to diagnosis of the existence of hernia;
yet, to the operator, an embarrassment might ensue like to that
which occurred in this ; and its relation is of importance, as
forewarning him of a probable though remote contingency, and
preparing him, by a foreknowledge of it, with the means best
suited to meet the difficulty.

These cases, even in the female, are unfrequent ; they are
still more so in the male, and, I believe, never occur in that
sex, unless produced by means wholly independent of anatomi-
cal formation and development. They may, however, be pro-
duced by other causes ; and the subject has an important bearing
upon the application of trusses to the relief of the ordinary
kinds of inguinal protrusions. From the manner in which a
truss is usually applied, and from the sufficiency in the size of
its pad, both the internal and external inguinal rings are guard-
ed, and the more especially when the two are approximated by
the descent of the former, as is common in old hernia. But in
an incipient hernia, when the rings are in their normal position,
or nearly so, a truss may be so applied as to guard the external
ring and lower part of the inguinal canal only. In that case,
the hernia is not prevented from protrusion through the inter-
nal ring; and its increase in size may continue, notwithstand-
ing this imperfect use of the instrument. If such increase does
take place, the truss has no other effect than to alter the course
of the hernia by preventing its descent through the canal and
external ring, and constraining it to take that direction which
alone is open to it. That direction appears to be upward and
outward ; and thus the intermuscular hernia, as described above
in the foregoing cases, is produced. To prevent such a form
of hernia in a male, arising from the use of a truss, is an im-
portant desideratum, and appears easily attainable by its proper
application-. As the recurrence is the result of pressure of the
pad upon the lower part of the canal and external ring, while
the internal ring remains unguarded, there are two courses
open for selection. The one course is to remove the pressure
of the truss altogether, by which means the hernia will have an
opportunity of descending in its usual course ; the other is to
guard the internal ring also, and to prevent protrusion from the
abdomen altogether. Of the two, it need scarcely be observed,
that the last" is to be preferred. Although this is generally
done, it is not always so; and it may serve a good purpose to
show what may take place, and what has taken place, from
inattention to this deficiency in the application of trusses.
They should always be so applied as to guard the internal ring.

An illustration of the above came under my notice a short
time since, in the case of a gentleman, about 50 years of age,

1350.] Fracture of the Thigh and Patella. 543

who first applied to me in consequence of some uneasy feelings
which he experienced in the abdomen, and irregular action of
the bowels, attended by occasional flatulence and nausea. He
also complained of pain in the region of the csecum ; in exam-
ining which and the adjacent part, it was found that he was the
subject of hernia. This had descended partially into the scro-
tum ; but he had been in Jjjjt habit for some years of retaining
it by means of a truss. ^P much larger tumor occupied the
space between the crest of the ileum and the usual seat of the
internal ring, which, by the communication of impulse, was
ascertained to be connected with the lower tumor. Thus it
was found that the entire hernial sac was of very considerable
dimensions, and contained a large mass of viscera. Probably
to this circumstance were referable the symptoms of intestinal
derangement, which were the immediate cause of his applica-
tion. It became, therefore, an object of primary importance
in the treatment, that the contents should be replaced within
the abdomen. In the attempt to accomplish the reduction, the
lower tumor was readily made to disappear; but, as it did so,
the upper tumor became more full and large. Attempts at
reduction of the upper tumor in the upward direction, were
wholly unavailing ; but, when pressure was made upon it in a
direction downwards in the course of the inguinal canal, while
the other hand was kept upon its lower extremity, so as to pre-
vent the contents from descending through the external ring, it
was, by a little manipulation, partially returned into the cavity
of the abdomen. Old adhesions of the contents either to each
other or to the sac, appeared to be the obstacle to the reduction
being complete. Sufficient, however, was accomplished to
afford some relief to the patient, and the intestinal disturbance
became less severe. Should strangulation occur in the case,
the circumstances which complicate it are well calculated to
try the skill of the most experienced surgeon who shall under-
take an operation for its relief; all which complication, with all
its present ills and prospective embarrassments, I think, might
have been prevented by the proper use, in the right position,
and at an early period, of an efficient truss.

Perpendicular fall from a height of 192 feet Fracture of the
thigh and patella, with severe concussion of the thoracic visce-
ra perfect recovery. The following extraordinary case is
recorded by Dr. Knox, Surgeon to theStrangford Dispensary,
in the Dublin Med. Press, May 8th, 1850 : (Amer. Jour.)

"On the 8th of September, 1834, Alexander Boyd, of the
coast guard service, under the command of the late Captain

544 Fracture of the Thigh and Patella. [September,

Gilbert, R. N., whilst patrolling on the cliffs which overhang the
sea, in the vicinity of Kenbarwn-head, near Bally-castle, in the
county Antrim, mistook his way, owing to the extreme dark-
ness of the night, and fell over a precipice, rising sheer from the
seamark, as I afterwards ascertained by measurement, to the
height of 192 feet. In his descent he grazed slightly the face
of the cliff at one point only, about<G3 feet from the summit, and
fell on a slip of grass land lying I^Bveen the base of the cliff
and the sea. Here he lay for some hours, until a little dog, the
companion of his walks, gave the alarm by whining at the door
of his cottage, and caused a search to be instituted along the
coast. The circumstances of his almost miraculous escape at-
tracted so much attention at the time, that the place where this
extraordinary accident occurred was visited by great numbers
of persons for many week afterwards.

When called to see him on the following day, I found that
the femur had been fractured obliquely at the superior portion
of the middle third, and the patella of the same side, longitudin-
ally. Slight abrasion of the cuticle of the leg and the outer

ankle were observed, and the thigh and knee were greatly
swollen. He complained of severe pain at the upper part of
the sternum, and in the course of the splenii, muscles, as well
as of much dyspnoea, aggravated by deep inspiration. The
pulse was 100, and the respirations 24 in the minute, the skin
hot, the tongue white, and the bowels costive. His mind was
apprehensive but unclouded, and no injury of the head was ap-
parent.

As the injured limb was both very painful and much swollen,
I at once detetermined not to attempt immediate reduction of
the fractures, but to trust to secondary coaptation or setting,
after the inflammatory symptoms should have subsided, and
contenting myself, in the meantime, with placing the limb in the
position most easy for the patient, and supporting it by cushions
properly adapted to prevent motion of the broken extremities
of the femur. A cold spirituous lotion was directed to be ap-
plied with great regularity ; the most perfect quiet and very
low regimen were enjoined ; a full dose of castor oil was ad-
ministered ; and on account of the injury of the chest, which
obviously presented the chief source of danger, thirty ounces
of blood were detracted from the arm.

Sept. 10th. The symptoms were little changed. An addi-
tional purgative was necessary, and calomel and antimony were
prescribed, in small doses, three times a-day.

11th. The medicines have acted powerfully; the pain of
the chest and difficulty of breathing are much abated ; the
swelling of the limb remains undiminished, but he complains of
no pain in it except on motion; pulse 80 respiration .16.

1850.] Fracture of the Thigh and Patella. 545

12th. Griping and tenesmus having occurred, the mercury
was suspended, and a draught, containing castor oil and lauda-
num, relieved the abdominal irritation. On the 15th the
pectoral symptoms were completely removed, and the swelling
and inflammation consequent on the fractures sufficiently
abated to admit of the application of a laced cap to the knee,
and of the necessary bandages and splints to the thigh. The
limb, when the fracture was reduced, was apparently of the
same length as- the other. Regular action of the Bowels was
promoted by the occasional use of aperients, and the patient
wTas allowed a more generous regimen.

On the 22d, the apparatus having become somewhat disar-
ranged, was cautiously removed, and the limb being found
in its proper position, it was again carefully and firmly ad-
justed.. The pulse 70, the bowe!s regular, and the appetite
good. Animal food was new. allowed.

On the 26th, considerable pain in the course of the thigh be-
ing complained of, the bondages were slackened a litte, and an
aperient administered. On the 5th of October, and again on
the 13t.h, the splints were slightly re-adjusted, and the bandages
tightened. On the following day, sharp pain at the site of
the femoral fracture annoyed the patient considerably, but he
received instant relief by the division of one or two turns of
the bandage. On the 29th of October the entire apparatus
was removed, when both fractures were found to be consoli-
dated; the limb apparently unshortened, but with imperfect
power of motion, the muscles appearing paralyzed by long
pressure and want of use. The knee also was somewhat stiff,
and painful on flexion being used. The repeated application
of a stimulant embrocation was therefore directed, and careful
passive motion of the affected joint, the entire limb being
swathed in new flannel.

Nov. 2d. The patient was permitted to leave his bed, his
health being excellent, and the power of using the injured limb
gradually increasing. By the middle of the month he could
move about with the aid of crutches; and on the 8th of De-
cember, exactly two months after the accident, the only
symptom which remained was a degree of stiffness of the knee-
joint, preventing the full use of the limb. This gradually
abated, and in a short time he was enabled to rejoin the coast
guard service, and to patrol as usual for several years after-
wards. I have lost sight of him lately, but I believe he is still
in the service.

The chief points of interest in the above cases are the suc-
cessful result of secondary setting of the fracture, andthe very ex-
traordinary escape of the patient from immediate death, as I have

n. b. VOL. VI. no. ix. 35

548 Fracture of the Thigh and Patella. [September,

never heard of a similiar case nor should I have believed in the
possibility of a fall, from a height of 200 feet, occurring with-
out certainly fatal results. Once, indeed, in the harbor of
Malta, I was an eye-witness of the fall of a seaman from the
truck, of a line of battle-ship, perhaps 176 feet; but in that
case, the man fell in the water, having only glanced against
the chains in his descent, by which, however, the os femoris
was fractured in twTo places. He was, I believe, uninjured in
other respects, as he swam until picked up, and rejoined his
ship in a few weeks, after cure of his fractures in the Malta
Naval Hospital.

The other point, which is of more practical importance, was
the treatment of the fracture of the thigh by delaying the ap-
plication of the permanent apparatus until the inflammatory
symptoms had in a great measure subsided, applying only, in the
first instance, such support, by means of position, folded sheets
and cushions tied round the limb with sufficient firmness to pre-
vent injury of the soft parts by displacement of the injured ex-
tremities of the bone. This mode of treating fractures I
learned from Sir. S. L. Hammick, now of London, when I was
serving as assistant surgeon in the Royal Naval Hospital at
Stonehouse, Plymouth, and observation of what I had an op-
portunity of seeing in his practice, and subsequently in my
own, justifies me in forming a most favourable, opinion of the
plan advocated by that very distinguished surgeon .in his truly
'Practical Remarks,' where the reader may find the compara-
tive merits of primary and secondary fractures ably discussed.
The frequent occurrence of shortening in oblique fractures of
the femur, even when most carefully treated, is known to all
surgeons, and it has even been stated on high authority, that
this is inevitable; but a result so unfavourable has not occurred
in the experience of the eminent surgeon alluded to, and the
cases treated by him, under my observation, by secondary
setting were perfectly successful. This very day, by a singu-
lar coincidence, I have had an opportunity of examining
accurately a fracture treated by him, in the person of a
pensioner of marines, which occurred about forty years ago.

The cure was most perfect, not the slightest difference being
perceptible either in the dimensions or (as I am assured by the
patient), in the sensations, or motive power of the affected side.

Without entering here into a discussion of the comparative
merits of primary and a secondary setting of fractured bones, I
shall content myself with stating that I have found the latter
mode of treatment perfectly successful in several cases. But
if only equally successful in the results with the plan of im-
mediate reduction almost universally recommended, there

1850.] Fracture of the Thigh and Patella. 547

appear to be several reasons which entitle it to a preference, of
which the risk of severe and dangerous inflammation is one of
the principal, and the consequent necessity for removing the ap-
paratus perhaps more than once. No doubt cases occur in
which the immediate application of splints is indispensable, as
on board ship in rough weather, or where the patient is furious
from delirium or intoxication ; but under favourable circum-
stances, I believe any surgeon, who shall judiciously try the
mode of treatment here advocated, and which is very minutely
described in the work alluded to, will find that it shall not dis-
appoint his expectations. It may be said, however, as the
swelling and inflammation were too far advanced, before the
patient was seen, to admit of primary co-aptation of the
fracture, that the case detailed is scarcely in point. The fol-
lowing instance, however, is : A strong muscular labourer was
struck by the end of an enormous log of wood, which fractured
the middle third of the os femoris obliquely.. As the man was
so circumstanced that J could have him closely under observa-
tion, I contenied myself with flexing the thigh on the great
trochanter, and flexing the leg to such an extent as rendered
the position most easy to the feelings of the patient, and with
taking such general measures as the nature of the case re-
quired, for preventing displacement of the bone, and modera-
ting the inflammation. When this was abated about the tenth
day, I placed the patient on his back, reduced the fracture
accurately, and applied very firmly the necessary bandages and
two splints along the inner and outer aspect of the thigh, suf-
ficiently Ions: to secure the heads of the bone. A third splint,
but shorter, so as not to press on the patella, was placed in
front. The whole apparatus was firmly secured by strong
tapes, and beyond occasionally tightening, or slightly readjust-
it, nothing further was requisite.

The bone was perfectly consolidated by the ninth week, the
callus having been thrown out rapidly and abundantly. In
ten weeks the patient was permitted to move about with
crutches, and he very rapidly regained the full power of the
limb. There was no apparent shorlening, nor the shiniest halt
perceptible. Now, I would not assert that an equally perfect
consolidation might not have been affected in the ordinary mode
of immediate setting, bufa better one certainly could not. and
if only attended with an equal degree of success as to the final
result, the mode in quesiion appears to have, as I have already
stated, some important advantages. Where it shall be adopted,
it appears to me that the starch bandaging of Seutin may be
employed with much greater safety than when used immediate-
ly after the receipt of the injury."

548 Two Cases of Sloughing Phagedcena. [September,

A Report of two Cases of Sloughing Phagedcena. By Joseph
Drew, M. B. LoncL, House-Surgeon to the Manchester Royal
Infirmary. (London Lancet.)

Two cases of sloughing phagedaena of the face have recently
presented themselves in this Infirmary at the same time; and
since the best method of treating this affection is still sub
judice, and knowing that all the old remedies are of little avail,
two simultaneous cures through the influence of similiar agents
cannot be but of interest, and even possess some weight in
favour of the means employed.

The first is that of Anthony McDonnell, aged nine, admitted
to the wards of this hospital on the 18th of last October. From
the statements of the parents, he had been of robust health from
infancy until about eighteen months ago, when he became the
subject of some febrile action, but concerning the nature of
which they could not particularly specify. Six weeks before
the date of his admission, he was attacked with acute and con-
tinued pain in the left cheek, soon accompanied by a small
dark discoloration, which had rapidly increased in size, notwith-
standing the treatment of one or two medical men, until it had
attained its present dimensions ; the pinched physiognomy, and
the usual attendant symptoms of this disease were now fully
developed and on examination the dark-coloured slough was
found to occupy the whole of the left side of the face, passing
irregularly from a point just below the orbital surface of the
superior maxillary bone, inward and downwards along the side
of the nose, implicating half of the upper lip, to about half an
inch below the angle of the mouth, and backwards and down-
wards over the substance of the masseter muscles the cartilages
of the nose were intact; the immediate edges of the still living
parts were deeply reddened, and to all appearances there was no
tendency to the formation of a definite line to its progression.
McDonnell was at once put on the best meat diet, ordered daily
fifteen grains of chlorate of potash in divided doses, and four
ounces of sherry wine; to have the edges of the slough touched
all round wTith strong nitiic acid and a linseed poultice repeat-
ed three times a day. Without entering into detail, the
remainder of the treatment may be thus summarily stated ; for
four successive days the acid was freely reapplied, when rapid
separation of the slough took place, and subsequently to its
complete removal this potent agent was employed at two
irregular intervals on a few suspicious points still remaining, so
that altogether it. was called into use on six different occasions.
The fourth day of his admission he was attacked with diarrhoea,
but it readily yielded to a compound of opium, catechu, and chalk

1850.] Two Cases of Sloughing Phagedena. 549

mixture. On the cassation of this complication, the chlorate
was increased to a scruple, and the wine to six ounces daily ;
under th3S3 enlarged doses he continued gradually but steadily
to improve in appetite and acquire strength, and was made an
out-patient on t h 3 3rd of December, or# forty-sixth day of treat-
ment. Some time before he left the hospital, it was very
ev.dent that a large portion of the superior maxilla would
exfoliate, for the ulcerating line of separation was being formed,
and bone loosened to nn equal extent; and on the seventeenth
day after going out, they had progressed so favourably, that
evulsion of the parts was performed by the aid of a strong
pair of forceps, two out of the four processes of this bone (the
alveolar and the molar) coming away entire, with two of the
milk teeth still firmly implanted in their sockets; since then the
surrounding soft parts have been so busy in throwing out
plastic organizable matter and contracting, that at the time I
now write the disfigurement is not nearly so great as might
have been expected, nor the breach so extensive that it may
not be remedied at some future period.

The second case is that of Eliza Lomas, aged six who was
admitted on the 22nd October, with an account from her parents
that she had been extremely delicate from birth, and that she had
suffered from the effects of the usual tribe of infantile diseases
in a scrofulous constitution. The history of her present attack
very closely resembled that of the boy above related ; she had
lately undergone some febrile affection ; she had been ill a few
weeks before presenting herself, and continued to get worse in
spite of medical aid; acute and continuous pain preceded the
formation of a slough ; and she, too, was now greatly prostrated
by the depressive powers of the disease. It did not appear,
however, that the morbid process had made any very rapid
local progression, for the measurement of the circumference of
the dead portion did not exceed that of a wafer of the largest
size, extending from a point corresponding to the alveolous of
the first molar tooth, completely through the side of the cheek,
and implicating, at the same time, more internally a small
portion of the gum; the surrounding edges of the still living
parts possessed a deep livid blush, and were found to be tender
and somewhat painful.

Precisely similiar treatment was put in practice in this case,
too; at first fifteen grains of the chlorate, afterwards increased
to twenty grains daily, and four ounces of wine, increased to six
ounces, the best meat diet, and local application of nitric
acid; the latter was used on three successive days before
the coming away of the slough, and was esteemed necessary
only once afterwards. By the aid of these medicaments she

550 Two Cases of Sloughing Phagedena. [September,

rapidly improved in health, great contraction of the sides of the
aperture took place, numerous healthy granulations were
thrown out, and by subsequently uniting with others from the
implicated portion of gum, this gap, though at first large enough
to admit of the middle finger, was completely closed, and she
went out of the hospital, on the 10th of December, with a slight-
ly sunken and puckered cheek, but in all other respects better
than she had every been before in her life.

On the fourteenth day of her admission J noticed that about
three-quarters of an inch in front of, and somewhat above, the
original solution of texture, a small, irregularly circular slough,
three lines in diameter, had developed iiself; and anticipating
its tendency, gently tore away the surface, to ascertain the ex-
tent; already it had been penetrated to a greater depth than the
thickness of the cheek, but fortunately, on account of the very
oblique direction, without yet implicating any portion of the
mucous membrane. Its progress was at once arrested by the
strong acid, a clean surface was obtained in two days, kindly
granulations were thrown out, and it soon heale'd, without ever
opening into the cavity of the mouth.

Observations. Sloughing pha^edcena of the face, in children,
was recognised by the older writers on medicine; but the late
Mr. Pearson was the first to bring the subject prominently be-
fore the profession, in a short essay, entitled "Canker of the
Mouth," and appended to his ''P'irst Principles of Surgery,"
published in 1788. Since his time many men have thought it
worthy of their attention; and thoujih considerable additions
have been made to the pathology, still it must be confessed that
until very lately no advance had taken place in the requisite
therapeutics. Contenting myself, however, by referring those
readers who may wish to know more particularly concerning
the disease to the writings of Mr. Pearson, Dr. H. Hunt, Dr.
Symonds Dr. Cuming, and Rokitansky, (Sydenham edition,)
I will proceed to notice a few of the peculiarities and points of
interest in the cases just related.

1st. The respective ages of these little patients, or at least the
age of one of them, was considerably above the average of
those affected with this disease. Mr. Pearson makes the date of
liability vary from eighteen months to six or seven years, and
Dr. Symonds from two to five years of age ; but one of these
instances is a girl of six, and the other a boy of nine, being, in
the latter two years beyond the maximum of Mr. Pearson, and
four beyond that of Dr. Symonds.

2nd. In each case the formation of the dark slough was pre-
ceded by violent and long-continued suffering, differing, in this
respect, with all the authorities I have been able to consult, for-

1850.] Two Cases of Sloughi?ig Phagedena. 55!

by them is generally stated that \ery little pain accompanies
either the development or the progression ; but it would appear
from these instances, that sometimes, at least, symptoms of
acute inflammatory phagedena may be present. Dr. Hull be-
lieves that this affection is subject to the snine causes of origin
as phagedsena of any other mucous part at an early age ; and
truly there does not appear to be sufficient ground for supposing
that it possesses any specific power oi action, or that it is dif-
ferent to sloughing phaizedaena, affecting any part of the bodv
at a more advanced age, for in one, as in the other, disintegra-
ting granules, just before separation, impart their attributes by
continuity of texture, toother portions of the surrounding tissue,
which then immediately take on similiar virulence of action and
tendency to death ; it will be found, too, that each possesses
many like peculiarities, and when subservient to the power of a
remedy, will give way to that endowed with similar virtues.

3rd. In the course of the disease in the little girl, it was a
point of considerable interest that on the 13th day of treatment, a
small, secondary slough should haved formed, like, to all appear-
ances, the nature of the primary one yet not originating in the
mucous membrane, or implicating it in the smallest decree,
but in the skin, most clearly passing from the surface to within.
Calling to mind, at the time it was observed that many phvsi-
cians believed in the contagiousness of a discharge from such
sores, I carefully examined all the edges of ulceration, but
found that, contrary to their being the appearance of any sus-
picious points, the whole surface had assumed a most kindly
aspect, and taking this in conjunction with the facts, that the
freshly diseased spot was situated above and in front of the
original slough, and t hat the parts and face were cleansed at least
oncea day with warm milk-and-water,the evidence seemed suffi-
ciently strong to show that the local disense may occasionally
begin, de novo, in the skin, as advocated by Dr. M. Hall, and
that it dues not always, as most authors have stated, commence
in the mucous membrane or gums. It is true that the precise
point of origin of any local departure from health is not a sub-
ject for speculation, but a matter of fact, after due observation;
still theknown correspondence in structure between the skin and
mucous membrane, and their intimate sympathies in other
affections, would lead us to anticipate that a disease might at
onetime originate in the cuticular, and at another in the mucous
tissue, although known by experience to affect after a directly
reverse fashion, in the majority of instances.

4th The termination of each case possesses its own peculiar
interest; that of the lad, on account of the intensity of the dis-
ease a youthful constitution may be made to support, and the

552 Two Cases of Sloughing Phagedena. [September,

strong efforts made by nature to close a breach of surface so
extensive: that of the girl, on account of the very fortunate re-
covery that may sometimes be expected to ensue, notwith-
standing a delicate conformation of the body, and a subjection
to continued sickness from birth. Both cures will be rendered
more complete at some future period, when by a slight
Taliacotian operation, the breach of substance still existing in
the first shall have been filled up, and when, in the second, the
band of adhesion uniting the cheek, to the gum shall have been
divided, and the side of the face once more released with a fair
chance of regaining its former position.

-5th. The profession is indebted to Dr. H. Hunt for the in-
troduction of chlorate of potash as a remedy for cancrum oris;
but since he tendered an account of its virtues in 1843 many
persons have thought proper to doubt it efficacy, and others
have not hesitated to deny it altogether ; still, though it may be
quite true that the method of its action upon the organism is
doubtful, it is only an accumulation of the evidence of expe-
rience that can establish or deny its merits as a medicament.
When first made use of, it was thought to produce a beneficial
influence by the diffusion of some of its contained oxygen; but
as soon as it was objected that it might be detected unchanged
in the urine of persons taking it, many thought this fact quite
sufficient to upset the r.hemico-physioiogical theory of its action,
without remembering that it had not. been shown that the same
amount of the salt might be collected from the urine as was
administered by the mouth, and consequently not proved that a
portion at least might not be acted upon and decomposed. As
far, however, as the experience of five cases will enable me to
judge, I should not think it advisable to trust to any con-
stitutional treatment alone, any more than in that of sloughing
phagedsena in a different part of the body. It is essential that
the portions of tissue which have taken on diseased action
should be thoroughly destroyed, whether by the nitric acid,
other potential agent, or the actual cautery itself, after the
fashion recommended by Mr. Obre appears to be quite imma-
terial ; neither, on the other hand, should I like to trust the
the local treatment alone, for the gradual death of tissue is
merely the consequence of a constitutional disease; and though
layer after layer of texture might be destroyed, still the root of
the evil would remain untouched. Both methods should be put
in practice at the same time ; and I am sanguine enough to
think that the person who will put his trust in them will find
this disease, by their combination, as much under the influence
of treatment as most other affections to which our bodies are
liable.

1850.] Causes of the Epidemic Puerperal Fever. 553

6th. In applying the nitric acid, it is a matter of some import-
ance to instruct the little patient to inspire fully previous to its
application, that the lungs may be filled with air, and thus guard-
ed in some degree against the difficulty or even danger that
might result from the inhalation of nitrous fumes; and in the
course of treatment it will be found of great advantage to sepa-
rate carefully every slough as soon as formed, using, if neces-
sary, even some little violence for the attainment of this object,
on account of thus obviating to a considerable extent the great
contamination of the air of inspiration.

Lastly. I would bez to state that I am indebted to the artistic
skili of my esteemed friend, Mr. Swan wick, for the accompany-
ing representations of the patients in their present condition,
who has very kindly made for me ^wo excellent chalk drawings
of them.

On the Causes of the Endemic Puerperal Fever. By C. H. F.
Routh, M. D. (Medico-Chirurg. Review.)

The author's remarks, it is stated at the commencement of
this paper, are to be regarded as applying especially to Vienna,
although it is believed that similar causes are brought into
operation in other countries, and might as effectively be com-
bated.

The facts in which they originated may be briefly stated.
It appears that there are two divisions in the Vienna Lying-in
Hospita', of which the first is open for the instruction of medi-
cal men and midwives ; the second, for that of midwives
exclusively. The general arrangements are similar in both
divisions, but the wards of the second are neither so large nor
so airy as those of the first. Nevertheless, it was found that
the mortality in the first division was very much the greater,
and sometimes reached a fearful amount. Thus the average
monthly number of deliveries beim: 275 in each division, the
ordinary number of deaths in the first was 30 per month, or
one in 0-1G deliveries, which occasionally rose to 70 per month,
or rather more than one in 4 deliveries ; while, in the second
division, the ordinary monthly mortality was about 8, or one
death in 34*37 deliveries, which sunk occasionally to 3, or to
one death in J) 1*66 deliveries. In one particular year, indeed,
out of some 3000 cases delivered, about 500 died in the first
division ; while in the second division, out of the same numbers
delivered, the deaths frequently did not exceed 40.

The frightful mortality in the first division, as compared with
the second division, became at last so notorious, that many fe-

554 Causes of the Epidemic Pusrperal Fever. [September,

males refused to become patients in the former ; and public
opinion compelled the Austrian government to make it a sub-
ject of inquiry. The commission appointed for that purpose
came to the conclusion, that the prevalence of the fever was
due to the excess of students in attendance, and the number
of these was reduced from forty to about thirty, but without
advantage. A presumption arose in the minds of some, that
the fever was excited, in the first instance, by the rough manip-
ulations of men midwives as compared with those of women ;
but further consideration showed this opinion to be groundless.

Under the heads of contagion and infection various argu-
ments are adduced, to show that the excessive mortality at
Vienna could not be referred to the introduction of typhus
fever; nor to the conveyance of a contaminating poison from
one patient to another by the person or clothes of the attend-
ants, nor to its more direct communication from the sick to the
unaffected. The general fact of the occasional origin of puer-
peral fever in some matter or miasm, communicated by those
who are attending upon patients laboring under other diseases,
or under puerperal fever itself, is admitted by the author, since
he says :

"That the contact of fomites, the direct or indirect commu-
nication with persons affected with puerperal fever ; that some
influence, carried either by the patient herself or her attendants,
from other contagious diseases, such as erysipelas, typhus, and
other low fevers, has in many cases, given rise to puerperal
fever among lying-in patients, is a fact that admits of no doubt."

He must therefore be understood as maintaining only that, of
the peculiar feve\- at Vienna, and of that of some similar insti-
tutions at Prague and Paris, some other explanation must be
sought. His arguments seem indeed to show that the fever
under discussion having the origin presently to be assigned to
it, is less capable of conveyance through infection than other
forms of the same malady. We shall give heie the conclusions
arrived at regarding the causes of this particular fever; the
beneficial results that followed the adoption of precautions
based upon them ; some particulars relating to the symptoms
and post-mortem appearances ; and the general rules which
should guide accoucheurs under all circumstances, as derived
from the lamentable facts here detailed. The author thinks
himself justified in concluding that

1. The puerperal fever of Vienna may be looked upon as
an endemic fever.

2. That it is produced by the direct application of poisonous
cadaveric matters, introduced by the hands of the male obstetri-
cians in attendance. (The midwives made* no post-mortem

1850.] Causes of the Epidemic Puerperal Fever. 555

examinations or dissections, and studied anatomy by means of a
lay figure.)

3. That the cadaveric matters derived from the bodies of per-
sons dead of typhus, erysipelas, puerperal or other low fevers,
are peculiarly dangerous ; but that there is no evidence to show
that ordinary cadaveric matters may not produce it.

4. That it does not appear to be either contagious or infec-
tious.

Dr. Semelweiss, acting on these conclusions, recommended
all students frequenting the division not to handle dead matter,
or if they did so, he forbid them to make an examination of
lying-in women till the following day. He directed all
students who attended the practice of the divison to wash their
hands in a solution of chlorine, prior to and after every examina-
tion made on the living subject. The result of these precaution-
ary measures, was, that the number of deaths at once iell to seven
per month, orto theusual average of the second division.

In this malady the feverish symptoms usually occurred on
the second or third day after labour, but in some instances not
till the seventh or fourteenth day. The fatal result was gener-
ally deferred to the fourth or fifth day after the seizure, but
sometimes occurred within twenty-four hours. A diarrhoea
generally preceded the attack ; sometimes, but rarely, the pa-
tient was costive. Then followed languor, weakness, and
rigors, a pulse from 120 to 130 in a minute, sometimes 100,
and very weak ; anxious countenance, pain about the uterus,
heat, dry tongue, and thirst followed. The lochia and milk
were unaltered in quantity and appearance; the intellect was
generally clear to the last. Lar<re violet macula} sometimes
occurred on the extremities. The more marked local svmp-
toms were those of peritonitis, but the pain disappeared a short
time I efore death.

After death there were signs of arachnilis in a slight degree,
occasionally endocarditis, very generally pericarditis. Exten-
sive peritonitis with sero-purulent effusion. The uterus was
much enlarged, softened, tearing easily, with pus in the veins, es-
pecially near the Fallopian tubes. The bodies underwent speedy
decomposition ; the blood was generally liquid and very dark.

A postcript informs us, that wheieas in 1846 there were
459 deaths, in 1817 the nurnher fell to 176. and in 1848, after
the precautionary measures were fully carried out, it sunk to
45 in about 3300 deliveries in each year.

The precautions, adopted for all times and climates, that
flow from this melancholy history, are that

" 1. Accoucheurs should, as much as possible, avoid making
autopsies, and all contact with cadaveric matter.

550 Condition of the Intestinal [September,

" They should never attend any woman in labour, in clothes
which may possibly have been infected; and, if compelled to
handle cadaveric matters, or poisonous secretions of living
persons, should effectually disinfect the hand by means of
chlorine water before entering the lying-in bed-chamber."

We conceive that Dr. Routh is eminently entitled to the
thanks of the profession and of the public, for the lucid and able
manner in which he has brought forward the particulars of this
melancholy and very instructive history.

Report of the Committee appointed to examine into the condi-
tion of the mucous msmbrane of the intestinal canal in per-
sons dying of Cholera. (Trans. Philadelphia College of
Physicians.)

Science is positive only when its facts are positive. A sub-
ject, the phenomena of which are numerous and complex, can
be understood only when each of its phenomena or facts have
been analyzed and positively ascertained.

In Epidemic Cholera, the most prominent and constant phe-
nomena, are purging and vomiting: and in ninety or more, of
one hundred cases, these phenomena appear to induce the con-
dition that usually terminates fatally. It is therefore an im-
portant obj jct, in determining the phenomena of Cholera, to
ascertain whether any, and if any, what constant anatomical
alterations can be detected in the intestinal canal of cholera
patients who have succumbed under the disease.

The College, with the view to obtain, as far as possible, ac-
curate information on this single question, appointed the under-
signed, at the meeting held on the 19th day of June last, a
committee to investigate this subject.

The Committee having attended to this duty, submit the fol-
lowing report :

The ordinary autopsical examinations, heretofore practised,
have railed to yield any satisfactory information, and are nearly
useless for the purposes of science.

Extensive structuial lesions may exist, that cannot be seen,
or very imperfectly discerned by the unaided sight, and without
proper preparation. #

It was determined by the Committee that the intestines, be-
fore submitted to examination, should be finely injected, and
subsequently inspected with a microscope.

This task was undertaken for the committee, by Dr. John
Neil, Demonstrator of Anatomy in the University of Pennsyl-
vania. The admirable manner in which he has performed

1850.] Mucous Membrane in Cholera. 557

this duty, can be judged of by the beautiful preparations now
on the table, which he has presented to the College for its
museum.

The injections are made with turpentine colored with Ver-
million. It was found by Dr. Neil, that when he employed
size, it did not penetrate well, and numbers of capillaries were
not filled ; the same result occurred when Canada Balsam was
used. It led, at fii st, to the supposition that the capillaries were
destroyed by the disease.

The Committee, confining themselves strictly to the single
object for which they were appointed, report the following
facts as the result of their investigation.

1st. In the recent subject, the peritoneal coat, like all the
serous membranes, was in all, remarkably dry. The lubricating
serositv is deficient in the serous membranes.

2d. The epithelial layer of the intestinal mucous membrane,
was, in all the specimens, either entirely removed, or was de-
tached, adhering loosely as a pulpy layer, mixed with mucous,
or an albuminoid substance.

3d. Peyerian Glands. Peyer's Glands were developed to a
greater or less extent in all the cases examined.

4th. Solitary Glands. These were also developed, and con-
tained, in the recent subject^ a minute quantity of white sub-
stance. These enlarged solitary glands have the appearance
designated by Serres and Noaat, as Psorenterie.

The villi covering the glands of Peyer,and the solitary glands,
present the same appearances as in other parts of the same
intestine.

5th. ViOL They are denuded of the epithelial covering, but
are unchanged in other respects.

6th. Capillary Vessels. These are entire, and manifest no
departure from their normal state. The appearances of the
capillaries of a cholera intestine, are identical with those of the
healthy mucous membrane when the epithelium has been re-
moved. In the natural state, the epithelium, from its thickness,
conceals the injected capillaries.

In no instance was a vesicular eruption observed. In some
of the dry specimens, there is an appearance that might be mis-
taken for it, but it is an emphysematous state, resulting from
commencing putrefaction.

The foregoing facts are derived from tne examination of
twenty-five subjects.

Samuel Jackson, M. D.
John Nlil, M. D.
Trans. College of Physicians, ) Henry H. Smith, M. D.

Philadelphia^ \ William Pepper, M. D

553 Jaundice as an Epidemic. [September,

Facts and Observations tending to prove the existence of Jaun-
dice as an Epidemic. With an attempt to explain the
phenomena of that peculiar form of disease. By C. J. Clark,
M. D., of Jacksonville, Ala. (New Orleans Med. and Surg.
Journal.)

In noticing the communication of Dr. Pitman in the March
number of your Journal, in relation to the prevalence of Jaun-
dice in an epidemic form in the vicinity of Rocky Mount, N. C,
you say, * we apprehend, however, that the cases observed by
Dr. Pitman, and reported as jaundice, were examples of bilious
remittent fever, &c." If this decision is based upon the opinion
that jaundice never prevails epidemically, it is probably erro-
neous. A part of the cases at least would seem, from the date
of the correspondence, to have occurred in mid-winter, when
it is not probable there was any bilious remittent fever in the
vicinitv of Rocky Mount, to be confounded with it ; and I shall
proceed to show that jaundice has occurred in an epidemic
form at other times and places, although, I believe there are
but few instances to be found on record.

Mr. Samuel Cooper, in a note to the article "icterus," in
Good's Study of Medicine, says, "the disease (jaundice) ap-
pears to have been epidemic at Cronstadt in 1784 and 1785,
and at Geneva in 1814. In the latter city, it occurred after
the hot weather in sum-mer, being in some cases combined with
bilious fever; in others, not associated with anv manifest dis-
order."

Dr. James C. Harris, in the Western Jour. Med. and Surg.,
for July, 1848, has described an epidemic jaundice as occurring
at and in the neighborhood of Wetumpka, Ala.

Jaundice occurred in an epidemic form in this place and the
vicinity in the summer and fall o'f 1839. The first case in the
community was accompanied by febrile excitement of a high
grade, and was pronounced by a practitioner not very exten-
sively read, to be a case of yellow fever !

A 'large number of cases occurred subsequently during Au-
gust, September and October. A few were accompanied by
febrile symptoms, but much the largest number were free from
them; and there was no case except the first, and perhaps one
other, that could be taken, or mistaken for bilious remittent
fever. The disease confined itself almost exclusively to adult
males. There were a few females affected, but no children.
Three physicians out of. five in the village had the disease.

The disease came on very gradually and was characterized
by languor, loss of appetite, a bitter taste in the mouth, furred
tongue, sense of weight at the epigastrium, yellow skin and

1850.] Jaundice as an Epidemic. 559

conjunctivae ; urine a deep color, staining the linen, and consti-
pation nf the bowels, with clay-colored stools. A few com-
plained of some fullness or pain in the head. In one case, there
was great irritability of the stomach and vomiting, the dejec-
tions consisting of the articles swallowed, mixed with the
secretions of the stomach, but without any bilious matter.
There was no case of death, and many of the persons who had
it, were able to attend to their ordinary business most of the
time.

In a few instances the patient had to keep his room, and per-
haps his bed for a few days. The greatest complaint was ofa
feeling of excessive lethargy ; a disgust for food, and the sense
of sinking or weight at the epigastrium. The loathing of food
and bitter taste were frequently compared to that produced by
measles; and it was a common remark with patients that they
had "never had anything to make them feel so mean."

The treatment was various and all modes were attended with
about the same success, as there seemed to be a natural ten-
dency in the disease to terminate in from about ten days to two
weeks 'or a little more. The first case that came under my
charge was in a young man twenty three years old. I under-
took to vomit him for the purpose of arousing his liver. Tartar
emetic was administered in divided portions until he had taken
six grains. It produced great nausea and distress with but
slight vomiting. No bile ejected. His pulse sunk to 45 beats
in the minute; he became deathly sick and the tartar emetic
was stopped. A full dose of blue pill was given followed by
rhubarb, and subsequently by two ounces of castor oil before
al valine evacuations could be procured. The stools were of
an ashy color and small, without the least appearance of bilious
matter.

Calomel was next exhibited pretty freely without any better
success with the liver. After the first few days the treatment
w7as rather expectant than otherwise, and the patient recover-
ed in about the ordinary time.

I succeeded in vomiting another patient freely after giving a
considerable quantity of ipecac and tartar emetic, and found
some slight traces of bile after severe straining.

Another patient, in taking calomel to "act on his liver," wTas
severely salivated. The ptyalism did not appear to affect the
functions of the liver, or modify the disease in any way. The
fact is, that until the disease began to subside of itself, or from
other remedies, the boasted "Sampson" of the materia medica
seemed to have lost all its influence over its peculiar organ.
The best treatment finally appeared to be the use of occasional
purgatives with the regular exhibition for some days of such

560 Jaundice as an Epidemic. [September,

tonics as quinine, barks, and an infusion or tincture of the bark
of the wild cherry. The latter was the popular remedy, and
was all that several persons used.

Epidemic jiundice is no doubt produced by the same cause
that gives rise to bilious remittent fever ; its influence being in
some manner modified so as to give different results under
different circumstances.

It was at Geneva, found occurring "after the hot weather in
summer," and " in some cases combined with bilious fever."
Dr. Harris describes it as occurring in company with a form
of fever that was evidently bilious remittent fever. Dr. Pilman
finds some of his cases ''complicated with intermittent fever;"
while it occurred with us in the season of our autumal fevers,
appearing for the time to take the place of them. We had
bilious remittents during the latter part of the time, and after
the jaundice prevailed.

As epidemic jaundice has seldom if ever proved fatal ; there
have perhaps been few if any opportunities of determining
by post mortem examinations the precise condition of the liver,
the organ at fault in the disease. In searching for its immedi-
ate cause in such cases as those presented by epidemics, we
may set aside calculi, obliteration of the biliary ducts, organic
diseases of the liver, pressure from tumors and enlarged
viscera spasm of the gall ducts ; inflammation of the liver, and
inflammation of the duodenum. It has been thought to be pro-
duced sometimes by a closure of the choledochus duct by a
viscid mucous. This we may dismiss also, as emetics and
cathartics would certainly dislodge such an accumulation with-
out difficulty; and these are not found to cure epidemic
jaundice.

If we agree with Darwin, Chevreul and Mayo, that the bile
is formed in the blood and merely separated by the liver, we
might suppose the morbific agent had simply caused a cessation
of the functions of the liver, leaving the bile in the blood ; and
therefore that the yellow skin and secretions resulted from a
suppression of bile. If this hypothesis were true, then every
individual whose liver ceased to secrete, even temporarily,
would become jaundiced, which we have reason to believe is
not the case. Our skins would be constantly becoming
yellower or clearer as the formative power or separating power
preponderated. It is very certain that in many diseases the
functions of the livei are almost if not entirely arrested for seve-
ral days, as are those of the salivary glands, skin, &c, and that
without inducing jaundice. Further, all analogy teaches us
that the bile is not formed in the blood but by the action of the
liver ; while chemical analysis has failed to detect it in that fluid.

1850.] Periscope. 561

The true pathology of epidemic jaundice will perhaps be
found in the increased activity of the absorbents of the liver
produced by the action of the morbific agent, resulting in the
absorption of the biliverdin or coloring principle, a portion of
the blinn or bitter principle, and the main part of the water,
(which amounts near to eighty-five parts in the hundred,)
leaving the balance of the constitutients in the ducts and gall
bladder in a state of inspissation. It is not improbable that
this absorption takes place mainly in the larger ducts and gall
bladder.

It has been urged against the theory of absorption that the
absorbents would not take up such an irritating fluid as the
bile. But it does not appear from observation that the ab-
sorbents are less disposed to take up irritating fluids than
bland ones ; and moreover, the absorbents would be as apt to
tolerate the bile, as the delicate endangium, upon the hypothesis
of its existence in the blood vessels ready formed. Besides, it
remains to be proved that the bitter and coloring principles in
the state of solution in which they are supposed to be taken up,
are peculiarly irritating.

The coloring principle of the bile just taken into the blood
constitutes foreign or effete matter and is thrown off by the
kidneys and cutaneous emunctories, or lodged in the cutis
vera the delicate tissues of the conjunctiva, and the mucous
membranes. The loss of appetite, impaired digestion and
constipation, are readily accounted for by the absence of bile
from the alimentary canal.

PART III.
ill o n 1 1) I n }?rt0C0p*,

The Treatment of Epilepsy. (Journ. of Insanity.) Dr. Cheneau
has presented to the Academy of Sciences, Paris, a memoir on the
treatment of epilepsy, which is well worthy of perusal. He desires
to prove that the disease is curable by medicine, resting his principal
mode of arresting its progress upon the judicious employment of digi-
talis. The cases that have proved the most inveterate have yielded
to a perseverance in the use of this remedy for a period of six or eight
months. He has submitted six instances to the Academy, in which
he has been successful ; the first occurred at the Bicetre, under the
care of Dr. Voisin. A young man, aged twenty, had been epileptic,
it is supposed from fright, from his fourteenth year; two months
treatment restored him to health. The second was one in which the
disease, produced at the age of thirteen, by fright, had lasted till the
individual had attained his forty-second year. The treatment com-
menced the 20th of April, 1847, and after the 16th of June in the

X, S. VOL. VI. NO. IX. 30

562 Periscope. [September,

same year he had no attacks, which before had appeared, it is true, at
only very long intervals ; as many as six years having at one time
elapsed without any access of paroxism. The third case is certainly
one as singular as any that has been registered upon the rolls of
medical science. A young lady, thirteen and a half years old, had
been subject for several years, to the disease, which had at length
brought on idiocy and paralysis of half the body ; the paroxysms
were not very frequent, but were of great violence, frightening the
persons who nursed her, the countenance wearing a purple and
almost a black hue, which sometimes lasted twelve hours after the
fit had ceased; the hemiplegia, which was of the right side, prevented
the movement of the limbs, and partially affected sensation. The
treatment was commenced on the 4th of July, 1846, and by the month
of January in the following year, the epileptic fits altogether ceased.
A year has elapsed since the young lady has been able to go on with
her education, and she is also able to run in the garden and to amuse
herself with gymnastic exercises. The fourth notice is that of a
young girl often years of age, upon whom epilepsy supervened after
fright ; it had lasted two years, but soon yielded to the usual remedy of
Dr. Cheneau. The fifth case was that of a patient in the Bicetre ;
he was, when placed under the treatment, sixteen years of age, and
had been afflicted by the malady since he was five years old. At first,
the paroxysms were but slight ; he suddenly turned himself mechani-
cally round any object immediately in his neighbourhood ; this lasted
about a minute. As the disease advanced, he had convulsions, and
the fits became very frequent. The remedies were commenced on
the 2d of October, 1847, and in January, in the following year, was
his last attack. Since that time his health has become perfectly es-
tablished. The last case carries with it the same interest as the
preceding ones. A boy, of ten years of age, after having been for
three years subject to frequent fits, once as many as fourteen in twen-
ly-four hours, was subjected to the use of the digitalis, and at the end
of two months was an instance of the excellence of the system pur-
sued by Dr. Cheneau. The essay is well written, and certainly
demonstrates that digitalis, properly combined, has cured epilepsy,
even when complicated with paralysis and idiotism ; that the cure
has not been confined to youth, but has been decided at an advanced
age, and that the time occupied has not been of great duration. An
incidental subject of discussion has been the subject of the sudden
paleness of the face, which has been noted down by the nosologists
as one of the symptoms of epilepsy. One of the characteristics, as
given by Georget, in the " Dictionairy de Medicine," is " extreme
pallor of the face, suddenly coming on towards the end of the fit, suc-
ceeding to a redness more or less intense which previously existed."
In the hospital of the Bicetre, one hundred and twenty fits have been
watched with the most scrutinizing care, and this state has never
once presented itself; on the contrary, the redness came on during
the paroxysm, continued throughout the convulsions, and often lasted
for some* time afterwards. On no one occasion was the sudden
paleness observed. ^

1850] Periscope. 5G3

M. Delasiauve, one of the physicions to the Bicetre, is investigating
with great attention the resources which we possess for the cure of
epilepsy ; his observations on the employment of sedatives are of con-
siderable value. To valerian he gives the first place, though he does
not speak of it quite in as sanguine language as did Tissot ; a decoc-
tion of valerian given in doses of two wine glasses full, morning and
evening, have produced a radical cure, but the medicine requires
to be perserved in for a considerable length of time, otherwise it is of
little avail ; assafcetida decidedly moderates the violence of the access,
but it does not seem to produce the same permanent good effect. The
hydrocyanate of iron is found in some instances very beneficial ;
belladonna and digitalis are each serviceable, but Pluvrey of Lille
prefers a combination of the two. The root of artemisia is occasion-
ally useful; of liquid ammonia, according to the formula prepared by
Martinet, he has some good reason to speak, and will shortly give the
results of his experience ; camphor is found in those cases where the
reproductive system is in a high state of excitement, as not unusually
occurs in epileptics, to be of remarkable service ; zinc, musk, castor,
ambergris, have but little curative power ; preparations of copper are
to be but little confided in ; nitrate of silver has lost the high char-
acter it once obtained ; sulphate of quinine has also fallen into
disrepute. He enters very minutely into the subject of the diet and
exercise of the patient, preferring vegetable to animal food. It is to
be regretted that the series of papers which this observant practitioner
had prepared for the press are for the present suspended, for want of
that encouragement which would have been at another period given to
inquiries of such deep moment.

On the value of Lemon Juice in Rheumatism. By Dr. Owen Rees,
(Ranking's Abstract.) Dr. Rees first called attention to this mode of
treating rheumatism in a paper published in one of the weekly peri-
odicals ; he has since put forth a pamphlet, in which he has narrated
eight cases illustrative of the practice.

The form of rheumatic disease in which the greatest benefit is de-
rived, is acute rheumatism and rheumatic gout. In pure gout, with
high inflammatory symptoms, more advantage has been obtained than
in the chronic forms of the disease.

In doses of half an ounce to an ounce thrice daily, the lemon-juice
appears to exert a marked sedative effect on the circulation; in one
case, the pulse, which was 120, and full, was after one day's treatment
reduced to 75, and rendered at the same time smaller ; in another
case, the pulse, which was 110 when the lemon-juice was first given,
was in two days reduced to 100, and in four days to 74. If we can
rely on results obtained in one experiment, this action is mnnifested
also in the healthy body. A clinical clerk took one ounce of the juice
three times a day for three days, and carefully noted his pulse, which
was naturally full, and 75 in the minute. After five doses the pulse
became much weaker and more compressible, and numbered 70 in
the minute; conditions accompanir-d by a feeling of general depres-

564 Periscope. [September,

sion. On the third day the pulse became as low as 66, and was very
small and compressible. The urine was always acid, and also natu-
ral in quantity till the third day, when it increased somewhat ; the
specific gravity was then 1*017, and there was a deficiency of lithic
acid.

In the cases of rheumatism related by Dr. Rees, the urine was ne-
ver rendered alkaline by the use of the lemon-juice ; and in one case,
in which the urine was alkaline before treatment, it became acid after
the juice had been employed. We think it premature to speculate
on the modus operandi of the drug, until its utility shall have been
confirmed by more extended experience, and before we are in posses-
sion of more accurate knowledge as to^its physiological action, more
especially in reference to its effects on the urine, and the quantity of
solids contained in that secretion.

Of the advantages of this method, we can speak from personal ex-
perience; and it has been confirmed by other observers, as will ap-
pear from the subsequent article.

Since the announcement of the value of lemon-juice in rheumatic
affections by Dr. Rees (mentioned above), a paper illustrating the
practice, was presented to the Medical Society of London by Mr.
Middleton, upon which Dr. Golding Bird remarked as follows :

Now, in rheumatism, how were we to get rid of this morbid matter
in the blood ? Opium would remove it to some extent ; colchicum
would remove it. But it was taking a more common-sense view of
the subject to employ some remedy which would eliminate the mor-
bific matter from the circulation at once, by carrying it off by the
urine. How, then, were we to effect this ? Why, in acute rheuma-
tism, by the administration of cream of tartar, citrate of potash, lemon-
juice, or carbonate of soda. There was little difference between the
action of these neutral salts ; but lemon juice, which was the super-
citrate of potash, was more quickly absorbed into the blood, and con-
sequently more active in effecting a cure. He had, however, in his
own practice, been in the habit of employing the acetate of potash in
these cases. This salt, with a mixture of sugar, water, and essence
of lemon, acted with marvellous rapidity. In addition to this, given
every four hours, he administered five grains of the soap pill, with
opium, night and morning ; for this not only relieved pain, but pre-
vented the other remedy being carried off by the bowels. These,
with the vapour-bath, constituted his treatment of rheumatism, and
the result had been always successful. Soda and lemon-juice equally
produced an alkaline condition of the blood, but he preferred the ace-
tate of potash, as it was not liable to be neutralised by the presence
of acid in the stomach. In respect to the treatment of agjue, he never
began at once with an anti-periodic. He always disgorged the liver
by the employment of mild mercurials, and then some quinine. He
mentioned one case, however, in which the quinine failed ; he then
gave the acetate of potash, and the case was cured. By these reme-
dies we immediately altered the character of the blood, and cured the
disease a much more practical and philosophical mode of proceed-
ing than that of treating disease according to name.

D O C

1850.] Periscope. 565

Physiological Effects of Oil of Turpentine. Dr. Thos. Smith, in
an interesting article on the Therapeutic Uses of Terebinthinate
Medicines, in the London Journal of Medicine (April, 1850), gives the
following account of the physiological action of turpentine. [A?ner.
Jour. Medical Sciences.

" Turpentine, when taken internally, exerts a peculiar action on the
mucous surfaces, and the tissues superimposed upon them : it increas-
es the peristaltic motion of the 'bowels, inducing purgation, and, in
very large doses, hypercatharsis ; it promotes the flow of urine, im-
pregnating it with a violet odour ; and, if its action be speedily direct-
ed to the kidneys, may produce strangury and bloody micturition.
It determines to the skin, producing copious and free diaphoresis,
sometimes attended with an itchy eruption. It also taints the pulmo-
nary exhalation with its characteristic smell. A large dose has been
taken internally, and failed to produce action of the bowels or kidneys ;
the vapour of the turpentine has then been discharged through the
skin and pulmonary organs ; this was the case with the experiment
that Dr. Copland instituted upon himself. I once gave half an ounce
to a boy of sixteen years of age, which occasioned no other unpleas-
ant symptoms than an increase of the respiratory movements, and
acceleration of the circulation, with a tendency to somnolency, follow-
ed by a profuse discharge from the urinary organs. The breath and
perspiration were tainted with a turpentine odour for upwards of .a
week ; the bowels remained inactive until he had taken eight ounces
of the compound infusion of senna, with ten grains of calomel ; the
evacuations, when passed, were extremely fetid, black and slimy, but
giving off no smell of turpentine. Hertwig injected two drachms into
the veins of a horse ; trembling, reeling, with inclination to pass
stools, and frequent micturition ensued. Fever and bronchitis were
set up, and the animal died in nine days. Schubert found that two
drachms, given to a dog, caused tetanus and death in three minutes.
I once saw half a drachm administered to a young cat : the poor crea-
ture mewed piteously, was extremely restless fer several hours, and
had constant micturition, unaccompanied with diarrhoea ; after some
hours it fell into a profound lethargy, from which it awoke perfectly
well ; its eyes remained injected for several days.

" Turpentine seems peculiarly destructive to vegetable existence.
Small insects are speedily destroyed by it; indeed, no other drug ap-
pears to exert so fatal an influence over the majority of parasites
which infest animal and vegetable life.

" When taken internally, it has been detected in the various secre-
tions of the human body. Todd and Johnson have met with it in the
kidneys of a patient who died from hemorrhage ; it has also been de-
tected in the chyle of a dog and horse, to which it had previously been
administered, bp Tiedemann and Gmelin.

Injections of Nitrate of Silver in Dysentery. By J. W. Richard-
son, M. D., of Rutherford Co., Tenn. (Transac. Med. Society of
Tenn.) Dr. Richardson said that he wished to direct the attention of

5CG Periscope. [September,

the Society to the use of injections of nitrate of silver in malignant
cases of dysentery. He had first used it in Sept. 1848. The patient
was a delicate female, mother of several children, who had been la-
boring under a severe form of dysentery for five or six days, and who
had been well treated in the usual manner by an intelligent physician.
All the usual remedies having failed to afford any relief, Dr. R. said
that on his second visit to the patient, whilst thinking of the case, and
having witnessed the unsuccessful use of many remedies, the inflam-
mation and ulceration of the mucous surface of the large bowels,
characteristic of dysentery, suggested the nitrate of silver as the very
remedy to relieve them. Upon his arrival, he found the patient worse
than she was the day before. The discharges were very frequent,
consisting of large quantities of dark, gangrenous looking mucus, and
more offensive than any he had ever smeiled. The woman was near-
ly pulseless every discharge produced the most deadly sickness, and
she could not be turned on the bed without approaching syncope.
Dr. R. advised the nitrate of silver, an injection of which was prepa-
red about 15 grs. to 4 ounces of water, by the attending physician,
and thrown up the rectum. This remained some six hours before it
was thrown off, and the bowels were quieted until the next morning,
when, as there seemed to be a tendency to a return of the dysenteric
symptoms, the remedy was repeated. The disease was arrested im-
mediately, and the patient recovered. Dr. R. said the result of this
case, and the speedy and effectual relief afforded by the nitrate of
silver, filled him with astonishment and pleasure : astonishment,
because he had never before thought of the remedy in intractable
cases of dysentery, when he had so often witnessed its remedial
virtues in inflammations and ulcerations of various mucous surfaces ;
and pleasure, because he thought that he had made a grand and im-
portant discovery ! But he said, when reading Braithwaite's Retrospect
a few evenings afterwards, he found that the remedy had been used
in Europe in similiar cases, before he had ever thought of it. See
Braithwaite's Retrospect, pail 16, p. 156. c. 7, where you will find
some valuable facts recorded in favor of the use of nitrate of silver,
not only in dysentery, but also in the troublesome, frequent and pain-
ful diarrhea in typhoid fevers, and in the protracted diarrhea of young
children. He thought the remedy might be used in much larger
doses.

Dr. R. had used the remedy since, in several cases, after the usual
" course of treatment had failed, where the patients where completely
prostrated, and invariably with success. He used it in about the
proportion of 10 grs. to 4 and 6 ounces of rain water, if the latter
could be obtained, if not, he used common spring or well water; and
he had also combined laudanum, and sulph. morph. with the nitrate,
but could not say that the smarting or burning was prevented by the
combination. The pain produced by the injection was not always
sufficient to make the patient complain, though it did sometimes. He
thought that he had used as much as 15 or 20 grs., or that this
quantity had been used by his advice in one case. He did not desire

1S50.] Periscope. 567

to fix the precise quantity of the nitrate, nor water to be used in the
enema, so much as to direct the Society to the remedy, and to solicit
their experience.

Dr. Avent said that having heard of the use of nitrate of silver as an
injection in dysentery, he had tried it in the worst case of dysentery
he had ever seen, and which had resisted all treatment for five days.
He said he gave only one enema, composed of 20 grs. of the medicine
to 4 ounces water, which afforded immediate relief, the griping and
purging ceasing instantly. He had also used it in another case, not
so bad a case, however, but with marked relief.

Dr. Gordon said that he was not surprised at all at what he had
heard from Drs. R. and A. as to the efficiency of nitrate of silver, in
malignant cases of dysentery. He was prepared to believe any thing
almost as to the remedial effects of this article in diseases of mucous
surfaces indeed it was the greatest of all remedies. But he had
been in the habit of treating dysentery in a different way altogether
to the one commonly pursued. He converted the dysentery into a
diarrhea by giving Epsom salts in small and separate doses, and the
patient scarcely ever needed any thing else. He scarcely ever gave
any other medicine. The diarrhea ceased of itself by withholding the
salts, and the patient got well.

On dressing Wounds and Ulcers with Charcoal. By Dr. Newmann.
(Casper's Wochenschrift. Med. Chir. Rev.) In 1846, Dr. Newmann
recommended the employment of charcoal as a substitute for charpie,
plasters, ointments, &c; and since that time numerous cases ("thou-
sand" in allhe says) have confirmed him in the conclusion that the
great majority of open surfaces are far more rapidly healed by this
means than by any other.

One great object of applications of any sort is the exclusion of the
atmospheric air, which coming in contact with the pus decomposes it.
The capillary action which takes place between the granules of the
charcoal prevents a great accumulation of the pus on the surface of
the wound, and spreads it widely, so that it dries and fills up the in-
terstices of the powder, and prevents the access of air to the wounded
surface. Charpie and lint also exert capillary action, but not to the
same extent, as they cannot penetrate so closely among the irregulari-
ties and depressions of the wound. Besides this effect, due to its po-
rosity, charcoal exerts a most favorable influence by its power over
putrefaction, and hence its great use in gangrenous wounds, and in
fact in all open surfaces when changes in the pus are to be feared.
In corroboraton of this general eulogium, the author selects certain
special cases, which usually offer some difficulty in their management.

Thus every one knows what a troublesome affection is produced by
an ingrowing nail, and the painful character of the remedies employed";
Dr. Newman declares he is enabled to heal the obstinate ulcer thus
produced in as many days as these various means require months.
Having separated the soft parts from the nail, so as to expose the ulcer
in its entire depth, he deposits the charcoal freely therein, having

568 Periscope. [September,

combined with it a little acetate of lead, or oxide of zinc, leaving the
entire nail covered with this, and binding a piece of lint over it, the
patient .wearing a wide shoe and keeping quiet. In twenty-four
hours the toe is bathed in tepid water, and new charcoal is added to
the wound, without disturbing any of that previously applied, which
may be firmly adherent. A week or a fortnight of such treatment
suffices to heal the wound. Sore nipples constitute one of the minor
ailments that cause great suffering and trouble in healing. In this
case he usually employs lycopodium mixed with a little oxide of zinc
(for a fine powder, not charcoal alone, though usually the most pre-
ferable one, constitutes the basis of treatment,) with which the part is
well powdered each time the child has sucked. This penetrates into
the fissures of the nipple, and however strongly the child may suck,
some of it remains in contact. The wound quickly heals. Dis-
charges from the ear, dependent upon ulceration of the meatus, are
healed by charcoal in three or four weeks, even if the ulcerations
were considerable. The meatus is syringed out every day, and the
charcoal then freely introduced. Fissure of the rectum is one of
the most painful and distressing diseases that come under the
cognizances of the surgeon. The charcoal should be applied after
every stool, and often in the day besides, care being taken to have it
effectually and freely brought into contact with the fissured surface.
Dr. Newmann, after expiating upon the difficulty of treating the sup-
purating wounds supervening on extensive burns, so as to prevent
deforming cicatrices, declares that charcoal obviates much of the in-
convenience, by keeping the surface of the wound dry, even when
the suppuration is abundant; and that contraction does not follow, or
it is much less considerable than after any other mode of treatment.
If the burn is on the back, the charcoal may be freely strewed over
the bed. Since he has employed the same means in gun-shot wounds,
he has met with much less trismus and tetanus, and has been surprised
at the rapidity of the cure. In the treatment of ulcers of the legs,
even without insisting upon the recumbent posture, he has also been
very successful. In a few days the surface becomes cleaned, and a
good crop of granulations developed, while the callous edges are
levelled. To diminish the circumference of the sore more rapidly,
strips of adhesive plaster are now applied above and below it, and
across its middle, the intervals between the strips being strewed with
charcoal, covered with ointment spread on lint, and bandaged. This
dressing is renewed every two or three days. In this way ulcers,
which have continued open for years, have been healed in six or eight
weeks, the patients still taking moderate exercise.

The cheapness of the substance, and the ease with which it may be
prepared under a varity of circumstances when ordinary dressings are
not obtainable, should recommend it strongly, Dr. Newmann observes,
to hospital and military authorities.

Chloride of Gold in the Treatment of Lupus. In the Bulletin de
Therapeutique of the 30th May, M. Malichecq, ancien interne of the

1850.] Periscope. 569

hospitals of Lyons, highly recommends the use of the chloride of gold
as a caustic in cases of Lupus. His opinion is founded on well ob-
served facts, though as yet these are not numerous. He states that
there are two forms of lupus, the scrofulous and the tubercular the
first a most grave affection, the last not so unmanagable the first
generally manifesting itself during early life, the last generally oc-
curring at a later period in life. In the year 1849, in the hospital de
Antiquaille, M. Malichecq observed sixteen cases of lupus, eleven of
which were tubercular and five scrofulous. In the course of less than
six months, seven of these cases were cured, and left the hospital ; in
all the other cases there was such amelioration as to induce a hope of
complete success. The treatment in all these cases was 1st, a bitter
or depurative tisan ; 2d, cod-liver oil internally ; 3d, cauterization
with a solution of the chloride of gold repeated about every eight
days. This preparation is made with one part of gold leaf, one part
of nitric acid, and three parts of chlorohydric acid. This solution
should be preserved for the contact of the air.

M. Malichecq gives the following rules for its application : A piece
of lint held with a pair of forceps is wet with the solution, and is then
passed over the diseased surface, unless it is very extensive, in which
case it is better to touch only a portion at a time. The part may be
freely exposed to the air. When first applied, the surface assumes a
yellow color, then it becomes orange, then violet, and lastly, black.
Eighteen or twenty hours after the application, irregular black scabs
appear upon the surface, which fall off in six or seven days, leaving it
dry if it was simply tuberculous, and apparently cicatrised if the ul-
ceration was superficial and of small extent. These scabs must be
suffered to fall off without any aid from the patient or the operator.
When the scabs have fallen off, then, and not till then, the cauterisa-
tion is to be repeated.

This application usually produces an instantaneous, cutting pain,
which gradually subsides in the course of an hour or longer, accord-
ing to the extent and depth of the cauterization. In conclusion, M.
Malichecq declares that the chloride of gold is superior to any other
caustic in the treatment of lupus, whatever may be its form.

Hemorrhoids cured by the use of Linseed Oil. ( Annales de Roulers.
Bulletin de Therapeutique.) Dr. Van Ryer asserts that for nearly a
quarter of a century he has employed linseed oil successfully in the
treatment of piles. He gives two ounces of the fresh oil morning and
night. So rapid is the amendment, that it is rarely necessary to con-

570 Periscope. [September.

tinue the remedy for more than a week. The stools are usually
somewhat augmented, but neither vomiting nor other unpleasant ef-
fects are produced. Dr. Van Ryer does not consider it necessary to
adopt any particular diet, except in severe complicated cases, but he
advises that alcoholic drinks should be avoided, and that the alimenta-
tion should not be of a very stimulating character.

New Cause of Deafness. We find in the Gazette Medicale of
July 13lh, an interesting case of deafness, originally reported by M.
Bartolozzi in II Progresso. A man aged forty-eight, had been deaf
for many years : M. Bartolozzi, after an attentive examination, was
unable to discover the cause of this affection, but he observed that
the auditory canal of the left ear was white, marked with black
streaks, and dry, and that the tympanum did not exhibit its usual
transparency. Cotton, wet with a solution of the acetate of lead, was
introduced. Five days after, he remarked some scales in the lowest part
of the canal. To his great surprise, in endeavoring to remove them
with the forceps, without the application of any force, he brought away
a complete leaf having the exact form of the auditory canal, and with
an interior extremity which had been attached to the tympanum. The
patient at once recovered the sense of hearing, which was so acute as
to render the sounds of the voice painful, and rendered it necessary to
close the ear with cotton, until the organ could gradually accommodate
itself to its changed state. The surface from which this covering
was taken appeared red and injected, but soon acquired a natural ap-
pearance. A similar membrane was removed in detached pieces
from the other ear. A female, aged thirty-eight years, was similarly
affected, and was in a like manner cured.

The membrane was composed of several lamina, intimately united,
but presented no traces of organization. When subjected to the action
of fire, it gave out an odour similar to that of the hair and nails, and
is consequently regarded by M. B. as of an epidemic nature.

An extraordinary case of Lesion within the Uterus, with partial
reparation before birth ; By J. D. Jones, Esq., m.r.c.s.e. (British
and Foreign Medico-Chirurgical Review.) A lady in her first con-
finement had, from the ample size of the pelvis, a more than usually
speedy and easy labour, and was safely delivered of a male child of
of average size. The attendants were somewhat frightened at ob-
serving on the back of the infant, an extensive open wound, reaching
from the third dorsal vertebra, across the scapula, along the back part
of the numerous, to within an inch of the elbow. A large proportion

ISoO.] Periscepe. 571

of one part of the wound, with the exception of a nipple-like process
near the vertebra, was already cicatrized, so as to negative the idea of
the .wound having been produced during labour ; and other parts had
a healthy granulating surface. The skin and integuments only were
implicated, the muscles not being in the least affected. How came
this wound ?

It appears that the mother, during the whole term of pregnancy, en-
joyed more than her usual health, and took much walking exercise.
About six weeks before her delivery, when running down stairs, she
trod upon a cat, and made a sudden spring to the bottom (five or six
steps.) and alighting on her feet. A severe shock was felt at the
time, and slight faintness. Rest on a sofa and a glass of wine soon
rallied her ; but next day she had a slight sanguineous discharge from
the vagina, which passed off, and the circumstance might have been
forgotten but for the marked child. A blow, the funis, and the violent
and sudden contraction of the uterus, are briefly discussed and dis-
missed as causes of this remarkable phenomena; and it is referred to
the fall of the mother six weeks before as its most probable source.
The case is believed to be unique ; and it is pointed out as a warning
against a too hasty conclusion of guilt in the mother, should such a
wound be found in a recent state on the body of the offspring of an
unmarried female, in whom a simihar accident might possibly pro-
duce, together with the wound, premature labour and the death of
the child.

New Practice in Cases of Distorted Pelvis. (Med. Xews, from
Med. Times.) M. Delfraysse proposes to administer iodine to the
mother during the last two months of pregnancy, with the view of ar-
resting the development of the foetus in cases of distorted pelvis. The
following is the formula he employs :

R. Iodine, 3j ; ioduret of potassium, 3ij ; distilled water, j. Six
or eight drops to be taken every day in an ounce of any bland fluid.

The two following cases, illustrative of the effects of this practice,
may be worthy of record :

" A lady, whose pelvis was deformed, the antero-posterior diameter of
the outlet measuring three inches only, had lost several children
during delivery. The last was prematurely delivered at the age of
seven months, and died a few minutes afterward. Under these^cir-
cumstances, M. DelfVaysse resolved on making a trial of the iodine. It
was given every day during the last two months of gestation, and un-
der its influence the lady was twice delivered at the full period without
the slightest difficulty. The children were healthy and vigorous,
though not larger or heavier than the child expelled at seven months.
One weighed 22% ounces less than the first children born of the same
parent; the other weighed 23j ounces less.

M The second case \s ;>> also one of deformed pelvis, having previous-
ly given rise to several difficult labours, during which all the children
were lost. The patient having become pregnant for the sixth time,
was treated in the manner described above ; the child was born at

572 Periscope. [September,

the full period, strong and healthy, though weighing three pounds and
a half less than any of the former children. No artificial means
were employed. The child is now well, and strongly constituted^"

Extraordinary length of Umbilical Cord. (Boston Med. and Surg.
Journal.) Dr. G. N. Thomson reports a case which recently occur-
red in his practice, in which the umbilical cord measured five feet and
nine inches in length, and was entirely free from the varicose and
knotty appearances exhibited in most cases. The child weighed be-
tween six and seven pounds, and was very lean.

Case of Lactation in a Male. By C. W. Horner, M. D.. of Phila-
delphia. (Medical Examiner.) It occurred in the person of an
athletic American, named Charles Collins, aged 22 years, a black-
smith, working at his trade in New York. About the 10th of Februa-
ry last, his attention was first drawn to his left breast, which appear-
ed to be enlarging, and continued to increase in size for three
weeks, when he came to Philadelphia. After being in this city for
three weeks, he became quite anxious in regard to his condition, for
although he suffered very little pain, the mamma had become quite as
large as that of a female nursing. He therefore, through the per-
suasion of an aunt, was, on the 23d of March, induced to apply at the
Clinic of the Jefferson Medical College to consult the faculty of that
Institution. His case came up before Prof. Mutter, who, upon exam-
ination, found the mammary gland largely developed, and filled with
the lacteal secretion, which differed in no wise from that of a mother.
He could assign no cause for this freak of nature; his health was
very good, and the other breast natural. A soap plaster was pre-
scribed, and compression ordered to be kept up, which he persisted in
for full six weeks, when the gland returned to its usual size ; and when
I saw him this morning at Fairmount, where he now resides, it was
in every respect like the other.

On the Hydrostatic Test. By Dr. Casper. (Casper's Wochen-
schrift. Brit, and For. Med. Chir. Review.) Dr. Casper states, that
rhe very numerous opportunities he has had of investigating suspicious
deaths, enable him to protest against the doubts which have been
thrown upon the validity of this test. Of what value is the objection
derived from the possibility of emphysema pulmonum being present,
for who has ever seen a pathological emphysema in a new-born child ?
So, too, in speaking of the possibility of artificial inflation, we forget
the nature of the cases which practically come before us. They are
examples of solitary and clandestine delivery ; and who is to act the
perfidious part of infiltration ? Moreover, every one who has tried it
for himself must know how difficult it is to fill the lungs of a new-born
child with air, and only once in about ten times can it be accomplish-
ed to the extent sufficient to alter the indications of the test. The ob-
jection derived from the effects of putrefaction is more important, but

1850.] Miscellany. 573

the careful judicial physician will never be deceived even here. It
results from the author's repeated investigations, that the lungs are
among the organs which latest undergo the process of putrefaction ;
and we may with certainty declare, that if lungs taken from a fresh
or only slightly putrified body swim, they do not do so in consequence
of putrefaction. Even when the child and its lungs are in an advanced
state of putrefaction, the test may be of value when it furnishes a
negative indication; e. g. the lungs sinking, even when far advanced
in putrefaction, as Dr. Casper has frequently observed them to do.
A remarkable case occurred to him, in which the heart of a very
putrid child swam, but in which the lungs sank. As to atelectasis, it
is very rarely met with to a great extent in new-born children ; and
when it has been said to have been so, this has arisen from the products
of inflammation, which, unaided by the microscope, may easily hap-
pen, being mistaken for it. The author exhibited to his class the lungs
of a child who died when eight days old from pneumonia, and which,
throughout, were of the brownish-red colour and compact consistence
of those of a dead-born child, and even the smallest portions of them
sank in water. It is true that we very frequently meet with small
isolated patches of atelectasis in the lungs of new-born children, but
these should exert no influence in our appreciation of the test.

flleirual iHtstrllanii.

Dr. John Bell and the Medical Faculty of the University of Penn-
sylvania. We have received a pamphlet of some sixteen pages, entitled
"a Memorial to the Trustees of the University of Pennsylvania, " by Dr.
John Bell. It is an attack upon the Medical Faculty of that University,
provoked, we suppose, by the defeat of the writer in his late candidacy
for a professorship, for he alludes to his having been '"tripped up"
recently by a majority of that body. Dr. Bell thinks that the Univer-
sity is not what it was in former days, when its halls were " resonant
with the teachings of genius, fashioned by science, and adorned by
literature." He is particularly severe upon the Professors of Anato-
my, the Institutes, and Midwifery. Of the first, he complains that he
borrows no philosophy from Paley, snatches no poetry from Childe
Harold, or jest from Hamlet. The style of the Professor of the Insti-
tutes he charges with an obscurity which renders it unintelligible,
"belonging to the school of Jeremy Bentham, bating its philosophy."
He intimates that the soporific influence which the Professor of Ob-
stetrics might desire to exert over his patients with ether and chloro-
form, "overspreads his class when listening to his sedative discourses."
Dr. B. closes his pamphlet by intimating that the I'nivcr^ity of Penn-

574 Miscellany. [September,

sylvania has not in reality extended its lecture term to six months.
He says, " is there a continuous and connected teaching of his branch
by each professor during this period, in such a manner that the students
failing to attend in the first month, and going away in the last, are
made to understand that they lose an integral part of the courses of
instruction, and that an ignorance of this part will tell against them
in their examination for a degree ? Mere odds and ends of lectures,
theories taken up at random, during the first month of the extended
session, do not meet the requirements of the case nor the expectations
of too credulous friends."

We entertain a high regard for Dr. Bell, and we therefore regret
that he has published his " memorial." Such strictures, under existing
circumstances, do not come from him with a good grace. He is un-
doubtedly a gentleman of ability and distinction; but the public rarely
give much weight to charges prompted by personal pique, let them come
from what source they may. Recently Dr. Bell has been appointed to
the Professorship of the Theory and Practice in the Medical College
of Ohio, and is about to remove to Cincinnati. We have no doubt
that he will prove a valuable acquisition to that institution.

Who are the Regulars ? (Medical Gazette.) In variety of doctors,
New- York is beyond all England, and the distinction, if we could
enumerate them all, would be multitudinous and amusing.

1. Regular graduates, M. D's. who claim to be both Physicians
and Surgeons.

2. Honorary graduates, M. D's. many of whom are guiltless of any
education of any sort.

3. Fictitious M. D's. who may or may not be licentiates, and yet
they claim the title and wear it.

4. Licentiates of any county or state societies, who when honest,
prefix the letters Dr. to their names; though many of these fictitious-
ly assumed to be graduates.

5. Homcepaths, all of whom sign their names M. D. whether with
or without authority.

6. Hydropaths, ditto.

7. Magnetic and Mesmeric doctors, some of whom claim the title.

8. Paw doctors, who profess to cure by friction with the hand.

9. Indian doctors, who profess to have knowledge of aboriginal
remedies.

10. Cancer doctors, who promise to cure cancer without the knife,
and who apply arsenic and other caustic plasters.

11th. Seventh-son doctors, whose "laming cum by natur"

12. Thompsonian doctors, who use lobelia, cayenne, and steam.

13. Natural bone setters, who cure by dislocating and reducing all
the bones at pleasure.

1850.]

Miscellany.

575

14. Botanical doctors, who claim to reject all minerals, and rely
for remedies on roots and yaros.

And besides all these we have so-called oculists, and aurists, lung,
liver, kidney, and urine doctors, dyspepsia doctors, and a numerous
class of Lock Hospital, or secret doctors, with pile and corn doctors,
et id genus omne, whose name is Legion ; so that surely in this great
city no one need suffer without doctoring, or being doctored, in every
conceivable variety.

Thus far no mention has been made of the tribe of blood doctors
and pill doctors, and panacea doctors, and bitters doctors, and consump-
tion doctors, and the clergymen's sore throat doctors ; though many
of these are veritable M. D's. But our limits will not permit us to
enlarge at present, though we are sensible very many of the doctors
have not yet been named. Indeed some of them, it would be a shame
even to name, so shameless is their craft.

Our British brethren however have nothing to boast of in the way
of exemption from quackery. So far from it, we are indebted to
England, especially to London, for the worst examples among us ; but
it is fair to presume that many of them " left their country for their
country's good%"

Statistics of Medical Schools 1849-50.
and Surg. Journal.)

University of Pennsylvania,
University of the City of New York, -
Harvard University, v -

College of Physicians and Surgeons, N. Y.
Medical College of Ohio, -
Buffalo University, -
Yale College, -
Rush Medical College,
Albany Medical College, -
University of Louisville, -
Transylvania University, -
University of St. Louis,
University of Missouri, (St. Louis),
Medical College of Evansville, -
Indiana Central Medical College,
Starling Medical College, -
Jefferson Medical College,
Pennsylvania Medical College, -
Medical College of Georgia,
Berkshire Medical College,

(North Western Med.

Students.

Graduates,

438

111

23

49

42

115

27

16

120

44

100

26

376

113

92

32

110

110

40

6

50

10

154

516

211

106

34

179

44

93

23

Death of Dr. Griffith. (Phila. Medical News.) It is with feelings
of the deepest regret that we have to record the death of Robert
Eglesfeld Griffith, M. D., which took place in this city on the 27tli ult..

576

Miscella ny. Meteorology .

in the 53d year of his age. Dr. Griffith possessed fine talents ; in
addition to a through knowledge of his profession, he was familiar
with most of the branches of natural science, while in botany and
conchology he stood second to few in this country ; and his social
and moral qualities were of the highest order.

Southern Medical Reports. We announce to our readers that this
work has been received at the book-store of Thos. Richards & Son, of
this city. By reference to our July No. the object of this publication,
by Dr. Fenner of New Orleans, will be seen. As it richly deserves
the encouragement of the profession, we hope the enterprise will bo
generously sustained by every friend to medical science.

Dr. Buckland. This distinguished geologist, is now the inmate of
a lunatic asylum in England.

METEOROLOGICAL OBSERVATIONS, for July, 1850, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet. By Dr. Paul F. Eve.

>>

Sun
Ther.

Rise.
Bar.

Ther.

P.M.

Bar.

Wind.

Remarks.

1

73

29 77-100

93

29 70-100

s. w.

Sprinkle much thunder.

a

75

<: 75-100

92

" 75-1001

N.W.

jFair morning.

a

71

" 77-100

94

" 77-100

N. W.

jFair.

4

74

" 78-100

94

" 80-100

S.

N. E. storm at 2* p.m., 85-100.

5

72

< 84-100

92

" 80-100

s. w.

Fair rain at 9 p.m., 5-100.

6

72

" 84-100

89

" 80-100

w.

|Fair.

7

74

" 81-100

94

" 75-100

s. dr.

Fair sprinkle at 9 p.m.

8

73

" 77-100

86

" 75-100

s. w.

F. morning r. at 8 p.m., 60-100.

9

73

" 78-100

91

11 75-1 00:

s.

Cloudy thunder.

10

75

" 77-100

83

" 75-100

s.

Cloudy. [10-100.

11

73

" 84-400

87

" 83-100,

S. E.

Cloudy afternoon rain eve'g,

19

73

" 84-100

81

83-100

N. E.

i Cloudy.

13

71

" 83-100

88

" 77-l00;

S. E.

;Fair.

14

75

" 77-100

88

" 73-100

S. E.

iFair some clouds sprinkle.

15

76

" 71-100

92

" 73-100

S. E.

Fair morn'g thun. sprinkle.

16

76

" 75-100

93

" 74.100'

W.

Fair sprinkle.

17

76

" 73-100

94

" 64-100

n. vr.

; Fair breeze sprinkle.

18

76

<: 59-100

96

" 50-100

N.W.

Fair storm at 7 p.m., 10-100.

19

75

" 54-100

94

56-100

s. w.

iFair.

20

74

" 64-100

96

" 65-100

N.W.

Fair.

21

76

" 66-100

98

11 66-100

N.W.

(Fair.

22

75

" 60-100

95

" 52-100

W.

j Fair morning cloudy at 4 p.m.

23

73

62-100

73

" 65-100

N. E.

(Storm at 12 M. at night 1 in.

24

70

" 74-100

86

80-100

S. E.

Cloudy r. afternoon, 25-100.

25

74

" 90-100

90

90-100

S.

jSome clouds.

26

74

" 90-100

93

11 85-100

s. w.

[Some clouds thunder.

27

76

" 83-100

92

" 78-100

s. w.

[Some clouds thunder.

2s

76

" 83-100

91

1 84-100

s.

'Cloudy thunder sprinkle.

29

74

" 88-100

94

" 87-100

s.

Cloudy afternoon thunder.

30

76

" 86-100

98

" 83-100

s.

Fair.

31

74

" 83-100

97

85-100!

w.

Fair.

14 Fair days. Quantity of Rain 2 inches 95-100. Wind East of N. and S.

days. West of do. do. 17 days.

This has been one of the hotest months ever experienced South.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] RBW SERIES. OCTOBER, I860. |Xo. 10.

PART FIRST.

Original dammunicatians.

ARTICLE XXVIII.

Fungus Hcematodes icith Cases. By Paul F. Eve, M. D.,
Professor of Surgery in the Medical College of Georgia.

It is proposed in this article to present to the profession what
I have seen of Fungus Haematodes. I have nothing new to
offer respecting this formidable affection, no original matter
to propose, not even a suggestion to make for its relief or
treatment ; but as the observations of any one who has seen
cases may contribute something to the little known of this,
fortunately, not common disease, a faithful narrative of my
experience on the subject is the object intended by this com-
munication.

Fungus haematodes belongs to the family of adventitious
formations, class heterologous formations, order tissue, genus
cancer or carcinoma, variety encephaloid. This is the nosolo-
gical arrangement of Dr. Walshe, Professor in the University
College of London, and has perspicuity and propriety to com-
mend it for general adoption. A good classification of diseases
not only prevents confusion, but simplifies their study and
facilitates their acquisition : and there are certainly few affec-
tions requiring a more accurate definition than the one under
consideration. Hence the necessity for an inquiry into what is
meant by Fungus haematodes.

We need not quote the language nor present the opinions of
authors who have written upon the subject, in proof that differ-

\. s. vol. vi. \o. x. 37

578 Eve, on Fungus Hcematodes. [October,

ent terms have been applied to the same disease. Indeed, it is
only since the commencement of the present century that any
distinction was made among the species of cancer. Up to this
period all is confusion as regards encephaloid, schirrus and
colloid; three varieties now readily recognized by all who study
carcinoma. Fungus is at present spoken of by some (Burns,
Hays, S. Cooper, A. Cooper, Liston, James Miller, and others)
as a very peculiar kind of soft cancer, while others (Colles,
Walshe, Gross, &c.) make no difference between it and ence-
phaloid in general.

The late M. Breschet of the Hotel Dieu of Paris, proposed
that the word fungus should be restricted to those spongoid
tumors which have no external ulcerations, and that the term
fungosity be applied to denuded surfaces presenting luxuriant
projecting granulations. By adopting these definitions, and
adding hsematodes to the former, the Greek etymology of
which is resembling blood, we come at once to a correct com-
prehension of these two words in juxtaposition ; viz., a Mood-
like spongy tumor.

The true synonyms of Fungus haematodes, are, spongoid
tumor, (Burns) ; fungoid or spongoid disease, (Hodgkin, A.
Cooper) ; sanguine carcinoma, (various French authors) ; me-
dullary fungus, (Maunoir) ; cerebriform or encephaloid tumor,
(Laennec).

Dr. John Burns, F.R.S., regius Professor of Surgery in the
University of Glascow, was the first to describe this affection.
This was in 1800, and since then it has been examined by many
distinguished pathologists. Little, however, has been added to
the description of this disease as published in Dr. Burns's Prin-
ciples of Surgery, London edition, 1838. He says : " It begins
as a firm elastic swelling, which communicates to the feel the
idea that a fluid is contained under a firm fascia, or resembles
that which would be communicated by a sponge very tightly
tied up in a bladder, on which account I have called it spongoid
tumour.* When pressed with the finger, the point yields a
little, but rebounds with elasticity when pressure is removed ;
no fluctuation, however, is discovered in a large tumour, but

* Tumor, and yet every author who alludes to or quotes Burns, says he calls
the affection spongoid inflammation, [p, f. e.

1850.] Eve, on Fungus Hcemalodes. 579

merely an elasticity of individual points. This is a circum-
stance which in this and other much less formidable diseases,
indicates not the existence of matter, but merely of a very tense
state of the skin produced by a firm but compressible swelling
of the parts below the swelling, or a lymphatic packing between
it and the skin, as I have noticed on a former occasion. Some
parts of the tumour feel firmer and harder than others, but the
surface of the tumour is at first in general equal. Some degree
of pain, generally shooting, sometimes deep and gnawing, is
early perceived ; presently the surface becomes unequal, and
projects at one or more points ; these soon become discoloured,
and now, if not earlier, the lymphatic glands in the course of
the absorbents, become somewhat enlarged, the projections
become more prominent, redder, or more purple, the skin gives
way by a species of sloughing or abrasion, and the tumour soon
sprouts out, and at the same time its exposed surface discharges
a bloody serum. This surface, which is very vascular, becomes
covered, more or less completely with an ash-colored kind of
lymph. It discharges much thin, red, or saffron-coloured
serous fluid, whilst the vessels, particularly the veins, often
discharge pure blood. A large tumour may have several of
these exposed excrescences, which, passing for bloody fungi,
things which have no existence in any disease, have procured,
for this tumour, from Mr. Hays, the name of fungus nematodes.
Such excrescences are not fungous growths by granulation, but
protrusions consequent to the expansion of the tumour ; they
are elevated like a cauliflower beyond the tumour ; they are
soft to the feel ; and this decided elevation, this softness, the
elasticity of the tumour, and the absence of general hardness,
at once distinguish the disease from cancer. The skin for a
little way around the projections is inflamed, perhaps slightly
excoriated, the discharge increases, and becomes foetid, per-
haps haemorrhage becomes more frequent, the pain increases,
the health suffers greatly, the patient wasting away, till worn
out by suffering and increased debility, life be destroved. If
the disease be long protracted, the lymphatic glands swell
greatly, and assume the appearance of the original tumour.
By dissection, the tumour is found to be made up of various
compartments of different sizes and shapes, formed by the inter-

580 Eve, on Fungus nematodes. [October,

sections of a membranous substance. The smaller compart-
ments, which we suppose to be those of most recent formation,
are filled with grayish, soft substance, at first sight resembling
the foetal brain, but on more minute examination it seems of a
more cellular or organized texture. The larger, or what may
be considered the more advanced compartments, contain a
bloody substance, sometimes fluid, sometimes solid like coagu-
lum, or intermixed with brainular albuminous substance, so as
to give such portions of the section a' mottled appearance like
jasper. At those parts where the tumour felt externally hard,
the indurations are found to proceed from a thickening of the
intersections. The muscles in the vicinity become converted
into a substance like liver, and the bones become soft and
spongy. There is no part of the body exempt from attack of
this disease, and it may often, but not always, be traced to ex-
ternal violence."

Prof. James Miller, of Edinburgh, in his Principles of Surge-
ry, states, that in order to constitute a true Fungus haematodes,
three things are essential ; a fungus projection of morbid struc-
ture, that it be dark and blood-like and that it bleed more or less
profusely.

In the Cyclopedia of Practical Medicine, edition 1845, Dr.
W. Kerr says, fungus is "a morbid condition of the body,
evinced by the development of an elastic uneven tumor, or
tumors, not painful in their early stage, and becoming so only
by implication with surrounding parts ; tending to ulceration,
and by ulceration presenting to view a soft and spongy fungus,
rapid in its growth, readily bleeding in vascular textures, and
emitting a peculiar serous discharge of a very fetid odor, more
or less colored with blood."

There are two distinct structures entering into the formation
of Fungus : one is the contained parts or brain-like, blood-like
pultaceous mass ; the other is the containing areolar tissue,
which is remarkably thin. This divides the tumor into lobes,
and conducts into it numerous blood-vessels which increase in
proportion to the development of the disease. Injections pass
into the arteries and the veins, but their coats are found to be
greatly attenuated. Prof. P. Berard, now Dean of the medi-
cal faculty of Paris, detected his injected material only in the

1850.] Eve, on FSingut Hcematodes. 581

arteries, nothing having penetrated the veins of the tumor.
This was afterwards accounted for by observing that the venous
system of the encephaloid mass was filled with the cerebral
matter, and consequently the injection could not here penetrate.
Lenoir, Thibault, and Bernutz, subsequently to the above ex-
periment, presented to the anatomical society of Paris, instances
of both veins and arteries in this affection fully injected. Vidal
(de Cassis) in his Pathologie externe et de Medecine operatoire,
declares that neither nerves nor lymphatics have been traced
in encephaloid degeneration. Dr. Gross, in his Pathological
Anatomy, says, nerves probably exist in considerable abundance
in this disease ; he even supposes they may be of new formation.
We cannot but think further proof is required to establish the
fact that either nerves or lymphatics exist in Fungus.

As regards the organization or nature of encephaloid degen-
eration, we know but little. Chemistry has taught us by analysis
that the contents of the tumor not only resemble brain in ap-
pearance, but that its actual composition is cerebral ; the ele-
ments of both being precisely alike. About one-half of the
entire mass is' albumen the same is true of the other varieties
of cancer, schirrus and colloid. So entirely does encephaloid
compare with the structure of the brain, that Maunoir of
Geneva, ventured the opinion that it was furnished by the
nerves ; and Dr. Gross, now of the medical department of the
Louisville University, conjectures that the arteries become
surcharged with this matter, and instead of its being converted
into cerebrum, cerebellum, or spinal marrow, is poured out per
errorem loci into the tissues of the body. The opinion of Prof.
Carswell, of London, is, that encephaloid matter, like coagulable
lymph, is endowed with a high degree of vitality, by virtue of
which it creates its own blood-vessels, and by anastomosis
these communicate with the circulation of the surrounding
parts. To this independent origin of arteries and veins, to
which our friend, Prof. Gross, can see no particular objection,
we cannot subscribe. All adventitious formations are supplied
with blood by the extension and prolongation of vessels from the
neighboring tissues. Dr. Hodgkin declares that the idea of new
formed vessels in encephaloid is totally inadmissible. M. Cru-
veillier affirms, too, that arteries of new formation are never
found in accidental tissues.

582 Eve, on Fungus Hcematodes. [October,

On the 25th of June, 1850, the distinguished Orfila read a
memoir before the academy of medicine on the subject of de-
tecting cerebral matter. The occasion which induced the
experiments proving that by concentrated sulphuric and hydro-
chloric acids together with the microscope, the smallest portion,
even when dried upon the clothing, could be established with
certainty, was the commission of a murder in France, in which
the prisoner presented a small stain, supposed to be from brain,
on his shirt, corresponding to his shoulder. This celebrated
chemist has satisfied all, without a doubt, that with the micro-
scope and by the two acids mentioned it is possible, under
almost all circumstances, to recognize cerebral matter, for their
re-action upon brain differs from that obtained upon all other
known organic substances these never producing with it the
least trace of blue, but a dirty gray or red color. Now, whe-
ther this test can be applied to encephaloid matter, we know
not. The experiment is a curious one, and we hope will soon
be tried.

Fungus nematodes is the result of perverted nutrition
and secretion. The microscope reveals this substance to be
produced by what is known as the cell-theory. By this
doctrine the cytoblasts are deposited, and the tumor thus ac-
quires volume ; its size and form being determined from the
resistance or impressions communicated to it by the surround-
ing organs or tissues. It is, of course, derived from the blood,
but whether this fluid is primarily affected in this distemper or
not, is a question still undecided. Velpeau, Cruveilheir, An-
dral, Langstaff, and Berard, have each announced the detection
of carcinomatous matter in the blood, and Prof. Carswell now
advocates its origin there. But supposing this t'heory true, and
the opinion established that the blood was the sole primary
seat of the encephaloid degeneration, how are we to account
for the malignancy of this production ? Is there not something
superadded to the brain and blood-like matter which consti-
tutes the very disease in question ? The mere deposit of cere-
bral substance in an organ will not produce a highly pernicious
tumor, and bring about a cachectic condition of the system.
We know in reality nothing of the nature of Fungus, and why
or how malignancy, local or constitutional, apart from chemi-

1850.] Eve. on Fungus TIcematodes. .r>83

cal poisons, originates or is created. What know we of animal
poisons, either intra or extra human? Precious little!

The symptoms of Fungus nematodes are generally quite
obscure in its early stage. It may attack at any age, but is
chiefly met with in early or adult life. It may even commence
in intra-uterine existence, which we confess points to a dis-
eased condition of the blood. Mr. Travers and Sir Astley
Cooper saw a case of congenital encephaloid of the eye, in
which that organ at birth was as large as a walnut.

The first physical change observed in an organ or part af-
fected by Fungus is swelling or the production of a tumor.
Augmentum morbosum is more true of this than of any of the
species of carcinoma or cancer. Berard saw one in the thigh
of a female as large as the body of a man. We have measured
one at the shoulder-joint over thirty inches across. In its inci-
piency attracting but little notice, a blow, injury, or some other
violence may occasion the tumor rapidly to enlarge. Fluctua-
tion is now often so evident that a puncture has not nnfre-
quently revealed the error of diagnosis. The contents of the
Fungus are not of the same consistence, some parts may be as
soft as clotted blood, and others as hard as leaf-lard. Dupuy-
tren, believing the elementary tissue of encephaloid to be
erectile, sets down pulsation as one of the peculiarities of
the tumefaction. We think this sensation has been manifest
in some cases, but do not consider it a characteristic of
Fungus haematodes. This would certainly confound it with
aneurism. If we were to venture an opinion respecting
the peculiarity of the tumor, it would be its persistent obstinate
nature being amenable to no course of treatment, progressing
slow at first, then rapidly and continuously augmenting to
ulceration and destruction of all invaded tissues.

Pain is not a constant or characteristic symptom of Fungus.
There is no peculiarity respecting it. While all patients suffer
more or less, during the development and progress of the affec-
tion, some complain only of the distention in the parts affected,
a few of sharp, cutting or gnawing pains. It is, moreover,
generally intermittent. One told Dupuytren it was like flashes
oflightning.

As a local symptom even hemorrhage itself is only manifest-

584 Eve, on Fungus Hcematodes. [October.

ed after the period of ulceration. The blood is chiefly venous,
but is also arterial. There is no pathognomonic sign of ence-
phaloid so long as its envelopes preserve their integrity. The
brain-blood-like structure alone makes evident the diagnosis.

Fungus originates every where ; it respects neither internal
nor external organs; it frequently co-exists in several of them.
In Velpeau's celebrated case, in which the patient survived six
years, it invaded nearly the whole body. Unlike schirrus. it
affects many parts at the same time. For the eye, the ex-
tremities, but particularly the neck and shoulders, it has most
frequently declared its partiality.

Although the local symptoms of this disease are obscure and
insidious, the general system suffers so greatly as to be soon
impressed by it. This is made manifest by the loss of appetite,
impaired nutrition, hectic but without much fever, and a sallow
greenish cast of the countenance. Great and evident consti-
tutional distress exists sooner or later in all cases.

As we have confessedly no pathognomonic symptom, either
local or constitutional of Fungus, when other means fail, a punc-
ture may be made, and then any other further proceedings at
once executed. As soon as the nature of the tumor is revealed,
its total extirpation should immediately be performed.

This is one of the most formidable of all diseases few affec-
tions are so malignant. Dr. Burns says there are few instances
of permanent success attending operations performed after ex-
crescences had taken place. Dr. Walshe uses similar lan-
guage, in stating that few authentic cases are recorded of
permanent recovery after ablation of this affection. In Dr.
Allan's case, death from reproduction occurred after the fourth
operation. This is the sad experience of all with Fungus
hsematodes, with scarcely an exception : it is fully confirm-
ed by our own experience. Indeed, the great Scarpa laid
it down as a law, that ablation of encephaloid invariably has-
tens death. Graafe, the late surgeon-general to the Prussian
army, whose acquaintance we had the pleasure to make in
Berlin, about the time this declaration was published in the
Gaz. Med. de Paris, (1835,) contradicted this by declaring he
had often extirpated Fungus haematodes, without any relapse
having occurred for sixteen, eighteen or twenty years. In

1850.] Eve, on Fungus Ilcematodes. 585

deciding the question for an operation in cases of encephaloid,
we have been influenced by the considerations that all other
means have heretofore failed, and extirpation or amputation
may relieve the patient and retard the development of the dis-
ease, though neither should cure.

The following cases have come under our immediate obser-
vation in private practice.

Case 1. Fungus hccmatodes of the Shoulder a seton appli-
ed death of the patient in about six months. This occurred
in a son of a physician, but not a practitioner of medicine at the
time. A successful planter, and now a merchant, Dr. P. had
recently moved to our city : in 1837, 1 was invited to see, with
the late Dr. Antony, Drs. Carter and Dugas, one of his sons
aged seven. He had a large tumor under the right clavicle
and scapula. It projected both below and above the former
bone, and bulged out the latter considerably from the thorax.
It was soft, doughy, elastic and lobulated. The skin over the
swelling was not inflamed, neither was pulsation detected in it,
nor was it painful when handled. There existed also another
tumor in the left iliac fossa, which, though large and distinct,
wras undefined. The little boy seemed in great distress, had
hectic fever and sallow complexion.

In the consultation I suggested Fungus, and the plan of treat-
ment and prognosis not being satisfactory to the family, the
patient was soon taken to their country-seat in Greene county,
where his father subsequently passed a seton through the tumor
at the shoulder, and the patient died in some six months from
the commencement of his attack, exhausted by hemorrhage and
the disease.

Case 2. Fungus of the Face operation death in about
eight months after it. August 18th, 1840, I was consulted by
the Rev. Mr. D., of Edgefield village, aged about 40, for a very
painful tumor in the right cheek. It occupied a position in
front of the parotid gland, was under the masseter muscle and
in contact with the coronoid process of the inferior maxillary
bone. It was the size of an egg. No cause could be assigned
for its origin. Dr. Dugas saw the patient with me ; the acute

586 Eve, on Fungus Hcematodes. [October,

suffering was attributed to pressure upon the neighboring
nerves, but neither of us would venture an opinion as to the
nature of the tumor. Mr. D. attempted to visit Charleston, to
see my friend Dr. Geddings, but found the motion on the rail-
road so to aggravate his sufferings, that he stopped in Aiken.

On the 11th of September the tumor was laid open by an in-
cision parallel to the duct of Steno and the facial nerve, and
encaphaloid matter mixed with blood rapidly poured out. The
cyst-like cavity was emptied and the hemorrhage restrained by
pressure with compress and bandage. The outer surface of the
coronoid process and down to the angle of the lower jaw-bone
could be felt denuded of periosteum. Our patient, made aware
of the character of his disease, returned home in a few days
after this operation, with sad forebodings of the future. A
large, bleeding Fungus, soon appeared at the opening made by
the knife, which nothing applied could repress.

The 6th of October, I found Mr. D. confined to his room, pre-
senting on the right side of his face a tumor the size of a cocoa
nut, the irregular surface of which was studed over with large
spots of coagulated blood. I could compare it to nothing so
well as the fungous growth occasionally seen on luxuriant corn-
stalks, except that this was blacker. The foetor and repeated
hemorrhages in this case proved insupportable to the system,
and death soon put an end to the patient's sufferings.

[This case I have alluded to among those published on opera-
tions upon the jaws.]

Case 3. Fungus of the left Lumbar Region Speedy death.
On the 8th of August, 1844, I was sent for to consult with Dr.
Keith, then of So. Carolina, now of Alabama, in the case of
Mr. L., one of his patients. He was a youth of some twenty
years, and had been afflicted about three months. His disease,
though acute, was undefined ; he was evidently cachectic, and I
was specially requested to ascertain the nature of a large tu-
mor persisting in the lumbar region. This was only under the
skin, and about eight by four inches in size, uneven on the sur-
face, lobulated, elastic when pressed upon, painful when com-
pressed, apparently of different consistence, and presenting no
distinct pulsation or fluctuation like pus or serum. It was pro-

1850.] Eve, on Fungus Hcematodes. 587

nounced a Fungus. The patient died soon after my visit, and I
learn nothing transpired in the case to affect this diagnosis. I
do not recollect if ulceration with hemorrhage occurred, but
Dr. Keith was of the same opinion respecting the tumor still
doubts may exist as to our correctness.

Case 4. Fungus of the Inferior Extremity Speedy death.
December 21st, 1844, I was called near to Sandersville, to see
with Dr. Haynes a patient, in whose family he was the attend-
ing physician. A lad of sixteen, son of Mr. W., had attempted
in a carriage to reach me, but becoming exhausted by the way,
returned home. He had a tumor over the instep of the left
foot, rather flat, as if confined by the fascia, and a much larger
one behind the internal malleolus ; besides these, there was un-
defined tumefaction in the iliac fossa of the same gide, and his
lungs evidently had deposits in them. Amputation was unhesi-
tatingly declined, and the patient sank a victim to disease in a
few weeks. That this was a case of Fungus I have never en-
tertained a doubt. The local and constitutional symptoms in
it were quite positive. Dr. Haynes, an experienced and most
judicious practitioner, who had only incidentally examined it
previous to my visit, was equally certain.

Case 5. Fungus of the inferior Extremity Speedy death.
During the autumn of 1846, I saw a lad of eleven years old,
from Lincoln county, having a large tumor on the external sur-
face of the right leg. It was situated just below the head of
the fibula, under the skin and fascia, of the size of the largest
orange, but more ovoid. No special cause could be assigned
for it. It presented more the character of a Fungus than any
other described, and such it was pronounced to be. This
youth returned home, and all I could learn concerning him was
a rapid development of his disease and speedy death. There
are some doubts respecting this case.

Case G. Fungus of the Shoulder Speedy death. This was
the case of a negro girl about 17 years old, sent to me in 1847,
by the Rev. Mr. S., of Creene county. In situation the tumor
was similar to case 1, but immensely greater in size, measuring

588 Eve, on Fungus Hcp.matodes. [October,

across the shoulder-joint thirty-one inches. It projected so
much posteriorly, under and beyond the scapula, that the patient
could only lie upon the abdomen, and then she inclined upon
the opposite side. This tumor had been punctured by a lancet
and there issued dark-colored blood. It is deemed unnecessary
to detail the local and constitutional symptoms exhibited in this
case, so plain and manifest did they point to Fungus hsematodes.
There was but one opinion respecting it and the patient died
soon after her return home. How her death occurred, whether
from hemorrhage, fungous excrescences, &c, I could never
learn; but recollect her master saying the case terminated in
a short time after reaching home.

Case 7. Fungus of the Axilla and other parts operation,
rapid reproduction and death. May, 1848, Mr. McM., of Ma-
con, called upon me for an opinion about a tumor in his left axilla.
This was of the size of a goose-egg, felt fibrous, appeared to be
an enlarged gland and was obscure as to its source. The pa-
tient had received a blow three or four years ago, which he
supposed had injured his back, and had ever since repeated
attacks of hsematuria. He was now evidently in a bad state
of health, and dated the tumor to be only of a few months
growth. There were also other morbid enlargements, about
the size of rifle-balls, in other regions of the body. The parox-
ysms of nephritic distress were irregular, occurring about every
two to four weeks and were aggravated by rough exercise.
The tumor in the arm-pit was becoming daily more painful.

Mr. McM. had tried several plans of treatment, both for the
hsematuria and swelling in the axilla. He believed there was
no connection between the two affections. He was now placed
upon local and constitutional means, with instructions that
should the tumor continue to enlarge and distress him, it ought
to be removed. In less than a month after his return home, I
was telegraphed to operate upon him. There was now, in ad-
dition, a sub-clavicular tumefaction. Not yet positive as to the
nature of the disease, a deep incision was made into the tumor
situated in the axilla. Blood and encephaloid matter of larda-
ceous hardness were turned out, and then the tumor was fully-
extirpated. Being now certain I had to deal with Fungus, and

1850.] Eve, 071 Fungus Hcematodes. 589

knowing how little could be done for one whose system was so
completely affected by it (all doubts being removed as to the
source of the bloody urine), a most unfavorable prognosis w7as
left with his physicians and friends. Although attended by
excellent practitioners, the wound made in the operation never
entirely healed, the disease rapidly progressed; our patient fell
then into the hands of quacks and died in about six weeks
after the removal of the tumor from the axilla.

Case 8. Fungus of the Neck two operations death. On
the 25th of January, 1848, I removed before the class, from the
neck of a negro man, from Warren county, a tumor about the
size of a turkey-egg. Believing there was nothing special
about the morbid production, no minute examination was made
of it. The 28th of May, 1849, this patient was sent again to
me, having now a much larger tumefaction under the cicatrix
of the neck, than he had presented before. Still undeceived as
to its character, a second operation was attempted. While
endeavoring to dissect it out of the sub-mental region of the
right side, blood and brain-like substance poured out ; so copi-
ous wras the hemorrhage, and now convinced of the character
of the complaint, the operation for extirpation was abandoned,
a sponge was thrust into the wound and pressure applied. In
a few days the patient w7as able to leave for home, where he
lingered some months.

Case 9. Fungus of the inferior Extremity Amputation
wo return in ten months. December 3d, 1849, Col. G., of South
Carolina, brought to me one of his negro men, aged about 40?
who says,.eleven years ago he received a blow just below his
left knee-joint. A tumor has gradually been developing ever
since and has now attained the size of a large orange. With-
in a few weeks it has ulcerate^ and at a small nipple-like pro-
jection has bled copiously, repeatedly and spontaneously. A
probe introduced gives great pain, and its withdrawal is follow-
ed by hemorrhage. The volume of the tumor projects between
the tubercle of the tibia and the internal surface of the joint.
It is under the skin and fascia, but does not penetrate the articu-
lation. The leg cannot be fully extended on the thigh.

590 Eve, oTi Fungus Hozmatodes. [October,

In the presence of the medical class, chloroform was admin-
istered, the ulcerated opening in the tumor enlarged to verify
the diagnosis that it was a case of Fungus, when blood and
brain-like matter flowed out copiously. Amputation of the
thigh was immediately performed. The head of the tibia was
found involved in the destruction of parts attacked, the knee-
joint being only partially affected by it. The patient had a
good recovery, and was ready to return home in three weeks
after the operation. There has been no return of the disease
yet, none from special information received six months after-
wards.

Case 10. Fungus of upper Extremity amputation, recent
case. This was a case occurring in a little girl, aged six years,
daughter of Mrs. H. of So. Carolina. The Fungus developed
itself in the muscular part of the left fore-arm, involving all the
tissues and distending the skin in nearly every direction. For
such an age it was an enormous tumor, and had to be suspend-
ed in an handkerchief around the neck, and when seated was
supported by the little sufferer in her lap. There was also a
flattish tumefaction in the sub-clavicular region of the same
side. From the great swelling above and below the upper arm
appeared quite small. The patient presented the usual cachec-
tic condition of the system.

Mrs. H. had come to Augusta during my absence at the
meeting of the American Medical Association at Cincinnati,
and in June, 1850, revisited it in search of relief for her daugh*
ter. She was told little could be done for her child. An opera-
tion, while it might disembarass and relieve the patient for a
time, did not promise a cure even remotely death sooner or
later was considered inevitable in the case. She asked for the
respite, and with some reluctance the arm was amputated.
Strange to say the stump heale^by the first intention ; it may
be there was not sufficient vigor remaining in the system to
produce inflammation in the wound. The swelling below the
clavicle has somewhat subsided, and my patient continues to
improve for the time in the country.

The amputated member was put into alcohol, but the tumor
burst about the middle of the fore-arm, and has continued to
pour out a large mass of encephaloid matter.

1850.] Eve, on Fungus Haimatodes. 591

Case 11. Fungus of the Female Mamma operation, recent
case. July 13th, 1S50. I removed a voluminous breast of a ne-
gro woman aged about 35, sent to me by Mr. G. of So. Carolina.
The tumor presented a mixed character, some parts soft, others
firmer. There were no enlarged glands in the axilla. The
patient complained greatly of the pain in the distended mamma.
This was removed under chloroform, and laying it open a
sanious fluid escaped to the extent of two or three ounces, and
then were encountered masses of lardaceous-looking substance,
which, when broken up, resembled brain. An unusual number
of vessels were ligated, the hemorrhage having been considera-
ble during the operation. The patient remains well so far.

Case 12. Fungus in volving the Parotid Gland recent oper-
ation. This case has just been operated upon, and I was in-
disposed to admit it Fungus haematodes, thinking I might be too
much influenced in making a decision, by the fact of being
engaged at present in investigating this disease. Having a
very ill patient in the country prevented an application of the
microscope or chemical reactions in verifying the diagnosis.

Mr. H., of Lincoln county, aged about 30, called, Sept. 5th,
to consult me about a tumor situated over the parotid gland of
the right side. Two years ago he observed a small pimple-like
projection in this region, which gave little inconvenience until
recently, but had gradually enlarged to the dimension of an egg.
A week or ten days since it was punctured, when dark blood
freely issued mixed with matter, but which the patient admits
might have been cerebriform. The tumor was lobular, pre-
senting a small opening with reverted edges, and covered with
cotton and a handkerchief to prevent a constant disposition to
bleed. Probing produced pain and hemorrhage. The skin
covering the enlargement was greatly distended, thin and of a
dark purple color. The patient was of the sanguine tempera-
ment, with a constitution apparently unaffected specifically.
He complained of sharp intermitting pains through the part
affected. This could not be distinctly isolated from the parotid
gland. Assisted by Dr. Litten, of Alabama, (incidentally here.)
and others, the whole diseased mass was included in an ellipsis
of one and a half by three inches, which was followed by a

592 Eve, on Fungus Hcematodes. [October,

vigorous haemorrhage. As was apprehended, a portion of the
affection dipped downward into the gland beneath it. This
was fibrous, or even hard as schirrus, while the other portions
removed were soft and brain-like. Finding ligatures impracti-
cable, a thick compress with roller and then a handkerchief
arrrested the bleeding. The dressing was removed on the
second day, and the exposed surface cauterized. Iodide of
arsenic internally, and the actual cautery as a local application,
were the suggestions offered to arrest a reproduction of disease
should it occur in this case.

I recollect being consulted in two other cases supposed to be
Fungus, and am now engaged in one in which unfortunately too
many symptoms of this dread affection are present, but cannot
with propriety enumerate them among those here reported.
Indeed, this article is not concluded without expressing the re-
gret that greater distinctness and more minute description of
the instances referred to could not be obtained. To several
letters requesting information and particulars, no answers were
received. In pathological anatomy the microscope is emphati-
cally of recent application, and even now morbid alterations are
not well defined by it. By it I have recognized the fusiform
nucleated cells, said to be characteristic of cancer as a specific
disease.

Of cases of encephaloid fungosity or ulcerations, as distin-
guished from Fungus haematodes, I have seen several, have
operated on some of them, but have never succeded in curing
one. In only one instance have I removed a carcinomatous
disease in which death or reproduction has not occurred, and
that was an ulcer involving the whole mammary structure,
resembling a cauliflower excrescence.

RECAPITULATION.

Region affected.

Neck and Shoulder, 3 cases*

Face, - - 2 "

Trunk, - 2 "

Inf. Extremity, - 3 "

Upper do. - 1 "

Mamma, - 1 "

Total, 12 cases.

Causes of the Disease.
Uuknown in - 11
Attributed to blow in 1

Total, 12 cases.

Result. No operation in 4

cases. Of 7 operated upon by

me, 5 were probably benefited.

1850.] Gautier, on Leucorrhaa. 593

ARTICLE XXIX.

Leucorrhoea: JEliology, Pathology and Treatment. By Wm.
J. Gautier, M. D., of Brazoria, Texas.

The present century is distinguished from all that has pre-
ceded it by the most important discoveries and rapid improve-
ments in the Arts and Sciences. Medical men have reason to
be proud, that in a profession whose aim is to relieve human
suffering," the advance in knowledge has kept pace with that in
any other branch of science. And it is a matter of peculiar
gratification to the faculty, that in a disease, or set of diseases,
involved in so much obscurity, and producing a train of suffer-
ing as wide as the human family, the discoveries and improve-
ments have been so marked that we are enabled to approach
them in their most formidable condition with a strong hope of
relief, and permanent cure : I allude to functional and organic
diseases of the uterus. The invention and use of new instru-
ments for examination, the application of new principles, and
the prying research of a deeper philosophy, have unmasked
these "protean"' forms of disease; by the aid of which the
intelligent practitioner of the present day may come to the
relief of suffering woman.

Uterine diseases are more numerous, and far more complica-
ted than was formerly imagined. That organ is alike the seat
of life and disease. Its great functions and nervous connec-
tions expose it to constant derangement. The Indian woman,
borne down by the drudgery of a camp-life, and the luxurious
lady, are alike its victims.

Those improvements which promise cure, or even mitigation,
to suffering so wide, become, at least to the female sex, like the
air we breathe, a blessing and a common inheritance. And to
whom are we indebted for these improvements in uterine
pathology? In Europe and America, the voice oft he profession
is loud in bestowing imperishable honors upon the names of
Velpeau, Bennet, Whitehead, Jobart, and, though last, not
least, the illustrious Madame Boivin, to whose labors France
owes much for the reputation it enjoys, as the land where dis-
eased woman may find a physician and a cure. Long may the

jr. s. vol. vi. \o. x. 38

594 Gautier, on Leucorrhcea. [October,

impulse that has been excited continue to animate the medical
profession, until an entire knowledge of uterine disease, with its
means of cure, has been ascertained. The spirit of research
which, in Europe, is fast casting off the dogmas that have
weighed down medical literature, is finding its way to our
American continent, and is kindling into a glorious enthusiasm
which promises much for "Medical Reformation."

The diseases that I have selected, as possessing material for
several communications, are 1st, Leucorrhcea. 2d, Indura-
tion of the Os Uteri. 3d, Ulceration of the Os Uteri. 4th,
Prolapsus Uteri. 5th, Yesico Vaginal Fistula.

The treatment of each of the diseases selected is illustrated
by the recital of cases, as they occurred in the practice of my
intelligent and worthy preceptor, Doctor E. Stephens, of Bra-
zoria.

The first disease in the order of arrangement, and upon
which I propose to offer some general remarks, is Leucorrhcea,
a discharge from the female genital organs, which varies in
quality, and quantity, in a ratio to the increase of functional
derangement, or lesion of structure. It is of considerable value
in practice, to discriminate between the character of the differ-
ent vaginal discharges, for frequently they will be found to
throw considerable light upon the cause or causes which pro-
duces them.

Sir Charles M. Clark has gone so far as to arrange and clas-
sify diseases of the uterus according to the condition of the
vaginal discharge; and though many objections may be urged
against such a system, still we must acknowledge that good
has resulted from the investigation of the nature of vaginal
discharges.

Those who have examined the observations of the older
writers on this disease, cannot fail to detect a prevalent error :
that of attaching too much importance to a single, or a few
symptoms ; or of overlooking the disease, and treating the re-
sult or phenomena of the disease as the pathological derange-
ment. Symptoms are essential to the formation of a correct
diagnosis, but in the application of our remedies we must look
upon the external evidences of disease. From the deficiency
of our knowledge on uterine diseases, it may be difficult always

1850.] Gautier, on Leucorrhasa. 595

to separate the symptoms from the disease ; yet it is essential
in order that our diagnosis may be consistent, and that our
treatment may be based upon rational assurances. To illustrate
the point. The hasty examiner would be too apt to treat
leucorrhcea as an idiopathic affection, and an attempt to cure,
would, in the majority of cases, result in failure ; while the
more skilful would look upon the discharge as symptomatic of
functional change, or lesion of structure, and the quality of the
discharge as a special diagnostic mark.

According to the recent researches of Mr. Whitehead, leu-
corrhcea exists under two distinct forms, both as regards the
secreted fluids and the sympathetic disturbances by which such
are attended ; and also as to the nature, extent, and precise seat
of the lesion upon which each depends.

The two forms are Mucous and Purulent. There are two
well-marked varieties of mucous leucorrhcea, distinguished by
the condition of the discharge, and the source from whence it
issues. In one, the secretion is transparent, glairy, and com-
municates no stain. It indicates a state of high vascular ex-
citement of the mucous membrane near the os uteri. The
other variety is an affection of the lining membrane of the
vagina. It is characterized by an opaque discharge of pure
whiteness, and exhibits an intense acid reaction. The vagina
is much relaxed in this form of the discharge.

Purulent leucorrhcea, from its being characterized by the
appearance of pus, indicates a state of suppurative action, the
discharge is of a yellowish or greenish color, and communicates
a deep stain to the linen. It has an alkaline reaction. The
vagina is not usually implicated in this form of the disease, but
the lower part of the uterus is in a state of hypertrophy, some-
times indurated, and generally presents an ulcerated or exco-
riated surface. Of the two varieties, purulent leucorrhcea is
more fatal in its ultimate tendency, and unless the condition of
the uterus upon which it depends is relieved sterility is often
the result, or if conception should take place, abortion is the
inevitable consequence. Recent researches as to the cause of
abortion have established the fact, that the condition oi' the
parts which gives origin to purulent leucorrhcea, is a very com-
mon cause of miscarriage.

596 Gautier, on Leucorrhoea. [October,

The causes of leucorrhoea may be arranged under several
heads : 1st. Derangement or prevention of the general health.
2d. Lesion of structure. 3d. Causes that cannot be classified
under any special order, but include loss of uterine function,
mechanical irritants, and the application of a specific virus.

The difficulty attending any attempt at an unobjectionable
classification of causes, from the very nature of the subject, is an
arduous task. To say that a single cause can be productive of
several effects, is an illogical assumption, for it is demonstrated
that no two effects follow the same cause, nor can a simple
increase or diminution of a cause, give origin to different effects.
There must be some essentia] element in each causation which
impresses a difference in the intensity and character of diseases.
What this element is we know not; it is a something which
is capable of developing in one a fever, the second a myolitis,
and in the third a neuralgia.

Trcatn/tent. The first form, or mucous leucorrhoea, as it
depends on an ancemic or debilitated state of the general sys-
tem, must be cured by the exhibition of invigorating tonics ;
these, by giving tone to the constitution, alter that state of the
mucous membrane which produces this too abundant secretion.
The furruginous preparations are the best : of these, the iodide
and chloride of iron, or the sesquinitrate of iron, are preferred.
Cinchona may also be employed. Also the cold shower bath,
unless the general health is too much enfeebled, or where there
is a great deficiency of carbonaceous materials in the food and
blood. The bath should always be followed by an agreeable
reaction. Exercise will aid in imparting tone to the system,
and should be regularly taken. Here, too, it is necessary to
make an important exception, for when the dynamics are low,
the strictest quietude should be enjoined. The deficiency of
the dynamics of life is indicated by an inability to take the
gentlest exercise without inducing fatigue.

The genital organs should be kept clean by frequent ablu-
tions. Generally no local treatment is necessary; though
should the secretion become very abundant, an injection of a
solution of nitrate of silver thrown up the vagina will be found
beneficial. As an almost infallible accompaniment of uterine
disease, whether functional, or structural, we have an altered

1850.] Gautier, on LeucorrhcBa. 597

action of the spinal nerves, which may develop itself in a gen-
eral neuralgic condition. The spine is sometimes morbidly
sensitive, and on pressing the spinous processes, if there is much
irritation, the pain is referred in a great degree to the terminal
extremities of the nerves. The nerve of organic life, from its
intimate relationship with the spine and uterus, soon becomes
implicated, and as the centre of a mighty power, extends its
sympathetic influences over the entire frame. As to the pa-
thology of spinal neuralgia, the limits of my subject does not
allow me to enter into its discussion, but I must refer to the
excellent description given of it by Breschet. It is necessary
that this condition of the spine should be altered, and nothing
promises more good than revulsions and counter-irritants, and
of these, Granville's ammoniated solution, local depletion by
cups, and tartar-emetic pustulation, are the best.

As purulent leucorrhoea usually depends on an alteration of
structure, as ulceration or induration, I shall offer but few re-
marks as to the treatment, reserving any special notice until
those diseases are taken up in detail. When this discharge
exists we should have recourse to vaginal examination, and if
the cause, which produces it, can be detected, it must, if possi-
ble, be removed. In an investigation of uterine diseases, no
physical examination can afford such conclusive evidence of
its existence as will be afforded by the speculum uteri, and in
the application of our remedies we can, with this instrument,
overcome the difficulty presented by the anatomical relation of
the parts. To lessen the discharge, we must remove the offend-
ing cause: if it is inflammation or ulceration of the os uteri,
nitrate of silver offers a speedy cure; if it is induration of the
uterine neek, caustic potassa is a good remedy. The condi-
tion which gives rise to the discharge, must be changed before
we can hope for a radical cure.

Leucorrhcea connected with functional derangement and
mechanical irritation, must be treated with an eve to the exciting
cause. If the discharge depends on amenorrhoea, menorrhagia,
or dysmennorrhoea, these onditions must be relieved by their
respective remedies. Masturbation is sometimes a cause of
leucorrhcen, and no medicine will give relief so long as the faulty
habit is continued. In such cases, moral cultivation is of more

598 Gautier, on Leucorrhoea. [October,

value than any pharmaceutical remedy. Ascarides of the
rectum and vagina, may cause a persistent leucorrhceal dis-
charge which will continue until they are got rid of. A very
interesting case of leucorrhoea, caused by ascarides of the vagi-
na, was brought to my notice by Dr. Powhatten Archer, of
Texas, which I intended to embody in this communication, but
space will not allow. The too frequent use of pessaries often
results in vaginal discharge, and is frequently the source of
aggravated uterine disease. A pessary cannot usually remain
a length of time in the vagina without resulting in serious
mischief. In prolapsus uteri the mechanical irritation it super-
induces causes a general increase of morbid derangement, and
seldom, if ever, succeeds in effecting a permanent and satisfac-
tory cure.

I shall bring forward but one case of leucorrhoea, and that
of an obstinate purulent form.

Rose, a negress, aged 50, naturally of a vigorous and robust
constitution, has enjoyed uniform good health until within the
past few years. She has been subject to a vaginal discharge,
but never so abundant as to prevent her from attending to her
occupation, until within the last six or eight months. She
came under medical care November, 1847, three years after
the first discovery of the leucorrhceal discharge. The woman
was unable to assign any cause that gave origin to the disease.
I am positive, that some time before she became sensible of her
condition her husband was affected with gonorrhoea. I have
no evidence that he communicated the disease to her, though I
strongly suspect it. She was never subjected to any treatment
for gonorrhoea. For three years the discharge gradually in-
creased, up to the time she was placed under treatment, in No-
vember ; at that time it amounted to sixteen or eighteen fluid
ounces in twenty-four hours. It was thick and tenacious, of a
greenish color, and left a deep stain on the linen. It was puru-
lent, and so very offensive as to render it impossible to approach
her person without nausea and disgust. Her health was very
much enfeebled, and she was emaciated to an incredible degree.
She had no strength, and was unable to walk ; inability to speak
without great sense of fatigue ; appetite generally good, though
digestion was imperfect.

1S50.] Gautier, oji Leucorrhcsa. 599

She complained of pain in every part of her body, especially
in the back, upper and lower extremities. On examining the
spine, it was found quite sensitive to pressure, and a painful
sensation referred to different parts.

The first day that the woman was seen, directions were given
to have the vagina well syringed out with warm water and
soap: afterwards to use as an injection a weak solution of
chloride of soda, to correct the fetor ; which was followed up
for several days. She was directed to keep perfectly quiet,
and to have good diet ; bowels to be moved once daily.

Nov. 6th. Gave her an astringent injection, to be repeated
several times a-day, until the discharge diminished : gave her
Carpenter's ext. of bark, as a tonic; applied a blister over the
spinal column.

Nov. 15th. The discharge not so offensive, and some less in
quantity. After the blister drew well, she experienced marked
relief from her neuralgic condition. It was kept discharging a
week. Ordered a continuance of injections for some time.

Dec. 1st. Considerable alteration in leucorrhceal discharge.
Stopped the use of bark, and gave her iodide and chloride of
iron, ten drops three times daily.

Dec. 20th. Her general health begins to improve ; iron
agrees well with her. Examined spine, portions of it quite
tender: applied to it Granville's solution. The discharge still
thick and yellowish, and extremely offensive. Ventured an ex-
amination to-day with the speculum, which was quite unsatis-
factory. Saw the os uteri, but so covered over with the tena-
cious discharge, that I could see but a small ulcer. Discontinued
astringent injections, and made her use the black wash.

Dec. 25th. Used speculum again ; after clearing away the
mucous from the field of the instrument, saw the os uteri
distinctly. It felt rather hard, and had several very distinct
ulcers upon it, touched them with nitrate of silver, passed a
small sized bougie into the mouth of the uterus. She is much
stronger and digests better.

Jan. 10th, 1848. Examined with speculum ; painted over the
os with tinct. iodine ; stopped use of black- wash ; discharge not
so offensive, and considerably less in quantity. Continue iodide
and chloride of iron, increased to fifteen drops three times daily.

600 Pendleton's Case of Pustular Eruptions. [October,

Jan. loth. Os uteri not quite so hard ; ulcers still very dis-
tinct. Use no injections ; keep the parts clean, by cold ablu-
tions. Her difficulty of talking is leaving her ; discharge not
more than a fluid ounce daily. Touched ulcers with nitrate of
silver; blistered her back with Granville's solution.

Jan. 20th. Painted os uteri over with tinct. iodine.

Jan. 25th. Ulcers appear in a much more healthy condition.
Used again nitrate of silver ; stopped use of iron, and put her
on tinct. of bark and hydriockte of potassa. Says she feels
quite well ; discharge troubles her but little. The old woman
has fattened up considerably, walks about freely and talks with
ease bowels regular and appetite good.

Feb. 10th. Examined with speculum : no discharge; all of
the ulcers healed except one small one touched it slightly with
nitrate of silver. She is entirely clear of all neuralgic symp-
toms; her spine is free from all irritation; the os feels quite
natural, and admits of a good large bougie.

Feb. 28th. All of the ulcers healed no discharge. Suffi-
ciently strong, feels well, and says she wants to be discharged.
Gave her tincture of bark, to take occasionally. Discharged,
well.

This affords a bird's-eye view of a very interesting case. I
have only selected those portions which are of most interest,
and which clearly show the incalculable advantage of medical
treatment.

ARTICLE XXX.

Case of Pustular Eruptions, from Vaginal Manipulation.
By E. M. Pendleton, M. D., of Sparta, Ga.

On the 13th ult., I was called in consultation with Dr. Stone,
on a case of difficult parturition in the person of a healthy
negro woman, belonging to Mr. Samuel Hall, of this county.
She was about 27 or 28 years of age, and this was her fifth
accouchement. On Monday night, the 11th, she was taken in
labor; a midwife attended and delivered her of a fine, healthy,
female chil J, at 3, A. M., on Tuesday. On examination, a se-
cond child was found in utero, which, however, after severe

8150.] Pendleton's Case of Pustular Eruptions. 601

labor pains during the day made no progress. Dr. S. was sent
for at night, and found the right arm and shoulder presenting
at the upper strait. He made an effort to turn, but failing, sent
for me, with a request that I should bring my instruments to
perform embryotomy, if necessary. I reached the place at
noon, on Wednesday, a distance of seventeen miles, put the
patient partially under the influence of chloroform and pro-
ceeded to make an effort at turning. The manipulation lasted
about one hour; during which time, with the exception of short
intervals of rest, one or the other fore-arm rested on the four-
chette at a point just below the elbow ; and. from the frequent
change of position, no doubt considerable friction took place
between the arms at this point, and the vagina amounting
almost to abrasion of the skin. I succeeded at length in bring-
ing down both feet and delivering her of a stout boy, who had
doubtless been dead some time. The right arm was used the
most during the operation, but it is doubtful whether at the point
mentioned, it was in contact with the mucous membrane of the
vagina, or the decaying placenta of the living child which lay
in the vaginal passage.

On the subsequent Friday, I observed a few small pustular
eruptions breaking out over each fore-arm where they had rest-
ed on thefourchette. They were attended with an intolerable
itching during the first day. The next day considerable in-
flammation had taken place, extending along the whole course
of the fore-arm, with soreness and enlargement of the glands
near the elbow and under the axilla. The fever and constitu-
tional disturbance was considerable, with partial loss of appe-
tite, bad taste in the mouth, aching of the limbs and some thirst,
and great restlessness at night. 1 think the disease reached
its culmination on Sunday, being the fourth day alter its incep-
tion.

I did not succeed in establishing any etiological data until
about this time, though fully convinced that I had imbibed a
disease by inoculation from some source, and had been busy in
endeavoring to bring it to light. At length the case of turning
presented itself, and the mystery was explained at once. I
became fully convinced that it had originated from acrid secre-
tions of the vagina, or, from contact with the decaying placen-

602 Pendleton's Case of Pustular Eruptions. [October,

ta. Drs. Brown and McKie, who saw the eruptions, were of
the same opinion, and each expressed their surprise at the near
resemblance of the pustules to varioloid. All admitted that
there was nothing syphilitic in their appearance, and the sequel
proved that they were the effect of an acrid poison, acting topi-
cally on the skin like tartar-emetic, and presenting no greater
evidences of malignant or constitutional disease. On the right
arm were some seven or eight pustules, embraced in a circle of
three inches in diameter, and not quite so many on the left, but
in- an exactly corresponding situation. Some of the pustules
broke on Monday,. and others remained a day or two longer.
When fully natural, the circumference of the largest was about
equal to that of a half dime. They all ultimately run into each
other, however, forming a solid scab on each arm, which did
not entirely scale off for several weeks. After they had entire-
ly healed, I was plagued for several weeks with small risings
similar to those in the neighborhood of blisters, and tartar-
emetic eruptions, but differing very essentially from the first
crop of pustules.

The most important question connected with this case is, as
to its etiology. Whether it is a specific disease, and can be
propagated by inoculation, or whether it is simply the effect of
an acrid poison, which may have been secreted by the vagina,
or generated from the placenta, which was now in an incipient
state of decay, having been expelled from the womb some thirty-
six hours. This being the fact, might not a similar poison have
been produced, to that originating in dead bodies, the fatal ef-
fects of which are familiar to every student of medicine who
is timely forewarned by the demonstrator to be cautious in his
dissections, at the risk of life ? The placenta is a living sub-
stance, and undergoes a similar death and decay to other organ-
ised masses of human flesh, and my present impression is that
the arm rested upon it, instead of the pressure of the vagina.
I therefore incline to the latter opinion, though it is a new field
of observation with me, as it is the first case I have seen, and
do not now remember any reports of a like character. Deem-
ing all such cases of direct interest to the profession at large,
I have thought it proper to report it, hoping thereby to elicit
further information on a subject which will doubtless be new
and interesting to many.

1850.] Dugas, on Gangrenopsis. G03

The only prophylactic means that I am able to suggest, is to
oil well and wash well, as it is very probable that in the instance
above neither of these means were used as thoroughly as they
should have been at so high a point on the forearm.

ARTICLE XXXI.

Remarks upon Gangrenopsis in a letter from Prof. Dugas, to

the Editor.

Mr. Editor, The publication in the last No. of your Journal
of "Two cases of Sloughing Phagedsena/' with the details of
successful treatment, will recall to many of your readers the
melancholy remembrance of similar cases. In this section of
our country, the occurrence of gangrenous affections of the
cheeks, lips and gums, in children, is by no means uncommon,
and there are few communities in which there may not be found
some living evidences of its havocs upon the face, as well as of
the possibility of occasionally preventing a fatal result. I do
not know of any satisfactory explanation of the fact that it
affects exclusively those of tender years, and most frequently
those between 5 and 8 years of age. The object of this com-
munication is to direct attention to a corresponding suscepti-
bility of children of this age to mercurial salivation and slough-
ing, and to elicit the inquiry into the probable influence of
mercurials in the- occasional causation or excitation of such a
state of things. Without denying, for a moment, that slough-
ing phagedena, cancrumoris or gangrenopsis (as the affection
is variously denominated) may and does occur in individuals
who have never taken mercurials, is it not possible, nay, is it
not probable, that the use of an agent which does of itself some-
times induce a very similar destruction of tissues, and which is
especially prone to do so at the very period of life most subject
to gangrenopsis, may increase the tendency to this disease, if
any exist in the system ? The affirmative would seem a ne-
cessary or at least a rational corollary. Having had my atten-
tion very early drawn by a practitioner of genius and fine
judgment (my preceptor), and one who was never accused of
being afraid of mercurials, to the danger of giving calomel to
children during the period of second dentition, I have never

604 Treatment of Erysipelas. [October,

forgotten the lesson, and feel strongly disposed to attribute to
it the fact, the remarkable fact, that during a practice of twenty
years, I have never had a case of gangrenopsis to originate
under my treatment ! I have, of course, seen cases of it, but
they had always originated in the hands of others. I have
now vividly in my recollection a family of five children, three
of whom had during the same autumn been successively taken
with remittent fever and died with most awful sloughing of the
cheeks and lips. They were all treated with calomel. Dis-
couraged at the result, the parents determined to change their
medical adviser, and I was requested to seethe other two chil-
dren when similarly affected with fever. These were treated
without mercurials and recovered, without gangrenopsis. Far
be it from me to wish to generalize from isolated cases, or even
from the mere results of my own experience. Yet I have
deemed it a duty, in a matter of such vital importance, to
make the above remarks, with the hope that they may incite
others to endeavor to determine how much should be legiti-
mately attributed to an original defect of constitution, and how
much to the treatment instituted. It will be observed, that in
the cases published in your last number, nothing is said of the
treatment to which the patients had been subjected prior to
their admission into the hospital.

PART II.
HXcvxtws anir (Extracts.

Treatment of Erysipelas. By Albert J. Walshe, M.D., &c.
(Dublin Journal.)

I have come to the conclusion, that erysipelas is a peculiar
kind of fever, or constitutional irritation, producing an inflam-
mation of the skin, or skin and subjacent areolar membrane,
for the following reasons :

First. The disease, like small-pox, measles, &c, is subject to
metastasis.

Second. There is always the same train-of symptoms prece-
ding and attending each case.

Third. A very minute dose of tartar emetic, which would

1850.] Treatment of Erysipelas. 605

have comparatively no effect in other inflammations, generally
causes severe vomiting and purging in this.

Fourth. In mild cases, the disease will wear itself out ; the
part where the eruption first appeared getting well, while the
disease is spreading to sound parts; and this continues until the
system is completely rid of the poison which caused this pecu-
liar fever. The patient then is in better health than for some
time previously.*

Fifth. It often recurs in the same patient at stated intervals ;
or if a patient who has had an attack lives irregularly, he is
almost certain to suffer from a recurrence of the disease.

Sixth. That it is propagated by contagion will most probably
be acknowledged, though I have myself seen but two instances;
yet the observations of Lawrence, Copland, and others, appear
to establish the point.

Erysipelas has been variously classified in all ages, but the
following division appears to me to be the most natural and
practical, viz: First, Idiopathic Erysipelas, that which arises
spontaneously without any manifest cause ; and second, Trau-
matic Erysipelas, or that which arises from some external or
manifest cause, such as surgical operations, wounds, &c. Hav-
ing propounded the opinion, that erysipelas is a poisoning of the
blood caused by derangement of the chylopoietic viscera, and
that nature excites a peculiar inflammation to get rid of the
poisoning, I shall now attempt to prove that the plan of treat-
ment which I have followed, and which is founded on that theo-
ry, is the most effieacious.

The treatment recommended in erysipelas has been as oppo-
site as possible. Some practitioners advise it to be treated as
a purely inflammatory disease, by venesection, local bleeding,
purgatives, and low diet. For this plan, high authority, both
ancient and modern, can be brought forward. Others, taking
rffar different view of the disease, look on it as a species of
putrid fever, and recommend tonics and stimulants, such as
bark, ammonia, and wine, and object to all kinds of evacuations.
Mr. Lawrence, who has written one of the most valuable trea-
tises on the subject, f is at the present day the most strenuous
supporter of the antiphlogistic treatment. He thus speaks:
"As erysipelas resembles other inflammations in its causes,
symptoms, and effects, it should be treated on the same princi-
ples, that is, on the antiphlogistic plan. Venesection, local
bleeding, purging and low diet, are the first measures, to which
saline and diaphoretic medicines may be afterwards added.

* There are cases of this kind recorded where the eruption passed over the
entire body,
t Medico-Chirurgical Transactions, vol. xiv., p. 1.

606 Treatment of Erysipelas. [October,

He then says, the earlier these means areemployed the better.
Vigorous treatment in the beginning seems to him most calcu-
lated to shorten the attack and prevent the disease from spread-
ing beyond its original seat. This treatment, Mr. Lawrence
states, must be, like that of any other inflammation, modified
according to the age, constitution, previous health and habits of
the patient, and the period of the complaint. He likewise re-
commends, in that form of erysipelas which he calls phlegmon-
ous, one or more long incisions to be made through the inflamed
skin and the subjacent adipose and areolar textures, which are
the seat of the disease, and these incisions to be made at the
commencement of the attack. If this be not done, the inflam-
mation, he says, will pursue its course, both in the areolar mem-
brane and skin, in spite of bleeding, whether local or general ;
suppuration and sloughing rapidly supervene, and these destruc-
tive processes soon extend over a large portion of a limb.
Medical practitioners, he states, are in general too anxious to
begin the strengthening plan, which often causes relapses ; he
considers that ammonia is the best stimulant when there is doubt
on the subject, bark next, and that wine should be given very
sparingly. Mr. Lawrence has followed in the steps of Syden-
ham, who says: "I bleed from the arm at once; next day I
give my usual mild cathartic ; and at bed-time, in case the pa-
tient has passed too many motions, a paregoric draught, such
as syrup of poppies. In the meanwhile the patient must live on
barley broth, oatmeal gruel, and roasted apples. He may take
a little of the smallest beer, and leave his bed for a few hours
daily. To this method the fever generally gives way in a short
time ; if not, I bleed a second and a third time."

Such are the opinions of two of the most strenuous support-
ers of the antiphlogistic plan of treatment. I shall next men-
tion that of Dr. Fordyce, who is one of the strongest advocates
of the stimulant plan. He says, "that he has ahvays found
bleeding and evacuations hurtful, and Peruvian bark the best
remedy. It should be exhibited in substance, if the patient's
stomach will bear it (and in this disease it always will) and in
as great quantity as the patient will bear, which is commonly
to the quantity of a drachm every hour." Dr. Fordyce is fol-
lowed by Dr. Wells, and other practitioners, both foreign and
English, who to the present day strongly advocate the tonic
plan of treatment.

Having mentioned the antiphlogistic and tonic methods of
treatment, I shall now allude more particularly to the third
plan, that recommended by Desault. He says : " In the bilious
erysipelas, whatever degree of fever and heat may exist. I give
inthfe first instance, a grain of tartar emetic dissolved in a con-

1850.] Treatment of Erysipelas. 607

siderable quantity of fluid. The symptoms generally diminish
as soon as the effects of the medicine have ceased. I have
seen them entirely subside, although the medicine produced no
other sensible alteration in the animal economy than an increase
in the secretions of the insensible perspiration and the urine.
Sometimes the symptoms resist the evacuations, and we are
obliged to have recourse once or twice, or even more frequent-
ly, to the use of emetic drink." " When the erysipelas is cured
and the bitterness in the mouth and fever have subsided, two
or three purges of cassia and manna, with a grain of tartar
emetic, are exhibited. During the treatment the patient is or-
dered to drink freely of a diluting ptisan acidulated with oxymel.
As soon as the symptoms are mitigated, the diet of the patient
is enlarged; for when it is too rigidly observed the acrimony
of the humours is apt to be increased, and the bilious erysipelas
to be reproduced, particularly in hospital, where the air, gener-
ally speaking, is unhealthy. I have invariably observed that
the cases of persons who had been bled previously to their ad-
mission into the hospital were more serious and obstinate, par-
ticularly when it had been frequently repeated. The same
practice is not applicable to the phlegmonous erysipelas: in this
kind emetics and other evacuants augment the irritation and
tension already considerable, nor should they be had recourse
to till the plethora and irritation of the patient are diminished
by one or more bleedings, according to the urgency of the
symptoms and the strength of the patient. The bilious erysi-
pelas that then appears points out the necessity for evacuants,
and the proper time for their exhibition."

I have now alluded to the different modes of treatment re-
commended both here and on the Continent. The first and
second are diametrically opposed ; and the last agrees with the
first, with this exception, that in it is employed an agent which,
in my opinion, may be called a specific. But Desault says we
are not to bleed in the bilious erysipelas, but to depend on the
tartar emetic ; in the phlegmonous, on the contrary, we are to
bleed even more than once if necessary, until we have reduced
it to the bilious, and then we are to commence with the tartar
emetic. Now, in my opinion an opinion borne out by the
results of sixty-three cases of erysipelas which I have treat-
ed there is no form of the disease which should not be attack-
ed from the first with tartar emetic, whether there be high
inflammatory fever, low typhoid fever, vomiting, or purging ;
and under all and every circumstance we shall find that the
disease, yields to this remedy. But I must be understood to say,
that we are not to give this medicine in large doses, as recom-
mended by Richter and other practitioners,, who adopt his plan

608 Treatment of Erysipelas. [October,

of treatment ; for then it produces too violent an emetic effect,
causing much general irritation, which being superadded to the
irritation of the disease, the beneficial effect of the remedy is pre-
vented : but I advise it to be given in very small doses, as recom-
mended by Desault, which may have to be repeated three or
four times, so as not to allow the action of the medicine on the
system to subside, for if it does we shall very likely find the
disease to make more rapid progress after the first check.

Tartar emetic appears to me to act specifically in erysipelas
for the following reasons, which depend on its sensible effects:
In most cases it vomits and purges after the second dose, or
it vomits only, or it purges only: and what is vomited is
green bile, and the same is passed by stool. I have known the
second dose to cause from twelve to fourteen stools of bilious
matter, with a decided remission of the symptoms. Now I
have ordered this medicine in the same proportion in other
diseases, as in phlegmonous inflammation, without the least
perceptible effect on the patient; I have given it in bronchitis
without any visible effect ; and in other diseases I have admin-
istered it in the same proportion, and have found no such vio-
lent action as I have invariably seen even in the mildest cases
of erysipelas.

If, from what I have now said of tartar emetic, it is to be ex-
pected to cure every case of erysipelas when administered
alone, disappointment will ensue, as all that it seems to do is to
remove from the system the morbid matter which appears to
have caused the disease, and which nature was attempting to
get rid of; as soon as that is done we must give the patient, ton-
ics, either wine or porter, strong broth, bitters, bark, ammonia,
or quina: of all these I have found the sulphate of quina the
most successful. It may be asked, at what time are the tonics
to be given? The general rule I would lay down is, that as
soon as we find the erysipelatous surface to be getting a yellow
tinge, and the skin shrivelling a little, the tongue cleaning, and
the pulse, which generally falls under the influence of the tartar
emetic, becoming more frequent, the proper time has arrived to
commence with tonics and omit the tartar emetic. In some
cases where we have not so marked an improvement in the
symptoms, and we are afaid the strength is failing, we shall
have to commence the tonics, while we are still continuing the
tartar emetic. In other cases, where there are low typhoid
symptoms, with prostration of strength, we shall have to give,
with the tartar emetic, stimulants and tonics from the com-
mencement.

While the patient is taking tartar emetic the bowels may be
constipated, and we shall have to give some aperients : the sa-

1850.] Treatment of Erysipelas. 609

line aperients are what are generally recommended, but I usually
order the compound rhubarb pill, with blue pill, in the propor-
tion of three grains of the former to one of the latter, to be
made into a pill : two of these to be taken for a dose, and, if
necessary, to be repeated in six or eight hours. I prefer this
combination, as it acts on the liver and large intestines.

I will next refer to the different local means that have been
recommended in the treatment of erysipelas; first premising
that I am opposed to any local application, except in idiopathic
erysipelas, in which flour or powdered starch may be used,
which I consent to, more to gratify the patient than from any
idea of their efficacv ; and in traumatic erysipelas I recommend
the part to be enveloped in a large linseed-meal cataplasm.

The first local treatment I shall mention is the abstraction
of blood by the application of leeches; against this there is a
great prejudice, as erysipelas often ensues from the bites. The
second is that recommended by Mr. Hutchinson, viz., making
from four to eighteen incisions of about an inch an a half in
length, and from two to four inches apart, down to the fascia,
with the intention of relieving the tension of the parts, of ab-
stracting blood, and allowing the serum and other fluids to
drain off. Mr. Lawrence has proposed a modification of this
treatment: he makes one long incision, the entire length of the
diseased surface. The objections to these plans are, that in
most, if not in all cases, they are unnecessary, unless when the
case has gone into the third or suppurative stage, then incisions
are required to give exit to the matter and sloughs ; they cause
the cure to be very tedious, and there is danger of a greater loss
of blood than the patient can bear. The long incision recom-
mended by Mr. Lawrence is that which is most generally
approved of in this city; but, from my own experience, I am
satisfied that the antimonial treatment, if adopted at an early
stage, is quite adequate to obviate the necessity for any of these
plans of local treatment, at least in the great majority of in-
stances.

Dr. Fahnestock of Pittsburgh recommends the local appli-
cation of creasote : " In every case of local erysipelas," says he,
* we must apply the purest creasote, with a camel's-hair pencil,
over the whole affected surface, extending some distance be-
yond the inflamed part; but at the same time we must admin-
ister a dose of calomel, followed by a sufficient quantity of
jalap to insure free catharsis." * I have never seen this appli-
cation used, and therefore cannot speak of its effects.

Another local application, and one which is strongly recom-

* Provincial Medical and SfjFgical Journal I I I, 1818.

x. s. vol. vi. no. x. 39

G19 Treatment of Erysipelas. [October,

mended by professor Yelpeau, is sulphate of iron, either in
solution or ointment, the former in the proportion of an ounce
of sulphate of iron to a pint of water, to be applied every second
or third hour to the affected parts ; the latter in the proportion
of two drachms and a half of sulphate of iron to an ounce of
prepared lard, to be applied every third hour. But he says,
"Should the disorder appear to be produced by some internal
cause, we must first direct our remedies against this; the sul-
phate of iron being only really efficacious when the inflamma-
tion is purely local.'' For my part I consider all cases of
erysipelas to depend on some internal cause.

Nitrate of of silver has been recommended, by Mr. Higgin-
bottom of Nottingham, to be applied over the entire- of the
in flamed surface. He says: "I have never in any case seen
metastasis or any other bad effect from its use." He uses it in
the following manner: nitrate of silver, four scruples; nitric
acid, six drops; distilled water, half an ounce; mix. This is
to be applied several times on the inflamed parts, and for two
or three inches beyond the inflamed on the healthy skin.

M. Piorry has recommended the use of linear blisters, by
means of which he states that he has discovered a method of
effecting the desired limitation of inflammatory action with
great certainty. At the commencement of the disease he ap-
plies narrow blisters around the entire circumference of the
inflamed skin, at the distance of one or two inches from its
border. Nitrate of silver and solutions of sulphate of iron have
been long used with the same view, but they have for the most
part failed.

The only other application which I shall mention is mercurial
ointment. This is to be smeared over the entire of the inflamed
surface. It was first recommended by Ricord, and is still
strongly advocated by some of our leading men.

The last is the only local application which, in my opinion, is
worthy of consideration, as it acts not locally but constitutional-
ly, for we know that in a very short time the system is affected by
the mercury, and as soon as that takes place the erysipelas grad-
ually declines. But with respect to the other local applications,
I consider that they are injurious without constitutional treat-
ment, and with it unnecessary. As, if my ideas are correct,
viz., that the erysipelatous inflammation is the method taken to
throw off the morbid state of the blood, anything that tends to
check that eruption will be the means of preventing the efforts
of nature, and probably cause a metastasis to some other part of
the body, it may be to a more vital organ, for we have on record
many cases of metastasis of erysipelas to the brain, larynx, and
pericardium.

1S30.] Lecture on Irritable Bladder, fyc. 611

As a summary of these remarks I would draw the following
conclusions:

First. That erysipelas is a constitutional disease, depending
solely on a morbid state of the blood ; and that the eruption and
fever are the means nature takes to get rid of this poison.

Second. That, for all practical purposes, it is only necessary
to divide the disease into idiopathic and traumatic.

Third. That tartar emetic seems to act specifically in erysi-
pelas, Dy assisting nature in her efforts to throw off the disease.

Fourth. The best method of administering this medicine is
by dissolving one grain in a quart of any bland fluid; the solu-
tion to be taken in the twenty-four hours.

h. That as soon as the tartar emetic has acted sufficient-
ly, sulphate of quina, or some other tonic, is to be administered.

Sixth. That if the patient is debilitated we must administer
tonics at the same time that we give the tartar emetic.

Seventh. That under this treatment the erysipelatous inflam-
mation may spread, but not with the same violence, nor to the
same extent, as if the disease Were left to itself.

Eighth. That we shall often require to give aperient medi-
cine during the course of the case, as it is absolutely necessary
to keep the bowels free.

Ninth. That local applications are unnecessary, and often
injurious.

Tenth. That incisions are not necessary, except in the third,
or suppurative stage; and if the antimonial treatment be early
resorted to, it very rarely occurs that suppuration takes place.

Lecture on Irritable Bladder, c. Delivered at St. Thomas's
Hospital, by John Simon, Esq., F.R.S. (Lond. Lancet.)

To pass urine too frequently; or to pass it without an effort
of will, as during sleep ; or to pass it with pain the pain either
preceding, or accompanying, or following the contraction of the
it with an impediment, laborious'v; or to
:eous elements with it blood, or pus, or ropy
mucus, or cancer-cells; any one of these symptoms may occur,
as you have seeu. eith .ately, or in combination with

some one or more of the i

The fact of a too frequent urination may arise, as you all
know, independently of any real disease of the bladder. Nerv-
ous p are apt to
suffer in this manner to a lu it is not iced parti-
cularly where there is mental disquietude, accompanied by
bodil\ n* a state station, oi [tdepends

612 Lecture on Irritable Bladder, $c. [October,

partly, no doubt, on the greater attentiveness, or vigilance, as
to one's bodily sensations, which exists under these circumstan-
ces; but partly, also, I dare say, on some qualitative change in
the urine, which, by operation of the same class of causes, will
often, for the time, have become alkaline.

In gonorrhoea, too frequent micturition is an almost invaria-
ble symptom ; and, in most cases, it arises in a simple sensational
sympathy between the bladder and urethra; a reverse of that
same consensual relation, which causes pain to be felt in the
urethra when the bladder is being hurt by a calculus. In other,
and severer cases, there is no doubt that the specific inflamma-
tion of gonorrhoea diffuses itself from the urethra to the mucous
lining of the bladder, as is evinced by the copious cloud of mu-
cus which the urine contains, and by pain (sometimes of severity)
in the region of the bladder. Under the latter circumstances,
you will rarely fail to relieve your patient by the hip-bath, the
recumbent position in bed, and an opiate clyster. It may, how-
ever, happen to you in the management of gonorrhoea, to find
cases of the former class, where the bladder is presumably free
from inflammation, where the frequency of micturition is sym-
pathetic only, but yet is so extreme as to be a source of serious
inconvenience, and to require distinct treatment. Now, in these
cases, (which are very frequently accompanied by much scald-
ing, and often by not much discharge,) having quite satisfied
yourselves of the absence of pain, tenderness, or mucous secre-
tion, referable to the bladder itself, you may often give speedy and
effectual relief by applying a bougie, smeared with nitrate of
silver, to the first two or three inches of the urethra. This ap-
plication exhausts the sensitiveness of the mucous passage, and
thus, indirectly, cures the consensual irritability of the bladder.
Very often, indeed, if judiciously used, it fulfils the additional
purpose of terminating the gonorrhoea. You would, of course,
refrain from trying this expedient, not only (as I have said)
where there is evidence of inflammation in the bladder, but also
where the testicles are at all swollen and painful, or where
there is oedema of the prepuce, or other inflammatory infiltra-
tion of the superficial parts.

We have now in the ward a lad, John Roche, in whom con-
siderable irritability of the bladder accompanied an obstruction.
The prepuce was almost imperforate, and the anterior part of
the urethra was also much contracted. The former evil was
congenital, and (probably by its interference with the flow of
urine) had caused irritation and inflammation of the urethra,
sufficiently to produce its partial closure. I have often before
noticed this concurrence of a very close congenital phimosis,
with astrictured state of the spongy part of the urethra. The

1S50.] Lecture on Irritable Bladder, fyc. 613

dresser operated on this lad's prepuce a short time since, and
is now dilating his urethra. On completion of the latter pro-
cess, his irritability of bladder will cease. I had a very similar
case here last summer, in a child of three or four years old,
where the frequency of micturition and other symptoms were
such as closely to mimic the signs of stone in the bladder.

You have had many opportunities of observing, in ordinary
cases of stricture in the adult, that irritation of the bladder
causes a noticeable part of the symptoms, seen, in the slighter
cases, only as a more frequent desire to urinate, which will dis-
turb the patient in the night, and oblige him to rise, once or
oftener, for the purpose ; but at other times, in inveterate cases,
(such as that of the old man now up-stair, or of Vesey, who
was under treatment in the summer,) manifested in all the ad-
ditional results of chronic cystitis great deposit of ropy mucus,
streaked with phosphate of lime and often tinged writh blood ;
ammoniacal foetid, discolored urine ; pain extending throughout
the whole urinary apparatus; and constitutional disturbance
commensurate with the local symptoms in its severity. I will
not now dwell on these more aggravated cases, since they lie
beyond the question of irritable bladder, and I may have some
more convenient time for speaking about them. I may only
remind you, that in Yesey's case, after full diiitation of his stric-
ture, during which process we had to support and soothe him
with abundant supplies of stimulus and large doses of opium,
the remaining irritable and catarrhal state of the bladder was
very quickly and remarkably relieved by the daily injection,
through the catheter, of a weak solution of chloride of lime.

There is no cause in which the phenomena of irritable blad-
der so commonly arise as in chemical derangements of the urine.
Persons of adult life sometimes suffer in this way, but it is im-
measurably more frequent in children.

In adults, you will usually find the derangement of the secre-
tion to be dependent on a depressed and exhausted state of the
general system, and you will find the urine alkaline at the time
of being passed, and containing copious crystals of the triple
phosphate. These cases do not so often come under notice in
hospital patients as in private practice, for they have their ori-
gin in circumstances to which the humbler classes of society
are comparatively strangers viz., in conditions of mental fa-
tigue after protracted intellectual labor, nervous prostration
consequent on sensual excesses, of prolonged anxiety and rest-
lessness, &c. In these, as in many other cases, the irritable
bladder only serves to draw our attention to more important
ailments, for it is often the first symptom which excites the
patient's notice. The disordered urine provokes the bladder to

614 Lecture on Irritable Bladder, fyc. [October,

frequent contraction, just as an altered secretion of bile will
irritate the intestinal canal.

As we have not recently had under treatment here any case
exactly of this description, I may wait for some future opportu-
nity of dwelling on their management. I would now only tell
you, that, as regards the bladder merely, you may alter that
condition of urine which renders it irritable, by giving a few
minims of mineral acid three or four times a day; but your
patient will require much more treatment than this. Mindful
of the fact that this disordered chemistry of the urine arises in
conditions of exhaustion and debility which are peculiarly
nervous, you will of course employ those tonic remec-ie:; which
are most calculated to re-invigorate the nervous system. The
most powerful pharmaceutical agents will rarely succeed in
restoring the patient, unless in combination with temporary re-
pose from labor, or with relief from such other depressing influ-
ences as have shattered the health ; and in respect of London
patients, I may confidently assure you, that a fortnight of coun-
try air (especially at the sea-side, and with cold shower-baths)
does more for recovery than an unlimited quantity of medicine
taken amidst the patient's previous and unhealthy circumstan-
ces.

In children, almost invariably, that alteration of the urine
which produces irritable bladder, is in the opposite direction to
the one just alluded to; the secretion is excessively acid, and
contains crystals oflitlvic acid, forming in the chamber-pot a
granular sediment like cayenne-pepper. Such cases are very
frequent in hospital practice; but they are also very often met
with in the wealthier ranks of society, among the children of
dyspeptic and gouty parents. It is a common remark, that
calculus, as a disease of infancy or early childhood, belongs
almost exclusively to the poor. I believe that the truth of this
remark (for true it certainly is) depends on the fact, that among
these classes there is for less probability than among the rich,
that the gravel-stage of the disease, as presented in children,
will obtain attention and proper treatment. The tendency to
form crystalline concretions is probably not unequal in the two
classes; but among the poor the requisite treatment is rarely
sought till the symptoms have become very severe, and the
chifd very clamorous for relief; whereas among the rich, those
slighter and earlier symptoms, which I am at present consider-
ing, those of irritable bladder and crystalline sediment in the
urine, generally attract attention in time for the hinderance of
further mischief. Irritability of the bladder in Children usually
takes, with more or less completeness, the form 6f inc. ontfa
of urine: the child wets its bed. Whenever this symptom is

1850.] Lecture on Irritable Bladder, $c. G15

presented to you, if you proceed to examine the urine, (as in
every such case you should do,) you may pretty confidently
expect to find copious crystals of lithic acid. This condition of
the urine in children is very far from painless : and in severe
cases the symptoms cannot at first sight be distinguished from
those of calculus: the child makes water very often, and a
little at a time, doubles itself up, and cries with the pain of each
effort, and pinches and pulls its prepuce, just as it would with
stone in the bladder. The pain experienced is a severe scalding
in the urethra, and sometimes this passage will be so much
irritated as to inflame and secrete pus.

You have recently seen a case under my treatment in
Abraham ward, which, though not one of incontinence of urine,
(for it was in an adult.) will yet serve to show you the manner
of dealing with such inconveniences, generally, as depend on
the pasa:re of crystals of lithic acid, in the urine. The patient,
Wm. Matthews, aued twenty-two, had for two or three years
suffered occasionally with symptoms, which make it probable
that he hns a calculus lodged in his left kidney : but the imme-
diate cause of his admission to the hospital (Dec. 18) was the
circumstance of his then habitually passing lithic acid gravel,
occasionally mixed with blood. His urination was frequent
and painful. His pulse was feeble, and he was of little muscu-
lar power; his skin acted fairly; his tongue was white and
coated, his bowels a little constipated. I ordered him live
grains of Plummer's pill every night till his tongue was quite
clear,and then changed the treatment, giving him quin. disulph.
gr. ii. twice a day, and potass, bicarbon, half a drachm, live
hours after his chief meal. He left the hospital, after a month's
stay, quite free from uneasiness in his urinary organs, and ma-
terially improved in general health.

This case will illustrate to you the sort of treatment which I
generally pursue in similar instances of chemical derangement
of the urine. If the tongue is coated, and if (as is usually the
case with children) the intestinal secretions are unhealthy, f
give hydrarg. c. creta, or some other preparation of mercury,
till that evil is remedied; I then commence the exhibition of
alkalies, giving usually a single large do after the com-

pletion of the digestion of the chief meal of the day ; andal
invariably I find it ve quinine tv.

day during the same period. Tonic treatment is often si
larly useful in curing errors of I stive process ; in I

which give rise to the ailment under our notice, quinine, in my
hands, has answered far better than any preparati< 1 1, and

especially so in the combination] ' mtioned. I gi

usually before break fa linner, and the alkali

616 Lecture on Irritable Bladder, fyc. [October.

pious solution five hours after the latter meal. I need scarcely
inform you, that extreme attention to the quantity, quality, and,
above all, to the simplicity of the diet, is essential.

With this treatment you will seldom, I think, have occasion
to resort to blistering over the sacrum and other measures of a
similar nature, which have been recommended for the cure of
incontinence of urine in children.

You have lately had under your observation a case of irrita-
ble bladder, in which 1 was unable to give the patient any re-
lief. I suspect that there must have been some slight tubercular
affection of the mucous membrane.

" Thomas Ellenden, aged fifteen, admitted, under Mr. Simon,
Sept. 4, 1849 ; is of general strumous appearance, pale, slightly
made, red-haired, with light irid'es ; his father died of phthisis.
Ever since he can recollect he has had some enlargement of
either epididymis, and this enlargement has gradually increased
of late years. About two years ago he suddenly became una-
ble to retain his urine for more than three-quarters of an hour
at a time, but it did not escape involuntarily. A few weeks
later he had pain in the region of the bladder, and the urine be-
came thick and cloudy. From that date to the present time he
has felt this pain, and has had difficulty in holding his water for
more than an hour. His general health has been tolerably
good ; he has no pain or tenderness in the loins, no cough or
nocturnal perspiration. When the urine was examined, it was
found to have an acid reaction in the normal degree; it con-
tained a small quantity of albumen, and on cooling deposited a
slight cloudy sediment; the microscope showed in it only the
nuclei and nucleated cells of muco-purulent secretion from the
bladder. There was no stricture of the urethra. On firm
pressure, directed downwards from above the pubes, some
tenderness was felt ; as also in the examination per rectum.''

The points to guide an opinion, in this case, were the follow-
ing: absence of chemical disorder in the urine; presence of
inflammatory products derived from the bladder ; pain, increas-
ed by distention and relieved by evacuation of the bladder;
personal and inherited scrofulous diathesis; tubercular disease
in one part of the genito-urinary apparatus; and guided by
these, I felt little doubt as to the nature of the complaint. If
you look in the museum, or if you read the history of cases of
scrofulous disease in these quarters, you will find that the epi-
didymis is apt to suffer with the urinary system. WThen you
have tubercular deposit in the testicle or epididymis, it is a
matter of extreme probability that you will have the same sort
of disease at the opposite extremity of the vas deferens and in
the vesicula seminalis; and in such cases there is (as you will

1850.] Lecture on Irritable Bladder, cj-c. G17

easily believe, and as experience shows) great likelihood of the
bladder participating in the same affection. I remember a case,
(the worst I ever witnessed,) in which there-was uninterrupted
continuity of tubercular deposit from the kidney to the epididy-
mis; that is to say, down the ureter, throughout the bladder,
(which was ulcerated,) and from the prostrate into the vesdeu-
la seminalis, and along the vas deferens to the epididymis. In
Ellenden's case, I thought it very likely that there was some
such prolongation of the disease as I have described, and I was
therefore little surprised at its obstinacy; for during the two
months and a half that he remained in the hospital, no material
impression was made on the complaint. A variety of treatment
was tried, both constitutional and local ; and with the effect of
producing little, if any improvement.

Cases of this nature are very apt to advance, in spite of any
known treatment, till the bladder is extensively ulcerated ; and
then, whatever difficulty of diagnosis may have existed origin-
ally, it will no longer be experienced. The severity of suffering
and of constitutional disturbance, the tenderness on pressure,
both above the pubes and by the rectum, the extensive and
protracted pain, the constantly-increasing irritability of the
cavity, the presence of pus in large quantity, mixed with tuber-
cular detritus, and often, towards the close of the disease, a
bloody, serous condition of urine, (as if raw beef had been wash-
ed in it,) these symptoms will be more than sufficiently indi-
cative of the mischief which is advancing.

Gentlemen, I need hardly tell you, that in the progress of
diseases of the bladder many symptoms originally distinct may
become mixed and blended ; and if they are suffered to advance
uncontrolled, all, or nearly all, at last merge their individual
characters in those which I have just given you as the signs of
extreme inflammation and ulceration of the bladder. Thus, if
you mentioned it as pathognomonic of stone in the bladder,
that severe pain is felt only at the close of the process of urina-
tion, no doubt you would be right in regard of the earlier part
of the disease, but wrong, of course, when the disease has last-
ed long enough to inflame the mucous membrane, and to render
the cavity of the bladder as impatient of distention as if it had
been idiopathieally inflamed. Similarly, if you spoke of the
pain of inflammation of the bladder as confined to the period of
the organ's fulness, and as consisting chiefly in an extreme in-
tolerance of distention, so that it is great when the bladder
contains urine, and little when it is empty, such a description
might be accurate as regards an early stage of the disease, but
wrong subsequently, when the bladder is severely inflamed or
ulcerated, and when every part of the process of urination, and

G18 Physiological and Therapeutical [October

every attempt of contraction of the bladder, is almost as pain-
ful as if a calculus were contained within it. So with hemor-
rhage ; it does not belong symptomatica!! v to stone in the blad-
der or to inflammation of the bladder, except where these dis-
eases have continued for a long time, and where their other
symptoms have acquired great severity: and if you have hem-
orrhage from the bladder accompanying or folloicinsr the effort
of urination, and not coupled with other very obvious symptoms,
the presumption is great for the presence of a malignant tumour
in the bladder. A certain degree of irritability belongs to all
the cases enumerated, but if you endeavor to draw a distinc-
tion in their histories, you will observe this : the primary sign
of an inflamed bladder, or of a bladder irritated by abnormal
chemical conditions of the urine, is that the bladder has become
intolerant of distention ; so that the patient refers his pain to
the fulness of the organ, and is relieved bv its evacuation ; the
primary sign of a foreign bo . . a stone) in the bladder i>,

that pain is referred to the contraction of the bladder, and is
greatest when that contraction completes itself; and the sign
(perhaps chiefly negative) of malignant tumour of the mucous
membrane of the bladder is, haemorrhage attending the con-
traction of the bladder, without either of the preceding signs
being developed in a marked degree. No doubt, you might
have the haemorrhage, as a symptom coincident either with
stone or with ulceration ; but such could only be the case when
these diseases had for some time produced their more charac-
teristic symptoms, and had caused great suffering to the pa-
tient. By attention to these points you may often save your-
selves the necessity of sounding the patient's unnecessarily ;
and I need hardly tell you, that however indispensable this
operation may be for satisfactory proof of the presence ol a
stone, yet it is bad practice to perform it needlessly in cases of
simple irritability of the bladder from chemical disorder of the
urine, or in cases of inflammation or ulceration from other
causes. Especially I would add that, where the presumption
is of malignant disease in the bladder, it is particularly inexpe-
dient to use the sound superfluously.

Physiological and Therapeutical Effects of Tannic Acid. By
Dr. Alison. (London Jour. Med. Ranking's Abstract.)

As an astringent, I have found Tannic acid exceedingly effica-
cious, certainly as much so as any other agent, vegetable or
mineral, that 1 have ever employed. It has equalled the salts
of lead, copper, and zinc, without producing any of those poi-

1850.] ' cts of Tannic Acid. Gli)

sonons effects which are liable to follow the free use of the salts
of the first two metals.

Internal Use. In the chronic bronchial catarrh of weakly
and elderly persons, unconnected with disease of the heart or
great blood-vessels, and attended with copious and debilitating
expectoration, the administration of tannic acid by the mouth, in
doses of one, two, and three grains, two or three times daily,
has greatly and gradually abated the secretion, relieved the
frequent cough, and improved the strength of the patient. In
the second stage of pulmonary consumption viz., that of soft-
ening, when bronchial catarrh lias been present to a large extent,
weakening the patient, causing frequent cough,, and disti
sleep, the same results have followed, and have greatly contri-
buted to the comfort and welfare of the sufferer. But in pul-
monary disease, the greatest amount of benefit has obviously
been derived when large cavities have been present in the
lungs, the walls of which have thrown out large quantities of
purulent matter, occas! ixed with blood. In such cases

the discharge has been efl controlled, and the rate of

tear and wear of the system obviously restrained, without the
induction of oppression or other evils.

In chronic diarrhcea, which had resisted the ordinary treat-
ment by chalk, opium, and regulated not dependent
on obstructive disease of the heart or liver, tannic acid, in a
form, has proved of surprising etficacv. In cases of severe
disease, depending on irritabfe mucous membrane, I have not
known of one failure; and of those examples connected with
chronic inflammation and disorganization of the mucous mem-
brane, only two proved beyond the influence of this remedy.
These two cases occurred during the last autumn, while cholera
was prevalent, and the disease of the mucous membrane wis
extensive. The complaint, in one of the examples; was of long
standing, and the patient had been addicted to habits of intem-
perance. But it was not tannic acid only that failed ; the salts
of copper, iron, lead, and zinc, in large i roved to be of
no more avail. In this fori annic acid was adminis-
tered in the form of pill, in combination with opium.

In leucorrhcea, unconnected with ii action, I have

found tannic acid effi i restraining the disc;

in iricT he strength of the

combine ,\ | proportion of dilute nitric acid, Was the

form usually e.' In

menorrhagia, not d

or on local congestion, it was also set\ . administered

in the same form.

The excessive sweating in phthisis, and in other diseases

C20 Physiological and Therapeutical [October,

running on to a fatal termination, has been usefully restrained
by the use of tannic acid, combined with dilute nitric acid ;
and the habitual cold damp upon the skin of soft, weakly con-
stitutions, has been corrected by the same means. I have had
no opportunity of testing the virtues of this remedy in the
hemorrhagic diathesis ; but I am strongly disposed to believe
they would be found very considerable, conjoined with other
suitable means. I believe it would prove serviceable in albu-
minuria, dependent on chronic disorganization of the kidney,
and not associated with obstructive disease. When the egress
of albumen results, as I believe it often does in no small degree,
from reduced tone and elasticity in the organ, and is not (as in
a great majority of cases) a wholesome outlet necessary for the
relief of the circulation, tannic acid offers the promise of benefit.
Such a case, however, I have not lately met with, and conse-
quently have not had an opportunity of testing the treatment.

Local application. In the form of aqueous solution, used as
a gargle, tannic acid has been most useful in correcting relaxa-
tion of the throat. Sponginess and hemorrhage of the gums
have been greatly controlled by a lotion of tannic acid, and by
the application of the dry powder. By this means loose teeth
may be retained for a time, and the impediment to articulation
thereby prevented, which would result from their removal.

In prolapsus ani I have prescribed tannic acid, dissolved in
water, as an injection. This remedy is particularly indicated
when the disease is associated with great relaxation of the
solids. Applied to hemorrhoidal tumours, free from inflamma-
tion, in the form of a fine powder, mixed with lard, it would
doubtless prove more efficacious than galls, the usual remedy.
It is assuredly due to the tannic acid which it contains, that uva
ursi proves serviceable in catarrhus vesicce.

In gonorrhoea, chronic or about to become such, tannic acid,
applied externally as a lotion, has proved serviceable. In the
latter mode it has induced no smarting, although the parts have
been tender, and though it has been applied with little intermis-
sion for several days. It is as a local astringent that tannic
acid produces the most obvious effects, as Dr. Garrod has re-
marked.

Of tannic acid as an astringent, I have merely further to say,
that it is of special excellence as an external application to the
skin, when such a remedy is required. I have found it of ex-
traordinary efficacy when reduced to a fine powder, mixed with
lard, and applied to the skin. The parts soon acquire a healthy
aspect; very little of the smarting or pungency is experienced,
which so generally results from the use of the salts of alumina,
lead, zinc, or copper. I have found it far superior to gallic acid.

1850.] Effects of Tannic Acid. Gv>l

By way of testing their comparative powers, I lately employed
an ointment of gallic acid to one spot of psoriasis, and one of
tannic acid to another. The strength of both was the same.
The spots were of old date, and had resisted much treatment.
Jn the course of two days, the spot to which tannic acid had been
applied was all but healthy ; that for which gallic acid had been
similarly employed was more enflamed than before. The gal-
lic acid had caused smarting, and brought away the protecting
scales. This treatment was adopted merely to test the com-
parative powrers of the two acids, and not as curative practice.
Astringents, if they be applied in psoriasis, must be used only
as subsidiary to other treatment.

As a peptic, tannic acid is very efficacious. This I soon
found, while employing it as a pure astringent. Symptoms of
dyspepsia disappeared under its use ; the appetite increased,
flatus and sense of distention were abated at the same time ;
and in several instances the bowels, far from becoming consti-
pated, acquiriug a more healthy tone, actually became more
free. A lady affected with phthisis, who has been under my
care for three years, during which time she has taken tannic
acid alternately with cod-liver oil, complained very lately of
loss of appetite while taking the oil. The morning dose of the
oil was replaced by tannic acid, combined with dilute nitric
acid, and the result was a very striking restoration of the ap-
petite. With such obvious improvement in the condition and
action of the stomach, it is reasonable to believe that one of the
results is the formation of a more perfect chyle. The action
as a peptic is in accordance with the statement of one of the
best writers on materia medica. Dr. Pereira says : "Admin-
istered in moderate doses, they (astringents) promote the appe-
tite, assist digestion," &c.

As a histogenetic, in promoting the genesis, and in improving
the quality of the blood, tannic acid, it may be inferred from
what has been stated above, would probably prove effective;
but that it is really so, I have the evidence of improved com-
plexion, greater fulness of the blood-vessels, increase of strength,
buoyancy of spirits, and improved secretions, in numerous ex-
amples of anaemic and other diseases, in which this agent has
been long employed.

The formation of structures in the young, I have reason to
believe, is subserved, to a valuable extent, by the long-continu-
ed administration of tannic acid, in moderate doses. It is nearly
six years since I began to prescribe this remedy in cases of cur-
vature of the bones in children, with short shafts and enlarged
epiphyses. The number of cases placed under this treatment
while I was physician to the Northern Dispensary, was consid-

622 Physiological and Therapeutical [October,

erable, and not a few occurring in private practice were simi-
larly treated. The general health was improved in all. The
secretions, in many cases exceedingly offensive, were greatly
corrected. In the course of a year or two, an obvious im-
provement in the shape and form of the bones was manifest.
The curve was reduced, and the heads of the bones had lost no
small amount of their disproportionate prominence. I have
lately seen two or three children, presenting no appearance of
having suffered from this affection of the bones, who some
years ago really were deformed, and who were put under the
influence of tannic acid, and also, it is true, of suitable regimen.
In most of these examples of disease, when they came under
my care, the urine contained an undue proportion of lime.
This continued to be the case, at least for some time, even under
the use of tannic acid, though perhaps not to the same extent.
If tannic acid really possesses the power of correcting the ten-
dency to rickets, or of staying the progress of this affection, it
cannot be through any astringent action on the kidney arresting
the exit of an undue quantity of lime, which is only a sign or
consequence of the disease, and not its cause. It must act by
invigorating the general health, and by imparting a more heal-
thy character to the formative processes, by virtue of which
lime and other mineral ingredients in the blood are more forci-
bly attracted to, and fixed in, the osseous structure. Further
evidence of the power of tannic acid to improve the formation
of tissues has been afforded by the increase in the volume and
firmness of the soft parts of children placed under its operation,
which I have frequently observed.

As a nervine of a lasting character, I have found tannic acid
useful in several cases of nervous debility, languor, and excita-
bility. These distressing conditions have been relieved; and
the benefit, in one or two examples, has been permanent. Un-
der the use of moderate doses of this medicine, I have known
even the symptoms of weakly organization, or, as I have
thought, of impending softening of the brain, such as flightiness
of speech and manner, impatience of attention or of application,
hasty judgments, weakness and unstable gait, to lose not a
little of their prominence. It has always, however, been my
object to guard against depending on this' or any other such
remedy where there has been good reason to suspect the pre-
sence of inflammatory action, even in a subdued torm. When
thus used as a nervine, tannic acid should generally be com-
bined with camphor, hops, or hyoseyamus. The shower-bath
has been employed, and the secretions have been attended to,
at the same time. Thus exhibited, I believe that tannic acid,
by improving the1 natural galvanic battery, if our brain and

1850.] Effects of Tannic Acid. G23

nerves may be so figuratively designated, will really, in many
cases of feeble volition and muscular action, produce not a little
of that benefit which has been sanguinely looked for from gal-
vanism and electricity, and which, when obtained, has been so
fleeting at least in my experience.

Practical Remarks upon Ipecacuanha, with a formula for a
more uniform and efficient preparation of the syrup, than
that laid down in the Dispensatories.* Bv Edward Jexxer
Coxe, M.D., New Orleans. (N. O. Med. and Sur. Jour.)

Before noticing the main object of these remarks, it may
prove neither uninteresting nor unprofitable to direct attention
to some of those diseases in which this medicine, or some of its
preparations and combinations, may be employed. The value
and efficacy of ipecacuanha, as an emetic or expectorant in
many affections of the respiratory organs, more particularly of
children, are too generally conceded and acted upon to require
an extended notice.

In dysentery, ipecacuanha has been and continues to be much
used.

By Mosely who held it in high repute, ipecacuanha was
given in doses of half a drachm to two scruples, and by the
late Professor B. S. Barton, it was regarded as almost a speci-
fic, particular in cases of a typhoid character. In chronic
diarrhoea, small doses of the powder repeated several times a
day, either alone, or preferrable in conjunction with opium or
Dovers powder, will be found of great value, and frequently,
with strict attention to a proper regimen, will succeed in curing
many most unpromising cases.

In these last cases, when dependent upon, or connected with,
derangement of the biliary secretion, additional power will be
given to the above by uniting with them two or three grains of
blue mass to be repeatd every night for three or four nights,
and subsequently every third or fourth night as long as may
be deemed requisite or advisable for the individual case. In
hemorrhage from the lungs, or uterus, small closes of ipecacu-
anha, combined with sugar of lead and opium are used with
decided benefit.

In hem. from the stomach, large doses of ipecacuanha

have been strongly recommended, more particularly by Dr.
Condie who has published some valuable practical remarks
upon the subject.

In the early stages of the bowel affections of children, no less
than in adults, an emetic of ipecacuanha, will often succeed in

621 Practical Remarks upon Ipecacuanha, c. [October,

arresting the progress of the disease, and rarely fail to prove
beneficial. I

Combining from one fourth to half a grain of ipecac, with a'
minute portion of opium, and two or three grains of blue mass,
the alterative properties of this last are materially enhanced,
and will be found of great benefit in most of the mild cases of
biliary and bowel derangements so prevalent in this region, at
different seasons of the year.

With the exception of that sudden and often fatal disease,
croup or Hives, there are perhaps none of the pectoral diseases
of children, in which the syrup of ipecacuanha may not be re-
sorted to with advantage ; but in croup, no little experience,
and an almost uniform success in its treatment, authorize the
confident belief, that we possess no one remedy or combination
of remedies comparable or equal to the well known Coxe's hive
syrup, provided it be properly prepared. Dr. Good has re-
marked, that the ipecacuans concur in operating very generally
upon the skin, at the same time that they excite the stomach,
increasing in a slight degree the discharge of mucus from the
lungs, and adding a little to the peristaltic motion of the bowels,
while the antimonials act more violently upon the stomach,
bowels and skin, but less upon the mucous secernents.

To recur to the syrup of ipecacuanha, I may remark, that
being obliged to prepare it frequently, and finding the process
recommended in the United States Dispensatory attended with
unnecessary trouble, and, without constant care, great proba-
bility of a want of uniformity in the preparation, I adopted,
after many trials, the following formula, which can be depend-
ed upon at the bed-side, and which has been found to keep well
in this climate :

ty. Ipecacuan. Rad. Contus. l'\\\

Aqua O. ij.

Ip. Vin. Rect. . . I x.

Sacch. Alb. . . lbs. iij.
Macerate the bruised ipecac, in one pint of boiling water for
12 hours, then add the remainder of the wrater and alcohol, and
continue the maceration for five or six days. Place the whole
in a small displacement apparatus, returning the fluid that pass-
es until it becomes perfectly clear, and then continue to pour a
small quantity of water occasionally upon the surface, until two
pints and ten ounces by measure shall have passed. Now add
the sugar, and with a gentle heat, evaporate until the syrup shall
be of a proper consistence, readily ascertained by occasionally
taking out a small portion and allowing it to cool. When of a
proper consistence, pass it through a small quantity of fine tow
placed in the tube of a funnel to render the syrup clear and

1850.] Bibliographical. 625

transparent. Three pints and ten ounces of syrup is the quan-
tity obtained, and is in point of strength nearly double of that
prepared by the usual formula, which I consider an additional
recommendation.

BIBLIOGRAPHICAL NOTICES.

1. The Unity of the Human Races, proved to he the doctrine of Scrip-
ture, Reason, and Science, with a Review of the present position of
Professor Agassiz. By the Rev. Thomas Smyth, D. D., Member
of the American Association for the advancement of Science.
New- York : George P. Putnam. 1 vol.. 12 mo., pp. 404. 1850.

Among the various questions which are at this time under the discus-
sion of men of science, none possess more interest, or are entitled to
a larger share of attention, than those connected with the natural
history of man. The doctrine of the unity of the human races has
been admitted, and is yet received by the great mass of the Christian
world, but there are able, scientific men, who dissent from this doc-
trine, and their efforts for its overthrow, have brought into the field
some equally able advocates of human unity. Among the ablest of
these last, are Drs. Bachman and Smyth, both of Charleston.

Dr. Smyth's work is devoted to "a comprehensive survey of the
whole subject in its relations to Scripture, Reason and Science." It
evinces great ability and research, and its positions are sustained by
facts and arguments of great interest and force. A careful perusal,
we think, will scarcely fail to lead the reader to adopt Dr. Smyth's
conclusion, that all the races of men have sprung from one pair.
Prof. Agassiz, and some others who hold to the plurality of origin of
the human races, profess to rest their theory on the declarations of
Scripture ; upon this question Dr. Smyth's argument is complete and
unanswerable, and such must be the conclusion of every impartial
reader, even should he incline to the views of Agassiz in other partic-
ulars.

Dr. Smyth's work richly merits, and will doubtless have an exten-
sive circulation. We understand that an edition will soon appear in
England, and from some notices we have read, we doubt not, it is
destined to attract considerable attention, and secure for the author
the same high reputation in that country, which he now enjoys in his
own.

N. S. VOL. VI. NO. X. 40

626 Bibliographical. [October,

2. General Therapeutics and Materia Medica ; adapted for a Medical
Text Book. By Robley Dunguson, M. D., Professor of Institutes
of Medicine, etc., etc. One hundred and eighty-two Illustrations*
Fourth edition, revised and improved. In two volumes. Phil a*
delphia : Lea & Blanchard. 1850. pp.996.

The Therapeutics and Materia Medica of Prof. Dunglison has met
the general approbation of the profession, and in this edition the au-
thor has noticed the new remedial agents which have come into use,
and in other respects, has brought the work down to the present im-
proved state of the science. Although this work is not so full in man}-
matters pertaining to .Materia Medica, as Pereira's great work, yet we
believe that nothing is omitted which is essential ; and we have no
hesitation in recommending it to medical students, and to the profes-
sion generally, as richly entitled to a place in their libraries.

3. Materia Medica and Therapeutics, with ample Illustrations ofPrac*
tice in all the departments of Medical Science, and very copious
notices of Toxicology, suited to the wants of Medical Students and
Practitioners. By Thomas D. Mitchell, A. M., M. D., Prof, of
the Theory and Practice of Medicine in the Philadelphia College
of Medicine, etc., etc. Philadelphia : Lippincott, Grambo & Co.
1 vol. 8vo., pp. 738. 1850.

This work, we are informed, is the substance of Prof. Mitchell's
lectures on Materia Medica and Therapeutics, delivered in the Medi-
cal department of the Transylvania University, in eleven successive
winters. An opportunity has not been afforded us to give the work
more than a cursory examination, and we are therefore unable to ex-
press any decided opinion as to merits or defects. It contains a con-
siderable amount of valuable practical matter, but we confess that we
are not favorably inclined to the alphabetical arrangement of the sub-
jects which has been adopted in this work. We perceive that the
author has omitted many " dry details on the natural, botanical and
chemical history" of the various articles ; but it may well be ques-
tioned whether many of these details, "dry" though they be, are not
of too much importance to be overlooked. To many persons, unfor-
tunately, the whole subject of which the author treats, is dry, but it
by no means follows that for this reason it may be dispensed with.
Yet we doubt not the valuable practical remarks which the work
contains will amply compensate the reader for the time spent in its
perusal.

1850.] Periscope. C27

PART III.

fttcntljlti fizxistayt.

Some observations on the Contractile Properties of the Blood- Ves-
sels and Lymphatics ; By Professor Kolliker. (Kolliker and Sie-
bold's Zeitschrift. British and Foreign Med. Chir. Rev.) Professor
Kolliker gives in this paper a number of experiments on the vessels
of an amputated limb, as a sequel to those performed by him oil
several placentas, for the details of which he refers to a dissertation
by Dr. Wild.

The leg of a boy, aged 15, was amputated above the knee for ne-
crosis of the os-femoris. The limb was subjected to a series of expe-
riments by means of an electro-magnetic apparatus, from the moment
of its removal at 25 minutes past 10 a m., until 12 o'clock.

1 . The vena saphena minor was touched in the fossa poplitca, on the
lower part of the leg and on the foot, the vena saphena magna on the
lower part of the leg and dorsum pedis. A few seconds after the ap-
plication of the wire, contraction took place; at the end of a minute
the parts touched contracted so much, that the blood they contained
in large quantities was pressed out, until the vessel had the appearance
of a white cord. On smaller veins of the skin, the effect was not so
rapid or so powerful.

2. Three applications of the wire had no effect on the vena popli-
tea, but it was already very flaccid and empty before the experiment.
The vena tibialis postica was emptied by contraction in a minute.

3. The almost empty arteria poplitea contracted a little after the
wire had been applied for two minutes. The effect was greater on
the arteria tibialis postica.

4. Five well-filled lymphatics on the skin of the dorsum pedis,
\ fin diameter,contracted powerfully in the space of^ to 1 minute;
the lumen of the vessel did not entirely disappear, but it was diminish-
ed at least one half.

5; No effect was produced on the skin of the shin.
6. The effects on the nerves and muscles were the same as is usually
described ; the irritability remained longest in the muscles.

Duration of irritability in veins 1 hour 15 minutes.

II

arteries

1

10

u

lymphatics -

1

" 12

a

muscles

1

" 35

II

nervus ischiadicus -

0

" 35

a

nervus tibialis posticus

0

" 45

In the first four the irritability still persisted, when the experiment
was interrupted at 12 o'clock, and existed in the vessels in a powerful
degree. The writer does not consider these experiments as in every
respect conclusive, but urges that they prove the existence of contrac-
tility in the coats of the blood-vessels and lymphatics, and he promises
to carry his inquiries further.

628 Periscope. [October,

Aphonia. (Trans. Philad. Col. of Physicians.) Dr. Parrish stated
that within the past three months, he had met with three cases of com-
plete, though temporary, loss of voice, occurring under circumstances
so peculiar, as to render them worthy of record.

The first case was that of a young man residing in Camden, N. J.,
who was seen by Dr. P. in consultation with Dr. Cooper of that, place.
This patient was about nineteen years of age, tall, and of rapid growth,
and of a highly nervous temperament. He had been subject, for
some months prior to his attack, to epistaxis, proceeded by head aehe,
and coming on after a fast walk, on entering a heated room, &c.

In 4th month, (April) last, the young man's father was taken very
ill, which caused him much anxiety ; he lost several night's sleep in
wratching over his sick parent, during which time he had eaten but
little, and was in constant apprehension of his father's death. A few
hours prior to this event, he commenced weeping aloud, and on being
checked by some of the family, he immediately left the room, and
went into another apartment, where he was seized with a violent hys-
terical convulsion.

Dr. Cooper was sent for, and found him lying on the floor, perfectly
insensible ; on becoming conscious he complained of his head, and of
a severe pain in the left side over the heart, which continued most of the
time for several days. Several of these convulsive attacks occurred
during the day, in one of which Dr. Parrish saw him.

The muscular contractions were very violent, with episthotonos and
tearing of the hair, requiring several persons to restrain his move-
ments.

During the intervals he wras conscious but unable to articulate,
communicating his ideas by gesticulations and indistinct mutterings.
After he had been conscious for several days, it was thought proper to-
communicate to him the fact of his father's death ; this, though done
in an indirect manner, brought on a most violent convulsion, which
continued for more than half an hour, requiring the united strength of
several men to hold him.

On recovering from this he was totally unable to articulate, or in-
deed, to raise a sound, although his mind appeared perfectly clear, and
his expression was natural.

After several days he attempted to communicate his thoughts by
writing, but was unable to connect sentences, having first to practice
upon single letters. At the end of nine days he was able to write out
his ideas intelligently, and on the 12th day his voice suddenly return-
ed soon after awaking in the morning.

Since his recovery he has described the sensation under which he
labored, as though something were in his throat, preventing the use of
the tongue, the will having no apparent power over it.

Since this attack the young man has suffered from a slight convulsive
seizure, without any of the severe symptoms which marked the first at-
tack ; with the exception of this, he has enjoyed his accustomed health.

The next case was that of a young unmarried female, who had suf-
fered a number of hysterical attacks dependent upon disordered men-

1850.] Periscope. 62CJ

struation. She was subject to pain in the left side, palpitation cf the
heart, and other nervous symptoms.

During a recent monthly period, the symptoms were so severe as to
bring on a hysterical convulsion, succeeded by paralysis of the limbs
of one side, and complete loss of voice.

For several days after the return of consciousness she was unable
to move the right arm or leg, although she distinctly apprehended the
wishes of those around her that she should do so, and would make the
attempt. At the end of three or four days the power of motion return-
ed, but she was still totally unable to speak, although she could com-
municate her wishes by signs. In about a week from the attack the
voice also returned suddenly, and she has since been well.

The next case was more extraordinary. A lad of sixteen years of
age, in good health, and not considered nervous, was attacked with
hoarseness and slight sore throat, after a check of perspiration brought
on by violent exercise of a hot evening. During the first day he could
scarcely speak above a whisper, but it was only regarded as a com-
mon sore throat, and he went to school as usual. On the second day
his voice was so far gone that the teacher sent him home, and he retired
to his room to rest. On awaking from a nap, he felt as though something
gave Way in his throat, and he was from that time unable to speak.

On the next day Dr. P. saw him, his voice was now entirely gone,
and though he made repeated attempts, at my urgent request to cry-
out, he was totally unable to produce a sound. There was no infla-
mation of the throat to be perceived; he had no fever; his expres-
sion was good, pulse natural, appetite and sleep as usual ; the only
uneasiness of which he complained, was a sense of tightness across
the chest. A strong solution of nitrate of silver was applied to the
fauces, and powerful sternutatories and the shower bath were recom-
mended. Dr. P. at the same time expressing a confident opinion that
the voice would return. This state of things continued for eighteen
days, the boy all the while using a slate to converse with; his hearing
was not impaired, and his mind was as clear and active as usual.

One afternoon while bathing he made a plunge into the water, where-
by he got some water down his throat, which caused him to struggle for
breath, in which effort he cried out aloud. On attempting to speak he
found he could make a noise, and immediately spoke to his compan-
ions. He soon dressed himself and ran home with delight to tell the
news. For a few days he stammered in his speech, but this gradually
wore off, and he now talks with his usual fluency.

In these cases there was no apparent inflammation or lesion about
the organs of the voice, or any defect in the movements of the parts
concerned in the act of speaking ; there was no want of ideas, nor of
the power of communicating t!i"iii by signs or writing, but a simple
want of power to execute the commands of the will. So far as Dr.
P. could judge, the medical treatment had no influence in restoring the
voice, unless the strong excitement and efforts to which the last patient
was subjected while in the water, may be viewed in the light of a reme-
dial measure. The cases are chiefly interesting, as illustrative of that

630 Periscope [October,

mysterious power which operates through the nervous system, and
without the presence of which, even our volition fails to execute its
office.

Tcenia Solium : Experiment icith the Kousso. By Dr. Budd. (Lon-
don Lancet.) Dr. Budd, considering that the most certain and trust-
worthy remedy (turpentine) for taenia often gives rise to very unplea-
sant symptoms, was lately induced to give trial to a plant, the Brayera
anthelmintica (Rosacese), or Kousso, which has lately been found very
effective in France. In that country a very proper way of introdu-
cing a new remedy to the notice of the profession is the following :
A memoir on the subject, with samples, is sent to the Academy of
Medicine ; if the society think the matter worthy of a trial, they ap-
point a committee, principally composed of physicians, in a case like
the present : these make experiments, and report to the Academy the
result they have obtained, with their opinion as to the efficacy of the
remedy. The report in this instance was extremely favorable; the
kousso had been experimentally used in various hospitals with complete
success, and the conclusion of the. report stated, that the kousso is a
valuable remedy for taenia. (Meeting of May 25, 1847.) A favor-
able opinion was likewise expressed by the Academy of Sciences.
The flowers of the plant, reduced to powder, are mixed with lukewarm
water, allowed to infuse for a quarter of an hcur, and the whole infu-
sion, along with the suspended powder, is swallowed either at once or
in two or three portions, the intervals being very short. Lemon-juice
should be taken before and after the ingestion of the remedy. A
young female servant was lately admitted under the care of Dr. Budd,
who exhibited all the symptoms of taenia. From notes taken by Mr.
Jordan, clinical clerk, it appears that for the last year and a half the
girl had been living in London, principally in Tooley-street ; she did
not know any one in that neighborhood with tape-worm, though she
thinks she got it there, as she never felt uneasiness previous to her
leaving Ireland. One year ago she passed a large portion under the
influence of turpentine and castor-oil ; her symptoms were then gen-
eral languor, weakness, and at first ravenous appetite ; lately the appe-
tite had fallen off, but there had been a permanent feeling of flatulence
in the stomach. About six months ago she was often passing small
portions of the worm, and felt much better. For the last four months
the patient had taken various remedies, among which turpentine was
the most frequent ; with none of these, however, did she pass any
portion of the worm. On the 7th she evacuated a piece without
medicine, and on the 11th she was admitted into the hospital. She
was ordered compound powder of jalap, ten grains, and low diet.
After various purgatives and a better diet, the kousso was administered
before breakfast. It made rather a thick infusion, owing to the pow-
der being suspended, and looked much the color of ergot of rye, the
taste being somewhat like that of senna, but not so unpleasant. The
kousso did not cause the slightest feeling of sickness, nor give any pain
in the bowels. She complained, however, of headache, and unusal

1850.] Periscope. 031

depression and languor ; and it seemed, according to her account, to
have a decidedly diuretic effect. About a quarter to one she passed,
without any motion, a portion of worm about three feet in length ; the
head was not attached to this, but there was about an inch and a half
of the narrow segment leading to it. In the afternoon she took some
castor oil ; this opened her bowels, but she brought away no portion of
the worm that could be detected, though she says she saw something
like a thread, of which no notice had been taken. The worm brought
away is evidently torn off at both extremities. On the next day she
felt very sick, her appetite was bad, and it should be noticed that
on the day she took the kousso she passed water very frequently,
and in large quantity ; since then her urine has been scanty and pas-
sed with some pain ; the bowels have been rather loose and the mo-
tions very dark, and accompanied with a certain amount of uneasiness.
If further trials yield favorable results, the plant may prove a valuable
addition to our pharmacopoeia.

Second Case. The second case refers to a woman, aged forty-four
whose history, as taken from Mr. Jordan's notes, is as follows :

The patient is married, and seventeen years ago went to the Cape
of Good Hope ; she lived at first at Graham's Town, and moved after,
wards to Fort Beaufort, v.- he re she thinks she became affected with the
worm, as it is very prevalent in that neighborhood, especially among
the natives, who often die from it. So long as sixteen years ago, she
first passed joints of the worm.

The remedies in use among the natives are 1st. An infusion of
pomegranate-bark in milk ; betbre taking this they prepare themselves
by drinking daily, for a short time previously, an infusion of orange-peel
in brandy. 2nd. They likewise use caster-oil and turpentine, as in-
troduced by the English. 3rd.. The native treatment consists in giv-
ing the root of a plant called Cacay ; it is round like a turnip, sweet
to the taste, and when scraped, white in appearance.

The patient took these three remedies : with the pomegranate-root,
she passed seven yards and a half at a time ; with the castor-oil and
turpentine, she passed lesser portions ; but with the Cacay root, she
only evacuated isolated joints. It is now sixteen years since she first
felt the symptoms peculiar to tape-worm, and passed portions of that
entozoon ; since then, the longest interval of time which has elapsed
without her passing any joints, has been five days.

The symptoms caused by the presence of the worm were, gnawing
pain, and a constant feeling of sinking, referred to the epigastrium ;
pain in the limbs, general feeling of lassitude, and dimness of sight;
there was, however, no increase of appetite, but a constant sensation of
faintness. At present her appetite is slight, the tongue white and
coated ; she suffers from nausea, especially on first getting up in the
morning; still the bowels are generally regular; there is a slight
cough, and she has lost strength. At times; the patient fancies she
feels the movements ofthe worm. She has lately been in the surgical
wards of this hospital for prolapsus ofthe uterus, under the care of Mr.
Fcrgusson. It is now four years since she passed any number of

632 Periscope. [October,

joints connected together, but she has not, for sixteen years, as above
stated, gone a longer interval than five days without passing isolated
joints. The day before she took the Kousso she passed four of these
joints, which looked much like gourd-seeds, and apparently belonged
to the tsenia solium.

The patient took the Kousso at half past nine a. m., before breakfast.
She states that the medicine tastes very much like pomegranate bark ;
she had after it a feeling of nausea, which lasted about a quarter of an
hour.

An immense tape-worm was passed, just before two o'clock, in two
pieces, one about two yards and a half in length, and of unusual size,
the other piece about three quarters of a yard. Connected with the
larger portion was a narrow slip, coming from very near the head.
The worm was evacuated without any feecal matter passing at the
same time. In the evening a few more joints appeared, and the pa-
tient took some castor-oil.

On the next day, joints, and a portion about a foot in length, were
evacuated ; and in the evening a part of a smaller tape-worm, about
a yard and a half in length, and also a small portion of the larger worm,
were ejected.

On the 12th, two days after the first ingestion of the kousso, an im-
mense number of isolated joints were passed, apparently long dead,
and decayed. Up to the 15th of April, no more joints have been seen,
and the patient remains in the hospital to be treated for the prolapsus
uteri under which she labors.

It thus appears that the kousso has an almost certain effect upon the
tape-worm, and if further trials confirm Dr. Budd's practice, we shall
have a fair chance of removing the unwelcome guest whenever we are
called upon to promote its evacuation. Turpentine has doubtless ren*
dered great services, but it does not act uniformly, and is very repul-
sive to take. It must, on the other hand, be confessed, that the kousso
is very expensive, (17s. 6d. the dose ;) this circumstance will, of course,
prevent its rapidly coming into general use.

Clinical Remarks on Gangrene of the Lungs. By Wm. Stokes,
M. D (Dublin Journ.) In this interesting paper on one of the most
terrible and unmanageable of the diseases of the lungs, the author
presents the following conclusions as justifiable in the present state of
our knowledge of the subject.

" 1. That gangrene of the lung is met with under a variety offorms,
differing from one another not only in the duration and violence of the
symptoms, but also in their relations to various local and constitutional
diseases.

2. That in a great proportion of the cases, the disease is attended
with putrefactive action engaging the necrosed portion of the lung,
and affecting its secretions.

3. Thai in the progress of a case, we may observe the septic ac-
tion singularly variable. It is increased by over-stimulation of the
system.

1850.] Periscope. 633

4. That we cannot explain the symptoms in many cases of this
disease, without assuming, either that a spot of mortification, so small
as to be undiscoverable by physical means, causes severe symptoms,
and is attended with super-secretion ; or that a process of putrefactive
secretion precedes, in many cases, the death of the lung.

5. That pain of the most extreme kind may attend this disease ; and
in the remittent form, appear on each access of the aflection with un-
mitigated violence.

6. That the contact with air is not necessary for the formation of a
gangrenous eschar or cavity.

7. That hemoptysis commonly attends each access of the remittent
disease.

8. That in the earlier periods of this disease, auscultation and per-
cussion often fail in detecting any signs of organic change : or, if such
is discovered, it appears incommensurate with the gravity of the
symptoms.

9. That, in many cases, the evidences of congestion and parenchy-
matous infiltration seem to follow rather than precede the symptoms
of gangrene.

10. That dexiocardia, from diminished volume of the lung, may
occur in gangrene of the right lung.^

11. That gangrene may attack a lung previously hepatized from
ordinary inflammation, or in a chronic tubercular condition.

12. That from the pre-existence of signs and symptoms of the
stages of pneumonia, or from the early appearance of signs of exca-
vation, we may be able to distinguish between feted abscess of the
lung and gangrene.

13. That in certain cases of chronic bronchitis, the breath and ex-
pectoration may become fetid, and yet no gangrene appear to have
formed,

14. That the diseases with which gangrene may be found compli-
cated are divisible into general and local affections ; but that its oc-
currence in the class of general diseases, termed putrid or asthenic, is
much more rare than might be expected.

15. That it is rarely observed in the typhus fever of this country,
even were the secondary bronchial affection is intense ; but that in
typhoid pneumonia it may be occasionally observed.

16. That it may complicate a previously existing disease of the
lung, such as pulmonary tubercle, or an unresolved hepatization.

17. That it may be directly induced by the pressure of a tumor on
the nutrient vessels and nerves of the lung, so that, in cases of cancer-
ous or aneurismal tumour, the patient may die, not from the extension
of the original disease, but from its inducing a rapid mortification of
some portion of the lung.

18. That the disease, though always of a formidable character, is
not neccssarially fatal."

On the Dyspepsia of Liquids. By M. Ciio:,iel. (Union Medicale.
Med. Chir. Rev.) There is a symptom of dyspepsia having its seat in

634 Periscope. [October,

the stomach of great value, and one to which sufficient attention is not
paid, viz. gargouillc merit. This stomachic gargouillement depends espe*
ciallyupon a dyspepsia of liquids, i. e. a difficulty of digesting them.
They remain in such cases a long period without becoming absorbed,
those taken in the morning still being in the stomach in the evening.
For the production of this gargouillement it suffices to shake the body
forcibly, or to apply both hands at the opposite points of the epigastrium.
It is a valuable sign, as it indicates that the quantity of liquids taken
should be diminished.

The saliva, too, in dyspepsia is very frothy, and on this account gives
rise to a sign that should direct attention to the stomach. Two white
lines are formed along the edges of the tongue, in consequence of the
action of this organ during speaking having frothed the saliva, which
then accumulates at its edges.

On the Shivering of Pneumonia in the Aged. By M. Chomel.
(Ibid.) The shivering of Pneumonia is remarkable, inasmuch as it is
very intense, and of long duration, and hardly ever accompanied by the
chattering of the teeth observed in the cold fit of ajme. A shivering fit
occurring after the age of from 55 to 60, almost always announces the
onset of this disease; and this may be accompanied with alimentary
or bilious vomiting, or more or less disturbance of the mind, without
diminishing its semeiotic value. Pneumonia is the commonest of
acute diseases in the aged, and one the possibility of whose existence
we should always have in mind in doubtful cases, even when pheno-
mena, referable to the nervous system, which ordinarily have no rela.
tion to it, are present. An old gentleman, on returning from the thea-
tre, was seized with a shivering fit, and very considerable disturbance
of the mind, which were succeeded next day by intense fever. Al-
though there was neither cough or dyspnce present, M. Chomel, in op-
position to his colleagues, pronounced the case one of pneumonia, and
soon afterwards a return of the intellectual powers and the develop-
ment of the symptoms proper to the disease, justified his diagnosis.

One form of the initial shivering may give rise to considerable
embarrassment, namely when a second attack occurs twenty-four or
forty-eight hours after the first, which, when the ordinary symptoms of
pnuemonia are absent, may easily lead to the belief of the existence
of an intermittent. A robust man was seized with a violent shivering
fit, which was followed by delirium, and a slight cough. Next day a
second shivering, with embarrased breathing occurred ; and on the
third day small crepitation was heard. Treated thus far by quinine,
he was now energetically treated by antiphlogistics, and althought66
years of age, easily cured. A double shivering is not a very rare
symptom, and may be due to successive development of the disease
in the two lungs.

On the Morbid Appearances observed in sixteen cases of Arsenical
Poisoning. By Prof. Geoghegan, of the Royal College of Surgeons,

1850.] Periscope. 035

Ireland. (Dublin Med. Press. N. Y. Jour, of Med.) The following re-
sults have been arrived at from the examination of sixteen fatal cases :

1st. All (with one exception, in which maceration had altered the
parts) exhibited signs of irritation in the form either of a, vascular
injection, b, ecchymoses, or c, coloration. The mucous membrane
was engaged in fitteen ; the submucous coats also, in five ; the peri-
toneal in two ; and the venous arrangement of the great extremity in
one case. The ramiform vascularity I have only found in the sub-
mucous coat, which seems also not subject to any of the other varie-
ties of injection. The punctiform, or closely stellate, is by far the
most common variety, occupying extensive tracts of the mucous sur-
face, and either uniformly distributed, or disposed in sinuous lines or
scattered patches. The striated vascularity I have met with but in
one instance,

2nd. Diffuse redness, although more frequently present, according
to my experience, than any other deviation from the natural state, I
have not enumerated under the head of vascular injection, since, with-
out denying its occasional morbid character, I feel disposed to view it
as a pseudo-morbid change resulting from the influence of transudation
and imbibition on the punctuated vascularity. Accordingly, I have
observed the latter to degenerate into difluse redness by the influence
of time and exposure to the action of the stomachic, contents. The
diffuse redness may exist alone or in combination with other results
of irritation.

3d. Ecchymosis as a consequence of arsenical poisoning has pre-
sented itself to my observation under the form of a, well defined
blotches, oval, angular, or circular, and generally small ; or b, of
lengthy streaks, parallel or areolated. Both are formed of a thin
stratum of altered, nearly black, and apparently coagulated blood, de-
posited in the tissue of the mucous membrane. They are scarcely
elevated, and (the mucous membrane at the point occupied being much
softened) are readily removed by gentle scraping, leaving behind an
erosion of corresponding figure. A variety of ecchymosis which I
venture to designate the petechial (seen in five cases) is essentially
different from the foregoing. It consists of invariably small and ra-
ther florid blotches of fluid blood, thinly scattered for the most part
on the summit of the ruga?, and unaccompanied by softening of the
membrane. This condition might be confounded by the inexperienced
observer with the punctuated injection, from which, however, it is
readily distinguished by the lens, which reveals the vessels of the
latter.'

The ecchymoses just described do not appear to me to result, as
might be supposed, from the lodgement of small masses or particles of
the poison on the mucous surface, which I have not observed in any
instance. On the contrary, I have seen them produced by fluid poi-
sons, as ardent spirits, &C, which can only act by creating a violent
determination of blcod in the entire surface, and consequent rupture
of the weaker vessels. One at least, of those conditions, may more-
over exist under circumstances in which the poison could have only

636 Periscope. [October,

reached the affected part by absorption ; as in the external application
of arsenic, or where the spots involve the endocardial membrane.
The only effect which I have observed as strictly traceable to the local
action of arsenic on the mucous coat, is a fungous thickening (form-
ing an elevated ridge or circular raised patch), with or without the
effusion of lymph, and surmounted by adherent arsenic.

It is possible that the non-occurrence of sloughing of the mucous
membrane, from the local contact of arsenic, is due either to its high
vitality, or to a partial protection of its surface by these mucous or
fibrinous effusions.

4th. Erosion of the lining membrane I have met with in one-fourth
of the cases examined, and under two forms. 1. The circular. 2.
Long narrow sinuous streaks. Both expose the submucous coat.
The former, which generally occupies the splenic end, presents a soft
undefined non-elevated margin free from red coloration. The margins
of the eroded streaks, on the contrary, are sharp. A careful exami-
nation of these erosions has impressed me with the belief that they
are produced by the removal of the mucous membrane where occupied
by the black extravasation. Accordingly, they can be produced by
gently scraping the latter ; and in one instance (fatal in thirty-six
hours) in which I found extensive linear erosion, a portion of the ero-
ded surface was found still coated with the black matter.

I have never encountered true ulceration of the stomach in arseni-
cal poisoning, although I have seen it extremely well defined on the
posterior part of the buccal mucous membrane (in the case fatal in
four days and a half.

I have not been able to trace softening of the mucous tunic to the
action of the arsenic, not having seen it in cases examined sufficiently
early to preclude the possibility of its pseudo-morbid origin. From
the great tenuity of the membrane at the splenic end, a very short con-
tact with the contents will suffice to produce considerably softening,
particularly when the latter (as often occurs) have a decidedly acid re-
action. In such I have witnessed from the latter cause, in arsenical
poisoning, another pseudo-morbid change ; namely, extensive brown-
ish black staining of the mucous surface of the splenic end, similar to
what is occasionally seen from the action of oxalic acid. This arises
from the influence of gastric acid (lactic ?) on the blood contained in the
highly inflamed mucous surface ; and a like color is imparted to the
contents when bloody. Although softening of the mucous membrane
appears not an equivocal result of the influence of arsenic, to the latter
it may be referred.

5th. Diminished adhesion of the mucous to the submucous coat.
This is best observed at the pyloric third, where traction will often
furnish a flake of an inch and a half to two inches in length, being pro-
bably three or four times the natural amount.

Having spoken of the mucous and submucous membranes, I have
only to state, that in two instances I have observed diffuse red colora-
tion, and in two, capiliform injection of the peritoneal coat, without
effusion of fibrine or serum.

1850.] Periscope. G37

Insanity from the Use of Chloroform. (Psychological Journal.
American Journal.) In our preceding Number, we noticed a case of
Insanity from the use of chloroform during parturition, communicated
to the Westminster Medical Society, by Dr. Webster. Three similar
cases were related at a previous meeting by the same gentleman, and
we now give the report of them :

Case 1. In this instance the patient, who had been delivered under
the influence of chloroform, was, for three days subsequently, con-
stantly incoherent and rambling. She soon after became perfectly
maniacal, and so furious as to require confinement in a lunatic asy-
lum, where she remained for twelve months, when the lady was dis-
charged, cured.

Case 2. This patient never recovered from the effects of the chloro-
form exhibited during her confinement ; and soon afterwards became
quite maniacal, and continned so for many months, but she recovered
ultimately.

Case 3. As this example might perhaps be considered by some
psychologists not a true instance of insanity, Dr. Webster related the
chief symptoms manifested by the patient, in order to remove all
doubts on the subject. In the case reported, the cerebral disturbance
following the exhibition of chloroform during delivery, never ceased
entirely ; the patient could not sleep at night for a long time, and often
said she felt as if in the presence of a madman who was going to mur-
der her. Three weeks afterwards she became almost maniacal
exhibited much mental excitement, laughing frequently ; had a strong
desire to sing, with other extraordinary feelings ; conducted herself
like an infant, and lost her memory ; in which state the patient con-
tinued during five months, when recovery took place.

Formula for the External Use of Glycerine. (Ranking's Abstract.)
M. Startin furnishes the following useful formulae for superficial
burns, scalds, or excoriations : intertrigo, chaps of the lips, herpes
labiorum, &c:

R Gum tragac. pur. 3ij.ad. gss ;
Liq. calcis. iv;
Glycerine purif. j;
Aq. rosse dest. giij;
to form a soft jelly, to be used by way of ointment or embrocation*

For prurigo, lichen, strophulus, lepra, psoriasis, pruritus &c:
R Acid, nitric, dil. 3ssad 3j;
Bismuth, trisnitr. 3ss;
Tine, digitalis, 3j;
Glycerine purif. ss;
Aq. rosac, jviiflS.
M. for a lotion, to be used by dabbing the part.

For chapped nipples or hands, fissures of the lips, irritation of ths

638 Periscope. Miscellany. [October,

skin of any kind, as after shaving, exposure to the sun, for pityriasis,
&c. R Sodas biboracis, 3ss ad. 3j

Glycerine pur. gss;

Aq. rosoe, gviiss.
M. for a lotion, to be used by dabbing the part affected.

For alopecia following fevers, &c, or for the falling off of the hair,
dryness, or want of action of the scalp, thinness of the hair, &c:
R Sp. Ammon. co. gj;
Glycerine pur. gss;
Tinct. cantharid. 3j ad. 3ij:
Aq. rosmarin, gvij.
M. for a lotion, to be used with a wet hair-brush once or twice a day.

For " hot" rheumatism, or arthritic gout, neuralgic pains, sprains*
bruises, stiffness, &c:

R Lin. Saponis comp. giss;
Glycerine pur. gss;
Ext. belladon. 3j, &c.
M. for an embrocotion, to be used twice in a day in the ordinary man-
ner

illeirical ill isccllanrj.

Dengue Su?i Fever Break-hone Fever. A disease known by
these several appellations has been prevalent for some weeks in many
of the cities on the seaboard, and to a limited extent in some parts of
the interior. It bears a very strong resemblance to the Dengue which
prevailed along the coast some twenty years since. In Charleston,
where it is known as the Break-bone fever, it began in the latter part
of July, and in its march visited almost the entire population. The
Editor of the Charleston Medical Journal estimates the number of
cases existing at one time (22d August) at from ten to twelve thou-
sand. In New Orleans, where it is called " Sun fever," the cases are
also quite numerous. We learn that it prevails in Savannah also, to
a considerable extent, Our own cily has not entirely escaped, though
the cases are not very numerous, or severe. We have heard of seve-
ral cases occurring in the country.

This fever is of short duration, and rarely, if ever, proves fatal. The
Journal already referred to, states that, after the most minute enquiries,
in no single instance could death be referred to the disease per se.
The fever in some cases is ushered in suddenly with chills, er violent
pains in the head, loins, and limbs; in others it is preceded by slight
headache, soreness of the flesh, &c. The pain in the head is gener-
ally supra-orbital, extending from one temple to the other; the eyes*

1850.] Miscellany. C39

are injected and watery, with intolerance of light. The pains in the
various parts of the body and limbs are often very severe, but there
are cases in which there is little pain except in the head. The appe-
tite is destroyed, but generally the stomach in other respects seems but
little affected. Sometimes there is vomiting, and diarrhoea, though
mcst commonly the bowels are constipated. The pulse is frequent,
in some cases full, and hard, in others soft and compressible ; the skin
is hot and dry, though in a few cases perspiration continues throughout
the fever. In a vast majority of cases the fever is continued, and con-
sists of but a single paroxysm lasting from 24 to 48 hours ; in a few
instances it is remittent. Although of such short duration, the muscu-
lar prostration which accompanies the disease is very great, and the
convalescence is very slow. In a large proportion of the cases, after
the subsidence of the febrile symptoms, a rash very similar to that of
scarlatina makes its appearance. Occasionally the eruption assumes
a purpuric character.

The symptoms of the disease as it exhibits itself in New Orleans,
are similar to those which it presents in other localities. It is said
however to have proved fatal in a few instances. Dr. Fenner states,
that in New Orleans the convalescence is usually "easy and rapid."

We are unable to state what is the treatment in Charleston. In
New Orleans, in young and plethoric subjects, a few ounces of blood
are taken from the arm, followed by local depletion from the loins and
nucha. Mild purgatives are employed in some cases, and full doses
of Quinine are administered as soon as the vascular excitement sub-
sides, and the pain in head and limbs are somewhat relieved. In our
own city, we believe most cases are treated with gentle aperients, and
stimulating sudorifics. Opiates, especially in the form of Dover's
powder, are generally given, and their effects are highly satisfactory
Some physicians administer Quinine freely during the convalescence.

A full account of the disease, we presume, will hereafter be furnish-
ed by some of the medical gentlemen in whose vicinity it has prevailed.

New Hampshire Journal of Medicine. We have received the first
number of a new monthly Journal, bearing this title* published at Con-
cord, N. H., under the Editorship of Edward II. Parker, M. I).
In his salutatory, the editor announces that he does not intend to de-
pend upon extracts from other Journals, or to be their copyist, but
hopes to be furnished by the profession with reports of cases and other
original articles sufficient to fill his pages. We shall see, but if the
physicians of New Hampshire are as free from the cacccthcs scribendi

640

Miscella ni/ . Meteor o logy.

as those of most other sections, our friend will be compelled to write
most of his articles himself, or fail to redeem his promise. We rather
suspect that occasionally, that is to say about once a month, he will
find it necessary to borrow a little matter from some of his exchanges*
Whether this should be so or not, we wish the Journal great success,
and shall be happy to receive it in exchange.

Medical Examiner. In the September number of the Examiner,
we find that the interesting article of our Paris correspondent, Dr.
Hareis, on the Discovery of the Renal Circulation, by M. Bernard,
which appeared in our August number, has been copied without proper
credit bein rnven to the source from which it was derived. We
presume the omission was accidental.

METEOROLOGICAL OBSERVATIONS, for August, 1850, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet. By Dr. Paul F. Eve.

c

Sun Rise.

2, P. M.

Wind.

Remarks.

^

Ther.

Bar.
29 89-100

Ther.

Bar.

1

76

86

29 90-100

s. w.

Threat'd storm 12 M. Th. 94

2

74

" 90-100

99

84-100

w.

Fair breeze. 94 at sun-set.

3

76

" 80-100

90

" 82-100

S. E.

Cloudy thund. 9i at 1 p.m.

4

77

" 75-100

98

" 70-100

\T.

F. breeze. 94 at 12, 93 s. set.

5

72

' 79-100

90

" 81-100

B. IT.

F. afternoon storm at 9^ p.m.

6

73

" 87-100

90

" 80-100

S. E.

Rain at 4 p.m -storm 9 p.m. 1 in.

7

72

" 77-100

90

" 70-100

S. E.

Cloudy storm at 4 p.m. 80-100

8

G8

" 77-100

90

" 79-100

E.

Fair.

9

72

" 80-100

93

" 77-100

3.

Fair. [1 in. 5-100.

10

76

" 70-100

94

" 60-100

g.

Fr. afternoon storm at 7* p.m.,

ii

73

" 61-400

90

" 65-100

S.

Storm at 2 p.m. from W. 15-100.

1-2

72

" 82-100

82

" 85-100

S. E.

Showery, 25-100.

13

72

" 85-100

90

79-100

S.

Fair.

14

74

" 77-100

93

" 71-100

S. \V.

(Fair.

15

78

" 72-100

94

' 74-100

N. W.

(Fair.

16

76

" 78-100

93

" 81.100,

N. W.

IFair.

17

71

82-100

92

" 81-100

S. E.

JFair.

18

73

,: 83-100

92

82-100

S, E.

iSprinkle at 4 p.m.

19

74

" 79-100

90

" 70-100

S. E.

Shower at 2 p.m.

20

74

71-100

96

69-100

N. W.

j Fair thunder at 3 p.m.

21

78

" 68-100

95

69-100

E.

Fair. 94 at 1 1 . 90 at sun-set.

22

76

" 74-100

88

" 74-100

E.

Fai r. [threat'd storm at 7 p.m.

23

76

" 73-100

92

M 65-100

S.

Rain from 4 p.m. 2 inches.

24

75

11 65-100

77

<! 25-100

E.

Hurricane, 65-100 inch.

25

75

" 60-100

90

M 67-100

w.

Fair.

26

69

" 74-100

88

" 73-100

W.

(Fair.

27

70

" 82-100

87

82.100

w.

Fair.

28

73

" 90-100

77

1 " 94-100

N. E.

Cloudy rain, 10-100,

20

73

" 95-100

85

93-100

1 N. E.

Fair.

30

68

" 91-100

86

" 85-100

E.

Fair.

31

68

" 75-100

87

" 66-100

E.

.Fair some clouds.

18 Fair days. Quantity of Rain 6 inches. Wind Eastof N. and S. 16 days.
West of do. do. 11 days.

At the Cohutta Springs, Murray county, Ga:, at 4 P. M., Thermometer was
82 on the 25th. At sun-rise on the 26th it was 59 some ladies were seated
around a fire. The temperature of the Springs is 59 waters calybeate one
contains a little sulphur.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. NOVEMBER, 1550, [No, 11.

PART FIRST.

(Original dommttnications.

ARTICLE XXXII.

Thoughts on the Present State of Medicine. By Charles
Todd Quintard, M. D., of Roswell, Ga.

"Scribimus indocti, doctique." (Hor.)

" We prescribe whether doctors or not." {Free Translation.)

The present state of Medical Science presents to the lover of

the ars divina, an aspect at once encouraging and perplexing

encouraging if he considers the progress it has made within the

last few years, by the adaptation of true inductive philosophy

to the machinery of the science perplexing, if he considers

the systematized empiricism which invades it, or the futile

legislation which hinders it. Time was when fear restrained

the hand of ignorance when the laity contemplated with awe

the erudite mysteries of medical knowledge.

Xavem agere ignarus navis timet; abrotonurn segro.
Xon audet, nisi qui didicit, dare; quod medicorum. est,
Promittuntmedici.

But the superstitious respect for the practitioners of medical
art has sriven way before the utilitarian spirit of our age. The
"World in its search after facts, exhibits a radical intolerance of
abstract enquiries, and hence often mistakes base metal for pure
gold. Hence the quackery in politics and religion, as well as
in medicine. Pretenders succeed in the ratio of their boldness.
Pretenders to medical skill are to be distinguished by the arts
they employ to conceal their ignorance, and to impose that igno-*

jr. s. VOL. VI. NO. xi. 41

642 Quintard, on the Present State of Medicine. [November,

ranee on the unwary. The physician is one really skilled in the
art of healing diseasesone who prescribes a certain method
and certain medicines, because he knows the disease and its
cause one whose accurate observation and knowledge of the
laws of animal life in its various phases, have taught him the
means of controlling their operation. Let it not be supposed that
we intend to add another to the many essays against quacking,
which, however good in themselves, fail in their object, be-
cause of the credulity of mankind. Nor do we intend to write
a regular essay on medical reform, (watchword of empirics,)
nor wTould we presume to point out the means of securing a
proper esteem and respect for the great science. This respect
and this esteem will be awarded to it "as sure as wood grows
and water runs." It may be years hence, but it will come "for
a' that." We have jugglers within and without the profession
quacks who pretend to cure all diseases by the use of one or
two remedies quacks of the Hahnemann and Yon Bonning-
hausen school, who associate in all the mystery of superlative
incomprehensibility. We have to deal with the aquatic disci-
ples of Priesnitz and the stroking philosophers of the Elliotson
school. These all go to makeup the mess of quackery as it
at present exists, galvanized into a life of more than ordinary
vigor; but which, sooner or later, system by system, must de-
compose from the rottenness at its centre. Ages rolled away
while the certain and the uncertain the true and the probable
were being sifted, and the lines drawn betwen hypothesis and
fact. Empiricism was the only mode of practice for centuries.
Practitioners used remedies because they had been known to
be effectual in removing certain forms of disease. Nor have
we indeed much to boast of the science of medicine till towards
the close of the 16th century, except, indeed, the works of the
great father Hippocrates, which for their truthfulness, valid
worth, and actual merit, have withstood the revolutions of
centuries. Let us just glance at the history of medicine from
the period when the Aristotelian philosophy was rejected for
the system of Bacon. This taught that the most certain way
of arriving at the knowledge of truth was by making accurate
observations and judicious experiments, carried on by just in-
ductive reasoning and confirmed by other experiments.

1850.] Quintard, on the Present State of Medicine. 643

It is true, before this time Andrew Vesalius had discovered
and corrected various anatomical errors which Galen had made,
It is true Eustachius had published his Opuscula Anatomica,
and that Dr. Thos. Linacre had translated and published the
fourteen books De Methodo Medendi and by the assistance
of Cardinal Woolsey, had procured letters patent from Henry
the VIII, for the foundation of the Royal College of Physicians.
Dr. Cains had also published his Ephemera Britannica, but
it was impossible for the science of medicine to progress.
The practice was still in the hands of ignorant monks, who
managed to evade the edicts of the Council of Louis (1139),
of Pope Alexander the III, (A. D. 1103;) and Pope Hono-
rius, (A. D. 1216.) Except here and there a lay-gentleman,
whose fancy prompted him to the study, there was really no one
who even understood the practice as taught by Galen, and
the Alexandrian school, much less any who were capable of
detecting the fallacies and errors with which it abounded.
Not only did the monks hinder the progress of medical art by
the basest tricks, but when one of the laity prosecuted the study
in any degree beyond their ignorance, they became fierce in
their resentment, and unscrupulous in their revenge. The
story of Andrew Vesalius will illustrate the dangers which
surrounded laymen who attempted to practice the healing art.
Vesalius was born in Brussels* A. D., 1514. After studying the
languages and philosophy at Louvain, he went to Paris, and gave
himself to the pursuit of Medical science under the guidance of
Sylvius. When only eighteen years of age he composed his
treatise De Corporis Humani Fabrica, and returing to Louvain*
delivered lectures on Anatomy. He afterwards visited Italy,
and by his lectures and demonstrations at Pisa, Bologna, and
other Italian cities acquired great reputation. These Were
sufficient reasons for the priests and monks to look on him with
an evil eye, but he, understanding their ignorance, not only
treated them with contempt, but exposed them. They resolv-
ed to be revenged upon him, and either created or found oppor-
tunity. While Arclicator to the king of Spain, he attended
with other physicians, a gentleman of the royal household, the
cause of whose disease they were unable to discover. Vesali-
us, therefore, obtained leave to make a post mortem. On

644 Quintard, on the Present State of Medicine. [November,

opening the body, the monks who insisted on being present,
either did, or pretended to see, the breast of the deceased move.
He was at once accused of homicide and impiety before the
Inquisition of Spain. Nor could the supplications of the king
save him from priestly rage and tyranny, until his Aulic Council
united their petitions with his, and he was allowed to expiate
the supposed crime by a pilgrimage to Jerusalem. From this
pilgrimage, made in the height of his fame, he never returned,
but was shipwrecked on the Island of Zante, and died there from
hunger and hardships in 1564.

Eustachius, a contemporary of Vesalius, could only obtain
from the Inquisition a license to publish his Opuscula Anatomi-
ca. but not his other anatomical works and tables. Nor Was it
until 150 years after his death that they were given to the world,
when Boerhaave wrote to Dr. Lancicius, the Pope's physician,
to solicit an order to search the Registers in Italy to find where
Eustachius died, and see, if possible, if the anatomical tables
could be recovered. But we need scarcely record these ex-
amples of individual persecutions, when we recall to mind the
fact that superstition rose to almost as great a height under the
shelter of pseudo Christianity, as under the religion of the an-
cients that of the Greeks and Romans least of all excepted
we cease to wonder at the slight progress of science, particular-
ly of that science to which "old wives and stores were council-
lors." Never was the folly of witchcraft in such credit as in
the reign of Henry III of France. A magician, condemned to
be burned, declared on his examination that there were above
thirty thousand of the same profession in France. In the vear
1609, six hundred sorcerers were condemned in the jurisdiction
of the parliament of Bordeaux, and most of them were burned.*
In 1554, Bonner, bishop of London, forbids "amydwife of his
diocese to exercise withcrafte, charmes, sorcerye, invocations
or praiers, other than such as be allowable and may stand with
the laws and ordinances of the Catholic Churche." And in
1559, an enquiry was directed to be made "whether you knowe
any that doe use charmes, sorcery, enchantementes, invocations,
circles, witchecrafte, southesaying, or any like craftes or ima-
ginations invented by the devyl."f It were indeed vain to write

Vide Priesly's Lect. t 1st Eliz.

1850.] Quintard, on the Present State of Medicine. 645

the history of all the superstitions which have clung to medicine,
and in the popular mind seem apart of the science itself. Every
age has had its own order of quacks, but they and their reme-
dies silentlv go down in the sea of time. There has hardly ever
been an epidemic which has not produced hosts of empirics, and
nostrums. At the time of the great plague in London, according
to Defoe, incredible quantities of nostrums were sold. "It is
incredible," says he, "and scarce to be imagined how the posts,
and houses, and corners of the streets were plastered over
with doctor's bills and papers of ignorant fellows quacking and
tampering in physic, and inviting the people to come to them
for remedies, which were generally set off with such flourishes
as these, viz : " Infallible preventive pills for the plague," &c,
&c. In the space of twenty years, from 1662 to 1682, there
were 92,107 persons touched by the King of England for the
cure of scrorfula yclept " Kings evil." The royal gift of heal-
ing commenced with Edward the Confessor, ami was continu-
ed to the close of the reign of Charles II. The London Ga-
zette, No. 2180, Oct. 7 and 11, 1686, contains an advertisement
stating that his majesty would heal weekly for the evil upon Fri-
days, and commanding the attendence of the King's physicians
and Surgeons at the Meuse upon Thursdays in the afternoon, to
examine cases and deliver tickets, and we learn from Evelyn's
Diary, March 28, 1684, that so great was the eagerness to
obtain tickets that six or seven were crushed to death at the
surgeon's door. Every age too has exclaimed at the monstrous
evils of quackery; but, cui bono! Has it grown less? We
are told not. Since the 17th century, we have had quite as
many marvels as before. Some of them have indeed changed
names, and that is all. No, not all, for it has become systema-
tized. The world has been blessed with the Tractors of Dr.
Perkins, and a Perkinean Institute the learned Dr. Thomp-
son, whose glory was to have no learning, and whose practice
is yet pursued the almost as great Hahnemann, who pro-
claimed to the world that his system was the "great gift of God
to man." We have had "Natural Bonesetters," and there are
still a few of them extant. We have Chrystie's galvanic rings,
Old Jacob Townsend's Sarsaparilla. We have All Healing
Ointments, Life Bitters, Indian Vegetable Pills, and hosts of

646 Quintard, on the Present State of Medicine. [November,

nostrums, id omnes genus. But what must be the end of all
these falsities? Can they be put down? Never cut off one
head and two will come in its place. These devil-tricks must
indeed have an end, but othsrs will spring up in their places so
long as human credulity can be tickled with the straws of
quackery. "You take wheat to cast into the earth's bosom ;
your wheat may be mixed with chaff, chopped straw, dust, and
all imaginable rubbish ; no matter, you cast it into the kind, just
earth she grows the wheat the whole rubbish she silently
absorbs." So will it be with science-*

duicquid sub terra est, in aprjcum proferet cctas 5
Defbdiet, condetque nitentia,

Nature only requires truth, and as true seeds are sown broad-
cast, so they will grow, and bear fruit, some an hundred fold,
and the rubbish and chaff of quackery will serve only to nourish
the good seed. We cannot see that the present age is in any
Way remarkable for its quackery ; but we do indeed consider
the progress of true philosophy, and, as a consequence, true
science, since the introduction of Bacon's system, unparalleled
in any previous age. Sum up all that has been done in science
from the days of Galen to the 17th century, and what does it
all amount to when thrown in the balance with what has since
been accomplished, Is it not true, that very little had been
done in the practical departments of philosophy before that
time, and is it not quite as true that since then, medical philoso-
phers have ascertained by what the Rev. Robert Hall calls, "a
sublime process of experiment and induction," the relation which
the corporeal frame sustains to the various objects, both natural
and artificial, with which the stores of nature are fraught.
That they have extorted her secrets and summoned from the
bowels of the earth, and the caverns of the ocean, and from the
boundless fields of air, the most powerful antidotes to disease
that they have levied a contribution from all the departments
and provinces of nature, and compelled them to yield their ser-
vice toman in all the varieties of physical disorder to which he
is exposed. The effect of Bacon's system was at once to
change not only the routine practice of the physicians of that
day, but all formulas of thought, and modes of reasoning. We
need only mention the name of Sydenham, whose improvements
are said to form an era in the history of medicine, to illustrate the

1850.] Quintard, on the Present State of Medicine. 647

effect of the newly introduced philosophy. He applied himself
to an attentive observation of the phenomena of morbid action
and founded his practice on#the obvious indications of nature,
rather than ou any prevalent theory then extant. Indeed he
seems to have thrown aside all theory, nor did his mind admit
any auxiliary to the exercise of its own observation. Accord-
ing to Boerhaave, he "was the ornament of England, and the
Apollo of the art ; whom I never consider but my mind presents
me with the true picture of a Hippocratic physician.''* His
mind seems to have been incapable of gaining any thing second-
hand which it could gather fresh from the reality ; and he ap-
pears to have had a bold confidence in that wonderful faculty of
observation with which he was endowed, and so resolved to
use and trust it to the uttermost, unaided and unencumbered
by any foreign helps. In 1666 he gave to the profession the
result of his observations, in a work entitled Method us curandi
Febres propriis Observationibus Superstructa, which was re-
printed with considerable additions in 1675. Among his prin-
cipal works are Epistolae Responsoria? dure, 1. De Morbis
Epidemicis, a 1675, ad 16S0; 2 De Lues venerea? Historia et
Curatione, 1680; De Pedagra at Hydrope, 16S3, and Processus
integri in Morbis fere omnibus curandis, published posthumous-
ly. He met with considerable ill treatment and opposition, as
all innovators on old established systems do, but he neverthe-
less established for himself a reputation which will be lasting as
the art of medicine. Sydenham's mind is not indeed to be ta-
ken as the guage of intellectual endowment and capability for
medical men, because we cannot estimate the power of obser-
vation in the generality by what it was in Sydenham. This
would be to take the measure of all mankind by the proportions
of a giant, and make the single wonder of an hundred years the
common expectation of every day. Xor is this all, for, if the
faculty of observation and the power of analogies were devel-
oped in each of us in all perfection, we should still require some-
thing more. There are objects beyond the reach of observa-
tion objects which are beyond and uncontrolled by the ordi-
nary laws of vital phenomena and yet the knowledge of these,
has, in the progress of our art, come to be considered as essen-
tial to the safe and successful practice of physic, as those which

648 Quintard, on the Present State of Medicine. [November*

lie strictly within its sphere. This is true of morbid processes
in all their variety, as they affect the structure and functions of
our bodies. This knowledge must be derived from other me-
thods of research from anatomy from chemistry, and from
experiment. The effect of the Baconian system was to in-
duce a degree of research and activity in every department of
physic. Discoveries were made and useful improvements in-
troduced into the art of medicine, which added new dignity to
every one of its branches. Cotemporary with Bacon lived the
eminent and ingei.ious Harvey, who, by observation, experi-
ment and inductivs reasoning, discovered the circulation of the
blood. At the same time lived Sanctorius, Professor at Padua,
who, by a course of experiment which continued some thirty
years, shed much light on what before was dark. Dr. Lower
wrote on the Heart } Ridley and Willis on the Brain ; Glisson
on the Liver ; Wharton and Steno on the Glands ; which were
afterwards much improved by Prof. Nuck in his Adenographia
et Siolographia ; Bruner on the Pancreas ; Pequet on the Lac-
teals, Receptaculum Chyli, and Thoracic Duct;* Leal Lealis
on the Spermatic vessels ; Drilincourt on the Spleen ; De
Graafe de Organis Generations Mulierum, et de Pancreate;
Swammerdam de Utero; Malpigius de Glandulis, et de ovo
Incubato ; Viensens in Neurographia et de novo vasorum sys-
temate corp. Heim.; Haeras and Palsin on the Bones ; Gagli-
ardus on the Teeth ; Hovius on the Eye ; Valsalva, Du Ver-
ney, and Shelamere on the Ear and on Hearing; Peyerus on
the Intestinal Glands. These all made considerable improve*
ment in Medicine, although they made not much in its practice.
From Sydenham we must come down to Boerhaave, who was
not less eminent in the profession of Physic than Sir Isaac New-
ton in Philosophy only mentioning the names of Ruysche,
Morgagni and Albinus as persons who made important disco-,
veries. An ardent admirer of Boerhaave says that "he was
the ablest and greatest Physician that any age has produced
since the great Hippocrates ; and that Hippocrates and Boer-
haave were the two greatest physicians that ever adorned the
profession or the world produced."

Boerhaave began his medical education by studying anato-
* Discovered by Eustachius, A. D. 1564.

1850.] Quinlard, on the Present State of Medicine. G49

n\y, to acquire a knowledge of which he read the works ofVe-
salius, Fallopius and Bartholine, and attended the demonstra-
tions of Professor Nuck. He read the Greek and Latin wri-
ters in succession, and especially the works of Hippocrates, for
which he entertained a great veneration. He examined all the
theories which has prevailed from that of the great founder of
medicine to the "divine Sydenham,'" and formed from thern a
theory which, if far from perfect was much less exceptionable
than any that had preceeded it, and which, when matured, su-
perseded them and became the ruling doctrine all over Europe
for more than a half century. But there were others who at
thistime wereassistinginthediffusion ofsound and practical doc-
trines. Stahl maintained that the chief duty of the physician
was to watch the healing efforts of nature, to leave the cure of
diseases to them, when they seemed adequate to its accomplish-
ment, but to assist them when they were too feeble, and to mo-
derate their violence when they were too powerful. The basis of
Hoffmann's doctrine is, that matter is essentially and necessari-
ally passive and inert, and that all its active properties or pow-
ers are derived from an immaterial animating principle which
is superinduced or added upon it. His observations of the
operation and influence of the mind on the body led him to re-
ject both the chemical and mechanical theory as inapplicable to
the phenomena of life, and he consequently bestowed all his
energies on what he terms vitalism. Hoffmann, who was a
close reasoner, endeavored to controvert the theories of Stahl
and to exhibit their supposed atheistical tendency. He consid-
ered the human body a machine, governed by the laws of me-
chanics, and put in motion by a nervous fluid, or ether contain-
ed in the brain, the nerves, and the blood.

Medicine, he believed, was to be improved, not so much by
experience as by the skilful application of mechanical princi-
ples, and by the sedulous study of proximate causes. All dis-
eases he held to consist in irregularity of action : when too
violent, spasms were produced ; when too weak, atony was the
consequence. And yet he agreed with Stahl in referring much
to obstructions of the humours, particularly in the vena porta?;
but maintained that they always implied relaxation or atony of
the vessels. To this triumvirate, as thev have been calied, to

630 Quint ard, on the Present State of Medicine. [November,

Boerhaave, Stahl, and Hoffmann, pathology and therapeutics
owe many of their greatest improvements. The fanciful views
of Stahl had the effect of fixing the attention of physicians on a
most important branch of the economy, the influence of the
nervous system upon the other organs of the body, and its co-
operation in the production and cure of diseases, and although
we may be tempted to smile at the wisdom Hoffmann ascribed
to the etherial fluid, there can be no doubt that by this very
hypothesis he was led to the discovery of the relations which he
pointed out between the different functions of the living frame,
and the sympathies which are the consequence. Such was the
popularity of Boerhaave, so extensive his research, and so eru-
dite in all that appertained to the science of medicine, and the
philosophy of his time, that he attracted students from all coun-
tries. The majority of physicians having studied under him,
or his immediate disciples, were followers of his system. The
experiments and splendid discoveries of Haller obscured the
brilliancy of Boerhaave's. After the death of Boerhaave, in
1738, Haller published his Prelections with considerable
original matter, in six volumes, and in 1747, he gave to the
world the first edition of his Primae Linear Physiologia, which
rendered Boerhaave's prelections almost obsolete. The innate
powers of natural force of the constituents of the body, which
had been seen by Glisson and Hoffman, were examined by Hal-
ler with a characteristic acuteness, and the result of his long
and well directed efforts, was the establishment of his theory of
irritability and sensibility, as specific properties, attached to the
muscular and nervous systems. The manner in which Haller
conducted his investigations, gave an impulse to science, and
was not less important than the actual discoveries which he
made. He carefully abstained from all opinions founded mere-
ly on speculative grounds, and deduced his general principles
exclusively from experiment and observation. The same kind
of service which Haller rendered for the science of Philosophy,
was performed for that of the practice of medicine by Cullen.
His duties, as a teacher of medicine, led him to review and
examine the theories and systems which were then in vogue,
and he abandoned, after strict investigations, the humoral doc-
trines of Boerhave, the " perturbata idea" of Stahl, and the me-

1830.] Quintard, on the Present Stale of Medicine. Gol

chanical hypothesis of Hoffmann, although he did assent to and
adopt some of the fundamental principles of the doctrine of
Hoffman, such as those relating to spasms and debility, from
which he deduced all the phenomena of febrile disorders. No
one can investigate the writings of Cullen without being forci-
bly struck by the earnestness and sincerity of his searching after
truth. He pursued the path he deemed best for its obtainment
and while he detected the defectsof former hypotheses with
shrewdness and sagacity, he proposed his own views with a
degree of candor and modesty which tended to render them the
more acceptable. Philosophical doubts are inseperable from
philosophical research. But the well organized mind of Cullen
discriminated much that was true from much that was false,
and much that was certain, from much that was conjectural.
Still later discoveries in the sciences of chemistry and philoso-
phy, have indeed proved that certain parts of his system are not
tenable, and that others require to be considerably altered and
modified ; but it may be asserted that no one has produced a
more powerful and lasting effect upon the state of medical
science than Cullen.

When a mathematician arrives, in the course of his reason-
ing, at a principle so evident that no arguments could either
illustrate or enforce it, he knows that his reason can carry him
no further, and if he can satisfy himself that the whole investi-
gation is fairly conducted and does indeed terminate in this self-
evident principle, he is persuaded that his conclusion is true
that it cannot be false. True science aims at this demonstra-
tive solution it aims at an analysis of the immensity of facts
which flourish in the rich domain of truth. Thus, Cullen, while
he exhibited a becoming deference for the wisdom of his pre-
decessors, and in nothing overstepped the boundaries of scien-
tific authority, was nevertheless ever on the alert, for those fre-
quent facts which had never yet been the subject of critical
examination. By him, old truths truths consecrated by the
experience of ages were brought into proximity with the re-
cently adduced tacts of his predecessors. These he studied in
all the minutia of their relation not only the relation they
bore the one to the other, but to the observation, the experience,
and the undoubted accuracy of the philosophers who had gone

C52 Harris, on the causes of Malarial Fever. November,

before him and his great merit, and that which entitles him to
the admiration and gratitude of posterity, is the sagacity and
diligence which he manifested in the description and discrimi-
nation of the phenomena of disease. In this talent he may be
considered as rivaling Sydenham or any of his most distin-
guished predecessors, while the recent improvements in physi-
ology and other branches of medical science, gave him advan-
tages which he did not fail ^duly to improve. His career forms
an era in the history of medicine. His " First lines on the
Practice of Medicine," are even yet received as a safe guide
in the mysteries of the art, although his doctrines, like those of
Hoffman, with which they more nearly agree than with those
of any other modern author, have become, in the advance of
anatomical and physiological knowledge, nearly obsolete. At
this period, the progress made in medicine by such men as
Gregory, Black, the eJder Monroe and Cullen. (who were co-
laborers in the University of Edinburgh, and who elevated it
to the zenith of its reputation) must arrest the attention of every
reader of the history of the science. Opinions and theories
become more settled as we advance. Truths which had been
glimmering in the misty light of hypothesis and superstition,
for ages, begin to shine with a pure light and drive away the
masses of credulity which had floated over the wit of centuries.
The diamond facts with which Hippocrates had engraved his
immortality, are re-set and sparkle in the casket of the more
revered wisdom of modern times.

[To be concluded in next No.]

ARTICLE XXXIII.

Malarial Fever, the result alone of physical causes. (A chap-
ter from an unpublished manuscript.) By J. C. Harris, M.D.,
of Wetumpka, Alabama.

Section I. Perfectly aware of the difficulties that surround
our subject, and knowing that we may talk and write as much
as we please about the insalubrity of the air of the maremma,
or pestilential vapours, generated in other localities, under vary-
ing circumstances of heat and moisture, from organic matters
undergoing decomposition, and even being forward arguments

1850.] Harris, on the causes of Malarial Fever. G53

apparently based on experiment in support of our opinions, and
then signally fail of success, from the want of accuracy in some
even of the minor details, we have been induced (for the purpose
of making what has been already advanced more plain) to attempt
to show the disease producing power of all of them in excess,
with perhaps the exception of malaria, thereby giving greatly
the preponderance to atmospheric variations over the locality.
For this purpose, we know of nothing to compare with the
observations made by Lieut. Lynch, in his explorations of the
Dead Sea.* Observations, it will be recollected, too, that
were commenced and carried out at the peril of life; and
amidst the most discouraging circumstances, must be some-
what enhanced in value from the fact that they were made by
one who made no pretensions whatever to medical acquire*
ments, and therefore had no preconceived opinions in this par^
ticular to warp his account. Notwithstanding, therefore, then*
we are told by this truly good man, and more than veteran
explorer, that there could be nothing pestilential in the atmos-
phere of the sea, there being but little verdure upon its shores,
and by consequence but little vegetable decomposition to ren-
der the air impure ; still this very want of learning in the par-
ticular already alluded to, rendered him but badly qualified to
determine what were really elements and circumstances neces-
sary for the production of disease, and in support of which
assertion we herewith submit, carefully compiled from the nar-
rative, the following analytical account of the exploration, and
in so doing cannot refrain from the expression of the opinion
that the account, as a whole, from which the analysis is made,
perhaps will scarcely ever be equalled, either as regards accu-
racy of detail or elegance of style, and in which we are inform-
ed that this sea the creation of God's wrath, together with the
whole plain of the upper shore, has probably sunk down some
fifteen hundred feet below the original level, with the greatest
depression abreast of Wady Shuwier, and that the streams
which formerly run through to the Red sea, were thereby de-
barred an outlet, and submerged the plain; the cities of which*
from the abundance of bitumen that prevailed, were most pro-
bably the theatre of a preceding conflagration. The opinion

* This party consisted of Lieat. Lynch and fifteen others,

654 Harris, on the causes of Malarial Fever. [November,

that the vale of Siddim was thus submerged, is, we think, very
strongly supported by the fact that the soundings made, ascer-
tained the bottom of the sea to consist of two plains, an elevated
and a depressed one, averaging, the former 13 and the latter
1300 feet below the surface ; through the northern and largest
and deepest one runs a ravine, which seems to correspond with
the bed of the Jordan to the north, and with another at the
southern end of the sea.

But leaving here the study of this part of the narrative for
those who may feel an interest in such matters, we will proceed
with'a description of the sea, and in so doing will merely ob-
serve that, from lake Tiberias to the sea, the course of the
Jordan, although extremely crooked, is nearly due south ; the
Dead seaextendingdown on the same parallel of longitude, and
lying entirely between the thirty-first and thirty-second de-
grees of north latitude, may be described when undisturbed by
winds, as a sheet of placid salt sulphureous water of some forty-
five miles in length, and varying in width from three to eleven
miles, and bounded on the north, north-west and west, at no
great distance from its shores, by the high precipitous cliffs and
mountains of Jordan, and on the south-east and east by those
of the lands of Moab and Ammori, and the recipient at all times,
but more particularly during the rainy season, of a large amount
of water discharged into it, through the Jordan, the Kidron, the
Arnon, and the warm springs of Callirrohoe through the Zerka
Main: through this latter next to the Jordan, during the rainy
season, is certainly discharged the greatest amount of water.

The saltness and specific gravity of the water was found by
experiment to be considerably greater than that of the Atlantic
ocean, and on analysis gave as solid constituents in certain pro-
portions, the chlorides of magnesium, sodium and calcium, and
the chloride and bromide of potassium, with a small amount of
the sulphate of lime ; but failed under the most powerful micro-
scope to show any animalcule or vestige of animal matter. Its
temperature, as ascertained by a series of experiments made
with the self-regeristering thermometer, was found to beat the
depth of 1044 feet, 62 at the surface immediately over it 76 ;
at the depth of 10 fathom, there was an interruption to the
gradual derease of temperature, by a stratum of cold water, the

1850.] Harris, on the causes of Malarial Fever. G55

temperature of which was 59; after this, the diminution was
gradual. The increase of temperature below 10 fathoms was
attributed to the evolution of heat during crystalization : its
water, as it mixed with milk, had the color of diluted absinthe,
and over its surface hung continually throughout the day, and
of various colors, being sometimes blue, purple, or yellow, a
thin mist of evaporation.

For the purpose of preventing any unnecessary confusion,
we have thought proper, before entering on a topographical
description of its shores, to state that the exploring party enter-
ed the sea through the mouth of the Jordan at the northern
extremity; on the evening of the 18th April, 1848, and after
encountering a heavy squall from the north-east, landed and
encamped for the night at Ain el Feshkhah, on the north-eastern
beach ; they then continued their explorations around the north-
western shore, to Ras el Feshkhah, and from thence, along the
western shore, to Ain Jidy. From this point, on the 24th of
April, they crossed over to the eastern shore, and landed on
the Peninsula ; and after examining its shores, returned again
the evening of the same day to the western shore ; and from
thence sailed around the western shore to Sabbeh, spending
the night at Mubughghik ; thence to Ras Hish and the extreme
south point of Usdum and the sea ; thence around the south-
eastern shore, landing and encamping on the southern side of
the Peninsula, near WadyHumeir; from this place, sounded
across, and landed at Wady Muhariwat, on the south-western
shore ; passed up from this point, April 27th, keeping parallel
with the western shore, and encamped for the night on a fine
pebbly beach of a spacious bay at the foot of Rubtat el Jamus.
From this point, returned to Ain Jidy, remained there through
the 29th, and on the morning of the 30th, commenced opera-
tions by steering over to point Castigan, and from thence, in a
s. s. east direction, landing and spending the night on the east-
ern shore, a short distance from a shallow stream descending
the Wady Beni Hamed. May 1st, completed the topographi-
cal sketch of the shore lines of the bay, and verified the mouth
of Wady Kerak. May 2d, left the shores of the sea, and visit-
ed the walled town of Kerak, returning on the evening of the
3d to the boats, launched the same, and all hands going aboard,

656 Harris, on the causes of Malarial Fever. [November,

steered down the bay, and landed and spent the night on the
Delta, at the mouth of the river Arnon ; from thence, they
coasted along the eastern shore to the warm springs of Callirro-
hoe and the Zerka Main; from Callirrohoe, Lt. Lynch crossed
over to Ain Terabeh, sending Mr. Aulic with Dr. Anderson
to complete the topography of the Arabian shore, and determine
the position of the mouth of the river Jordan. This done, they
rejoined him at Ain Terabeh, where, after spending twenty-two
days and nights upon this sea, they, on the morning of the 10th
of May, took up their line of March for Jerusalem.

With this brief outline of the route of the party, marked on the
map with red lines, we will be somewhat better prepared to
understand the following topographical sketch of its shores.
The northern shore* is described as an extensive mud-flat, with
a sandy plain beyond, and the very type of desolation, having
scattered over its surface in every direction the branches and
trunks of trees ; some charred and blackened as by fire others
white, with an incrustation of salt the north-western as an
unmixed bed of gravel Coming in a gradual slope from the
mountains to the sea ; and the eastern as a rugged line of moun-
tains, bare, of all vegetation a continuation of the Hauran
range, coming from the north, and extending south, beyond the
scope of vision, throwing out three marked and seemingly
equidistant promontories from its south-eastern extremity.
Their first encampment was pitched in a cane-brake, beside a
clear but brackish spring, with a strong sulphurous smell, and
near a foetid marsh, the miasm from which was anything but
agreeable. Between this point and Ain Jidy, the mountain
sides and shores Were almost entirely devoid of vegetation,
with the exception of a low, narrow plain near Ras el Feshkhah,
skirted with canes; from Ain Jidy, to five or six miles north
of the salt mountain of Usdurri, with the exception of the clifTof
Sebleb, which is removed some distance from the margin of
the sea, by an intervening delta of sand and ..detritus of more*
than two miles in width, there is but little variety in the scene-
ry, and nothing in a medico-topographical point of view worth
notice.

f April 26. Started, and steered in a direct line for

Nar. of the Expd., p. 173-4. + Ibid, P. 201.

1850.] Harris, on the causes of Malarial Fever. 657

Ras Hish, the north point of Usdum, sounding every few min-
utes for the ford, stretching out occasionally from the shore
line, and returning to it again when the water deepened to two
fathoms. At 8.12. stood in, and landed on the extreme point of
Usdum. Many dead bushes along the shore., which are en-
crusted with salt, as at the Peninsula; found it a broad, flat,
marshy delta, the soil coated with salt and bitumen, and yield'
ing to the foot.

At 8.30, started again, and steered east s. east, sounding eve-
ry five minutes, the depth from one to one and three-quarter
fathoms ; white and black slime and mud. At 9, the water
shoaling, hauled more off shore ; soon after, discovering a lofty
round pillar, supposed to be the identical one into which Lot's
wife was transformed for her disobedience, we immediately
pulled in shore and landed, for the purpose of examining it.
We found the beach a soft slimy mud, encrusted with salt, and
a short distance from the water covered wtth saline fragments,
and flakes* of bitumen.

* ''Intending to examine the south end of the sea, and then
proceed over to the eastern shore, in the hope of finding water,
we discharged all our Arabs but one, and sharing our small
store of water with them, and giving them provisions, we start-
ed again, steering south."

"11.28. Unable to proceed any further south, from shal-
lowness of the water, having run into six inches, and the boats'
keels stirring up the mud. The Fanny Skinner, having less
draught, was able to get a little nearer the shore, but grounded
three hundred yards off. Mr. Dale landed to observe for the
latitude: his feet sank first through a layer of slimy mud a foot
deep, then through a crust of salt, and then another foot of mud,
before reaching a firm bottom ; the beach was so hot as to blis-
ter his feet. From the water's edge, he made his wav with
difficulty for more than a hundred yards over black mud, coated
with salt and bitumen."

t " The southern shore presented a mud 'flat, which is termin-
ated by the high hills bounding the shore to the southward.
A very extensive plain, or delta, low and marshy, towards the
sea, but rising gently, and farther back, covered with luxuriant

* Nar. of the Expd., p. 203. t ibid, r. 201.

N. S. VOL. VI. NO. XI. 42

G58 Harris, on the causes of Malarial Fever. November,

green, is the outlet of 'Wad y el Safish, anxious to examine it,
we coasted along, just keeping the boat afloat, the in-shore oars
stirring up the mud. The shore was full three-fourths of a
mile distant, the line of demarcation scarce perceptible, from
the stillness of the water and the smooth shining surface of the
marsh; on the flat beyond were lines of drift-wood, and here
and there, in the shallow water, branches of dead trees, which,
like those at the Peninsula, were coated with saline incrusta-
tions. The bottom was so very soft that it yielded to every
thing, and at each cast the sounding lead sank deep into, and
brought up a soft, marshy, light-colored ?nud.,i>

"It was indeed a scene of unmitigated desolation: on one
side, rugged and worn, was the salt mountain of Usdum, with
its conspicuous pillar, which reminded us at least of the catas-
trophe of the plain ; on the other, were the lofty and barren
cliffs of Moab, in one of the caves of which the fugitive, Lot,
found shelter. To the south, was an extensive flat, intersected
by sluggish drains, with the high hills of Edom semi-girding the
salt plain where the Israelites repeatedly overthrew their ene-
mies; and to the north, was the calm and motionless sea, cur-
tained with a purple mist while many fathoms deep in the
slimy mud beneath it, lay embedded the ruins of the ill-fated
cities of Sodom and Gomorrah. The glare of light was blind-
ing to the eye, and the atmosphere difficult of respiration. No
bird fanned with its wing the attenuated air through which the
sun poured its scorching rays upon the mysterious element on
which we floated, and which alone, of all the works of its Maker,
contains no living thing within it.

"12.21. * In two hours, we were close in with the eastern
shore, but unable to land, from the soft bottom and shoalness
of the water. At 2.50, a light breeze from west n. west ; haul-
ed to the north, towards the base of the Peninsula, A long,
narrow, dry marsh, with a few scrubby bushes, separated the
water from a range of stupendous hills two thousand feet high.
Steering along a low marshy flat, we landed on the sooth side
of Wady Humeir, the most desolate spot upon which we had
yet encamped."

Opposite the mouth of the Wady Beni Hamed is quite ar*

* Nar. of the Exptf., p. 205.

1850.] Harris, on the causes of Malarial Fever. C59

extended plain, having scattered over it groves of Acacia,
Tamaisk and Osher trees ; and on which were found growing
millet, tobacco, and some indigo. On this plain, stands the
town Megra-ah, and in the near vicinity of which are found the
suppose ruins of Zoar.

Besides the deltas at the mouths of the different streams and
ravines, and the stagnant pools of water on the northern shore,
may be mentioned the small Post Plioceve or Allevium islands,
at the mouth of the Jordan, and which are subject to overflow.

Now, when we take into consideration, in connexion with
the foregoing account, the fact, that the rivers Jordan and
Arnon are continually discharging, through their waters, into
this great reservoir, large quantities of organic sedimentary
matters, in various stages of decomposition, which are carried
and deposited along the northern shore, and at the southern
extremity of the sea, by the action of a central current that has
always been observed setting south, we cannot be surprised at
the result, when we reflect that during the great evaporation
consequent upon the dry season, there is always presented to
the action of the sun, at the southern extremity, and around
the shores, a surface varying from a few hundred yards to
several miles in extent, and containing these organic remains
under favorable condittons for the evolution of malaria.

Plants, fruits, flowers, grasses, grain and trees, found grow-
ing in the immediate vicinity, and on the shores of the sea.
Near Ain Terabeh, were found the lily, the yellow henbane,
the night shade, the lambs quarter, and a species of kale. On
the plain, near Ain Jidy, the rock rose, the common pink, the
alleppo senna, the common mallow, and yellow migniotte ; on
the upper part of the plain, near Wady Sudier, the prickley
gherkin, and two patches of barley ; and near the north-west
of Usdum, a melon, resembling the cantelope, and very bitter.
Canes and grasses the former at many places along the chore,
and particularly at the mouths and along the banks of the dif-
ferent rivers and ravines. The dhome or spina christa and Its
fruit, resembling a dried crab-apple; the fountain of Ain Jidy
is concealed in a grove of these. The pistachia, the zamariah,
the acacia, the osher, and shurrha, together with a few willows
at the mouth and along the shores of the Zerka Main. On the

660 Harris, on the causes of Malarial Fever, [November,

south-east shore, there were some fields in cultivation, in which
were growing millet, tobacco, and indigo.

Section II. Meteorological Observations. Tempera-
ture. The thermometer, we are informed, ranged during the
day, in the shade, from 79 to 110, never falling through the
night below 68, and on but one occasion, near the upper end of
the sea, during a clear and calm night, as low as this point.
The highest temperature experienced, was from the 1st to the
10th of May, during the explorations around the southern
shores of the sea, the thermometer varying here, in the shade,
from 80 to 110, and never sinking, during the night, below
74. It was, during one of these cold nights, at the mouth of
the Arnon, under the influence of a cold north-west wind, that
George Overstock, one of the seamen, had a chill.

Barometer. As we feel more deeply interested with the
oscillations of pressure, as given by this instrument, on the same
level, than the mean pressure, at different elevations we ac-
cordingly find these, as given by Lieut. Lynch,* varying from
79.26 to 80.345 cent., with a gradual diminution in elevation
and oscillation, as he approached the heated and varied atmos-
phere of the southern extremity of the sea.

Dew and the dew-point. Upon this subject, we are informed
that, " although the nights were mostly cloudless, there was
scarcely any deposit of dew, the ground remaining heated
through the night, from the intensity of the solar rays during
the day." " On the first of May, although the wind was high
too high to take observations of polaris the night was sultry,
thermometer 81, and the dew so heavy as to filter through the
tent awnings and drop upon our faces." This is noted as the
second time that dew had been observed, and each time it had
been attended with a hot wind from the north ; the first time
it was succeeded by a sirocco, and the last by a thunderstorm.
For the deposition of dew, we know that the atmosphere must
be either charged to saturation by evaporation, or cooled down
to condensation ; and although we have no account of its hav-
ing been charged to saturation more than twice, we have every
reason to know that during the frequent calms, from the rapid

Report to the Sec'ry of the Navy, p. 33.

1850.] Harris, on the causes of Malarial Fever. GG1

evaporation that was continually going on from the surface of
the sea, that the circum-ambient air must have been loaded with
watery vapour, the deposition of which, as dew, was prevented
by the frequent hot, dry winds that swept it from the west,
south, south-east and east.

Winds. These were evidently of two kinds, local and gen-
eral: that the former were no less the result of inequalities in
the temperature of the air of the two extremities of the sea,
than were the latter of similar causes, on a more extended
scale, we have an abundance of evidence ; hence, by the rarified
columns ascending at the south, currents of warm, moist air
were set in motion from the north, but of an entirely different
character from the general ones, blowing from the same direc-
tion, and coming from the snow-capped summit of Mount Her-
mon and the Lebanon ranges. Up to April 23d, each day, in
the forenoon, the wind had prevailed from the southward, and
in the afternoon, until about midnight, from the northward.
The last wind quite fresh, and accompanied with a smell of sul-
phur ; after midnight it generally fell calm.

The general winds, that came from the north and north-west,
over the sterile plains of Judea, and those from the south, over
the desert of Zin, were as completely robbed of their moisture
as those that came from the south-east and east, across the
great deserts of Syria and Arabia, and over the barren plains
and calcined cliffs of Moab and Ammon. These hot, dry winds
were always unrefreshing, and, from their low dew-point, must
have been exceedingly unhealthy. The approach and effects
of a sirocco, at the southern extremity of the sea, is thus des-
cribed. "Clouds in the east, nimbus seemed to be threatening
a gust; presently the light wind subsided, and it became op-
pressively hot ; air 97; water twelve inches below the surface,
90 ; a thin purple haze over the mountains, increasing every
moment, and presenting a most singular and awful appearance:
the haze so thin that it was transparent, and rather a bluish
than a distinct color. Apprehending a thunder gust or an
earthquake, we took in sail. At 3.50, a hot, blistering hurri-
cane struck us from the south-east, and for some moments we
feared being driven out to sea. The thermometer rose imme-
diately to 102 the men, closing their eyes to shield them

662 Harris, on the causes of Malarial Fever. [November,

from the fiery blast, were obliged to pull with all their might,
to stem the rising waves, and at 4.30 physically exhausted ;
but with grateful hearts we gained the shore. My own eye-
lids were blistered by the hot wind, being unable to protect
thern from the necessity of steering the boat. After landing,
one man mounted spectacles to protect his eyes, but the metal
became so heated that he was obliged to remove them. Our
arms, and the buttons on our coats, became almost burning to
the touch ; and the inner folds of our garments were cooler
than those exposed to the immediate contact of the wind."
Shortly after the subsidence of this sirocco, saw appearances of
sandpits on the surface of the sea, doubtless the optical illusion
which has so often led travellers to mistake them for islands.
On the next day, from the same cause, the great refraction of
the atmosphere, the Fanny Skinner* around the point, seemed
elevated above it. Her whole frame, from the surface of the
water, was distinctly visible, although the land intervened.

Section III. Having now concluded all that is necessary to
be said in relation to the medical topography and meteorology
of this most remarkable locality we come next to enquire,
what were the immediate and subsequent effects upon the
health of those exposed to its vapours and atmospheric varia-
tions. Upon this subject, we are informed by Lieut. Lynch,
that there is a tradition among the Arabs that no one can ven-
ture upon its waters and live, and that repeatedly were the fates
of Castigan and Molyneux cited to deter him from the under-
taking. Undismayed, however, by these reports, and knowing
no other object than the faithful execution of his orders, fear-
lessly himself and party at once launched upon its waters; and
although we are told that there had been symptoms that had
caused him some uneasiness, still, up to the 30th of April, all,
with one exception, had enjoyed good health. About this time,
the figure of each one had assumed a dropsical appearance :
the lean had become stout, and the stout almost corpulent; the
pale faces had become florid, and those which were florid, rud-
dy : moreover, the slightest scratch festered, and the bodies of

Fanny Skinner and Fanny Mason were the names of the copper and iron
boats.

1850.] Harris, on the causes of Malarial Fever. GG3

many of the party were covered with small pustules all had
good appetites, and these sores were evidently the result of the
greasy acrid water of the sea. Shortly after this, and while
the party were asleep, we have the following description of
their condition : "My companions had yielded to the oppres-
sive drowsiness, and lay before me in every altitude, of a sleep

that had more of a stupor in it than of a repose Some

with their bodies bent, and arms dangling over the abandoned
oars, their hands excoriated with the acrid water, slept pro-
foundly ; others, with heads thrown back, and lips cracked and
sore, with a scarlet flush on either cheek, seemed overpowered
with heat and weariness, even in sleep; while some, upon
whose faces shone the reflected light from the water, looked
ghastly, and dosed with a nervous twitching of the limbs, and
now and then startling from their sleep, drank deeply from a
breaker, and sank back again to lethargy. Subsequently (but
after leaving the immediate shores of the lakes) every one of
the party were attacked with a. fever of a low nervous grade,
attended with great exhaustion, and partial delirium, the same
which carried ofTCastigan and Molvneux, and of which Mr.
Dale unfortunately died. We are also informed, that of the
three thousand Egyptians sent to the shores of this sea, by
Ibrahim Pasha, some time during the year 1838, for the pur-
pose of making a settlement, every one of them died within
two months after their arrival.

Section IV. Effects of the foregoing facts, as regards the
origin of fever, upon the animalcular, vegeto-animalcular and
cryptogamous hypothesis. Aware that it is contended for by
philosophers, that the class of infusoria prove life generally
diffused, and that under the most powerful magnifying glasses
almost all fluids, and even earths and stones, are shown to pos-
sess more or less of it ; still, as no animalcular, or vestige of
animal matter, could be detected by the most powerful micro-
scope, in the water of the Dead seas, renders it highly proba-
ble, nay, almost certain, that nothing of the sort did exist there,
or any where else, either in the mud and slime along its shores,
or in sufficiently close proximity to the same, as to be brought,
through the agency of the dews, within the influence af its life

664 Harris, on the causes of Malarial Fever. [November,

destroying properties : hence, the vegetable matters entangled
with the mud, washed down from the surrounding countries of
the different streams, and supposed to contain animalcular life,
must have had every vestige of vitality thus destroyed, long
before reaching and being deposited at its southern ex-
tremity, and along its shores thus furnishing evidence of the
fallacy of the doctrine, alike conclusive, either as regards the
animalcular or vegeto-animalcular origin of fever. As regards
the other hypothesis, we are informed by Dr. Mitchell, in his
essay on the Cryptogamous Origin of Malarious Fever,* that
"just on the line which faintly marks the division between the
animal and vegetable kingdoms, lie the litchens, the algai, and
the fungi: these cryptogamous plants are so closely allied to
each other, as to be indistinctly separated by naturalists, some
of whom include under one division, species, which are found
differently disposed of by other phytologists. Lindly, follow-
ing the great continental cryptogamists, admits that the loca-
tion, rather than the structure of these plants, affords a final
distinction, and that while the litchens live on dry and scanty
soils, and algae in water, salt or fresh, the fungi occupy the
intermediate place, loving a damp and unsound or loaded atmos-
phere, and feeding on organized matter, the vitality of which
is gone, or going.

In all of them, the element is a very minute cell, not often
distinguishable, when isolated, from the elementary cells of even
animal organisms : indeed, some of the confervce, obviously
vegetable in one state of existence, as the anthrodice, offer in ano-
ther the plainest character of animal life, supposing that animal
life is to be inferred from motions indicating a well-marked
power of volition. Some of the oscilliarias have oscillatory
movements extremely active and perceptible, and the ulva
labyrinthi formis and anabaince, with all the other conditions
of a vegetable, have, according to Vauquelin and Chaptal, all
the chemical characters of an animal. We have, therefore,
chemically constituted plants with animal motions and volition ;
and those of animal composition, with the exclusive habitudes
and structure of vegetables. Now, as regards the animal mo-
tions and volitions of the first class, and animal composition of
* Kar. of the Expd., p. 35-6.

1850.] Harris, on the causes of Malarial Fevers. 065

the second, the facts already stated are perfectly fatal, as no-
thing of the sort could exist, within the waters, or in the imme-
diate shores of the sea. In fact. Dr. Mitchell, in the work from
which the foregoing extracts are made, in his eager search for
a new cause of malarial fever, seems to have entirely forgotten
that the handfull of dust, which he picked up whilst standing
at St. George's, Delaware, filled with the spores of wThat he
supposed to be the polyporus distructor, and merulius vartator
cryptogamous plants, whose active existence had been bought
at the expense of the old stumps, might have already, or even
then, under well established chemical laws, been disengaging
into the surrounding atmosphere a gas, the cause of all the pre-
vious mischief. That such a result as this is nothing but natu-
ral, and w7hat was to be expected, will, to the student of nature,
not appear so strange, when he learns that a law once establish-
ed forever remains, operating always upon the same general
principles, and forever producing similar results; and that at-
traction and gravitation are no more an illustration of the law,
than is malaria, under certain circumstances, the result of vege-
table matter undergoing decomposition ; and that the one is as
susceptible of proof as the other.

Having, in the preceding chapters and sections, defined our
geographical limits, and given their geographical structure and
physical features, and endeavored to showr, in connexion with
topography, the influence in the production of malarial fever,
of heat, light, electricity, moisture, elevation and winds, in va-
rying proportions, but determinate quantities, over surfaces
unequally supplied with vegetable matter undergoing decom-
position; and having seen them not only greatly modified in
malignancy and type, but prevailing in almost exact proportion
to the presence or absence of one or all of these elements has
brought us rather to view them in the light of bearing towards
each other the relation of cause and effect, than otherwise.

606 Casey, on the "Mange.91 [November,

ARTICLE XXXIV.

The "Mange" communicated to three persons by a pig. Re-
ported in a letter to the Editor, by H. R. Casey, M. D., of
Columbia county, Ga.

I will give you the particulars of a conversation held a few
days since with a gentleman of this county, and if the deduc-
tion I have drawn from the facts as reported is correct, we
have presented to us (so far at least as my observation extends)
anew disease of the cutaneous system one hitherto undescri-
bed by dermatologists.

Mr. S. asked me "if I had ever known a man to have the
mange?" to which I gave a negative reply: having always
understood that it was a disease peculiar to the quadruped
He then asked me "if I thought it possible for a man to catch
it from a hog?" I replied, that there are a great many things
regarded as impossible, which are not found to be so when sub-
jected to the test and that this might be one of t*he cases.
He then proceeded to give me the following particulars:

He states that about the first of May last, having a pig badly
diseased with the mange, and being desirous to cure him, he
had some soap and water got and went to work on him with
his hands and that after giving him a good washing, he strip-
ped him almost of his entire external with his nails. That he
was entirely well at this time; but that in about three hours
thereafter, he felt an itching on his hands and wrists, and an
eruption which commenced spreading upwards ; that about the
same time, his ankles began to itch him and the eruption there
made its appearance, which also spread upwards and met the
eruption from above at the half-way house the umbilicus ;
that it reached its height in about two weeks ; that the eruption
was characterized by great heat and intolerable itching, com-
posed of small vesicles, which, though not confluent, stood close
together over his entire tegumentary tissue. Thus was he at the
time of his commencement with the ablution a sound and
healthy man but in a very short time thereafter, he was
transformed into a Lazarus. He thought he had contracted
his disease from the pig, and went to work to cure himself,
using first the soap and water. This not benefiting him, he

1850.] Casey, on the "Mange" GG7

was bled and took salts. This failing, he tried pot-liquor then
the grease from fried bacon then a solution of blue-stone-
He does not think that any of the means used had any control
whatever over the disease, but that it seemed to pursue its
course, knowing no conqueror, until it finally wore itself out,
in about five week?.

Now, from the above narrative, I can but infer that the dis-
ease in question was one identical with the mange, and that it
was communicated from the quadruped to the man. And I
am further strengthened in this view of the case, from the fact
that a female and the negro boy who held the pig while
being subjected to treatment, became in like manner affected.
The view I have taken of this case, I know to be in direct con-
flict with the long-established dogmas of the veterinary school,
but I think I am sustained in my position from the facts of the
case and "facts are stubborn things."' By reference to the
il History of the Horse" I find the following language. The
author, in speaking of the contagiousness of the mange, goes
on to say "If the same brush or curry-comb be used on all
the horses, the propagation of mange is assured ; and horses
feeding in the same pasture with mangy ones, rarely escape,
from the propensity they have to nibble one another. Mange
in cattle has been propagated to the horse and from the horse
to cattle but there is no authenticated instance of the same
disease being communicated from the dog to the horse. There
is as much difference in the character and eruption of mange
in the horse and dog, as between either of them and the itch
in the human subject; and the itch has never been communi-
cated to the quadruped, nor the mange of the quadruped to the
human being."

My only reply to the above quotation, is the presentation of
the case related; and if I am not sustained in my corollary
from the facts of the case, this article will go for nothing. I
pretend to no familiarity with cutaneous diseases ; but if I were
called upon to classify the mange, I should locate it in the group
dermatoses scabienses of Wilson, not only from the pathologv,
but also from the therapeia of the disease; for I find sulphur
the anchor of safety to the veterinary surgeon. Nor do I think
there is any thing very strange in all this; and the only reason

668 Word's Case of Hysteria. [November,

why we have never before had the mange communicated to
man arises simpiy, I think, from the fact, that in all probability
more caution has hitherto been experienced than was in the
case before us. We have examples of other diseases occur-
ring in the human subject, the result of propagation from the
lower order of animals. In the Revue Medicale of July, 1845,
we have detailed a case of an officer who took the glanders
and farcy from a horse, and in which experiments were made
by M. Andouard, to test the contagiousness of the human fluid
introduced into other animals the results of which experiments
went to prove that the disease was not only communicable
to man from the horse, but that the disease was again trans-
missible from the human subject to the quadruped. In the
Southern Medical and Surgical Journal, Nov., 1847, we have
a case of Glanders in the human subject, derived from the
horse, reported as occurring in your own city. Other diseases
might be mentioned occurring in the great paragon of animals,
communicated from the lower order; but I have already spun
out this article to a greater length than was designed at its
commencement, and will conclude by merely advising those
persons who may have to treat the mange in stock, to touch it
lightly, and never make a curry-comb of their hands : to which
injunction I know my friend F. will say amen.

ARTICLE XXXV.

Case of Hysteria. By Robert C. Word, M. D.,
of Cassville, Ga.

At 9 o'clock on the evening of the 21st inst., a negro woman,
the property of R. H. Patton, of this place, was seized with
what was supposed to be "a fit," with evidences of alarming
prostration. When I arrived, about 10 o'clock, found her in a
complete state of insensibility, breathing rather heavily ; pulse
full and firm, but not unnaturally frequent ; eyes rolled back;
pupils contracted and insensible to light, and occasional spasm-
odic movements in the extremities. Upon inquiry, learned
that for the last two days the patient had complained of sore
throat, with a sense of constriction about the fauces and difli-

1850.] Word's Case of Hysteria. G69

culty of swallowing. Negro ordinarily healthy, save occasional
catamenial irregularities, for which she had been often bled.
It immediately occurred to me that the case was one bordering
upon apoplexy, consequent upon a plethoric condition of the
system. With this view, I bled freely from the arm, applied
sinapisms to the extremities, with the cold douche, and contin-
ued cold cloths to the head : after which the spasmodic move-
ments were less frequent, and the patient regained a slight
degree of consciousness and partial amelioration of the symp-
toms for about two hours, when the convulsive movements in
the extremities entirely ceased, but was followd by a very dis-
tressing symptom, not unlike the hiccough, which seemed to be
occasioned by an obstruction in the air passages. At first it
occurred about every third inspiration, but gradually become
more frequent, attended by fits of suffocation, during which it
was necessary to raise the patient and shake her, when large
quantities of glary mucous and froth would flow from the mouth,
followed for a few minutes by very slight relief. These parox-
ysms continued to recur with increased violence until they be-
came alarming. The patient, during the paroxysm, would
grasp at whatever was in reach an instinctive effort to aid
the muscles of respiration. When water was handed her, she
would eagerly snatch it to her mouth, but the effort to swallow
occasioned strangulation, and the water would be ejected with
a violent struggle. I now became satisfied that the case was
an unusually severe attack of hysteria, and that these symp-
toms arose from spasmodic constriction of the glottis and par-
alysis of the muscles of deglutition. Uncertain whether the
bleeding in the first instance had been beneficial, I hesitated as
to the propriety of repeating it. A warm bath was ordered
and Dr. W. Hardy called in consultation. The violent and
almost fatal fits of suffocation had well nigh induced a resort
to tracheotomy; but as this was rather a novel procedure in
such cases, it was determined first to try the effects of the bath.
She was immersed wholly in warm water for 15 or 20 minutes
removed and rubbed dry, and a sinapism applied to the cer-
vical and dorsal vertebrae. This was followed by partial relief
for two or three hours, and the patient enjoyed occasional mo-
ments of repose. Dr. II. now left, under the impression that

C70 Sequelae of the Diseases of Children. [November,

the patient would improve; if not, he thought the lancet should
be resorted to. About day-break the symptoms of suffocation
again returned and became at intervals more alarming than
ever. In this condition she continued until 6 o'clock, growing
evidently worse and worse. My co-partner, Dr. Underwood,
was now called. Sinapisms were again applied to the extrem-
ities and to the whole course of the spine, but the patient was
insensible to their effect. The inhalation of ether was then
tried which seemed to have no other effect than to render the
patient more comatose and insensible. It was now determined
to bleed to relaxation. Before the arm was untied, relief was
apparent a large quantity of viscid, ropy mucous was ejected
from the throat and the patient fell into a calm sleep, from
which she awoke after a time writhing under the effects of the
sinapisms. She could now swallow and make herself under-
stood by whispering. An enema was administered, which
added to the improvement. All the distressing symptoms
gradually subsided, and to-day (24th) she can articulate freely
and is able to set up and take nourishment.

PART II.
IXtvxtms anir <&xtxatt$.

On some distressing Sequela? of the Diseases of Infancy.
Purulent Discharges from the Aural, Nasal and Vaginal
passages. By Thomas Weeden Cooke, Esq. (London
Lancet.)

The very slight reference made in systematic Works profes-
sing to treat of the diseases of children to an annoying and, in
its consequences, serious discharge, to which the passages
above named are liable during childhood, has for a long time
struck me as an extraordinary and curious fact, considering
the numbers of children who suffer from this form of disease.
Feeling, some three years since, the want of information upon
this subject, and finding no resource but the book of Nature, I
was induced to take notes of every case that came before me,
and to watch this particular class of cases carefully. The
notes thus taken, both in hospital and private practice, have
now* so accumulated, that I believe I have acquired accurate
data upon which to found a short paper, that may perhaps

1850.] Sequelce of the Diseases of Children. 671

prove of some interest to those who are engaged in the treat-
ment of the young. Amongst the poor, these affections are
very rife indeed, and although less prevalent in the wealthier
classes of society, their offspring are still by no means exempt
from a disgusting, foetid, debilitating discharge from some of
the passages named, which, if neglected, or not properly
treated, will lay the foundation of diseases which medicine may
essay in vain to eradicate.

Dr. Abercrombie, in his great work on the brain ; Mr. Solly,
in his ; and Sir B. Brodie, in the Medico-Chirurgical Transac-
tions ; have each recorded cases, showing the positive and
absolute connexion between abscess of the brain and diffuse
meningeal suppuration, and a neglected suppurative discharge,
commencing in the external auditory passage. A similiar dis-
charge from the nasal passages, although of less frequency, is
not the less disagreeable, and will, if neglected, lead to perios-
teal inflammation and bony exfoliation. Vaginal discharges
have received more attention than either of the others, having
especially obtained the careful investigation of Sir Astley
Cooper, and of most surgeons who have written on sexual dis-
eases, as well as of those gentlemen who have devoted them-
selves to legal medicine. Worms and intestinal irritation have
been suggested as the most probable cause of this complaint,
but it appears to me that all have failed to attribute it to that
origin which my own investigations lead me to believe is the
true one, and to which the two other affections are likewise at-
tributable.

Scarlet fever, measeles, remittent fever, and occasionally
hooping-cough, sufficiently destructive as they are in them-
selves, mowing down weekly sometimes a fourth of the children
that are born, are still more dire in the evil after-effects they
produce upon the tender saplings they attack ; rendering a pre-
viously healthy child a miserable, puny, "grizzling" creature;
tiresome and unhappy itself, and a source of painful and anxious
concern to its parents. For a longer or shorter period this
state of things is allowed to continue without any supposition
that medical aid is necessary the cross temper of the child
being looked upon by some as an indication of returning health ;
and that, consequently, the vis medictUrix natures will do all
that is needful. The infant, however, continues peevish, rest-
less at night; its appetite is capricious; it wastes; the mouth
is hot, the lips are dry, the eyes unnaturallv bright, and the head
becomes burdensome, so that the poor little creature is often
glad to rest for a time from its continuous moan by laying its
head in its mother's lap. In this stage two things may occur:
either the cerebral irritation will increase, and subacute inflam-

672 Sequelce of the Diseases of Children. [November,

mation of the brain or its membranes be set up, (with which we
have at present nothing to do,) or the membrane lining the exter-
nal auditory passage will begin to secrete a puriform discharge,
varying in its consistency according to the strength of the sub-
ject of it, being sometimes very nearly laudable pus, but more
frequently approaching the flour-and-water looking fluid of the
true scrofulous diathesis, not unfrequently having a bloody tint,
and exhaling an odour such as scrofulous secretions only are
capable of producing. This discharge being set up, the head
symptoms become relieved, and there is less of the peevishness
which was previously so distressing. Some slight treatment
in the shape of warm water injections into the ear is directed ;
an opening powder or two are prescribed, the ear is plugged
with cotton wool, and there the treatments ends; until the
ulceration of the external canal extends to the tympanum, eats
through it, and running into the external auditory passages, and
destroying the auditory apparatus, produces caries of the tem-
poral bone, abscesses within the cranium, and, as a consequence,
the loss of hearing, convulsions, sometimes paralysis of the
facial nerves, exfoliation of bone, and certain death. These
are the frightful consequences of a neglected purulent or
strumous discharge from the ear, coming on after some great
disturbance of the system, such as that arising from an attack
of fever eruptive or otherwise. Frightful indeed to witness,
most painful and unsatisfactory to treat, after the suppurative
process has gained the internal ear, but entirely under surgical
control whilst it is confined to the outer side of the tympanum :
and this I am emboldened to say should ever be the case if the
child has the opportunity of obtaining and who has not?
surgical aid.

In the treatment of this very distressing and important
sequelae of the exanthemata, I have almost invariably found it
necessary to support my little patients with a nourishing diet,
including a modicum of animal food, in some form, once a day;
whilst I have thrown into the system as much of the sesqui-
oxide of iron as the stomach could take without discomfort. I
am partial to this form of administering iron to children, because
they take it very well in treacle or honey ; and although I have
used iron largely in all forms, I am positive not with the same
beneficial results that have been obtained from the old red car-
bonate, as it used to be called. As an injection, I never have
occasion to use anything but a solution of sulphate of zinc,
from three to five grains to the ounce, and this it is necessary
should be so injected that it may reach the tympanum. Gener-
al cleanliness, free ablutions of the the whole body, sea-bathing
and out-of-door-exercise, are of course, at all times, highly con-

1850.] Sequelce of the Diseases of Children. 673

ducive to the restoration of diminished power of life, such as
this suppurative discharge loudly indicates.

Desirious as I am to give a few selected cases, showing the
various stages of this malady, the perfect ease with which slight
cases are managed, and the difficulties we have to contend
with when it has proceeded to the destruction of the tympanum
and bony structure of the ear, I yet fear to swell my paper to
too great a bulk. Before, however, quitting this part of my sub-
ject, I may mention that it is in the advanced stage of this
affection of the ear, when the tympanum is destroyed by
ulceration, that the glycerine is found serviceable. This sub-
stance, which has proved so valuable an addition to our thera-
peutic agents in aural medicine, it is well known, was first in-
troduced to the profession by Mr. Thomas Wakley, jun., in a
communication to the journals last year, and the extensive
employment of it proves how justly the virtues of this agent
were even then described. The impure lees of the soap-boiler
is called glycerine, and had been previously employed as a
useful application in squamous diseases of the skin ; but the
bright pure liquid, for which the profession is so much indebted
to Mr. Thomas Wakley, jun., and which was accurately and
chemically described by him in his paper, is altogether different.

The suppurative discharge from the lining membrane of the
nostrils is likewise a sequela of the exanthemata, but one neither
so constant or important, although equally as disagreeable, as
that from the ceruminous membrane of the ear. In some cases,
there is a constant flux of muco-purulent matter, occasioning
a continual sniffling and blowing of the nose ; in others, the
muco-purulent matter hardens, and collects in very large
scales, which irritate for a long time, and after much blow-
ing come away in huge masses. Upon careful examination,
the Schneiderian membrane will be found denuded in some
parts, and in others (especially that lying over the turbinated
bones,) thickened and inflamed; sometimes the discharge has a
very offensive odour, and sometimes not, and this will be the
case with the same child at different periods. I have now cases
before me exemplifying these variations, which at some future
time I may copy out and publish. It has never occurred to me
to see any formidable evil result from this affection of the nos-
tril in children, but I can call to mind many cases in adults
where a chronic inflammatory condition of the Schneiderian
membrane has been allowed to go on until the turbinated bones
and even the vomer itself, have become carious; and who shall
say but that timely surgical aid would have saved the nose and
averted the misery of many a now disconsolate mortal. With
children suffering from this affection, I have pursued the same

n. s. vol. vi. no. xr. 13

674 Sequelce of the Diseases of Children. [November,

plan which I employ for discharges from the ear supporting
tonic treatment, meat and iron, and the sulphate-of-zinc injec-
tion ; that failing, I have used the r.ed nitrico-oxide-of-mercury
ointment, melted, and introduced by means of a small mop,
and, in very obstinate cases, one or two applications of the
nitrate-of-silver ointment of Guthrie have effectually healed
the ulceration.

In approaching the consideration of discharges from the
vagina, I cannot but remember how large an attention this
subject has received from some of the most distinguished mem-
bers of our profession, and what stories we have heard of the
sad consequences of attributing this very common and innocent
affection to causes which, happily, are of but rare occurrence
in this country. Connected officially, for the last six years,
with the Royal Free Hospital, where there is so large an out-
patient practice, I have had ample opportunity of learning the
merits of these cases, and am proud to say, that in one instance
only during that period was there any evidence of a criminal
attempt. The muco-purulent discharge to which little girls-
are obnoxious, is as frequently to be traced to the exhaustion
produced by fever as are those other fluxes previously spoken
of. There is the same flaccid condition of the. muscles, the
same peevishness and constant restlessness ; in general, a disin-
clination for food ; the bowels are inclined to be confined ; the
pulse is quick and weak, and the tongue is coated with a whitish
fur. These general symptoms are accompanied by some red-
ness around the nymphae ; the discharge is profuse, slightly
yellow, full of pus globules, and occasionally acrid, since it pro-
duces excoriation, if the nurse be not very cleanly. It is very
rare that the child has ardor urinae a symptom which would
be looked for if gonorrhoea were expected, and which, together
with laceration or ecchymosis would be the only signs by which
the surgeon could positively conclude that a criminal attempt
had been made. The large number of cases of this sort which
have come before me is surprising, and equally so the unanim-
ity of their histories. All these patients have, but a short time
before, recovered from some of those febrile disorders whose
sequelae are so often neglected by parents, and the conse-
quences of which are more fatal than the parent disease.
Happily, the expectant timid treatment commonly pursued in
the two forms of the same disease already discussed, has, in
this particular instance, not been followed, owing partly to Sir
Astley Cooper's example, and partly, I suspect, to the parts
affected being considered less susceptible of injury. I believe
that the zinc injection, or one composed of Goulard extract and
water, together with iron, and an occasional aperient, is as uni-

1850.] Habitual use of Opium. 675

versally the plan adopted as my experience would lead me to
hope for ; whilst my out-of-door exercise, and good nourishing
diet, will be acknowledged as necessary as in the other forms
of this very disagreeable and sometimes dangerous malady.

In tracing the history of these affections of the mucous pas-
sages, it has been already said that they are to be found follow-
ing some exhaustive fever, and very frequently accompanied
by the presence of worms in the intestines. This latter cir-
cumstance led to the inquiry, if there be any truth in the com-
monly received opinion, that the irritation produced by the
presence of parasites in the intestines was sufficient to account
for the discharges mentioned? I conceive that this opinion
cannot be held, inasmuch as ulcers are constantly seen in va-
rious parts of the body, produced by poorness of living; and
we likewise know thai it is only in the intestines of weak chil-
dren that parasites retain their hold. Both the suppurative
discharge and the worms may, and do, exist together, but not
as cause and effect; the origin of both must be traced to the
atrophied condition of body produced by the wasting fever.

In concluding these few crude remarks upon a class of dis-
eases which has no place or name in any nosological table, and
which has been generally looked upon as unworthy of much
consideration, I would beg to urge the evil results arising from
an absence of early treatment as a moving cause whv we
should not overlook things apparently, and only apparently, so
trifling. Allow an ulcerated condition of the aural, nasal," and
vaginal membranes to continue unchecked, and you will cer-
tainly lay the foundation for deafness, loss of the sense of smell,
disfigurement of the features, incurable cerebral disorders, and
all those distressing diseases to which the internal organs of
generation in the female are from so many causes peculiarly
obnoxious. One great cause of neglect I believe to have arisen
from a fear, lest in treating these discharges from delicate pas-
sages in the same manner we do indolent asthenic affections of
the body generally, some fancied but undefined ill should arise
to the organ itself, or that by suppressing the discharge, neigh-
bouring parts, equally important, should become congested.
This fear, I beg to assert, after much careful experience, is not
warranted by facts, whilst the magnitude of the evils resulting
from non-interference is daily demonstrable.

Habitual Use of Opium. (American Journal Med. Sciences.)

The number of the Monthly Journal of Medical Science for
June, 1850, contains an abstract of a highly important paper
by Mr. R. Little, of Singapore, in which is given a very inter-

076 Habitual use of Opium. [November,

esting account of opium-smoking in China, the mode of
preparing the opium for that purpose, and the effects of the
practice on health and longevity. From this paper, we make
the following extract :

"A difference of opinion prevails as to the ultimate effect on
the health, when opium is used in this way so often as to con-
stitute a habit. It was long universally thought to undermine
health and abridge life. But in recent times doubts have been
raised on this head. Dr. Burnes was led to conclude, from ob-
servation when at the court of Lahore, in the time of Runjeet
Singh, that the habit of eating opium does not tend to shorten
life. More lately Dr. Macpherson came to the same conclusion,
from what he saw of opium-smoking among the Chinese at
Canton. And in Europe, since the inquiries on the occasion
of the jury trial at Edinburgh in 1832 connected with the insur-
ances of the late Earl of Mar, it has been thought by not a few
persons of weight that the habit of eating opium, or drinking
laudanum, may be by no means so injurious to health and
longevity as its immediate effects on digestion and the nervous
system would lead one to prognosticate. It may be true, as
these skeptics have stated, that some people, long abandoned
to the vice, have lived to a good old age, miserable from its
immediate effects, yet not unhealthy. But the experience of
most travellers, who have witnessed its effects on a large scale
in the East, is directly the reverse ; and although this proposi-
tion may be in some measure liable to the objection that it is
the statement of casual observers merely, it is amply born out
by the results of careful and extensive inquiries at Singapore.
These inquiries were made by personally examining the owners
of opium shops, the smokers who frequented them, the prisoners
in the house of correction, and the paupers of a poor-house sup-
ported by voluntary contributions. The following information
is the result.

"As the habit grows upon its unhappy victim, the first evils
experienced are disturbed sleep, watchfulness, giddiness, some-
times headache, capricious appetite, a white tongue, frequently
costiveness, indescribable oppression in the chest, and haziness
of the eyes. Afterwards, a copious secretion of mucus takes place
from the eyes, and often from the nose also ; digestion becomes
much impaired, and micturition difficult ; a mucous discharge
begins to flow from the organs of generation; the sexual organs,
at first preternaturally excitable, gradually lose their tone; the
body wastes, the muscles lose their torosity, and the bones are
affected with dull gnawing pains for some hours in the morning.
By and by, the figure stoops, and a peculiar shuffling gait is
acquired, by which alone a practiced eye may recognize an

1850.] Habitual use of Opium. G77

old opium debauchee. At the same time, the eyebrow droops,
the lower eyelid becomes dark, the eye itself seems to sink and
grow dim, and the whole expression is that of premature old
age. In both sexes, the procreative power is greatly lessened,
and in those women who nevertheless do bear children, the
secretion of milk is defective. The influence of the habit on the
generative functions is indeed so decided that were it not for
fresh arrivals from China and other parts of theEast. the popula-
tion of Singapore would very soon be seriously diminished.

"Still there may be no structural derangement. At length,
however, food and drink are vomited almost constantly when the
system is not under the primary action of a dose ; there is in-
cessant gnawing nainiji the stomach when its effect is off;*diar-
rhcea comes on, relieved only by fresh indulgence, and dysentery
sometimes supervenes ; a turbid mucous urine is discharged
with unusual frequency, the result sometimes of renal disease ;
and, among affections of the kidneys, Bright's disease is not
uncommon. In others, difficulty of breathing is a prominent
symptom, increasing gradually to an urgent sense of suffoca-
cation, and depending generally on oedema of the lungs, or
effusion into the pleural sac. In others, irregularity and feeble-
ness of the pulse, with pain in the cardiac region, indicate the
supervention of organic disease, or severe functional disturb-
ance of the heart. Some suffer excessively from boils and
carbuncles, from the latter of which few confirmed opium
smokers recover. Foul, indolent ulcers are extremely common
among the poor ; strumous affections of all kinds are apt to be
developed, and the constitution is prone to succumb without
resistance under all violent diseases.

" The influence of opium-smoking on the morals of its victims
is not inferior to its impression on the bodily health. Indolence
and inaction, neglect of business or work, and consequent pov-
erty, though the most obvious, are not the worst results. Deeper
depravity often follows in the train of these evils. Wife and
children are disregarded ; frequently, however, not before they
are inoculated by example or positive encouragement with the
same unhappy vice. Misery leads at last to crime, and crime
to deeper misery. Not unfrequently theft supplies the only re-
sources for persevering in the fatal pleasure. Of forty Chinese
prisoners in the Singapore HouseofCorrection.no fewer than
thirty-five were opium-smokers. Seventeen of them, who had
earned on an average eighteen shillings of wanes monthly,
spent nearly twenty-four shillings upon opium, the difference
being necessarily made up by the gains of stealing. One of
them, who earned twelve, but smoked twenty-four shillings, on
being asked how this was how it was possible ? aptly replied,

678 Habitual use of Opium. [November.

* What am I here for ? The sedative action of the drug is well
exemplified in the crimes for which these people were impris-
oned. In Europe, where the habit of intoxication with ardent
spirits adds fearfully to the contents of prisons, it is well known
that crimes are committed chiefly during the excitement
caused by the poison, and are therefore generally directed
against the person. But the opium-smoker knows no such
state of existence. His intoxication is quiescent. It is not till
this stage passes off that he begins to think of crime; his object
is to supply the means for the next debauch ; and accordingly
offences against property constitute a large proportion of the
causes of imprisonment in this class of the population of
Singapore. Of twenty-two opium-smokers in the prisons of
Singapore and Penang, nineteen were condemned for offences
against property and only three for offences against the person.
Opium-smokers constitute 80 per cent, of those confined in the
House of Correction at Singapore for vagrancy and police
misdemeanours, but only 40, or at most 50, per cent, of those
in prison for larceny, highway robbery, burglary, and other
similiar offences requiring boldness and enterprise.

"Unfortunately, the effects produced on the health by aban-
doning the hahit of smoking opium, after it has become deeply
rooted, are even worse than the perseverance in it. A gloomy
despondency is added to the usual symptoms of the ordinary
stage of depression ; a state ensues somewhat like a low state of
delirium tremens, attended with extreme prostration of strength,
and often with exhausting diarrhoea and vomiting ; all pre-ex-
isting diseases are aggravated, dropsy frequently ensues, and
death may soon result, most generally by effusion into the great
cavities, and general anasarca. When these effects have begun
to show themselves under a compulsory cessation of the
habit, the most marked improvement of health is produced by
resuming it. Hence no one who has once fairly given himself up
to this unhappy vice will surrender it voluntarily. The result
of the examination of several hundred opium-smokers on this
point was, that, by their own confession, the extent of their indul-
gence was limited only by their means, and the spontaneous aban-
donment of it impossible. The writer of an essay on the opium
trade says, 'There is no slavery on earth to name with the
bondage into which opium casts its victims ; there is scarcely
one known instance of escape from its toils, when once they
have fairly enveloped a man. Mr. Marsden also says it is
almost impossible to shake off the habit. And Sir Stamford
Raffles gives it as his opinion 'that the use of opium is all the
more dangerous, because a person once addicted to it can never
leave it off.'

1850.] Habitual use of Opium. G79

"Nevertheless, under medical advice, with due caution on
the part of the physician, and some exercise of resolution on
the part of the patient, the habit may sometimes be effectually
and safely broken. Its abandonment, either sudddenly or
without due precaution, is attended with danger. But that
recovery is practicable and safe under a methodical treatment,
the following case will sufficiently show: A Malwah opium
merchant and opium-eater had often endeavoured to abandon
the habit, but always in vain. On one occasion, when wrecked
on the coast of Cochin-China, his strength of mind enabled him
to observe his religious dietetic principles, so as to live for weeks
on dry rice and water, because he could not cook food accord-
ing to his creed. But when he wished to give up his opium,
this man of iron nerve was like a child for feebleness of pur-
pose ; he could not encounter the sufferings of the stage of
probation. At length, on arriving at Singapore, and learning
that the habit could be broken by means of a wonderful medi-
cine, he resolved to subject himself to treatment, on condition
that he was to undergo, neither the rending of the bones nor
gnawing at the stomach, which he experienced in all previous
attempts. At this time, he ate twenty grains of opium, morn-
ing and evening He was directed to use twice a-day a
mixture containing a drachm of Battley's solution, a drachm of
laudanum, and two drachms of tincture of gentian, and to wash
down each dose with a mixture containing essence of ginger
and two drachms of some aromatic stimulating tincture. He
was likewise enjoined to take gentle walking exercise morning
and evening. He felt no inconvenience, although his dailv
allowance was thus reduced at once from forty to about twenty-
four grains ; on the contrary, he felt stronger and more com-
fortable. The quantity of the preparations of opium was then
gradually reduced, while that of the bitter and aromatic
tinctures was increased; and after the opium was thus all
withdrawn, the tinctures were gradually exchanged for de-
coctions of black pepper, ginger, and quassia. In this way, he
recovered entirely without any suffering: and twelve months
afterwards he continued scrupulously to abstain from the drug,
and enjoyed the best of health.

''From this and other parallel cases, there is no reason
to doubt that the habit may be broken off with safety by a
gradual progressive reduction of the dose of opium, and the
substitution of strong bitters and hot aromatics for a time,
especially if with this change be combined free air, regular and
increasing exercise, and a good nutritive food. But it is im-
possible to give up the habit at once with safety."'

Prof. Christison, in a supplement to this paper, has added some
interesting information to that furnished by Mr. Little.

680 Habitual use of Opium. [November,

Prof. C. says: u Important as the inquiries of Mr. Little un-
questionably are, they do not absolutely settle the question
of the influence produced on health and longevity by the
habitual use of opium, as indulged in by inhabitants of this coun-
try. The subject still requires more extended European ob-
servation.

"lam sorry to add, after this introduction, that my opportuni-
ties of adding to existing information have not been so consid-
erable as might be desired. But I have met with one case
which would undoubtedly have proved fatal in early life, had
not the habit been broken ; and which, on that as well as on
other grounds, well deserves to be made known: and, having
had some little experience in the treatment of the habit with a
view to its cure, I have thought the particulars may prove
both useful to the profession and encouraging to the unhappy
victims of the vice1; more especially as my observation does
not correspond with that of Mr. Little, as to the great danger
arising from its abandonment.

" The first case was that of a seaman, of the age of twenty-
eight, who had contracted the habit while in the mercantile
service in the Eastern seas, in consequence of being obliged to
use opium for a protracted dysentery. He had continued it
for two years. His daily allowance was a drachm of solid
opium, which he took in divided doses in the day-time. Im-
mediately on his return from a voyage to the islands of the
East Indian seas, he applied for admission into the Edinbnrgh
Infirmary, to be cured of the habit. He had a sallow yellow-
ish complexion, which, however, is well known to be occasion-
ed by the climate merely of the parts he usually visited. Far-
ther than this, nothing remarkable could be observed in him ;
and he assured me that he could follow his occupation well
enough, but that it cost him a great effort to do so, and that his
misery was great on awaking in the morning, until he com-
menced his doses. The bowels were little liable to constipation ;
but he had been long free of the remains of his dysentery ; and
he had not the affection of the eves and nose, described by Mr.
Little to be generally observed among the smokers of opium
at Singapore. His constitution being obviously little impaired
as yet by the habit, I contented myself with simply withdraw-
ing his allowance of opium at once and entirely, and with sub-
stituting a draught, with two drachms of tincture of hyoscya-
mus, in the evening, as a soporific. Great prostration of
strength ensued ; he either lay in bed motionless, or wandered
about the ward with a languid gait, and woe-begone counten-
ance ; he was affected with incessant loathing of food, nausea,
and indescribable uneasiness in the stomach, but not with pain

1850.] Habitual use of Opium. 681

there, or in his limbs ; and he slept none, notwithstanding the
hyoscyamus. This state of matters continued for three days
and nights, during which no change of treatment was made,
except that a little brandy was given to assuage the uneasy
feeling in the stomach, and that an attempt was made, but in
vain, to obtain sleep by increasing the hyoscyamus to three
drachms. On the fourth night he took no hyoscyamus; na-
ture asserted her sway, and he slept soundly; in the morning,
he felt revived, took some food with relish, and had no uneasi-
ness afterwards. From that moment, he quickly recovered
strength and spirits, under no other treatment than a generous
diet ; and, in the course of a fortnight alter his admission, he
left the hospital quite well. This instance may perhaps serve
as an example of what may be expected when the habit, as
seems often to happen under the counteracting effects of an
active occupation, has not materially undermined the consti-
tution.

"Subsequently, I was consulted in a very melancholy case,
which, although its result is not known to me, is worthy of
mention, on accout of its remarkable circumstances. A medi-
cal gentleman in England had long been dissatisfied with his
wife, on account of her neglect and indifference, so that at last
a separation was contemplated. But he continued from time
to time to put off the evil day. At last, he was one evening
hurriedly sent for home, to find her in a state of deep sopor, and
in circumstances which left no doubt that a large dose of lauda-
num had been swallowed. By the application of the usual
remedies, she was with some difficulty roused, and eventually
recovered. To the consternation of her husband, however, he
then for the first time discovered that she had been long in the
habit of drinking laudanum to excess, and that on this occasion
she had merely taken, by some accident, a more potent dose
than usual. He came to Edinburgh to consult me what was to
be done, as she expressed a willingness to be cured of her fear-
ful habit ; and more particularly he was anxious to know
whether it might with safety be abandoned abruptly; because
he despaired of accomplishing a gradual reform. The narra-
tion of the previous case determined him to adopt a similar
treatment. I have never heard the result. Should these pages
meet his eye, he may perhaps be induced to communicate it
still.

"Some years ago, I had for a patient a gentleman who had
cured himself successfully of the habit, which he had con-
tracted while engaged in a literary undertaking of some dura-
tion, and requiring protracted fatigue of the mind. I do not
know the particulars, however; but he had recovered from the

682 Habitual use of Opiam. [November,

vice without danger ; and, when I saw him, several years had
elapsed without inconvenience or relapse.

"The last easel have to mention is the most instructive that
has yet occurred to me. An English gentleman, twenty-five
years of age, whose pursuits rendered him somewhat migrato-
ry, consulted me, while in Edinburgh early in the spring of 1848,
on account of ordinary stomach complaints. The pulse being
very frequent, his body emaciated, his complexion anaemic, and
his expression of countenance haggard, I suspected something
more than stomach complaints in one of his age. My suspi-
cions naturally turned to phthisis; and although they were not
confirmed by a stethoscopic examination of the chest, I advised
him to repair at once to his friends in the south of England,
whom he intended to visit in no long time at any rate, and
there to put himself under medical advice. After this, I heard
no more of him till near the end of last August (1849), when
I was requested by Dr. Ebenezer Skae to see him here, on ac-
count of a return of his stomach complaints, in a very urgent
form. In the spring of that year, they had assailed him with
increased severity. During the summer, they got progres-
sively worse, though with occasional brief intermissions. Lat-
terly, chronic organic disease was suspected ; and, after various
remedies had been used without any permanent advantage, a
gentle course of mercury was recommended by one of his phy-
sicians, and had been commenced before I saw him. I found
him much emaciated, and extremely prostrate. He vomited
most things he took; but for three weeks had taken scarcely
any food. The pulse was frequent and feeble; the tongue
whitish and clammy ; the bowels rather confined ; the skin
cool ; the urine scanty, natural in colour, not coagulable by
heat or nitric acid. The abdomen was very lank; and in the
epigastric and both hypochondriac regions there was no ful-
ness, firmness, tenderness, or dulness on percussion. The coun-
tenance was bloodless and sallow ; the eyes clear, large, ring-
eyed ; the expression anxious and dreamy. There was no
unusual secretion from the eyelids or nostrils. Suspecting
organic disease. I recommended perseverance with mercury,
and for the vomiting medicinal naptha and hydrocyanic acid.
In three days more, as he had become worse, I was sent for
again ; but, on my arrival, I was surprised to find him much
more comfortable since the morning, and this without naphtha,
hydrocyanic acid, or apparently any other remedy. Mean-
while, however, Dr. Skae had learned that a suspicion was
entertained that he took opium in excess. I therefore under-
took to tell him that the symptoms resembled the after-effects
of opium in those accustomed to use it, and that he must put

1850.] Habitual use of Opium. G83

his confidence, without any reserve, in his medical attendants.
He seemed a little surprised at the announcement ; but all he
would admit was, that he did acquire the habit three years
before, in consequence of using laudanum too heedlessly lor
toothache; and that after nine months' indulgence, he had
broken the habit, though with great difficulty, and with six
weeks of constant suffering. This did not satisfy us, however,
and on finding out his druggist, and putting the question, it
was discovered that for two years he had been supplied with
large quantities of opium in various forms ; that at one time his
daily allowance was three ounces of laudanum; that latterly
he had purchased at the rate of two drachms of hydrochlorate
of morphia that is, about two ounces of opium every week ;
and that he had got that quantity only a few days before. The
druggist having been bound down by him to secrecy, it was
necessary to extort a confession, if possible, from the patient,
without making use of this information. But it was all in vain.
He persevered in denying that he used any preparation of
opium ; and nevertheless he had just contrived to obtain two
additional drachms of hydrochlorate of morphia. He was now
removed to airy lodgings, two miles out of town, and from any
druggist's shop ; and I then intimated to him our positive know-
ledge of his evil habit. which, however, he began to deny
again, until I stopped him abruptly with his druggist's admission.
He then surrendered a paper of hydrochlorate of morphia,
which he took from under his pillow; and gave his consent to
any thing we chose to do for the purpose of ridding him of
his enemy. We proposed to withdraw the morphia at once
and entirely, to administer tincture or extract of Indian hemp
at night only, and to allow him every four hours half a glass
of brandy, diluted with water a beverage to which, moreover,
it appeared that he was not unaccustomed. At the same time
he was placed under the vigilant observation of a sister, who
had come from England to look after him.

"The vomiting, which had previously ceased for some days,
owing undoubtedly to the resumption of his doses, now recur-
red with increased severity. For three days and nights, he
had excessive retching and vomiting, and extreme muscular
prostration ; and on the third day frequent watery discharges
from the bowels. But, from the first, the brandy relieved the
irritability of the stomach for a lime, and the Indian hemp was
retained in the form of extract, though not in a draught. On
the fourth morning, the vomiting and retching ceased. But
the diarrhoea continued ; neither infusion of catechu nor gallic
acid made any impression on it; on the sixth day, there were
ten watery evacuations; and therefore a little opium with

084 Gonorrhoea. November,

acetate of lead was used in the way of injection. This had at
once the desired effect. On the sixth day, he was able to dress
and sit up for half an hour occasionally ; which he had not
done for two months. Next day, he walked out for half a mile.
The pulse had now fallen from 120 to 90 ; the tongue was
moist, and tolerably clean ; the appetite, which had begun to
return as soon as he ceased to vomit, was good, and digestion
undisturbed ; he slept well ; thirst was his only uneasiness, and
his countenance, although still haggard, was nevertheless great-
ly improved in expression. Medicines were now abandoned.
On the eleventh day, having still continued free alike of sick-
ness and of diarrhoea, he set off for England, and made out the
journey comfortably. Three months afterwards, I heard that
he went on favourably, gaining strength, and abstaining from
opium, and also from stimulating liquors, except sparingly for
medicinal purposes.

" This case is probably a good illustration of the usual phe-
nomena, when the constitution has been seriously undermined
by the use of opium. It is not easy to imagine a worse case,
short of the production of organic disease. The habit evident-
ly could not have been continued much longer without immi-
nent danger to life. Nevertheless, it was broken off abruptly,
without hazard. No one can answer for such cures being
permanent. An insane craving, as in the instance of the insane
abuse of spirituous liquors, may lead to the habit being resum-
ed. But, at any rate, it would appear from the instances given
in this paper that the habit may be easily broken; and that
there is no danger in suddenly breaking it, in so far, at least,
as we see it in Europe. The knowledge of this fact may give
to the physician in like circumstances a confidence and deter-
mination, which might otherwise be shaken by the symptoms
of alarming exhaustion, but without which he can scarcely
inspire his patient with the resolution necessary for encounter-
ing the trial which must be undergone. It is true, that in some
instances, the opium may be withdrawn gradually, in the way
recommended by Mr. Little; but I apprehend that, in general,
as in the case of habitual excess in the use of spirituous liquors,
patients may be found ready to submit to the physical evils of
an abrupt abandonment of the opium, who will not undertake
the moral trial of a gradual reduction."

On a peculiar Form of Gonorrhoea. By W. Colles, F.R.C.
S. I., Surgeon to Stevens' Hospital, &c (Dublin Journal.)

There are few diseases occurring so frequently in medical
practice, the treatment of which has undergone so little modi-

1850.] Gonorrh&a. 685

fication, while the result of that treatment has been so uncertain
and variable, as gonorrhoea. Thus we meet with two patients
whose symptoms are appparently similiar ; we subject both to
the same routine of practice, and the result will be, that one
will be cured in the space of two or three weeks, while the
other will continue to labour under the disease for months, if
not for years.

It has been the habit of the surgeon to consider the disease
to be the same in both cases, and to attribute the different results
of his treatment to some peculiarity of constitution, which either
will not tolerate the remedies proposed, or resists their effects.
I think, however, that if we examine the subject more closely,
we shall find that there may be various affections or morbid dis-
positions in the several organs concerned in the disease or in
the neighbouring parts, which added to the original inflamma-
tion of the urethra, will contribute to keep up the discharge,
and which must be removed before the patient can be perfectly
cured. I had -proposed alluding to such of these affections as
I have found most frequently complicating the disease, and to
the treatment required for each, before the gonorrhoea can be
cured ; but from the limited space that can be allotted to this
communication in the present Number of the Journal, I find
that I must postpone doing so until a future opportunity. I
shall, therefore, confine myself now to the consideration of one
which I have frequently iound co-existing with and conducing
to the severity of the original disease, rendering it much more
intractable in its nature and progress, requiring a modification
in its treatment, and one which has not yet attracted the atten-
tion from surgeons that its importance and frequency would
seem to merit.

Gonorrhoea was considered by Mr. Hunter to be a peculiar
inflammation of the lining membrane of the urethra, which nev-
er extended beyond the first two inches of the canal, and this he
named its specific distance; he seems to have come to this
conclusion from observing that the patient always referred the
pain to this one part. Subsequently to him, surgeons seem to
have adopted this opinion, without much consideration, for it
will be found, on inquiry, that there is scarcely a disease of the
urinary organs, however remote, in which the patient will not
fix on this spot as the seat of pain : I need only refer to calculus
of the bladder as a striking example.

Contrary to this received opinion, I have no doubt that this
peculiar inflammation, with secretion of pus from the lining
membrane of the urethra, may commence at the orifice, spread
along the entire of the canal, and very often attack the lining
membrane of the bladder itself and at times extend, 1 suspect,

686 Gonorrhoea. [November,

even to the ureters and kidneys : while thus progressing, a very
slight cause might direct it towards the testicles, constituting
the disease termed hernia humOralis. That such is the fact as
regards the bladder, is evinced both from the general symptoms
and from the appearance of pus in the urine. The symptoms
are, I believe, never so severe as in that form of disease called
catarrh of the bladder, when a thick ropy mucus is secreted in
great quantity ; they are at times so slight as scarcely to attract
the patient's attention, who will merely consider that with him
the symptoms are more severe than usual. I have seen this at-
tack of the bladder ushered in with a severe rigor, and on close
inquiry we may find that the patient labors under a slight de-
gree of feverishness or uneasiness coming on or increasing
towards evening; and that he will complain' of a dull heavy pain
across the pubis, extending round to the sacrum and anus, and
at times even to the region of the kidneys. The calls to pass
water will be somewhat more frequent than usual, and when
they do occur they are irresistible, attended with considerable
pain and forcing, which continue for some time after the last
drops have passed away, and which are referred chiefly to the
neck of the bladder, and extend from thence to the perineum
and anus. The urine, when passed, at times appears clear and
natural ; in general, however, we can observe a slight cloudiness
through it, and on allowing it to settle in a glass vessel, we shall
perceive, after one or two hours, a copious yellowish or cream-
coloured deposit, consisting entirely of pus. If we take a drop
of this urine immediately after it has been passed, before any
alteration can occur in it, and place it under a microscope, it
will be found to be loaded with pus globules. In some instan-
ces in this affection, a number of yellowish, shreddy particles
will be seen floating through the urine, which at times alarm
the patient, causing him to suppose he is laboring under seminal
weakness: on examination, these particles will be found com-
posed of clusters of pus-globules and epithelial scales adhering
together.

That the pus thus equally diffused through the urine has its
source from the bladder, cannot, I think, admit of a doubt. It
cannot be from the urethra alone, for I believe that there is a
peculiar action of this canal on its contents, which tends to
drive them forwards, and resists any retrograde movement.
Besides, the urethra alone could not pour out the quantity of
pus we meet with in some of these cases.

My friend, Dr. Fleming, at my request examined the urine
with the microscope in some of these cases, and the result of
his observations is contained in the following extract from a
letter I received from him on the subject :

1850.] Gonorrhoea. G87

"As regards your views respecting those inveterate cases of
gonorrhoea, which are so annoying to the patient and so puz-
zling to the surgeon, no second opinion can be entertained but
that the lining membrane of the bladder furnishes a portion of
the purulent fluid, and, as you remark, at a much earlier period
than at a first view would be suspected. To test the direct
passage of the pus from the bladder, I have made the following
experiments, both on the male and female. In the latter it is
often most important to do so. I introduced a catheter, allow-
ed the first ounce or so of fluid to escape, so as to get rid of the
urethral discharge, then collected some of the urine in a clean
glass, examined it forthwith with the microscope, and found pus
globules. I have applied the same test in equivocal cases of
hematuria, and found equally satisfactory results, as regards
blood-globules."

In the case which first drew my attention to this subject, the
patient a few days after infection had a severe rigor, with con-
siderable pain and irritation of all the urinary organs, attended
with a copious deposit of pus, exceeding eight or ten ounces
in the twenty-four hours. He soon began to waste, became
emaciated, and even symptoms denoting hectic set in ; and it
was only by great attention he ultimately recovered. I at first
feared that an abscess must have burst into the bladder ; but
his previous good health, and the absence of any symptoms
indicative of a collection of matter, soon removed this impres-
sion. Since then, having suspected that this purulent state of
the urine was at trmes both a consequence and a cause of the
continuance of the disease. I have sought for its presence in
several cases ofgonorrhoea, and have met it much oftener than
I had any reason to suspect ; though I cannot form any con-
clusion as to the comparative frequency of its occurrence. I
have observed the urine thus loaded with pus in two or three
days after the commencement of the gonorrhoea, and after-
wards keep pace with the original disease. I have also in two
or three cases known the discharge from the urethra to con-
tinue, and pus to be found in variable quantities in the urine, for
the space of nearly two years after the original infection.

I have no specific remedy to* offer for the removal of this
affection ; in its treatment we must rely on, and be guided bv
the general principles of surgery. And first, as to the value of
that plan of treatment, ca led by the French abortive, I have
no means of forming an opinion. I doubt not but that the
injection of strong stimulants, as nitrate of silver or corrosive
sublfmate, may at times prevent the extension of the inflam-
mation ; yet, if they fail at first, they cannot but materially
aggravate the subsequent stages of this disease. When the

688 Asthma treated by Nitric Acid. [November,

pus has once appeared in the urine, we must follow the anti-
phlogistic plan more strictly than is generally done; low diet
and rest being strictly enjoined, and purgatives, diluents, and
such remedies as tend to lessen the inflammatory condition of
the blood being exhibited : when the inflammatory symptoms
have subsided, and not till then, should we resort to those
remedies considered as specifics, the balsams, or cubebs. Of
these I think the former have more influence over this form of
thedisease,and do not add so much to the irritation, as the latter.

Should these means fail, it is customary to resort to the va-
rious tonics, astringents, acids, alkalies, oils, preparations of
iron, &c. I must, however, confess, I have been often sur-
prised to find what little influence medicine of any sort has had
over this secretion of pus from the bladder. Each seemed for
a time to benefit, yet no single remedy appears to possess any
specific control over this disease. Should general remedies
fail, and the case become chronic, surgeons resort to injections;
but in this form of disease they must prove ineffectual. How-
ever, I would consider it a very justifiable proceeding, and one
which I believe has often succeeded, to apply the remedies to
the entire diseased surface; to inject, not only the urethra, but
also the bladder itself with any of those numerous applications
which are used in diseases in many respects similar, such as
weak solutions of sulphate of zinc, of nitrate of silver, or even
of balsams.

I have been induced to offer these crude and imperfect ob-
servations on this one form, or rather complication, of gonor-
rhoea, because it has not met the attention it merits ; and I
trust, by having called the notice of the profession to it, a body
of facts and observations may be collected, which will speedily
enable us to arrive at a more perfect knowledge of its diagno-
sis and treatment.

Cases of Asthma successfully treated by Nitric Acid. By T.
S. Hopkins. M. D., of Bethel, Glynn County, Ga. (Amer.
Journ. Med. Sciences.)

The following five cases of asthma, cured by the use of nitric
acid, have occurred in my practice since the summer of 1847.
It is not my desire to attempt any explanation as to the modus
operandi of this remedy in the above disease. Its beneficial
effects were accidentally discovered, and, after a fair trial in
five consecutive cases, with the most entire success, I am in-
duced to bring it to the notice of the profession, trusting that in
other hands than my own it may prove a potent agent for the

1850.] Asthma treated by Nitric Acid. 689

relief of a disease which so often resists the best-directed
treatment. Several of these cases were from twenty-five to
thirty-five miles distant from my office. Most of them were
not seen by me from the time of my first visit and prescription
until a cure had been effected. I describe them as I found
them at the ti-me of my visit, and from the history given by
parents and masters, which I think can be depended upon.

Case I. Emma, negro girl, aged five years, belonging to
Mr. T. G., had been asthmatic almost from birth. Nightly
paroxysms of dyspnoea, cough, &c, were represented as most
distressing. During the day, she would be up and about the
yard with the other children. At the time that I saw her, her
respiration was somewhat embarrassed, with slight elevation
of the shoulders during inspiration, and a very distinct mucous
rale. Her appetite was impaired, and her countenance cheer-
less.

I ordered nitric acid, three drops, to be increased to five,
three times daily, in a wineglassful of sugared water. A month
elapsed before I again saw this patient, at which time every
symptom of disease had disappeared. I prescribed for her in
December, 1S47, and up to date no symptom of asthma has
returned.

Case II. 1 was called in November, 1848, to see W. S., aged
about six years, son of a planter of Giynn county. I was in-
formed that this boy had been a subject of asthma, for four
or five years; that no expense had been spared in seeking for
relief in his case; and that all the efforts of the best physicians
in the neighbourhood in which he had resided, had been in vain.
When I saw him, had cough, slight dyspnoea, with mucous
rale distinctly audible at the distance of several feet. By
walking up and down the steps of the house, once or twice, the
difficulty of breathing and cough would be much increased.
He was very lively and cheerful, with a good appetite, and
had had no fever for months. His father informed me that,
upon the least exposure during the day, he would be attacked
at night with the most fearful symptoms. Wheezing, panting,
incessant cough, distressing dyspnoea, with impending suffoca-
tion, were the inevitable consequences (at night) of exposure
during the day.

I ordered nitric acid, five drops, three times daily, in a wine-
glass of sugared water, with a strict avoidance of exposure.

In a fortnight, he had been so much relieved that his parents
imagined him cured, and discontinued the acid. In a few davs,
he relapsed, and I was again sent for. I ordered the acid to be
continued, as before, and in one month from the time of my
first visit he was cured.

\. s. VOL. VI. \o. xi. 4 t

C90 Periscope. November,

Up to date there has been no return of disease.

This boy's father died of phthisis pulmonalis. Several of
his mother's family have died of the same disease; and all of
his brothers and sisters, without an exception, have in early
childhood been sufferers from enlargement of tonsils and ulcera-
ted sore throat. He is now the picture of health-.

Case III. A mulatto girl, belonging to Mr. W. D. Tv aged
four years. This was a case of congenital asthma.

The symptoms in this and the following case (aged about
four years) were so similiar to those of Case I. that I shalll not
describe them.

The treatment was nitric acid, three drops three times daily,
in a wineglass of sugared water.

The case resisted the treatment rather longer than the other
cases, but was cured in about six weeks.

In Case IV., the immediate effects of the acid were perceived
in a few days ; and in eight or ten days she was cured.

Case V. I never saw. It was a negro girl belonging to
Mr. C. of Camden county. She wras seven years of age. Her
master applied to me for a prescription, after giving some of
the most prominent symptoms, which convinced me that the
case was asthma, as he had declared it to be.

I prescribed five drops of nitric acid, three times daily.

I heard nothing more of this case for several months after I
had prescribed, when I was informed by her master that she
was well.

A sufficient time has elapsed, in all these cases, to convince
me that they have been radically cured."

Should you deem the above remarks and cases worthy a
place in your valuable journal, you will please to insert them.
It is at least something new in the treatment of asthma.

PART III.
ill o n 1 1) I jj ft c r 1 0 c o p t .

Comparative size and shape of the Typhoid Foramen in the Male and
Female Innominaium. By Dr. Neill. (Trans. Philad. Col. Phys.)
He believed that many teachers of Anatomy and of Obsteterics were
in error upon this subject, while others had failed to point out the dif-
ference in the male and female pelvis in this respect; that this was
the case especially in this city, and perhaps in this country generally.

He had learned that Dr. Wistar and Dr. James taught that in the
female the foramen was oval, and that in the male it was triangular,
although there was no statement upon the subject in the old edition of

1850.] Periscope. 691

Wistar's Anatomy which he had examined, nor in the more recent
edition known as Pancoast's VVistar. Dr. Horner also stated, in his
work, that " in the male it is triangular, in the female, rather oval."
On the other hand, Meckel, Cloquet, Cruvielhier, Harrison, and
Quain and Sharpey make a statement precisely the reverse of this.

The lecturers upon obsteterics with whom he had conversed,
either teach the former view, or are silent upon the subject. Den-
man, Baudeloque, and Maygrier say nothing. Neither do Monroe or
Cheselden, both high authority on the bones, nor Winslow, Bell,
Bartholin, &c, &c.

Scemmerring says "the foramen is elliptical in children, and tri-
angular in adults." Wilson and Von Behr say it is triangular in
women.

In order to satisfy his own^mind on the subject, Dr. Neill had, up
to this period, examined thirty-two skeletons, and the result was so
contrary to the view which he, and perhaps most of the Fellows had
been taught, that he had thought, it worth while to prepare a chart,
exhibiting diagrams of the male innominata in one column, and those
of the female in another, to show at a glance, the distinctive differ-
ence.

He believed from an inspection of this, everyone would be con-
vinced that the foramen in the male is oval, while in the female, it is
triangular.

It will also be observed that the male foramen is longer and narrow-
er, and that the line representing the long axis is more vertical, and
nearly parallel to the rami of the pubesand ischium ; whereas, in the
female the foramen is not only smaller and triangular, but that the
apex of the triangle is downward, that its internal side is nearly paral-
lel to the rami of the ischium and pubes ; and that the base of the
triangle is proportional to the chord of the arch of the pubes.

He remarked that the establishment of this fact, by investigation or
by authority, would not interest the Fellows of the College in a prac-
tical point of view, its only value consisting in its affording another
mark of distinction between the male and female skeletons.

Administration of Opium in Strangulated Hernia in Infants. By
Joseph Reid, M. D., L R.C.S.I., Southam. (London Lancet.)
On Monday, the 29th of April last, I was requested to visit an infant
(eleven months old,) on account of its having been attacked on the
previous evening with continued vomiting, pain in the abdomen, and
inability on the part of the mother to reduce an oblique inguinal hernia.
The vomiting continued throughout the night, and the child was
sleepless and exceedingly restless. On making an examination, I
found the integuments over the protruded parts red and inflamed ;
the tumour hard and tense, and very tympanitic on percussion ; pain
and uneasiness much increased by pressure. My friend Mr. Smith
had seen the case in the early part of the day, and ordered a mixture
containing a considerable quantity of opium, for the purpose of cettinc
the patient fully under its influence : he had also ordered cold to be

692 Periscope. [November,

unremittingly applied to the tumour. When this treatment had been
persisted in for some hours, I endeavoured to reduce the hernia by the
taxis, which having failed at Mr. Smith's first visit, I did not wish to
employ, until the medicine had had time to produce its relaxing effect.
My endeavours were alike unsuccessful, the protruded parts being in
a state of close strangulation a rather rare occurrence at this very
early period of infancy. I now, with Mr. Smith's consent, directed the
medicine to be continued, an enema to be administered, and the child
to be placed in a warm bath : in the event of these measures not suc-
ceeding, I determined at my next visit to proceed to operation. The
first part of my instructions alone was carried into effect namely the
continuing the opium treatment, and wi<h the most satisfactory re-
sults, for on repeating my visit I found the infant fully under the
influence of the drug, and the protruded parts entirely returned into
the cavity of the abdomen. This case argues strongly in favor of the
opium treatment in similar instances ; and I consider it to be better
adapted to strangulated hernia in infants than to cases of the same
description occurring in the adult. No doubt opium diminishes pain
and sickness of stomach in both young and old ; but pain in the child is
always accompanied by crying and convulsive sobbing, which cause
a bearing-down, and therefore a greater pressure on the protruded
parts ; thus affording no slight obstacle to the successful performance
of the taxis, and consequently to the recovery of the child without un-
dergoing the pain and dangers of ;

On Chloroform in Orchitis. By M. Buisson. (L'Union Medicale.)
As surgeon to a venereal military hospital, M. Buisson has had
ample opportunity of testing the value of the different modes of treat-
ing this painful disease ; and he has come to the conclusion, that of all
these, the local application of chloroform is by far the best, whether
used in the simple, the blenorrhagic, or the rheumatic variety
of the affection. It is chiefly in very painful cases that he resorts to
it, after the use of leeches ; but used as soon as pain appears, it may
even act as an abortive. A compress of several folds is wetted with
the chloroform and accurately applied to the testis, covering this with
oiled silk, and placing the whole in a suspensory. The first day this
is renewed every three hours, and continued the next day if required.
For some minutes after it causes great heat and redness of the part,
which is soon followed by a diminution of the oiiginal pain. The re-
lief of pain is, in orchitis, the first step towards a cure of the disease ;
and with the proper combination of internal means this is accomplish-
ed in half the usual time, the chloroform being suspended as soon as
an improvement is visible. The number of cases M. Buisson has
thus treated now amount to about sixty, and he has found the remedy
no less efficacious in what he calls ileo-scrotal neuralgia.

Removal or destruction of Wens and analogous Tumors. (Journal
des Connaissances MSdicales.) At the sitting of the Academy of
Sciences, on the 22d July, M. A. Legrand read a memoir on the re-

1850.] Periscope. 093

moval or destruction of wens and analogous tumors, without resorting
to the knife. His method consists in dividing the skin, as with the
bistoury, by a linear and often-repeated application of a solution of
pure potash as strong as can be made. By repeating the cauteriza-
tion always on the same points, the linear eschar which is produced
becomes deeper, until the tumor may be seized with the forceps, and
removed. The solution of continuity closes as when made bv cutting
instruments, and a cicatrix is obtained which differs in nothing from
that which follows a wound made by the knifj. If the cyst adheres
too strongly, if it is multiple, or if the tumor is not enclosed in a cyst,
the morbid products must be destroyed by successive cauterizations.
In this process, as in the ordinary one, the membrane proper to these
tumors must be entirely removed or destroyed, otherwise the disease
will reappear.

M. Legrand has employed this method ii: o cases, and in

no instance has it given. rise to any symptom which could induce a
fear of erysipelas.

Consecutive Arterial Hemorrhages. (Archives Generates.) In an
essay read before the Academy of .Medicine, on 9th July, Dr. Xelatore
has arrived at the following conclusions : 1. The mechanism of the
spontaneous obliteration of arteries on the surface of suppurative
wounds, differs essentially from that which effects the obliteration in
recent wounds. The term occlusion is proper to the first, that of oblit-
eration to the last. '2. This occlusion consists essentially in the adhe-
sion of fleshy excrescences or granulations (bourgeons) which develop
themselves in the mucous sheath after the retraction of the artery, in
the same mode as in other parts when there is a solution of continuity.
3. The ligature in the method of Anel may effect a suspension of a
secondary hemorrhage, provided it interrupts the course of the blood
in the divided vessel until the fleshy cxcresences have effected a union
sufficiently intimate to resist the impulse of the bloed brought below
the ligature by collateral ways. 4. If the arterial wound is situated
in a region where anastomoses permit the circulation rapidly to resume
its course in the hand, for example, or the foot, or the neck the re.
turn of the hemorrhage, under the method of Anel, is almost inevitable,
should any cause, either local or general, retard the process of cica-
trization. 5. The ligature of an artery may be effected in a suppur-
ating wound without any danger of a separation of the vessel or pre-
mature coming away of the ligature. 6. This mode of ligation as
certainly effects the obliteration of the vessel, as when applied in a

694 Periscope. [November,

recent wound ; it should therefore be preferred to that of Anel, in all
cases where it is practicable.

Statistics of Amputations that have been performed at the Massachu-
setts General Hospital, from January 1, 1840, to January 1, 1850.
By Geo. Haywaed, M. D. (Boston Medical and Surgical Journal.)
During the year ending on January 1, 1850, there were 76 amputa-
tions performed on 74 patients, two patients having two limbs removed
at the same time. One of them had one leg taken off above the
knee, and the other below ; the other had one arm amputated above
the elbow, and the other arm below.

There were 35 amputations of the thigh, and 10 deaths.

" " 28 " below the knee, and 5 "

" 7 " above the elbow, and 1 "

" " 6 " below the elbow, and 1 "

The aggregate therefore is 76 amputations and 17 deaths. One of
the deaths was from tetanus, and one from phthisis. Ten of the am-
putations of the thigh were performed in consequence of injury,
and 25 in consequence of disease. Of each of these two classes of
patients,^/be died. In every case of death after amputation below
the knee, the operation was performed in consequence of injury.
The deaths after amputation of the arm were in cases of severe
compound fractures.

Forty of the patients had amputation performed in consequence of
disease, of whom 5 died, or 1 in 8 ; thirty-four had been injured, of
whom 12 died, being over one-third. In one-half of the operations,
the circular amputation was adopted, and in the other half, the flap ;
nine of the former died, and eight of the latter. Forty-eight of the
patients inhaled some anaesthetic agent, and of this number 12 died.
In no case did fatal effects follow the use of these agents, nor even
any serious ill consequence.

The number of amputations of the large limbs performed in this
Hospital, from its establishment to Jan. 1, 1850, amounts to 146, in
141 persons. Of these, 69 had the thigh amputated 19 deaths ; 50,
the leg below the knee 10 deaths; 11 above the elbow 1 death;
11 below the elbow 2 deaths.

Vaccination. (Proceedings Mobile Medical Society. N. O. Jour-
nal.) l)r. w . H. Anderson having read a very interesting paper on
vaccination, Dr. Fearn observed that it brought to his mind a very
interesting experiment that he was witness to in Mobile some years
ago. Twenty persons in one family were exposed to the contagion

1850.] Periscope. 695

of small-pox. In thirty hours after the first exposure they were all
inoculated from the person ill with the disease. The day after the
inoculation and two days after the first exposure, they were all vac-
cinated. The vaccine took in every instance, after the vaccine pus-
tule run through its usual course and declined the inoculated pustule,
rose, dried prematurely and fell off, not one of the subjects of the ex-
periments had small-pox. Dr. Fearn explained, that these facts were
observed under the following circumstances : The head of a family
was attacked with the small-pox, the children and other members of
the family were necessarily exposed to it ; no vaccine matter could
that day be procured, and it was thought better to inoculate all who
were exposed to the contagion than have them take the disease in the
natural way; the day after they were inoculated, some vaccine virus
was procured from. New Orleans and the result of its use was as above
stated.

Mode of Administration of Tannic Acid. By Dr. Alison. (Rank.
Abstract.) For administration, tannic acid is well suited. It possesses
no great bitterness, is free from odour, and does not induce nausea.
A little sugar or syrup will suffice to cover all unpleasantness. It is
perfectly safe, and may be continued for months without any evil
effect ; in moderate doses, it does not reduce the secretions below the
healthy standard. It may be administered at all hours, before, or
during, or after meals.

Tannic acid may be employed alone in the treatment of disease,
but it is capable of exercising its virtues harmoniously with other
remedies. The use of this medicine does not preclude the employ-
ment of iron, cod-liver oil, and other such means ; but on the con-
trary, I believe it will make them more available to the patient. It
may be given at one time of the day, and the other remedies at
another ; or a week or a fortnight may be given alternately to each
medicine. Tannic acid, moreover, may be advantageously combined
at the same moment with other means: it may be prepared with
bitters and aromatics, or conjoined with astringent wines.

For diseases of the mouth, tannic acid may be dissolved in water ;
three or four grains to the ounce of water make a strong styptic lotion.
It may be reduced to a fine powder, and dusted over the parts. Mr.
Morson has prepared a lozenge, which is well adapted for the mouth
and throat. Each lozenge contains about half a grain of tannic acid.
Some have added to them essence of cayenne, the more to fit them for
relaxation of the fauces and glottis. For the stomach, the aqueous
solution is well adapted ; and when a pure bitter is required, some
infusion, such as that of gentian, may be used instead of water. When
it is intended to influence the bowels, tannic acid is suitably exhibited
in the form of pill ; and as circumstances indicate, in combination
with opium and other remedies. If we desire it to enter the circula-
tion, or to act quickly, at a distance from the stomach, on some inter-
nal part, the form of solution or powder should be employed. As a
styptic for the rectum, uterus, vagina, or urethra, the aqueous solu-

696 Periscope. [November,

tion, used as an injection, will generally prove most serviceable. For
local skin diseases, requiring an astringent, tannic acid may be
advantageously used, either as a lotion, or in the form of ointment.
As, however, the application is really effective, it will be well to attend,
at the same time, to any requirements that the general system may
demand. Reduced to a very fine powder, I have found that tannic
acid may be inhaled into the lungs and air-tubes. It has produced
no irritation or cough when tolerably well managed. I have not had
much experience of it in this form; but I believe that a cautious trial
might be made of it in cases of disease of the lungs and air-tubes, in
which the local application of a non-irritant styptic is indicated.

The dose of pure tannic acid must vary according to the circum-
stances under which it is employed. For urgent disease, such as
hemorrhage from the stomach, bowels, or lungs, five to ten grains
should be used every few hours. For chronic fluxes, wherever
situated, two or three grains, given twice a day, will generally
suffice. When the general improvement of the health is simply
desiderated, one or two grains, two or three times daily, are enough,
but the remedy should be long continued. For children afflicted with
rickets, half a grain to one grain answers well, given night and morning.

Tannic acid is contra-indicated in hemorrhages and fluxes, wherever
situated, which are only the relieving of an obstructed circulation, or
of inflammatory or congestive action. It is, under such circumstances,
calculated to do mischief. In obstinate constipation of the. bowels,
when circumstances render a lax state necessary, tannic acid is con-
tra-indicated in large doses, as a general rule. Irritability of stomach
and gastritis are liable to be aggravated by tannic acid.

Several preparations of tannic acid have been carefully prepared,
at my suggestion, by Mr. Morson, the eminent pharmaceutist, of
Southampton Row. These preparations are the tannates of quinine,
cinchonine, alumina, bismuth and lead. They are all coloured,
possess more or less the styptic taste of tannic acid, and are inodorous.
I have not had time to make sufficient trial of them, so as to be enabled
to report at present upon their virtues. I shall now only hazard an
opinion that they, as well as tannic acid itself, will be found, upon
full trial, to possess very considerable power, and to form valuable
acquisitions to the resources of the physician, wherewith he may
render himself more formidable to disease, and still more serviceable
to the sick.

Therapeutic action of the Liquor Ammonia. By Dr. M. B. Tessier.
(Bulletin General de Therapeutic.) We extract the following con-
clusions from an interesting article of Dr. Tessier on the therapeutic
action of the liquor of ammonia, when given internally.

1. Liquor of ammonia may be given with benefit in diseases caused
by the emanations from tobacco leaves.

2. It also affords great advantages in the remote accidents resulting

1850.] Periscope. 697

from a prolonged use of alcoholic drinks, especially such as are char-
acterized by great nervous derangement. It is a mistake to suppose
that this article is only useful in cases of slight or occasional drunk-
enness, for it is highly beneficial in more permanent lesions, as in the
case of Amblyopia already referred to.

3. The action of the ammonia is not confined to its stimulant and
sudorific effects. To restrict the circle of its action thus, renders it
impossible to explain its happy effects in a number of diseases, in cer-
tain neuroses, in hooping-cough, in fevers accompanied by a retroces-
sion of eruptions, in poisonous bites, and in other kinds of poisoning.

4. Ammonia possesses antidotal properties of a higher order than
is generally supposed. It may be justly regarded as an alexipharmic.
Its antidotal properties explain its good effects, not only in a great
number of poisoning and by narcotics, but also the good results ob-
tained in a great number of diseases in which noxious principles are
to be neutralized or eliminated, such as suppressed eruptions, malig-
nant fevers, chronic rheumatisms, poisoned wounds, and the pains
that precede painful menstruation. This proposition, of course, has
not the value of a demonstration, but it flows logically from the facts
observed, and merits a careful examination.

5. The doses usually recommended in therapeutical works are in
general too large. It is best to give no more than ten to fifteen drops
per day, if we do not wish to expose the patient to the dangers of hem-
orrhage and a feeble cachectic state.

Prolonged Tepid Baths as sedatives. (Gaz. des Hop. British and
Foreign Med. Chir. Rev.) M. Rostan, while ordering a tepid bath for
two hours, to allay palpitation in a case of organically diseased heart,
for which purpose digitalis had been of no avail, observed that he
usually derives far more advantage from the employment of prolonged
tepid baths as sedatives than from the use of any internal medicines
whatever.

Arsenical Paralysis. Reported by F. P. Colton. (New York
Journal of Medicine.) Charles Wilson, 41, Swede, seaman, was
admitted into hospital Dec. 1st. 1849. lie states that, accidentally,
about five months ago, he swallowed some arsenic, which had been
laid aside for the purpose of killing rats ; that remedies were promptly
used, which counteracted the primary effects of the poison : felt per-
fectly well for seven days afterwards, was then attacked at night with
a violent cramp in index finger of right hand, successively invading
the other fingers, and lastly the thumb, then attacking the other hand
in the same manner, and finally the feet, the pain in hands subsiding
as the feet became affected : that tho whole duration of cramp was

698 Periscope. [November,

about thirty minutes, after which he fell into a sound sleep, which
continued until morning : that when he awoke felt free from pain,
but on attempting to rise, was surprised to find that he had lost the use
of the af&cted parts, and was, in fact, perfectly helpless ; and that this
paralysis has continued unchanged to the present time, accompanied
with a feeling of heat and numbness, which invaded the upper ex-
tremities, from tips of fingers to a point about three inches below the
elbow, and the legs, from the toes to a point a little below the knee.
Has also had lancinating pains in these parts, regularly commencing
about 5 P. M., andcontinuing until midnight.

July 14th. Has used for a time Quin. Sulph. Strychnine, in or-
dinary doses, and Electricity, persevered in for a considerable time.
Has slowly and pretty steadily improved. About Jan. 7th, first began
to walk with a shuffling, unsteady gait ; soon after could use his hands
in feeding himself. Now can walk quite well, grasps the hand with
some firmness, but cannot yet button his own clothing: has had no
pain for some time, save in the approach of stormy weather, when
peculiar painful sensations are perceived in fingers. On Jan. 10th,
his urine, as tested by Professor Reid, was found to contain arsenic,
estimated at TT oVoo l^ Part> but on ^av 18th all trace of the poison had
disappeared.

July 15th. Discharged relieved.

Phlegmasia Dolens. (Medicinisches Corresponding-BlatL Gaz.
Medicale.) Dr. Camerer has reported the results of eleven cases of
this disease. All were cured with the exception of one, who died of
a typhoid fever consecutive to the phlegmasia alba. In the other cases
the cure was perfect, save in one in which a compact oedema (cedema
scliirrosum) of the inferior portion of the thigh remained for a consid-
erable time. The disease in no instance was followed by suppura-
tion, or any sensible elimination of any morbid product. Two of
these females were between 28 and 28 years of age; one was 40;
all the others were in their thirtieth year.

In seven cases the disease appeared after easy deliveries, from the
tenth to the fourteenth day after accouchement; in one case, on the
eighth day, in one after six weeks, and in another after twelve weeks :
the right leg was attacked in seven cases, the left in four. Some of
these women had been previously affected with rheumatism others,
either at the beginning or close of the malady, had a miliary eruption,
and exhibited other conditions connected with what has been called
the atmospheric rheumatismal constitution. May we not suppose that
this constitution favors the development of phlegmasia dolens ?

In his treatment, Dr. Camerer endeavored to diminish the tension of
the vascular system by the use of antispasmodics associated with anti-
phlogistic agents, not debilitant in their action, such as digitalis in

1850.] Periscope. CAW

combination with calomel. Dr. C. also employed the digitalis in infu-
sion, combined with the nitrate or acetate of potash, at the same time
he employed frictions with the oils of juniper and henbane. General-
ly he obtained a resolution of the engorgement in the course of three
weeks, without any apparent critical phenomena.

Another medicine, which appears to merit a preference, because it
calmed the violence of the pains with great promptness, is opium, in
the form of a watery extract, or in combination with nitre. Dr. C. in
no instance found it necessary to employ an energetic antiphlogistic
treatment, or to resort to general or local sanguine emissions.

Turning by External l>Ianipulalion. (Dublin Medical Times, from
Froriep's Xotizien. .Medical Examiner.) The endeavor to rectify
the faulty position of the fcetus in utero, by external manipulation,
engaged much of the attention of the older practitioners, and especially
of VVjgand in 1807, but is scarcely alluded to in modern works on
midwifery. Prof. Martin, of Jena, has recently published an interest-
ing essay upon the subject, based upon twenty-seven cases related by-
other authors, and seven which have occurred to himself. In these all
the mothers did well, as also all the children but four, of which number,
too, one was already dead, and another was delivered by perforation.

It is evident that an exact knowledge of the position of the child
must be obtained before the attempt is made, and Professor Martin
believes it is preferably acquired by external examination, although
this implies a certain amount of dexterity. It is only prior to, or im-
mediately after, the discharge of the waters, that the fcetus will be found
possessed of sufficient mobility. As long as the os is undilated, and
the pains irregular, the patient is kept on the side upon which the part
desired to be forced into the pelvis is placed, so as to afFordga moderate
support. When, however, the os has become dilated, and the waters
are expected to be discharged, she is laid (the bladder and rectum
having been emptied) on her back, the lower part of her body being
somewhat raised. With one hand the operator presses the part of the
foetus which lies nearest the os, whether it be the head or breech,
downwards, while with the ether, he presses the rest of the body up-
wards. This simultaneous pressure is begun during the interval of a
pain, and continued during its commencement, while, during the height
of this, the uterus is firmly supported on every side. After a short
pause, the manipulation is again recommenced, and. if the operator's
hands become tired, an assistant may, during the intervals of the pains,
support the belly on each side, whereby the ovoid configuration of the
uterus is better secured, and the child more easily brought into a pio-
per position. If the pains are long absent, she may otten be advan-
tageously placed on her side, supporting the projecting part by the
hand or a firm cushion. Especially is this position advantageous if
manipulation has already somewhat improved the position, and it

700 Periscope. [November,

should, if possible, be continued after the head has entered the pelvis.
For the purpose of retaining the head within the pelvis, when the im-
provement of the position is not durable, the rupture of the membranes,
after the head or buttocks have been brought over the os, is a very
efficacious procedure.

Among the rules to be observed, there is that of never employing a
cold hand, for, not only is it disagreeable, but it may give rise to spasm-
odic action and a' premature discharge of the waters. The pressure,
too, should be moderate and continuous, and applied sometimes in a
diffused manner with the flat hand, and at others by particular fingers,
to various parts of the child. It must be always a double and simul-
taneous pressure, exerted equally towards the fundus and upon the
part we are seeking to engage in the pelvis. A change in the position
of the woman is often an important aid to the manipulation.

There are certain conditions requisite for rendering the operation of
external turning an eligible one. 1. Absence of reasons for a rapid
termination of labour, as haemorrhage, presentation of funis. 2. Mo-
bility of the child. Generally this ceases after a discharge of the
waters. If, however, few pains have occurred, the presenting part
has not become far forced down, or the uterus firmly contracted around
it, atrial is justifiable. 3. Absence of great sensibility of the womb
or abdomen. 4. Sufficient capacity of pelvis. A moderate degree of
contraction- is no contra-indication. 5. A normal activity of pains
has been set down as a condition. It certainly is a very favorable
one, but it is rare in faulty presentation, and not an essential one for
external turning. Spasmodic or crampy pains which render the first
two stages tedious, if due to cold, are best treated by mustard poultices
and small doses of ipecacuanha. The very rectification of the posi-
tion sometimes imparts a normal activity to the pains. External
turning is rarely successful when the defective pains are dependent
upon a rheumatico-catarrhal affection of the lower portion of the uterus
giving rise to a softened state and premature rupture of the membranes.
6. The child being alive is a subordinate condition ; for, although in
the case of its death, internal turning may usually be advised, yet we
very frequently cannot be certain of this.

Collodion in Mammary Inflammation. By Prof. Jxo. Evans.
(North Western Med. and Surg. Journal.) Disheartened by the
general want of success in preventing suppuration by the ordinary
means of treatment, and satisfied that the most prominent indication of
cure was to overcome the freedom with which the blood is forced into
the mamma, and, by compression, cause the absorption of the lymph,
as is done by the roller applied on the extremities, in various forms of
inflammation, I determined to use a complete coating of the collodion
to obtain the benefit of its contraction ; the -result of which will be
more fully illustrated by relating the following cases in which it has
been used.

Case I. Dec. 18th, 1849 ; called to see Mrs. J., suffering from
Mammary Inflammation during lactation. Found she had bathed

1850.] Periscope. 701

with liniments, applied poultices and kept the milk well drawn from
the breast, but without apparent benefit. I could detect decided
fluctuation at the point of greatest suffering. I ordered a coat of the
liquid adhesive plaster which gave very prompt relief, and the inflam-
mation speedily subsided. A few days after I opened the abscess
which pointed, but it discharged a very small quantity and rapidly
recovered.

Case II. Mrs. S. was confined June 5, 1850, with her third
child. On the 7th, she was attacked with a chili, followed by high
Fever and active inflammation of both mammse. She had suffered,
after each of her previous confinements, with extensive abscess of the
left breast. The secretion of milk was very profuse, and notwith-
standing strenuous efforts to keep the milk drawn off by the assistance
of a little girl who drew it very freely, the left mamma became ex-
tensively indurated and was acutely sensitive and painful at the point
of the former abscesses.

I applied the collodion so as to cover the indurations completely,
with the effect of promptly relieving the suffering of the patient; and
by repeating the coating morning and night for a few days the indura-
tions were removed. The only additional treatment used was
Seidlitz Powders given to produce a laxative effect.

Case III. Mrs. McC. eight days after confinement, was attacked
with mammary inflammation attended with chill and high febrile ex-
citement on the 8th of June, 1850.

Gave Mass Hyd. grs. xij. with Pulv. Doveri grs. viij., in the
evening.

June9lh. This morning the breast is very painful and extremely
tender to the touch, great thirst, dry mouth, frequent but compressible
pulse and a troublesome cough. The bowels had not been moved.
Ordered Sul. Mag. gss. and an application of the collodion to the
breast, and free abstraction of milk.

June 10th. Much better; says the application of collodion to the
inflamed breast gave immediate relief to the pain, and the soreness has
rapidly diminished. Ordered the application to be repeated.

The recovery was rapid without suppuration.

Case IV. Mrs. P., three weeks after confinement, was attacked
with inflammation of the mamma on the 24th of June, 1850. She
had been previously under treatment for uterine phlebitis, from which
she was recovering.

The breast was swollen, indurated and very painful. The collo-
dion was applied so as to cover the induration and swelling, with
almost instant relief to the pain. By repeating the application the
swelling subsided gradually, without suppuration.

Case V. July 15th, 1850. iMrs. M. had an attack of inflamma-
tion of the right mamma, about ten days after confinement. I was
called the next day and found it swollen, indurated and painful, not-
withstanding the milk had been kept freely drawn and the breast well
fomented. A. coating with collodion, as in the preceding cases,
promptly gave relief to the pain, and gradually removed the swelling.

702 Periscope. [November,

In no case where I have used the collodion, except the first one
reported, has the slightest suppuration taken place.

In every instance the relief from suffering has been prompt, and no
inconvenience has resulted from its use in any case, except the slight
smarting that attends its application.

On the Application of Ligatures to Uterine and other Polypi.
(Lond. Journ. Med. Amer. Journ. Med. Sciences.) Prof. Langen-
beck, of Berlin, in an interesting paper on this subject in the Deutsche
Klinik, remarks : The numerous instruments which have been con-
trived for ligature of polypi of the uterus and pharynx, show the
great apprehension of hemorrhage from their excision or evulsion.
Even the assurances of Siebold, Dupuytren, and other distinguished
surgeons, that there is no greater danger of hemorrhage from the
excision of polypi than from other operative methods, have not re-
moved this apprehension ; and the ligature of uterine polypi is rapidly
gaining ground, in spite of the difficulty of its performance. It. is
true that the excision of large fibrous tumours from the pharynx and
uterus may be complicated with considerable hemorrhage ; but this
generally ceases of itself when the operation is ended, or may be
quickly and surely restrained by the continued injection of cold water,
by compression with the finger, or, in the most obstinate cases, by
plugging. The cases in which actual danger arises from the patient
becoming exhausted by hemorrhage through the cut pedicle of the
tumour are very rare. But the dangers attending on ligature of the
polypi are far greater ; and this operation would certainly be had
recourse to only in exceptional cases, if the fatal cases following it
were not less apparent than those from the much-dreaded hemor-
rhage. A death occurring some days or weeks after a bloodless
operation seems less terrible than one occurring suddenly from hem-
orrhage under the hands of the operator. The danger of purulent
infection, after the application of a ligature to uterine polypi, is so
obvious that I have not yet been able to determine on performing this
operation. During the last ten years, there have occurred to myself
alone ten fatal cases of pyaemia after ligature of polypi. The larger
polypous (fibroid) tumours of the uterus and pharynx are furnished
with large veins with thin parietes, doubtless arising from the impedi-
ment to the return of blood caused by the dependent position, or con-
striction by the os tincae, of the tumour. As the firm parenchyma
of these tumours can only be slowly cut through by a ligature, the
blood must still circulate in one part, while another is in a sloughed
and softened state. As long as the pedicle is not entirely cut through
by the ligature, pyeemia is to be feared. F.ntirely independent then
of the danger of convulsions, suffocation (in polypi of the pharynx),
secondary hemorrhage, etc., the application of the ligature ought to
be entirely rejected on account of the danger of pyaemia. But if it
be still determined, in spite of the marked success attending the ex,
cision of polypi, and in opposition to which scarcely a single case of
unrestrainable hemorrhage can be related, to apply a ligature, I con-

1850.] Miscellany. 703

sider it indispensable that the polypus should be immediately excised,
that the ligature should be used only as a preliminary measure, and
that it should be removed as soon as the danger of hemorrhage appears
to have been obviated.

It is not my purpose to enter on a critical examination of the various
methods and instruments employed in applying the ligature to uterine
polypi, as, for the most part, they possess only a historical interest.
With very few exceptions, they are all faulty in being difficult of ap-
plication, in tending to produce violent irritation of the neighbouring
parts, and in the ligature being unable to be removed until the pedicle
of the tumour is entirely divided.

IIUMcal fllistrllanrj.

Medical College of Georgia. Dr. Paul F. Eve has resigned the
Professorship of Surgery in this Institution, and accepted the same
Chair in the University of Louisville, Kentucky. The vacancy thus
created has been filled by the appointment of Prof. L. A. Dugas, and
Prof. H. V. M. Miller has been appointed to the Chair of Physiology
and Pathological Anatomy, vacated by the transfer of Prof. Dugas.

The eminent qualifications of Prof. Dugas for the position he is to
occupy, and the well established reputation of Prof. Miller as an ora-
tor, a teacher, and a man of great scientific attainments, furnish a
satisfactory assurance to the friends of the Institution, that the chairs
of Surgery and Physiology have been most satisfactorily filled.

Singular Revenge. In a memoir of Sir B. C. Brodie, the Editor
of the London Lancet relates the following remarkable circumstance :

11 Late one evening a person came into our office, and asked to see
the editor of The Lancet. On being introduced to our sanctum, he
placed a bundle upon the table, from which he proceeded to extract
a very fair and symmetrical lower extremity, which might have
matched

" Atlanta's better part,"

and which had evidently belonged to a woman " There,*' said lie,
"is there any thing the matter with that leg? Did you ever see a
handsomer ? What ought the man to be done with who cut it off?"
On having the meaning of these interrogatories put before us, wo
found that it was the leg of the wife of our evening visitor. He had
been accustomed to admire the lady's leg and foot, of the perfection of
which, she was, it appeared, fully conscious. A few days before, he
had excited her anger, and they had quarrelled violently, upon which
she left the house, declaring she would be revenged on him, and that

704

Miscellany. Meteorology.

he should never see the objects of his admiration again. The next
thing he heard of her was, that she was a patient in ****** Hospital,
and. had, had her leg amputated. She had declared to the surgeons
that she suffered intolerable pain in the knee, and had begged to have
the limb removed a petition the surgeons complied with, and thus
became the instrument of her absurd and self-torturing revenge upon
her husband !

Correction. In our editorial notice of the Break-bone fever, in the
October number of the Journal, Dr. Fenner's name was inadvertently
substituted for that of Dr. Hester.

METEOROLOGICAL OBSERVATIONS, for September, 1850, at Augusta,
Ga. Latitude 33 27' north Longitude 4 32' west Wash. Altitude above
tide, 152 feet. By Dr. Paul F. Eve.

a,
H

Sur
Ther.

Rise.
Bar.

29 65-100

2, ]
Ther.

P.M.

Bar.

Wind.

Remarks.

1

75

88

29 64-100

S. E.

Showerv, 15-100.

2

70

" 77-100

88

" 80-100

w.

iFair.

3

67

" 87-100

90

" 87-100

N.W.

Fair.

4

74

" 83-100

81

" 78-100

S. W.

Cloudy much thunder.

5

68

' 77-100

88

" 68-100

S.

Fair.

6

69

" 69-100

91

" 70-100

E.

Fair.

7

70

11 73 100

89

" 72-100

N.

Fair breeze.

S

69

" 77-100

89

" 79 100

N. W.

Fair sprink. at 10 p.m., 10-100.

9

72

" 78-100

78

" 76-100

N. E.

Showery, 15-100.

10

69

" 80-100

78

" 80-lOOj

N.

Cloudy.

11

65

" 82-400

85

" 83-lOOj

N.

Fair very foggy morning.

12

G6

" 87-100

88

" 86-100

W.

Fair.

13

71

" 83-100

86

" 80-100

w.

Fair.

14

71

" 70-100

86

" 65-100

N.W.

Fair breeze.

15

68

" 68-100

82

" 71-100

E.

Fair sprinkle at 9 p.m.

16

70

" 68-100

81

" 74 100

N. E.

Cl'dy morning blow gale at

17

60

" 89-100

78

" 87-100

N.W.

Fair breeze: [10 p.m.

IS

56

,: 87-100

84

" 7S-I00

W.

Fair breeze.

19

61

" 69-100

87

" 60-100

s. w.

Fair morning shower 20-100.

20

70

" 68-100

84

" 66-100

8. W.

Cloudy.

21

* 70

" 80-100

78

" 83-100

N. E.

Cloudy breeze.

22

69

" 90-100

85

" 96-100

E.

Fair.

23

65

" 90-100

81

" 90-100

E.

Fair.

24

63

" 90-100

88

'' 88-100

N.

Fair.

25

63

" 85-100

90

" 82-100

S. E.

Fair.

26

64

11 83-100

90

" 78-100

S. E.

Fair.

27

66

" 80-100

90

" 75-100

S.

Fair.

28

73

" 75-100

90

" 71-100

S. W.

Fair.

29

70

" 79-1 Of

81

" 81-100

N. E.

Cloudy morning.

30

64

" 90-100

70

" 98-100

N. E.

Cloud)'' dry gale.

18 Fair days. Quantity of Rain 60-100.
West of do. do. 12 days.

Wind East of N. and S. 12 days,

2tst, 9 a.m., Ther. 73, Bar. 83-100.

12 m. 77, " 84-100.

6 p.m., " 74, 86-100.
no wind or breeze.

Wind N., breeze, clearing up.
,c N. E., breeze, very cloudv.
" E., very cloudy, sprinkle at 4,

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 6.] NEW SERIES. DECEMBER, 1850. [No. 12.

PART FIRST,
rxgtnal (Eommunuations.

Thoughts on the Present State of Medicine. By Charles
Todd Quixtard, M. D., of Roswell, Ga.

(CONCLCDED.)

In this brief glance at the history of medicine up to the be-
ginning of the present century, we see a gradual improvement,
as well in theory as practice. We find that the advanced state
in which Cullen left the Science was the result of attentive ob-
servation. By observation, we mean something more than the
mere act of taking cognizance of simple and abstract phenom-
ena. " Observation," says Prof. Leslie, " is the close inspection
and attentive examination of those phenomena which arise in
the course of nature ; experiment, as the word implies, consists
in a kind of trial or artificial selection and combination of cir-
cumstances for the purpose of searching after the remote re-
sults." The philosopher, therefore, who observes, may be said
to listen to nature, while he who experiments, interrogates her.
Newton, by observation, was led to the discovery that the re-
fractive power of transparent substances was, in general, in the
ratio of their density, but that of substances of equal density,
those which possessed the refractive power in a higher degree
were inflammable. By analogy he concluded that, on this ac-
count water must contain an inflammable principle ; and ex-
periment enabled Cavendish and Watt to demonstrate the sur-
prising truth of Newton's induction, in their great discovery
of the chemical decomposition of that fluid. The beginning of

K. S. VOL. VI. NO. XII. 45

705 Quintard, on the Present State of Medicine. [December,

the 19th century found the science of medicine, on a firm and
solid foundation.

The study of anatomy had been cultivated by men, whose
great aim and object was the solution of the Various vexed
questions which had originated in a too superficial knowledge
of that fundamental part of medical science. And this study,
which, until the 16th century, had been pursued, merely to illus-
trate the writings of Galen, brought to light many of the most
important principles embraced in organic composition. Fallo-
pius, Eustachius, Veral and Vara], in the 16th century, had made
important discoveries, which were further prosecuted by Har-
vey, Wirsung, and Schneider in the 17th, and by Pacchioni,
Valsalva, Keil, Sancisi, Haller, Boerhaave, Vicq d'Azir, and
others in the ISth century. Anatomy was made to assume its
true, philosophical and scientific character under the researches
of these eminent men. Hitherto anatomists had founded com-
parative anatomy on the unity of the functions, because they did
not know how to proceed, except upon perfect organs, exercising
determinate functions, and did not recognize identities, except in
pursuing the inesnsible gradations of forms. But the philoso-
phical spirit which had begun to prevail, adduced new inquiries
and still newer discoveries. The doctrines of St. Hilaire were
founded on the following propositions ; 1st. That identity does
not always depend upon the organs, as a whole, but only on
the materials of which each is composed. 2d. That inquiries
after identity should regard the mutual, necessary and conse-
quently invariable, dependence of the parts. 3d. That the
organic elements which touch, are, from their position, neces-
sarily constrained to assist one another reciprocally. 4th.
Finally, that any organ, whether in its normal or pathological
state, never possesses extraordinary activity, unless some other
one of the same system, or of those connected with it suffers
proportionally, and in the same ratio (Vide Meckel.) Con-
clusions drawn from premises like these, exercised a direct in-
fluence on the science. It is seen in the splendid discoveries
of Sir Charles Bell, in Neurology.

For a long time the hypothesis that a nervous fluid was de-
rived from the brain, and transmitted by nervous tubes, wag
deemed consistent with anatomical demonstration, and there

1859.] Quintard, on the Present State of Medicine. 707

was no hope of improvement ; and although the points to
which he directed his investigation had been examined by
Monro, Santorini, Wrisberg, Prochaska and Soemmerring, to
him alone belongs the merit of discovering the true anatomy
of the nervous system. It is true, these celebrated men had
approached this knowledge very nearly, but they, as also their
followers, were not directed by any principle, and the multipli-
city of anatomical facts that had been accumulated, served
rather to retard than promote the acquisition of that knowledge.
In anatomy, however, which depends more immediately upon
the accumulation of matters of fact, and which require for
their attainment little more than industry and observation,
errors were more readily discarded, than on those subjects re-
quiring a greater degree of mental discipline and reasoning*
and in which it was rather an inference from facts* than the
facts themselves, which constituted the object of investigation.
We may also instance the introduction of auscultation, as a
means of diagnosis, to show what the close inspection and at-
tentive examination of the phenomena of nature may do towards
advancing truth. It is true, there is one great obstacle in the
way of acquiring knowledge by means of percussion, and this
consists in so cultivating the sense of hearing as to enable it to
appreciate minute modifications of sound. We are obliged^
nevertheless, to consider this one of the greatest improvements
ever made in physic. But the limits of this paper will not ad-
mit of further particularity. There are thoughts (ideas) which,
occurring in or to minds properly disciplined, shed a flood of
light on that which had been for ages hid in darkness. This
is true of the discoveries of Volta, of Galvani, of Newton, and
of Franklin. It is true of the hypothesis of Glisson, relative to
muscular irritability, which he considers a specific property
attached to the living fibre, and from which is deduced its
peculiar power of contraction. And how marvellous has been
the change wrought by the improvements of Bell, Hall, Anen-
brug, Laennec, Volta, Glisson and Baglivi. The publication
of Glisson's treatise, " De Ventriculo et Intestines," which ap-
peared in 1671, is regarded as the foundation of the change of
opinions which afterwards took place in reference to humoral
pathology, and of which Baglivi was the first systematic oppo-

708 Quintard, on the Present State of Medicine. [December,

nent. We are to consider all legitimate medicine as a truth es-
tablished by an immense accumulation of facts of facts which
have been collected by the industry and perseverance of centu-
ries. It is a fallacy to look upon medicine as a "conjectural
art." The enlightened practitioner has instead of " guess work,"
a knowledge guided by reason and science. The alleviation
of disease depends upon the application of natural principles,
and consequently the art of medicine is true when it is in ac-
cordance with these principles. Viewed as a certain art, says
Dr. Shapter, we possess the assurance that our hope is not in
vain, and that, though from our blindness, we may not always
perceive the truth, yet we are surrounded by it, and that
by seeking it, it may be found. Have we not a rich inheritance
in the almost infinity of facts which have accumulated during
the last three centuries ? It is an inheritance for which philo-
sophers have long labored. It is an inheritance of knowledge,
and not of knowledge only, but of excellent wisdom. With this
knowledge, which has come down to our times, the science of
medicine has been built up by the Hunters, the Monroes, by
Cullen, Cooper, Black, Baillie; by Pinel, Andral, Breschet,
Broussais, Croivisart, Cruveilheir, Dupuytren, Laennec, Bayle,
Gendrin, Foville, Chaussier, and Velpeau; by Camper, Blu-
menbach, Ludwig Soemmering, Meckel, Tiedemann, Spreuzel
Jacobron, Carus, Pfaft, Oken, Oriander, Ackerman, Rosenmul-
ler, Gmelin, Walter, Triveranus, J. Miiller, Wagner, Heule,
Gerber, BischofF, Burdach, and Valentin, and many others
throughout Europe, who have made most important additions
to our knowledge, on the subjects to which they have directed
their attention. We may point to Italy also "Italy, which
so long took the lead in all scientific pursuits, but now offers the
prospect of a splendid ruin" and there we find recorded in a
niche, high up in the temple of fame, the names of Scarpa, Cal-
dani, Marcagni, Rolando, Bellingeri, and Tommasini. And the
profession in America can justly boast of such men as Rush and
Shippen, Wistar, Bard, Mitchell, Hosack, Post, Warren, and
Godman. The inheritance belongs not alone to the profession
of medicine, but to the whole human family. There is no de-
partment of science which medical men have not helped to ad-
vance, and the services of the medical profession, have been

1850.] Quintard, on the Present State of Medicine. 709

among the most disinterested ever rendered to mankind. Med-
ical science has been, and is to be, for centuries to come, a
mighty moral agent, which in its application to social and poli-
tical economy, promises the most brilliant results. We may
mention the arrest and extinction of epidemics as one of these.*
True for many of the results we have to
"Learn to labor and to wait."

* The application of an efficient medical police to our larger towns by the es-
tablishment of "Boards of Health," with the requisite powers, may be reckoned
as one of the most important results accomplished by the social influence of the
profession. Under this head is included the introduction of a supply of pure
water within the limits of a city, and a system of domestic sewerage. Let ua
take for example the city of New York. The want of a sufficient supply of
good water was early felt in New York, and even while the State was a colony
of Great Britain considerable expenditure had been made to supply this want.
Various proposals were made previously to 1778, when Dr. Joseph Brown re-
commended the introduction of the waters of the Broux river. He argued the
question in his communication on the subject on the score of health, safety and
comfort. The yellow fever had madegreat ravages in the city, and Dr. B. who
believed in its domestic origin, demonstrated that its virulence was much aggra-
vated by the insufficiency of the supply ol water and its impure quality. He
says "I do not presume to say that the introduction of a large quantity of water
into thecity would alone prevent the rise and spreading of putrid diseases, but
I am warranted in saying that under Providence it would more than all other
things contribute to this most desirable end." The Manhattan Company, incor-
porated in 1779, was a mere speculation, and did little towards affording a suf-
ciency of water, and. moreover, when analyzed it was found to be quite too im-
pure to answer the great purpose of improving the public health. An analysis
of it, as made by Air. Chilton, yielded 125.80 grs. of solid matter to the gallon,
consisting of the following ingredients Mur. Sodae. 45.20, Mur. Magnes 40,
Sulp. Magnes. 6, Carb. Lime with Carb. Magnes. 12.80, Sulp. Lime 4, and ex-
tractive matter with combined water 17.80. The next attempt was to bore an
artesian well. Water was found at a depth of 4-12 feet, but loaded with solid
matter in the proportion of 80 grains to the gallon. The only water suitable for
domestic purposes was that obtained in the upper parts of the city, or in the
neighborhood of the squares, as the pavements in the lower part of the town,
carried off about one half of all the water which fell, and the remainder was
so contaminated by the action of the vast qualities of excrementitious matter
daily deposited in the soil as to be unfit for use. The quantity of excrement de-
posited has been estimated at 100 tons every twenty-four hours. It was found,
therefore, that from this circumstance, the quality of the water was annually de-
teriorating with the increase of the city, and that a better supply must be obtain-
ed, not within the city, but elsewhere. In May, 1834, an act passed the Legis-
lature authorizing the introduction of the Croton Water, and in July, 1642, it
was introduced into the Distributing Reservoir, a distance of 40 miles. The
limits of this note prevent our saying anything of the public sewers of New
York. To show the bearing they have on health, wc may quote the language

710 Quintard, on the Present State of Medicine. [December,

Wait the evolutions and development of the minute and search-
ing investigations of science itself. There are many who
sneer upon the progress of legitimate medicine, and point tri-
umphantly to the systems which the credulity of man render
successful. By others we are told that the profession is behind
the age that its votaries are wedded to the past, and fail to
keep their minds open to new convictions. To all such we
would commend the following eloquent quotation, from the
"Anniversary Discourse, delivered before the New York
Academy of Medicine," on the 10th Nov., '47, by the distin-
guished Dr. John W. Francis, at one time President of that
institution: "Have those who cast this reproach upon the
laborers in our science of being contented with the past, ever
seriously examined into the actual state of the profession, at
distant and distinct eras of its cultivation ? Have they com-
pared the different systems and theories of medicine which
have held sway at different times and among different nations at
the same time? Have they weighed the facts and reasonings
which have led to the diversified results which have crowned
both, in the speculative and practical branches of the art? Have*
they observed the evil and the good arising from the authority
of renowned names, and been prepared to fathom the difficul-
ties inherent in the vast study of the philosophy of life, and the
means of its preservation? Have they been able to weigh the
controlling influences of the kindred branches in physic upon
the art of healing? All these circumstances have exercised
at various periods a modifying power in the advancement of the
great scienoe. Have they, fortified with the requisite know-
ledge, compared the anatomy taught, in the schools some forty
years ago, with the knowledge of the human structure as now
set forth by the teachers of these days ? Have they compared
Monroe and Fyfe, with Bichat and Cruveilheir ? Have they
looked at Blumenbach, and Andral, and Edwards, and Muller
to find whether there be progress in physiology ? Have they

of Dr. Smith, Physician to the London Fever Hospital, which we find in Hunt's
Merchant Magazine, Jan. 1845. Dr. Smith says, that "when a fever exists its
locality may be determined by an inspection of the map of London, in the office
of the Commissioner of Sewers, for where the sewers are, there the fevers a$e
not, and where the sewers are not there the fevers.

1859.] Quintard, on the Present State of Medicine. 711

ascertained what Gall, and Spurzheim, rnd Tiedemann, and
Solly, and Noble, have done with the brain and nervous sys-
tem ? Have they sought knowledge of cerebral structure by
the methods of procedure formerly in vogue, by the researches
of the scalpel, and then compared it with the elucidations of the
encephalon, derived from the new system of investigation, not-
withstanding the preceding great efforts of Varolius and Wil-
lis? Have these skeptics dwelt upon the coincidence which
obtains between particular structural developments and func-
tional manifestation and mental phenomena? Have they
arrived at a determinate result whether Charles Bell's discove-
ries on the sensitive and motor nerves have real foundations,
and shed new light on pathology of the deepest practical value,
and simplified a mighty train of complex disorders? Do they
know that that philosopher presented us with new revelations
of richest results ; and have they opened the pages of his
volume in order to comprehend its diagnostic problems in per-
ilous intricacies?

Allow me to propound a little further: Have these doubters
and disputers of our progress compared the materia medica of
former times with that had recourse to at present? I mean
not the corrections of disease, and the auxiliaries of health
indicated by palmistry, and astrology, nor the treatise of Cul-
pepper, nor the primitive physic ot Wesley. I will limit my-
self to the materia medica of our immediate predecessors. Let,
then, an estimate be formed of the articles modern discovery
has introduced, drawn from the several kingdoms of nature,
and let scrutiny be directed to the qualities of the substances
now added as remedial agents to our pharmacopoeia. Look at
that once universally admired book, Duncan's Dispensatory,
and then turn to Pereira, or to the commanding volume of
Wood & Bache. Therapeutical science was never enriched
with such copious treasures as at this day, nor ever before
yielded a moiety of her benefits."

Are we asked, " What has been done in Surgery ? We
point triumphantly to the records of skill in this branch of heal-
ing, and challenge them to compare the deeds of Abernethy
and Cooper, of Dupuytren and Larrey, of Physick and Post,
and of Mott, with what had been accomplished by all their

712 Quintard, on the Present State of Medicine. [December

predecessors. We feel confident that facts will bear out the
assertion, that the profession of medicine has never before oc-
cupied so proud an eminence, and that when compared with
other sciences, it loses nothing by the most careful scrutiny.
It is wrong to consider the field of medical science as of no
greater extent than those of the mechanical sciences. It em-
braces the whole science of living bodies or biology. The
phenomena of living bodies are much more various than those
of inorganic bodies. The collection of the physical sciences,
then, which concern inorganic matter, are all together to be
placed in comparison with the science which relates to the laws
of living matter.

".Now," says Dr. John Ware, "when we compare the amount
of labour which has been bestowed on mechanics, or astrono-
my, or chemistry, individually, these sciences are found in
advance. But compare the whole of the labour which has
fallen to the lot of astronomy, mathematics, chemistry, natural
philosophy, geography and geology, on the one hand, with that
which has been bestowed on medicine as a science, on the
other, and the progress it has made is rather a subject for pride
than for humiliation." And yet, with all that has thus far been
accomplished, we yet lack many things. We require an estab-
lished system of medical philosophy, which shall have in its
definiteness and completeness"* and in the universality of its
application, the same kind of -claim to general assent as that
which is conceded to the Newtonian physics. The present is
a sort of transition period in our history. We are rapidly ac-
quiring a knowledge of the principles necessary to the comple-
tion of the science of life. Something more is necessary to
understand what has been done, and what is yet doing, in this
science, than a mere casual glance at individual cases or theo-
ries, for, like the chrysalis stage of insect life, (to use the lan-
guage of M. Rennard,) while nothing appears to change exter-
nally, an admirable metamorphosis is operating within, the
progress of which is not revealed. It becomes a question then,
what is the duty of the profession generally, in view of the
advanced and advancing state of medical knowledge, and what
means are best calculated to secure to the profession the rights
and immunities which have been withheld by the public, in

1850.] Quintard, on the Present State of Medicine. 713

consequence of an improper and perverted estimate of the
science itself? It is not to be denied, that numbers of the pro-
fession have, in some measure, helped to bring reproach on the
body, by lending countenance to the fashionable whims and
follies, and the absurd theories and systems, which captivate
the credulous and entice the unwary; but this has a mere tem-
porary effect on the science itself it can in no way stay its
progress. The hosts of homoeopaths, hydropaths, and other
Charlatans and empyrics, who jog along on the uneven legs of
a short mortality, and a long love of lucre, are not to be reck-
oned in the same evils with which legitimate medicine has to
contend. These must have their day, and it is worse than
folly for us to spend our time in exposing their trickery to
those who encourage and uphold their knavery. In the place
of continual denunciations, let there be more of calm, candid,
and patient investigation and discussion. We are not to look
for sympathy and support from legislatures: this were, indeed,
to ask quackery to destroy itself. Science is in no way de-
pendent upon the action of legislative bodies. The whole
history of legislation on the subject of medical education and
medical practice exhibits the most glaring absurdity. What
our legislature does, another undoes so, "unless," as Horace
Walpole says, "one could cure men of being fools, it is to no
purpose to cure them of any folly, as it is only making room
for some other."

At the last session of the Legislature of our own State, a me-
morial was presented from the Medical Society of the State,
asking the passage of an act for the registration of births, mar-
riages and deaths, and there were found in that body, men,
whose capacity for ridicule, was greater than their wisdom, and
who, in the plenitude of their little brief authority, actually
sneered at a memorial, originating with some of the highest
intelligence of the medical profession in the State. Whether
this memorial was rejected because the sapient legislators were
unable to comprehend the importance of statistical details, (to
the political economist, as well as the medical philosopher,) or
whether "party," that eternal bugbear of democracy, frowned
upon it, because of the dollar and cent philosophy it involved,
we are unable to opine. It teaches us, however, to rely on our

714 Quintard, on the Present State of Medicine, [December,

own strength, and in the truth of our cause to labour more
earnestly for the accomplishment of the great ends and objects
we desire. Nor are we to look to the newspapers of our day
not even the so-called ''religious press" to do one jot or tittle
towards elevating the profession in the estimation of the public.
" If," says a late writer, (t there is one nuisance in the country,
which stands next to the use of intoxicating drinks in its injurious
influence on the public health and morals, it is theadvertisingand
lying puffing of patent nostrums in the newspaper press." Take
up any sheet, whether of town or rountry, and we find a large
portion of it filled with these infamous advertisements. It will
not do for the proprietors of these papers to tell us that such
advertisements are mere business cards, for which they are not
responsible ; for this is only saying that a business card is legiti-
mately a licensed vehicle of falsehood. Falsehoods they know
them to contain. Let any one examine the advertisements of
Townsend's Sarsaparilla, Ayers Cherry Pectoral, &c, in such
a paper as the '-Religious Recorder," or almost any other that
is issued from the press,* and ask himself if the enlightened
and pious editors do not know that these advertisements are
directly and positively false, and artfully designed to obtain
money by false pretences; and yet these men would start with
horror at the idea of adopting the Papal practice of selling
indulgences to sin, while they make no scruples in selling the
columns of their journals, for a few dollars, to the base purpose
of falsehood and deception. We speak particularly of the reli-
gious press; for it scouts at the idea of admitting anything
immoral in its columns. Oftentimes these insane puffs are cer-
tified to by men calling themselves "preachers of righteous-
ness,"f who step down from the platform of their morality, and

* It gives us pleasure to except the Southern Presbyterian, and the Southern
Literary Gazette.

t Hear one of the most distinguished divines of our country : " Another point,
akin to that just noticed I refer to the ready endorsement, by clergymen, of
puffed specifics, panaceas, and legions of various inventions, surpassing all the
marvels of that most marvellous inventor ; Ferdinand Mendez Pinto. Truly, if
we are to believe all that is certified to us every day, the doctors may shut up
shop, the undertakers will soon be bankrupt, and the world will have uo occa-
sion to deplore the failure of that romantic expedition of Ponce de Leon to
Florida, in search of the 'Fountain of Youth;' nor the fruitless search of the

1830.] Quintard, on the Present State of Medicine. 715

despite their clerical cloth, testify that they have been cured of
"piles," or some of their family of "fits," by such and such a
nostrum, and that they would be glad to see it adopted as a
panacea by all their friends. These men know that they are
incompetent to judge of matters of this kind matters which
involve alike the life of multitudes of their fellow-men, and yet
they put forth their glowing puffs as though their statements
were ex-cathedra. What, then, is the course to be adopted?
One of the most effectual means of continuing and advancing
the improvements we have already noticed, is the promotion
of a thorough education of those who seek admission into the
profession. The higher the standard of education is among
medical men, the less will be the number of ignorant pretenders
who will gain admission into their ranks. In a letter recently
received from Dr. John W. Francis, on the subject of medical
education, he remarks : " We must enjoin the necessity of more
general elementary education. Men who take the M. D.
ought to possess some knowledge of Latin and Greek, in order
to comprehend our techicologia ; and to secure accuracy in
formulas and ordinary materia medica prescriptions, classical
knowledge must be enforced." How few, comparatively, are
the cases in which the preliminary education of young men
intended for the profession of medicine is at all adapted to the
end proposed. How few are they who have even a smatter-
ing of chemistry, to say nothing of languages. We are not one
of those, who, in magnifying our office, reckon in the affair of
literature, Latin, and Greek, and French, and Italian, and
German or in science, mathematics, and metaphysics, and
mechanics, and optics, and hydraulics, and pneumatics, miner-
alchemists for the 'Philosopher's Stone.' and the ' Elixir of Life.' I have seen
a string of ministers names appended to recommendations and certificates, in
newspapers and pamphlets, thrust in at your doors, of all sorts of healing inven-
tions of which they could know little or nothing perhaps somebody, unable to
pen a decent advertisement, has sent a box of patent pills apd, presto, it work-
ed like a charm. The disease is gone, and forthwith comes forth an endorse-
ment of what not? But some one will say, ' have we not read the pamphlet 1
and did we not see the cure? and must we not trust the evidence of our own
eyesV No, not always; sometimes the liberal gulled will take in not only ODe
little 'powder, pill, orpotion,' but with equal facility, will swallow a xchok sys-
tem."[The Reciprocal Relations of Physicians and Clergymen Rev. John M.
JChebs, D. D.

716 Quintard, on the Present State of Medicine. [December,

alogy, botany, zoology, and geology ; for such are the porten-
tous forms that guard the threshold of the medical temple: but
we do advocate such a knowledge of the languages as will ena-
ble the student to comprehend medical terms and phrases, and
such a knowledge of chemistry as will fit him to appreciate the
lectures, on that subject, which he is to hear in the medical
college. As it is, many students spend their first course, not
in learning, but in hearing how to learn. Their minds are not
habituated to the reception of knowledge, and, consequently,
when they enter upon their professional course they can only
darkly apprehend what is presented to them. And when once
the pupil has entered upon his medical curriculum he attends to
nothing else; and so goes stumbliug on with a fearful fore-
boding of the "green room." Nor has he time to attend to
anything beside the course of study laid down, because it is
amply sufficient to occupy his whole time. It must be evident
to every one, that if the mind of the student were disciplined,
trained, and prepared to receive the teachings of the medical
professor, previously to his entering the medical college, his
progress would be greatly facilitated, and his advance more
satisfactory and sure.

Says Dr. Ware, " The habit of acquiring knowledge is not
attained at once. It is not sufficient that the mind be opened
to knowledge. It does not flow in spontaneously. It must be
sought and actively appropriated. The power of doing this to
advantage, is to be acquired ; and it is in no way so easily or so
well acquired, as by the teaching of the school and the college.
The graduate, other things being equal, starts in his course with
some advantage. He has already learned how to learn, and
has only to occupy himself in the appropriation of knowledge."
{Med. Dis) There are many reasons why chemistry should
be embraced in the elementary studies of a young man, instead
of being made a part of his medical curriculum. At present,
few students acquire more than sufficient knowledge of chemis-
try, from the eighty lectures which constitute the course, to
enable them to pass an examination. They gain nothing of
those applications to practical medicine which constitute its
real value to the medical practitioner. They may, indeed, pick
up a few disjointed principals which will apply to physiology,

1850.] Quintard, on the Present State of Medicine. Ill

pathology and pharmacy, but of its real value they learn, com-
paratively, nothing. It is a little surprising, too, that so indis-
pensable a department of the science, as pathological anatomy,
should be so neglected as it is at present. The pathological
researches of the last half century, have done more than all
other causes combined to advance the art, from an empirical
to a scientific character. Says a recent writer, "Before every
other inducement to the study, I feel bound to give you this :
Pathology is the scientific foundation of medicine; your suc-
cess in the practice of your profession your success in pro-
longing human life and lessening human anguish, will (ceteris
paribus) be exactly commensurate with your pathological ac-
quirements. I am not unaware that the ingenuity of indolence
may find partial contradictions to this sanguine belief, and may
point complacently, no less to the imperfections of our present
knowledge, than to the occasional felicities of the merest em-
piricism ; but such arguments are almost hourly losing their
low and limited application ; and for the general accuracy of
my statement, I appeal, without hesitation, to the enlightened
members of the profession. ******* Iam sure that their
experience corroborates my assertion, and justifies me in stating
that your chief inducement to the study of pathology is included
in those motives which should impel you, with hopes of disj-
unction and utility, to labour in your profession generally.'

These are the words of a master in the profession the distin-
guished Mr. Simon and they were delivered before a medical
class in one of the celebrated hospitals of the British metropolis.
They are surely worthy of consideration on this side the Atlan-
tic, where Pathology is only incidentally introduced in the
lectures of our medical schools. Very few of our colleges
possess the means of presenting the subject, practically, to the
attention of their classes, and the present students are obliged
to learn it as well as may be from the various authors who have
shed such brilliancy on this department. This, though it is
seeing "through a glass, darkly," must be borne, until the in-
telligence of the profession and of the public is more awakened
to the necessity of a better state of things.

Next in order to the reforms which are required in our pre-
sent mode of teaching, stand the obligations which the member*

16 Quintard, on the Present State of Medicine. [Decembery

of the profession are under, to advance the improvements in
the science; and here the importance of a more careful study
of disease, in all its ramifications, presents itself. The practi-
tioner must, if he would practice with success, in common par-
lance, "find out what is the matter." He should have a know-
ledge of temperaments, constitutional peculiarities, and be alive
to the necessity of studying the patients constitution as well as
his particular disease or infirmity. He should beware lest in
his speculations on particular forms of disease, he be tempted
to disregard the great principles which have been received as
leading doctrines from the labours of Hippocrates down to
Cullen and Rush, and Andral,&c. The experience of twenty-
five hundred years is not to be discarded for the phantasms of
the day. A more careful study of the diseases of our own
climate, our localities and their influence on health and disease,
is required. This subject was well brought to the notice of the
Medical Society of our State, in a comprehensive resolution
introduced before that body, by Dr. W. L. Jones, at its session
in 1849. Dr. Jones remarks, in a preamble to this resolution,
that, "The great desideratum for establishing the laws of the
phenomena of life and death, of health and disease, is an im-
mense accumulation of facts ; and the determination of these
laws is the only sure foundation of medical science." The
resolution reads as follows:

"Resolved, That the attention of physicians in this State is
respectfully directed to the subject of keeping records of phy-
siological, pathological and meteorological phenomena, and that
it be recommended to the auxiliary societies to take measures
for obtaining full and accurate data in reference to the diseases
of their districts ; also, records of the states of the thermome-
ter, barometer, atmospheric electricity, thunder-storms, rains,
clouds, winds and dew-point, during each day of the year.
Also, to prepare geographical and geological maps of their dis-
tricts, containing descriptions of the surface of the country as
relates to hills and valleys, land and water ; also a description
of the soils, of the nature of the vegetation, and of the relative
abundance of cleared and woodlands : and that such records
HX)d maps be deposited in the archives of the society."

Of course it is not to be expected, that all physicians can find

1850.] Quintard, on the Present State of Medicine. 710

'

time to comply with half of the provisions of the above reso-
lution; but all can do something towards it. Practitioners in
the country, engaged in the toil and labor of an arduous pro-
fession, can hardly find time for the relaxation necessary to
health, while the fatigues attendant upon their professional du-
ties, as well as the duties themselves, oftentimes interfere with
the systematic observation of pathological and meteorological
phenomena. They can, however, do mare in the way of pa-
thological research, in obtaining a knowledge of the diseases
of their particular localities in pursuing the attractive studies
of geology and botany and in establishing a kindlier inter-
course, and in a more strict observance of professional etiquette
than they at present do accomplish. Could the members of
our State Medical Society be made so to feel the importance
of this matter, as to induce each one to make one single report
at each meeting of the Society, we should soon have a mass
of interesting matter that would illustrate the medical topogra-
phy of Georgia, the history of our local diseases, and tend to
elevate the character of the profession of our State, as well as
improve the art of medicine. Let members of the profession
throw off those indolent habits of mind which unfit them for
the prosecution of scientific enquiry, and do, every man, his
duty, as best he can. The foundation and encouragement of
societies is doing much towards improving the character of our
profession throughout the Union. It is developing a degree of
energy and solid wisdom which heretofore has been circum-
scribed in its influence. Much, too, is being done by the press,
that mighty engine of revolution and reform; and we look to
our medical periodicals, as direct agents in spreading through-
out our land the influence of scientific minds. In periodical
literature we are still somewhat deficient much yet remains
to be done in improving the character of our medical journals,
as well as in increasing their number. " The opinion of plenty
(says Lord Bacon,) is amongst the causes of want ; and the
great quantity of books maketh a show rather of superfluity
than lack: which surcharge, nevertheless, is not to be removed
by making no more books, but by making more good books,
which, as the serpent of Aaron, might devour the serpents of
the enchanters.'' As it is, we are proud of our journals and

720 Quintard, on the Present State of Medicine. [December,

reviews,* for they come to us laden with the riches of observa-
tion and experiment, but we would have them made the medi-
um of diffusing that philosophic spirit, which, as Dr. Thomas
Brown justly observes, is far more valuable than any limited
attainments in philosophy, and which is becoming the charac-
teristic of our age. We would have them garners into which
may be gathered the fruit of every gleaner in the field of sci-
ence. We would be glad to see them expressing more fully
the experimental researches of the " workers" in the profes-
sion. It is, palpably, a duty of every member of the profession
to lend his aid in supporting the literature of the profession.
Let each one ask himself, what am I doing to encourage the
establishment of a sound, distinctive literature for the profes-
sion of which I am a member ? what am I doing towards
removing the evils of which I complain? And in answering
these queries, let them remember that they perform but a part
of their duty, by simply paying the small subscription price of
their journals.

There is somewhat of a national character attached to medi-
cal science in this country. American physicians are probably
unrivalled in the knowledge and use of "heroic remedies."!
They have introduced new and rational doctrines respecting
the operation and effects of remedies. We must build up our
literature, if we would preserve the character and standing to
which we are justly entitled. The achievements of the pro-
fession in this country, are the more surprising, when we con-
template the obstacles it has had to contend with. If a know-
ledge of the science of anatomy is the basis of medical skill
if pathology can unfold lessons of wisdom, in which we may
learn how to prolong human life and lessen human anguish,
then ought the state, to whose service the physician is devoted,

* In the United States, there are published, as we learn by the report present-
ed to the American Medical Association, by the committee on Medical Litera-
ture, twenty American medical journals and four reprints of foreign journals.
Of these, five are quarterlies, six are issued bi-monthly, six monthly, one three
times a year the Transactions of the Philadelphia College of Physicians
and one weekly.

t The writer would not be understood as introducing this fact to illustrate the
superiority of American practice, but only to notice a peculiarity of that prac-
tice.

1850.] Quintar d, on the Present State of Medicine. 721

by liberal laws, legalize these stufdies. How stands the matter
in most of the states of this Union? Physicians and surgeons
are liable to prosecution for not possessing that knowledge
which it is a penal offence for them to obtain. The inattention
of the patient to the directions of the surgeon is often the origin
of prosecutions, and prosecutions the most wilful and malicious;
but there are instances in which men of limited means are ad-
mitted into the ranks of the profession, by "State Boards," who
have actually been prevented, by the stringency of law, from
acquiring a knowledge of human structure. It is true, the ad-
mission of such persons into the profession is wrong, and ought
not to be tolerated; but if the State will decorate them with
sheep-skins, it ought also to secure them from prosecutions for
mal-practice, though they be wolves in sheeps clothing. But
this is not the only class subject to damages at law. The most
accomplished practitioner of the healing art, will, in the course
of a few years, forget much of his minute knowledge of anato-
my ; and to be even a tolerable surgeon, requires a constant use
of the scalpel. Take a case which actually occurred in our
State, not long since : The patient, a gentleman, was thrown
from his horse, and in falling fractured one of the bones of his
fore-arm, and dislocated the other at the wrist. The surgeon
in attendance, did all that any one could accomplish to remedy
the case, and give the patient a good arm. But the bandages
becoming painful, were cut. and par consequence the arm, just
above the wrist, was slightly deformed. A- few months after,
the surgeon was sued for the round sum of $10,000. A surgeon
at Lowell, was prosecuted, for not relieving, internally, dis-
eased eyes, for which he had operated in a most skillful man-
ner. Admitting that an error of diagnosis was the cause of
failure in both these cases, are the surgeons to be blamed for
those errors? Certainly not. The choice in surgical opera-
tions, lies between success and a state prison. But errors will
occur even to the most distinguished surgeons even to those
who daily perform some half dozen operations, as well as to
those who do not operate that number of times in the course of
a twelve-month. One of the most distinguished surgeons of
Paris being about to operate upon what he supposed a common
cataract of the eye, observed to the students present, at the

N. S. VOL. VI. NO. XIT. 40

722 Quintard, on the Present State of Medicine. [December,

close of a brilliant lecture, Here is a cataract easy to operate
on by displacement. The needle introduced into the eye was
manoeuvred for a long time without causing the opacity to dis-
appear. The instrument was then withdrawn, and the opera-
tor, without saying a word, turned his back upon the patient.
A witty confrere, wishing to ascertain the cause, examined the
eye, and, laughingly, said, "I see what it is: it appears that
there has only been here & displacement of diagnosis." (South.
Med. and Surg. Journ., 1845.)

When the State shall see fit to encourage the efforts of the
profession to obtain material for the study of practical anato-
my when it shall adopt a higher grade of requisitions for
those to whose skill the life and health of the people is commit-
ted, then, we shall be glad to see bungling surgery rewarded
"with many stripes." This is only one of the many obstacles
which the profession, in the United States, has to surmount,
before it will occupy its proper position. The office of a phy-
sician is a thankless one : he meets with the basest ingratitude :
his services are received by many, as a matter of course, as
something to which they have a sort of natural right. The
tooth of calumny gnaws at his reputation, and the voice of ma-
lice oftentimes destroys his prosperity. That general respect
to which the profession is entitled, by the public benefits* it has
conferred upon society, are in a great measure withheld. The
reasons which secure the respect of well-informed and intelli-
gent men for other sciences, fail altogether, when they come
to medicine. They even indulge in a playful contempt when
speaking of its claims. In seasons of trial even, instead of ex-
tending to physicians their confidence and support, they reward
their toils with an ungenerous and inconsiderate fault-finding.
This ingratitude of the public is sometimes manifested in the
most offensive manner. After the yellow fever in Philadelphia,
in 1798, had subsided, at a meeting of the citizens, in which the
committee who superintended the city during the prevalence

* To estimate the public benefits which the medical profession has conferred
upon the world, you need only to look at the zealous, and, I may say, leading
agency, which it has always exercised in instituting and maintaining hospitals,
asylums for the insane, institutions for the instruction of the deaf and dumb,
and the blind, and associations for the advancement of the sciences. (Dr. Hook-
er Phys. and Patient.)

1850.] Hammond's Case of Lithotomy. 723

of the disease was honored with a vote of thanks, a similar vote
was proposed in relation to the physicians, but was not even
seconded, though nearly one-fourth of their number perished in
their efforts to save the people from the ravages of the pesti-
lence. (Dr. Hooker.)

In this desultory paper, we have pursued no particular order
in the arrangement of our subject, but have dotted down our
thoughts as they have occurred. The position of the profession
at present is a peculiar one : it has lost that veneration which,
a half century since, almost amounted to superstition; but the
true representatives of the science they to whose lives and
labors I have referred in the foregoing pages must always
command respect, and be venerated according as they triumph
in the intellectual gladiatorship, which is the glory of our time.
"The skill of the physician shail lift up his head; and in the
sight of great men he shall be in admiration."

" For of the Most High cometh healing, and he shall receive honor of the
King." (Eclesiasticus, xxxviii. 2, 3.)

ARTICLE XXXVI.

Case of Lithotomy. By D. W. Hammond, M. D.,
of Cullodens, Ga.

Notwithstanding lithotomy is regarded as one of the capital
operations in surgery, it always has occurred to my mind, that
the publication of a simple case of the kind, without something
uncommon or extraordinary being connected with it, would
not be likely to elicit much, if any, interest on the part of the
profession. Having long entertained this sentiment, I have,
up to the present time, with-held from the public any of my
operations for stone. The following case, however, which I
now tender to the Southern Medical and Surgical Journal for
publication, being one of no ordinary character, is my apology
for offering it to its readers.

I was called on the 10th March, 1849. near the Indian
Springs, in Butts county, to see (with Dr. Shannon and Head)
Mr. James Morris, a young man of 22 years of age, who, his
parents informed me, had been afflicted with what they sup-
posed to be gravel, from early childhood.

724 Hammond's Case of Lithotomy. [December,

He was rather small for his age, of the lymphatico-sanguine-
ous temperament., much emaciated and pallid ; the expression
of his countenance indicated great bodily suffering and mental
anguish. He was tormented with incessant and unmitigated
itching not of the prepuce, but of the perineum ; he had a
discharge of bloody matter from the penis ; red tongue, ceph-
alalgia, anorexia, much derangement of the primse viae, together
with a wasting, hectic fever.

The introduction of the sound detected the existence of an
enormous calculus. Although the particular prognosis in this
case was unfavorable for the operation, on consultation, it was
thought best, under all the circumstances, to give to the unfor-
tunate sufferer, the last, though forlorn alternative for life, by
removing at once the calculus.

After being placed in the usual position, and properly secur-
ed, the point of a common size scalpel was inserted through the
skin just below the insertion of the ejaculator seminis muscle,
and cariied down on the left of the raphe, terminating midway
between the lower margin of the anus, and tuberosity of the
ischium; the incision being about three inches in length. By
a few successive strokes of the scalpel, the membranous part of
the urethra was brought into view with the sharp-pointed
bistoury, the groove of the staff was now laid bare to the extent
of a half inch or more. One of Physick's three-quarter inch
gorgets completed the operation by dividing the prostate gland,
and neck of the bladder. The stone was now readily felt with
the finger. By manipulating for some minutes, with Tarious
size forceps, with the aid of the scoop, syringe, and flax-seed
water, &c, the bladder was freed entirely from the calculous
deposit. Fortunately for the patient, as well as the operator,
the calculus was of the fusible kind, consequently very easily
broken down. Its external surface was laminated, friable and
easily separated, being held together by minute crystals of the
triple phosphate of magnesia and ammonia. An anodyne be-
ing administered, the patient was removed from the table, and
placed in bed.

The fragments of the stone were now gathered up from the
floor and table, and after being carefully dried in the sun, weigh-
ed a few grains over six ounces. The following is its analysis,
bv Professor A. Means :-*-

1850.] Hammond's Case of Lithotomy. 725

Oxford, feU., April 13, 1849.

Dear Doctor, At my earliest convenience, I have made the
analysis of the fragments of the urinary calculus enclosed under
your envelop, and submitted to me for examination.

Its external characteristics, viz, its lamellated structure,
white hue, chalky trace, friable texture, and harsh powder, led
me at once to regard it as the fusible calculus an opinion
verified by the application of the blow-pipe, and appropriate
chemical tests. It is a compound of the Phosphate of Lime,
with the Phosphate of Magnesia and Ammonia, its chem-
ical elements being expressed by the following lengthy formula,
viz : (8 ca 0, HO -|- 3 P05) -|- (2 MgO, NH4, O, P05 -|- 14
HO.)

This form of calculus frequently attains a large size in per-
sons of advanced age, or exhausted constitutions, but the speci-
men extracted by you, and weighing 6 oz. (from a portion of
which the above analysis has been made,) must be regarded
an extraordinary growth for a subject of only 22 years of age.
Very truly, your's, &c. A. MEANS.

Dr. D. W. Hammond.

The patient spent a restless night after the extraction, from
excrutiating pain in the region of the bladder and sacrum. On
the morning of the 20th, his pulse beat quick and feeble, num-
bering 130 per minute ; he complained of nausea and headache
had considerable tenderness and tympanitic distention of the
abdomen bloody water passing out of the wound with the
urine. In this unfavorable condition, I left him in the hands of
my worthy and esteemed friend, Dr. Shannon, of Gullettsville,
the family physician through whose kind attention and skillful
management, after a tedious and protracted struggle, he finally
recovered not, however, until after the lapse of six or eight
months.

I visited him in the latter part of the year, at which time the
opening had firmly coalesced, the urine passing pervias ?iatur-
ales. His health, though still feeble, was rapidly improving.
I saw a gentleman last summer, who saw him at the Indian
Springs: he informed me, that his health was almost entirely
restored; so much so, that he amused himself by taking short

726 Hammond's Case of Lithotomy. [December,

excursions in the woods, with his gun, shooting birds and squir-
rels.

There were several circumstances connected with this case
worthy of consideration :

1st. In regard to the composition and chemical analysis of
the calculus. The fragments sent to Prof. Means, consisted of
the crust of its periphery alone ; but I find in an examination,
made recently, that the central portion, which weighs over
two ounces, is of a dark, brown color, very rough and tuber-
culated, hard, quite dense, and imperfectly laminated, and com-
posed of the Oxalate of Lime. This is what is denominated
the Mulberry Calculus. Here we have a specimen of the al-
ternating variety the nucleus consisting of the oxalate of lime^
whilst the exterior crust is composed of a mixture of the phos-
phate of lime, and phosphate of magnesia and ammonia.

2d. This is the largest calculus ever extracted from the hu-
man bladder, in the State of Georgia, and may I not venture
the assertion the largest ever extracted in the United States,
save one, where the operation was followed by a complete recov-
ery. I cannot now call to mind but one ; this was a case oper-
ated upon by Prof. Dudley. I will here allow him to speak for
himself. In a letter, which he addressed to me on the 22d of
May last, he says

" Taylor, a youth of the mountain region of this State, came
to Lexington in his eighteenth year, after six years suffering,
and had a calculus removed from his bladder, of eleven inches
in its great circumference and three inches in its smallest diam-
eter, weighing about nine ounces. The extraction was follow-
ed by sloughing of the bulbous portion of the urethra, together
with the whole of the accelerator urinae muscles, and a large
portion of the perineal cellular tissue.

" At the end of the sixth week, the wound was healed. The
patient was dissatisfied because the contents of the bladder
could not be projected as far as he had expected ; a defect ori-
ginating in the loss of the accelerator muscles. He is, how-
ever, the father of a large family of children, and was living
last fall, thirty years since the operation.

" Very respectfully, your obd't serv't,

"Lexington. B. W. DUDLEY."

1850.] ' Medical Treatment of Insanity. 727

3rd. The opening through the perineum in this case, was
small, which should always be less than the calculus, in every
case. I do not me in to c< nvey the idea by this assertion, that
it is better to tear than to cut, but I contend, that it is better to
dilate than to cut. I must therefore be permitted, without ar-
rogance or presumption on my part, to differ in pinion from
the ancient and distinguished Celsus, who, in writing on this
subject, lays down the following maxim: "plaga, paulo major
calculus sit." I would prefer substituting the wrord minor, for
major.

4th. The prognosis in this case was very unfavorable, both
before and after the operation, yet it terminated favorably, and
as did the case of Taylor, who is still living, thirty years since
the operation, and has raised a large family of children.

5th. From the favorable termination of these two cases, I
am of the opinion, that when the death of a fellow-being is in-
evitable, from the existence of stone, that the surgeon should
assume every responsibility, regardless of consequences, and
extend to him the last, and only chance for life, by performing
the operation without any preparatory treatment.

PART II.
Wtvxtms anir (Extracts.

Report on the Medical Treatment of Insanity, and the diseases
most frequently accompanying it. By James Bates, Pysi-
cian and Superintendent of the Maine Hospital. Read be-
fore the Association of Medical Superintendents of American
Institutions for the Insane, June 18, 1850. (American Jour-
nal of Insanity.)

Were I to write an essay for the student, some mode of
classification would be deemed indispensable.

The various forms of disease, the different organs to be
acted on, or the classes of remedial agents to be had in requisi-
tion, wrould form convenient modes of arrangement, to assist
the understanding and the memory.

But to a class of gentlemen who have spent their adult lives
in the midst of disease, only general remarks may be made,
avoiding chapter and verse, grains, scruples and drachms.

The medical treatment of insanity at the present day, is far

728 Medical Treatment of Insanity. [December,

from being uniform among well informed medical men, though
sufficiently so for all useful purposes, with that branch of the
profession who have made the treatment of the insane the prin-
cipal field of their labors.

When, however, we contrast the practice of the present,
with that of the preceding century, the difference in the medi-
cal, is scarcely less than in the moral treatment of the insane.

It is, I believe, everywhere admitted by educated physicians,
that the medical, as well as every other curative indication in
the treatment of insane ,persons, is a problem to be solved by
an investigation of each individual case.

To lay down distinct and specific rules for the management
of the various phenomena exhibited by insane people, of all
ages, sexes, and temperaments ; modified by instincts, propen-
sities, sentiments, intellect and habits, embracing every form of
the malady, is a labor which never has been, and probably nev-
er will be satisfactorily accomplished.

The task is not simplified by the various and often discordant,
opinions which exist, and have heretofore influenced the pro-
fession, in relation to the pathological condition of the organ or
organs, on which the instincts, propensities, sentiments, and
intellect depend for their normal or abnormal manifestations.
No man can prescribe understanding^ in a single case, much
less lay down general principles of practice for himself, or the
guidance of others, without notions more or less satisfactory to
himself, at least, of the morbid condition of the organs he wishes
to affect by his remedies.

Special physicians are very minute in their inquiries into the
causes which have produced the mental troubles they have to
investigate ; whether they have been physical or moral, or
both ; whether primary as affecting the brain and nervous sys-
tem without the agency of other organs ; or secondary, as hav-
ing originated in disordered action of the latter, disturbing the
operations of the sensorium through the medium of the nervous
or other communications.

All this is well and useful, though it should happen that pre-
cisely the same pathological changes have been produced by
the one class of causes as by the other.

To understand myself, and to be in any good degree under-
stood by others, as to the objects to be accomplished by the
medical treatment of the insane, it is proper that I say some-
thing of what I conceive always to exist in the brain at the
time insanity, properly so called, commences.

Whatever may take place afterwards, I believe no case of
prolonged aberration of the affections and intellect manifests
itself without the existence of irritation.

1850.] Medical Treatment of Insanity. 72U

Whether it is caused by super-excitation of external or in-
ternal, physical or moral agents, directly ; or by the absence or
exhaustion of the amount of excitation necessary to healthy
action, indirectly, I believe theprima?y forms of insanity never
exist without it.

Undoubtedly this may be followed by inflammation more or
less active, by which both the disease and the appropriate reme-
dies will be essentially modified.

Whether this condition is less frequent than formerly, may
not be easy to determine ; for some cause the treatment has
undergone a great change.

If remedies, relied on, as late as the beginning of the present
century, for combatting the inflammation, supposed to exist in
almost every case of acute mania, were as freely resorted to, I
think we should not be greatly flattered with our success, what-
ever may have been that of our predecessors.

I may hazard the opinion, that physical and moral changes
have gradually pervaded whole communities, whereby the
brain and nervous system have become more frequently the seat
of diseased action than formerly, giving rise to a more marked
and rapid prostration of the physical and vital forces, exhibit-
ing more frequently mental troubles, requiring, not only in
insanity, but in most grave diseases, greater caution in the use
of active, depleting remedies.

Possibly, these circumstances, added to the fact, that most
persons admitted to institutions for the insane, have already
passed the most vigorous stage of vascular action, may have a
tendency to lead to conclusions and a practice apparently ultra,
so far as depletion is concerned, in our hospitals for the recep-
tion and treatment of this unfortunate class of sufferers.

So far as I am advised, there does not remain, anywhere,
the mode of practice formerly pursued at Bethlehem, and other
hospitals, of bleeding all the curable patients on the first of
June and last of July; enabling one physician to say, "that
although he had bled one hundred and fifty in a day, he had not
seen a single accident follow." Nor do I believe the man is
living, who, like Dr. Rush, would order the abstraction of 470
ounces of blood at 47 bleedings in ten months ; nor like Plater,
direct 70 bleedings in 70 weeks. Nor do I think the adminis-
tration of cathartics and emetics at stated seasons of the year,
anywhere finds countenance at this dav.

Few, if any, in our time, would let blood "because the con-
tents of the cranial cavity had not the same facilities for reliev-
ing itself of fluid turgescence as have those of the other great
cavities." Nor should we much fear that local, practiced pre-
viously to general bleeding, would be dangerous, by inviting an
increased flow to a debilitated organ.

:30 Medical Treatment of Insanity. [December,

Fifty years since a physician who should manage a case, in
which there was evidence of congestion in the vessels of the
brain to such a degree as to produce long continued insensibili-
ty, without general or local blood-letting, or both, would have
been considered little less than a madman or a fool. There
may be localities where he would be thought so now.

It is peculiarly unfortuate for the practioner in medicine,
that he is compelled to select one of the two or more pathways
which seem to lead in varied directions, to the same point.
Could all be followed at once, it would be easy to strike the
balance, and to arrive at a degree of certainty, approaching
that of an axiom. Only one selection is properly at our dis-
posal, and our decision must be made in each case by the aid of
the best analogical information in our possession.

I confess to having repeatedly occupied a most anxious
position, in such cases, (in one instance during eight days,)
watching the recuperative action of nature, aided by such ex-
ternal and internal applications as could be administered, with-
out the volitions or consciousness of the subjects.

Perhaps it will be said, I should have been more uniformly
successful had I added to my remedial agents the abstraction of
blood.

This is the very point on which I desire proof, wishing most
religiously to pursue the best mode possible.

It cannot be doubted, that there are cases, perhaps more
than some of us imagine, in which, if we saw them in their
stage of most active vascular action, we should resort to de-
pleting and antiphlogistic remedies entirely beyond what is
customary with us now.

At the risk of being considered ultra, (for which I have
certainly no ambition,) truth compels me to say, the most of
the blood-letting my patients have undergone, since I had the
care of an institution, has been practised on themselves. Some
of the cases seemed as likely to be benefitted by it as any I
could have selected, but I have known no good to result from
their bold operations.

Nor will my experience coincide with that of Mayo on this
subject, viz: that dementia is not the result of the practice.

1 have not doubted that several cases have come to me, in
which acute dementia had been produced by abstraction of
blood, and that recoveries, if they took place, had been delayed
months by this cause.

In cases where natural or abnormal evacuations are sup-
pressed, a judicious use of cups or leeches, may not only assist
in restoring them, but in relieving the nervous irritation arising
from their absence.

1850.] Medical Treatment of Insanity . 731

Both these modes of abstracting blood are often either offen-
sive or frightful to our people, and care should be taken, that
injury from this cause does not outweigh the benefit.

Many of the observations on blood-letting are applicable to
depletion by drastic purgatives, but probably not to the same
extent.

From the first history of the medical treatment of the insane,
until recently, drastic purgatives have been extolled, especially
in melancholia and hypochondriasis.

Their use latterly has been mostly confined to cases in
which the disease is not only recent, but exhibiting symptoms
unequivocally requiring antiphlogistic treatment, beyond what
could be accomplished by the use of milder means, or a state of
constipation which has resisted milder methods I may add to
such cases, perhaps, the class of persons who evidently need
the evacuation of the first passages, and who resist all our
efforts to administer the requisite medicines in their usual forms,
when we feel called on to administer secretly, in a concentra-
ted form, an efficient purgative.

Those who have had much experience, will not need to be
told that extreme caution is required in certain persons at all
seasons, and all persons at some seasons, lest diarrhoeas, not
easily controlled, follow the use of strong cathartics.

In most cases, the exhibition of mild preparations of mercury
followed by common aperient medicines, is much more judici-
ous than giving those of a more debilitating class.

I do not know that the hellebore is now much in use the
Croton oil seems well adapted to our use when an active medi-
cine is required in a concentrated form, and when formed into
a pill with powdered nutmeg or other mild aromatic, may be
so divided as to be as safe in its action as any simple laxative
in use.

The compound Colocynth pill and the common infusion of
senna and anise, with sulph. of Magnesia, are medicines in
daily use with such patients as require their action.

There is an inactive state of the first passages which indicates
a kind of paralytic state of the muscular coat of the organs. In
these cases, whether the person be insane or not, the use of nux
vomica, compounded with aloes, rhubarb, or other mild
cathartic drug, in small doses, steadily preserved in, will often
overcome cases of obstinate constipation.

As I have prescribed to myself no particular arrangement to
be adhered to, I may as well speak of other states of these
organs, which sometimes tax all our skill, and occasionally bid
defiance to our best directed efforts.

From the effect of our own remedies, the peculiarities of the

732 Medical Treatment of Insanity. [December,

season, or the state of the individual, we are frequently called
on to treat troublesome, and sometimes incurable cases of
diarrhoea. On two or three accounts the insane are more
difficult to treat than the sane. The state of the nervous system
seems to render the local affection more grave the general
restlesness renders the adjustment of external applications, and
even proper covering, difficult, if not impossible, and our internal
remedies, however we may direct their administration, are
rendered irregular and uncertain.

With due weight given to exceptions like these, there is
nothing very peculiar in the treatment of this affection in the
insane. Every attention should be paid to sustain an equal
and natural heat on the surface, and as vigorous capillary
action as may be a duty as difficult to accomplish, as impor-
tant to the well-being of the patient.

The application of external heat, wet or dry, frictions and
concentrated stimulants to the skin, locally or generally, should
constitute our first efforts. They may be aided, but never
superseded, by appropriate internal remedies. Alteratives,
opiates, astringents, stimulants, and tonics, all have their proper
time and place, in the course of treatment. There are cases
which seem to have arrived near a fatal termination, in which
spirits of turpentine both internally and externally, combined
with anodynes, have appeared to give a favorable change to
the action of the mucous membrane and the glands connected
with it. To all of us the various modes of moderating the
effect of the most exciting remedies, by judicious combinations,
are too familiar to require further remarks.

The most formidable disease of this class of organs, which
has come under my care, I shall take the liberty to call Asthenic
Colonitis. This affection which has its seat high up in the
large intestines, mostly, has been fatal in many locations in
families, and not less so in some of our hospitals for the insane.
It has been epidemic at the season when bowel complaints are
usually most prevalent.

In our institutions for the insane it has chiefly attacked those
whose physical energies had been diminished by protracted dis-
ease, and many such have fallen victims to it.

The disease is not attended with the same degree of pain,
vascular action or febrile heat, usually present in dysentery.
The discharges from the bowels are generally frequent and
abundant ; at first resembling newly made soft soap, more or
less streaked or tinged with blood. In its progress, the blood
is no more seen, but a sort of muco-purulent fluid in great
quantities is voided day after day. The odor is peculiar, and
not like that from epidemic dysentery, as usually encountered.

1850.] Medical Treatment of Insanity. 733

Anodynes, alteratives, astringents with lavements of lauda-
num and solution of tannic acid were with us often powerless
to arrest the progress of the disease. If any prescription was
better than others, it was the free use of Laudanum, Bals.
Copaiva and mucilage.

No disease can require greater vigilance as to the application
of external and internal means. No precaution of cleanliness
produced even a tolerable state of purity in clothing and rooms
without the aid of chlorine gas.

An apology may be necessary for speaking of affections not
necessarily connected with insanity.

It is not easy to treat a malady considered by many as only
a syjnptom of peculiar troubles in physical organs, without re-
marks on the occasional affections which, often accompany and
influence these troubles, or are modified by them. These com-
bined circumstances call for more care and caution, as to the
quantity and quality of remedial agents, than incases where the
symptom of insanity does not exist.

The remarks to be made will relate more exclusively to the
medical treatment of the organs laboring under their peculiar
physical derangement manifested chiefly by mental aberration.

The classes of agents mostly in use for this purpose are alter-
atives, calmants, and tonics. The first class is required for the
same purposes and under the same circumstances as in cases
where all the other symptoms existed without the insanity.

When I speak of alteratives, I allude to the moderate use of
mercurials and other medicines considered, as having a tenden-
cy to restore deficient secretions or to correct such as are
vitiated in quality. I can speak of the Extract of Conium, in
its most efficient form, as entitled to no other credit than as an
alterative, nor can I speak highly of it as such.* I am inclined
to think some of us still use it, as much out of respect to the
testimony of respected names, and because of the rather con-
venient form of its compounds for administering tonics, as from
any conviction of its value as a narcotic.

To my mind it is rather an innocent affair, for one which has
been so much extolled, and in cases where an expectant course
is deemed advisable. I know of few drugs which may be more
safely trusted as a placebo. I have not seen apparent injury
from it, and must leave it to others to testi'y to the good it does.

The whole class of narcotics, has been had in requisition, and
though each variety may come in, alone or in combination, for

The writer is aware that manyof'his friends have a decided conviction that
Conium is calculated to produce valuable sedative effects on the system. He
believes also that the medicine in very large doses in neuralgia and spasmodic
affections olten produces happy results.

734 Medical Treatment of Insanity. [December,

certain constitutional peculiarities or states of the system, one
alone maintains its general superiority above every, and all
others.

Although opium is not suited to all constitutions, nor to any
individual case at all times, it has, when the system is properly
prepared for its exhibition, maintained its superiority for ages
past as a narcotic, and probably is destined to, for ages to
come.

In the early stage of maniacal disease, the irritation and
vascular action are such, that opium in any of its forms seems
rather to increase than to allay excitement. But when this
irritation is moderated and the vascular action somewhat
equalized and diminished, by the well directed use of baths,
antimony and saline draughts, some of the salts of opium or
other compounds, in which the article forms the most active
agent, may usually be safely and advantageously administered.

In chronic cases we have no need of these preliminary pre-
cautions in most instances, and frequently find benefit in
adding to our opiate some active stimulant, as camphor, ether,
&c. From a wish to find a substitute for this drug, in cases
of extreme watchfulness, and in some measure influenced by
the recommendations of others, I have administered almost
every combination which has acquired credit with the faculty,
such as the campor, sulph. ether and infusion of hop, Hoffman's
Anodyne, hyoscyamus, stramonium, belladonna, ex. of valerian
by displacement, Brigham's mixture, &c. It is not unlikely
that the cases and periods have been injudiciously selected, but
I have rarely found a benefit from their use which would not
be more certainly realized by an equivalent, so to speak, of
opium.

Undoubtedly there are constitutions and stages, in which
some of these would be tolerated, not only, but do good, where
opiates would not. I think the necessity for a quieting medi-
cine, in a case of insanity must be very slight, in which any of
these remedies would answer the requisition. I fear the ex-
tensive use made of similiar appliances in the medical world, is
more a matter of routine than of judicious reflection and dis-
crimination.

May we not frequently give credit to a long continued use
of inefficient medicines, which is due to time and the recupera-
tive efforts of nature ?

One word on the danger of acquiring a habit of using opium,
which it is not easy to abandon. My own experience has not
been as fortunate in this respect, as was stated at one of our
meetings a few years since, by a highly respectable member,
now no more, who said, he had never experienced any dirfi-

1850.] Medical Treatment of Insanity . 735

culty in stopping the use of the medicine, nor had known trouble
to follow.

One of the most troublesome cases I ever saw, acquired the
habit in the institution under that gentleman's care and the
use of the drug followed for six years after leaving the Hos-
pital. By very gradually diminishing the enormous dose she
was taking when she came to me, it was wholly left off, at the
end of six months : but the sulph. of quinine with which it was
combined, was continued six months longer so that she never
knew when the morphine was stopped. She has been my
neighbor for four years, in good health and spirits.

I have now under treatment a case of melancholy, princi-
pally from moral causes, in which I have seen my patient get
apparently well and happy, but no sooner did I omit the mor-
phine, than all the trouble was renewed. Three times I
resumed and gradually discontinued its administration with
similar results; which made me determine on another course,
without the opium. The appearance is favorable for ultimate
success.

I fully agree with the gentleman from Kentucky that it is
generally best to commence with small doses, as 25 or 30 drops
of Laudanum, or solution of morphine of equal strength, and
gradually to increase the dose if necessary to a large amount.
My experience however does not enable me to say, "if the
design is not answered by less, give thirty draclnns."*

It is not easy to reconcile the discordant opinions of our best
practitioners as to the value of narcotics in the treatment of the
insane.

Some placing a very high, and others a very low estimate
on their value. Jt may be those who extol them most, have
gone far beyond those of more moderate expectations, in their
use.

In this way, they may have experienced advantages, un-
kown to those who have been more cautious in their adminis-
tration.

Not having prescribed them to the greatest extent, I cannot
pretend to decide the question, but hope to hear testimony
which will enable me to use medicines of this class more suc-
cessfully.

I have had no opportunity to make trial of the eastern com-
pound called hachich, nor have I learnt that its use has been

* I am aware that many practitioners use, and as they think with decided ad-
vantage, enormous doses of Laudanum and solution oi morphine in certain
cases of mania, even in some cases as high as seven or eight ounces per day.
I am not disposed to question their success, but have nut gone myself -to the
same extent.

736 Medical Treatment of Insanity. [December,

throughly tested in Europe or in America. From what I have
read and heard on the subject, it would appear to act like
stramonium, exciting a disordered action peculiar to itself; and
possibly may supercede an existing disordered action, by sub-
stituting one of its own, more powerful, but less prominent.

If this and similiar poisons act on the principle of Hahne-
mann, I presume the dose must be some hundred-millionth parts
less than we usually administer.

I have used stramonium in severe cases of epilepsy, compli-
cated with insanity, without any benefit.

Two cases seem to have been successfully treated, one and
two years since, by spirits of turpentine in large doses for
several days, followed by a long use of oxide of silver, as much
per day as the mucous membrane would tolerate. In several
others no benefit followed any course.

I come to speak of vegetable and mineral tonics.

There are few cases of long protracted insanity which have
not seemed to require a free use of these, and I believe every-
where, they are administered in our Hospitals, in cases where
the physical vigor is much diminished.

In subjects where the tonin course does not require to be
prescribed for the relief of any particular organ, the prepara-
tions of cinchona, may represent most of the vegetable class,
as the oxides and salts of iron and silver do that of the mineral.

Every one's ingenuity must suggest the various additions
and combinations required to affect particular organs or special
cases.

There is a form of disease affecting mostly the young, in which
maniacal excitement alternates with acute dementia, possibly
from renewed congestions. From one or the other of these states
we see our patients gradually recovering, taking on the usual
appearance of health and intelligence, when suddenly a state of
phrenzy or stupidity comes, and the same goes over again.

If we carefully observe the first signs of amendment and in-
troduce a large seton in the back of the neck, I think we shall
often avert a relapse.

I have no remedy for cronic dementia, nor general palsy,
never having seen either benefitted to any considerable extent.

I feel indebted to Dr. Stedman for his observations on the
use of ether for those who refuse nourishment and to Dr. Bell
for his excellent paper on the same subject.

I am not aware that I have advanced a single idea which is
not perfectly familiar to every member of the Association. I
would gladly have posted some new discoveries, if I had found
them on the blotters.

Having expressed some preferences, some doubts and some

1850.] On the Action of the Kidney. 737

objections, I expect them to be corrected where ever they meet
your disapprobation.

Having designedly avoided any mention of moral treatment,
it may be thought I consider the medical as the more impor-
tant. I can give my views in a single and short paragraph.

In the first stage I deem the medical more efficient than the
moral treatment, in the second equal, and in convalescence the
moral has decidedly the preponderance.

On the Action of the Kidney. By Arthur Hill Hassal, M.B.,
London. (London Lancet.)

The quantity of urine eliminated in a given time varies very
considerably in health.

A similar variation exists in disease also, but to an extent
even more remarkable.

Sometimes the urine is in excess in both health and disease,
at others it is deficient in quantity.

It is proposed in this communication to ascertain how far
these variations admit oi'satisfactory explanation.

The extreme rapidity with which, in many cases, a larsre
quantity of urine is thrown off by the kidney is one of the most
Striking phenomena connected with the elimination of that fluid.

The excretion or elimination of the urine is, to a very great
extent, a physical phenomenon, and is dependent upon those gen*
eral laws which regulate the passage of fluids through organ-
ized membranes, both vegetable and animal.

One of the principal properties of membranes is that of per*
meability, the degree varying with the character of the mem-
brane, the nature of the fluid or fluids passing through it, and
the amount of pressure to which it or they are subject.

The fact or law of Dutrochet, that two fluids of different den-
sities pass through the membrane by which they are separated,
and mingle together, the lighter fluid permeating the tissue in
the greatest proportion, and mixing with a denser, is familiar
to all.

A little reflection is sufficient to show that this law does not
apply to the elimination of the urine. In this case, there is re-
ally but one fluid, the blood; the urine is drawn off from the
blood, and is carried away nearly as fast as it collects. "More-
over, the operation of this law, if in action, would cause, not
the water of the blood to pass into the tubules of the kidney,
but the fluid which might be in those tubules to make its way
into the bloodvessels, thus keeping the organ in a void condi-
tion.

IT. 8. VOL. VT. NO. XII. 'IT

739 On the Action of the Kidney. [December,

The elimination of the urine, or at all events of the watery
part of it, as well as all those of its constituents, the presence
of which in the blood has been satisfactorily ascertained, de-
pends, then, primarily, upon the porosity or permeability of the
membranes forming the coats of the bloodvessels, and of the
renal tubules.

The permeability of membranes is shown by the gradual
diminution in the bulk of any fluid either entirely or partially
included in a membranous texture, as bladder.

The passage of fluids through membranes is greatly facilitated
by pressure, their permeability bein" thereby much increased.
A simple experiment will illustrate this.

Let the expanded portion of a curved tube be tied over with
bladder, the wide pail filled with water, and the upright nar-
row portion partially so with mercury. The external surface
of ihe bladder will speedily become covered with drops of wa-
ter: these, if the column of mercury be increased in height,
will unite, and flow over, until, at length, an additional quantity
of mercury filing added, the bowl is entirely emptied of wrater
and filled with mercury.

Now I propose to appl;^ this experiment to the kidney, and
to show how far it will explain the varying phenomena connect-
ed with the elimination of the urine.

That the contractile walls of the bloodvessels, great and
small, especiallv those of the capillaries, exert considerable
pressure upon the fluid contained within them, is undoubted ;
that this pressure varies, also, with the degree of contractility
of the vessels, and the amount of fluid within them, is likewise
very certain.

That, also, the quantity of urine which* passes through the
permeable membrane forming the tnbuli uriniferi varies with
this pressure, being greatest when it is greatest, and least when
it is least, follows, from what has preceded, as a matter of
course ; and herein we have an exact and satisfactory explana-
tion why, under certain circumstances, the urine is abundant,
and under others, deficient, in quantity.

It now becomes evident how admirably the kidney is suited
by its structure to accomplish the office here assigned to it
viz., that of a filter; inclose^ in a dense and unyielding cap-
sule, the repletion of the vessels of the kidney does not occasion
any considerable distention and enlargement of the organ, but
is just sufficient to put the fibrous investments on the stretch,
giving rise to increased pressure, and determining the blood
towards the free surfaces of the tubules, the only outlet of relief
and escape for the contents of the surcharged vessels. Again,
by the disposition of the organ in tubules, the greatest extent of

1850.] On the Action of the Kidney. 739

surface an important consideration is obtained, with the
least expanse of space, and with the least complexity of struc-
ture.

We will now enumerate the cases in which we have either
an increase or deficiency of urine, and then proceed to ascer-
tain how far the principles laid down admit of application to
each case.

There is an increase in the quantity of urine eliminated in
health in the following cases :

In a state of repletion of the vascular system.

In impeded cutaneous transpiration.

In deficient nervous energy.

Under moderate exercise.

There is a decrease in the amount of urine voided in health-.

In a state of the vascular system the opposite of repletion*

Where there is free cutaneous action.

There is an increase in the quantity of urine passed in dis*
ease :

In hysteria.

In certain structural lesions of the kidney*

There is a decrease in disease:

Where the vessels are only partially filled*

In inflammatory and febrile affections.

In constriction of the small intestine.

In certain organic changes of the kidney.

In a state of repletion of the vascular system, as after the
imbibition of fluid in large quantities ; as at breakfast, dinner
and tea, all persons must have noticed how very quickly the
kidneys throw off the excess of water. Now, hi this state, the
bloodvessels are distended, the contractile walls react upon
their fluid contents, and the results are, augmented pressure
and increased penetration and escape of fluid through the mem-
branes of the vessels of the system generally but especially
through those of the vessels and canaliculi of the kidnev.

Where previous to imbibition, the vascular system is in a
state the opposite of repletion, where thirst exists,*and the quan-
tity of fluid drank is not large, consistently with the reasoning
advanced, we should not in such cases have an increased and
speedy flow of urine, the fluid imbibed being sufficient in quan-
tity only to fill the vessels to their natural extent.

In impeded cutaneous perspiration, as from cold or damp
applied to the surface, a state of repletion or congestion of in-
ternal organs, the kidney amongst the number, arises, and under
which, as in the previous case, there is augmented pressure,
and increased elimination of urine.

Where the nervous energy is weakened, as under the infiu-

740 On the Action of the Kidney. [December,

ence of the depressing passions and feelings, from fear, anxiety,
disappointment, &c, the heart contracts with diminished
strength, the blood is not propelled to the surface and extrem-
ities with the usual force, local repletion ensues, followed by
the usual results, and terminating in augmented elimination.

Under moderate exercise, where the vascular system is in a
medium condition of repletion, the activity of the circulation is
increased, more blood passes through the kidney in a given
time, and it is to this circumstance, rather than to pressure,
that the increased elimination is due.

In the first of those cases in which the urine is deficient in
quantity in health, as where the vessels are only incompletely
distended, as happens when drink has been abstained from for
along time, but little pressure is exerted upon the contained
fluid, and but little urine, in consequence, passes into the tubuli
uriniferi.

In the second case in which the urine is deficient in health,
viz.. where there is excessive cutaneous action, as in the warm
weather of summer, also under the influence of the hot bath,
or immoderate exercise, a condition of vessels exists, although
arising from a different cause, similar to that described in the
previous case.

After recovery from an attack of hysteria, the condition
of the nervous and vascular systems is analogous to that which
obtains under the influence of the depressing passions and feel-
ings, and the explanation of the increase in the quantity of
urine thrown off by the kidney, already given, holds good in
the present instance.

The majority of the structural alterations of the kidney are
attended, not with increase, but rather with diminution of the
urine ; it is difficult, however, to account for the presence
of albumen, unless on the supposition that the membrane of
the tubules has undergone some change, which allows of the
passage of that substance through it.

There are certain cases chiefly connected with disease in
which the bloodvessels are not in a state of repletion, but are
only partially filled, as where the watery portion of the serum
is carried off either by the bowels or the skin, as in purgation
from medicine, diarrhoea, cholera, or excessive diaphoresis, as
in hectic fever; in each of these the quantity of urine elimina-
ted is very small, and this arises partly from diminished pres-
sure, and partly from increased density and inspissation of the
blood.

Where considerable constriction of the small intestines ex-
ists, a mechanical difficulty is presented to the passage of the
water along them ; the absorption of fluid introduced into the

1850.] On the Action of the Kidney. 741

stomach is consequently impeded, and the bloodvessels are
thus kept in a partially filled condition, and there is therefore
but little filtration of urine through the membrane of the renal
tubules.

An explanation, different from any yet given, is necessary to
account for the diminution in the quantity of urine voided in
inflammatory and febrile affections. Here the vessels may be
in a state of repletion, and the pressure exercised by them upon
the blood considerable, and yet the urine eliminated be small in
quantity. This evidently depends upon increased density of
the serum of the blood, and consequent augmented difficulty to
the passage through the membrane of the tubules.

It is here proper to remark, that the elimination of the urine
is in all cases dependent, to a certain extent, upon the condition
of the blood as to density; where the serum is very dense, the
elimination is retarded, and where it is of low specific gravity,
it is facilitated, and which seems to account for the fact fre-
quently observed, that in persons whose blood is habitually
impoverished the kidneys act with facility.

The same facility of action of the kidneys is observable in
individuals remarkable for the possession of a delicate organ-
ization, and in whom the coats cf the bloodvessels and the mem-
brane of the tubules may be supposed to be more than usually
thin and permeable.

The organic changes of the kidney, accompanied by a dimi-
nution of the urine, are obliteration and destruction of the ves-
sels and tubules.

Action of Saline Diuretics. I am not aware that any satis-
factory explanation of the action of the saline diuretics has yet
been proposed, I therefore place before the profession what
appears to be at least a very probable view of their modus
operandi.

Liebig, in his "Researches on the Motion of the Juices in the
Animal Body," has shown that membranes imbibe and retain
a less quantity of a saline solution than they do of water unim-
pregnated with saline matter, and less of a weak than a strong
saline solution ; and in these facts, rightly applied, we find, I
believe, the correct explanation of the action of saline diuretics.

According to Liebig, 100 parts of animal membrane, dry
ox-bladder, absorb in twenty-four hours, 268, in forty-eight
hours, 310 volumes of water, and only 133 of saturated solution
of salt. Hence it follows, he writes, "that when bladder, satu-
rated with water by forty-eight hours contact, and well dried
in bibulous paper, without pressure, to remove superfluous wa-
ter, is strewed with salt, there is formed, at all points where salt

742 On the Action of the Kidney. [December,

comes in contact with the water filling the open pores, a satu-
rated solution of salt, the salt contained in which diffuses itself
equally in the water of the bladder. Of the 310 volumes of
water which Becomes thus saturated with salt, only 133 volumes
are retained in ihe hladder; and, in consequence of this dimi-
nution of the absorbent power of the bladdor for the brine, ]?7
volumes' of liquid are expelled, and run off in drops from the
surface of lie bladder."

The extent of membrane presented by the entire vascular
system, including especially the capillaries, is evidently very
great.

When a saline diuretic is introduced into the blood through
the stomach and small intestines, it is applied in an exceedingly
short space of time to the whole extent of the membranes con,
stitutmg the walls of the bloodvessels; in accordance with the
fact already noticed, the results of the application are, the dis-
charge of acerlain quantity of water and the contraction of the
vessels. This contraction, combined with increased repletion,
gives rise to augmented pressure and discharge of fluid into the
tubuli uriniferi.

On Albumen in the Urine. When it is remembered that a
fluid holding albumen in solution, as the serum of the blood will
pass freely through bladder, it seems a remarkable circum-
stance that albumen is not constantly present in the urine in
health.

I believe that we find an explanation of this circumstance in
the nature of the membrane fanning the tubules of the kidney.
Ordinary animal membrane, as that of the bladder, walls of the
capillaries, &c., is a fibrous tissue, whereas the membrane of
the tubuli erinifei i is homogeneous, and, as far as has been as-
certained, structureless.

While, therefore, albumen passes readily through the one
form of membrane, it is very probable lhat the other variety,
when in a state of integrity, presents a difficulty to its passage
altogether insuperable under the usual conditions accompany-
ing health.

If this view be correct, then there is much reason to suppose
that in all cases where albumen is present in the urine, there
is lesion of the membrane of the tubules.

The correctness of this suppositicn very frequently admits
of demonstration by the microscope: thus, in fatty degenera-
tion, where the kidney is increased in dimensions, the follow-
ing is the condition of parts usually noticed : The tubes vary
greatly in size, are not unfrequently more or less spirally twist-
ed, and, in extreme cases, even torn ; their cavities are occu-

1850.] On the Action of the Kidney. 743

pied either with fa'ty deposit, in the form of minute spherules,
some of. which are included in the secreting cells, but the ma-
jority are usually free, or else contain fibrinous coats; it is to
be observed, further, that the larger tubes generally contain the
fatty deposit in the greatest abundance.

Now, accompanying the dilatation of the tubes, and which is
real y the cause of the increase in the size of the entire organ,
the membrane forming them must undergo some structural
change, it becomes thinner, and in this state allows of the pas-
sage of the albumen through it.

The occupation of the cavities of the tubes with the deposit
and fibrous coats, offers a considerable impediment to the pas-
sage of the urine and albumen, as is strikingly shown by the
occasional twisting of the tubules.

It is, further, quite possible that, under extreme pressure, such
as does not occur except in disease, and which possibly exists
in the congestion of the kidney occurring after scarlatina, the
form of membrane constituting the walls of the renal tubules
does allow of the passage of albumen through it, even without
lesion.

Why the form of albuminuria following upon scarlatina
should be curable, and while most other forms of that com-
plaint, or rather, symptoms of one or more complaints, should
in general not be under the control of treatment, it is not diffi-
cult to explain; the first is dependent upon local causes; the
impeded action of the skin produces a state of temporary ful-
ness of the vessels of the system, under which there is increased
pressure and elimination from the kidney, accompanied and
modified by the local congestion, and even inflammation of the
organ present. The second form too frequently arises from
general and constitutional causes, under which the local affec-
tion is, first originated, and subsequently progresses.

From the term albuminuria, and from the frequency with
which albumen is spoken of. in connection with the urine, it
might, by some be supposed, that it is the only element of the
blood present in such cases; this is not, however, the case, for
the same condition of membrane which allows of the passage
of albumen through it, permits also of the escape of t tie fibrin ;
but while the first remains in solution, the latter solidifies in the
renal tubules, from which they are from time to time dislodged,
and are to be detected, by means of the microscope, in the
sediment of the urine.

All the elements of the blood, except the red corpuscles,
are therefore contained in the urine in ordinary cases of albu-
minuria.

The above brief remarks seem to illustrate the truth of the

744 On the Action of the Kidney. [December,

following observations, made by Liebig, in the interesting work,
the title of which has already been cited:

"Since the chemical nature and the mechanical character of
membranes and skins exert the greatest influence on the distri-
bution of the fluids in the animal body, the relations of each
membrane presenting any peculiarity of structure, or of the
different glands and systems of vessels, deserve to be investiga-
ted by careful experiment ; and it might, very likely be found
that in the secretion of the milk, the bile, the urine, the sweat,
&c, the membranes and cell walls play a far more important
part than we are inclined to ascribe to them.''

General Remarks. From the preceding observations it
would appear, then, that the kidney is to be regarded to a great
extent as a mechanical apparatus, as a filter, in fact, the action
of which depends upon the fluid contained in it, and the pres-
sure under which this is forced through.

It wTould be a very great error, however, to regard the elimi-
nation of the urine as entirely a physical phenomenon, wholly
independent of vital influences; the nerves distributed to the
bloodvessels have doubtless the power of affecting their calibre,
hastening or retarding the flow of blood within them, and thus
of giving rise to diminished or augmented pressure.

How far the urine itself is to be regarded as a true secretion
has not yet been determined, seeing that the presence of very
many of its constituents has been detected in the blood, and it is
possible that they are all eliminated from that fluid.

Action of Oleaginous Purgatives. It may not be considered
altogether out of place if, in this communication, which treats
of the passage of fluids through animal membranes, I make a
few brief observations on the subject of the modus operandi of
oleaginous purgatives.

Two fluids of different densities pass through the membrane
by which they are separated in opposite directions, and thus
mingle together, the lighter fluid permeating the membrane
most quickly mixes in the greatest proportion with the heavier.
This is the law of Dutroehet already referred to.

On tins law we have a familiar illustration in the softening
effect produced by the application of oil to a salad of lettuce;
the divided leaves, at first crisp and juicy, soon become soft and
flaccid, the water included in the cells of the vegetable tissue
escapes, while a portion of the oil is absorbed in less proportion
to supply its place.

Now the action which comes into operation when oil is
poured into the intestines is of a precisely similar nature; the

1850.] Case of Excision of the Uterus. MS

fluid of the bloodvessels of the villi and follicles being less dense
than the oil, escapes into the cavity of the intestines, while a
part of the oil is taken up ; the increased quantity of fluid in the
intestines excites peristaltic action, and the passage of the faecal
matter is facilitated.

Other examples of the increased permeability of membranes
to fluids under augmented pressure might be cited, and the
great elimination of the watery part of mucus in catarrh is pro-
bably another manifestation of tne same law.

Case of Excision of the Uterus. By Paul F. Eve, M. D.,
Prof, of Surgery in Med. Coll. of Georgia. With Remarks,
by C. D. Meigs, M. D., Prof, of Obstetrics and Diseases of
Women and Children in Jefferson Med. Coll. of Philadelphia.
(Amer. Journ. Medf Sciences.)

To the Editor,

Dr. I. Hays Dear Sir : When Professor Eve, of Augusta,
Georgia, passed through Philadelphia, on his return from the
meeting of the Association at Cincinnati, he gave me a patho-
logical specimen, which is now in my museum. This speci-
men consists of the uterus of a woman of colour, which was
removed by Professor Eve, in the hope that, by such a desper-
ate operation, he might be abie to rescue the patient from the
imminent death which seemed by no other means to be avoided.
The uterus, which he removed in the manner described in his
letter, has been very much changed in its external form by the
ravages of a cauliflower excrescence.

I do not know that any American surgeon has heretofore
extirpated the entire uterus in situ an operation that is said
to have been first performed bv M. Sauter, of Constance, in
1822.

M. Colombat de I'Isere informs us that the operation has been
executed by Sauter, by Hoelscher, twice by Siebold, and thrice
by Langenbeck; four times by Blundell ; once by Banner;
once by M. Lizars ; twice by Recamier ; once by Dubled ;
twice by Roux, and once by Si. Delpech; while this operation
by Proiessor Eve adds one integer to the whole number, which
amounts to twenty operations, in all of which the result was
contrary to the hopes of the surgeons.

M. Colombat expresses the opinion that operations for the
removal of the womb in silii ought not to be in future perform-
ed, in consequence of the disastrous summing up of the statis-
tical records. He does not apply his objections to the cases of
incurable inversion of the organ.

746 Case of Excision of the Uterus. [December,

There are too many examples of recovery after extirpation
of the inverted organ to leave any doubt on the mind as lo the
hopefulness of such an operation. Still, as I have firm confi-
dence in the opinions I have published in other places as to the
power of spontaneous cure of inversio uteri, I should hesitate
long before resorting to the measure of extirpation. In my
friend's -operation, there is cause to congratulate him upon the
skill and resolution manifested by him, and upon the very hope-
ful success up to a certain point.

The following extract, from Prof. Eve's communications,
will show that, but for the recommencement of the original
heterologue development in the vagina, the patient had, in the
most remarkable manner, been rescued from death.

I send you herewith an extract of a letter from Prof. P. F.
Eve; also a letter from Dr. J. A. Eve; and, lastly, extracts
from two letters from the surgeon.

Very respectfully, your obedient servant,

CH. D.MEIGS.

"On the 16th of April last, I removed the entire womb from
a patient, who has recovered. The operation was performed
at my surgical infirmary, in which I was assisted by my cousin
Dr. J. A. Eve, Professor of Obstetrics and Diseases of Women
and Infants, and by Drs. Murray, H. Campbell, Longstreet,
and Montgomery, and in the presence of several others con-
nected with the profession.

" The patient is a negro woman, twenty-eight years of age,
has been married ; but never conceived, as she believes. For
more than three years, she has been labouring under uteiine
affection ; at least, she has been annoyed for about that length
of time by a vaginal discharge. The history of diseases among
our negro population is generally very imperfect and unsatis-
factory ; and this is especially true as regards uterine derange-
ments. All we can obtain, in the present case, is that the
patient experienced great irregularity in menstruation, and had
frequent hemorrhages from the vagina.

Yours, &c, P. F. EVE.

We now refer to Dr. J. A. Eve's statement ol the case, as he
observed it before she arrived at the infirmary in Augusta.

Augusta, April 24, 1850.
Dr. P. F. Eve :

My dear Doctor: Early on the morning of the 10th instant,
I was called to visit Mary, the patient, whose womb you extir-
pated on the 16th. in consultation with Drs. Murray and Cook,
some eleven or twelve miles from town.

1850.] Cast of Excision of the Uterus. 747

Under the influence of morphine, which had been given
before my arrival, the patient had become easy. On examina-
tion, I iound a tumour of considerable size in the hyDOgastrium,
and the whole pelvis, to the outlet, filled and blocked up with a
lobulated, r.onvuluted, incomprehensible mass, from which
issued a copious and horribly letid discharge.

As this was unquestionably carcinoma, cauliflower ex-
crescence, encephaloid tumour, or some malignant growth, the
patient's certain doom was death, after a few months, or at most
a year, of miserable existence worse than death, unless rescued
by surgery, in the performance of a heroic operation which
would involve the removal of a portion or the whole of the
uterus.

If such an operation would ever be indicated or warranted,
the age (twenty-eight years), the vigour of constitution, and
the comparatively unimpaired general health of the patient,
made it proper in this case.

In consul i ation, I suggested to Drs. Murray and Cook that,
as neither of us could take charge of, or do justice to, her case,
so far from our respective residences, she should be removed,
as soon as practible to your infirmary, where she would enjoy
every advantage and benefit that favourable circumstances, as
well as science and art, could afford her case ; and that we
should all meet and confer with you afjer her removal to this
place ; to which suggestions these gentlemen cordially acceded.

1 know nothing of the previous history of this case except
what has been related to us by Dr. Murray. In consultation,
all the physicians present concurred in opinion with you, that
the operation was one of extreme danger, and that the proba-
bilities were as many, perhaps, as a hundred to one against its
success.

Before the operation, Dr. Murray and myself visited the
patient, explained to her its great danger, and the very great
probability that she might not survive it ; telling her that,
although it afforded but little hope, it was the only hope of de-
livery from suffering and death. We told her, farther, that it
rested entirely with herself to determine whether or not she
would submit to the operation. Without persuasion or in-
fluence of any kind, she determined promptly and unhesitatingly
to submit to ihe operation, terrific as it was represented to be.
She is now doing well, and in all probability will return home
next week. Your sincere friend, J. A. EVE.

Operalion.-^-The bowels having been previously emptied, a
large quantity of urine was drawn off by the catheter, which
diminished considerably the hypogastric tumour, and proved

748 Case of Excision of the Uterus. [December,

the bladder to have been generally distended, as there "was then
no urgency to micturition in fact, the patient, was uncon-
scious of the distension. About two pints were thus evacuated.
Chloroform was now inhaled to its full anaesthetic effects, when
the vaginal tumour was seized by various forceps, but which,
after large tubercular masses were torn off, was finally brought
down to the os externum by the left hand. Finding it impos-
sible to remove the firm resisting body now presented to view,
it was carefully excised from above downwards, or in an
antero- posterior direction, by the knife I confess, with some
suspicions at the time, it might be the uterus. One artery
(now believed to be the left uterine), throwing out blood quite
vigorously, was seized, and an animal ligature cast around it.
A solution of sulphate of zinc was applied to restrain further
hemorrhage, which had been considerable.

There was no protrusion of the bowels, nor was the case
fohowed by any very severe symptoms. A most rigid con-
finement to the horizontal position was strictly enforced for
about ten days, with absolute diet, &c. &c. The bladder, it is
presumed, filling up again, pushed the intestines backwards,
while the opening made into the peritoneum was closed by
agglutination and subsequent adhesion. The rectum was
evacuated on the fourth day after the operation by warm water,
and the bowels were moved freely by oil on the fifth.

In the mass removed, the uterus is readily recognized, with
its Fallopian tubes, broad and round ligaments ; but the os
tincse is involved in the encephaloid degeneration. The
tumour in the vagina was about the size of a child's head at full
term. No one, it is believed, who has examined it has enter-
tained the least doubt but that the entire womb was removed,
and this includes, besides the gentlemen who witnessed the
operation, Dr. R. D. Mnssey, Prof, of Surgery in the Medical
College of Ohio, and Chairman of the committee on Surgery
for the past year in the American Med. Association ; and my
preceptor, Dr. C. D. Meigs, the distinguished Professor of Ob-
steterics, &c. &c, in the Jefferson Med. College, with whom
the uterus has been deposited, and who has kindly insisted
upon presenting the case to the profession in his own way.

During my absence at the meeting of the Medical Associa-
tion in Cincinnati, the case was left under the care of my
relative and assistant, Dr. A. P. Longstreet. The patient
returned home on the 3d of May, visited Augusta again on the
20th, to inquire why she had had no hemorrhages (menstrua-
tion) since the operation ; and, in answer to a letter, Dr.
Murray writes, on the 10th of June, that he saw her "up and
about"' the day before, and promised to bring her in a few days
to mv office.

1850.] Properties of Poly gala Senega. 749

Ffteenth of June, two months after the operation, the patient,
Mary, has called, after riding eleven miles on a loaded lumber
wagon. She is much improved in flesh and appearance, and
has enjoyed good health. She says there has been a slight
show of blood but once since the operation, and only a moderate
discharge at times of colourless fluid. But I regret to add we
have most unmistakable evidence, both ocular and by touch,
of a rapid reproduction of the encephaloid disease, which in
all probability must sooner or later destroy life.

{Extract of a Letter dated Augusta, July 20th, '50.)
My dear Doctor: I write to say Mary, my non-uterine
patient, is dead. She died on the 22d of July, having lived
three months and a week after the operation. She became
cedematous (ascites, also), but' had no hemorrhage, neither
protrusion of the disease from the os externum. I regret no
post-mortem was made by the physician in attendance, and I
only learned her decease incidentally at the time.

PAUL F. EVE.
Dr. C. D. Meigs.

Observations on the Emmenagogue properties of Polygala
Senega. By Caspar Morris, M. D., of Philadelphia. (Medi-
cal Examiner.)

Among the articles contributed to the materia medica by our
own country, not one is more important than the Polygala
senega. However little its virtues may be esteemed abroad,
there are few American Physicians who do not recognise its
importance in the treatment of certain stages of croup and
bronchitis. My present object, however, is not to celebrate
its praises in affections in which its value is so generally ap-
preciated, but to draw attention to its effects in a class of cases
which often baffle the efforts of the physician and cause no lit-
tle anxiety to the patient; to properties which, though recog-
nised before, have been overlooked or forgotten. It is now
more than twenty years since my attention was first directed
to the emmenagogue properties of this root. I cannot recal the
source from which the knowledge of its virtues was derived,
but am disposed to ascribe it to the teaching of Piofessor Chap-
man, as I find on reference to his work on therapeutics, that he
speaks of them in very strong terms of commendation, and
gives the credit of first drawing the attention of the profession
to them, to the late Dr. Joseph Hartshorne. At the period to
which I refer, I was induced to direct the employment of the
Senega for an unmarried lady, of about thirty years of age.

750 Properties of Poly gala Senega. [December,

suffering from suppression of the menstrual discharge of seve-
ral months duration, combined with a catarrhal affection. So
prompt was the restoration of the uterine discharge, that I
considered it a mere coincidence, and remarked it as one of
those cases of facts which may be misapplied so as to teach
error instead of truth. Since then I have had ample oppor-
tunity to verify its claims to the credit of the result.

The tendency of its influence to the sexual and urinary
organs has often since arrested my attention, in cases of children
to whom I have given it for croup, in which I have found diffi-
cult micturition follow its use, sometimes to a degree quite
inconvenient. Pereira mentions among its physiological ef-
fects, "increased secretion of urine and a feeling of heat in the
urinary passages," and adds, "it appears to excite moderately
the vascular system, to promote the secretions, (at least those
of the kidneys and skin, uterus and bronchial membrane,) and
to exert a specific influence over the nervous system;" he
mentions the fact that "it has been used as emmenagogue in
amenon-ncea." In the Dyspensatory of Wood and Bache there
is a mere casual allusion to its having been recommended in
amenorrhea; while Dr. Eberle refuses credence to the asser-
tion that it possesses any emmenagogue properties. The
strong testimony of Dr. Chapman deserves to be disseminated
anew, as it may be overlooked among the many modern works
on materia medica and pharmacy. I shall therefore furnish it
for the benefit of your readers.

He introduces it first on the list of emmenagogues in the fol*
lowing terms :

" To Dr. Hartshorne of this city, we owe the credit of having
discovered the properties of this article as an emmenagogue.
Conversing with him some years ago on the dirficuly of man-
aging certain forms of amenorrhcea by the common treatment,
he told me that he thought he had used it with advantage in
these cases. Confiding in the accuracy of his observations, I
determined to lose no time in making trial of the medicine.
This I have done since, both in my public and private practice,
to a considerable extent, and with sufficient success to warrant
me in recommending it as one of the most active, certain, and
valuable of the emmenagogues. It may be used either in
powder or decoction, though I greatly prefer the latter mode.
My rule in the administration of the medicine, is to direct about
four ounces of the decoction, more or less, during the day,
according to the circumstances of the case. But at the time
when the menstrual effort is expected to be made, and till the
discharge is actually induced, I increase the dose as far as the
stomach will allow, having given sometimes as much as two

1850.] Properties of Poly gdla Senega. 751

ounces every hour. In the interval of the menstrual periods,
1 lay aside the medicine for a week or two, as without these
intermissions, if it does not lose its power, it become disgusting
to the patient." Dr. Chnpmnn directs the decoction to be
made by putting one ounc; of the bruised root in a pint of
boiling water, in a covered vessel, and reducing it one third by
slowly simmering; and recommends that its nauseating ten-
dency should be averted by the ndddition of an aromatic
bitter. I have not found my patients able to bear so large
doses as those indicated by Dr. C, and have been wont to add
liquorice root, which disguises the peculiar taste of the. senega,
and to continue the process until it is reduced to one-half. A
tablespoonful three times daily of this strength, is generally
tolerated without difficulty. My habit is, when I can deter-
mine the period at. which the natural tendency to the discharge
will occur, to give the medicine in these doses for a fortnight
before; and then, as Dr. C. advises, I have suspended it until
the same period is again approaching. The causes of inter-
ruption to the menstrual discharge, being various, it is of course
impossible to find any remedy which will meet every case.
Where it depends on debility, or accompanies an anemic state
of the system, other remedies than senega are more appropriate,
or should be conjoined with it. Iron, aloes and myrrh, in com-
bination, form an excellent remedy in such cases. The senega
is appropriate to those cases where the suppression has been
caused by improper exposure, and to those very frequent
instances in which there is but little disturbance of the general
health.

Every practitioner in our large cities, must have had his
attention arrested by the numerous calls for advice on account
of obstruction, on the part of newly arrived immigrants; who
complain of headache, and miserable general feelings, with
swelling of their lower extremities. To what cause we are to
ascribe the interruption of the natuial functions, under such
circumstances, it is difficult to say. The same result has been
noticed in the cases of young women coming from the country
to Paris. It is not, therefore, due to any impression made by
the sea atmosphere, but. very probably, is caused in both cases
by a less nutritious diet than has been customary, and the con-
finement in a vitiated atmosphere.

In those cases in which hemorrhoids, or an irritable condi-
tion of the lower bowels, prohibit the resort to the formulae into
which aloes so generally enter, the senega may be resorted to
with benefit, and also, when there is a diseased state of the ova-
ries or uterus itself. 1 have not yet tried it in cases of dys-
menorrhoea, with scanty secretion, but believe it will be found

752 Periscope. [December,

a very admirable remedy for these cases, which are so distress-
ing to the habitual sufferer, and vexatious to the phvsician. I
shall certainly take an early opportunity to test its powers,
combined with some of the narcotic extracts. Hellebore and
hyoscynmus, have been the agents on which I have heretofore
relied, with a good degree of satisfaction ; and the senega ap-
pears to" me to partake of the same character as the hellebore,
without that tendency to purge, which is often displayed by
the hellebore when given in full doses. I am aware that some
of our best teachers are disposed to deny the existence of a
class of remedies having a specific tendency to promote the
menstrual flow, and rely on general treatment for the restora-
tion of this function when suspended. This is, perhaps, a na-
tural reaction from the disposition to rely on specific remedies
in all cases. Either extreme, is unsound. We may not disre-
gard the state of the general health, but must adapt our specific
means to meet special indications. I know of no reason to
doubt the tendency of certain remedies to produce an action on
the uterus in its unimpregnated stale, which would not lie with
equal force against the aciion of calomel on the liver and sali-
vary glands, or ergot on the same organ at the time of partu-
rition.

PART III.
iH o n 1 1) I g Periscope.

Scrofula and Tuberculosis, Analogies of '. (Med. Times. Rank-
ing's Abstract.) The following propositions are a resume of the im-
portant work of M. Lebjskt on "Scrofula/' They contain the
essence of his doctrines and experience :

1. The disease described under the name of glandular scrofula is
commonly a tuberculosis of the superficial lymphatic glands. The
tubercular matter is here of the same kind as when it exists in other
organs.

2. These tubercles have a manifest tendency to softening; the
symptoms of inflammation and suppuration often arise from the tissues
surrounding the tubercles.

3. Glandular tubercles do not constitute a form, but a complication
of scrofula. The latter does not present any precise element which
the microscope can discover. Scrofulous affections consist in a series
of chronic inflammations or cacoplastic formations, which, from their
multiplicity, duration, and alternations, denote a special morbid state
affecting the whole economy.

4. Hypertrophy of the superficial lymphatic glands is rarer than
tubercular degeneration.

1830.] Periscope. 753

5. Superficial tuberculosis often exists alone, without any scrofulous
complication; but the two morbid states have a tendency to co-exist
in the same subject.

6. It should, however, be remarked, that in 614 patients affected
with external glandular tubercles or scrofulous diseases, 439 were
exempt from any trace of tuberculosis a fact which proves the two
diseases to be independent of each other.

7. With respect to progress and prognosis, there is a notable differ-
ence between external glandular tubercles and internal tubercle, es-
pecially in the lungs. The former may exist for a great length of
time without danger, then dry up or be eliminated. The latter pro-
gress mare rapidly, and more often prove fatal.

8. External tubercles arise more frequently in a spontaneous man-
ner than as a consequence of hereditary disposition. The latter
manifests itself, in the same family, sometimes through scrofula, some-
times through tubercle a circumstance showing affinity, but not iden-
tity of the diseas

9. External tuberculosis does not produce death, unless it be com-
plicated with internal tubercle.

10. The prognosis becomes unfavorable whenever scrofulous affec-
tions of the bones or joints are added ; or when a large quantity of
tubercular matter is deposited in the glands for then internal tubercle
arises more easily.

11. The surest means of eliminating the diseased matter is suppur-
ation. External tubercles rarely become cretaceous, though they
often remain station

12. Scrofula is most frequent between the ages of 5 and 20 ; girls
are more frequently affected from 10 to 15, than from 15 to 20 ; the
contrary holds good for boys. Puberty does not exercise the influence
which it is supposed to do over the progress of the disease ; the influ-
ence of seasons is also feeble.

13. The influence of proper hygienic treatment is more marked
in proportion as those means had been previously neglected.

14. There is no specific, nor any remedy capable of producing the
absorption of crude tubercular matter. Iodine may improve the con-
stitution and diminish the chronic inflammation of the tissues surround-
ing the deposits ; but it does not remove the latter. Its use is contra-
indicnted by permanent dyspepsia or diarrhoea. Ioduret of potassium
or of iron are the best preparations in such cas

15. Cod-liver oil exercises no direct influence over glandular tu-
bercle ; it can only act usefully on the different scrofulous complica-
tion >.

16. Calomel, once so much employed in the form of Plummers
pill, merely acts as a purgative on the inflammatory complications.
We have no proof whatever of the utility of the preparations of gold,
sulphate of barytes, or the salts of lime.

17. Bitters and tonics are indicated in cases of long-continued sup-
puration. Bark and iron are the best A decoction of nut leaves is
a useful adjuvant. Saltwater and other medicated baths are

x. s. vol. vr. vo. xit. 48

54 Periscope. [December,

useful as means of improving the constitution ; but the tubercular
matter can only be removed by suppuration.

18. Sulphurated baths are useful when a great number of ulcers
are suppurating. Hydropathy, with the use of iodine, merits exami-
nation.

19. A good animal and vegetable diet, pure air, cold baths, and
exercise-, act favourably on the constitution.

Fatal case of Acute Articular Rheumatism.. At the session of the
Academy of .Medicine on the 5th August, Prof. Andral reported a case
of acute articular rheumatism which terminated fatally eight days
after the attack, without any complication which could explain this
rapidly fatal termination, and presenting this singular circumstance,
that the affected articulations were the seat of an intense hyperemia
with a formation of pus. A woman aged 67 years, of feeble consti-
tution, entered the Charite on the first of July last, labouring under
inflammation of the inferior lobe of the left lung, which was in a state
of hepatisation. She was bled, and subjected to the action of tar-
tar emetic, of which she took every twenty-four hours, during five or
six successive days, seven grains: she rapidly recovered. During her'
convalescence, upon exposure to a current of air, she was suddenly
attacked with acute pain in both shoulders, with swelling and slight
redness of the skin around each scapulo-humeral articulation. The
right humero-cubital articulation was also somewhat painful, but
without tumefaction. The fever was intense, but there Was no de-
rangement of the respiratory apparatus, so recently the seat of a grave
disease. She was immediately bled, the blood presenting the appear-
ance usual in such cases. On the next day the patient was so feeble
that the bleeding was not repeated. The Sulphate of Quinine wa3
then given in doses of twelve grains every twenty-four hours, for sev-
eral days. Notwithstanding, the disease marched towards a fatal
termination with frightful rapidity, without presenting any com-
plication, and without any apparatus exhibiting phenomena which
could explain the steady exasperation of the disease, without any
abnormal sounds of the heart, and, moreover, without any extension of
the rheumatism to other articulations. The patient died eight or nine
days after the attack. An autopsy exhibited no latent lesion of any
important organ which could explain such a termination of acute artic-
ular rheumatism. The cranial, thoracic and abdominal contents, were
free from disease. The blood exhibited its ordinary qualities. There
was no trace of phlebitis, nor any thing which could lead to a suspi-
cion of purulent absorption. The interior of the scapulo-humeral

1850*] Periscope. 755

articulations were filled with a white homogeneous and apparently
phlegmonous pus. The whole synovial membrane exhibited a most
intense redness, and upon its surface innumerable vessels were unusu-
ally injected. This injection terminated abruptly on the articular
cartilages, which presented their ordinary appearance. The diseased
appearances were alike in both articulations. The articular cavity
of the right elbow contained a quantity of a fluid of a rather ambigu-
ous character. All the other articulations were carefully examined,
bilt nothing abnormal was discovered.

Application of Electricity to Diagnosis. At the same sitting of the
Academy of Medicine, M. Martinet read a memoir on the application
of electricity to diagnosis, from which are derived the following con-
clusions: 1st. The exploration of the contractility and the sensibili-
ty by the aid of electricity, is a valuable means of diagnosing diseases
in which these two properties are affected, and of determining with
more precision than heretofore their degree of intensity. 2nd. It is
by the conservation, diminution, or abolition of the contractility,
during the passage of the electric current in the paralysis of move-
ment, that the diagnostic is especially founded, as it is by the degree
of electric sensibility, that the paralysis of sensation is to be estima-
ted. 3rd. The conservation of the electric contractility is the dis-
tinctive characteristic of cerebral, hysteric, and rheumatic paralysis.

The diminution or abolition of this contractility will, on the contra-
ry, indicate organic diseases of the spinal marrow and nervous trunks,
of saturnine palsy, and of that which results from violent disorders of
the nervous centres when no material alteration exists. 4th. No
other means of exploration, in exactness or rapidity of application, can
compare with this mode of investigation which submits the vital ac-
tions to an examination, not less rigorous than that to which material
alterations are submitted.

Milk in the Treatment of Variola. (Annales de la Societe de Roul-
ers. Bulletin de Therapeutique.) M. Vandezande, upon the recom-
mendation of Dr. Fritz, has treated a number of severe cases of
variola, by the internal and external use of milk. He gives from one
to three glasses of milk a-day, diluted with one third of the quantity of
water. To obviate costiveness he uses the milk in enemas. To the
surface, it is applied in the form of a bath, and linen compresses wet
with the milk are applied to the face. These compresses are changed
every twenty minutes. Dr. M. V. asserts that this treatment has
been successful, and recommends it to his brethren.

756 Periscope. [December,

Arsenic. (Ranking's Abstract.) Among the many advantages
which have accrued from the proceedings of the Provincial Medical
and Surgical Association, not the least is the endeavour to concen-
trate the experience of a body of upwards of two thousand of the pro-
fesion. upon questions of a doubtful but interesting nature. In this
praiseworthy attempt Mr. Hunt has much distinguished himself, and
not the least so in the inquiry we have now to notice on the " Medi-
cinal Action of Arsenic." To those of our readers who are not
members of the Provincial Association, it may be necessary to state,
that in accumulating the information which he has been enabled to
acquire, Mr. Hunt was at the pains of addressing a certain number
of queries to each member. These were freely responded to, but for
all practical purposes the following digest will be sufficient.

1. The most important point ascertained by this inquiry is, that
arsenic is a safe medicine; none of the respondents having found it
permanently detrimental. When given in a judicious manner, it did
not even induce serious temporary effects. In the few cases appa-
rently leading to a contrary inference, there was sufficient evidence of
ignorant administration, or injudicious perseverance on the part of the
patient. The inquiries elicit a vast difference of opinion as to the
proper dose to commence with.

2. As respects the action of arsenic, it appears that it varies more
than any other mineral ; this has been noticed in poisonous as well as
in medicinal doses.

3. The third question relates to the forms of disease in which ar-
senic has proved useful. The replies show that its powers ore chiefly
manifested in chronic non-contagious skin diseases ; next to these
come intermittent and neuralgic maladies. In the former, the expe-
rience of many proves that combined with quinine, it rarely fails.

4. The third question inquires the circumstances which justify
or contra-indicate the use of arsenic. To this it is replied, that arsenic
should not be given when other medicines will answer the purpose,
and that a passive state of system is more favorable than the reverse.

5. The signs of an over-dose are stated, by the majority of the
respondents, to be conjunctivitis, irritation of the mucous membranes,
desquamation of the entrails, &e. The information given under this
section is vague.

6. When an overdose has been given, Mr. Hunt advises that the
dose should be diminished, and not that the medicine should be alto-
gether omitted, as is commonly done.

Some other questions are replied to, but the above brief abstract
includes the chief points of interest in the Report.

Chinoidine. (New Orleans Journal.) At a meeting of the Mobile
Medical Society, Dr. Jno. P. Barnes stated that he had lately been
using chinoidine quite extensively in his practice, as a substitute for
quinine, and that he was much pleased with its practical utility. Ho
had found it quite efficient in controling the ordinary attacks of inter-
mittent diseases. Dr. Fearn remarked that he had first seen this

1850.] Periscope. 757

remedy used in 1826, in the alms-house in Philadelphia, by Dr. With-
erill. The experiments with it were quite satisfactory. He had,
however, made but little use of it since, until recently, when he had
employed it in several cases where quinine usually produced unpleas-
ant effects. He had been particularly well pleased with it in one or
two cases of phthisis, when the patient had an attack of chills and
fever differing from the ordinary hectic exacerbations observed in
that disease. He advised its use in all such cases.

Hydrangea Arborescens, a new remedy in Litldasis. S. W. Butler,
M. D., in the October number of the New Jersey Pveporter, speaks
very highly of this plant as a remedy in lithiasis. It grows abun-
dantly in the Southern, Western, and Middle States, " in the moun-
tains and hills, and on rocks and near streams." The observations
upon which Dr. B. claims a high character for this remedy, have
been made principally by his father, Dr. E. Butler, who for the last
thirty years has been a missionary among the Cherokee Indians.
Dr. B. does not propose the Hydrangea as a prophylactic, but as a
valuable agent for removing calculi after they have been formed.
Dr. B., the elder, employed a simple decoction, or syrup, made from
a decoction of the root, with honey or sugar ; made of such strength
as to be given in the dose of a tea-spoonful three times a-day, "In an
over-dose it produced somelmpleasant symptoms, such as dizziness of
the head, oppression of the chest, &c. The effect the remedy seems
capable of producing is, removing by its own specific action on the
bladder, such deposits as may be contained in that viscus, provided
they are small enough to pass the urethra. It seemed also to have the
power of relieving the excruciating pain attendant on the passage of a
calculus through the urethra."

Dr. B. refers to four cases in which the Hydrangea was employed
with benefit. In one case, 120 gravel were passed in a few days after
the use af the medicine was begun, together with a large quantity of
sand. The patient was perfectly cured.

The species of Hydrangea to which Dr. B. refers grows abundant-
ly in the north-western region of Georgia and in Alabama.

On the employment of Ergotine in External and Internal Hemor-
rhages. By M. J. Bonjean, Pharmacien, Chambery. (Gaz. Med.
Medical and Phys. Journ.) Ergotine, when applied to wounds, has
the property, M. Bonjean states, of facilitating their cicatrization, and
moderating inflammation of the wounded tissues. Under its iniluence
union takes place by the first intention, and cicatrization occurs with-
out further assistance.

?58 Periscope. [December,

In certain cases ergotine may perform all the offices of the ligature.
M. Bonjean enumerates the following circumstances attendant on a
capital operation in which its employment is indicated :

1. When, in order to arrest the hemorrhage, it would be necessary
to disturb the lips of a wound in which cicatrization is commencing.

2. When the patient manifests a tendency to gangrene of the cut
Surfaces.

3. When the source of the haemorrhage is from vessels embedded
in the inflamed and swollen tissues.

4. When the blood flows from many small arteries of which the
orifices cannot be perceived.

5. When haemorrhage occurs from the sloughing of an eschar, as
in gun-shot wound, &c.

In these difficulties the application of ergotine is as often efficacious
as the use of pressure is ineffectual. The application of ergotine
supersedes ligature of the arteries, and effects cicatrization without
interfering with the permeability of the artery.

The mode of employing ergotine is to dissolve it in five or six
times its weight of water, tor ordinary wounds ; and in three or four
parts, or even in a concentrated form, for more serious haemorrhages.
A portion of tow or lint is to be moistened with the fluid, and applied
with gentle pressure to the surface previously wiped. When the
haemorrhage does not return on the pressure being removed, another
pledget moistened with the solution is to be laid over the former, and
the limb bandaged as usual. Perfect rest is to be observed,

Internal administration. Ergot of rye has been successfully em-
ployed

1. As an excitant of uterine contractions.

2. As a stimulant to the muscular system in general.

3. In haemorrhages and certain fluxes.

4. In congestion of the uterus.

5. As a stimulant to the nervous system.

The latter poisonous effect of ergot of rye is due, according to M.
Bonjean, entirely to its fixed oil, The preceding properties are due
ergotine alone.

Simple extract, or ethereal tincture of ergot, both contain a portion
of its poisonous principle. Pure ergotine is in the form of a solid ex-
tract of a deep brown colour. In thin laminae it presents a blood-red
colour. It has the odour of roast meat. Its taste is bitter. It is
perfectly soluble in water, and this solution yields neither oil nor resin
when heated with ether.

Treatment of Aneurism by Gafoano-puncture. By MM. Petrequin
and Gdielle. (British and Foreign Med. Chir. Rev.)* It is now
some years since M. Petrequin advocated the treatment of aneurism
by galvano-puncture, and he has left no means untried, as far as con-
stant publication upon the subject has been concerned, of propagating
the practice. He has, however, met with but indifferent success
which is not surprising, seeing that while the means has proved infin-

1850.] Periscope. 759

itely more uncertain in its results than the ligature, it requires, ac-
cording to him, much tact in manipulating with the electricity, and
causes the most intense suffering, which even chloroform, in some
instances, has failed to prevent. It has been more frequently tried in
Italy than elsewhere, chiefly in aneurisms of small vessels, and with
only occasionally satisfactory results. We are not aware of its recent
successful employment in London and Paris, although we understand
M. Petrequin stating as much in one of his papers read before the
Academy, wherein he makes no mention of the unsuccessful employ-
ment of electricity by Listen and Phillips, long before he himself had
taken up the subject. Perhaps the best example hitherto published
has been the successful employment of galvano- puncture in the treat-
ment of a subclavian aneurism by Iff. Abeille, an account of which
he forwarded to the Academy, upon which M. Gimelle has delivered
in an able report. The patient was a lady, aet. 65, and in conse-
quence of the ill success which had hitherto attended the ligature in
this description of aneurism, M. Abeille resolved on resorting to gal-
vanism. He employed twenty-two pairs of plates, often centimetres
in diameter, and four needles. Notwithstanding that chloroform was
given, the sufferings of the patient are described as having been hor-
rible, several persons being required to restrain the consequent con-
vulsive movements. After thirty-seven minutes of extreme suffering,
the tumour was found to have become hard, resisting, and destitute of
pulsation. Moderate compression was maintained afobve the tumour
for ten hours. It had quite disappeared in thirty-seven days, and the
cure, now three years old, has held good, the radial pulse being some-
what feebler than on the sound side.

M. Gimelle, in his Report, passes in review the various cases in
which galvanism has been employed, and shows that several of these
were unsuccessful in even M. Petrequin's hands, while other sur-
geons have met with suppuration and gangrene of the sac and other
accidents. So impressed is he with the numerous dangers and ill-
successes of this operation, that he wished the Academy to pass an
absolute condemnation upon it. This, however, was considered as too
extreme, since cases in which the ligature could not be employed, or
had been so usually without success, might sometimes prove amena-
ble to this procedure. This was the view taken by M, Velpeau, who
having lost a patient from inflammation of the sac of a popliteal
aneurism, for which he had employed galvanism, is naturally not
prepossessed in favour of it. He believes that in cases analogous to
that now related, it should be resorted to. M. Robert took the same
view, believing it should be confined to cases in which the ligature is
difficult or impossible. M. Laugier, judging from a case which had
occurred to himself, in which the sac of a brachial aneurism was
obliterated, considers that the operation may sometimes even be ad-
vantageously employed in aneurisms of the extremities.

New method of relieving Retention of Urine without the use of the
Catheter. By M, J. J. Cazenaye. (L'l nion Medicale. New' York

760 Periscope. [December,

Jour, of Med.) When called to a patient having retention, complete
or incomplete, M. Cazenave in the first place directs the large intes-
tines to be cleared out by an enema. When this has returned a second
is administered, but consisting solely of a quart of cold water. Abso-
lute rest on the bed is enjoined ; while cloths dipped in cold water,
or, better still, bladders of ice-cold water, or pounded ice, are applied
to the anus, perineum, thighs, and hypogastrium. If the patient do
not void his urine in the course of half an hour, or void it only very
scantily, he is placed on the edge of the bed which is properly guard-
ed, and a stream of cold water is poured on the region of the bladder
during from twenty to twenty-five minutes. After the lapse of this
time another enema of cold water, and small smooth fragments of ice,
are introduced into the rectum, the cold amplications to the external
parts being at the same time continued. The cases in which this
mode of treatment is found applicable are those in which the reten-
tion proceeds from acute inflammation or spasm.

Acetate of Lead hi Granular Lids. (London Lancet.) Dr. Florent
Cunier, of Brussels, has recently published the successful results of
the practice of Dr. Buys, in granular lid. His treatment consists in
the application of acetate of lead to the palpebral conjunctiva, instead
of the nitrate of silver commonly used. Dr. Buys takes neutral ace-
tate of lead, reduced to an impalpable powder, dips a moistened pencil
into it, and takes up about a grain, or a grain and a half, of the salt,
which is enough for one lid. When the lid is touched it should be
kept everted until the tears have dissolved the acetate, and those por-
tions of the salt which escape solution should be taken off with the
pencil. On the upper lid the tears will be insufficient to dissolve the
salt, and moisture must be applied to it from the angles of the eye.
As soon as the acetate is dissolved by the tears, and has penetrated
the tissues, the latter are noticed to contract powerfully, and a very
remarkable phenomenon takes place ; for the granulations, and grooves
between them, disappear at once, if they be of a moderate size, and the
conjunctiva looks smooth and uniform as long as it remains exposed to
the air; but the shining, white colour produced by the lead is per-
ceived only when the lid comes again into contact with the globe of
the eye. When the granulations and furrows between them are
large, two or three applications are necessary to obtain smoothness ;
one, however, is sufficient when they are not of great size. These
applications produce more burning and astriction than pain, and when
the lid is replaced, hot and whitish tears escape, the flow of which may
last from a few seconds to two or three minutes ; it rarely lasts long-
er, and the eye can then be kept open. When the granulations are
of an indolent character, the slight injection of the ocular conjunctiva,
which occurs on the application of the lead, goes off rapidly ; if, on
the other hand, the cornea be vascular, the vessels become smaller
soon after the cauterization of the lids. Slight cedema of the palpebrae
may follow, but in twenty-four or forty-eight hours it wholly disappears ;
a dry compress rubbed with camphor will hasten resolution, and like.

1850.] Periscope. 701

wise lessen the burning sensation, if the latter happen to persist.
One lid only should be touched at a time, and not again be interfered
with, unless all trace of the salt is removed. Dr. Buys has used the
lead in a great many cases of contagious ophthalmia among the mili-
tary, and Dr. Cunier, in acute and chronic catarrhal ophthalmia; the
results seem to have been more satisfactory in the latter variety, as
also in scrofulous affections of the eye, vascular cornea, and ulcers of
that membrane. The mineral has likewise succeeded in cutting
short incipient inflammation of the organ.

Causes of Urinary Calculi, By E. H. Davis, M. D. (Xew York
Jour, of Med ) At the annual meeting of the Ohio State Medical
Society, held in June last, we learn, from the Western Lancet, that
Dr. Davis, of Chillicothe, (now of this city, and professor of Materia
Medica and Pharmacy in the New York Medical College,) made a
report on the causes of Urinal Calculi; Ke said that he had analyzed
the waters of different regions to find, the influence the composition
had on the formation of stone, but his investigations were not yet
matured on that subject. The principal impurities in the water in
Ohio, are carbonate of lime and magnesia. He exhibited a map
dividing the State into three Geological Regions, viz : the "Blue
Limestone," "Cliff Limestone,'*' and the " Coal Regions." He had
sent a circular into each county of the State, inquiring of the physi-
cians the number of cases of stone that had occurred in each during
the last ten years ; but he had not received answers to more than
about thirty of them, and some of those were imperfect ; yet they were
sufficient to show the ratio in the lime and coal districts to be as three
to one, being the greatest in the lime region. He said that it appears
from statistics of other countries, that there was noplace in the world
where stone was so frequent in proportion to the population as in
Ohio and Kentucky.

A Crowing Child. (New Jersey Reporter.) H. A. L is
an exceedingly nervous, excitable person. Before her marriage she
was frequently under my care for hysteria in a variety of forms. I
attended her, about nine months since, in her first accouchment.
Her labour was tedious, and very painful; the child was of full size,
and well formed. There were no signs of life exeibitedby the infant
at the moment of its birth, but after spending half an hour in attempts
to resuscitate it, respiration was fairly established. The mother
recovered her usual health in a short time, and resumed her house-
hold duties ; but, to the astonishment of all who were interested in
the case, the child did not cry. When I discontinued my visits to the
mother, it had not cried once. I called occasionally to watch it, and
though for a short time it grew, and seemed to be in perfect health,
when about a fortnight old, it began to lose flesh, and became very
fretful ; and though it took the breast well, its nourishment was gen-
erally rejected, in part or entirely, soon after it was received into the
stomach. It would not lie on the bed, but required constant nursing.

762 Miscellany. [December,

At times it appeared to suffer pain, and tried to cry ; but the effort to
expire produced a singular noise, which resembled very much the
crowing of a young chicken. From the loss of rest, and almost in-
cessant jactitation, it became quite emaciated, and the hope of recove-
ry was very slender. 1 was not able to discover any organic affection
of the respiratory organs ; the air entered the lungs without difficulty,
and when, the little patient was free from suffering, and perfectly at
rest, they gave, upon percussion, a healthy, resonant sound ; the diffi-
culty seemed to be in expiration, and that only when the effort was
accelerated by the presence of pain, hunger, or other sensation which
created the desire to cry. A variety of treatment was adopted in the
case. Assafcetida by the mouth and per anum, was administered
daily, for some weeks. Musk, hyoscyamus, valerian, and other ner-
vous stimulants, in combination with remedies to correct the secre-
tions of the digestive apparatus as hyd. cum creta, calomel in small
doses, sub-nitrate of bismuth, &c, &c, were all resorted to, but with
no permanent benefit. Salt-bathing was also adopted for a time, and
frictions upon the spine, with the oils of amber, cajeput, and olive, but
with the same unsatisfactory results. At one time a small abscess
formed on the throat externally, near the margin of the thyroid carti-
lage, which I hoped would be of service, but it discharged and disap-
peared without any apparent change. I finally put my patient, now
reduced to a skeleton, distressing its parents day after day, and night
after night, with its pitiful, crowing noise, under the use of alterative
doses of calomel and extract of belladonna, which seemed to produce
a speedy change for the better : the child began to improve very soon
after the commencement of this treatment, and is now robust and
healthy. At this time the respiratory function is performed with less
interruption than formerly, and the effort to cry produces a sound very
much like a hurried, broken laugh : the crowing sound has disap-
peared.

The history of this curious case is submitted to the reader without
any attempt to explain its pathology. During its progress, I have had
so many conflicting suggestions presented to my mind as to its true
cause, that I forbear to offer any of them, but will be glad to show
to any of our friends who may call on us, the singular spectacle of a
well-grown, healthy child, of nine months old, who has never cried.

ill e b \ t a I ill i s c c 1 1 a n a .

TO OUR SUBSCRIBERS,

The present No. completes the sixth volume of the new series of the
Southern Medical and Surgical Journal, and with it terminates our con-
nection as its editor. Circumstances of a private nature have induced
us to adopt this course, and we have been impelled to it in an especial
manner by our inability to give that attention to the work which it
demands. The Journal will be hereafter under the editorial man-

1850.] Miscellany. 7G3

agement of Professor L. A. Dugas, whose well established reputation
as a writer, and as an accomplished physician, affords a satisfactory
guaranty that the work will be so conducted as to entitle it, not only
to a continuance of its present extensive patronage, but to a large
increase of subscribers. To our friends, whose kind words have
cheered us in our short editorial career, and to our contributors, we
tender our grateful acknowledgments, and earnestly request for our
estimable successor a continuance of their favors.

The Western Mcdico-Chirurgical Journal. We have received the
first number of a new monthly Journal bearing this title. It is pub-
lished at Keokuk, Iowa, under the editorial management of J. F.
Sanford, M, D., and Samuel G, Armur, M. D., Professors in the Iowa
State University. Our western brethren are an enterprising people.
Cities and villages are springing up as by magic, where a few years
since were but pathless forests, and the warhoop of the savage has
given place to the eloquent teachings of science. We extend a cor-
dial welcome to our young cotemporary of the "far west/' and hope
that honor and profit may crown the enterprise.

The New York Register of Medicine and Pharmacy, This is the
title of a new Medical Journal published in the city of New York, and
edited by C. D. Griswold, M. D. The two numbers which we have
received are highly creditable, and we doubt not, the work will be
ably conducted,

Fees paid to the Medical Attendants of the late Sir Robert Peel.
(London Med. Gaz.) An evening paper states that the executors of
the late Sir Robert Peel have, within the last few days, remitted fees
to the various medical gentlemen who attended him, and endeavored
to alleviate the effects of the fearful accident which was the means af
terminating his life : To Sir Benjamin Brodie, Bart., 250 guineas ;
to Alexander Shaw, Esq., 100 guineas; and to the other gentlemen
proportionate sums.

0^7" We trust our readers and correspondents will overlook the
typographical errors, which are somewhat numerous, in the Novem-
ber, and in a portion of the December numbers. The Editor, pub-
lisher, and printers, were all suffering with break-bone fever, and the
proofs were necessarily committed to unpracticed hands.

INDEX TO VOL. VI.

Abscess, treatment of..

Aconite, therapeutic effects of

Adhesive a gent

Adulteration of Drags

Alcoholic Stimulants

Alopcecia

AJoetic Febrifuge Elixir

Amaurosis a symptom of Albimin-
uria

American Medical ) .^.^ .
Association, $ ' Z1

Anatomical elements in Medulla-
ry canals of bones

Anaesthesia by Ether or Chloroform

Angina Pectoris

Aneurism treated by Galvanism..

Anti-asthmatic Pi -.s

Anti-syphilitic Inoculation

Appearances in arsenical poisoning

Apoplexy of the South

Arsenic

Arsenic in Intermittent fever

Arsenical Paralysis

Arsenical Poisoning, frequency of

Asthma treated by Nitric acid ....

Bach man on the unity of the hu-
man race

Bandaging in the Cramps ; :
leraT. ..

Bell. Dr. Jno. and Medical Facul-
ty c: ot Pennsylvania

Belladonna, therapeutic properties
" in incontinence of urine

Bennet on diseases of the U

Bignon, Dr. H. A., on treatment of
Dysmenorrhea

Blistering in Endo-Carditis

Bloodletting in Pneumonia of chil-
dren

Blue Mass, preparation of

Brandon, Dr. D. S., cas* of Gun-
shot wound

Break-bone Fever

Calculi in the kidneys

Calculi urinary, causes of

Calycanthus Floridos

Campbell, Dr. H. F. on influence cl

Dentition

Cancer, cases of. .. ..

Capsicum. tincL of in chilblains . . .

Carpenter's human physiology

Casey, Dr. H. R., cases of Mange. .
Cazc'aux's treatise on n
Charcoal in wounds and ui

Chilblains, treatment of

Chinoidine

?roform, means of arresJing fa-

al effects of 10

: 75 r.loroform, death by 61. 100

601 u action in sensitive plant 191

193 " conclusions in relation to 050

314 Chloroform 304

119 ,; in Ophthalmia 376

in Orchitis 699

53 " in puerperal convulsions 405

, ,- !i in Eczema Rubrum " 7

:s febrifuge properties of 508

Chlorosis in pregnant females 317

lorosis, observations on 513

archill on diseases of females.. 371

IS M on diseases of cbildien 115

' on Puerperal fever 503

314 Chloride of Sodium in diseases of

379

634 Chorea', treatment of 437

- ronic mammary tnraor .2

756 Citrate of iron ar. I M ssm 510

1 7 Z iaiate and diseases of our State . . 523

697 Cod Liver Oil in Phthisis 33

i Liver Oil in Phthisi*

: nee in hooping cougb 440

Corns, radical cure of 377

ractile properties of blood-

sels

Consecutive Arterial Hemorrhage 693
49 Collodion in Mammarv inflamma-
tion 700

Ichicum in Gonorrhoea 54

1 SO Condie on diseases of children 114

188C r.vention for revising Pharma-

:o7ceia 351

Compensation of physicians for au-

445

unter Irritants

Compression of the Aorta in uterine

435 hemorrhage 58

209 Constipation, prevention of 343

Corvza. abortive method of treating 509

aniotomy 191

rsote to remove taste of Cod-

- Oil 105

106 Crowing child 761

005 Davis. Dr. John, on modus operan*

i di o: Quinine in fever 106

301 Deiective teem

curative action of the Bile 117

37- Dentition, influence of in produ-
cing disease 301

666 Demonstrative Midwiferf 382

eafness, new cause of . MO

ihcult parturition, causes of 363

53 Distorted pelvis, new practice in
756 case of 371

OG

IXDEX.

Disease of the knee-joint 212'

Drake's Treatise, review of 396j

Dugas, Dr. L. A., on Quinine in

Singultus and Tetanus 340

Dugas, Dr. L. A., on Gangrenopsis 603

" " on Fractures 80

Dungl i nson's Therapeutics and Ma-
teria Medica 626

Dyspepsia of liquids 633

Dysmenorrhea, Gluinine and Prus-

siate of Iron in 395

Dysmenorrhcea 184

Editor's valedictory 762

Electricity as a means of diagnosis 755

Elephantiasis , 65

Epilepsy, treatment of 561

Ergotine in hemorrhage 757

Erysipelas and Puerperal fever,

identity of 417

Erysipelas, treatment of 601

Eve, Dr. P. F.. case of Hydrocele . . 29

" cases of Fungus Hematodes. . 577

<: case of encysted Hematocele . . 141

" report of Surgical clinique. . . 257!

Exchange Journals, postage on 61

Excision of the Uterus 71."

Fall from a height of 192 feet 5 13

Febrifuge pills 314

Female Medical School 38 1

Fees to Sir 11. Peel's physicians. . 763
Foetus discharged by the mouth
Foreign bodies, extraction of.. 232. 281
Foreign bodies in the windpipe ... 241
Formulae for the use of Glycerine 637

Formulae of Ricord in Syphilis 442

Forced flexion in wounds of the

palmar arch ^ 56

Fractures, treatment of B

Fungus Hematodes 577

Gamboge, therapeutic effects of. . . 249

Gangrene of the lungs 632

Gangrenopsis 603;

Garvin, Dr. I. P., on treatment of

internal Piles 13?

Gamier, Dr. W. J., on Leucorrhcsa 503

Gleet, treatment of 377

Glvcerine in deafness 51.

Gordon, Dr. J. M., on Elephantiasis 65
Gordon, Dr. J. M., case of chronic

mammary tumor 52-2

Gonorrhoea, peculiar form of 684

Great longevity 448

Griffith's universal Formulary 370;

Gun-shot wound of the knee-joint 53-2
Gutta percha Catheters, dangers of P25

Hammond, Dr D. W. on the Caly-
canthus Floridus 265 '

Hammond, Dr. D. W. case of Li- ^
thotomy 723

Harris, Dr. J. on the production of

sugar in the human system 273

Harris, Dr. J. on Renal circulation 474
Harris, Dr. J. C. on the causes of

malarial fever 652

Ha sting's Practice of Surgery 44

Hematocele of the spermatic cord 141
Hemorrhoids, internal, treatment of 138
Hemorrhoids cured by linseed oil . . 569
Hernia, ascendingor intermuscular 538

Hooping cough, treatment of 310

Hydrocele containing 40 ounces.. 29

Hydrophobia, cure of 184

Elydrangea in Lithiasis 757

Hydrostatic test ..... . . ^ 572

Hysteria, case of . < 668

Insanity, treatment of .-. 181

Insanity, medical treatment of 727

Influence of the foetus in utero . . . . 279
Influence of pregnancy and phthisis 123
Intercostal neuralgia as a sign of

phthisis 439

Intestinal mucous membrane, con-
dition of in cholera 556

Introductory lecture of Dr. Paul F.

Eve, review of 84

Iodide of Potassium in ascites 52

Iodine, tincture of, in chronic artic-
ular rheumatism 183

Iodine, tincture of in variolous erup-
tions 376

Ipccacuhana, remarkson 623

irritable bladder.; 611

Jaundice as an epidemic 558

Jones, Dr. W. L. on the climate and

diseases of Georgia 528

Jongh on Cod Liver Oil 47

Jnglans regia in serofukras affec-
tions 506

Khaya Senegalensis 313

Kidney, action of 737

Lactation in a male 572

Laryngotomy in Croup 122

Lead, acetate of in granular ophth-
almia 760

LeConteon the science of Medicine 456
Lemon-juice in acu^e rheumatism 563

Lesion within the u.erus 560

Leucorrhoea 598

Ligatures to uterine polypi 702

Liquor Ammonia,- therapeutic ac-
tion of 696

Lithontriptic drops of Palmieri ... 58

Lithotomy during labor 189

Lithotomy, case of 723

Long, Dr"., letter from 63

Longstreet, Dr. A. P. case of dislo-
cation in knee-joint 479

Lupus treated with chloride of gold 568

IKDEX,

76'

MacliM Surgical Anatomy. ..115.

Manganese in Anaemia

Manganese, preparations of

Mange, cases of

Malarial fever, causes of

Mayes, D\: J. A. on Chlorosis

Mayes, Dr. J. A. on the preparation
of Blue Mass ...

Medical College of Georgia

" :: ' commencement of
_JUedical Society of the State of Geor-
gia 190,

Medical education, practical views
on

Medical officers in New York

Medical Education in Spain

Medical School in Egypt

Medical experience with indigen-
ous plants

Medulla oblongata, physiology of. .

Mercurials and Chalybeaies in

Syphilis

Meteorological table for Nov. 1849
ii u .< j)ec#

" Jan. 1850

" Feb. "
" Miir u

" " April "

<: May 11
II tl (.' J.mie II

II II u JHly ||

,( " " Aug. "
" " " Sep. "
Mitchell's Materia Medica & The-
rapeutics

Milk in Variola

Mortality in England

Mortality in cities

" in Providence, R.I

Modus Operandi of Quinine in

fevers

Movements of the respiratory or-
gans in disease

Neutral Citrate of Soda

Nervous cough

" <: treatment of

New anaesthetic

New Hampshire Journal of Medi-
cine

New York Medical Gazetle

~Ne\v York Register

Nisbet, Dr. 11. B., on the Vaccine
Virus

Nitrate of Silver in inflammation
of the bladder

Nitrate of Silver in Venereal Bu-
boes

Nitrate of Silver

" ' in cholera

11 u in dysentery

N. O. Medical and Surg. Journal . .

Northern Lancet

372 Norwood, Dr. W. C, on Veratrum

308 Viride 333'

372 Nutritive properties offish oil 119

666

652 Oil of Turpentine in Intermittent
513 fever 118

Oil of Turpentine, physiological ef-

200 feels of 5G5

703 Oliver, Dr. J. H., letter from 318

25G On the Science of Medicine 45G

Operation for removal of ovarian
31" tumor 492

'Opium, habitual use of G75

531 Opium in strangulated hernia of

512 infants 691

1-27 Opium, new preparation of 188

63 Dpacfciesol the cornea, treatment of 40

Ophthalmia neanatornm . 53

351 Operation superseding that of remo-
505 ving testis 253

119 Passage of an iron bar through the
Gi head 480

128 Pathology of the different races. . . 178
192 Pendleton, Dr. E. M. case of pustu-

250 lar eruptions i. GOO

320 Percussion 319

3S-1 Pericarditis, effects of Mercury and

448 Bieedin- 30G

512 Phlegmasia Dolens b98

576 Physiological anatomy of the spleen 241

610 Pneumonia of children 47

703 Pneumonia in the aged G34

Poisoning with Strychnia relieved

626 by Chloroform 251

755 Poisoning by colored confectionary 497

191 Position of the icetus in utero 315

127Potassa fusa in external Hernor-
330 rhoids 56

Poultices in ophthalmia, improper

129 use of 20G

Present state of Medicine 641, 705

176 Production of sugar in the system 273
Proportion of Graduates to popula-

510 tion 382

IS l Puerperal mania, treatment of 379

182 Puerperal fever, causes of 553

50 Pustular eruptions from vaginal

manipulations 600

63n

511 Ojiintard, Dr. C. T. on Poultices
763 in ophthalmia 206

duintaid, Dr. C. T. On counter-
irritants 449

jGtuintaid, Dr. C. T. on present state
509| of Medicine 641,705

i&uinine in Croup 50

121 1 " deprived of its bitterness. 375
293 " in singultus and tetanus.. 310
ll

565 Reconstruction of an entire phalanx 434
318 Reduction of dislocation at the knee
319J joint 479

768 INDEX.

Retention of urine after delivery . . 505

Renal circulation 474

Rheumatism, fatal case of 754

Robertson, Dr. F. M. on Alcoholic

Sugar in hiccup 52

Tartar Emetic in inflammation of
cellular tissue 355

stimulants 193Tartar Emetic in Tetanus 375

iTaylor's Medical Jurisprudence .. 500

Scarlatina, treatment of 248 Tamponing the nasal canals 122

Scarlatina, trea'ed by hot water ap- (Taenia Solium treated with Kousso 630

plications 307iTannic Acid, mode of administer-

Scarlet lever 101 1 ing 695

Sciatica treated by the actual cau- iTannic Acid, effects of 618

tery 179 Tepid baths as sedatives 697

Scrofula and Tuberculosis, analo- IThe Kidney in its relation to sear-

gies of 752' let fever 91

Scrofulous constitution 167 Thyroid foramen in male and fe-

Senega,emmenagogue properties of 749; male 690

Sequelae of diseases of infants 670 Tonsillitis 164

Simpson on Anaesthesia 46 Transactions of College of Physi-

Singular Revenge 703 cians of Philadelphia.. .' 30

Sloughing phagedena 548 Turning by external manipulations 691

Smith's mode of reducing disloca- jTyphoid fever, remarks on 3

tion of the shoulder 252, Typhoid fever, prompt cure of 52

Smoking, danger of 61

Smyth on the unity of the human Umbilical Cord, extraordinary

races 625 length of 572

Spermatozoa in encysted hydrocele 57 University of New York 511

Statistics of Medical Schools 575 University of Pennsylvania 447

Statistics of French Medical estab- Urethral hemorrhage, treatment of 431

lishments 62 Urine, removal of without catheter 759

Statistics of Amputations in the Uterine displacements 142

Massachusetts General Hospital 694 Uterine hemorrhage, suppression of 124
Stanley on diseases of the bones.. 116J

Sterility, mechanical treatment of. 152 Vaccination 694

Still-born and premature births in I Vaccine Virus, remarks on 385

New York City 51 1 Vegetable Charcoal 313

Stricture of the urethra cured by (Ventilation, discovery in 126

cutting 173 Veratrum Viride 333

Si. Louis Probe 190 Vermifuges 427

Strychnine in Intermittent fever. .. 508 Vicarious menstruation 445

Strychnine in Chorea

Sumbul 444 Wens, removal of 692

Surgical Clinic of Medical College West on Diseases of Infancy 45

of Georgia 257 Western Medico-Chirurgical Jour. 763

Southern Medical Reports 409 Williams, Chas. C. C, death of. .. 128

Supplementary Mammae 445,Wooten,Dr.H. V. on Typhoid fever 3

Sulphuric ether in atonic ulcers. .. 312) Word, Dr. R. C. case of Hysteria 668

Date Due

. - m

Library Bureau Cat. No. 1137

^o^Hajl*^ Med* V-

thern

/>J%6 6-3