Southern Medical and Surgical Journal, 1851

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

L. A. DUGAS, M. D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGIA.

Medical College of Georgia.
"Je prends Ic bien ouje le trouve.^^

VOL. VIL 1851. NEW SERIES.

^ngnsta, a.

JAMES McCAFFERTY,

PRINTER AND PUBLISHER.

1851.

CA/'

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9

SOUTHERN i

MEDICAL AND SURGICAL j

JOURNAL. j

=====_================. !

Vol. 7.] NEW SERIES. JANUARY, 1851. [No. 1. !

' 'i

PART FIRST. 1

4

riginal fflommtTnicattona.

ARTICLE I.

Remarks upon the Dislocation of the Radius and Ulna hack- .

wards at the Elbow icith Cases. By L. A. Dugas, M. D.,
Professor of Surgery in the Medical College of Georgia. H

The object of this paper is to direct attention to a species of
dislocation, which, although not so common as some others, i

occurs sufficiently often, and is attended with consequences
so serious, when upreduced, as to make its study a matter of .1

great importance to every practitioner, and to the community
who rely upon his skill. The cases to be subsequently report- -i

ed will demonstrate the correctness of these premises. Errors 1

of diagnosis are, however, not peculiar to our country, for I

Listen observes that, "many cases of unreduced luxation are j

met with ; I have seen it in both elbows of the same person ; i

and I have had a dozen of cases, in as many months, of unre- '

duced elbows shown too late for attempts at reduction. The
frequent occurrence of such blunders is the more lamentable,
as it is almost impossible to replace the bones after three or four
weeks ; indeed I have been foiled at the end of two weeks."
(Elem. Surg.)

The bones constituting the elbow-joint are held in their nor-
mal position by the capsular, the two lateral, the coronary and
the oblique ligaments, neither of which, individually, nor all
combined, are sufficiently strong to resist the violence to which
they are sometimes subjected. On the posterior aspect of the
joint we find the great triceps extensor cubiti, inserted into the

N. S. VOL. VII. NO. I. 1

^^ 4i^ Dugas, on Dislocation of the Radius and [January,

^ " '

olecranon process, and the anconeus, into the upper portion
of the body of the ulna, both of which muscles tend to
strengthen the capsular ligament by their attachments to it.
Anteriorly, the biceps flexor cubiti is implanted into the tuber-
cle of the radius, and the brachialis internus into the coronoid
process of the ulna and a portion of the bone below this point,
being also attached to the capsular ligament. The displace-
ment of such extensive articular surfaces, the rupture of the
capsular and lateral ligaments, and the strong traction to which
the biceps and brachialis internus are subjected, (the latter be-
ing sometimes lacerated,) will, especially when viewed in con-
nection with the tension of the median nen'e and brachial artery,
sufficiently account for the painfulness of the injury and the
seriousness of its character.

This accident is usually the effect of a fall from horse-back,
from a vehicle, or from some other elevated position, during
which the hands are thrown forwards for protection, receive the
principal force of the shock, and transmit it to the elbow-joint.
The bones of the fore-arm, being thus suddenly and violently
forced upwards and backwards, rupture their attachments to
the humerus and slip up behind the lower end of this bone.

The displacement is sometimes effected with such force as
to cause the extremity of the humerus to protrude through the
soft parts, and thus to constitute a compound dislocation, which
is then readily recognized by the exposed bone in the bend of
the arm. In simple dislocations, however, tumefaction takes
place very soon, and becomes so considerable as not unfre-
quently to obscure very materially the means of diagnosis. It
is true that, in the language of Sir Astley Cooper, " this dislo-
cation is strongly marked by the great change which is pro-
duced in the form of the joint, and by its partial loss of motion."
But when the case is presented to the surgeon, the form of the
joint is often so much changed by the swelling, as to make it
difficult to determine how much of the change belongs to this
and how much should be attributed to a displacement of the
bones. Indeed we find in the valuable work from which we
have just quoted,* the narrative of a case under the Editor's

* A treatise oa Dislocations and Fractures of the Joints. By Sir Astley
Cooper. Edited by Bransby B. Cooper, Philad., 1844.

1851.] Ulna backwards at the Elbow,

care, in Guy's Hospital, the true nature of which was not de
tected until the third day after its first examination, nor reduced
until the fifth or sixth day. The patient was admitted on the
12th January, when *' the tumefaction was so great as to prevent
a very minute examination." * * * " Thirty leeches were appli-
ed, and afterwards the spirit lotion. The next day the swelling
was still very great ; twenty leeches w^ere ordered ; purgative
medicine was administered, and the lotion continued. On the
next day (Jan. 14th) the swelling was very much reduced,
and the nature of the injury became apparent.'' * * * *
*' 15th. The sw^elling being much diminished, I made an attempt
at reduction, but unsuccessfully, in consequence of the great
pain it occasioned. Sir Astley Cooper corroborated my opin-
ion as to the nature of the accident. A day or two after, I
succeeded in reducing the dislocation." (Op. cit., p. 386.) We
doubt not that every surgeon of experience has met wnth
cases in which the diagnosis was obscured, as it was in this
instance. It is therefore important that we possess ourselves
of every means by which the nature of such accidents mav be
determined, even when the joint is swollen to the uttermost.
Let us then dwell a little upon the symptoms and diagnosis.

The first circumstance calculated to awaken suspicion that
the case may be one of dislocation backwards of the radius and
ulna, is the position in which the limb is- found. The fore-arm is
in a state of semi-flexion and the palm of the hand turned up-
wards. Pronation is impracticable, save in a very slight
degree. Any attempt to extend the fore-arm completely is
attended with pain and great traction of the bicipital tendon ;
and if it be attempted to Jlex the fore-arm beyond a right ano^le
with the axis of the humerus, pain will also be occasioned and
the tension of the triceps be materially increased. The fore-
arm may, however, be flexed and extended within the limits
just mentioned, without much inconvenience. The wrist may
be moved laterally, or carried from side to side, an inch or more
beyond the axis of the humerus without much pain. If we
now extend the fore-arm as much as may be, and examine the
anterior aspect of the joint, a considerable prominence will be
found in lieu of the depression which usually exists in the bend
of the arm. This resisting tumour terminates abruptly at its

Dugas, 071 Dislocation of the Radius and [January,

lower margin, is formed by the inferior extremity of the hume-
rus resting in front of the radius and ulna, and may generally
be easily traced by the fingers to be continuous with the
shaft of the humerus. The brachial artery is found in front of
the tumor, is unusually superficial and beats with great force.
The tendon of the biceps is also very prominent and tense, as
well as the belly of this muscle.

The lateral surfaces of the joint are much thicker than in the
normal state, because of the great increase in the antero-poste-
rior diameter. When the fore-arm is semi-flexed, there exists
a depression on either side of the olecranon, occasioned by the
increased prominence and distance of this process from the
humerus.

If the joint be examined posteriorly whilst the limb is extend-
ed as much as possible, and a line be drawm across it from one
condyle to the other, the olecranon will be found considerably
above this line. In the adult, it ascends from an inch to an inch
and a half beyond its usual position. In females and younger
subjects, this displacement will be less marked. In the normal
state, the external condyle is said to be on a level with the
upper end of the olecranon, and the internal condyle a little
above it. The head of the radius may also be felt (if the tume-
faction be not very great) on the external side of, and a little
below the point of the olecranon, and its identity as well as the
integrity of the bone determined by attempting to rotate the
wrist w^ith one hand, whilst a finger of the other is pressed
upon the bead of the radius. If the radius be unbroken, its head
will be found to follow the movements of the wrist.

The diagnosis will be materially facilitated by comparing the
tw^o arms placed in the same position, and by measuring in
each the distance from the lower end oftheulnato the internal
condyle, or to the point of the acromion process. The dislo-
cated limb will be the shorter of the two.

Some of the symptoms just enumerated may be presented in
other injuries of the joint or of its adjacent structures. The
dislocation of the ulna and radius may be lateral and backward,
in which case the coronoid process of the ulna will be found
resting upon the posterior surface of the external or internal
condyle, instead of lodging in the fossa of the humerus, as it

1851.] Vina backwards at the Elbow.

does in dislocations directly backward. If the ulna rest upon
the external coxid\\e, the head of the radius will present itself
upon the outside and somewhat behind the joint, where its rota-
tion may be distinctly felt during pronation or supination. If,
on the other hand, the ulna be thrown behind the internal con-
dyle, the head of the radius will occupy the posterior fossa of
the humerus. These peculiarities will not permit the lateral
to be confounded with the direct dislocation of the elbow-joint
backward.

The ulna may be alone dislocated backwards, leaving the
radius in its proper place. In this case the fore-arm can neither
be extended, nor flexed much beyond a right angle ; but its
inward inclination, the absence of the head of the radius behind
the humerus, where the great projection of the olecranon is to
be distinctly perceived, will suffice to establish the differential
diagnosis.

In forward dislocations of the radius, its head is thrown in
front of the external condyle and against the coronoid process
of the ulna. The hand is pronated, the fore-arm slightiy bent,
flexion to a right angle resisted by the head of the radius strik-
ing against the front of the humerus, and complete extension
impracticable without reduction. The natural position of the
olecranon, the absence of the head of the radius from below the
external condyle, and the sudden stop to the flexion of the fore-
arm, will sufficiently distinguish this from other injuries. If
complicated., however, with fracture of the upper end of either
or of both bones, the diagnosis maybe more difficult. These
accidents are of rare occurrence, and may be detected by care-
ful attention.

Backward dislocation of the radius is much more rare than
that forwards, and can scarcely be confounded with the
dislocation of both bones, although it does, to a certain degree,
impede the movements of flexion and extension.

A fracture of the upper portion of the radius may be attend-
ed with considerable tumefaction, and will render flexion and
extension of the fore-arm more or less painful. If the fracture
be below the tubercle, this will be drawn up by the biceps so as
to wound the soft parts in these motions of the fore-arm, and if
the fracture be above the insertion of the biceps the lower frag-

Dugas, on Dislocation of the Radius and [January,

ment will be likewise elevated and occasion the same incon-
venience, although in a less degree, during extension than
flexion. This action of the biceps, by removing the fragments
from each other, will often prevent the crepitation upon which
so much reliance is placed in the detection of fractures. This
fracture may be distinguished from the' dislocation we are study-
ing by the absence of the tumor in the bend of the arm formed
by the lower end of the humerus, by the natural position of the
olecranon, by the limb not being shortened, by the relaxed state
of the biceps and its tendon, &c.

Treatment. " The patient is made to sit do^vn upon a
chair, and the surgeon, placing his knee on the inner side of
the elbow-joint, in the bend of the arm, takes hold of the pa-
tient's wrist, and bends the arm. At the same time he presses
on the radius and ulna with his knee, so as to separate them
from the os humeri, and thus the coronoid process is thrown
from the pos^rior fossa of the humerus ; and whilst this pres-
sure is supported by the knee, the arm is to be forcibly but
slowly bent, and the reduction is soon effected. It may also
be accomplished by placing the arm around the post of a bed,
and by foicibly bending it while it is thus confined. I have
also reduced the limb by making the patient, whilst sitting on
an elbow-chair, put his arm through the opening in its back,
and then, having bent the arm, the body and limb being thus
well fixed, the reduction w^as easily effected.'' Such are the
processes recommended by Sir Astley Cooper. oMore modern
writers, however, as Liston, Miller, Druitt, &c., advise the re-
duction to be effected by forcible extension of the arm, and we
doubt not that it is in many cases decidedly the best mode.
We transcribe the directions given by Liston in his Elements
of Surgery. " The arm and forearm are extended, and the limb
is brought well behind the trunk, so as to relax the triceps ;
then the surgeon performs extension and counter-extension,
pulling the fore-arm wnth one hand, whilst he pushes with the
other placed on the scapula. If the force thus employed prove
insufficient, as it seldom will in recent cases, the patient may
be placed on his face, on a couch, and on the limb being brought
into the favorable position already noticed, counter-extension

]851.] Ulna backwards at the Elbow.

may be made by the heel planted against the inferior costa of
the scapula, whilst the wrist is pulled with both hands. It is
seldom necessary to employ pulleys, except in cases of old
standing; if so, the only peculiarity in their application to this
joint is the direction of the force, backwards. And this I con-
sider to be a very material part of the manipulations, for, by
attention to it, I have succeeded after previous failures, after
great force had been applied, creating excoriation and swelling
of almost the whole limb."

It is evident from this extract that Liston regarded the re-
laxation of the triceps as the peculiar advantage secured by
this mode of reduction. Professor Miller, of Edinburgh, en-
tertains the same opinion. " The patient is placed with his
back to the surgeon; and, the chest having been fixed, exten-
sion is made with the arm directed completely backwards, in a
rectangular relation to the trunk, so as to relax the triceps mus-
cle:' (ThePrac.ofSurg. By James Miller, &c. Philada., 1846.
p. 235.) Druitt expresses himself differently : "He (the sur-
geon) may forcibly straighten the arm, so as to make the ten-
don of the biceps pull the trochlea of the humerus back into
its place." (The Princ. and Prac. of Mod. Surgery. By R.
Druitt. Philada., 1848. p. 283.) With due deference to
these high authorities, I think that a very important element in
the mechanism of this process has been overlooked ; which, if
borne in mind by the sui'geon, will materially increase the
chances of success. I allude to the lever power secured by
using the olecranon as a fulcrum for dislodging the coronoid
process from the posterior fossa of the humerus. This effect
will be readily perceived if the reader will place the bones of
a skeleton in the position they would occupy in this dislocation,
and then gradually extend those of the fore-arm, making at
the same time gentle traction. It will be found that the resist-
ance offered to reduction is principally produced by the lodg-
ment of the coronoid process in the fossa but that, as soon as
the extension is carried a little beyond the straight line, the ole-
cranon will rest upon the humerus, the coronoid process will
rise from the fossa and the bones will promptly slip down into
their proper position. The surgeon should therefore carry the
fore-arm a little farther back than a straight line with the hu-

10 Dugas, 071 Dislocation of the Radius and [January,

merus, if he wish to derive all the advantages of this method
of reduction.

It is scarcely necessary to say that if the dislocation resist a
certain degree of force, whether applied with the arm flexed
or extended, prudence would dictate a cessation of efforts, ra-
ther than hazard the consequences of such lacerations as might
be produced, especially in old cases, and with pulleys. Unless
the limb have been injudiciously splintered in a straight direc- '
tion for some length of time, complete stifi^ening of the joint
will seldom occur. The bones \v\\\ gradually adapt themselves
to their new position, and an useful degree of motion be regain-
ed. Too violent eflfbrts, by renewing the inflammatory process,
may result in the loss of even this small amount of usefulness,
and perhaps more seriously.

The reduction having been effected, the joint should be sur-
rounded with cloths dipped in a saturnine solution, vinegar and
water, salt and v/ater, camphorated spirits or any other refriger-
ating lotion. A roller bandage should be then carried gently
above and below the joint in the figure of an 8, and the fore-
arm placed in a sling. The lotions should be frequently ap
plied, without removing the bandages. If inflammation be in-
tense, leeching and other antiphlogistics must be resorted to.
After the lapse of a few days, or the subsidence of inflamma-
tion, the arm should be daily subjected to slight motions of ex-
tension and flexion, pronation and supination. The length of
time necessary to retain the limb in a sling must vary according
to circumstances. In ordinary cases it may be removed in
two or three weeks.

The writer has seen seven cases of dislocation of the Radius
and Ulna backwards, and will now very briefly refer to them.

Case I. Miss A. E. H., having sustained an injury of the
elbow-joint by a fall from a moderate height, had been treated
three wxeks with discutient lotions and a nearly straight splint,
when I was requested to see her. The attending physician,
whom I met in consultation, not agreeing with me as to the
nature of the accident, a third physician was called in, who dif-
fered from us both. The opinion of a fourth was now request-
ed, and he fortunately concurred with me in the conviction

1851.] Ulna backwards at the Elhow. 11

that the bones of the fore-arm were dislocated backwards.
The patient was immediately seated in a strong chair, with the
injured arm projectiug through the back of it. A little tobac-
co was put into her mouth to promote a relaxation of the
muscles, and, when nausea supervened, the dislocation was
reduced by pulling the fore-arm strongly, and at the same time
bringing it into a state of complete flexion around the vertical
bar of the chair. The arm, being placed in a short sling, and
occasionally moved, was, in the course of a few weeks, com-
pletely restored to its natural uses.

Case II. This case presents nothing peculiar. It was that
of a little girl from South Carolina, about 7 years of age, who
fell from a chair, and dislocated the elbow-joint. She was sent
to me a few days after the accident ; the nature of the injury
was detected, and reduction immediately effected as in the
above case, but without the use of tobacco.

Case III. Mr. St. J. (about 30 years of age) Vv'as thrown
from his horse with great force, a short distance from the city.
It was probably two hours after the accident that I saw him.
The arm was semi-flexed, and the tumefaction of the elbow-
joint immense. Another physician was requested to see him
with me, but differed with me as to the nature of the injury.
The joint was therefore covered with cold lotions and gently
splinted until the next day, when I succeeded in convincing my
confrere that v\'e had to deal with a dislocation of the joint.
The reduction was effected by drawing the fore-arm around
the bed-post until flexion was complete. The case terminated
successfully.

Case IV. Mr. W., from one of the lower districts of South
Carolina, about 20 years of age, in falling from his horse, sus-
tained an injury of the elbow-joint, which was treated with
lotions and splints for six weeks before he called upon me.
The arm was nearly straight from the continued use of splints,
and possessed very limited motion at the elbow. The tume-
faction having entirely subsided, the dislocation of both bones
backwards was very obvious. After making, in vain, every
effort that prudence would permit to reduce the dislocation,
I ventured upon the subcutaneous section of the triceps exten-
sor cubiti, just above its attachment to the olecranon, thinking

IS Dugas, 071 Dislocation, <^c. [January,

it possible that by removing what then seemed to be the great-
est obstacle to the flexion of the fore-arm, I might succeed in
bending it, and that, even if he lost the use of this important
muscle, the -permanent flexion of the arm would be better than
a permanent straightness. I did, then, succeed in bringing the
fore-arm nearly to a right angle, but without reducing the dis-
location. The patient was directed to move the arm daily,
and to shorten the sling in which it was kept, from time to time.
About five years have now elapsed since the operation, and I
have not heard the result.

Case Y. This was a case somewhat similar to the last.
The gentleman (about 25 years of age) resided in one of our
upper counties, and had been treated several weeks under a
misapprehension of the nature of the injury. He then came
to this city and placed himself under the charge of another
physician. I was called in consultation and we detected a
dislocation of the elbow backward. xMy professional associate
administered chloroform and made every effort to reduce the
dislocation, in vain. Under the influence of the powerful aid
of Jarvis's adjuster, the attempt to flex the arm resulted in the
fracture of the olecranon. This permitted considerable motion
of the joint, and the patient left here much improved in that
respect but with the dislocation still existing.

Case VI. This is the case of a robust Irish laborer, whose
dislocation was of some weeks standing, when I was requested
to assist a professional brother in its reduction. Chloroform
was administered, and the most strenuous exertions made with-
out succeeding in the reduction.

Case VII. F. W., a boy 7 years of age, fell from a platform
about 4 feet high, and dislocated the bones of the fore-arm
backwards at the elbow-joint. Seeing him a few hours after,
the dislocation was readily reduced by traction with my right
hand, whilst the other was applied to the bend of the arm so as
to press back the bones.

It will be remarked that of the seven cases above reported,
three remained with permanent deformity and that this result
was in these three cases, the consequence of incorrect diagno-
sis. With these facts before us, the writer trusts that this
communication may not appear to be altogether a work of su-
pererogation.

1851.] Norwood, on Veratrum Viride. 13

ARTICLE II.

Observations on the use of Verati^um Viride in Fevers, Con-
vulsions, (^c. By Wesley C. Norwood, M. D., of Cokes-
bury, S. C.

In a former communication (see Jane No. of this Journal,
vol. 6,) we stated some of the leading and prominent powers
and properties of American Hellebore and its peculiar adap-
tation to the treatment of Pneumonitis. We then stated, that
all the powers and properties it was alledged to possess, were
true and free from all exaggeration. We now go farther, and
state, from the fact that some are disposed to doubt the v-alidity
of the assertions, that the half was not told. Its powers were
not fully unfolded nor revealed, lest by giving a too glowing
and brilliant statement of its capacity to arrest and subdue
disease, it might meet the fate of many articles which flourished
no longer than the short time occupied in breathing their praise.
We challenge trial, and pledge ourself to demonstrate at the
bedside, before any body of physicians, every power and pro-
perty we have heretofore claimed for it and asserted it to pos-
sess. We go farther, and state that all of its leading effects
are so striking that w^e are compelled to attribute them to the
article, and to nothing else. We are sorry that we dwelt so
long on the ill effects, if it can be said to possess any. It is not
a drastic emetic in the sense that tartar emetic is said to be.
Its nauseant powers are the most disagreeable of any effect
belonging to it. From the description given, we learn that it
deterred many from using it, and led others to question its use-
fulness. We deemed it far more prudent to enter fully into
any unpleasant effects, than to keep them concealed, and pre-
sent nothing but its prominent beneficial effects. We now
boldly hazard the assertion, that it is the only article or agent
known that will control certainly, and without disappointment,
the action of the heart and arteries that it is the only thera-
peutic agent known through which we can say to the heart and
arteries, so fast shalt thou beat or pulsate, and no faster. We
unhesitatingly assert, that it has not failed us in a single case
to reduce the action of the heart and arteries, down to any
point we wished, as to the number and frequency of pulsa-

14 Norwood, on Veratrum Viride. [January,

tions. We believe that it will be eminently useful in every
disease in which increased frequency of the action of the heart
and arteries take place to any extent. We also believe that
when its powers are fully ascertained, tested and developed, it
will produce an era in the treatment of disease.

We have no doubt that veratrum viride will prove a valua-
ble agent in the treatment of scarlet fever. We stated in our
former article in this Journal, that veratrum viride certainly
reduced the frequency of the pulse that it produced the most
intense paleness of the surface, and unusual coolness or cold-
ness of the surface, accompanied with more or less moisture.
In scarlet fever, we know there is unusual frequency in the
pulsations of the heart and arteries ; also, that there is great
heat and dryness of the skin, and congestion, if not inflamma-
tion, of the capillary system. Veratrum viride eminently sub-
dues, overcomes and removes every condition we find to exist
in scarlet fever. In scarlet fever there is often more or less
mucus in the fauces and trachea, and ulceration and inflam-
mation often exists. Veratrum viride, by its emetic eftect and
acrid properties, will remove the mucus and change the action
in the fauces. In scarlet fever, the heat, redness and dryness
of the skin are extreme. Veratrum viride produces coolness,
paleness and moisture of the surface ; thus certainly relieving
all these annoying conditions, and affording to the patient every
opportunity of comfort and relief.

Case I. Miss Q., aged 16 years, the daughter of Dr. Q.,
was attacked with typhus fever of the nervous type. We were
called to see her on the night of the sixth day, at 8 P. M. The
following were the symptoms: Pain in the head slight ; tongue
covered with a soft, wdiitish fur in the centre, and inclining to
yellow, the edges and tip were red ; the mouth sticky and
clammy, but not bitterish ; the flush of the face not general, but
confined to the cheeks, and more or less scarlet ; considerable
heat and dryness of the skin ; the pulse was one hundred and
thirty per minute, soft, and not full and strong; nausea slight;
bowels rather torpid ; considerable watchfulness and restless-
ness; there was no collection of sordes on the teeth ; slight
twitching of the tendons ; pain in the back : had catarrhal af-

1851.] 'Norwood^ 071 VeratrumViride, 15

feclion, which subsided when attacked with fever. Was, as
we should have stated, attacked rather suddenly, without rigor.
Was treated, previous to our seeing her, with calomel, Cook's
pills, decoction of seneca ; and seneca and quinine one day.
We were informed that the fever had abated but slig^htly, a few
beats of the pulse every morning, never below 120, except on
the day the quinine was taken in conjunction with the decoc-
tion of seneca; and that it was materially lessened on that day.
We ordered for the night the following, to be continued or
omitted as might be necessary. In the first place a large cam-
phorated powder to be given at 9 P. M.; and quinine in five
grain doses, to be administered every two hours, beginning at
10 o'clock. If the heat, dryness, pain, thirst, restlessness and
frequency of the pulse, w^ere not mitigated, or if increased, the
quinine was to be omitted after the second portion. It v/as dis-
continued after the second dose. The Doctor stated that the
symptoms were rendered more violent.

At 8 o'clock the next morning w^e found her as above, the
pulse being 120 beats per minute. We put her on the tinct. of
veratrum viride, to be given every three hours. Began with
ten drops, the dose to be increased one drop every portion, till
nausea or vomiting were excited. In sixteen or eighteen hours
nausea and vomiting were excited ; the skin became cool and
moist, and the pulse was reduced down to 80 beats per minute.
The veratrum viride to be continued every three hours in less
quantity, to prevent a return of the fever. The young lady
disliked it from the nausea it kept up, and, as it was called the
new way of doctoring, it was omitted. The consequence was,
in about eight hours, a return of the fever. We again ordered
the article to be given every three hours, beginning with twelve
drops, and to be increased two drops at each dose, till nausea or
vomiting occurred. In six hours the heat and dryness were
again subdued, and the pulse reduced down to (S^ beats in the
minute.

Notwithstanding the clear manifestations of the powers of
the article in controlling the fever, it was again discontinued. In
about twelve or fourteen hours the fever returned, and we
were again called. The veratrum viride was again resumed,
continued three days, and the fever was subdued in six hour.s,
and did not return.

t^ Norwood, 071 Veratrum Viride, [January,

Case II. A negro boy, about 10 years of age ; was taken at
the some house. He was treated, by his master, Dr. Q., with
calomel, pink-root and quinine, without benefit. His attack
and symptoms were very similar to those of the young lady.
The symptoms not yielding, we were called on to prescribe for
the boy at 8 o'clock, P. M., of the fourth day. Our prescription
was tincture of veratrum viride every three hours, beginning
with eiglit drops, and increasing the dose one drop each time,
till nausea or vomiting ensued. On the administration of the
third dose emesiswas excited, the skin became cool and moist,
and the pulse sank from 120 down to 70 in the course of nine
hours from the first dose of the viride. By continuing it there
was no return of the fever, and the boy rapidly convalesced.
There being a great deal of sickness in the family, the boy was
obliged to expose himself. The consequence was that he re-
lapsed in ten or twelve days. The severity of the symptoms
was more intense than at first. The case being one of relapse,
with violent symptoms and threatened stupor or coma, we
were called in on the night of the third day. We put him on
the use of the viride. In less than twelve hours he was clear of
all his untoward symptoms and of fever.

This case very strikingly illustrates the peculiar properties of
the viride. The Doctor having, in each attack, treated the boy
with other remedies, and without relief, up to the third and
fourth day of his disease, and in each instance the viride having
removed all the unpleasant symptoms in less than twelve hours.
In the case of the young lady, another physician besides Dr. Q.
had been in attendance before we were called ; showing that
at least one of the cases was considered to be severe.

Case III. On the morning of the third day of the attack,
we were called to see Mr. K. The fever had not abated up to
the period we visited him. He was taken with a chill, follow-
ed by chilly sensations which lasted several hours. Pain in the
head severe ; flush of the face general, and approaching to
crimson; the fur on the tongue more or less yellow, or ap-
proaching to a cream colour the edges and tip rather clean
and red; taste slightly bitterish; no collection of sordes on
the teeth ; slight nausea ; little or no torpor of the bowels ;
pain in back and loins considerable ; surface hot and dry ; pulse

1851.] "N oYy/ood, on Veratrum Viride. 17

120 to 130, soft and not very full, yielding readily to pressure;
great watchfulness and restlessness ; thirst moderately intense.
We put him immediately on the use of veratrum viride every
three hours ; the dose to be increased one drop every portion
till nausea or vomiting followed. In less than twelve hours the
heat and dryness of the skin were removed, and the pulse re-
duced to sixty-five or less. The viride was continued a day or
two, and was then omitted without any return of fever. He
had taken a portion of calomel the day after his attack. We
gave him no more.

Case IV. A negro girl, belonging to Dr. T., was attacked
with a chill, followed by intense pain in the head ; intolerance
of light; fur on the tongue thin, whitish and slimy, edges and
tip red ; mouth sticky and clammy ; no sordes on the teeth ;
more or less nausea and vomiting; no diarrhoea ; skin hot and
dry being of light complexion, we could see that the flush on
the face was not general, but circumscribed; pulse 130, small
and soft ; more or less spinal tenderness. She had no return of
chills. We found her with the above symptoms on the after-
noon of the third day. We gave her three powders, composed
of five grains of colomel and five of camphorated powder, (with
the exception of the first, which had ten grains of camphorated
powder,) at 3, 6, and 9 o'clock, P. M. A blister was applied
to the forehead. We had no veratrum viride with us, or we
would have put her on its use. At 12 the next day the calomel
had acted kindly ; the blister had drawn well; the pain in the
head, nausea and vomiting were much relieved: but the heat,
the dryness of the skin and the frequent pulse, were not in the
least reduced or mitigated. We put her on the use of vera-
trum viride every three hours, commencing with twelve drops,
the dose to be increased two drops every portion till nausea or
vomiting were excited. In less than ten hours the skin be-
came cool and moist, the pain was removed, and the pulse
reduced down to G5 or less. The nurse, contrary to orders,
omitted the viride: on the next day there was a slight return
of the fever. We ordered the viride to be given for two days ;
there was no return of fever, and the patient convalesced ra-
pidly.

We could give many other cases, in whicii the effects of

18 Norwood, on Yeratrum Viride, [January,

veratrum viride were as striking and manifest as in the above ;
but we think we have marshalled sufficient evidence to estab-
lish the point we had in view when w^e set out. If we have
failed, the fault is with us, and not in the article recommended.

We will give a single case of convulsions, treated, as we be-
lieve, successfull}^ with veratrum viride.

Case V. A child of 5 years of age, the property of Dr. S.,
had been complaining of pain in the bowels and head for a day
or two, but not so as to confine him to bed : had more or
less fever. On the afternoon of the day of his attack he had
an increase of fever, and complained much of his head and
bowels. Between the hours of 5 and 6, P. M., he was seized
with convulsions. We saw him at 8 o'clock. The convulsions
were general, but one side was more convulsed than the other.
The convulsions.and spasms cr rigidity did not subside until
2 o'clock in the morning. After the convulsions and rigid
condition of the muscles had entirely subsided, he lay in a stu-
pid and comatose state, from which he could not be aroused for
two hours the side most convulsed being left more or less
paralytic during the intervals of convulsion. He now awoke,
as .out of a deep sleep, called for water, with an earnestness we
never before witnessed, and continued to talk and plead for
water, (which was given him, in moderation,) till he became
convulsed again. The period of wakefulness lasted half an
hour or more. Up to the period we shall shortly mention,
there was at no time more than one hour of interval between
the paroxysms of convulsions. The skin was hot and dry ; the
pulse from 135 to 140 in the minute, without fullness nor hard-
ness ; the face pale and ghastly ; pupils much dilated ; more
or less frothing at the mouth. We were compelled to keep a
piece of leather between the teeth to protect the tongue from
injury. Warm bath was tried ; injections of salt and water
were used ; the spine was irritated ; calomel, in ten grain doses,
w^as given every six hours, and oil and turpentine midway be-
tween the portions of calomel. Also, China-root tea, several
portions of Perry's vermifuge, and five drops of Croton oil.
The above course was adopted because of the pain and fullness
of his bowels, and his being frightened and grinding his teeth
during sleep. We trusted much that as soon as the bowels

1851.] Norwood, on Veratrum Viride, 19

were operated on freely the convulsions and fever would sub-
side ; but they continued.

We commenced the above treatment the night we were call-
ed, which was continued the next day and night before the
bowels were moved. In addition to the purging, we tried
tincture of stramonium and laudanum, without benefit. As
all things were unfavorable and began to threaten seriously to
involve the life of the child, and that nothing had so far con-
trolled the frequency of the paroxysms, nor reduced the heat
and dryness of the skin, nor the rapidity of the pulse, we de-
termined to reduce the frequency of the heart's action. With
this resolve we put the child on the use of viride. We gave
at first three drops, in one hbuv repeated the dose, giving it
every two hours afterwards and increasing one drop every
portion. Before the third dose was given, the pulse began to
decline in frequency, the paroxysms were less severe, and the
intervals much longer. In eight hours the pulse was reduced
to eighty beats per minute ; the skin cool and moist ; the pu-
pils contracted, and no convulsions. The veratrum viride to
be continued every three hours. If any symptoms threatened
a return of the convulsions, an intermediate dose was to be
administered.

If we had the case to treat again, we would order the viride
at once, and would give ten drops every half hour till three
doses were taken, and then every hour till emesis was excited
or the symptoms were relieved.

Why would it not be the remedy in puerperal convulsions,
when accompanied with frequent pulse, great heat and drvness
of the skin ; alone or after blood-letting, where venesection
was indicated ? We are so fully persuaded in our own mind
of its adaptation to the treatment of puerperal convulsions,
where the pulse is frequent and the skin hot and dry, that we
are determined to try it, either with or without premising de-
pletion, in the first case that comes under our care.

N. S. VOL. Vll. NO. T,

to Campbell, on Dengue Fever, [January,

^ ARTICLE III.

History and Treatment of the Dengue Fever, prevailing in
Augusta in the year 1850. By Hexry F. Campbell, M. D.,
Demonstrator of Anatomy in the Medical College of Ga.

In the present article, we propose submitting a brief notice of
the epidemic fever which has solately prevailed in our city, under
the various names of "Dengue," "Break-bone" and "Neuralgic
fever." As will be seen by reference to all the accounts of the
disease, as it occurred during the past season in various locali-
ties, it was also here, preceded by a protracted period of unusual
heat and drought. For many years past, the almost universal
type of our summer and autumi>al fevers has been intermittent
or remittent ; indeed this tendency is so predominant in our
locality, that a continued fever is almost unheard of among us
during the seasons above mentioned.

As early as the beginning of April, the unusual number of
cases wherein the paroxysmal type was very obscure or did
not at all obtain, was the subject of remark. In many, the
fever would expend itself in one long paroxysm, without the
well-marked characteristic stages so constantly observed by
our fevers of ordinary seasons. On the 22d of August, my
brother and associate, Dr. R. Campbell, saw a case in which he
has since recognized most of the characters of the epidemic
though at the time it was viewed by him as a remittent of some-
what obscure type, similar to others that had occurred to us
earlier in the season. This case was characterized by great
prostration of strength, loss of appetite, furred tongue, depress-
ed pulse, and dry but moderately hot skin. It lasted four or
five days, was not at all amenable to treatment, and the conva-
lescence rather tardy, attended with protracted muscular fee-
bleness. Shortly after, other cases appeared in a part of the
city quite distant from the above, somewhat better marked than
this ; but even these did not pass with us as confessedly cases
of Dengue. x\boutthe 10th of September, the disease became
fully manifest in all its unique and indubitable individuality.
Then, what was dreaded in the vague uncertainty of rumo r
became more manifest in the tangible reality of painful, person-
al endurance.

1851.] CsimpheW, on Dengue Fever. 21

The popular name of Break-bone Fever has pretty generally
here, as elsewhere, been adopted in common parlance, to de-
signate the disease. The term Neuralgic Fever has been sug-
gested, along with various others ; but inasmuch as the disease
in all its important characteristics, so closely resembles the
Dengueof 1828, in Charleston, described by Dr. S. H. Dickson,
we have adopted this nomenclature as the one least liable to
produce confusion, in a comparison of the reports of the epi-
demic as it has prevailed here and elsewhere.

Here, the disease was usually preceded by a period of dis-
comfort, varying from twelve to thirty-six hours, in which the
patient, without 'any defined sense of ill being,' was disinclined
to engage in any exercise whatever, mental or physical. In its
accession, he suffered first from a feeling of extreme fatigue
had a disposition to extend the limbs, and to stretch and gape
there was frequently severe pain in the loins, attended with
general lassitude and debility. There was loss of appetite ;
the tongue slightly furred, but red and not very dry; some
thirst, and occasionally, even in this stage, nausea would add
to the general distress of the patient, though most frequently it
characterized a later period of the disease. On examination,
we would find the spine almost invariably tender, especially in
the lumbar region, where most of the suffering was referred.
The pain would also extend down the course of the nerves of
the inferior extremities, even to the end of the toes. Frequent-
ly, the superior extremities would be affected in the same man-
ner, while the intercostal nerves also would indicate most
definitely their distribution in becoming channels of distress to
the patient. But, above all, perhaps the most invariable atten-
dant on the earlier stages of the complaint, was the severe pain
in the frontal and temporal regions, which, in the majority of
the cases, became par excellence, the torture of the disease.
The eyes also became affected with a species of rheumatic ten-
derness, which rendered their movements quite painful. Some-
limes, there was total inability to move the eyes; the skin was
generally dry and hot ; the pulse quick and full, varying from
80 to 120 per minute in the adult: the heat of surface did not
always correspond with the frequency of the pulse. After a
continuance of from two to eight days, the pain in the head and

iS2 Campbell, on Dengue Fever, [January,

loins would subside, the fever decline, and the patient begin a
slow and unsatisfactory convalescence.

In the vast majority of cases, though not invariably, during
some period of the attack, there appeared on the surface
an eruption, which, in adults most frequently, according to our
experience, would assume the forms of urticaria or erysipelas,
while in children, scarlatina and rubeola were the diseases sim-
ulated. This eruption, of whatever form, was usually attended
with much itching and burning over the surface, followed often
by partial or general desquamation. We have found it most
frequently in those cases that have suffered from gastric and
intestinal derangement, and on the appearance of the eruption,
there was much abatement in the violence of the symptoms.

Above, we have given the progress of perhaps the generality
of cases, but by no means, the course invariably pursued by
this truly protean epidemic. In many cases, the brain gave
evidence of being much affected throughout the whole course
of the disease. Sometimes, there was stupor so profound, that
it was difficult to arouse the patient even for a moment, while
in others, the most obstinate watchfulness obtained, amounting
even to delirium. In these cases the pulse was full, hard and
rapid, the skin hot and dry, and the headache and lumbar pains
unusually violent. Another point of variation, is the mode of
attack: in some, instead of the gradual approach above descri-
bed, the patient would be taken with a chill, more or less vio-
lent, attended by great nausea and vomiting ; in others, the
prostration was sudden, even on the first day rendering him
unable to undergo muscular exertion.

We have already adverted to the nausea observed during
the earlier stages of the attack. There were cases wherein
this symptom was persistent throughout the whole period, ac-
companied by vomiting or violent retching. The patient
would complain of tenderness in the epigastric region, with
a sense of great oppression. There was much thirst, and
with this urgent craving of cold fluids, the stomach would not
retain them more than a few moments. The tongue in these
cases was unusually red, with prominent papillae ; sometimes
with a whitish fur in the centre, at others perfectly clean.
Where nausea obtained, the eruption was tardy or altogether

1851.] Campbell, on Dengue Fever,

absent, and on its appearance, the gastric distress usually abated.
The pulse was frequent, but depre-sed, as observed during
chill the skin not generally very hot. The condition of the
bowels has varied exceedingly: in the majority of cases, they
were in a natural condition, especially ^vhere the attack was
sudden, then, its accL^^s would be preceded by constipation of
twenty-four to thirty-six hours, and again a copious diarrhoea
would usher in the disease, or be superinduced by the mildest
laxative. The tendency to diarrhoea, we found exceedingly
embarrassing to our treatment, as it vv^as frequently the case,
where purgatives were apparently plainly indicated, a slight
laxative would produce the most uncontrollable hypercatharsis.
In one case, the bov/els being constipated for days, the patient
was urgent for a cathartic : being aware of the tendency to ca-
tharsis, we indulged him only with a saline enema : a purgation
ensued which was extremely inconvenient, and which was
checked only by large doses of opium, by the mouth and by
enema. The same irritability, though perhaps in a less marked
degree, was observable in many of the cases that came under
our observation. We will refer here to another, in which this
was even more remarkable than the above, where a most trou-
blesome diarrhoea and prostration was brought on by a mild
dose of rhubarb and magnesia. The diarrhoea here was so ob-
stinate that all concern for the case was merged into the desi-
deratum of arresting its prostrating draughts upon the patient.
The passages were generally copious, and at the end of each
evacuation the patient was tortured by violent tenesmus with
pain in the rectum.

The condition of the liver varied also though, from the
color of the stools and the absence of bile in the matter vom-
ited, it is probable that it was most frequently torpid, or at least
not in the excited condition observable during many of the
paroxysms of our autumnal fever. The urinary organs pre-
sented nothing remarkable ; we can recall no case of haematu-
ria complicating the disease.

Of the hcemorrhagic tendency of this epidemic, our observa-
tions were numerous. In a few cases, the nose was the seat of
haemorrhage; in two, the gums ; in one, the mucous membrane
of the lungs and also the gums; in many the bowels; and the

M Campbell, on Dengue Fever. [January,

cases of vaginal and uterine hcemorrhage were perhaps the
most frequent of all. The blood discharged from the gums
was of a dirty, venous colour; it presented the appearance of
blood undergoing incipient putrefaction. In the case where
the blood was discharged from both the gums and lungs, the
difference between the two fluids was remarkable that from
the gums being of the character above described, while the
expectorated blood was of a bright red color, and in parts re-
sembled very nearly the lateritious sputa of pneumonia. When
the haemorrhage came from the bowels, the passages were dys-
enteric and more or less mucus was mixed with blood, the pro-
portion varying according to the predominance of the haemor-
rhagic tendency. Frequently, the dysentery would be of the
most obstinate character. One case we relate in illustration :

Mrs. L , having passed through the stages of dengue,

regularly, during her convalescence was attacked by a copious
diarrhoea, which continued unrestrained under the most ener-
getic astringent treatment. Soon after, dysenteric symptoms
became manifest, and she discharged a considerable quantity of
blood and mucus at each evacuation. Every astringent means
we could suggest was put in requisition, w^ith only temporary
effect; passages, fluctuating between a diarrhceal and dys-
enteric character, continued to recur, Vv'ith incredible frequen-
cy, for nearly three weeks, until the patient was worn to a
mere skeleton. Although not on the treatment, we mention
here that this case appeared to receive its first impulse towards
recovery from the application of a small blister to the sacrum,
suggested by our friend, Prof. L. D. Ford, who was in attend-
ance with us.

The relation which this disease sustained to the menstrual
function is, according to our observation, truly remarkable : it
was invariably a provocative of the discharge. Should the
disease exist at any time near the period of the catamenia, we
have found it very apt to produce it ; should it bo before, but
within several days, the discharge would anticipate its regular
period, and also be unusually copious ; should this period have
passed, even by the lapse of several days, a recurrence of the
discharge would be induced amounting, sometimes, to true
hemorrhage. Menstruation occurring at this time was usually

1851.] Campbell, on Dengue Fever. Sf6

painful, probably owing to the excitable condition of the gen-
eral nervous system.

In the pregnant condition of the womb, the supervention of
dengue was an occurrence attended with much danger to the
well-being of gestation. The number of miscarriages was very
remarkable, and in the latter months of pregnancy, premature
labor was a very common result of the attack ; and, indeed, we
have been forcibly reminded of that passage, which we quote
most reverently, "woe unto them that are with child in those
days ;" for of all attacked, those females who happened to be in
this condition had most to dread from its advent. A species
of pains resembling what is known, in obstetric language, as
false pains, would precede the contractions, and seemed to be
excitor of them, if not arrested. Miscarriage, superinduced by
dengue, differed from this accident occurring from other causes,
in the fact that, if treated early, its prevention was more easy
in the former, and also the lumbar pain, first felt, was indepen-
dent of the condition of the womb, and instead of being the
consequence, soon became (or rather the irritation upon which
it depends) {because, of the miscarriage. The lumbar pain, in
ordinary miscarriage, is a true symptom of this approaching
catastrophe, indicating most frequently its eai^li/ occurrence,
whereas, in dengue, the pain in the loins must obtain for a con-
siderable time, when it becomes a cause of the accident.

In connection with the hemorrhagic phenomena of the dis-
ease, we mention a case of Purpura, kindly reported to us by
Prof. Garvin, the former Editor of this Journal. The subject
of the disease was a child, and it did not extend further than
the lower extremities. He considers its situation influenced by
the dependent position of these linibs, and as that diathesis pre-
vailed during the attack, gravity determined it to the extremi-
ties. Professors Dugas and J. A. Eve permit us to refer to
cases occurring to each, wherein the patient vomited matter
analogous to black vomit, closely resembling coffee grounds.
In the two cases of Dr. Dugas there were also copious de-
jections of a similar character.

Convulsions, in children, have been very common in this dis-
ease ; and when we consider the truly nervous character of the
complaint, we cannot be surprised at this complication. In

26 Campbell, on Dengue Fever. [January,

paroxysmal fever, we know that convalsions are of frequent
occurrence, and here, we have a disease which, in the condition
of the nervous system, is similar, as we believe, to its condition
under a prolonged paroxysm, and in the susceptible innervation
of the child, we find ample predisposition to the convulsions.
In some cases, the convulsions were of a most obstinate char-
acter, continuing for many hours, and returning with remarka-
ble tenacity. One marked feature of our epidemic we have,
until now, omitted to notice ; yet, from its frequency, it may
be considered among its prominent characteristics. We refer
to the relapse so generally succeeding the period of apparent
convalescence. On the fourth or fifth day from the access of
the disease, the patient, having passed through the attack as
above described, will experience a respite, varying from one
to two or three days, and then, without apparent cause, the
headache and pain in the back returns ; nausea and vomiting,
even if not existant before, will now almost certainly ensue,
and the eruption also, at this period, will either be seen for the
first time, or reappear the febrile symptoms, however, do not
usually run so high as during the earlier stage of the complaint.
The period of relapse has a duration of from two to four days,
when, with this last sally, the monster looses his grasp upon the
devoted patient, leaving him ill-natured, depressed and wreck-
ed. The appetite is gone, and in its stead, a most villanous
and persistent taste is left to sophisticate the delicacies which
are the natural and rightful concomitants of an ordinary conva-
lescence. We have noticed in the convalescence of several
cases, various annoyances, such as falling of the hair, eruption
of boils, and an obstinate wakefulness, which, in one iustance,
terminated in temporary insanity, rendering imprisonment ne-
cessary for the welfare of the patient.

From various calculations we have seen, we think, the num-
ber of cases in Augusta during the past season may be estima-
ted at between eight and nine thousand the majority of which
did not receive the attentions of a physician, being subjected to
domestic treatment. Out of this vast number, we have not
heard of a single death from the epidemic, uncomplicated. In-
deed the prognosis of the disease, under ordinary circumstan-
ces, was invariably favorable.

1851.] Campbell, on Dengue Fever. 27

A comparison of this disease with the epidemic of 1828
prevailing in Charleston, and so ably described by Professor
Dickson, with whose name the very term Dengue will be ever
inseparably connected, allows the following conclusions, viz :
that while the epidemic of '28, was an arthritic disease, af-
fecting the joints (especially the smaller joints) in a manner
similar to articular rheumatism, the present is neuralgic, and
bears the same relation to neuralgic rheumatism, that the other
did to the articular ioxn\ of the disease.

In the former epidernic, the sequelae were those of articular
rheumatism, whereas, in the present, we have heard of but a
single case, out of the multitude, wherein anything of the kind
obtained. This isolated case was in the practice of Professor
Ford.

Above, we have given a brief history of the more prominent
peculiarities of this epidemic as they have appeared to us, on
a review of our observations of them during the past season.
For the last month, the disease has disappeared, with the ex-
ception of an occasional case. Scarlatina, which had preceded
it, and seemed extinguished, or "disguised in its livery," during
its prevalence, is again making its ravages among us. From
several cases of this disease, we think we discover a greater
tendency to convulsions than usual, whether determined by the
previous prevalence of dengue, or not, w^e are unable to say.*

From the self-limited nature of the disease, the treatment, of
course, could not, in accordance with the true principles of the-
rapeutics, have been other than palliative. Any effort to cure
or shorten an attack, would, in our opmian, have been as vain
as to have attempted to modify the natural and fixed phases of
rubeola or scarlatina. Yet, we consider that dengue had its
appropriate and necessary treatment, for although " no one
could die of the break-bone," still, from ihe serious amount of
suffering to which its victims were subjected, palliation became
a very desirable object.

In the uncomplicated form of the disease, we have generally
preceded other remedies by the administration of a mild cathar-
tic : oil, or the sulphate of magnesia, has been used by us quite

Since the above was written, as many as four cases of Scarlatinal, attended
by convulsions, have come to our knowledge.

28 Campbell, on Dengue Fever, [January,

often. When there was hepatic derangement, or a tendency
to diarrhoea, we have preferred blue mass to any other cathar-
tic, and among children, particularly, we considered it prefera-
ble to all others. Emetics we have rareiy used, unless the
case was complicated by sore throat indicating their adminis-
tration, for the nausea, which was a frequent attendant on the
disease, seemed to forbid their use. After the evacuation of
the bowels, we could now attend to the most important indica-
tion for treatment, to relieve the severe pain with which the
patient is tortured ; for this purpose, our chief reliance has been
upon Opium, in the various forms of laudanum, Dover's pow-
der, morphine, &c., &c. From the tendency to nausea, we
have avoided, as much as possible, the administration of medi-
cines by the mouth, and we found that by enema, opiates ex-
erted a better influence than by the former mode; indeed, after
the evacuation of the bowels, the laudanum injection became
our constant and only remedy, and we have found it, above all
others, the most efficient.

Now, when we consider the location of the greatest amount
of suffering, viz., the lumbar region, and the rapidity of absorp-
tion by the rectum, the reason of our selection will be apparent.
Indeed, by this mode of administration, it has the double advan-
tage of a general and local remedy. The frequent tendency
to diarrhoea and dysentery, so common as a complication, was
also another reason for this mode of medication. In those
cases where abortion was impending, this, with the application
of sinapisms to the lumbar region, would invariably arrest the
pains, and b}^ repetition, the accident was prevented.

Rubefacients, also, were of the greatest benefit; mustard
poultices to the spine, together with mustard pediluvia, aflln'ded
invariable, if but temporary, relief But in the severer cases,
where the intensity of the frontal and temporal neuralgia was
too urgent to wait the effect of the opiate treatment, we found
the inhalation of chlonform, as well as its local application,
to afford immediate and entire relief. Of diaphoretics, we can
speak in the highest terms : nitre, the general bath, and indeed
every other sudorific means, we can recommend with the great-
est confidence; and if there is a disease wherein, from an
a priori view, we would suggest the Hydropathic "Packing"

1851.] CvimiiheW, on Dengue Fever. 29

with wet sheet and blankets, this is the one wherein its use
seems most applicable. The neuralgic pain, the hot skin, the
entire arrest of cutaneous transpiration, together with the gen-
eral nervous iriitablity characterizing its accession, all mark
conditions which the swathing and relaxing vaporizations of
these therapeutic ultraists are best calculated to ameliorate.
We have not made use of this remedial means in any case, but
from the general aspect of our epidemic, especially in its earlier
stages, we have been strongly tempted to test its efficacy
*'/e prends le Men ouje le trouve.''^

Now, with regard to the administration of quinine, as a gen-
eral remedy, we cannot speak with any great degree of confi-
dence. In a few cases, where the fever appeared to assume the
remittent type, we have seen marked benefit accruing from
quinine and laudanum enemata, applied during the remissions,
and in the latter stages of the disease, where the convalescence
was unusually protracted, this proved a valuable remedy. The
complications of the*attack were generally of themselves suffi-
ciently suggestive of their own appropriate treatment, not to
require here any amplification. The diarrhoea and the various
hemorrhages required nothing peculiar in their treatment ; but
for the nausea and prostration of the stomach, so distressing
during convalescence, we found small and repeated doses of
brandy the most efficient, indeed, the only remedy. This very
disagreeable attendant of the convalescence, seemed to depend
entirely upon the enfeebled condition of the stomach, and
required stimulants alone for its relief. After the failure
of various remedies opiates, camphor, antacids, with every
sedative imaginable, small quantities of brandy relieved this
distress with remarkable promptness ; and the amount of this
stimulant the most delicate females were enabled to bear under
these circumstances, without cerebral disturbance, was truly
stirprising.

Ale and porter were much used in the convalescence, and
generally with good effect. Our own experience, however,
does not corroborate their advantage, as beverages, to the ex-
tent which their popularity would seem to indicate. In a few
cases, we have observed diarrhoea of the most violent nature, re-
sult from their use, and also much gastric and intestinal distress.

98 Campbell, on Dengue Fever. [January,

After the long-continued nausea has in a measure subsided,
the stomach remains extremely susceptible to irritative impres-
sions the ingestion of almost any food, causing a return of the
distress ; therefore it became necessary to select such diet as
would be least apt to oppress this greatly enfeebled organ.
For this purpose, we have recommended, with advantage, fresh
cream and lime-water, one third of the mixture being lime-
water. This, being light, nourishing and demulcent, was re-
tained a sufficient length of time for digestion, which healthful
exercise repaired the energies of the stomach for more solid
ingesta. In many cases, from a second attack of the disease,
the convalescence would be unusually protracted. In this con-
dition tonics became appropriate. We have used the bitter
vegetable tonics exclusively of these, gentian, cinchona, and
columbo, have been our selection.

In the foregoing very imperfect sketch, we have forborne to
indulge in speculations about the cause of this singular disease,
a question which, judging from the sphynx-like pertenacity
with which the riddle has been plied, is infinitely more impor-
tant to some than their recovery from its inflictions. To the
more intelligent of the profession, it will be not more necessary
to assign a cause for this, than other epidemics ; but to those
ardent searchers after the invisible and inappreciable, whom we
meet in our daily rounds, to whom an answer must be given,
or a lengthy explanation why we cannot answer^ to such, our
invariable reply, delivered with as much profundity of manner
as we could assume, has been " It depends upon some modifica-
tion in the condition of the atmosphere, wherein the elimination
of morbific particles has been produced, and the epidemic is
the result of this elimination.'*' The mystery is cleared, the
whole becomes lucid as sunshine, it is atmospheric, that is, in
the air ; every one can understand this the explanation is
therefore extremely satisfactory. Until our means and appli-
ances for testing the accidental and occasional constituents of
the atmosphere have become more perfect than at present,
until years of meteorological and pathological observation have
passed, leaving an immense accumulation of simple, isolated,
but coincident /tzc^5 on record; until these facts are compared
and laboriously studied, with the strict scrutiny of inductive

1851.] Lecture on the Spinal System. 31

discipline, and the results accruing clearly interpreted, all of
which, we fear, must be in other times and by another race of
philosophers than the present, until then, we say, the answer
must still be superficial, to all who make so superficial an in-
terrogation.

PART II.
ScUctic epartm^nt.

A Synopsis of the Spinal System. Being the Croonian Lec-
tures, delivered at the iioyal College of Physicians, London.
By Marshall Hall, M. D., F. R. S., &c., &c.

Gentlemen, I regard it as a great privilege to be deputed to
give these lectures. It was within the walls of this college that
the great Harvey propounded his incomparable discovery of
the circulation of the blood. It is here that we are exhorted,
annually, to imitate his bright example in the search after
physiological truth; and it is here that each of us may, in his
turn, enjoy the opportunity of laying before the profession the
results of his labours.

It is to Dr. Croone, one of the original members and foun-
ders of the Royal Society, and a fellow of this college, that we
are indebted for the lectureship, the duties of which I shall
endeavour to fulfil on this and two subsequent days. I can
imagine no greater benefactor to our profession, after the la-
bourer himself, than the person who, by such an endowment,
encourages the labours of others. Honoured, therefore, be the
memory and name of Croone.

In the Royal Society the same munificent individual institu-
ted a lecture, to be given annually, especially appointing its
subject, that of Muscular Motion. I can suppose, therefore,
that he would have felt an especial interest in that of my own
labours, which I propose to bring before you on this occasion.

The investigations to which I advert were beguai twenty
years ago. They have been continued, wirthout interruption,
to the present time, and are still alas! how incomplete. Such
as they are, however, they have occupied me during 25,000
hours ! Nay, if I may add the hours devoted to the same sub-
ject in practice, as connected with disease, I think I may double
this number.

Of this persevering industry I may surely be allowed to
boast. It is by such, only, that new an'd great truths in medi-

2& Lecture on the Spinal System, [January,

cine are detected and elaborated and error avoided. I may
too, I believe, in the very spirit of the founder of these lectures,
make a boast of another kind, I have never, during my long
career, endeavoured to depreciate the efforts of any one of my
professional brethren. I am grieved to say that this cannot be
said of all of us, for the race of the Primeroses and of the
Parisanuse is by no means extinct.

But I proceed to my subject.

In 1831, I read a paper, on the circulation of the blood, as
observed principally in the batracia, before the Royal Socie-
ty. Besides the different schemes of the minute arteries and
minute veins seen in the several seats of the systemic and
pneumonic circulation, that paper contained the discovery and
the first enunciation of a distinct series of vessels or blood-
channels occupying the spaces intermediate betvi^een the last
branches of the arteries and the first roots of the veins, chan-
nels which I then designated the true "capillnries." This de-
signation has been justly criticized by Dr. Voigt, the pupil of
the celebrated Professor Berres, of Vienna, the anatomist to
whom we are indebted for the greater part of our knowledge
of the different forms of these vessels, which he proposes to
call, from their position between the arteries and the veins, the
"systema vasorum intermedium."

From the fact, that it is in these vessels or channels that all
the changes in the blood are effected, whether in the systemic
or the pneumonic circulation, I have more recently thought
that the designation victhcematous blood-channels, or more
briefly, methcemata, would be the most appropriate. The
veins, heart, and arteries are mere machinery for conveying the
blood to and from these methsemata, m which in reality, all the
purposes and objects of the circulation are effected. This dis-
tinction between the minutest arterial branch and venous root,
and the intermediate methasmatous blood-channels, is absolute
in every point of view form, structure, function, &c. In this
last respect, the former are mechanical merely ; the latter,
chemical.

Perhaps the most beautiful fact in the minute circulation is
the arrangement of the minute arteries and the minute veins, so
obviously adapted to accomplish the precise object of the
circulation in each individual part or organ. Observe this
diagram, and compare with it the following one: They
dis[)lay the arrangement of artery and vein in the web of the
frog an arrangement obviously intended to admit of the dis-
tribution of the intermediate or metheematous vessels, so as to
confer nutriment on the tissues. Compare the representa-
tion of the arteries and veins in the mesentery; Tliey are

1851.] Lecture on the Spinal System. 33

comparatively large. They obviously proceed farther than
they are seen. The seat of their real function is beyond. The
mesentery is, in fact, little more than a framework to convey
them to the intestine, and there the methaemata are evolved,
with their real and appropriate function.

But now, gentlemen, examine the third diagram, displaying
X\\Q pneumonic scheme of arteries and veins, the obvious object
of which is to give origin to innumerable methaemata which
actually spread over the intermediate spaces or area, so as
to expose the blood-globules to the action of the atmosphere
through the fine (and almost arachnoid) tissue of the lung. It
is the lung of the Triton Observe this artery running parallel
to this vein. The intermediate space is one field of methasma-
tous vessels. Here are branches of arteries. With each of
these arterial branches a venous root runs parallel. In this
spot there are no arterial branches. The same fact is observ-
ed in regard to the vein; there are no venous roots. There
\s, \.\\vou^\\o\Ji\., perfect parallelism. How obviously the result
of design I

But in this fourth diagram, you see the pneumonic methae-
matous channels themselves, as you may, when this lecture
is concluded, see, through this microscope^ the gold-like
flood of blood-globules to which they are destined to give
course.

But to return from this digression. It was during the pre-
paration of that paper that I was struck with the occurrence of
the phenomenon to which I have adverted, the first of the se-
ries which I have since designated " reflex actions."

My- friend Mr. Henry Smith and myself had, on a memorable
day, observed and traced the pneumonic circulation in the Tri-
ton. We then removed the head, and divided the senseless
body of the animal into three portions, anterior extremities,
posterior extremities and tail :

On irritating the separated tail with the point of a probe or
the forceps, it icas observed to move and become contorted into
varied forms I

On irritating the anterior or posterior extremity in the same
manner, these also moved, being withdrawn and made to ap-
proach the adjacent portion of the trunk of the animaK

Other similar phenomena were speedily observed ; and I was
gradually led on to the development of the spinal or diastaltic
system.

Having thus stated the short history of my first observation,
I proceed with my subject ; yet once more, before I do so, I
must take this early opportunity of explaining several new
terms, which I have thought it necessary to introduce, in order

34 Lecture on the Spinal System. [January,

that my views may be fully and unequivocally expressed, and
all but the most wilful misrepresentation prevented.

On analyzing the facts which have been detailed, I observed
that the following anatomical relations are essential :

1. A nerve leading /ro?/z the point or part irritated, to and
into the spinal marrow ;

2. The spinal marrow itself ; and

3. A nerve, or nerves, passing out of or from the spinal mar-
row, all in essential relation or connection with each other.

On these anatomical facts I have ventured to institute anew
nomenclature, descriptive of what I have hitherto designated
the Spinal System, and expressive of these essential points.
The term peristaltic (from itz^i and orsXXw, to contract,) is
familiar to us all. It may be justly extended to all the move-
ments of the inferior organs, as the heart, the stomach, the
large and small intestines, the uterus, &c. These movements,
it is well known, are independent of the spinal marrow. But
it has been shown that a series of experimental phenomena,
and it will be shown hereafter that a series of important func-
tions, are effected by means of the series of nerves in essential
connexion with the spinal marrow, to which I have adverted.
The action or act is performed through the spinal marrow as its
essential centre. I propose to designate the phenomena by the
term ^la-staltic.

The spinal system may henceforth be designated TheDia-
staltic Nervous System, a designation which will have the ad-
vantage of including this system in the invertebrate as well as
the vertebrate tribes of animals. This system embraces a pe-
culiar anatomy, physiology, pathology, and therapeutics.

Perhaps the only purely diastaltic function is Respiration ;
and this is variously modified by volition and influenced by
emotion. But there are many other functions which partake
of both the diastaltic and peristaltic character. Such are the
functions of the immediate conduits of ingestion and of eges-
tion ; the oesophagus, the rectum, the uterus. These functions
are dia- and peri-?,id\\.\c.

How much there is in these terms calculated to excite new
and accurate inquiry! How much to refute injurious and ca-
lumnious criticism ! I have hitherto spoken of the mode and
course of the diastaltic actions and functions. But I shall im-
mediately proceed to show that the Principle of action in the
diastaltic nervous system is as special and peculiar as its direc-
tion. This principle I long ago demonstrated to be the vis
nervosa of Haller, the ^^ excitahilite''* of M. Flourens, acting
in newly discovered, diastaltic forms. Now, the term "reflex"
may have been vaguely used by Prochaska ; but the full and

1851.] Lecture on the Spinal System, 35

distinct idea of a diastaltic action of the vis nervosa had occur-
red to no one.

We are much in need of other terms still, to aid us in this
investigation. The terms incident excitor and reflex motor
have been used to designate those nerves v/hose influence pro-
ceeds to and from the spinal marrow. But they have never
appeared to me satisfactory, and I have long wished for others
more expressive and explicit. The following compounds of
odoc:, a Way, have appeared to competent judges very appropri-
ate to our subject ; esodic (^Cw) will express the action into ;
exodic (tgoj,) the action out of; anodic (avw,) will express the
ascending, Q,^i\\odi'\c {xclto) the descending, course of action;
pollodic (croXutr) and panthodic (-^w^) will express the facts, on
which I shall shortly have to dwell at considerable length, of
the action of the vis nervosa from each one point of the diastal-
tic system, in many or even all directions, to every other.

Many important facts, many important truths, will be con-
veyed to the mind at once by these simple terms. Their root
is already familiar to us in the word periodic ; and several de-
rivations from it have already been employed, in the science of
his creation, by the illustrious Faraday. It must be distinctly
understood that they are all to be restricted to the anatomy,
physiology, pathology, and therapeutics, of the diastaltic nerv-
ous system, in which they express the modes of action of the
ms wert;o5a, distinctly from and exclusive of all other influences
whatever, as sensation, volition, emotion, &c.

According to the Roman critic

" Si forte necesse est
Indicus monslrare recentibus a-bdita rerum,
Fingere cinctntis non exaudita Cethegis
Coniinget; dabturque licentia sumpta pp.denter."

I here present you with the interesting object to which I
have alluded. On this plate I have placed a Triton, divided
so as to display the head, the anterior and the posterior ex-
tremities, and the tail, separately. If you touch the eye with
the point of this needle, the eyelids close ; if you touch'the an-
terior of the posterior extremity in the same manner, it is
retracted ; if you touch the extreme part of the tail, it coils up
immediately and energetically.

The last phenomenon was, as I have stated, the phenomenon
which I first observed. I did not touch nerve or muscle ; the
phenomenon could not then be one of the vis nervosa or vis
muscularis. What, then, was its nature? what its motor
principle? what its application in physiology? It was im-
possible for the inquiring mind not to be led into these and a
multitude of similar questions.

\, 3. VOL. vn. NO. I. 3

I

3i6 Lecture on the Spinal System, [January,

If, in the severed head of the frog, the toad, the eft, the
snake, the kitten, the puppy, the young rabbit, &c., we touch
the eyehd, the eyelash,, or the conjunctiva, the eye is immedi-
ately closed. The came event occurs in the horse stunned; to
insensibility by the blow of the pole-axe.

If, in the decapitated trunk of the animals, we irritate a toe
or other part of the foot of the anterior or posterior extremity,
this extremity is immediately withdravi^n ; if we irritate the
tail, or the integuments near the sphincter ani, still greater
movements are produced.

If the brain merely be removed, in a very young animal,, all
these phenomena are still observed.

The same effects are produced by irritating the dura matef
within the cranium, and other interior membranes and tissues
a fact which throws a beam of Hght on some pathological
events.

By any of these irritations, an act of inspiration, if respira-
tion were previously suspended, is especially apt to be induced.

Each irritation of a cutaneous or mucous surface appears to
induce a peculiar, special, and definite movement. If in the
very young kitten, deprived of cerebrum and cerebellum, the
foot be irritated, it is retracted ; if a finger be introduced be-
tween the lips, an act of suction is excited; if a soft substance,
as milk, be inserted into the pharynx, an act of deglutition is
attempted; if the border of the rectum be irritated, the sphinc-
ter is contracted. The eyelash, the meatus of the ear, and the
tufts of hair between the toes, are peculiarly excilor.

Similar phenomena are observed in the anencephalous foetus
in the early stage of asphyxia in young animals,, and in the
ana3thesia induced by chloroform.

In the case of perfect paraplegia in the human subject, when
sensibility is absolutely extinct, and voluntary movements to-
tally abolished, diastaltic actions are excited on the application
of appropriate irritants, such as tickling, a puncture, a pinch,
or sudden heat or cold ; all of which the patient is unconscious.

By continuing my experiments, I soon discovered that an
excitant and the presence of the spinal marrow were essential
to this phenomenon, and that from the point of the cutaneous
surface a continuity of nerve to the spinal marrow and from
this to the muscles of the part moved, were also requisite.

I soon found that the facts themselves were known to phy-
siologists; that Whytt had, in one paragraph, shown the ne-
cessity for the presence of the spinal marrow ; and that Sir
Gilbert Blane had stated that the phenomenon was not one of
the sensibility. But in this defective condition our knowledge
on the subject remained. It was not known that the phenotne--

1851.] Lecture on the Spinal Syatem, 37

na in question were limited io the spinal mvixvow exclusively o{
tlie cerebrum and cerebellum ; that they were always excited
and never spontaneous ; that they weie phenomena of the vis
nervosa acting according to a law then unknown; that though
then only observed in experiments, they had an extensive place
in physiology and pathology. All these relations, and many
others, it has been my object and office to trace.

Perfectly similar experiments had, I hav said, been made
long ago, by Redi, Whytt, Legallois, Blane, (fee. This was fully
stated by me in my first publication on the subject, (see Me-
moir I. lOT, 129, &c.) Whytt had even asserted the neces-
sity for the presence of the spinal marrow; and Blane had
stated that sensation is excluded. What then? Did those
observations lead to any result ? to any detection of the motor
principle involved f to any application to Anatomy, Physiol-
ogy, Diagnosis, Pathology, Therapeutics, or Obstetrics ?
JNo! Not one tittle of all this was accomplished by any one.

In making this assertion, I include Unzer and Prochaska, of
whom so much has been calumniously written in this country.

Whytt speaks of all the phenomena in question as dependent
on the soul.

Unzer asserts that the spinal marrow is merely " a thick cord
of nerves''' {?i view which excludes the idea even of a really
reflex or diastaltic action absolutely)^and may be fairly sup-
posed to speak through his pupil, Prochaska. Now the latter
author describes diastaltic actions as 'impressionum sensoriar-
um in motorias reflectio ; and, so far from even entertaining the
idea of a dia-sicihic function or System, confounds the effects
of volition and emotion, and 'the action of the heart, stomach,
and intestines, with actions really and truly diastaltic.

I will only add, in concluding these brief remarks, the ex-
pression of my regret, that any of my professional brethren
should be found, of minds so ignoble as to persist in the injus-
tice which has been so long, although vainly, attempted in this
matter continually immolating, during the whole course of
nearly twenty years, truth on the altar of misrepresentation
and detraction.*

Allow me now to call your attention to this experiment. In
this object I present you with the lower extremity of the frog,
attached to the lumbar nerve, but otherwise detached from the
rest of the tissues. If I irritate the nerve, the toes, the foot,
and the whole limb are moved.

In this second object, the nerve is still in connexion with a
portion of the spina! marrow, the rest of the tissues being re-

< See Dr. Forbcs's Revifw ; Dr. Todd's Cycbpocdia, &c.

38 Lecture on the Spinal System. [January,

moved. The same, but more energetic movements are pro^
duced, by irritating the spinal marrow.

The nervous influence by which these phenomena are pro-
duced was designated, by Halier and his followers, the Vis
Nervosa. This Vis Nervosa, this power in the spinal marrow
and muscular nerves, by means of which, if their tissues be
irritated, muscular contraction follows, was supposed by Halier,
by Bichat, by Professor J. Miiller, and I believe, by all physi-
ologists, to act in one direction only ^from above downwards^
Its action was supposed to be ca/-staltic only.

As long as this view prevailed, this motor power had, and
could have, no application to physiology. It was presented to
us as a mere experimental fact, or, at the utmost, in its relatiork
to pathology.

It was, like the facts noticed by Redi, Whytt, &c., sterile,
and without utility. Now the existence of a distinct and en-
ergetic motor power in the animal frame, without utility in the*
animal economy, would be a perfect incongruity, and contrary
to everything observed in creation.

By a series of oft-i*epeated experiments, I have demonstrated
other Laws of action of the vis nervosa, and especially one
which may be designated cZ/a-staltic.

By this discovery I have been enabled to prove the identity
of the motor power in the experiments of Halier, and in the-
experiments of Redi and of Whytt, and, disentangling the
maze, to show that that double series of experiments is not
without its application in physiology ; that the latter have, iri
fact, their prototypes in all the acts of irhgestion and of egestion
in the animal economy, and in some instances of pathological
and therapeutic actions ; and the former, in certain cases of
pathology. It is the first real step in the philosophy of involun-
tary motions.

Observe this preparation of the frog. In addition to the
portion of the spinal marrow with the denuded lumbar nerve,
presented to you in the last experiment, I have, in this, left the
lumbar nerve, of the other separated limb. If I pass a galvan-
ic current of some power along this portion of nerve, the limb
to which it is attached through the spinal marrow and the other
lumbar nerve, but to which it does not itself belong, is moved
as before, but with less energy. The nervous force called into
action the vis nervosa is the same. The phenomenon is dia
staltic, the others being ca^a-staltic.

But if the limb be not removed, and a toe be irritated,- the
same rZza-staltic phenomenon is observed.

If the lumbar nerves be denuded, but left in connexioy
through the spinal marrow, with the anterior extremities, and

1651.] Lectui^e en the Spinal System. * 39

subject to an energetic galvanic current, even these limbs are
moved. Tlie action is not only 6?/-staltic, but G?zrt-staltic.

If the spinal marrow, in the decapitated tortoise or turtle, be
dentkied and irritated by the point of a needle, or the galvanic
current, both anterior and posterior extremities are moved.
Thes;/2e irritation, applied to one and the same point of this
nervous centre, produces all these movements.

If, instead of irritating a point of the spinal marrow itself,
we denude and irritate a lateral spinal nerve, the same re-
sults, the same movements of both pairs of extremities are ob-
served.

In the first experiment, it is the vis nervosa of Haller which
acts on the posterior extremities. This is the general vievv\
Are the similar and sinchronous movement of the anterior ex-
tremities, and the similar movements of both anterior and pos-
terior extremities in the second experiment, oi different o\'\gm'{
But if the integument be irritated, the same movements stilUake
place; and this is one of the eases of reflex or diastaltic action.

Lastly, if we so irritate the border of the eyelid, the eyelids
close; or if we touch the border of the larynx, or of the sphinc-
tor ani, these orifices are closed. But these are Functions.

Such I believe to be the Demonstration of the diastaltic ac-
tion, and such the application to physiology, of the vis nervosa
of Haller.* Previously a sterile experimental fact, this princi-
ple of action hasnov/ taken its place as the dynamic force pre-
siding over the large class of i\\Q functions of ingestion and of
egestionin the animal economy.

It appears to me that the anastalic and the diastaltic actions,
in these experiments, are slower and more combined than the
merely catastaltic. There is a similar difierence between phy-
siological acts, which are all diastaltic, and those pathological
movements which are catastaltic.

Xor is the action of the vis nervosa, under these circum-
stances, merely diastaltic. It frequently occurs that, instead of
such an event, there are diastaltic actions in many or all direc-
tions.

Exp. If a frog be decapitated, and a toe of one anterior ex-
tremity be irritated with the forceps, this and all the other limbs
are moved. There are, therefore, a reflex action, and actions
in the various directions across the spinal marrow, and down-
wards along this nervous centre, both directly and obliquely, to
both inferior extremities.

Exp. If a toe of an inferior extremity be irritated, the
phenomena are still the same : reflex, across, and upwards, both
directly and upwards, both directly and obliquely, to both an-
terior extremities.

See Memoir II., 15 ; New Memoir, 95.

40 Lecture on the Spinal System. [January,

In the first experiment, the action of the motor power is
esodic in the nerves and variously reflex, diastaltic, and cata-
staltic in the spinal marrow ; in the second, it is ana-sVcdiic.
And, so far, the action might be designated as pollodic. But I
use the term panthodic in a very emphatic sense : I believe that
no spot of the diastaltic system can be excited without telling up-
on eveiy other. Inspiration, partially suspended, is excited by
irritation on aiiy part of the external surface. The application
of cold water on the face not only excites inspiration, but de-
glutition, micturition, contraction of the uterus, &c. The en-
tire system is in a state of static "tension, each part being in
strictrelation with every other ; this becomes dynamic force
on the application of a stimulus.

Sometimes there are comhined and concatenated actions ; and
wherever the excitation may be applied, there may be a leap
or a jump.

It must be observed that in all these cases the nerves are
esodic and exodic ; but of what takes place within the struc-
ture of the spinal marrow, on which might well be inscribed
the word mystery, we are still utterly ignorant ; we only
know that the result of irritation in such a case is not only va-
riously diastaltic, but panthodic.

The diagram to which I now call your attention displays, at
one view, the progress of the Demonstration of the identity of
the motor principle in tlie experiments of Haller, and in those
of Redi, "Whytt, &c., whilst it illustrates both.

This nerve, or the spinal marrow at this point, being irritated,
the limb is moved : this is the experiment of Haller. The toe
being irritated at this point, both limbs are moved: this is the
experiment of Redi and Whytt, Finally, this point of the nerve
being irritated, both limbs are again moved, but the one to the
right is moved by downward influence, as in the experiment of
Haller, whilst the one to the left is moved by reflex influence,
as in the experiments of Redi and Whytt. The same excitation
has acted downwards simply, and diastalticall}^ both limbs be-
ing moved.

I now lav before you another experiment. In the frog here
exhibited we have removed the cerebrum and cerebellum, and
all the viscera. The centre of the cerebral system, and the
ganglionic system and especially that intra-visceral-ganglionic
system which is the splendid discovery of Dr. Robert Lee, the
most important, in Anatomy, of the present century, are all
extirpated. Yet you will observe that an interesting series of
muscular movements are still excitable. If you irritate a toe,
the limb is retracted and the other limbs are moved ; if you ir-
ritate the skin near the sphincter ani, various movements of

1851.] Ijcclure on the Spinal System. 41

the posterior extremities especially, and of the animal generally,
are still performed. Sometimes, you will observe the combined
movements constituting a leap, or a jump even !

This experiment I consider as the analysis of the nervous
system into the cerebral, the ganglionic, and the spinal. The
very centre of the first is removed ; the second is removed with
the viscera; the third remains, with its rem.arkable phenomena.
I have in this experiment separated and isolated the spinal
marrow for the first time. It was previously, viewed in its
singleness, undetected and unknown.

And what an extraordinary object is this mere nervous and
muscular shell of an animal ! The skeleton of bones is familiar
to us. This is a skeleton of nerve and muscle as it were, all
their excito-motor power, and all their motor, remaining in its
vigour ! I know of nothing so extraordinary in physiology.

The cerebrum is removed, the whole ganglionic system is
removed, but the diastaltic nervous system remains, wnth its
diastaltic nervous and motor power, all its diastaltic nervous
arcs! The diastaltic system is singled out, and separated ab-
solutely from the other divisions of the general nervous system.
Everything which relates to the diastaltic system remains in
force ; all that is cerebral sensation, volition, spontaneous
movement, emotion, pain all that relates to the ganglionic sys-
tem all/?e?'2-staltic action, is removed. This experiment alone
is sufficient to establish the whole Theory of Diastaltic Nervous
Action once and for ever !

I beg now% gentlemen, to call your attention to a further ex-
periment. In the one just detailed and placed before you, I
made an analysis of the nervous system generally; I now
propose to make a similar analysis of the spinal system spe-
cially.

On this plate you will find a frog which was first decapitated
and then divided between the anterior and posterior extremities.

It is necessary, in doing this, not to make the division too
near the cranium in the first instance, or too near the anterior
extremities in the second.

If you touch the eye, the eyelids close, and the eyeball is re-
tracted. If you touch or puncture a toe of either extremity,
the limb is moved.

There diX&tkree modes of annihilating such movement.

The first mode is to remove from the foot or toe the cutane-
ous tissues. With these the origins of the incident or esodic
nerves are removed ; the first part of the reflex arc is wanting.

The second mode is to divide the brachial or the femoral or
lumbar nerve ; the course of the arc is interrupted, and tho arc
itself is again incomplete.

42 Lecture on the Spinal System. [Januar}%

The third is to destroy the portion of the spinal marrow in
connection with this nerve itself. The very key-stone of the
reflex arc is absent.

Can any thing be more deeply interesting, or indeed wonder-
ful, than this perfect analysis of the spinal system, and of each
arc of that system, consisting of the fibrillous organ, the pro-
gress in an esodic nerve, the spinal centre, an exodic nerve,
and its distribution in the muscles, all which is required, in
order that the reflex or diastaltic action may be uninterrupted
and complete!

Many as have been the years during which I have witnessed
phenomena of this kind, I never see them again without a new
and peculiar interest, nor do I think there is any fact in anato-
my or physiology more extraordinary. It is the complement,
as it were, of that which has preceded it, and of the analysis
of the nervous system.

But I have a fact an experiment of a still more remarka-
ble kind, to bring before you.

Examine this prepared frog: the head and the anterior ex-
tremities have been removed ; the tissues behind the lumbar
nerves have been removed in their turn, and the pelvis has been
divided, and the posterior extremities separated.

jVow observe what takes place wiien I irritate the foot : the
limb is immediately flexed and retracted ; the other limb is also
moved !

The influence the nervous motor influence must have
ascended this lumbar nerve, have proceeded to the spinal cen-
tre, have been reflected along the same nerve in the contrary
direction ! The action is diastaltic, and esodic and exodic
along the same compound esodic and exodic nerve.

Nor is this all. To and from the same spinal centre, a part
or portion of the same motor influence has been sent along this
other nerve to this other extremity.

What do you think of these diastaltic nervous arcs, of which
the idea did not previously exist in the science of anatomy and
physiology ? Do you imagine that they merely exist in these
limbs? or are merely displayed in these experiments? So
far is this surmise from being true, that they exist, and are, as
it were, difl'used, through a whole Class of the functions of life.
I have shown you I have laid bare before you a diastaltic
nervous arc in the limbs of the frog; but such arcs, hitherto
undetected, exist in the animal and in the human frame, and are
the anatomical and physiological agents in rt/Z the functions of
ingestion, of retention, of egestion, and of exclusion ; each and
all of these'functions are performed through the channel and
agency of a diastaltic nervous arc ! not as conducting sensa-

1851.] Lecture on the Spinal System. 43

tion or volition, but an excito-nnotor power, so totally distinct
from either of them, that whilst they ^re physical in their na-
ture, tiiis \s psychical : and whilst one of them is frequently
spontaneous in its action,, this is always excited.

The facts which I have to lay before you are absolutely
overwhelming from their number, and they are not less mo-
mentous than numerous. Examine this diagram. It represents
the superior and inferior laryngeal branches of the pneumogas-
tric nerve. In the function of deglutition, during which, as you
know, the larynx is closed, the origins of the first of these are
excited by the contact of the food or drink; the excitement runs
along the nerve to the spinal marrow; it is thence reflected,
and it is then sent along this inferior and recurrent laryngeal
to the muscles which close the larynx.

Thus we have traced a physiological Diastaltic Nervous
Arc. Many such a whole class, indeed exist in the animal
economy.

It is by the means and agency of such Arcs that all the orl-
Jices and exits all the sphincters of the animal economy are
guarded and governed.

The tubal structures, which proceed from, or lead to, these
sphincters, are generally influenced by a /M;ofoZc/ kind of ac-
tion the diastaltic, through a diastaltic nervous arc ; and the
peristaltic, through the ganglionic system. Such is the case
with the oesophagus, the rectum, the uterus. Prof J. Reid ob-
served that the oesophagus is an organ of diastaltic action. I
had previously observed its peristaltic action when insulated
and separated from all other tissues, and laid on the table for
observation : parsley contained in that of the rabbit was gradu-
ally extruded.

The same principles doubtless obtain in regard to the uterine
organs. Partly diastaltic, partly peristaltic, parturition may
take place from the influence and energy of either or both of
these powers. This act is doubtless further assisted by volition,
and it may be promoted by hope, or enfeebled by/er, as it is
by other elevating or depressing passions ; whence the ques-
tionable use of chloroform inordinary cases of accouchement.

But the most important, perhaps the most exclusive, of all
the diastaltic functions, is that of the respiratory movements.
They are purely diastaltic, ceasing instantly when their con-
nexion with the spinal centre is, by any means, destroyed.
These movements may be modified, and are always modulated
by volition, and they are rendered variously hurried and irregu-
lar by emotion. But otlierwise they are solely dependent on
several diastaltic nervous arcs, of which the medulla oblongata
is the centre. Of these a precise view of each is given in this
Table and diagram of the Diastaltic Arcs of Respiration.

44 Cauteri%aiion in ihe treatment of Sciatica, [January,

14

I. The Excitors q ^ III. The Motors

1. The Trifacial, "^ f 1. The Intercostal,

2. The pneumogastric, ^-g ^ 2. The Diaphragmatic,

3. The Spinal, Nerves. '^ & 8. The Lower Spinal, &c.

I may here observe that I have been anxious to illustrate
every principle of the spinal system by experiments, and by ex-
periments which I could lay before you: and I have chosen
the frog for these experiments, because it is most easily obtain-
ed, is most readily subjected to dissection, and possesses in an
eminent degree, especially on the return of spring, after the
season of hybernation, the properties of excitability and irrita-
bility. In every experiment the cerebrum may be severed, and
with it, all sensibility and susceptibility to pain, as the very first
step.

I have thus demonstrated the Diastaltic Law of Action of the
vis nervosa, and established the Diastaltic Nervous Arc in
anatomy. In my next lecture, I purpose to apply these princi-
ples to iPhysiology, and to treat of the varied abnormal condi-
tions of the excitability, preparatory to treating of Pathology
and Therapeutics. [Lo?iG?o?i Lancet.

The treatment of Sciatica by cauterization at points re-
mote from the seat of pain, has been engaging the attention
of our Parisian friends for several months. The application of
the actual cautery to the dorsum of the foot was noticed in the
last volume of this Journal (p. 179). We now present to the
reader some of the researches made in relation to its applica-
tion to the ear ; and also those upon the substitution of Electro-
galvanic shocks in lieu of the more objectionable incandescent
metal.

Cauterization of the Ear for Sciatica. (Translated from the
French for this Journal.)

It is a wise principle to reject nothing in practical medicine,
for our art has not unfrequently been benefited by facts collect-
ed by the unprofessional. Our readers doubtless recollect the
good effects of cauterization of the dorsum of the foot in the
Treatment of sciatica. We now have a new^ cauterization, the
modus operandi of which is still less understood. It is then for

1851.] Cauterization in the ireatment of Sciatica. 45

clinical experimentation to determine this, and we therefore
reproduce, in extenso, the following case reported by M.
Inteau.

Martinet, aged 42 years, of athletic constitution, was admit-
ted on the 22d May into the ward of M. Malgaigne. Two
years before, he felt acute pains in the lumbar region, which
obliged him to remain in bed. At the end of eight days' treat-
ment, consisting of frictions with an ointment, the composition
of which he did not know% he resumed again his occupation.
In the month of March last, he had a return of the disease,
which caused him to enter the Hotel Dieu. Jn three times,
forty-eight cups were applied to the right hip and the lumbar
region of the same side. Three large blisters were drawn over
the trochanteric region and knee. He took, besides this, ten
plain baths, fifteen vapor baths, and aftervC'ards forty sulphur
baths. He came out of the Hotel Dieu, IGth May, suffering
much less than when he went in, but still feeling pains in the
thighs, the knees, and sometimes in the loins.

When he presented himself to us, he had pain in the region of
the trochanter, along the posterior part of the thigh and in the
anterior part of the knee, and tvvitchings in the posterior part of
the leg and foot. He also felt some dull intermittent pains in
the lumbar region. All motion was very painful; walking im-
possible, without crutches; limping very marked, and great
restlessness at night. M. Malgaigne immediately cauterized
the anterior part of the helix with a heated iron, and ordered a
bath. To our great surprise, the patient felt afterwards but a
very insignificant pain. The movements of the knee and thigh
were f\-ee, and he could walk in the ward without crutches.
The limping had almost entirely disappeared as by enchant-
ment. By precaution the patient was ordered to keep his bed.
On the 23d he slept the entire nioht. I feel yet, said he, slight
pains in the interior of the thigh, the knee, and the external
side of the foot ; but they are not to be compared to what they
were yesterday morning. He was dismissed twenty-four hours
after his admission with the advice to take only moderate ex-
ercise, and to return in a few days. He came back on the
27th of xMay. After going out he fatigued himselfa little, not-
withstanding the advice ofM. Malgaigne, and felt a slight pain
behind the trochanter major. When in bed, he suffers no pain.
A little feeblencvss still existed, in consequence of which he
limped when walking. Since this attempt, similar cases have
presented themselves at the clinic of the hospital Saint Louis,
as they were not admitted in the ward. In two of them the
sciatica vyas simple, regular, followed exactly the course of the
perve; in finother, it followpcl verv ncarlv the course of the

4^ Cauterization in the treatment of Sciatica. [January,

gracilis muscle, occupied the knee, and passed down the calf of
the leg. The result of the same cauterization has been uniform ;
that is to say, the pain has ia^.rnediately .disappeared, either en-
tirely or partially, and the patients have returned home without
limping, considerably astonished at being so rapidly or so nota-
bly relieved, even when they were not coniplelely cured

IBul. Gen.de Therop., July, 1850.

In one of our last numbers we made known the favorable
results obtained by M. Malgaigne, in the treatment of Sciatica
by cauterizing the ear. However extraordinary a therapeutic
agent of this kind may appear, w^e publish it, because we think
that nothing should be disdained in practice, and that it is our
duty to keep our readers apprised of the results of cauterization
in the hands of various surgeons. M. Malgaigne seems to en-
tertain for it much regard, and, in the last number of the Revue
Medico-Ckirurgicale has announced that of sixteen or eighteen
cases, in which he has operated, about one-third have been
completely cured on the first day ; in another third, the pain
has diminished or disappeared to return in two, six, twelve, or
twenty-four hours ; and, finally, that in many there has been not
even a temporary benefit. These results are about the same
as those obtained at the Hotel Dieu, by M. Jobert (de Lam-
balle). But it does not appear that the results ^have been so
favorable at La Charite. M. Briquet has treated four patients
by cauterization. One, alone, was permanently relieved ; the
other three have derived no benefit, not even at the moment of
cauterization. We find in the last number of the Gazette Med.
de Lyons an article by M. Berrier, surgeon of the hospital of
that city, who, out of six cases, obtained but one complete, im-
mediate and durable success ; one not immediate, but tempora-
ry ; one half success immediate, but final result unknown ; one
success immediate, and very complete; and, finally, two com-
plete failures. Results so contradictory should make us very
reserved upon the future treatment of sciatica. All that is
known is that its efficacy is not uniform, but that when it does
succeed it is a most rapid and most marvellous remedy. It re-
mains to determine the circumstances in which its employment
is particularly indicated. [JB^^/. Gen. de Therap., Aug., isSO.

In making known to our readers in due time, the new or
renewed method of auricular cauterization, applied in the
treatment of sciatica, we do not dissimulate the fact that this
method is strange, and may even be styled barbarous ; never-
theless, favorable facts were reported in great numbers, collect-
ed in the large hospitals, and w^e have reported them as we did

1851.] C auterhation in iJie treatment of Sciatica, 47

subsequently those which followed. These last were far from
being so advantageous a collection as the first. At present,
enthusiasm has somewhat subsided, and the truth may be at-
tained. Auricular cauterization produces very dissimilar ef-
fects, and in proportions that it is yet impossible to determine.
It cures rapidly in a certain number of rebellious cases of
sciatica that have been treated without success by other means*
This fact is incontestible : it induces immediate, but not durable
relief, in a much larger number; and, finally, in a great many
it produces no change. But how does it act? It is true, that
this inquiry should be made only after positive proof that its
effects are favorable. It very frequently happens that we can-
not determine the mode of action of a remed}-, and when its
efficacy is not sufficiently established, we should certainly not
pre-occupy ourselves with its modus operandi. A priori, it
may be concluded that, cauterization acts by producing a brisk
and sudden revulsion upon the sciatic pain, in virtue of the
HipDocratic principle so often cited ^^ duohus dolorUms simul
ohortis non in codem loco^ vehementior ohscurat alterum^' and
that what induces us to lean towards this opinion is, that the
cauterization is not, as it might be supposed, an insignificant
and painless operation. It is, on the contrary, extremely pain-
ful, and in patients to whom it is first applied, causes a mincjletl
feeling of surprise and fright, and a great unwillingness to its
re-application in those who have once submitted to it. The
eflfect of cauterization seems to indicate that pain produced at
the same point by any other proceeding would bring about the
same result, and that an}^ great or instantaneous pain produced
upon any portion of the body, equally or more sensitive than
the root of the helix, would also induce a similar result. This
assertion has been fully justified. In a criticism published in
the Union Medicale, M. Duchenne (de Boulogne) has reported
a process of Galvano-cutaneous excitation, which, by the pain
produced, rivalled that of cauterization, and the eff^ects of which
are identical with it, having the advantage, however, that it
produces neither a lesion of the skin nor'ofthe nerves. He
applies the extremity of a small copper wire upon the root of
the helix, and the extremity of the other one or two inches
from It, both wires being insulated with an envelope of silk.
The other extremities of the wires are placed in connection
with the indirect current of his apparatus. This current pro-
duces an electric action upon the cutaneous sensibility. The
apparatus being at its maximum, he arranges it so that the in-
termissions are as nearly approached together as possible-
The application is made during one or two 'minutes. The sen-
sation developed is most acute, and the patients say cannot be

48 New Treatment of Constitutional Si/philis. [January

surpassed by the action of fire. This ceases suddenly after thg
operation, without leaving any appreciable traces, and strange
to say, the cases upon which M. Duchenne has experimented
have been as rapidly modified as by cauterization. But the re-
sults obtained by this physician are not limited to this point.
In exciting other surfaces of the body, equally as sensitive as
the helix, the lobe of the nose, for example, and in other
cases the thoracic region, the face, the dorsum of the hand,
he has seen the artificial pain produced cure and calm the sci-
atica. This demonstrates that the painful excitation of the
auricular region does not possess more than that of any other
cutaneous surface, a curative privilege in this affection. The
future will denionstrate whether, if a galvano-cutaneous excita-
tion, practiced upon a point remote from or near the diseased
nerve, will or not cure rebellious neuralgia. [^mZ. Gen. de
Tlierap., Oct., 1850.

New Treatment of CGnstitutional Syphilis By Langston
Parker, Surgeon to the Queen's Hospital, &c., &c.

The treatment itself mainly consists in the fumigation of
the body, with mercurial preparations, whilst the patient is in a
vapour bath'. The salts employed are the bisulphuret, the bi-
noxide, and the black oxide of mercury, and sometimes the
iodide. The quantity of the first three mentioned varies
from half a drachm to three or four drachms; of the latter,
from five grains to half a drachm. It is often useful to com-
bine several of these together, and generally so with the iodide
of mercury. Thus, " In affections of the testes (sarcocele)
and of the bones (the various forms of ostitis, or periostitis), a
combination of a scruple of the iodide, and one or two drachms
of the bisulphuret or binoxide, would be a proper form." The
binoxide of- mercury is less irritating to the lungs than the
others, and is to be preferred when it is desired to get the va-
pour applied to the head or throat. The exact mode of its ap-
plication is thus stated :

" The patient is placed on a chair, and covered with an oilcloth,
lined with flannel, which is supported by a proper framework. Un-
der the chair are placed a copper bath, containing water, and a metal
plate, on which is put from one to three drachms of the bisulphuret of
mercury, or the same quantity of the gray oxide, or the binoxide.
Under each of these a spirit-lamp. The patient is thus exposed to the
influence of three agents, heated air, common steam, and the vapour
of mercury, which is thus applied to the whole surface of the body in
a moist state. After the patient has remained in the bath from five to

1851.] New Treatment of Consdtutional Syphilid. 40

ten miritites, perspiratioh generally commences, and by the end of
twenty or thirty minutes, beyond which I do not prolong the bath, it is
generally excessive. The lamps are now removed, and the tempera-
ture gradually allowed to sink ; when the patient has become mode-
lately cool, the coverings are removed, and the body rubbed dry ;
the patient is suffered to repose in an arm-chair for a short time, du-
ring which he drinks a cup of warm decoction of guaiacuni, sweeten-
ed with syrup of sarsaparilla." (pp. 5-6.)

When nnercury is to be emplayed internally in combination
with the baths, Mr. Parker prefers the binoxide or bichloride,
in doses not exceeding the twentieth of a grain.

Such are the main features of Mr. Parker's method of treat-
infTthat protean disease, Syphilis. There are some nji nor de-
tails, such as attention to tlie bowels, the regulation of the
quantity of mercury, and the time of remaining in the bath,
which will readily suggest theinselyes, or can easily be learned
from the book itself. Our object is only to direct the attention
of the profession to it ; and we shall therefore abstain from the
expression of any opinion, until we have an opportunity of
judging for ourselyes. In transcribing some cases from Mr.
Parker's volume, the observation occurs, that they are almost
all destitute of dates, and of many of those minute particulars
which alone can give a scientific value to them : nevertheless,
such as they are, we present them to the consideration of our
readers. The first is an example of superficial disease of the
skin, in which the constitution of the patient was inimical ta
the employment of mercury in the ordinary way.

" A gentleman consulted me respecting certain symptoms, which'
he considered, and which doubtless were, due to constitutional syphi-
lis. He had had primary ulcers eight months previously, for which
he could not take mercury ; the smallest quantity produced diarrhoea^
and it even affected him so, when used by friction. The ulcers had
healed under a similar treatment, but, soon afterwards, the skin be-
came covered with small scaly blotches ; there was deep redness of
the throat and nasal fossa?, and the hair and eyebrows came off rapid-
ly. He had taken iodine and sarsaparilla, under varions forms, with-
out success ; occasionally there was a partial amendment,- but he
constantly relapsed when medicine was discontinued.

" So confident was I of success in this case, that I predicted a cure
by the baths in three weeks. I told my patient he would not relapse.
The result justified my prophecy.

" The baths were used twelve times, the gums rendered uneasy and
swollen, but nothing more, not a bad symptom accompanied the treat-
ment, and the patient has had no fresh symptom tor fifteen months.
He took no internal medicines whilst under my care. The thivd
bath checked the falling of the hair and eyebrows, which began rapidly
to reappear before the termination of the treatment." (pp. 21-2.)

50 New Treatment of Constitutional Syphilis. [January,

We shall next cite a case of sloughing phagedaena quickly
arrested.

"A gentleman contracted, from a suspicious connection, a dis-
charge from his urethra, which, in the commencement, was supposed
to be gonorrhoea, and for which he was treated. The discharge did
not yield to the remedies employed, and about ten days afterwards
there appeared round the orifice of the urethra a white ring of ulcera-
tion, which spread rapidly. His surgeon became alarmed, and sent
him to Birmingham, to be placed under my care. When I first saw
this case there was an ulcer the size of a shillincr surrounding the
meatus, covered with a white slough, and the whole of the glans penis
was intensely red, swollen, and shining. On separating the lips of
the urethra^ the ulcer was seen to extend some distance dowrj the
passage.

" I placed this patient immediately in the bath, and kept him there
nearly an hour ; he was directed afterwards to take a full dose of
opium, to apply some decoction of poppies to the part, and to confine
himself strictly to bed. On the next day the bath was repeated, and
the same practice followed. On the third day the bath was again
taken, by which time the sloughs were separating^ and a healthy
granular surface appeared underneath.

"There had been no extension of ulceration since the first bath.
Nine baths completed this patient's cure in less than three weeks, and
the medicines employed, as well as the local applications, were of the
simplest character. The mutilation was very trivial. The under
surface of the urethra and glans penis was destroyed to a small ex-
tent, but from this the patient suffered very little inconvenience.

" This was a case of phagedaenic ulceration, commencing, as it
frequently does, in or at the orifice of the urethra, with the nature of
which I was unhappily too familiar, having seen frightful mutilation
from sores of this nature under ordinary plans of treatment.

"The first case of secondary phagedaena of the throat, in which I
had employed the mercurial vapour-bath, had been so successful^ that
I felt confident of success here, and the result justified my expecta-
tions. I reflected that rules of practice in cases of phagedasna were
quite unsettled, mercury being frequently employed as a last re-
source afier the failure of other remedies. It is during this period of
bringing remedies to bear upon the disease, and the uncertainty of
what to use, that the mutilations so commonly witnessed in such dis-
eases occur. The remedies which I advocate are without risk, and
may be employed from the very first appearance of phagedaena, with
every hope of success even in the worst cases." (pp. 29-31.)

Lastly, a case which is too recent to be of much value in
showing the power of the baths in preventing relapses, but is
still sufficiently remarkable to merit quotation.

"A dramatic artist of celebrity, who had been married for some
years, and who had not had anj primary venerial disease, in any

1851.] New Treatment of Constitutional Sypliilis, 51

shape or form, since his marriage, consulted me in the early part of
1849. He came to me as a forlorn hope, despairing of relief, as he
had constantly relapsed after discontinuing the best-framed ordinary
treatments, conducted by eminent surgeons, amongst whom may be
mentioned the late Mr. Aston Key. When I first saw this gentle-
man, his chief complaint was of the left fore-arm, the bones of which
were much enlarged, very painful, and tender to the touch ; but his
sufferings were much increased during the night, when the pains
were at times so excruciating as to deprive him more or less com-
pletely of rest ; he had not slept one night without pain for seven
years. The radius and ulna near the wrist were much enlarged, and
were noludated and uneven. The bones of the nose were a good deal
thickened, and he had shooting pains in them. The left testis was
five times the size of the right, heavy and lobulated, but neither pain-
ful nor tender.

" 1 considered this case as one of a decided venereal character ; al-
though mercury, pushed to salivation, and iodine had previously fail-
ed in affording more than a mere transient and temporary relief.
Knowing the benefit which I had derived in many former cases, from
the use of the baths, I held out to my patient a hope that they might
be serviceable to him also.

"I directed him to use half an ounce of the bisulphuret of mercu-
ry, and half a drachm of the iodide of mercury for each of the first
three baths, which were to be taken every third day, and to take in-
ternally some small doses of the hydriodate of potass with colchicum.

" After the third bath, which had slightly affected the mouth, the
nocturnal pains had disappeared, and the tenderness was gone from
the arm ; he could bear the bones pressed and handled, ahliough pre-
viously they had been exquisitely tender. The treatment was con-
tinued at intervals for three months ; sometimes the baths were ta-
ken once a week, at other times not so frequenth% the medicines also
were continued. The pains never returned, and at the end of the pe-
riod I mention, the nose and testis had been long perfectly well.

"This was a well-marked case of chronic syphilitic periostitis ; the
treatment of which, by my method, was rapid, safe, and successful.
Perhaps no forms of constitutional Syphilis are more formidable than
those which are seated in the"^periosteum and bones ; and such affec-
tions are very frequently due to exposure, neglect, or want of care
during a mercurial course which has been prescribed for the cure of
some form of secondary disease, but which not only frequently fails
in curing it, but disposes the system to the production of new symp-
toms of a still more formidable character than those lor which the
remedies were originally prescribed. It has been said tliat the iodide
of potassium is all but a specific for periosteal inflammation, more
particularly that of syphilitic origin ; it is certainly, in many cases,
an excellent aud eflicient reniedy, but there are many cases
also in which it totally and completely fails , not so with the plan of
treatment I am advocating ; it is all but certain in its influence over
such diseases, and the rapidity with which it cures is very remarkable.

X. S. VOL. VII. NO. I. 4

52 Iodine Injections in Hydrarthrosis, 6fC, [January,

" The patient, whose case I have just detailed, was so convinced of
the superiority of this method, that 1 could with difficulty prevent him
sending the details of his case, and its treatment, to a Metropolitan
daily paper. He had been under the best ordinary treatment for
nearly seven years, with little or no benefit ; and he was completely
and permanently cured in three months by my method. In such
cases I believe, after several experiments made on the subject that
the best remedies to employ arc combinations of the bisulphuret and
the iodide of mercury in the proportions, or nearly so, which I have
mentioned in the details of the case." (pp. 98-102.)

{Brit, and For. Med, Chir. Rev., July, 1850.

Iodine Injections in Hydrarthrosis, Hydrocele, Abscesses,
Ascites, <^c. By M. Velpeau.

When recently dismissing two patients in whom he had suc-
cessfully used iodine injection,. M. Velpeau took a general re-
view of the present state of the question of the propriety of
employing them in dropsical joints, his observations forming a
sort of appendix to the celebrated Academic discussion, a few
years since.

He observed, that the ill-success recorded by Boyer and
other surgeons, as resulting from throwing injections into joints,
much alarmed practitioners ; the mischief which resulted, how-
ever, really depending upon the nature of the cases which were
selected and the procedure adopted. M. Yelpeau appealed
against the abandonment of the practice on these grounds.
For fifteen years he had employed iodine as an injection in hy-
drocele, without any dangerous inflammation being excited, so
that he was encouraged to extend its application to various
serous cysts ; and in his 'Operative Medicine,' published in
1839, he suggested that it might without danger be thrown in-
to the peritoneal cavity, an opinion afterwards confirmed by its
injection into congenital hydrocele and hernial sacs. It was
only in 1840, however, that he ventured to inject the knee-joint
in two instances, and that by accident, the tumour in the ham
communicating with the cavity of the joint. The good success
of these cases, and of others in which joints were purposely
injected by M. Bonnet, of Lyons, led him, however, to adopt
the practice in numerous other cases. At least fifty such,
treated by different surgeons, are now on record, in none of
which were any alarming symptoms developed. The danger-
ous and fatal consequences resulted, in Boyer's cases, from the
joint being widely laid open, and irritating fluids several times
thrown in ; while in the modern operation the smallest possible
trocar is employed, and, in the majority of cases, a single injec-

1851.] Iodine Injections in Hydrarthrosis, <^c, 53

tion suffices. The pain and febrile action in some cases have
been considerable, requiring for their remqva1,in the opinion of
some surgeons, leeching and abstinence ; but M. Velpeau has
always found them, as in the case of their appearance in hydro-
cele, if let alone, gradually disappear. Their occurrence at
all is, indeed, rare. In general, a little redness, pain, and swell-
ing are observed after the injection, and are soon followed, by
slight fever. Increasing during three or four days, these symp-
toms then become stationary ; afterwards to diminish, and to
entirely disappear about the fifteenth day, together with a part,
or sometimes all the tumefaction.

M. Velpeau now considers there is not more danger in injec-
ting a joint than the tunica vaginalis, the chief fear being, in-
deed, that the operation may fail. Injection, in fact, succeeds
best in proportion as the cavity more nearly approaches a sim-
])le serous one. Thus, in cysts of the neck, where the membrane
containing the fluid is everywhere surrounded by soft tissues, the
operation never fails. In the tunica vaginalis where the testis pla-
ces the serous membrane in a less favorable condition, failures are
sometimes, though very rarely, met with ; while in the joints, in
which the serous membrane is free only to a limited extent,
and chiefly lies on solid or very hard parts, success is more
rare. Still, as the employment of injection is not preventive
of other means, is not dangerous, and scarcely more painful
than a blister, we should always resort to it, when a simple col-
lection of fluid resists ordinary treatment. As, however, such
collections are usually capable of being dispersed, it is an ope-
ration not often demanded, and it should not be resorted to
when the collection of fluid is dependent on caries, necrosis,
&c. The fears entertained by some that anchylosis might re-
sult, are unfounded, the patient recovering the use ofthepartas
soon as the swelling has disappeared. Gaz. des Hop., No. 58.

The French practitioners do not seem to have taken much
notice of the writings of Dr. Borelli, of Turin, upon the em-
ployment of iodine injections in various affections, although he
has been one of their most active advocates. In the last paper
we have seen, he reiterates his opinion of their great utility,
and furnishes additional cases. These consist of examples of
hydrocele (he states, that hydrocele in boys and hydrocele of the
cord in adults are always cureable by simple puncture), encys-
ted tumours after the evacuation of their contents, various
forms of acute 3.u(] chronic abscesses and adenitis. He objects
to the use of resolvents, as being both tedious and useless.
When matter is once formed, the abscess is rapidlv cured by
the injection. He relates, too, a case oiranula yielding to the
employment of the injection, although simple puncture had re-

54 Iodine Injections in Hydrarthrosis, SfC, [January,

peatedly failed. Bouchacourt had, however, already publish-
ed a similar case in the 'Bull, de Therap.' for 1843. After
quoting a case of j^s^zf/a m 7io successfully treated by Van
Camp, at Angers, and relating one of his own, he states he has
always hitherto failed in treating fistulce in connection with
diseased bone ; but quotes cases from the veterinary practice
of Professor Beroscino, in which the iodine was successfully
used in fistula connected with diseased cartilage.

Dr. Borelli considers his practice in treating abscesses by this
means as somewhat peculiar, inasmuch as he seeks to obtain
union by the first or the second intention, according to the re-
quirements of the case. The suppurative process being well
determined, and the acute inflammation ofsurrounding parts re-
pressed by cataplasms, after opening the abscess in its most de-
pendent part, and evacuating the contents as far as possible, he
introduces a small syringe through the aperture, and throws in
pure tincture of iodine with some force, allowing it to remain in,
when the pain is not too great, about half a minute. He waits
three or four days to see whether the plastic eflfusion into the pyo-
genic cavity will eflxict its occlusion. This, however, is seldom
the case, unless the abscess is very small and the engorgement of
surrounding tissues slight. The injection, therefore, will re-
quire repetition every two or three days, according to the
amount of reaction produced ; and when this is in excess, emol-
lient cataplasms are required. The author has never seen
any ill-effect, local or general, following the employment of the
iodine. Omedei Annali, vol. cxxviii, pp. 79-154.

The question of injecting the abdomen with iodine in ascites
is no longer one of mere hypothesis. M. Dieulafoy resorted
to it three times in the same subject, with the eflfect of produ-
cing a cure, and Dr. Leriche, of Lyon, has recently published
two cases, in which a single injection afier the complete evac-
uation of the fluid sufficed. M. Boinet also has recently pre-
sented a memoir to the Societe de Chirurgie, in which he has
collected eighteen cases of ascites from various sources, where-
in difl^erent substances, as gases, water, iodine, &c., have been
injected. In fifteen of these success followed, and in only one
did the patient die, iodine seeming to be the especially prefera-
ble substance, M. Morel, reporting upon this paper, pronounc-
ed an almost unqualified opinion in favour of the practice ; but
MM. Vidal, Gosselin, Robert, and others protested against
drawing any such hasty conclusions from cases the history of
which had been imperfectly given, and have to be confronted
with others in which a fatal termination has resulted, an exam-
ple of w^hich has recently occurred in Paris. L' Union Mcdi-
ca/e, Nos. 17, 18, 19 and 60. [Z?nl and For. Med. CJiir,
Rev., July 1850,

185L] Transparent Preparations of the Spinal Cord. 55

Method of making Transparent Preparations of the
Spinal Cord.

Mr. Swan details the following process, which deserves
to be more know'n oa account otils simplicily, as well as effec-
tiveness :

The spinal cord is to be cut inio pieces of one or two inches
long, so that each may include all the lools of one or more
nerves in each quaiter. The dura mater is to be removed, and
the nerves preserved as far as the ganglia. Each portion of
the cord is then to be divided through ihe median line, and
each half again between the appearance oflhe anterior and pos-
terior nerves, so that there will be four quai'terssepai-ated. As
the roots of the nerves enter rather obliquely, it is necessary
to cut off close to the nerves a somewhat tiiangular portion of
each side of the quart ei's, so as to make the preparation a flat
piece, containing the nerves and their continual ion through the
medullary and grey mailer. The piece thus cut is to be placed
on a glass slide, and dried befoie the fire on a plate covered
with paper. In two or three days it is to be raised from the
slide with a thin scalpel, and the soft matter undernealh is to be
cai'efully removed ; it is then to be placed on a fresh slide, and
gently pressed on this with ihe finger, and there remain
until it is dry. When dry it is to be raised again from the
slide and turned over, that any matter preventing the transpa-
rency may be removed; this is known by holding it from
time to time to the light. This process of cleajing is facilita-
ted by moislenino; it with spirits of turpentine now and then
dropped on it. If it had become uneven on the surface in dry-
ing, another slide may be pressed on itgently soas to flatten it ;
it may then be examined by the micioscope, and any matter
still obscurring it be removed. When it has thus been made
sufficiently transparent, a little thick Canada balsam is to be
smeared on the under surface, and by means of the ball of a
finger moistened with spiiits or tuipentine, pressed on the side
so as to remove any vacuity of air bubbles, which otherwise
make the preparation uneven under the microscope, and give
the idea of a membrane or some different substance interven-
ing amongst the rest. The next day a small drop of Canada
balsam is to be smeared over the surface of the preparation
with a finger, and immediately after two or three drops of spi-
rits of turpentine ; and this process of applying the balsam
and spirits of turpentine may require to be repeated two or
three times for giving sufficient clearness, and guarding it from
mould and atmospheric changes. Although it wants to be
transparent, it does not require to shine as if it were varnished,

6^ Rupture of the Spleen. [January^

and therefore the balsam and spirits of turpentine are directed
to be wiped off with the finger.

Another preparation may be made by cutting off a portion
of the surface of the spinal cord, with very short ends of
nerves attached to it, and very little of the medullary matter
underneath. It is to be dried, and treated like the other prepa-
rations, and when finished it will show the nerves very beauti-
fully, as they are collecting themselves into fasciculi ; and
some parts of it will be found only a coarser representation of
the more internal roots. Another preparation of a similar kind
may be made by leaving the medullary surface uppermost,
when nearly the whole of the medullary matter has been re-
moved. Medical Gazette.

Rupture of the Spleen. By Tiieoph. Mack, M. D., ^^. CatJie-
vines, C. TT^.

As the works ordinarily found upon the shelves of a medical
practitioner's library afford no instance of the above pathologi-
cal appearance, except resulting from external injury, I send
the following case for publication, in the hope that it may
prove of sufficient interest to reward the perusal.

Thomas Flynn, setatis 48, blacksmith, of medium stature,
constitution somewhat impaired. In earlier life he had served
as a private soldier in an infantry regiment, and had been ad-
mitted to the recrimental hospital a few times for some disorder
of the chylopoietic viscera, for which local depletion and
counter-irritation appear to have been prescribed, as marks
of leech-bites and visicants are apparent over the epigastric re-
gion. Last summer I was called upon to prescribe for some
abdominal affection from which he suffered ; its precise nature
I cannot now recall to mind, probably cholera morbus. Du-
ring the last eight or nine months he has resided chiefly in a
shanty on the margin of a stagnant pond, near the debouch-
ment of the Welland Canal into Lake Ontario. For some
weeks he had been labouring under Intermittent Fever of a
tertian tvpe. In the treatment of this disease he had employ-
ed a ce/tain nostrum ycleped "Cholagogue," which as his friend
expressed it, "broke the chill," z. e., interrupted the paroxysms,
so that he had been enabled to work at his trade for the space
of three or four days, still complaining of dizziness occasional-
ly, and the secondary effects of mal-assimilation. Li'pon the
day he was attacked with his last illness, viz., 22d June, ult., he
was engaged in the construction of some iron bands ; after
swallowing a moderate draught of cold water, he was sudden-

1851.] Rupture of the Spleen. 57

ly seized with severe pain, and having been carried to bad a
messenger was despatched for me. I found him writhing: in
great agony ; he referred the seat of pain to the left side of his
chest and abdomen. The skin was covered with copious sudor
which trickled in streams from his face, and completely satu-
rated the clothing ; features sharpened, and face expressive of
great anxiety ; intellectual system not afiected ; tongue cool,
of a leaden hue, slightly coated ; bowels torpid ; tenderness
on pressure, in left hypochondriac region, extending to the um-
bilicus ; the abdominal pain deep-seated, not of the acute cha-
racter of peritonitis ; respiration hurried : no abnormal re-
sonance ; no rale; heart's action extremely rapid, feeble, and ac-
companied with bruit de souffle ; pulse IGO, small and tense ;
urine suppressed. The group of symptoms rendered tie diag-
nosis ditiicult. Calomel andtinct. opii. were exhibited, fomen-
tations, followed by a large sinapism, were directed. No re-
lief having ensued in six hours, Croton oil and enemata, with a
long tube, were resorted to without producing any action of
the bowels.

23rd. Pulse becoming indistinct ; he appears moribund. As
I had decided the previous evening that the symptoms were to
be ascribed to some extensive extravasation within the cavity
of the abdomen, all curative efforts were desisted from. He
died about sixteen hours from the time of seizure.

Morbid Appearances. Our examination was limited to the
abdominal viscera, by request of his friends. The integuments
of the abdomen were distended and tympanitic. The first in-
cision through the linea alba was accompanied by the escape of
a large quantity of flatus, and followed by bloody serum. Peri-
toneum slightly injected, peritoneal covering of the intestines of
a pink colour. The liver of the usual size and weight, but sof-
tened in structure, and upon being incised the parenchyma ap-
peared much more dark than natural. P;mcreas small and
hard. Stomach and intestines healthy. These being taken
away, and having removed with a sponge about jive pints of
scrO'Sanguinolent Jiuid, we found upon the left side, extending
from the diaphragmatic extremity of the spleen, and behind
that organ to the commencement of the lumbar region, a larf^c
clot of fibrin, from blood which issued through a rent in the
investing membrane in the spleen , this was easily peeled off
from its contents, which were the substance of the spleen, of a
light chocolate colour, and extending from a defined edge, a
dark brown mass of eflused blood, destitute of any traces of
organization. The left kidney was enlarged and pale : the pel-
vis contained a small quantity of a dark grumous liquid. The
remaining contents of the abdomen presented no pathological
appearances.

58 Symptoms of Poisoning from Chlor. Mercury. [January,

In this case case, it is probable that a rupture of the splenic
vessels, orcun ing; duririg the congestion accompanying the cold
stage of asLie, first gave rise to an extravasation of blood
witTiin the splenic membrane. (This might have been increas-
ed at each subsequent congestion.) The afflux of blood follow-
ing the reception of the cold water into the stomach at the time
of'^the attack, ruptured the disturbed capsule and peritoneum,
and a fatal effusion resulted. Brz7. Amer. Fhys. Jour.

Suppression of Urine, one of the Symptoms of Poisoning
* from the Chloride of Mercury.

It has been observed that those who have taken large doses
of the bi-chloride of mercurv, (say poisonous doses), generally
have entire suppression of the urine. We believe the cause of
such disturbance in the kidneys has never been given, if indeed
it has ever been attempted. At a late meeting of the Suflolk
District Medical Societv, quite a discussion arose on the poison-
ous effects of this preparation of mercury, the probable quan-
tity necessary to produce death, and the time required to bring
about such a result. Tliere was much discrepancy of opinion
among the most learned of the members on the points in ques-
tion It was airreed, however, that entire suppression ot the
urine always followed when the poison was taken in sufficient
quantity. Another curious circumstance was alluded to, though
not explained, viz., that in those who die t>om the effects of bi-
chloride they^rmcBi'/ffi rarely revealed, on the post-mortem,
anv sicrn of inflammation or its results. When the prepara-
tions ol" mercury are exhibited to the patient, they produce ef-
fects varying in manner, according to the form, quantity and
manner Jf administering them. It is known that if ten grains
or more of the blue mass, or calomel, are given at one time to
a patient, its effects are entirely different from what they
would have been, had the medicine been given in divided doses.
So with the bi-chloride ; if large quantities are taken, it often
excites vomiting to such an extent that it proves harmless,
when grain doses would destroy life. In coming to the point
in question, why is it that the kidneys cease to perforni their
functions? We think it plausible to assume the following
reasons viz: Bi-chloride of mercury is a powerful stimulant
as well as sialagogue : it is a specific stimulant to the sa ivary
siand^ although many think it acts through the circulation.
Now if'these glands become aroused to such an extent that they
are continually pouring out their secretions, it mustbe evident
that the blood is deprived of so much of its elements, viz., wa-
ter with a trifle of other matter. This, of course, is the largest

1851.] Treatment of Rubeola hy Inunction. 59

constituent of urine. While the excessive action of the
saHvarv glands is in force, it must necessarily detract fj-om the
secretion of the kidneys. It is well known that the amount of
urine secreted in the summer is less than it is in the cold-
er or winter seasons, whch finds a ready explanation in
the fact of one of the great constituents cf the mine passinor
offby the skin in large quantkies during the warm season. No
matter what it is that takes from the biood its watery part, and
causes it to pass out of the body through any other than its na-
tural channel, the effect will be a suppression of urine. There-
fore we micrht safely come to the conclusion, that if the kidneys
fail to secrete, in these cases of poisoning, it is because they
have not their proper element to stimulate them. As this sub-
ject seems to be a mooted one, we have given our views, hoping
that sufficient interest may be excited to bring out the opin-
ions of those more learned in such matters. [^Boston Med. and
Sur. Jour.

Treatment of Rubeola by Inunction. By John Evans, M. D.,
Prof, of Obsterics, &c., in Rush Medical Gollege, etc. etc*

June 1, 1850, Miss F., aged 15 years, was lobouring under
the symptoms that characterize a violent attack of Measles.
The febrile action was strong pain in the extremities, loins
and head, severe the eyes were injected, suffused and intole-
rant of light distressing nausea was constant, and the char-
acteristic eruption was well marked upon the face, neck and
breast.

I gave Dovers powder grs. viij. every six hours with free
use of warm teas.

Finding no abatement of the distressing symptoms the next
morning, 1 determined to use inunction, and, as practiced by
Dr. Schneeman in Scarlatina, directed the patient to be rubbed
with apiece of fat bacon over the entire cutaneous surface.

The relief was marked by the subsidence of all the distress-
ing symptoms in a few hours, and the application was repeated
twice the next day. No other treatment was applied except
the free use of warm teas. The recovery was more rapid
than I had before seen in such cases, and without any disagree-
able sequel.

Two other members of the same family w^ere treated by the
inunction with the same favorable results.

I have since used the plan of treatment in a number of cases
and with uniform and prompt relief. INorth- Western Medical
and Surgical JournaL

60 Eclectic Department. [January,

Effects of Ether in Childbirth. It has been observed, when
ether has been given to parturient women, that its odor is dis-
coverable in the breath of the child after birth ; showing con-
clusively, that the blood of the mother must have been very
strongly impresnated with the ether. Having observed the
same phenomenon in a case that occurred in our practice a
short time since, we were fully coHvinced that the foetus may
be etherized in utero. But what appeared to us as very re-
markable, was the short time that elapsed between the mother's
inhaling the ether, and its sensible presence in the lungs of the
child, w^hich was born in just twenty minutes after the first inha-
lation by the mother. The quantity used, in this case, was
two and a half ounces only, and at no titne was the conscious-
ness of the patient destroyed, but on the contrary she was
bright and cheerful, even when the pains were most severe.
There was no mistake about it whatever, the child being at
the time in another room where there had been no ether. The
nurse, while washing it, directed our attention to the fact that
the ''child's breath was all ether" ; and upon drawing near to
it we could distinguish the smell of the vapor. The little fellow
was very good-natured indeed, and did not seem to mind the
manipulations of his first toilette, which tlie kind-hearted
nurse performed in a manner that would put the opposers of
hydropathy i?i shivers. [Boston Med. and Sur. Jour.

Theory of the Production of Males and Females. By Silas

Hubbard, M. D.
To the Editor of the Buffalo MedicalJournal :

Sir Many have been the theories of generation which have
been either proved to be, or are now regarded as erroneous,
and are merely mentioned as matters of history. Among'
these by-gones, are all the ancient theories of the causes of the
production of males or females ; but as this subject still occu-
pies the serious attention of very many respectable physicans,
1 may be excused for offering the following new and original
theory, viz: that males are begotten from one to ten days before,
and females from one to ten days after, the courses of the mo-
ther. In proof of this observation, I shall now^ merely say, that
it has invariably held true in all the cases I have had the means
of knowing, which are half a dozen. [Bifffalo Journal.

The Kite-tail Plug. This, which has long been employed
by M. Bretonneau, of Tours, M. Trousseau regards as excel-
lent in uterine hemorrhages, being both easy of application and
withdrawal. It is formed of a thread about forty feet long, to
which at intervals of about six or seven inches, pieces of card-

1851.] Miscellany. 61

ed cotton (to be oiled before using the plug) are attached. M.
Brettonneau prefers it to all other means of plugging in epis-
taxis. \_L Union Mcdlcale, No. 25. British and Foreign
Med. Cliir, Rev.

illxsccllanji.

To THE Readek. In assuming the editorial supervision of the
Southern Medical and Surgical Journal, the undersigned is apprehen-
sive that the loss of the judicious and able management of his pre-
decessor may be seriously felt. With abundant professional and
literary lore, quickness of perception' and a felicitous diction, the late
Editor possessed advantages well calculated to intimidate his successor,
in view of the unfavorable comparison to which his efforls might be
subjected. The undersigned, in entering upon an untried arena, with
his attention continually distracted by other arduous professional duties,
must therefore crave from the readers of this Journal their fullest in-
dulgence. It is proper, however, to add, that every exertion will
be made by the Editor, as well as by his friends who have kindly
proffered their assistance, to render the work acceptable, and to sus-
tain its high reputation. With a large and continually increasing
list of subscribers, the Publisher will also be incited to renewed efforts
to make the forthcoming volume equal in style to any in our country.

Contributions are earnestly solicited from those who have already
given interest to the original department of this periodical, and from
all who may be moved by the desire to aid in the advancement of
science. That there are many, very many, in Georgia and the ad-
jacent States, who might render efficient service to the profession, as
well as to their own interests, by devoting their leisure moments to
the record of interesting facts and practical observations, cannot be
doubted. The monthly form of the Southern Medical and Surgical
Journal is peculiarly adapted to the wants of active practitioners,
whose time is so much engrossed as generally to forbid the research-
es necessary in the preparation of lengthy and labored articles, and
who mighty yet, without much inconvenience, furnish contributions of
less pretensions and of more intrinsic worth. Medical statistics,
carefully drawn up, showing the peculiar diseases and mortality of
whites and blacks in our cities and villages, would be highly interest-
ing, especially if comprehending a sufficient scries of years to authorize
general conclusions. The bills of mortality of some of the Southern

62 Miscellany. [January,

cities have been published ; but we have never seen any relating to
the rural districts. As there are few or no public cemeteries in the
country, such bills cannot be obtained complete ; but ii would not be
\er^ difticuli: for a praclitioner to take the census of the plantations
and families under his professional charge, and to note the deaths
(with their causes) which occur among them during the year. He
would Ihus in a few years accumulate a fund of facts, of great value
in establishing the relative salubrity of different sections of the coun-
try, to tlie white and African races. Annual reports of this kind are
respectfully solicited. The proceedings of local medical societies
should find a place in this Journal, whenever of general interest.
Biographical notices of deceased physicians of distinction, setting
forth their virtues and peculiar skill, would not only be a just tribute
to merit, but tend to elevate the profession, by holding up examples
worthy of imitation. L. A. DUGAS.

The works of Marshall Hall never having been republished in this
country, many of his views may be novel to the reader. The practi-
cal applications of his researches upon the functions of the nervous
system are so numerous and important, that we feel assured that his
Lectures, containing, as they do, an epitome of his present and ma-
tured views, will not fail to be read with great interest. We shall
therefore offer no farther apology for giving them a place in this Jour-
nal whenever we can do so.

We invite the reader's attention to Dr. Norwood's article on the
properties of Veratrum Viride. If this agent can, in the hands of
others, be productive of the same striking modification of the heart's
action, the discovery will certainly be one of the greatest importance.
To be in possession of the means of diminishing at will the most in-
tense arterial excitement, would give the practitioner an advantage not
easily over-estimated. We are not surprised, therefore, at the enthusi-
asm manifested by one who believes that he has discovered this desid-
eratum. The remedy should be fairly tested, and the result reported.

We are authorized, by the publisher, to state that those who may
contribute to the pages of this Journal will receive it without charge
during the year.

Sir B. Brodie. Of the moral and scientific improvement of the
profession, Sir Benjamin has often descanted, with a clearness and
force amounting to eloquence, in his various addresses and introducto-

1851.] Miscellanij. 63

r}- lectures. He never did so more beautifully than at the recent
soiree of the Western Medical Society, when resigning the presiden-
cy into the hands of Dr. Robert Lee. On that occasion, instead of
descanting on the "degeneracy*^ of the profession, like Mr. Skey, he
summed up the whole question of the dignity or degradation of medi-
cine in a few words : "Gentlemen," said he, "Medicine is a noble
Science, but a Low Trade." This is true : pursued as a Science,
nothing can be higher ; followed merely as a Trade, nothing can be
more ignoble ; and the man in the poorest practice may reverence his
profession as a science, while the richest may grovel before it as mere
trading !

It is true praise of Sir Benjamin Brodie to say, that he is more dis-
tinguished as a physician-surgeon than as an operating-surgeon. His
vocation has been more to heal limbs than to remove them. His im-
agination has never been dazzled by the brilliancy of the knife, to
any great operative display. He has, however, always been a most
steady and successful operator : lightness of hand ; caution, without
timidity ; never failing coolness, and fertility of resources, have been
his distinouishino; characteristics. He has made no secret of his
opinion, that the operative part of surgery is not its highest part. Di-
agnosis has always been his great strength, and his opinion, has there-
fore, been always deeply valued by the profession and the public.
We believe his heart has always been with hospital, rather than pri-
vate practice, but in almost all cases men are more fond of their early oc-
cupations than of those which come afterwards. As a teacher he was
always distinguished for the value of the matter he had to communi-
cate. Those who heard him in the early part of his career say that
he was then energetic rather than polished ; that he appeared to
struggle with the weight and mass of facts he had stored up in his
mind. But in later year, his delivery has been fluent and perfect.
No man in his profession can deliver himself more readily or more
elegantly than Sir Benjamin. [^London Lancet.

Surgical Operation, Professor Parker, in an obstinate case of
Cystitis, at Bellevue Hospital, with the view to give rest to the bladder,
has recently cut down as in the lateral operation of Lithotomy, and
made a vertical incision into the bladder. This experiment may be
unprecedented, but is possibly defensible by the success of Dieffen-
bach and others in Germany, in an analogous operation for fistula in
perineo, in which, by allowing the urine to pass of!' through the artifi-
cial opening made by the incision, the fistulous canal has been closed.
Dr. P. is very strenuous in his advocacy of the theoiy that rest to an
inflamed organ is the first condition of cure, tiie hyi)othesis which is
supposed to justify tlie opium practice in enteritis and pneumonia.
This case, however, is probably the first instance in which an in-
flamed bladder has been opened through the perineum, for the single
object of securing rest for the diseased organ, and its result may teach
a salutary lesson in therapeutics, as well as surgery. [New York
Medical Gazette.

64 Miscellany, [January,

To the Medical Profession. The undersigned, Chairman of the
Standing Cominiltee on Practical Medicine, appointed by the American
Medical Association, May 1850, respectfully solicits the co-operation of
members of the iMedical Profession in furnishing materials for the an-
nual Report in May 1851. The duty of this Committee, as defined by
the Constitution of the Association, is to "prepare an annual Report on
the more important improvements effected in this country in the man-
agement of individual diseases ; and on the progress of Epidemics;
referring, as occasion requires, to medical topography, and to the cha-
racter of prevailing diseases in special localities, or in the United
States generally, during the term of their service." In order to fulfil
the objects thus expressed, the requisite data must be supplied by med-
ical practitioners in different sections of the Union. This is more
particularly true with reference to the 'progress of Epidemics'' and
''the character of prevailing diseases in special localities. '' Commu-
nications, therefore, are particularly desired from persons residing in
places in which Epidemics have prevailed, or in which prevailing
diseases have been marked by special characters during the present
year. Epidemic Cholera and Dysentery are known to have pre-
vailed more or less extensively in different parts of the country dur-
ing the past summer. Facts bearing upon the features peculiar to
the present season, the production, diffusion, mortality, treatment, etc,,
of these diseases, will be acceptable. It is requested that Communi-
cations upon these or any of the subjects coming under the cogni-
zance of -the Committee, be transmitted to the undersigned by the 1st
of March, 1851.

. All contributions with which the Committee mav be favored, will
receive due attention and acknowledgement. AUSTIN FLINT.
Buffalo, N. Y., Nov. 1850. [Bvffalo MedicalJournal,

Medicine in Turkey. The government of the Sublime Porte have
just decreed the formation of a body of salaried medical men, who shall
attend both the ricli and the poor, with the obligation of not receiving
any remuneration from the latter, and to pay especial attention to all
questions relating to the public hygiene of the country. [London
Lancet.

NOTICES OF NEW BOOKS.

We have received from the publishers, through Messrs. Joseph A.
Carrie & Co. and Thos. Richards & Son, of this city, the following
works, to which we cheerfully call the attention of the Profession.
They are all standard works, v\'hich we regret not having room to
notice critically.

The Diagnosis, Pathology, and Treatment of the Diseases of the Chest.
By W. W. Gerhard. M. D,, &c., &c. Third edition, revised and
enlarged. Philadelphia : Barrington & Haswell. 1850. pp. 351.

It fell to our lot to review for this Journal the first edition of Dr.

1851.] Miscellany. ^ 65

Gerhard's very valuable work. The present edition merits still more
the high enconiums bestowed upon the first, for it is brought up to the
present state of the science. It is certainly one of the very best works
of the kind, and inculcates the principles of physical exploration so
concisely and plainly that no one can read it attentively without feel-
ing'that the difficulty of acquiring a knowledge of auscultation has
been very much exaggerated.

Renal Affections : their Diagnosis and Pathology. "By Charles
Frick, M. D. Philadelphia: Lea & Blanchard. 1850. pp. 189.

This is a valuable compend of the present knowledge of Renal
affections, and especially of their diagnosis. It ought to be in the
hands of everj practitioner who has not leisure to study more volu-
minous productions on the subject.

The Races of Men : a fragment. By Robert Knox, M. D., &:c., &c.
Philadelphia: Lea & Blanchard. 1850. pp.323.

A work characterized by great independence of thought and novel
views. Although conflicting with many received opinions, it will
be read with interest by the unbiassed student of Natural History.

A Practical Hand-hook of Medical Chemistry. By John E. Bowman,
Fellow of the Chemical Society, &c., &c. Philadelphia : Lea &
Blanchard. 1850. pp. 288.

This publication is quite opportune. The subject of organic chem-
istry is daily increasing in interest to the practitioner of medicine.
We have here in a concise form " instructions for the examination
and analysis of urine, blood, and the more important animal products,
both healthy and morbid, and also directions for the detection of
poisons in organic mixtures and in the tissues." This mere state-
ment of the contents of the work will sufficiently indicate its import-
ance.

Elementary Chemistry^ theoretical and practical. By Geo. Fownes,
F. R. S., &c., &C. Edited, with additions, by Robert Bridges, M.D.,
Prof, cf Chemistry in the Philadelphia College of Pharmacy,
&c., &c. Tbird American edition, from a late London edition,
with numerous engravings. Philadelphia: Lea & Blanchard.
1850. pp.516.

The call for a third edition of Fowns's Chemistry, and its adoption
as a text-book by many of our medical colleges, is as good an eulogy
of the work as any we might indite.

66 Miscellany.

Observations on certain of the Diseases of Children. By Charles D.
Meigs, M. D., Prof, of Midwifery, &c., in the Jefferson Med. Col.
of Philadelphia, &C.J &c. Philadelphia: Lea & Blanchard. 1850.
pp. 215.

This work contains chapters upon Diagnosis, Caput Succedaneum,
Inflamed Eyes, Coryza, Bowel complaints, Jaundice, Dress, Cyanosis
Neonati, Respiratory disorders, Whooping cough. Laryngismus, and
Scarlatina all of which topics are treated with Dr. Meigs's acknow-
ledged ability and original diction. The work is neither a systematic
nor a complete treatise upon the Diseases of Children, but a fragment,
which may be consulted with much advantage.

The Microscopic Anatomy of the Human Body, in health and disease*
Illustrated zvith numerous drawings in colour. By Arthur Hill
Hassal, M. B., &c., &c. In two vols. London: S. Highly.
1849-50.

We are indebted for this splendid work to S. Hart, Sr., of Charles-
ton, Importer of Foreign Books. It is decidedly the best treatise of
the kind in the English language, and should be re-published in our
country.

Baron Humboldt is to spend the winter in Paris, and hopes are en-
tertained that he may visit this country in the spring.

It is stated that there were fourteen hundred deaths in Cincinnati,
by cholera, during the months of June, July and August last.

Prof. Parker, of New York, is said to have stated in one of his late
Clinical Lectures that Calculus of the Bladder has diminished in that
city since the introduction of the Croton water.

Our friends of the far-West are determined to educate their physi-
cians at home. The new building for the "College of Physicians and
Surgeons " of the Iowa University, in the city of Keokuk, is completed,
and will be used for the Lectures during the present term.

Practice of Surgery. The undersigned has made ample pro-
visions for accommodating such Surgical Patients as may be sent to
him from the country. White persons in indigent circumstances,
who may require Surgical operations during the term of Lectures at
the Medical College, will be provided for and operated upon gratui-
tously. L. A. DUGAS, M^D.,

Professor of Surgery in the Medical College of Georgia.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. FEBRUAKY, 1851. [No. 2.

PART FIRST.

rigxnal dommirnirations.

ARTICLE IV.

Contributions from the Case-Book of W. H. Robert, M. D.,

of Orion, Pike Co., Alabama.

Case I. A Keloid or Fibrous Tumor of the Skin, loith Neu-
ralgic disorder of the Stomach. Dilse, a negro woman aged
about 24 years, was brought to me in February last. She had
been taken with a very severe vomiting, about six months pre-
vious, while scouring ; menstruating at that time, the discharge
was suppressed. The vomiting which followed was so severe,
that it became necessary to call in a physician, by whom she
was temporarily relieved. ^The vomiting returned at intervals
of two or three weeks, until I saw her ; for which she had been
cupped, blistered, &c., without any more than a temporary
alleviation of the disease. I was told by the owner, that the
physician, under whose care she had been, regarded it as a case
of cancer of the stomach.

The patient presented no external appearance of disease;
her countenance was not distorted in the least the pulse was
not excited, yet presented the characteristic pulse of a nervous
female small and weak. She was subject to head-acl.es
appetite very defective no unusual thirst bowels regular
complained of pain in the region of the stomach, which was
aggravated by pressure. Over the region of the stomach was
a large fibrous tumor (caused by the blister) about five inches
long by three wide and one thick, which was very painful and
increasing in size. Vomiting occurred very frequently, without
any regularity. The matter vomited, consisted of food or

N. S. VOL. VII. NO. I[. f)

68 Robert's Contributions. [February,

gastric juice, mixed with water, and was never at alJ offen-
sive to the smell. There had never been the least trace
of blood vomited. The catamenial discharge was irregular.
A careful view of the symptoms led me to diagnosticate it, a
case of Neuralgic Disorder of the Stomach, and 1 based my
treatment upon that supposition.

I advised the removal of the fibrous tumor, which was readily
consented to, and therefore, put the patient upon a tonic treat-
ment to prepare the system for the operation.

April 19th. Assisted by Dr. J. Johns, I carefully dissected
away the whole of the tumor ; but before I could put in opera-
tion the plan I had devised to cover this large denuded surface,
the patient was taken with a spasm, apparently affecting the
diaphragm, the muscles of the chest, and the arms. The spasm
continued about a minute, and subsided as suddenly as it occur-
red. During the spasm, the pulse was not more affected than
the operation would have warranted. I made a counter incis-
ion through the skin on each side of the wound, sufficiently
long to enable me to approximate the edges to within an inch
of each other. Then by sutures and adhesive strips, they were
retained in position, and the wound carefully dressed. For
forty hours after the operation the spasms continued with in-
creasing severity, regardless of all treatment, until the tincture
of assafetida was given in very large doses.

As soon as it was convenient after the operation, she was
put upon the use of the Tinct. of Nux Vomica, in doses often
drops three times a day, for the relief of the neuralgic affection
of the stomach. Under this treatment she has regained her
health. The cicatrix is now (Nov. lOth,) scarcely one inch
wide and three and a half long.

This case is interesting, as illustrating the liability which
soTTzeof the negro race show to the formation of such tumors,
after blisters or other wounds of the skin. I say some because
all are not liable to it, I believe that whites are entirely exempt
from it, at least, so far as a practice of twelve years will warrant
such a conclusion. Moreover, I believe the nearer they ap-
proach the pure African race, the greater their liability to them.

The occurrence of the spasms during the operation, and their
steady increase for 40 hours after the operation, is also an inter-

1851.] Robert's Contributions. 69

esting fact, when taken in connection with the gastric affection,
and the beneficial effects of the treatment instituted for both.

Case II. Amaurosis successfully treated. In April last, I was
requested to prescribe for Mrs. P., aged 62 yrs., of very sanguine
temperament. I received the following history of the case :

The lady had always enjoyed very good health, had a good
appetite, and w^as fond of indulging it. Two weeks before
consulting me, while taking a walk in the garden, she discov-
ered that she could not see with her right eye ; which appear-
ed to be covered with a white cloud. When she applied to
me, she could not distinguish the slightest object ; scarcely day
from night. I directed her to apply a blister above the orbit,
and after it had drawn to remove the cuticle, and apply strych-
nine ointment to the denuded surface. The ointment was
made with 25 grs. strychnine to the ounce of lard. She was di-
rected to take a cathartic twice a week, and to live sparingly
on milk and vegetables ; as soon as the blister cured up, an-
other was to be drawn and the ointment again applied, until
some success followed. In two months the cure was complete,
and at this date (Nov. 19th,) her vision is as good as ever.

Case III. Paralysis of the right side of the Face. The pa-
tient, Mrs. S. aged 42 years, daughter of the lady referred to
in the second case, of sanguine temperament and flushed face,
although of very abstemious habits, has once before had paral-
ysis of the face (some five years ago.)

She was attacked one night in the latter part of June 1849,
and was not aware of her misfortune until morning. Was
treated for some months by a physician without any benefit. In
November, 1849, I w^as consulted, and advised her to be blister-
ed over the angle of the jaws, to use strychnine ointment and
to be purged as in case two. The amendment was more
rapid than in the preceding case. The treatment was faith-
fully followed, and in less than two months she was perfectly
well and remained so.

Case IV. Extensive Eruptive disease in a new-horn Infant.
The subject of the present history was the first child of white pa-
rents, a female of seven days old when attacked. At birth she
appeared healthy in every lespect, and nothing unusual was

70 Robert's Contributions. [February,

observed about her during the first week, except a tumor about
the size of a half walnut, situated under the scalp and over the
posterior superior spinous process of the left parietal bone.

On Saturday the 7th of Sept. 1850, a sniall pustular eruption
commenced appearing around the mouth, on the chin and neck.
Being regarded by the parents as the hives, no anxiety was
manifested about it. The eruptions progressed very rapidly,
and from the size of a pin's head, they would attain the diame-
ter of a half dime or less, in twenty-four hours. Then break-
ing and discharging a thin seropurulant fluid, and forming a
scab and remaining so. Sept. 12th. Dr. J. Johns was called to
see the little patient, and found it in the condition described
above, with the exception that the eruption had made its appear-
ance on other parts of the body, viz : on the fore arm, the back,
the genitals, and the thighs.

Dr. Johns ordered the child to have a dose of sweet oil, the
parts to be anointed with mercurial ointment, and afterwards
to be powdered with pulverized starch. Sept. 13th. Being call-
ed in consultation, I arrived at the house of the patient at four
o'clock, P. M., and found the child presenting a most frightful
appearance. The face, all around the mouth and on the cheeks,
was thickly studded with the eruptions, having on them scabs ;
some few points of the eruption were as high up as the temple,
but none existed on the head. The neck and throat were
almost raw ; the forearms and wrists were also affected ; the
back presented some points of the eruption as large as a dime,
the thighs and space between the vulva and the groins, were a
perfect mass tof pustulated points. 1 should have mentioned,
that the whole inside of the mouth, now for the first time, pre-
sented a highly inflamed appearance. Tongue, gums and roof
of the mouth almost purple.

The older pustules appeared to be stationary, and the great
point of interest was now in the left hand. About 10 o'clock
to-day, a small vesicle made its appearance at the root of the
nail on the index finger. It progressed so rapidly, that at my
visit (4 o'clock, P. M.,) it occupied both the palm and back
of the hand. The cuticle was raised so as to resemble a blad-
der ; the fluid contained was of a dark color, as is the case in
blisters preceding mortification. The vesicle was punctured
and the fluid allowed to escape.

1851.] Robert's Contributions. 71

The pulse was so exceedingly rapid that it was impossible to
count it, and the child cried almost incessantly. As an external
application, we used the common wheat flour, freely sifted over
all the ulcers, and internally gave one sixth of a grain of calo-
mel and one drop of the tinct. opii. camph. every four hours.

As soon as the raw surface was thoroughly covered with the
flour, the cries of the child ceased and it soon passed into a
quiet sleep, which lasted two hours, after which, she partook
freely of a sucking bottle, which she would not do before.
14th, 8 o'clock, A. M. Our little patient rested pretty well
until 12 o'clock, after that time she became very restless and
has continued so until now.

The large vesicle on the left hand has progressed very rap-
idly towards the elbow ; each of the pustulated points on the
left arm and wrist is surrounded b}^ a red margin, which pro-
gresses very rapidly under the cuticle, and presents the ap-
pearance of a vesicle caused by fire, the serum being evacua-
ted. These local inflamed spots very soon meet and form one
extensive surface extending in every direction with undimin-
ished speed. At daylight this morning, a small vesicle was
first observed at the root of the thumb nail on the right hand,
and by the time I arrived there it had extended so rapidly as
to occupy the whole hand. The cuticle slipped about but con-
tained no fluid ; all the pustules on the arm, and in fact, on the
whole body presented the same inflamed appearance, the same
disposition to extend and to commingle. The child is scarcely
able to swallow the blandest fluids ; the mucous membrane of
the mouth, is much darker than yesterday. The same treatment
to be continued. 4 o'clock P. M. Little patient continues to
grow worse. The pustules on the back have taken on the same
inflammatory action, and will now measure an inch and a half in
diameter each. There is one pustule on the breast below the
left nipple, and this is about all there is on the anterior part of
the body, unconnected with the pustules on the extremities.
The pustules on the face and neck have disappeared and in
their stead is an erysipelas, occupying all the neck and lower
portion of the face, which is gradually progressing up towards
the eyes. The eruption on the lower extremities occupies a
much larger space than at the last report, so also that on the

72 Robert's Contributions. [February,

upper extremities. Two new spots have made their appear-
ance, one on each heel. Patient can swallow some better, and
has nursed from the bottle. Continue the same treatment,
and anoint freely with sweet oil.

15th, 8 o'clock, A.M. Patient worse, the spots which ap-
peared on the heels spread over the whole of the feet by mid-
night last. The eruption at all the parts affected continues to
spread over the sound skin. That on the face has spread over
the eyes, and is worse, if possible ; can scarcely swallow, slept
very little last night; during the first part of the night its bow-
els became very open, the discharges were at first very dark
and of sufficient consistence, but soon becoming watery, they
were arrested by an anodyne enema. The respiration has be-
come very hurried ; for a few moments it is so, then there is an
entire cessation of respiration lasting generally about 15 sec-
onds; then, as if by a convulsive action, the respiration is re-
sumed again for a few moments, to be interrupted as before.
Wherever the eruption makes its appearance, the cuticle be-
comes separated from the true skin, and very great care is
necessary in handling the child to prevent detaching it. The
eruption on its legs has become very dark. Four o'clock P.
M. Little patient is fast sinking ; the eyes are much affected by
the eruption, one is closed and the other so much affected as to
present a very bad appearance. Patient died calmly at six
o'clock ; no examination was allowed.

Remarks. The object in publishing the foregoing case, is
to call the attention of the profession to an anomalous disease ;
at least so far as my reading and observations extend. If not
new to all, it may present points of interest to them.

First, we have a pustular eruption making its appearance on
different parts of the body of a child seven days old ; this state
of things existing for six days, is followed by an erysipelatous
eruption, if erysipelas it could be called, attacking the left hand
and then the right, where there had been no former eruption,
and finally invading parts previously affected with a pustular
eruption.

So far as the treatment is concerned, I have but little to say.
I did not believe it possible to produce effects upon the system
of so young a child, sufficient to counteract such a disease.

1851.] Campbell, on Amaurosis, 73

ARTICLE V.

Remarkable Case of Amaurosis, illustrating the Anatomy of the
Optic Nerves. By Hexry F. Campbell, M. D., Demonstra-
tor of Anatomy in the Medical College of Georgia.

The following very unusual case, we observed at Aiken last
summer, in the person of a gentleman of about sixty years of
age, and its history is as follows : For many years he had
been the subject of Myopia, which he thought was greater in
the left than the right eye. His occupation being that of bar-
rister, he had used his eyes perhaps imprudently, and for some
time previous to our seeing him, he said that he had been led
to think he was losing the sight of his right, or as he termed it,
his best eye. At the time of our observation, he remarked fre-
quently that he was very often unable to see at all with his
right eye, and that when he caught a glimpse of objects they
were such as were passing before him ; but, as a general thing,
vision was extinct in that eye. With the other eye, exactly
the reverse obtained : here, the faculty, though much impaired
in its distinctness, was still generally present, but occasionally
he lost sight of objects for a moment, when they would re-
appear as they changed their position on the field of vision.

In order to test the correctness of his views in regard to his
case, we passed the hand slowly before each of his eyes succes-
sively, the other being closed ; on the left side, he could see
the hand until it reached a certain point to the right, when it
would suddenly disappear, but by continuing the movement it
would become again visible. On the right side, the hand, on
being passed as above, was not perceived till it had attained a
point on the left exactly corresponding to the point on the right,
at which he could not distinguish it. This experiment we re-'
peated frequently and invariably with the same results.

To explain the very singular feature in this case, viz., that
in the right eye vision was confined to a small portion of the
retina, while the generality of this membrane was entirely
amaurotic ; and that at the same time the reverse obtained in
the left eye, which had most of its retina sensible to luminous
impressions, with only a small amaurotic spot, corresponding to
the healthy spot in the amaurotic eye, we will review some of

74 Campbell, on Amaurosis. [February,

the peculiarities in the anatomy of this important pair of nerves.
Firstly, we know that the nervous filaments, which are to
compose the optic nerves, arising on either side from the geni-
culate and quadrigeminal bodies, proceed through the optic
tract to the chiasm. Here all of them, with the exception of a
few fibres, cross over to constitute the optic nerve of the eye
on the opposite side, into whose retina they are finally expand-
ed, forming by far its greater portion ; but the few fibres which
do not cross 'dXidi on\Y approach x\\Q chiasma, pass on with those
from the opposite side to expand into the retina on the side
from which they originate, yet from their paucity, they can
supply only a very small portion of this membrane. And, se-
condly, the retina of each eye is produced out of fibres from both
sides of thebrain consequently the destruction or injury of
either nerve behind the chiasm would affect vision in both eyes,
though much more extensively in the eye opposite to the tract
injured. This is the fact illustrated in the present case.

Cases of partial amaurosis, we find reported in treatises on dis-
eases of this organ, but they were of an evanescent character,
and did not, in all probability, depend upon any aflfection of the
brain, but of the nerve or perhaps only the retina itself. Dr.
Wallaston's case, which occurred in his own person, is more anal-
ogous to the present than any within the range of our informa-
tion. There, in looking at objects, but half of them could be
descried ; he would see but half of a man's face and could read
but half his name on a sign : thus, '"johnson" appeared "son",
and in like manner every object he looked at. The affection
subsided in a short time, and there was no recurrence of it till
twenty years subsequently, when he was similarly affected.

Dr. Todd* refers to cases of partial amaurosis, which he says
are very unusual, but they were all of a temporary character and
in none of them was the fact of chiasm so plainly illustrated as
in the one under consideration. Here the disease was enduring,
the death of the nerve, functionally, at least, complete for a very
considerable time, and full opportunity was allowed for a correct
observation. Certain pathological observations find an explana-
tion in our case : for instance, it is known that when the optic

* Cyclopaedia of Anatomy and Physiology. Art. Optic Nerves.

1851]

Campbell, on Amaurosis.

75

nerves of an individual who had been blind in one eye for a con-
siderable time previous to his death, are examined, the nerve of
the healthy eye will be of fully its natural dimensions, while the
optictractsof both sides will be wasted, because they both con-
tribute to the formation of the perislied nerve. Here both re-
tinas are in a measure amaurotic, because both originate from
a defective tractus opticus.

A reference to the following diagram will serve to elucidate
our theory with regard to the extent and distribution of the
amaurotic regions in each eye, as well as the probable locality
of the disease from which it originated.

A fig:ure illustraling the origin of the fibres from the two sides of the brain,
and also their termination in the retinae. The dark parts of the cut indicate
portions of the brain, nerves and retina? that are diseased.

1.1. The two optic nerves, a majority of whose fibres cross to the opposite eye.

2.2. Tlie crossing fibres which ascend and expand, to form the greater por-
tion of the rciinoc,

3.3. Convergent fibres which are few and ascend to form a small portion of
the retinoe of their own sides respectively.

4. Amaurotic spot on healthy retina.

5. Healthy spot on amaurotic eye.

6. Left thalamus dark, to represent the disease of which it is the probable
seat; from it arises the paralytic nerve.

7. Healthy thalamus Irom the geniculated bodies ofwhich arise the sound nerve

8. GluadrigemiDal bodies: the left represented dark, the right healthy.

76 Campbell, on Amaurosis. [February,

Now, when we apply these pretty well established facts to
the observations made in the above case, we find the anatomi-
cal account and the condition of the retinae affording mutual
corroboration. Thus the extensive amaurosis of the right eye
corresponds with the extensive distribution of the paralytic
nerve on that side ; but the whole eye is not amaurotic, be-
cause the whole retina is not constituted by a diseased nerve,
and therefore a sensible spot is found upon it. Nor yet, again,
is the left retina wholly cognizant of rays, for a small portion
of its extent owes its development to the few fibres that do
not cross, but only approach the chiasm. Thus we find the
distribution of the nerves accurately defined by the propor-
tionate extent of the amaurosis in each eye. The cause of this
condition we must necessarily infer to exist at some point in the
optic tract or brain itself, posterior to the chiasma of these
fibres.

Apart from the pathological interest investing the above
case, it has importance in the relations it bears to the anatomy
and physiology of this portion of the nervous system, which,
even at this advanced state of science is still, in many points,
the subject of some degree of doubt and uncertainty. Inas-
much as our means of studying the functions of these nerves
are very limiited, on account of the mutilation and disturb-
ance of important superjacent parts necessary to arrive at their
very obscure position, we are in a great measure deprived of
the benefit of vivisections, and restricted in our investigations
to post-mortem observations and pathological phenomena.

On a careful consideration of our case, we think the follow-
ing facts in the anatomy of these nerves may be considered, in
a great measure, corroborated by it: fii'stly, that the theory of
chiasm in the fibres of the optic nerves, is correct, and also that
each nerve is engaged in the production of the retina of both
eyes; secondly, that the fibres are very unequally divided, one
eye receiving by far the greater number ; and, thirdly, that in
their distribution to the retinae the two sets of fibres, viz., the
crossing and continuous, are not intermixed together, forming
all parts of the retina, but are engaged in the production of
separate and distinct regions of this membrane.

1S51.] Qyi'miard^s Case of Glossitis. 77

ARTICLE VI.

Cas^ of Glossitis. By C. T. Quixtard, M. D., of Roswell, Ga.

The following Case, presents some peculiarities which call for
its publication. On Tuesday, September 23d, was called in
consultation, with Dr. P., on the case of J. F., who, I was in-
formed, had been sick since the Friday previous. The follow-
ing is the history of the case to date. About six weeks ago,
a dentist, in attempting to extract one of the larger molars on
the right side, broke off the crown, and left the root. For ten
days a continuous pain was felt about the part : it then became
intermittent until the 12th inst, when it ceased altogether. On
the evening of the 10th, the pain returned, the patient applied
a few drops of ol. caryopli, and went to sleep. In the morning
the pain became severe, and the tongue was slightly swollen.
During the day (20th) he complained of pain in the back, and
general malaise. In the evening Dr. P. visited the patient,
prescribed a cathartic, and applied a blister about the anterior
part of the neck.

Sept. 20th. Tongue, sub-lingual and sub-maxillary glands
much swollen ; pain severe ; the masseter muscles rigid, par-
ticularly that of the right side.

22d. Made my first visit at 10 o'clock, A. M. Patient, a
wagoner, aged 28 ; fine ruddy complexion, light hair, weighs
175 lbs., and is five feet one inch high. This morning there is
an aggravation of all the symptoms. Patient unable to articu-
late ; tongue protruded between the lips is tense, red and
painful to the touch ; his breathing laborious; his brow bathed
in perspiratior\ ; surface in other places hot; pulse 100, and
full; saliva flowing profusely. He had passed a restless night,
tossing to and fro on his bed, without any cessation of pain.
No dejection since the operation of the cathartic administered
on the 19th. Blood was at once abstracted to the amount of
25 oz. ; a large dose of sal. epsom administered, and a poultice
of hops and meal applied to the neck. Patient experienced
considsrable relief from the bleeding, and was able, after some
effort, to swllow the salts. Not being able to remain with the
patient, I advised the application of C. cups ad nuchcn, but no
blood was drawn, as I learnt on my return at 6 P. M. Breath-

78 Quintard's Case of Glossitis, [February,

ing easier, tongue not so painful; salts have operated well.
The pulse being about the same as at my former visit, again
advised venesection, and twenty-five ounces more blood was
drawn, together with six or eight ounces by cups under the
clavicles. At 9 o'clock, there was a free discharge of fetid
pus from an abscess at the base of the tongue.

23d. This morning found the patient sitting up, quite cheer-
ful. No pain ; tongue not so much swollen, nor so much les-
sened as was to have been expected from the discharge of pus
which had continued through the night. It was still impossi-
ble to pass the finger back to the base of the tongue. Ordered
only chicken broth. In the evening the discharge had ceased,
but was renewed by using a probe.

24th. Patient slept well till towards morning, when there
was a recurrence of pain. The right side of the tongue was
now more swollen than the left, and as there was evidently
another abscess forming, and the pulse again full and frequent,
the patient was put on the use of half a grain of tart, emetic
every two hours. 5 P. M. Has taken but two doses of the
tartar, which acted freely on the bowels, as well as having
produced the desired effect. At 2 o'clock the second abscess
discharged an enormous quantity of offensiv e pus. Ordered a cup
of strong green tea, and morph. gr. ss. to be taken at 8 o'clock.

25th. Patient better in every respect. Has some appetite,
and considered convalescing. It is proper to state that scarifi-
cation of the tongue had been attempted, but would not be sub-
mitted to by the patient.

Among the causes which predispose to glossitis are reckoned
compression of the jugular veins, (Stahl) ; ptyalism, (Slegel,
Frank, Hosack) ; rubbing the head with mercurial ointment,
small-pox, &c., (Trincavalleus). Among the occasional cau-
ses, are wounds, laceration, and contusions of the tongue. The
application of emetic to the organ, burns; while the most fre-
quent is the action of acrid or acro-narcotic substances on the
tongue. "Such effects have been produced by the juice of the
daphne mezereon, by tobacco leaves, and by the sting of wasps,
bees and other insects.'' Dupont relates a case of a young
man who, for a wager, " took two bites at a toad, and was
speedily attacked with severe glossitis." (Vide Brit, and For.
Med. Chir. Rev., July, 1850, p. 54.)

1851.] }la,rpeY's Case of Puerpe7^al Convulsions. 79

The treatment of this disease is generally simple, consisting
of venesection, scarification of the tongue, or incisions made
parallel to the raphe, the introduction of ice into the mouth,
and if the patient can swallow, the administration of cathartics
or laxatives. Emetics are highly commended by Dupont,
Raggi, Wettengins and others, in the earlier stages.

ARTICLE VII.

Case of Puerperal Convulsions. By P. W. Harper, M. D.,
of the Shoals of Ogeechie, Georgia.

On the 12th of last November, I was called at 9, P. M, to
visit Mrs. L., aged 18 years, complexion very fair, of a healthy
and strong constitution, with her first child. Parturition had
commenced some twelve or fifteen hours- previously to my
seeing her. I learned she had had two violent convulsions,
and while I was conversing with her, one came on that lasted
several minutes. I bled her while convulsed, until the pulse
yielded, say from twelve to sixteen ounces. This com-
posed her for an hour, then another convulsion came on,
though not so violent nor so long as the other. I opened the
vein and took about eight ounces of blood. This reduced the
pulse considerably, and I had hoped would put a stop to the
fits. At twelve o'clock, she had another convulsion as violent
as any of the others. I opened the vein again, and took, say
twelve ounces more of blood, pulse weak and 120 per minute.
During all this time, labor steadily progressed, and at one
o'clock in the morning, she was delivered of a very large child,
though dead. This w^as what I expected. From the first to
the last, she was the most ungovernable patient I have ever at-
tended, and during her convulsions, it took several persons to
keep her confined to her bed. After being composed for two
hours, she had another convulsion, though shght. I gave her
a tea spoonful of paregoric which made her rest well for a
while. At four o'clock, she had another convulsion, though
mild. I gave her a tea spoonful of laudanum, which composed
her until eleven o'clock that morning, when she awoke per-
fectly in her senses, but not recollecting what had happened
not even my visit and attendance on her. She had no other

80 Harper's Case of Puerperal Convulsions. XF^hrw^ry^

convulsions afterwards. After giving the usual directions in
such cases, I left her in the afternoon much better than I could
have expected.

14th. Found that the 2^^e?'zzs had not contracted, with great
soreness extending from x\\^ pubis to the umbilicus. I directed
a dose of castor oil, tepid injections into the uterus and emol-
lient applications over the abdomen. 15th. No better, com-
plains of great soreness in the abdominal region, much swollen
and very hard. Applied a large blister which drew well.

16th. Swelling about the same, with great soreness, pulse
weak and 120 opened the bowels with castor oil, and opium
given at night to compose her. 17th. Rested well ; swelling
as great, soreness and hardness not so much as the day before ;
the same directions continued. ]8th. Blister looks well ; no
change in the swelling, &;c.; complains of numbness extending
from the left hip down the thigh, ^ leg and foot. Directed he-r
bowels to be opened with the saline purgative mixture, com-
posed of epsom salts, 2 oz ; cream tartar, 1 oz ; tartar emetic,
2 gr ; water, 12 ounces. One wine glassfuU to be taken eve-
ry three hours until the bowels are well opened. Tepid injec-
tions still continued, and one grain of opium at bed time.

19th. But little alteration in the general appearance of the
abdomen, left leg and foot very much swollen and very painful,
particularly to the touch, no pain in the limbs. Directed lau-
danum and spirits of camphor, in equal parts to be rubbed
over, and sulphate of morphine at night. 20th. Swelling of
the abdomen nearly the same, though not as much soreness
and hardness ; leg and foot pretty much the same. Directed
the saline purge, the same external applications together with
the tepid injections and morphine. 21st. Much better except
her leg and foot, which are very much swollen and very pain-
ful. The same directions, with the omission of the purgative.
22d. The blister looks well and the case assumes a more favor-
able aspect. Directed a dose of oil, tlie same applications and
morphine. 24th., Still improving; blister nearly well, with
very little soreness and pain. Bowels opened with oil and the
same remedies continued. 27th. Recovering rapidly ; the
same course continued* December 2d. so much improved as
to discontinue my visits.

1841.] Lecture on the Spinal System. 81

PART II.
(E c I e r t i c p c p a rt m c n t .

A Synopsis of the Spinal System. Being the Croonian Lec-
tures, delivered at the Royal college of Physicians, London.
By Marshall Hall, M. D., F. R. S., &ic., &c.

LECTURE II.

Gextlemen', In iny former lecture, I described, or rather
demonstrated the diastaltic law of action of the vis nervosa of
Haller, and the diastaltic nervous arc in anatomy.

I showed you, by means of experiments and diagrams, that
though the action of the vis nervosa is from above downwards
in ali preceding experiments, yet, that in newly devised experi-
ments, that action is first from below upwards, or from with-
out inwards, and that it is then reflected by the spinal centre
from above downwards or from within outwards, either along
the same or other nerves, to the muscles of the same and other
limbs, establishing another, or panthodic law of action of this
singular vital power.

This diastaltic law of action of the vis nervosa is portrayed
in these diagrams, to which I beg again to direct your atten-
tion:

The action is in the direction of the spinal marrow and
nerves, towards and to the muscles. It illustrates the/rtc^5 and
the Law of Haller. The action is first to, and ihew from the
spinal marrow. It is xh^fact of Redi, Whytt, &c. The action
is both. It is the demonstration of the identity of the principle
of action in both, and of a new Law of Action of that principle.

From one and the same point of irritation or excitation in one
limb or part of the frog, the stream of power may be sent in all
directions, upwards or downwards, into all the other limbs, just
as we observe in traumatic tetanus, wherever the wound may
be, in the hand or in the foot, the muscles of the maxillae,of the
neck, of the back and abdomen, and of all the limbs, are thrown
into tetanic spasm in the human subject, as in animals. The
action is panthodic.
This, gentlemen, is the nearest approach to a circulation
in the nervous system. The course of the streams of nervous
power is not a perfect circle, but it is an arc or arcs, very
nearly approaching to the circle, and broken only by the mi-
nute space between the integument and the subjacent muscular
fibre, when the same limb is aflected by excitation and move-
ment.

It is by the law of diastaltic action of the vis nervosa that
the experimental facts of Haller are identified with those of

82 Lecture on the Spinal System, [February,

Redi, Whytt, &c. But, what is far more important, it is by
the discovery of this law of nervous dynamics that the vis
nervosa of Haller becomes capable of application, for the first
time, to physiology, to the functions of the animal economy.

Previously, the facts of Haller and of Redi, were mere ob-
jects of experimental lore or curiosity, sterile, and without ap-
plication or utility. I was persuaded, at a glance, that this
could not be. A dynamic must have its use. Nature does
not expend itself in the mere production of useless power.
Wherever a power exists its. application exists, and that appli-
cation must be sought for. The vis nervosa, or the power or
dynamic in the spinal nervous system, is such a power. It was
without application. It is now of most extensive application.
It is the active or controlling agent in all the acts of exclusion,
of ingestion, of retention, of expulsion, in the aninal economy!

What is the nature of this surprising power? Of this, at
present, we know nothing! But we know what it is not. We
know that it is not sensation or volition, and that it is not elec-
tricity in any of its known forms or modifications. We know
that its seat is the spinal or diastaltic system exclusively of the
cerebrum and cerebellum, and in a certain sense, of the gan-
glionic system.

The actions of this power are always in diastaltic nervous
arcs, consisting of an esodic nerve, the spinal centre, and an
exodic nerve in essential connexion and relation with each
other a new fact and principle in anatomy, and represented
in its simplest forms, in this diagram of the Triton.

Each of these four portions of the animal presents the phe-
nomenon of a diastaltic nervous arc. In the first you have the
trifacial, in the frog, in essential connexion, through the spinal
centre with the facial; if you excite the border of the eyelid, the
eyelid closes ; the other eyelid closes simultaneously. You have
therefore a double diastaltic arc from the border of the eyelid
to the orbicularis, of the same and of the opposite side. Similar
facts and phenomena are traceable in this, the second portion
of the diagram, in reference to the nerves and muscles of the
anterior extremities, in this third, in reference to the lower ex-
tremities, and in this fourth, in the tail.

But I hasten to call your attention to the same, and other
similar phenomena in the human subject. In this beautiful
diagram you have the diastaltic nervous arc of the human eye-
lid. From the border of the eyelid, I trace a branch of the
trifacial to the medulla oblongata ; from this last, I trace the
facial to the orbicularis. If, in a patient affected with coma
and a gaping eye, you excite the border of the eyelid, it in-
stantly closes. The action is produced through this diastaltic

1851.] Lecture on the Spinal System. 83

nervous arc. This fact I have frequently observed in apo-
plexy, in hydrocephalus. The degree of diminution of the
diastaltic action affords a measure of the degree of danger !

In this second diagram, I have represented the diastaltic
nervous arc of the larynx. Along this superior laryngeal
nerve the energy of the vis nervosa proceeds to the medulla
oblongata ; and thence along this inferior and recurrent laryn-
gea, the same energy proceeds to the muscles which close the
larynx. Every excited closure of the larynx is of this kind.
If a crumb of bread or a drop of Water falls on the border of the
glottis, this organ is forcibly, violently closed, by the diastaltic
action of the vis nervosa, through this anatomical diastaltic arc*

Still more earnestly I beg to call your attention to the next
diagram.

It represents, for the first time, the natures, cause, and mode
of action in the vital function of Respiration.

The first inspiration, as the acts of inspiration in peculiar cir*
cumstances of asphyxia or syncope in after life, is excited by
the contact of the cool atmospheric air with the origins of these
the trifacial, or these the spinal nerves, in the cutis of the face
and general surface. Rhythmic respiration is excited by an
internal stimulus acting on the origins of an internal excitor of
respiration the pneumogastric. As the pneumonic circu-
lation proceeds, the blood exhales carbonic acid in the air-cells
of the lungs ; this irritating gas excites the origins of the pneu*
mogastric nerves in those cells, and inspiration and a concate^
nated expiration (as in sneezing) are effected. The same se^
ries of phenomena is repeated, and this with a rapidity in a
direct ratio with that of the circulation.

This ratio is thus explained : during sleep the circulation is
as slow as posible. The evolution of carbonic acid, and the
numberof respirations in a given time, are proportionately small.
Let the circulation be rendered rapid bv activity, by the accel-
eration of the motion of the blood in the veins by muscular ac-
tion, and the evolution of carbonic acid and the excitation of
respiration are proportionately augumented.

In this manner the ratio between the circulation and the res-
piration is strictly maintained. It is physiological. Whenever
it ceases, the phenomenon is one of pathology an event par-
ticularly apt to occur in diseases of the encephalon, in which
witii comatose affection, the respiration is apt to become mor-
bidly slow, irregular, suspicious, stertorous, &c.

Such is the nature and importance of Me Diastaltic Arc or
Arcs of llesp ira I in n .

The actions of this power are distinct from all actions of
volition or of emotion or pain, though they arc frequently

N. S. VOL. VII. NO. II. 6

84 Lecture on the Spinal System. [Februarj,

mingled with, and modified by them, the first of these occupy-
ing the upper part of the cerebrial system, the second the low-
er, and the third the lowest, with the ganglionic.

The disinction betwen the spinal system or the diastaltic
nervous system from all these is absolute, though Xheiv union in
the general nervous system is most intimate. It is only in the
latter restricted sense that we can any longer speak of the
cerebrospinal axis, we may speak of the cerebro-spinal axes,
for this structure embraces the cerebral and the spinal axes or
centres.

Each diastaltic nervous arc is actuated by the vis nervosa;
we must no longer speak in regard to the diastaltic action or
closure of the eyelids, or of the larynx, for example, as even the
late able and otherwise accurate Professor J. Reid has done,
of the '' sentienV ^udi of the motor parts of this arc ;or as Pro-
chaska (of whom so much has been, rather malignantly, I fear,
than ignorantly,and, atany rate, untruthfully, writen) does, when
be speaks of " impressionum sensoriarum motorias reflexio/'
slunibiingat the very threshold.

You will still, gentlemen, hear muchof Unzer and the author
whom I have just quoted. The whole idea of " anticipation'^
by this author is a fiction and a falsehood, totally unworthy of
further notice, and totally unworthy of our profession. Unzer
did not proceed beyond considering the spinal marrow or centre
as a *' chord of nerves," excluding in one word, all that I have
said to you ; and his pupil, Prochaska, had not even the initia-
tive idea of a diastaltic arc in anatomy, in vital dynamics, in
phvsiology,or in any sense whatever. They and all who have
followed them, remote or recent, have the former ignorantly,
the latter more culpably erred at the very threshold of this
new department of anatomy, physiology, and' pathology.

But, to quit this discreditable theme I must proceed to state
to you two important principles oy facts :

The first, that the vis nervosa usually exists in the form of
mere static equilibrium. It requires in every instance, a dis-
tinct excitant to rouse into dynamic force, action, or act . Its
agency is therefore, unlike that of volition, necer spontane-
ous.

The second, that, in the spinal centre, but not in the exodic
nerves, and, I suppose, not in the esodic nerves, the vis nervosa,
or the "excitabilite" of M. Flourens, admits of distinct gmo^-
mentation and other abnormal conditions.

These facts are portrayed in a diagram, which will be given
in the second part of this lecture.

The z/i-excitor property of the cerebrum and cerebellum ;
theexcitor property of the medulla oblongata and medulla spin-

J851.] Lecture on the Spinal System* 85

alls, with its susceptibility of augmented excitability, and the
excitor power of the exodic nerves, with ??i-susceptibility of
augmented excitability, are all displayed, and placed, as it were,
before the eye in this diagram in a manner not easily to be for-
gotten.

I proceed to discuss this important topic particularly*

Condition of the Vis Nervosa ; Static and Dynamic,

The cerebrum and the cerebellum are insensible and in*
excitor or a-staltiCj on being punctured or laceratedj whilst their
principle of action, the ^lux^, is spontaneous m its motor influ*
ences.

The spinal marrow,. on the contrary, is essentially excitor,
requiring the application and repetition of a stimulus for the
development of each and every movement.

The natural condition of the spinal marrow is one of inac*
tion, or of static equilibrium. It is by appropriate and succes*
sive stimuli that its dynamic force is made effective and mani-
fest.

This statement is true in every condition of the spinal mar-
row\ Even when its excitability is extreme, under the influence
of strychnine, freedom from stimulus is freedom from all motor
action.

Still more is this the case in the state of diminished excitabil-
ity from shock, from chloroform, &c.

After the application of a stimulus and the phenomena of
dynamic force, the spinal marrow again resumes its condition of
static equilibrium, but with reduced excitability. The action of
each stimulus is followed by this effect, and each second stimulus
is accordingly less effective than the former one. The excita-
^bility is, on the other hand, restored by repose. And thus the
static equilibrium and the dynamic force bear a certain relation
to each other.

A frog, affected by shock, or placed under the influence
of chloroform, may be deprived of voluntary movement,
respiratory movements, and reflex actions, the circulation being
also almost extinct. If it be now left at rest, respiratorv move-
ments return. If it be excited, they again cease. And thus
repeat6<:lly. The same obseg'vation applies to all other move-
ments. Quiet is the restorer, excitement the exhauster, of the
motor energies.

The Spinal Marrow susceptible of augmented Excitability.
The degree of Excitability of the spinal marrow is, in general
terms (like irritability of the muscular fibre,) inversely as the
deirree of activity or of stimulus.

80 Lecture on the Spinal System. [February,

' Augmented or restored during sleep, it is diminished during
each day, by every act of voHtiony every act of the respiration,
and by each meal.

But the excitability of the spinal mayrow admits of intense
augmentation and extreme diminution by theraputic agents.
That of the nerve admits of no such augmentation.

Exp. The tenth part of a grain of the acetate of strychnine
dissolved in distilled water, and applied over the cutaneous
surface of the frog, induces the most extreme excitability, or
hyperethism. The slightest stimulus induces violent tetanoid
spasm. Meantime, the circulation, in the intervals of such
spasms, I'emains unimpaired.

Exp. On the other band, if ten drops of chloroform be
dropped on a bit of spong and attached to the upper part of a
tumbler, and this be inverted on a plate of glass, so as to enclose
afrog, this animal first ceases from voluntary movements, then
loses its excitability, and lastly, its circulation.

Undue excitability is generally the effect of teething, of irri'
tated esodic nerves in general, and especially in the case of a
wounded nerve, as in tetanus.

The usual immediate effect of a convulsive serizure is aug-
mented excitability ; and therefore one seizure frequently
succeeds to another. The remoter effect is diminished excha-
bility, and the patient is frequently secure from other attacks
until the excitability is slowly restored.

Indolence allows the excitability to become morbidly great 5
activity diminishes its degree or intensity. Hence the impor-
tance, in such cases, of restraining the excitability by daily ex-
ercisCy limited only by approaching fatigue.

Relation of Iritahility of the Cerehrum and Spinal Marrow.

We are naturally led by the consideration given in the last
paragraph to the subject of the present one. Every act of an
organ is followed by diminished energy or power. This is not
only true of the nervous tissue, but of the muscular fibre. -
Each contraction of a muscle is followed by a diminution of the
irritability of the muscular fibre. If, on the contrary, all stim-
ulus be removed, the irritability exists in its maximum degree*

But, for the perfect state of the muscular irritability, it is
essential that the muscle should have remained in connexion
through the nerves, with the spinal marrow. The spinal mar-
roio is, so far, the source of muscular irritability.

If, in experiment or disease, the inflnenceof the brain, that is,
of volition, be withdrawn from a muscle, its irritablity becomes
greater, comparatively, than that of the similar muscles. In
cerebral paralysis, or that paralysis in which the influence of

1851.] Lecture on the Spinal System. 87

the cerebrum is removed from a limb, the muscles of that limb
are more irritable, tested by the mildest galvanic influence
which will produce an obvious effect, than those of the other
limb.

But if the connexion between the spinal marrow and the
muscle be severed, either in experiment or by disease, the irri-
tabihty of the muscles of the paralyzed limb (and the excita-
bility of the severed portion of nerve) is less than that of the
healthy iimb.

These conclusions are founded upon a vast number of experi-
ments, most carefully made and observed.

The fact affords a Diagnosis between cerebral and spinal
paralysis, or between the cases of paralysis in w^hich the influ-
eace of the cerebrum or of the spinal marrow is severed,
respectively a diagnosis frequently of great importance.*

Relation of Excitability and Irritability to Stimuli,

The chief stimulants of the animal frame are the acts of
volition, and what are in exact proportion to these, heat, food,
and air. The excitability of the nervous system, and the irri-
tability of the muscular, are inversely proportionate to these
stimuli.

This Law of the In'cerse Ratio prevails throughout animated
nature, and is, perhaps, the most general of all. It was
announced by me nearly twenty years ago, in the Philosophic
col Transactions.

During activity, the stimuli are all augmented; the excita-
bility and irritability are proportionately diminished. During
sleep the reverse obtains ; the stimuli are at their minimum,
the excitability and irritability are at their maximum.

Exp. Having removed the head of a frog, we separated
every part of the animal, leaving only a portion of the spinal
marrow in connexion with the denuded and separated lumbar
nerves, and the lower extremities deprived of integument.
We passed a galvanic current through the nerve and limb, until
the movements had nearl}^ ceased. We then passed a very
mild current equally along both lumbar nerves, excluding the
muscles; and then a stronger current equally through the
muscles of both limbs, excluding the nerves ; we found that the
excitability of the nerve and tiie irritability of the muscles had
been alike reduced by the repeated action of the stimulus.

A frog, prepared so as to expose the nerve in connexion with
the muscles, has been designated " galcanoscopic.'^ Galvanism
is, in its turn, the Test of the excitability of the nervous, and

* Vide the Medico-Chirurgical Transactions, vol. xxii.xxxi., and The Lancet
and the LondonJournal of Medicine, lor 1849.

88 Lecture on the Spinal System. [February,

ofthe irritability of the muscular, fibre. So tested, these
properties are found to be greater as we descend in the zoology
ical scale, whilst the quantity of stimulus food, respiration,
temperature is known to be less, in the same ratio, but in-
versely.

These facts, these principles, are the foundation of the;?^'
thology and the therapeutics ofthe diastalic system. In various
maladies, as epilepsy and tetanus, we have augmented excita-
bility of the spinal centre ; in all diastaliic actions of reme-
dies, it is the principle of renewed excitant or of alternation
which is our guide in practice. It is this principle, the prin-
ciple of alternation in the application of temperature, of relative
cold and heat, &c., which should be our guide in the treatment
of asphyxia.

There is a third principle of action in regard to the vis
nervosa, which I will merely mention in this place, for it still
requires investigation. A patient, once the subject of epilepsy,
is peculiarly liable to a return of the malady; augmented sus-
ceptibility seems to have been superinduced. But the patient
who is liable to epilepsy seems to lose this susceptibility/o?*
time immediately after each attack, as if the susceptibility had^
for that period, been diminished or exhausted, the interval of
comparative security being unlike in any two instances.

All attacks depend upon these principles of repetition of
excitants d^nd of alteration o{ excitability.

I now, gentlemen, proceed to illustrate these principles by
experiment :

I have here a frog from which the cerebrum and cerebellum
have been extracted, and on the skin of which I have dropped
five drops of a solution of the acetate of strychnine, or the
eighth part of a grain of that terrific poison.

In five minutes the animal is brought under its influence.
Now, let us carefully examine the extraordinary efiect. Whilst
it is left alone, untouched, unshaken, absolutely unexcited, it lies
tranquil, as if nothing had occurred to it. But observe the
extraordinary effect of a jar given to the plate or the table. It
is thrown into a state of rigid tetanoid spasm ; all its limbs are
violently extended and agitated. Now the paroxysm is over ;
it has sunk into a state of relaxation. It would remain in this
state until, if previously unmutilated, it recovered, or, being
mutilated by the removal of the brain, it ceased to live 1 No
excitement, no tetanus !

A thousand ideas rush upon the mind on viewing and con-
templating this extraordinary scene !

The first appearance which strikes the observer is the differ-
ence of position assumed by the anterior extremities of the male

1851.] Lecture on the Spinal System. 89

and female frog; those of the former being arched over the
thorax, those of the latter placed in straight lines alonsr the sides
of this region. These positions result from the difference of
development of the nerves and muscles of these limbs in the two
sexes, especially in the early part of spring. The fact displays
the special action of the spinal system, so similar to design in
various cases.

The second fact is of still greater interest. The animal re-
mains perfectly motionless unless it be excited. The vis ner-
vosa is in a state of static equilibrium, unless that equilibrium
be disturbed and changed into dynamic force by some cause of
excitation. But if I jar the plate, or the table, or the floor even ;
observe the effect sudden rigid tetanus !

The animal has now resumed its relaxed condition. This
it will retain until a fresh cause of excitation is applied.

All this is an effect of the spinal centre, the centre of the
spinal or diastaltic system. The cerebrum has been removed.
The viscera may be removed without interference with these
phenomena.

But observe this singular fact : if the integuments be stripped
from the foot, no irritation of the toe has any influence. The
o?'2^f?i5 of the esodic excitor nerves have been removed, with
the other cutaneous tissues.

The same effect results from dividing the nerve which pro*
ceeds from the foot towards the spinal centre in any part of its
course.

Lastly, a similar eflect is instantly induced by destroying the
corresponding portion of the spinal centre itself

This law is uniform, in pathology as in physiology. Destroy
any part of the diastaltic arc, and its phenomena cease.

I have now a remark to make of great importance. You
have seen that this tetanoid condition exists independently of
the cerebrum and cerebellum, which were removed in the first
instance in the experiment which I have laid before you. I
have also shown you that, after the induction of the effect of
the strychnine, all the viscera may be removed, without re-
moving the effect. This condition exists, therefore, indepen-
dently of the cerebrum and of the ganglionic system.

It consists in exaltation of the excitability.

Now this exalted state of the excitability, or vis nervosa, is
limited to the centre of the diastaltic system, and is not extended
to its nerves. As long as the femoral nerve remains attached
to the spinal centre, in the tetanoid state induced by strychnine,
the muscles partake of the rigid spasm excited by any irritation.
But let the nerve be divided, and let its lower portion be irrita-
ted, and it is found to possess the normal degree of excitability.

90 "" Lecture on the Spinal System^ [February,

The excess of this excitability, then, is restricted to the centre
of the system, exclusively of its nerves.

The centre and the nerves the exodic nerves at least are
both endowed with excitability, but the former alone is endow-
ed with the power of taking an augmented or exalted ex-
citability.

This principle doubtless prevails in disease. In teething, in
epileptoid disease, in tetanus, in hydrophobia, the spinal mar-
row is in this condition. Hence the value of sinapisms and
liniments well applied along the whole course, and especially
the upper part of the spine, in such cases.

The effects of strychnine present the type of hydrophobia.
They consist of augmented excitability, originatinij, like hydro-
phobia, in a poison applied by the blood to the spinal centre, or
the centre of the diastaltic system. Now, gentlemen, a frog so
affected by strychnine so made the subject of a tetanoid con-
dition recovers, if it be placed in a little cool water, and left,
absolutely undisturbed, in a cool place ! It dies speedily if con-
tinually stimulated even by the touch of a feather ! Quiescence
cures, whilst each excited tetanoid spasm exhausts the vital
power !

Do not these facts present invaluable suggestions for the
treatment of the class of diseases involving exalted excitability ?
Might not the hydrophobic patient even, who infallibly dies if
exposed to sources of excitement, survive if it were possible to
preserve him from all excitement ahsolutely ? One thing is
certain, the physiological facts and principles which I have
unfolded suggest the principles on which all onr treatment is to
be conducted.

An interesting question presents itself. How^ are poisons
eliminated from the system ? or, on what principle do their
effects subside ? Some facts, which it would be out of place to
detail on this occasion, lead me to think that some poisons, whilst
they are removed in all the secretions, are especially separated
by respiration. The subject is full of interest, and calls for in-
vestigation.

I may here ask another interesting question, What is the
difference between the phenomena of hydrophobia, which is a
poisoned condition of the blood, and tetanus, which results from
injury of an esodic nerve ? The or/o-/7i of the two diseases is
essentially different. Are the phenomena so too ; and in what
degree, and in what respect ?

It has been shown that the tetanoid state induced by strych-
nine is one of poisoned blood, acting on the spinal centre, induc-
ing there exalted excitability, but not necessarily, or without
an excitant, a state of tetanus or spasm. The case is tetano^e,
a state full of tetanus, w^ithout being tetan/c.

1851.] Lecture on the Spinal System. 91

I have now to state that tetanus traumatic tetanus is more
than a mere augmented or exalted excitability. There is, in
addition, a constant excitant in the wounded irritated nerve.
There is therefore constant spasm. But there is, also, exalted
excitability, and this spasm is exasperated in paroxysms on the
application of any other excitation.

The effects of strychnine, hydrophobia, and other congeneric
affections resulting from poisoned blood, are nz^er-mittent ;
tetanus is re-mittent only !

Teething, and all those cases of epileptoid disease in which
the chief exciting cause, though it be an excitant of the nerve,
jszTi^ermittent, also leads to an m^e?'mittent form of disease.

Have I convinced you, gentlemen, by these observations, of
the value of these investigations in practice ? Have I not put
into your hands the clue of Ariadne, to lead and guide you
through this labrynlh ?

In my next lecture, I propose to bring before you two most
important pathological laws, to which I, at least, can detect no
exception :

The first that no disease of the cerebrum or cerebellum can
induce spasm, except through excitation, by contact or coun-
ter-pressure, of the spinal system.

The second that no disease of this system, wherever situated
if limited to this system, can affect the cerebrum, except through
the nerves, and muscles, and veins, of '* The Neck " that
medical region to which I have recently, and earnestly, called
the attention of the profession.

Before I close the present lecture, I beg to notice a remark
which has been made to me, upon a statement made in my
former one. It v.^as said that I had done injustice to the late
Professor J. Reid, when 1 stated that he had spoken of the
action of the superior laryngeal nerve, in the excited closure of
the larynx, as being " sentient."

Nothing would grieve me so much as to misrepresent and
depreciate the opinions of any of my professional brethren.
This I have never done. I cannot say that I have never been
the subject of misrepresentation and depreciation ; for, as I have
already said, the race of the Primeroses and of the Parisanuses
is not yet extinct amongst us. But most of all I should regret any
such act on my part towards Professor J. Reid, whose memory
I respect, and whose labours I place in the very first rank in
physiology; for if they do not rise so high as to be entitled to
the designation of {//icorery, they certainly present a series of
new and invaluable results, and especially the papers on the pneu-
mogastric nerve. But I will read to you tlie paragraph, which
I quoted from memory in my last lecture. You will perceive

92 Lecture on the Spinal System. [February,

that the very term sentient, or at least " sensitive," is used as I
quoted it.

" When any irritation is applied to the mucous membrane of
the larynx, in the healthy state, this does not excite those con-
tractions of the muscles that approximatet he arytenoid cartil-
ages, by acting directly upon them, through the mucous mem-
brane, but this contraction takes place indirectly, and by a
reflex action, in the performance of which the superior laryn-
geals act as the sensitive^ or afferent nerves, and the inferior
larvngeals as the motor or efl^erent nerves." Dr. J. Reid's
"Researches," 1848, p. 251-2.)

The last proof that the phenomena in question do not depend
on sensation, if such proof were required, which it is not, is
afforded by the testimony of patients afflicted with paraplegia.
When this malady is complete when, as in a case which I
recently attended with Mr. Edwards, of Queen street, Cheap-
side, the spinal marrow is absolutely divided by the disease,
when all sensation and all voluntary motion are extinct these
diastaltic actions exist in their full force, the patient seeing the
movements induced, but not having the slightest power Xo feel
or to control them.

1 have witnessed many cases of the same kind. The proof
is absolute, and the lengthy controversy on this point may be
considered as terminated.

I have been favored by another criticism from a fellow of
this college, whom I beg leave to thank, both for the kind terms
in which he has spoken of my former lecture, and for his able
and learned suggestion. The latter relates to the term which
I employed at that lecture. Of opinion that the term " dias-
taltic " is a happy substitute for the former term " reflex," this
friendly writer suggests the use of other compounds of CrsXXsiv
in the place of the terms esodic, exodic, &c. It would certainly
be desirable to preserve uniformity in our nomenclature ; and
the kind suggestion, for which I beoj to offer my sincere thanks
shall receive my most mature consideration. But I think both
terms must be preserved; for example I do not see how we
could express by any compound oidrcWsw the idea conveyed by
the term panthodic.

1851] On Stricture of the Urethra, <^c. 93

On Stricture of the Urethra, and Fistula in Perineo. By James
Syme, F. R. S. E., &c., &c. Edinburgh, Sutherland and
Knox. 1849. 8vo., pp. 72.

Stricture of the Urethra, its Pathology and Treatment; com-
prising Observations on the Curative Powers of Potassa
Fusa in that Disease ; with Cases. By Robert Wade,
F. R. C.S., (fcc, &c. Second Edition. London, Churchill.
1849. 8vo,, pp. 247.

When a metropolitan surgeon, of such high reputation as Mr.
Syme has earned for himself, comes before his professional
brethren with a new plan of treatment for a frequent and im-
portant disease, his proposal calls for serious consideration; and
it is with this feeling that we have taken up Mr. Syme's essay
on strictures of the urethra and fistulas in perineo. In the pre-
face he remarks*

"That the method of treating obstinate strictures of the urethra
recommended in the following pages was communicated to the pro-
fession, fiTe years ago, through the periodical press, and again, two
years ago, in a collection of surgical essays ; but, so far as I know, it
has not as yet been adopted by others, even in a single instance.
Being deeply impressed wiih the importance of the subjeci, I feel it
my duty to make another attempt, with the view of awakening at-
tention to it, by publishing, in a separate form, full details of the
procedure, together with its advantages, positive and comparitive ;
and also further evidence of its efficacy, from cases in public as well
as private practice. Having done this, I leave the matter to the pro-
fession, trusting that, whatever may be their decision, they will at
least give me credit for an earnest desire to render the opportuni-
ties committed to me conducive to the improvement of practical
surgery.^'

Mr. Syme commences his observations by remarking:, that
the occurrence in surgical practice of cases in which strictures
of the urethra have existed for the greater part of a lifetime,
notwithstanding the efforts to remove them by practitioners of
the greatest skill and experience, evidently shows that the
means of treatment hitherto employed must either be uncertain
in their operation, or only temporary in their beneficial effect ;
and adds, that his object now is to explain and recommend a
method of treatment which has been found an effectual remedy
for the disease, even in its most inveterate forms.

In referring to the obstinate cases of permeable stricture, in
which his new mode of operation is recommended, for his ob-
servations do not at all apply to what are called, and, as he says,
improperly, impermeable strictures, Mr. Syme says:

94 On Stricture of the Urethra, S^c, [February,

*' I do not here allude so much to the mere tightness of contraction,
and the difficulty consequently experienced in passing a small instru-
ment through the stricture, as to the unyielding disposition manifested
by the constricted canal, and its tendency to contract, perhaps even
more closely than before, after being partially or completely dilated.
One other feature of such obstinate cases, of great importance to no-
tice, is the strong and general sympathy of the system with every
change taking place in the local disease ; when rigors and febrile at-
tacks, leading to various derangements in different parts of the body,
more or less connected with the part locally affected, are apt to result
from attempts, even of the most gentle kind, to pass instruments into
the bladder."

The following is Mr. Syme's description of his operation :

" If the patient has a great deal of pain, and wishes to escape from
the slight degree of it which attends the requisite incision, he should
be placed under the influence of chloroform ; not paj'tially, so as mere-
ly to suspend his consciousness, or impede his recollection of suffering,
but completely, so as to prevent any restlessness or unruly struggle,
which would tend very seriously to increase the difliculty of the pro-
cedure. He should then be brought to the edge of his bed, and have
his limbs supported by two assistants, one of them standing on each
side. A grooved director, slightly curved, and small enough to pass
readily through the stricture, is next introduced, and confided to one
of the assistants. The surgeon, sitting, or kneeling on one knee, now
makes an incision in the middle line of the perinseum or penis,
wherever the stricture is seated. It should be about an inch, or an
inch and a half, in length, and extend through the integuments, toge-
ther with the subjacent textures, exterior to the urethra. The opera-
tor then, taking the handle of the director in his left, and the knife
(which should be a small, straight bistoury) in his right hand, feels
with his fore-finger, guarding the blade, for the director, and pushes
the point into the groove behind, or on the bladder side of the stric-
ture, runs (he knife forward so as to divide the whole of the thickened
texture at the contracted part of the canal, and withdraws the director.
Finally a No. 7 or 8 silver catheter is introduced into the bladder, and
retained by a suitable arrangement of tapes, with a plug to prevent
trouble from the discharge of urine.

" The patient has merely to remain quietly in bed for forty-eight
hours, when the catheter should be withdrawn. The urine some-
times maintains its proper course from the first, but more frequently
passes in part through the wound for some hours; no attention or
interference is required on this account, but at the end of eight or ten
days a moderate-sized bougie should be passed, and repeated once a
week or fortnight, for two months."

Mr. Syme recommends the same perineal incision in cases of
obstinate stricture, accompanied by fistulse in perineo, and gives
two cases treated in that way.

1851.] On Stricture of the Urethra, ^, 95

He details eleven cases ofpermeable stricture, which he treat-
ed by external incision, and says :

"That of all the cases in which I have divided the stricture, only
one has been followed by any unpleasant result ; on that occasion the
patient suffered from a formidable attack of erysipelas, which, com-
mencing in the perinseum, gradually extended over the whole surface
of the body, accompanied by constitutional disturbance, so violent as
to prove all but fatal, and productive of emaciation, with prostration
of strength, to an extreme degree. During this illness, the wound,
instead of healing as usual, remained open for several weeks, just as
when first inflicted, and it retained its conical form after the process of
granulating contraction began, so that when the cicatrization was at
length completed, the urethra had a very thin covering at the seat of
the aperture, which, therefore, was apt to open from time to time, and
discharge a little urine. It may be added, that the combination of
circumstances which gave rise to this untoward occurrence was so
complicated and unusual that it can hardly by any possibility happen
again.''

Having reviewed the different methods hitherto proposed
for the treatment of stricture of the urethra, Mr. Syme con-
cludes the subject in the following manner:

" From what has been said in the foregoing pages, I trust it will ap-
pear established,

" First. That division of a stricture by external incision is sufficient
for the complete remedy of the disease in its most inveterate and
obstinate form.

"Second. That in cases of less obstinacy, but still requiring the
frequent use of bougies, division is preferable to dilatation as afford-
ing relief more speedily, permanently and safely."

We confess that we were rather startled when w^e read the
foregoing sweeping conclusions, at which Mr. Syme has arri-
ved, in favour of the treatment of passable strictures of the
urethra by external incision. That a free division of a cartila-
ginous stricture will enable the surgeon to pass a large-sized
catheter on into the bladder, and thereby afford him an oppor-
tunity of finishing the treatment by dilatation, we at once ad.
mil; but we are at a loss to understand on what principle the
mere longitudinal division of an adventitious texture, which
very frequently surrounds the urethral canal, and the nature of
which we know from experience to be that of having an extra-
ordinary tendency to contract, can lead to a permanent cure.
Mr. Syme says that no attention or interference is required, on
account of the urine passing out through the wound for a few
hours or days ; but at the same time lie states that at the end
of eight or ten days a moderate-sized instrument should be
passed, and repeated at intervals for two months ; and, as if not

96 On Stricture of the Urethra, <^C. [Febtu^ry^

quite satisfied himself as to the permanency of the cure by ex-
ternal incision, he says at p. 43 :

"In most cases the cure may then be deemed complete and lasting;
but if the tendency to contraction should have been extreme, or if the
patient's way of life should be such as to favour the reproduction of
the stricture, it will be a prudent precaution to have the bougie passed
four or five times in the course of a year^ m order to avoid all risk of
future trouble."

We must say, after a very careful perusal of Mr. Syme's
essay, that we are far from being convinced of the advantages
of the treatment by external incision over dilatation in cases of
permeable stricture of the urethra ; and as ihQ permanency of
the cure by the perineal incision is the great point on which
Mr. Syme lays stress, we should have wished him to have fol-
lowed out each case, so as to have proved the remote results of
his operation j for, with the exception of two, all of his cases
have been operated on within the year, many but a few months
since ; and his reports of the great bulk of his cases cease
with their dismissal from hospital, or, in private practice, with-
in a few days after the operation was performed. The follow-
ing is a report of the last of Mr. Syme's cases, which will give
an idea of the summary manner in which the cases in general
are dealt with, and which we conceive has left the boasted
advantage of Mr. Syme^s treatment, viz., its permanency, un-
proved.

*' Case XL A. S., aged 28, a book-binder, was admitted into the
Royal Infirmary, on the 29th of July last, for stricture of the urethra
at the bulb, complicated by a false passage, as stated in the recommen-
dation of a medical man which he brought with him. The complaint
was attributed to a gonorrhoea contracted ten years ago, and had been
very troublesome for the last five years, impeding micturition so much,
that the urine frequently could not be voided except by drops, and ac-
casionally causing complete retention. It was through ineffectual
attempts to afibrd relief during these attacks, by introducing instru-
ments, that the false passage had been established.

" Having allowed the patient to remain quiet for a few days, I suc-
ceeded, on the 7th of August, in passing a bougie through the stricture,
and thinking it likely that the treatment by dilatation would prove
unsatisfactory, performed division on the 11th, The urine escaped
partially by the wound for a few days, and the patient, who had been
quite well for a fortnight, was dismissed on the 2nd September with-
out any trace of the disease or its remedy."

But we are not informed as to the present state of the pa-
tient. Every hospital surgeon has sent out cases of stricture
treated by dilatation, with as favourable a note as Mr. Syme's

1851.] On Stricture of the Urethra, 6fC, 97

of A. S., but that does not prove the permanency of the cure;
and although in Mr. Syme's hands the operation by external
incision has, he says, but in one case turned out unsuccessful,
and which case Mr. Syme has, as we would have expected
from his high character, brought forward, still that one case is,
in our opinion, quite sufficient to place the profession on its
guard, the infliction of a fistula in perineo being a serious addi-
tion to a stricture of the urethra. la absence, therefore, of the
proof of the permanency of the cure of a permeable stricture
of the urethra by external incision, we are not at all surprised,
as Mr. Syme expresses himself to be, that the profession has not
adopted his treatment of stricture by the perineal incision, in
preference to that by dilatation.

The great practical feature in Mr. Wade's book consists in his
warmly advocating the treatment of stricture of the urethra by
potassa fusa. After furnishing his readers with a history of the
treatment of strictures of the urethra, Mr. Wade says :

" The severe effects occasionally produced by the nitrate of silver
in the hands of Sir Everard Home, who used it very freely and boldly,
naturally excited much prejudice against the method he employed ;
consequently, so formidable a weapon as the armed bougie of Sir
Everard is seldom wielded by modern surgeons. The nitrate of sil-
ver is occasionally used in small quantities to irritable strictures with
very good effects."

And after informing us that Mr. Whately recommended the
employment of potassa fusa in strictures, in preference to nitrate
of silver, Mr. Wade says that the practice of Mr. Whately has
generally been regarded as ineffectual, from the extremely
small quantity of potash which lie employed; and tells us that
it was the inefficient action of the nitrate of silver that first in-
duced him to try the effects of potassa fusa in impervious stric-
ture, more as a forlorn hope than with any confidence in its
success ; and he soon found it was necessary to use the potash
in more efficient quantities, and more frequently, than recom-
mended by Mr. Whately ; and, encouraged by success in two
or three cases, he has been induced to persevere in the use of
that agent. The cases in which Mr. Wade recommends the
use of tlie potassa fusa are the following: Firstly, fibro-carti-
laginous strictures, impervious to instruments, without the
employment of injurious pressure; secondly, hard strictures of
long standing, which, although admitting the passage of a small
bougie, bleed freely on its introduction; thirdly, irritable stric-
tures; fourthly, spasmodic strictures, nut arising from acute
inflanfimalion of the urethra; fifthly, strictures which have a

98 On Stricture of the Urethra, <^c, [February^

marked disposition to contraction. Mr. Wade applies the'
potassa fusa by inserting a small portion of it into a hole made
in the point of a soft bougie, and says that the eighth of a grain
is the smallest, and a grain the largest quantity of the potash
that he ever uses. Mr. Wade refers to the Westminster Gen-
eral Dispensary, to which institution he has been attached for
the greater portion of his professional life, for ample opportuni-
ties of witnessing the effects of different modes of treating'
strictures of the urethra; and the result of his experience, he
says, is, that more can be done in bad cases of stricture by the
judicious employment of potassa fusa, than by any other means.
Any person taking up Homers work would be led to suppose
that the treatment of stricture by nitrateof silver was the only
safe and permanent one, and as innocent as Mr. Wade says his
treatment by potassa fusa is ; however, a carefd perusal of Sir
Everard Home's own cases at once proves that the treatment
by nitrate of silver has been often followed by serious results.
Notwithstanding, such w^as the influence of Home's name and
writings, that for a time the treatment by nitrate of silver be-
came the fashion ; so much so, that the late eminent Professor
Colles says in a clinical lecture, the notes of which we have by
us, "I recollect when Dublin men, physicians and all, ran mad
about strictures ; it was just after Home's work came out, and
every man thought he had a stricture, and nothing was spoken
of at club-houses, &c., but strictures, and ' how is your stric-
ture?' became a complete watch-word. But some of the most
valuable lives were lost by caustic before sufficient experience
was obtained, and many died, others got violent rigors, which
they were pleased to call intermittents, but which, in fact, were
urinary fevers ; and after a short time we found to our mortifi-
cation it was a most dangerous practice. Home's plan did not
get into discredit till many of his patients returned to Dublin,
and then we found out that they^ were noi permanently cured.

We are of opinion that the use of potassa fusa, in sufficient
quantity to act on the urethra, is open to all the powerful objec-
tions which experience has raised against the treatment by
nitrate of silver. If there is danger in applying the nitrate of
silver to the sound, instead of the diseased portion of urethra,
how much must the danger be increased in applying so diffu-
sible an escharotic as potassa fusa ? And although Mr. Wade
says that in only one case was this use of the potash followed by
an untoward result, viz., by perineal abscess, even if the patient
should escape from urinary ^^yqy, false passage, profuse hemor-
rhage, retention of urfhe, still we hold, that if the deliquescent
potash be used in quantity sufficient to destroy an existing
stricture, it will produce one of a more formidable character,

1851.] Hernorrhage arresied with Spts, Turpentine. 99

from the unavoidable loss of substance and the consequent con-
traction, one bearing, in fact, a considerable analogy to that
form met with occasionally by every hospital surgeon at the
orifice of the urethra, and which takes place at the former seat
of a sloughing chancre, and is the result of the subsequent
cicatrization. If on the other hand, an insufficient quantity be
used, as recommended by Whately, and to a certain extent
followed up by Mr. Wade^ no more advantage is gained by
the application than would be obtained by the simple introduction
of a bougie, the potash, under such circumstances, exerting no
escharotic effect on the adventitious structure. ^[Dw^/iti Quar*
terly JournaL

Hemorrhage Arrested with Spirits of Turpentine.
(Translated for this Journal.)

Among the numerous therapeutic purposes for which the
spirits of turpentine has been used, there is one which we do
not find mentioned by any French writer. It is the use of this
article in arresting hemorrhage. English physicians, such as
Adair, Brooke, Chyne, Ciutterbuck, Copland, Elliotson, Hunter,
Thompson, Vincent, and others, consider it as an agent posses-
sing the most certain hemostatic qualities.

The known rapidity with which it suppresses mucous fluxes,
and its efficacy in the treatment of purpura hemorrhagica,
might have led to the belief that it would be good in hemor-
rhages, and particularly those in which there is no reaction or
inflammatory phenomena, that is, those of a passive or atonic
character, and also those produced by an alteration in the blood
or a peculiar diathesis. It is in the latter forms of hemorrhage,
that this medicine has proved most efficacious.

In the London Medical Journal, Mr. Smith has reported
facts, showing the success with wiiich he used spirits turpentine
in hemorrhages, and its ^superiority over other styptics and
astringents.

It will probably seem surprising, to see this used in hemate-
mesis and enterorrhagia ; its action, nevertheless; is sometimes
surprising.

In hematuria it is also used very successfully. It may sup-
press the hemorrhage by its astringent properties, in the
same manner that it does fluxes and morbid secretions from the
urinary passages. It remains to be seen, however, whether
certain conditions of the kidneys do not contra-indicate its use;
and on this account physicians should, perhaps, be more careful
in its administration in this disease than in any other.

Mr. Smith says that in all the cases of hemoptysis in which

N. 8. VOL. VII, NO. H. 7

100 Hemorrhage arrested with Spts, Turpentine. [February^

he used spirits turpentine, there were pulmonary tubercles in
various stages of development. In the hemorrhagic diathesis,
he used it with much success, and would check for a time the
progress of phthisis.

In atonic epistaxrs, such as is observed in the aged and
cachectic, the internal administration of turpentine will arrest
the hemorrhage in a very short time.

According to English writers, the use o-f spirits turpentine
with care, will never be accompanied by any unpleasant eiiect.
It will frequently produce purging, very seldom vomiting^, and
nothing particular about the genito-urinary organs. We be-
lieve, however, that this medicine should be used with great
care, and its effects very closely watched.

The dose is 20 drops every three or four hours, but 4 gram-
mes may be given every four hours w^hen the hemorrhage threat-
ens the life of the patient. The best vehicle for its administra-
tion, is water with the addition of some aromatic syrup. It is
well to combine the turpentine with some other therapeuti($
agent according to the case. In epistaxis, and generally in
passive hemorrhages wlien the loss is very great, it is well to
add the muriate of iron. In hematemesis and intestinal hemor-
rhage, the addition of sulph. magnesia, iced water, tannic or
gallic acid is advised, and so on with the other forms of hemor-
rhage.

The following are some of the formulae of Mr. Smith i

^ Comp. infusion of roses, . . 225 grammes,

Sulph. Magnesia, .... 250 *:

Manna, 16

Spts. Turpentine, 6

Add according to circumstances,

Tinct. Digitalis, 6 '*

In hematemesis, enterorrhagia, hemoptysis, two table-spoon-
fuls of the mixture every four hours.

^. Spts. Turpentine, 6 grammes.

Comp. Powder Adraganth 8 "

Ext. Hemlock 60 centigrammes,

Tinct. Digitalis, ...... 4 grammes.

Camphorated Mixture . . .250 "
In gastro-intestinal hemorrhage, dose same as above.

I^ Sulph. Magnesia, * ' * . 30 grammes.

Spts. Turpentine, 40 *'

Pulv. Uvaursi, 4 **'

Camphorated Mixture .... 250

1851.] Pharmaceutic Notice of Coffee and Cafeine, 101

'^ Pulv. Uva ursi, 4 grammes.

Ess. Peppermint, 2 drops.

Spts. Turpentine, ..... 8 grammes.

Pulv. Adraganth, 4

Water, 250

The two last used principally in hematuria. Two table-
spoonfuls every four hours.

Vf. Spts. Turpentine, 4 grammes.

Muriated Tinct. Iron, .... 10 drops in a little
water. Used in atonic epistaxis. Repeat the dose every two
hours, but give only half the quantity after the first dose.

Note. M. Ximmo, of Glascow, has discovered a method by
which the taste and smell of spirits turpentine may be destroyed
entirely. He takes eight parts of the medicine and one part
of rectified alcohol ; this is well shaken and put aside for a
while, it is then decanted and another portion of alcohol added
and decanted again, and this is repeated until the smell and
taste of the turpentine is entirely destroyed. It must then be
kept in halfounce vials well stopped, and away from the contact
of air and light, or it would very soon regain its former charac-
ters. It is questionable whether this manipulation does not
destroy some of its therapeutic properties.

\_Bul. Gen. cle TJierap,

Pharmaceutic Notice of Coffee and Cafeine,
(Translated for this Journal.)

M. Vanden Corput has just published an article upon the
chemical and medical properties of coffee, and its active princi-
ple, cafeine. Their febrifuge and anti-neural,2:ic properties are
now well understood by the Belgian physicians. Numerous
applications of coffee in the treatment of disease have been
made,although the fact is but little known. Lanzoni says that
he has obtained cures of obstinate diarrheas with the infusion of
coffee. Nebulius employed it in headache. Baglivi used it
with advantage upon himself in this disease. Alpin emploved
it as emmenagoiTue, anti-arthritic and anti-asthmatic. The
females of Ethiopia have used it from time immemorial as an
emmenagogue. Dufour, in the seventeenth century, gave it in
phthisis, in fever, and in sick headache. Willis, in the fifteenth
century, recommended it as an antidote for narcotics. This
knowledge he obtained from the Turks, who use it to counter-
act the bad effects of opium. Grindel and Dorpat employed it
as febrifuge. Musgrave, Pringle, Monin, Percivai, Lawrence,

102 Pharmaceutic Notice of Coffee and Cafeine. [February,

and many others, derived good effects from it in Asthma. In
that portion of Batavia belonging to Holland, the inhabitants
use the infusion of coffee, with a little lemon-juice, in their per-
nicious fevers. In Holland, this is preferred to quinine for
intermittent fevers. M. Amati has used with advantage the
vapors that are disengaged from it during its torrefaction in
chronic diseases of the eyes. Martin-Solon has administered
coffee in the adynamic form of typhoid fever. It has also been
proposed as a disinfecting agent ; and M. Guyot has recently
recommended it in the treatment of hooping-cough.

Besides its medical properties, properly speaking, coffee pos-
sesses another that is very precious. This property M. Yanden
Corput has forgotten to mention in his very interesting trea-
tise. We will notice it, however, in order that it may be gen-
erally known among practitioners. It possesses the property
of concealing the disagreeable tasle of the sulphate of quinine,
sulph. magnesia, senna, &c. Vv^e have already called the at-
tention of the readers of this Journal (T. xxxiii., p. 181) to this
singular property. The question whether or not the sulpb.
quinine preserved all of its medicinal properties, when it was
mixed with coffee, or whether it lost some of them, was dis-
cussed, but not satisfactorily answered. Are not the febrifuge
properties that it possesses, in favor of its administration in
connection with sulph. quinine 1

Another pi'operty of coffee that has not yet been noticed, is,
that it favors and developes the action of certain remedies.
Thus the effects of haschisch are rendered much more ceitain
when administered with coffee.

According to M. Payen, coffee is composed of cellulose, fatty
matters, glucose, an intermediate vegetable acid, legumine,
caseine, chloriginate of potash and cafeine, free cafeine, an
essential conci-ete oil, a fluid essential oil and mineral substan-
ces. Torrefaction produces a pyrogenous oil, that gives to
coffee its peculiar taste and odour, and forms a certain quanti-
ty of tannin, which makes it tonicx

To what principle does coffee owe its medicinal properties ?
It certainly derives them from an association of different prin-
ciples, but particularly from cafeine. We will therefore men-
tion the mode of obtaining it, borrowing the process from the
Traite de Chimie, by Liebig.

The best process for extracting the cafeine, is to infuse the
coffee in boiling water, and to add to it acetate of lead whilst
warm, and then a little finely powdered 'litharge. The liquid
should be reboiled as long as any of the yellow precipitate re-
mains that was caused by the action of the lead. After all the
precipitate has been taken up, the mixture should be filtered.

ISSL] Citrate of Cafeine in Sick Headache 103

and diluted sulph. acid added. The sulph. of lead should then
be separated from it, and the liquid be evaporated, when the
crystals of cafeine will be formed.

The preparation proposed by M. Yanden Corput is the citrate
of cafeine. This salt is obtained by saturating a solution of
citric acid with pure cafeine, and elevating the temperature to
32 K. The salt then crystalizes in long brilliant white needles,
grouped concentrically around a central point.

It can also be obtained by placing pulverized coffee in a very
weak solution of citric acid, agitating the liquid with an equal
volume of sulph. ether, decanting and leaving the aqueous solu-
tion to crystal ize. This salt is very soluble in water. The
quantity of the tribasic citric acid that saturates the cafeine is
but small, and hence the citrate solution produces but little
precipitate by the addition of acetate of lead.

The citrate of iron and of cafeine is prepared by a combina-
tion of one part of citrate of cafeine and four parts of citrate of
iron. The crystals formed are in radiated scales, that are
very soluble in water. The lactate of cafeine is obtained by
direct combination in dissolving cafeine in diluted lactic acid,
and evaporating by gentle heat. It crystalizes with difficulty,
and forms frequently an amorphous or half crystalized mass.

llhid.

Efficacy of Citrate of Cafeine in Sick Headache.
(Translated for this Journal.)

Our co-laborer, M. Dorvault, in one of the last numbers of
the Bulletin, published the opinions of M. Vanden Corput upon
the chemical properties, the pharmaceutical preparations and
therapeutical effects of the active principle of coffee, and men-
tioned, among others, its previous property as anti-neuralfric.
We will now mention the result of some attempts of M. Han-
non, which tend to demonstrate that cafeine, ^nd especially
the citrate of cafeine, enjoy an incontestible efficacy in ner-
vous or sick headache. It is in the idiopathic and not in the
symptomatic variety, that it is so serviceable. In two cases of
idiopathic sick headache that returned periodically, I\I. Ilannon
administered citrate of cafeine as follows: The evening be-
fore the first paroxysm he administered 10 grs. ; the evening
before the second 20 grs. ; thus increasing the dose at each
attack. These diminished in intensity, occurred at longer
intervals, and finally disappeared. A third case, in which the
disease occurred twice a month with great intensity, the citrate
of caffeine was given in larger doses (30 grs.), and at the end
of six months a complete cure was obtained. In many other

104 Sick Headache cured hy full Inspirations. [February,

cases that the author did not think necessary to report it has
been invariably successful. At each prescription, the symp-
toms either diminished or disappeared. The citrate is the best
of all the preparations, and has the advantage over pure ca-
feine, that it is not so irritating. These facts are not at all
surprising, for there is no physician who has not seen in
others, or felt upon himself, the power that coffee possessed in
curing or alleviating an attack of sick headache. We have,
ourselves, obtained good results in administering coffee com-
bined with lemon-juice.

The following is the mode of administration that Hannon
recommends. It has already been shown in what doses this
remedy is given in some cases ; they should vary, however,
according to circumstances of intensity, obstinacy, duration,
&c. If the disease produces intense pain and suffering, the
dose should be from 30 to 72 grs. before, or from the beginning
of the attack. In cases, where the interval betw^een the pa-
roxysms is very long, the dose should be proportionably large.
When the disease is ancient, the treatment should be continued
a long time ; but if, on the contrary, it is recent, and occurs at
short intervals, the dose should be small. M. Hannon is con-
vinced, by experience, that this medication should be made use
of, the evening before, or from the beginning of the attack,
when it cannot be foreseen the evening preceding. He sub-
divides the dose into several parcels, and gives each parcel at
equal intervals, except when the attack has commenced, and
then he gives the whole at a single dose. A trial of this agent
is very easily made, and but a short time is necessary to deter-
mine its true value. [^Presse Med. Beige.

Sick Headache cured hy full Inspirations.
(Translated for this Journal.

When a medication is based upon the experiments made
upon himself by an honorable professional brother, it is far
better, in reporting it, to give his own words. We will then
simply publish the communication of M. Tavignot upon the
new therapeutic agent in the cure of this painlul, if not dan-
gerous disease.

*'It was in the following manner that I discovered the effica-
cy of this new and apparently strange method for the cure of
this affection. In October last I was attacked with pain and
weight in the head, anorexia, a physical and moral prostration,
&c. Experience taught me that I had to remain in this state
for twenty-four hours. I concluded that this peculiar state of
the nervous centres might depend upon a stagnation of blood in

1851.] Tetanus cured hj Inhalations of Odor of orm. 105

the venous sinuses of the dura-mater, as M. Auzias Turenne
supposes, or upon an imperfect aeration of this fluid. I imme-
diately commenced respiring freely and fully during several
minutes. I perceived a sensible relief, which induced me to
continue, and in a short time I was cured. I got up and un-
dertook my usual occupations, as I felt but a slight pain in my
temples, which vanished in a quarter of an hour. This result
was doubly agreeable to me, as it furnished me with a new and
practical remedy. In ten persons, upon whom it has been
tried, one half have found instantaneous relief, and in the others
there has been an amelioration, or a complete failure. How-
ever, upon interrogating with care those who were not relieved,
I am convinced that they did not have genuine sick headache:
they had a neuralgic pain of the head, but it was not accompa-
nied with that profound prostration and melancholy that 1 have
mentioned as characteristic of the disease. It seems to me to
be useless to search for the modus operandi of full and profound
inspirations in the cure of sick headache. It is evident that
by this means the venous circulation is accelerated, and the
chemico-physiological act of hematosis is hastened. Then the
explanation of the success of this new method is in one or the
other of these conditions, or perhaps in both.

\_L' Observation.

Spontaneous Tetanus cured by Inhalations of Chloroform,
(Translated for this Journal.)

When a new medication is proposed, the best means to test
its value is to publish the results obtained by its administration.
This is the fourth fact that has been published in your excellent
journal upon the good effects of chloroform in tetanus.

The 1st August last, I was called to a young girl, 18 years
old, of good constitution, who, two days before, had been taken,
without known cause, with pains and contractions of the mus-
cles of the neck, which gradually extended to those of the
chest, abdomen and back. When I arrived, the masseter mus-
cles, the muscles of the back, and particularly tliose of the
abdomen, were considerably contracted. The head was drawn
backwards, the lower jaw fixed and immovable, the skin cov-
ered with an abundant perspiration, the face red, pulse frequent
and respiration accelerated. The girl groaned from the great
pain, and could not move in her bed. Spasmodic movements
occurred at intervals, and increased the pain and danger. I
first administered calomel and jalap, which caused several
alvinc evacuations, and the expulsion of two ascaris lumbri-
coides. This, however, produced no amendment in the state

106 Tetanus cured hy Inhalations of Chloroform. [February,

of the patient. I then prescribed 15 grammes (270 grs.) of
chloroform. I recommended a few drops of this to be placed
upon a piece of cotton and held to the nose every two hours,
and also during the spasms, when they occurred. The inhala-
tion soon procured repose, and arrested the paroxysms. The
patient was not incommoded nor stupified by the anaesthetic
agent. During three days the progress of the disease was ar-
rested, though the muscles continued tense and she frequently
bit her tongue. She could drink, but with great difficulty, and
the urine flowed involuntarily. Stools, however, were obtain-
ed with greatdifficulty, even when injections were employed.

From the third to the sixth day the paroxysms diminished
in frequency and intensity, except at night, when they continu-
ed strong. In the morning of the sixth day I administered the
following prescription:

Distilled orange flower water, 120 grammes,
Chloroform, ... 2 "

Tinct. of Belladonna, . 10 ra.

Syrup of Gum, . . . 30 grammes.
This was given by table-spoonfuls every two hours. A warm
bath was also prescribed.

On the seventh day the state of the patient was more satis-
factory the pulse had improved, the skin was covered with a
slight moisture, and the patient sufiered much less ; she slept
well the precedi'ng night, the jaw was more relaxed, the head
had returned to its natural position, and the spasms had ceased.
The chloroform was stopped except when the spasms threat-
ened to return.

Between the eighth and ninth days the spasms showed a dis-
position to return, but were warded off" by chloroform. The
patient refused to take the internal medicine, and frictions upon
the abdomen and along the vertebral column with chloroform
and tinct. of belladonna in equal parts were recommended.
The state of the case was much ameliorated on the tenth day:
she spoke and desired to eat. Inhalations mornipg and even-
ing, and at the moment of the paroxysm, were prescribed.

On the twelfth day the attacks were rare and very slwrt.
The patient consented to take a few doses of the portion above
mentioned.

On the fourteenth day she sat up in her bed for the first time,
took, without assistance, a few spoonfuls of milk, and was able
to project the tongue from the mouth ; the tongue was soft,
moist, and wounded in several places ; the muscles were less
contracted; the head free, though the face was still red. She
passed tranquil nights, but obstinate constipation existed during
the last few days.

1851.] Cauterization of the Nasal Fosscb in Ophthalmia. 10'

Convalescence was apparently commencing on the sixteenth
day. She spoke easily and laughed with her companions.
Liquid and foetid stools were obtained by the use of injections,
and her appetite increased.

On the nineteenth day she was convalescent. The spasms
had not occurred for four days. There was a little stifihess in
the muscles ef the neck, back and abdomen, but in a much less
degree than the preceding days. All danger seemed to be over,
as there was no appearance of a return.

This case, and those that have been reported in your journal,
have evidently been cured by chloroform. It is well known
iiow few cases were cured before the discovery of this pre-
cious remedy. I attribute little or none of the good effects ob-
tained to the belladonna that was prescribed at the same lime.
The inhalations were not pushed so far as to produce syncope,
and yet the spasmodic movements have been readily dissipated
by their use. The portion taken internally seemed to have
materially aided that inspired in producing a cure. I am satis-
fied that I owe my success in this cae to the chloroform alone.
[Barth, M. D., BuL Gen. de Therap.

Should not the above case be regarded rather as Hysterical
than Tetanic? Edt.

Cauterization of the Nasal Fossce in Chronic Ophthalmia,
(Translated for this Journal.)

About twelve years ago, M. Morand of Tours, made known
the good eflects he obtained by cauterizing the nasal fossae in
certain chronic ophthalmias, and particularly in the scrofulous
variety. The idea of the practice, was suggested to him by
the intimate relations that exist between the scrofulous affec-
tions of the eye, and chronic inflamations of the nasal fossa?.
This practice has been most generally abandoned, yet accord-
ing to Tavignot, it should not be neglected, but on the contrary
it should be more generally resorted to. Since 1844, he and
M. Aug. Berard have employed revulsives to the nasal mucous
.membrane in scrofulous and chronic affections of the eye, of
another character. The results obtained by them have been
very satisfactory. Sometimes they cauterized the membrane
with a stick of nitrate of silver, in other cases they employed
the ointment of nit. silver, made by rubbing up 180 grs. of lard
with 18 grs. nitrate of silver. The first eight days the mucous
membrane should be cauterized each day upon the side corres-
ponding with the diseased eye. If both are aflected, the side
most diseased should be cauterized first. At the end of this

108 Camphor in Nervous Coughs. [February,

time the ointment should be employed. The best mode of ap-
plying this remedy, is to pass it into the nasal fossas by means
of a quill opened at both extremeties, and after the introduction
of the quill, the ointment should be pushed out hy a stick.

M. Tavignot has changed this method, though he employs
it in the young to whom he cannot apply his modification.
He has substituted for the cauterization, a powder composed
of an inert substance to which he adds an astringent or caustic
in proportions varying according to circumstances. The pa-
tient can snuff this with great facility. The best formula seems
to be : sulph. zinc 36 izrs. and pulv. camphor 18 grs. rubbed up
together. This powder should be snuffed 5 or 6 times per day.
A kind of erythematous inflammation is thus obtained, that will
suffice in slight cases. Jf a greater effect is desired, the zinc
should be increased to 72 or 144 grs. to the same proportions o
ingredients. The following proportion is more active : nit.
argent 36 grs., pulv. camphor 18 grs., rub together. The dif-
ferent active substances in these powders may be increased or
diminished according to the effects produced, or the results
desired to be obtained. [Ibid. Union Medicale.

Good Effects of Camphor in Nervous Coughs.
(Translated for this Journal.)

Camphor is evidently an antispasmodic. Experience has
proved this, and our predecessors have employed it with advan-
tage in many cases. Because very great abuse has been made
of this agent, is it any reason why it should always be discredit-
ed by physicians? This is not our opinion, and we will con-
tinue to collect facts that will tend to make known its true
therapeutic effects, and to regulate its use. After having a
long time struggled against prejudices of this kind, M. Alquie
of Montpellier, determined to employ camphor in obstinate
nervous coughs, which had resisted the agents usually admin-
istered in such cases. The results he obtained are too re-
markable to be unnoticed. The first opportunity he had to
prove the prompt and decided influence of camphor in such
cases, was in the case of a young lady, very nervous, who had
been affected about a week with an obstinate and dry cough
that produced great w^eakness and pain in the chest. He ad-
vised her to take 12 grs. of camphor. The next day the cough
had almost entirely disappeared, and 10 grs. more completed
the cure. A short time after M. Alquie was called to a lady
affected with violent cerebral congestion and a strong cough in
consequence of exposure. A large bleeding, sinapisms to the

1851.] Pruritus of the Vulva treated with Saltpetre baths. 109

feet, and a blister to the arm, promptly dissipated the cerebral
symptoms but did not benefit the diliiculty of respiration, or
amend the nervous cough. The latter continued dry, painfol,
and was accompanied with a little fever. M. Alquie ordered
campor, as in the preceeding case, and the following day the
cough had disappeared. From these facts it would appear,
that camphor rapidly dissipates not only simple nervous coughs,
but also those that are dry, painful, produced by catarrhal irri-
tation of the bronchi without any appreciable lesion of the lungs.
No benefit, however, is derived from camphor when the cough
has become humid and accompanied with expectoration of
thick and yellow mucus, nor in cases where there is a material
lesion of the lungs. The mode of administration is very sim-
ple. The camphor should be slightly pulverized or crushed,
and a small portion swallowed at intervals of several houis.

lRet\ Therap. du Midi, and Aheille Medicale.

Pruritus of the Vulva of Infants^ treated with Saltpetre baths.

Pruritus is caused by the presence of small worms in the
genital organs and anus of little girls. These worms are call-
ed, by Rudolphi, oxyurus. We give two cases by Dr. Vallez.
The first was a little girl, ten years of age, who was brought to
the doctor for an affection of the eyes. During the examina-
tion of the eyes, he found, by the frequency with which she
carried her hand towards the region of the vulva, that she had
been sufferins^ from an intolerable itching in these parts for a
long time. The itching w^as so great that it was almost impos-
sible for her to remain quiet for the shortest time. M. Vallez
advised lotions of sublimate, but at the end of a few^ days, no
improvement having taken place, M. Vallez proceeded to an
attentive examination of the genital organs. To his astonish-
ment he discovered a quantity of small worms in the fossa
navicularis and fourchette, which by their movements produced
the itching. He prescribed tepid hip-baths, containing a
quarter of a pound of saltpetre in each bath. Whilst the pa-
tient was in the bath, the lips of the vulva were kept separated
so as to aid imbibition. After taking three baths the patient
was radically cured.

The second case, was that of a young girl who had been
suffering from continual itching about the vulva for two years.
M. Vallez treated her with the saltpetre baths, and after taking
two she was entirely cured.

Whilst recommending the treatment of M. Vallez, we must
add, that in several cases which came under our observation,
either in young girls or pregnant women, two or three frictions

110 Treatment of Varicocele, [February,

made with mercurial ointment upon the seat of the disease
caused the itching to subside. [Gaz, des Hopitaux.

Treaiinent of Varicocele.
To the Editor of the Boston Medical and Surgical Journal :

Sir, The treatment of varicocele by the pressure of a truss
over the spermatic veins, at the external inguinal ring, as first
recommended, in my notice, by Mr. Curling, in the London
Lancet for June 15, 1845, and since then approved by several
others, does not seem, as yet, to have obtained so general a
reception in practice as its merits deserve. The reason of the
caution or neglect with which the suggestion has been received,
undoubtedly is, the theoretical presumption that such a remedy
would inevitably be injurious, by preventing the return of the
blood from the spermatic veins. A single trial of the truss in a
case of varicocele will remove that presumption. No danger, or
inconvenience, or discomfort, will result. The proximate cause
of the varicosity and of the suffering that attends it, is the pres-
sure of the superincumbent column of blood, unrelieved and
unsupported by healthy vein-valves. The truss, by its pressure,
closes the vein, supports this column, and relieves the distended
veins below : these then contract of themselvs ; the blood, sent
into them by the spermatic artery, returns through the superficial
veins, and the irritation, which results solely from the distending
pressure, speedily subsides, and restores the patient to comfort,
and after a few weeks or months, to health, or all the signs of
health.

I first used this remedy four years ago. Then, and in several
cases in which I have recommended it since, it proved harmless
and effectual. If the remote cause of the disease be, as 1 sup-
pose, a deficiency of the valves, it is, of course, beyond radical
remedy. And, accordingly, I find that the complaint, sooner or
later, is apt to return, if the truss be dispensed with, and to
necessitate a second resort to that remedy. But if it may be
said, on this account, that the cure is not radical, it is at least true
that the treatment leaves the disease no more than an incon-
venience.

The case, the worst, and at the same time the most satis-
factory, of all I have treated, came into my hands in January,
1850. The patient, C. R., had himself brought to me, from his
residence, twelve miles distant, on his back a position that,
"with intermissions of not more than ten minutes^ he had main-
tained for three months, if I remember rightly, and which he
continued to maintain, as I will explain, as much longer. He
was about 50 years of age, and had suffered from varicocele

185L] Chloasma, 111

since early puberty. For several years, so irritable had the
parts become, he had been frequently obliged to confine himself,
for weeks and months at a time, mainly to the horizontal pos-
ture. At such times, as he informed me. the parts effected were
inflamed, swollen, tender and unusually painful. As we often
see in such cases, the pain had come to be, in a measure, of a
neuralgic character. The patient's physical and mental powers
were suffering under the constant irritation, and the superin-
duced hypochondriasis. Bad off as he really was, he thought
himself worse, and had as little peace of mind as of body. He
had long used a suspensory bag, but of late had found its relief
very limited. Other remedies had been tried. He had consult-
ed a good many physicians, and among them two professors of
surgery, who, having (very justly) little inclination to recom-
mend the common methods of seeking a radical cure, told him,
'' if he could net cret along otherwise, he had better have the
testicle removed." It was, in particular, for my opinion on
this point, that he came to see me. I recommended a truss.
This w^as altogether contrary to his theory of the disease.
He had read a good deal on the subject, and perhaps was not
the easier to manage on that account. I explained my notions
to him, and he went away half convinced ; consulted his books,
and his favorite doctor in the neighborhood where he lived, and
came back to me afraid to try it " for fear the veins would swell
up and inflame." This course of proceeding was repeated sev-
eral times, till at length I gave him my views in black and white,
fully, reasoned out, to all possible contingencies and results.
With this memorandum in his pocket, for easy reference, he
was able to keep his judgment steady. He got a truss and put
it on ; and the next time he came to see me, much to my grati-
fication and relief, he came on his legs. In short, he now calls
himself well, and insists thai I shall" publish his case," or he
will do it himself

A single practical direction in regard to the amount of pres-
sure: it should be quite slight, just enough to close the calibre of
the vein. Any easv hernia truss will answer the purpo.se.

Middlehury] Vt, Dec. 24th, 1850. Chas. C. P. Clark.

Chloasma. By Wm. Gray, M. D., of Manchester.

This disease of the skin is also known by the names, Epheh'sf,
Macula3 hepatica3, Pityriasis versicolor, Leberflcctete, and Liv-
er spots ; and generally makes its appearance on some part of
the chest or arms, and extends in very irregular patches to
other parts of the body, some times covering nearly its entire

112 Microscopic Examinations in Cholera, [February,

surface. As far as the disease spreads, the skin assumes a dull
yellow or brown color, sometimes varying in tints. There is a
very slight elevation of the cuticle inmost cases, with a very
fine eruption. Occasionally the itching is very annoying, though
not at all constant. The patches are often covered with min-
ute scales.

This disease is supposed to exist as a sequel to disease of the
stomach or liver; but several cases have certainly come under
my observation, where there was no perceptible functional
derangement, either of the stomach or liver; and I am of the
opinion, therefore, that it has no more connection with derange-
ment of the stomach and liver than has impetigo, lepra or pso-
riasis.

My principle object in introducing this subject is to speak of
the treatment which I think has been heretofore unsatisfactory,
both to the physician and the patient. During the early years
of my practice, the cure of this superficial disease annoyed me
exceedingly. In 1844, 1 began to use the Sulphur Fume Bath as
a remedy, and from that time have had entire success ; and am
now prepared to recommend this remedy as a specific for this
disease, if there be any specific in medicine. In recent cases a
few applications are sufficient ; and in no case has it been ne-
cessary to apply it more than eight or ten times. If any mem-
ber of the profession has a remedy as certain as this, and more
easily applied, it would be highly gratifying to have it made
more public. \_New Hampshire Jour, of Med.

Microscopic Examination of the Discharges from the Bowels
in Cholera. By R. S. Holmes, M. D., of St. Louis, in a
letter to the Editor of the American Jour, of Med. Sciences.

I have examined (microscopically) the discharges from the
bowels in six cases of cholera, and have found the cells of cryp-
togam! in a greater or less degree in four of these cases, and
vibriones very abundantly in one. The theory I think amounts
to nothing. I have found in flour every one of the forms of
cryptogami that I have been able to discover in cholera cells ;
one has a peculiar shape, which I have not seen described. I
have had a bottle of flour and water on my table for some
months, and I am confident I could show in the course of
afew days every one of the forms of vegetable growth in it that
are seen in cholera discharges, by a Ross one-eighth lens : I
say in a few days, for these cells vary in the flour, and are some-
times not to be seen ; the cell of the mould of flour precisely
resembles that of the smallest of the cholera cells, which is not
more than the one twelve thousandth of an inch in diameter,

1851.] Subcutaneous Punctures, <^'C. 113

although the peculiar cholera cell, so called, seems to have been
liiTiiteci by the English investigators to a much larger cell, with
buds upon it.

I may mention that I discovered distinct crystals, having the
exact forms of those of lithic acid, in one case where there
was suppression of urine. \_A?7ier. Jour.

Subcutaneous Punctures in articular Rheumatism. By M. Gui-
REN.-Frequently joints which have become invaded by an attack
of rhematism long remain the seats of most obstinate pain. On
a close examination we may assure ourselves that this pain is
neither uniform nor general, but partial and localized at certain
points. On handing the part we can even feel, opposite the
immediate seat of pain, little knotty points which are exquisite
to the touch. Such points exist even during the acute stage of
rheumatism, but are miUch more easily recognised and isolated
in the subacute stage. It is towards these points that the sub-
cutaneous punctures should be directed, taking care, as in the
ordinary application of the method, to raise a fold of the skin.
The point of the instrument divides and liberates this tume-
fied and, so to say, indurated part ; and the instant this is eflec-
ted the pain ceases, and pressure can detect no trace of the no-
dosity thus destroyed. Whether a few drops of blood flow or
not, the same result follows, so that the practice does not ope-
rate as an antiphlogistic. It is in fact only a liberation (dehride
merit.) [Gaz. Med. 1850, No. 22. British and Foreign Med.
Chir. Rev.

On venj Minute Doses of Tartar Emetic, in Phthisis and
Asthma. By M. Rerxahdeau. In vol. xxxi of the Bull de
Therap., M. Bernardeau gave an account of the great benefit
he has seen derived from the administration of minute doses
of tartar-emetic in the hectic of phthisis. Since that period he
has used it in other stages of tuberculization, and in several
cases of asthma, with excellent elTects. He gives from three
to six pills in the twenty-four hours, each containg l-25th of a
grain. By their use, the cough, dyspnoea, and inordinate ac-
tion of the heart become cahned,and in fact all the good elTects
of morphia, without its inconveniences, seem to be produced.
[Bulletin de Therapeutic, vol. xxxiv, ii, p. 311. Brit, and
For. Med. Chir. Rev.

Stethoscopic Sound attending the detachment of the Placenta.
M. Caillault relates in "I'Union Medicale" the discovery of a
peculiar sound produced during the detachment of the placenta

114 Caseine in the Blood of Nurses. [February,

after the delivery of the child. M. C, in making observations
at the " Hopital Beaujou," found that upon applying the steth-
oscope over the hypogastric region immediately after the ex-
pulsion of the fdetus, he beard at first nothing but the sounds
produced by the intestinal movements but that, as soon as the
uterus began to contract, a new sound was heard gradually in-
creasing and diminishing in intensity with the increase and
subsidence of the uterine contraction. This sound consisted
of a series of rapid crackings similar to what might be produ-
ced by passing the finger nails over the straw bottom of a chair ;
and it was regularly reproduced at each contraction, until the
placenta was expelled* M. C. has had ample opportunities to
determine the uniformity with which this sound is produced in
every instance -and has had his discovery confirmed by the
other physicians of the institution. He is therefore disposed
to deny the correctness of Velpeau's opinion, that the placenta
is usually already detached before the delivery of the child.

May not M. C. err in attributing this sound to the act of de-
tachment, instead of regarding it as the mere effect of the
compression of the placenta and to the consequent extrusion
of a portion of its blood. It seems probable that this may ac-
count for the sound*

Caseine in the Blood of Nurses. The blood of two women,
whilst nursing, was examined by M. M. N. Guillot and F. Le-
blanc, and the serum, after being separated from the albumen,
furnished an abundant white precipitate when it was boiled
with a few^ drops of acetic acid. They discovered all the
characters of casein in the solution. The quantity of this
product seemed to be in proportion to the diminution of the
quantity of albumen.

In experimenting with the blood of new born infants, no
sensible traces of casein could be found.

The blood of men and women treated in the same manner,
gave a light precipitate which was redissolved in a few drops
of carbonate of soda. The precipitate was much less, and of
a different appearance from that obtained from the blood of
nurses.

1 85 1 ] Treatment of Sprains of the Ankte, 115

On the Treatment of Sprains of the Ankle. By M. Baudens.
M. Baudens observes, that judging by the frequency of the
occurrence of this accident, its treatment ought to be well
Understood and successful!}^ practised : but that this is in fact
far from being the case, and he is therefore desirous of making
his own plan of treating it, by the cold-bath and gum bandage,
more extensively known.

The indications are, first, to prevent or remove inflamma^
lion, and then to secure immovability to the distended orlacei*^
ated parts, until they have recovered their power, the patient
being at the same time allowed the use of the limb. For the pur'
pose of subduing inflammation, numbers of leeches are usually
applied, and then an emollient cataplasm ; and M. Baudens
feels convinced that it is in consequence of such treatment that
degenerated sprains so often augment the number of imputa-
tions in hospitals. By free leeching of a joint, the seat of sprain,
two mischievous effects are produced. In the first place, the
pain, which is the first of the series of symptoms of inflamma-
tion after sprain, is increased by the leech-bites, in place of
being mitigated ; and, in the next, the increased afflux of blood
towards the part is encouraged instead of being repelled. M.
Baudens, on these grounds, strictly forbids the application of
leeches in all surgical maladies attended with acute inflamma-
tion, while he often derives most excellent aid from their em-
ployment in chronic inflammations ; thus, by the induction ot
a temporary congestion, giving a fillip to the too languid ac-
tion of the part. When blood need be taken in sprain, he
abstracts it by venesection, although probably both the profes^
sion and the public, from the force of habit, w^ould tax with
ignorance any one who neglected the use of leeches. As to
emollient cataplasms, they favor in place of opposing the afflux
of fluids to the part, while the long maceration the joint has
been thus submitted to, deprives it of its elasticity, gives rise to
a pasty engorgement, and predisposes to the formation of white
swelling.

M. Baudens has pursued his own plan of treatment now for
twenty years, and under it his patients have been enabled to
resume their trying military duties in a very short time. He
is not the first who has employed cold water in the treatment
of sprain ; but his originality consists in trusting to it alone, and
continuing its application for so long a period. His plan of
employing it, contrasted with that of his predecessors, may be
thus summed up: 1. Period of the Application. Cold has
usually been thought desirable only when it could be resorted
to very shortly after the accident ; but he applies it not only
immediately, but also several hours or days after the occur-

N. 3. VOL. V!T. NO. If. 8

116 Treatment of Sprains of the Ankle. [February,

rence, or even in chronic sprain whenever, in fact, there is a
inorhid degree of heat to abstract. 2. The local bath has never
been ordered by others for longer than five or six hours, although
some practitioners, since his first publicatioa on th subject,
have ventured to extend it to tweaty-four. In certain of his-
cases, however, immersion bas been continued for eight or ten
days, and, in one example, for fourteen days ; while in no cass
bas it been less than for two. 3. Mode of application. The
vessel containinor the water is brought to the bedside of the
patient so that he can conveniently place his leg in it, having the
heel resti-ng on a sponge at the bottom, the leg and thigh being
supported by cushions, so that the position may be maintained
as many days as required. In the vessels used at the Val-de-
Grace the water reaches as high as the middle of the leg, and
is changed about every three hours in order to keep it suffi-
ciently cool. Spring water is usually employed, and if the
inflammation is intense, ice is added. A purgative is given,
and. if indicated, one or two bleedings are resorted to. 4.
Effects. One of the first of these is the cessation of pain, which
sometimes occurs at once, and at others in an hour or two.
From the moment the foot is placed in the bath, the sw^elling
becomes stationary, and soon after, with the heat and redness, de-
creases. About ihe fourth or fifth day the part becomes wrin-
kled like the hands of a washerwoman, nnd usually abo-ut the third
or fourth day, the patient finds the water too cold, and then the
iimb is removed from it the period for doing this being regi>
lated by the patient, he being told to keep it in only as long
a& he derives comfort from so doing. Few of the patients
suffer from any general reaction. Gangrene has been said to
have resulted from this application, but the author has never
met v;ith such a case. The patient sometimes persists in keep-
ing the limb in water after the dispersion of the heat and pain, and
the consequeuce is the production of engorgement of the joint,
a tense state and dark color of the skin, toprether sometimes
with darkish lines precursory signs of congelation in fact on
seeing which the joint should be enveloped in a fomentation of
elder-flowers and poppy-heads at the temperature of the atmos-
phere. The objections which have been urged from the fear
of producing repurcussion.dive quite theoretical and unfounded.
It is in fact only the excess o^ morbid caloric that is abstracted.
Gum-bandage. When the inflammation has been subdued,
all the depressions in the vicinity of the joint are filled with
wadding, and a bandage carefully and equably applied. This
is well moistened, by means of a brush with very thick gum,
wliich in a short time imparts to it almost the hardness of wood.
After this has been worn for twenty-five or thirty days, it is

1 85 1 .] Refracture of the Leg. 117

removed and the joint slowly and gradually exercised ; for
-want of which precaution many patients (especially those
treated by leeches and poultices) suffer all the symptoms of
a sub-inflammation of the white tissues of the joints, even for
years. [Gaz. des Hop. Brit* and For. Med. Chir. Rev.

Refracture of a Less;, to improve defective Surgery. By
R. D. MussEY, M.D., Professor of Surgery* Medical College,
Ohio.

On the 29th January, 1848, Miss J. E. KingsleVj a school
teacher, in Jefferson county^ East Tennessee, in descending
a hillj was thrown from a buggy, and had both bones of the left
leg broken in two places ; one three and a half inches below
the knee, the other two and a half inches above the ankle.

It was six weeks before Miss K. began to sit up in bed, and
four months before she was able to ride out. She came to
Cincinnati in July of the same year. Ever since the injurv,
the leg had been considerably swollen, and there had not been
a day without more or less pain, sometimes severe, extending
from the upper fracture to the heel, back of the foot and toes,
indicating lesion or compression of the fibular nerves.

Both fractures were firmly consolidated. The lower frac-
ture was well enough, exhibiting no deformity at the upper
one, the leg w^as sadly bent, exhibiting a prominent external
convexity, or angle, so great as to shorten the distance fronl
the knee to the inside of the foot about an inch and a half; the
plantar surface of the foot looking inward, and its outer edge
looking directly downward. Of course, the limb was alto-
gether useless in walking ; any attempt to apply the foot to the
ground aggravating the pain. It was impossible to place the
sole of the foot down flat, or bring the heel within an inch of
the ground. The limb was therefore left to swing, while Miss
K. moved about upon the other leg, and a pair of crutches.

In September, 1848, aided by my son, Dr. Wm. H. Mussey,
I operated in the following manner. A firm pad an inch and a
half thick, was laid upon the inside of the knee, another upon
the inside of the ankle, extending five inches up the ]eg,. A
splint of hard wood, one inch thick, and three inches wide, was
laid, and secured by a bandage, upon these pads. A broad
padded belt was placed over the angular projection of the
fracture, and gradually tightened by a mechanical power, de-
rived from Jarvis' adjuster, till the fracture was crushed, and
the leg straightened.

Miss K. having been placed under the influence of Chloro-
form, was wholly unconscious of pain during the operation,
and occupied herself all the while, in singing sacred songs, and

118 Difficulty of Breathing, [Pebruarj^

holding celestial conversation; and while a bandage and splint
were being applied to maintain the new position of the limb,
finding herself coming to earth again, she entreated most
earnestly for more Chloroform, to prolong the ecstatic illusion.
After the operation, the pain in the leg and foot were dimin-
ished, and in two months the fracture w^as consolidated.

Dec. 12. There is now no pain at the heel, and comparative-
ly little in the leg and foot. The hmb has its natural direction,
is as long, and apparently as strong as the other. She can now
v/alk with a cane, and limpingly without one.

Feb. 1849. Miss K. now w-alks very well without crutch
or cane, and only now and then feels slight pain in the leg, the
nervous injury having been almost repaired. Some months
after the above date we saw Miss K. walking well in the street
as if nothing had happened. \_Western Lancet.

The Difficidty of Breathing from an over duse of Opium,
relieved by inhaling the Vapor of Water. By Charles W.
Wright, M. D., of Cincinnati.

The difficulty of breathing which is commonly met with in
cases of poisoning with opium, is generally ascribed to its pro-
ducing paralysis of the respiratory muscles, and that asphyxia
is thus induced, wMiich is the immediate cause of death.

Having observed this symptom in several instances, and
knowing the power which this drug has of arresting all the se-
cretions, except that of the skin,^ I was led to suppose that the
d'ifficulty of breathing was not, in all cases, to be referred to
paralysis of the muscles of respiration, but was to be accounted
for, in part, at least, on different principles.

Now it is absolutely necessary, that the mucous membrane
o-f the lungs should be kept constantly moist, otherwise it is
impossible for oxygen gas to be absorbed, and carbonic acid
eliminated. It is observed in some cases of poisoning with
opium, that the mouth and fauces become so dry, that it is al-
most impossible for the patient to swallow or speak, and that if
the dose is sufficiently large, this dryness may extend into the
respiratory organs, and thus give rise to great difficulty of
breathing. In these cases the patient is not so much disposed
to sleep, as when this symptom is not observed.

Having seen this effect of opium in several cases, I had deter-
mined to try the effect of the inhalation of the vapor of water,
in mitigating the unpleasant symptoms thus induced. This I
was enabled to do in my own case, a short tin>e since, from-
having taken by mistake an over dose of opium, which could
not have been less than ten grains. In this instance, the first
warning of the mistake I had committed was embarrassed res-

1851.] Chorea. 11\)

piration, which soon amounted to an agon}-, without the least
symptom of narcotism. In this case much the same sensation
was produced by each inspiration as is experienced by the inha-
lation of pure nitrogen gas, the air seeming to leave the lungs
without having performed its functions, there beins^ at the same
time a sense of dryness in the fauces and larynx. In this con-
dition I commenced breathing the vapor of hot water, which
produced immediate relief. After this, having ejected the poi-
son from the stomach, by an emetic, no unpleasant effect fol-
lowed.

When it is remembered that the power which a membrane
possesses of absorbing a gas, is in proportion to its moisture,
and that a dry one is as impenetrable to gases as horn, it is not
surprising that the above symptoms should be induced by opium,
which above all other substances, has the property of dimin-
ishing the secretion of the mucous membranes. It should also
be borne in mind, that by arresting the pulmonary secretion,
the blood loses its attraction, for the mucous membrane lining
the lungs.*

Probably the best treatment which could be adopted, where
this symptom is observed, would be to allow the patient to
inhale the nitrous oxyde gas, saturated with vapor, which w^ould.
have the effect of restoring the moisture of the lungs, and pre-
senting oxygen in a much more soluble form, than that which
enters into the composition of the atmosphere. [Ibid,

On Chorea. By Dr. Lee. An analysis of various published
cases of this disease, and of forty-two observed by himself at
the Hopitaldes Enfans, leads Dr. Lee to the conclusion that
there are four principal varieties of it.

1. One which has been called sympathetic, coincides with
the local lesions of the various viscera of organic life, and
especially with disease of the gastro-intestinal system and of
the heart.

2. A second, which is very common, depends upon o, general
disease, and especlaWy rheumatism. So frequent is this variety,
that it constituted seventeen out of the author's forty-two
cases, and thirty of seventy-four he has collected. Rheuma-
tism indeed may not only give rise to chorea, but to a varity
of other nervous disturbances, as simple convulsions, contrac-
tions, tetanic convulsions, pseudo-meningitis, pseudo-myelitis,
&c. ; and, in fact, there is no symptom usually referred to
lesions of nervous substance, which may not be dependent
upoQ a rheumatic affection of the joints or heart, such affection

* See LiebiYs iate work on the motion of the juices in the animal body.

IQO Ivjluence of Salt Diet vpon the Blood. [Februarj'

being almost always marked by the nervous derangement, and
giving rise to only very slight local suffering and febrile action,
especially in a chronic neurosis like chorea. When, however,
the febrile reaction is intense, the neurosis is usually only de-
veloped when the inflammatory fever has undergone some
remission ; and a reproduction of the febrile action alwa3^s in-
duces an improvement in the nervous symptoms ; except in
some cases in which the disease proves quickly fatal.

3. Another form of chorea quite independent of cerebral
alteration, is the so-called essevtial chorea, in which no appre-
ciable change of structure is recognisable either in the organic
viscera or the nervous system ; this, like rheumatic chorea, is a
very common form.

4, The last form depends upon cerebral or spinal lesion,
and is but the symptom of various cerebral and spinal affec-
tions. [Bull, de r Acad, British and Foreign Medico-Chir.
fieview.

Influence of a Salt Diet on the Cofnposition of Blood. Pog-
gaile has, moreover examined the blood of man, both at the
time that the usual diet was taken, and whilst 154 errs, of salt
were consumed daily. The following are the results :

During

During

usual diet.

salt diet.

Water

- 7799

7070

Blood corpuscles

- 1301

1430

Albumen -

77-4

74-0

Fibrin

21

2-3

Fatty matters

11

1-3

Extractive and salts r

9-3

11-8

From which it is evident that the proportion of solid constitu-
ents are increased ; this occurs chiefly in the blood corpuscles
and extractive, the amount of albumen being slightly diminish-
ed. \_Compt. Rendus, xxv.

Bonssingault has also extended his observations concerning
the influence of salt on the fattening of cattle. His earlier ex-
penments had shown, that salt does not exert that beneficial
influence on the growth of cattle, and the production of flesh,
which is usually ascribed to it. His present experiments have
been extended over a period of thirteen months, and have
been made on a number of steers, some of which had their
rations salted, while the others had not ; in other respects they
were treated in a precisely similar manner. The results have
shown that the increase in the proportion of flesh does not pay

1 S5 1 . ] Condition of Carbonic Acid in the Blood. \2 1

for the salt employed. Boussingault however, remarks, thai a
saline diet exerts a beneficial effect on the appearance and con-
dition of the animals ; for the steers which were deprived of
salt for eleven months, appeared sluggish, and of a languid tem-
perament ; their coats were rough, devoid of gloss, and par-
tially bare ; while those which had been fed with salt were
lively, had a fine glossy coat, and w^ere sure to obtain a consid-
erable higher price at market. [Aim. Ch. Phys., and Liehig's
Report, Ibid.

Condition of Carbonic Acid in the Blood. Liebig remarks,
that while water only takes up its own bulk of carbonic acid
gas, serum has the powder of absorbing twMce its bulk of it.
Now as this cannot be dependent on the presence of neutral
carbonates in the blood, Liebig endeavors to show that it is
owing to the existence of basic phosphate of soda. This chem-
ist finds that a solution of one pan of dry phosphate of soda
(2NaO, HO, PO-^) in 100 parts of v/ater, absorbs, likewise, a
double volume of carbonic acid. By shaking up with air, or
by diminishing the atmospheric pressure, two thirds of the car-
bonic acid taken up are evolv'ed at the ordinary temperature ;
the entire amount of carbonic acid gas is given off during sim-
ple evaporation in the atmosphere. When the blood absorbs
carbonic acid, the soda of the former is appropriated partly by
the carbonic acid, and partly by the phosphoric acid ; but the
phosphoric acid which has been expelled, remains and tries to
reunite itself with all the soda; consequently the phenomena
are different from what they would be if the blood really
contained carbonate of soda as such. [Liebig^s Report.

Liebig states, that serum strongly concentrated by evapora-
tion, does not evolve a trace of carbonic acid, on the addition
of acids. Lehmann, on the contrary, asserts that blood con-
tains a large quantity of alkaline carbonate. He has commu-
nicated the results of experiments, in which the free carbonic
acid was expelled by hydrogen introduced into the blood, and
the combined acid by means of acetic acid in a rarified space.
According to his determinations, 1000 grains of fresh ox-blood
yieldson an average 0132 grains, or 0*28 cubic inches of free
carbonic acid, and 0-676 grains or 1*42 of combined. He
mixed blood with an equal quantity of water, coagulated the
albuminous constituents by heat, and evaporated the filtered
fiuid to dryness. The residue was incinerated at tlie lowest
possible temperature; in 100 parts of ash there were found from
41 to 4'5 of sulphate of soda ; 3'7 of phosphate of soda (3XaO
PO^) ; from lo-8 to IS'l carbonate of soda; and from 740 to
750 of alkaline chlorides. [Liebig s Report. Ibid.

122 Growth of the Hair and Nails. [February ,

Ohsertations on the Growth of the Hair and Nails. By
Dr. Berthold. To determine the time required by the nail to
grow to a certain length, the writer first made some experi-
ments on himself, and found that the nail of the middle finger
grew 11 millimetres in four months. Continuing his experi-
ments, he found a great difference in the growth of the nail,
according to the age of the person, and the season of the year.
For instance, he found that the same nail, which would take
152 days in winter to attain a certain length, would grow to
the same length in 116 days in summer. The growth also
differs on different fingers, as also on the right and left hand.
On the right hand the growth is quicker than on the left.

The hair of individuals, from 16 to 24 years old, grew in two
years 12 to 16 inches, or 7 lines a month.

The growth of the hair is accelerated by frequently cut-
ting it.

During the day, reproduction of hair goes on more rapid-
ly than at night. In warm weather, the reproduction is greater
than in cold weather.

The quantitative formation of nail and hair coincides with
the peripheric secretions, perspiration, tkc, in this that it
increases in summer, and decreases in winter; whereas, the
development and nutrition of the body is decreased in summer,
and increased in winter ; so that the weight of a man is greater
in winter than in summer.

The growth of hair decreases in the night, w^hich coincides
with the decrease of the secretions, perspiration, formation of
carbonic acid gas, urine, milk, bile, &c.

IMiillei'^s Archiv, Ihid,

On Cod-Liver Oil in Phthisis. By M. Duclos. M. Duclos
thus sums up the results of his experience with this substance :
1. The presence of fever is what we must chiefly attend to,
relying more on this remedy when it is absent, and less when
it is present. 2. The remedy frequently arrests the progress
of the disease when only in the first stage. 3. It rarely arrests
it when in the second stage, although it may retard it. 4. The
third stage is not favorably influenced by the oil. 5. The oil
should be administered for a considerable time ; and, if a good
effect results, it should be suspended awhile, to be againresumed.
Thus, it may be given for two months, and then suspended for
a fortnight, resumed for a month, and re-suspended for a fort-
night again, so as gradually to reduce the length of the inter-
vals during which it is given. 6. The clear, sliglitly smelliufr,
nearly tasteless oil, is less efficacious tiian the brown, thick,
strong oil. [Bull, de Thcrap. Ibid.

1861.] S(dt in Intermiitents. 123

Common Salt in Intermit tents. Prof. Piony, in reporting
to the ^ Academie de Medecine" upon the proposed use of
table salt (chloride of sodium) in intermittent fevers, states that
if administered in doses of two table-spoonfuls, it will not only
arrest the disease, but also exert upon the spleen as marked an
effect as quinine does. In 12 cases of intermittent fever, the
salt uniformly arrested the paroxysms and lessened very mate-
rially the size of the spleen. The spleen was also found to di-
minish when tke remedy was given in cases of typhoid fever.

If similar results can be obtained in this country, the discov-
ery will be one of great value. It is very desirable to find a
cheap substitute for quinine, we would like to hear from tho5:e
who may try the salt.

Periodic Hemorrhage from (he Face. Dr. Chrestien, of Mont-
pellier, relates the case of a young lady who had been sent to
the baths at Rennes for the regulation of her menses which
had never appeared through the genital organs, but through the
pores o( the skin of the cheeks. Drops of blood appear upon
these parts, return very soon after being wiped off, and con-
tinue in this way until the loss amounts to about 100 or
120 grammes of blood per day. This hemorrhage has already
appeared several times at intervals resembling those of natural
menstruation, and seems to supply its place. He does not give
the result.

Nephritic Amaurosis. M. Landouzy announces the fol-
lowing facts :

1st. That an impairment of vision is an almost constant
symptom of Bright's disease.

2d. This impairment constitutes a new form of amaurosis
svhich may be called nephritic or albuminous.

3d. Amaurosis cannot be attributed to the deterioration of
the strength.

4th. It frequently announces the disease before the appear-
ance of the other pathognomonic symptoms.

5th. It disappears and reappears without following exactly
the changes of the albuminous deposition in (he urine or oedema.

6lh. Albuminous nephritis should be considered as the result
of an alteration in the ncrvo-ganglionic system.

124 Miscellany. [February,

New method of uniting Wounds of the Scalp. We notice
in the French journals the excision of encysted tumors from
the scalp of a female, after which the edges of the wound were
drawn together by platting the hair across it, and adhesion by
the first intention obtained. The advantage of this method is
obvious when it is desirable not to cut away the hair.

Ethereal Solution of Cantharidine.
Pulv. Cantharides, - - - 1 part,

Sulphuric Ether, - - - - 2 parts.
Digest 3 days and then separate by expression. By apply-
ing this solution to the skin \v\i\\ a camel-hair pencil, vesica-
tion takes place in one or two hours in children, and in three
or four hours in adults.

Cantharidine Ointment. This may be prepared by rub-
bing together equal parts of the Ethereal Solution and lard or
mutton suet. Frictions made with this ointment induce vesi-
cation in a few hours. It is much used in Prussia.

Cochineal for Hooping Cough. An anonymous writer, in
the N. Y. Medical Gazette, recommends very highly the follow-
ing prescription for hooping cough to be giv^en in teaspoonful
doses, three times a day. He regards the cochineal as the
active principle of the prescription, and hence gives it in larger
doses than usual.

Cochineal, in very fine powder, - - 3ij.

Carbonate of Potash, 3j.

Sugar, !j.

Tincture of Spear-mint, . - . - 5ij.

Water, !xiv. Mix.

ill i S U a U J1 .

*' Surgical Report for the American Medical Asssoclation. The
committee is invited to meet in the Charleston Hotel, South Carolina,
the evening of the first Tuesday in May next. All professional breth-
ren, who have surgical facts connected with the improvement of this
branch of tiie profession during the year, will please address them to
theciiairman of the committee by the first of April, at Augusta, Ga.
As all cannot be reached by a circular, it is hoped no one will wait
for a more direct application than this general invitation.

1851.] Miscellany. 125

"By extending this notice, the medical periodicals of our country-
will advance the interests of the American Medical Association, and
the editors will confer a favor upon their recent confrere.

PAUL F. EVE, M. D.,
*'Prof. of Surgery in the Louisville University, and
Chairman of the Committee on Surgery.
^^I^o|FisviLi,E, Ky., Dec. 1850."

Negroes in the Medical College at Boston. We publish the follow-
ing intelligence M^^itfeout comment, not doubting that Southern
readers will duly appreciate the philanthropy of those who wish to
furnish Liberia with " colored Doctors," and our own country with
^' women Doctors."

*' Trouble among the Medical Students at Harvard University.
The following facts have been collected respecting some unhappy
proceedings last week at the Massachusetts Medical College in this
city. Among the students attending the medical lectures, are three
colored young men. One of them is from Pittsburg, Pa., one belongs
in this city, and we believe is a native, a son of the late Rev. Mr.
Snowdeu, a colored preacher of much eminence for many years ;
the locale of the other is unknown to us. They are all, as we have
understood, under the immediate auspices of the American Coloniza-
tion Society, g,nd by them are to be educated as physicians for the
colony at Liberia. It was understood by the students last week that a
lady was also to he added to the class. These departures from estab-
lished rule gave offence to a portion of the members. On Tuesday
morning the class held a meeting, and appointed a committee to draft a
set of resolutions. The meeting was adjourned to the afternoon,
when the students again assembled. The resolutions, respectfully
remonstrating against the admission of colored men and ichite women
iye;fe then taken up seriatim, and passed by a majority of the students
present. We should here state, that the class attending the meeting
in the morning showed a majority fot* sustaining the faculty in the
course of admitting whom they pleased to their lectures ; but not sup-
posing any such resolutions would be presented, many of them did
not attend the afternoon meeting. Those present who disapproved of
the resolutions, immediately appointed a committee topreseiita minor-
ity report, sustaining the faculty, to be presented to the class at a
future meeting. We regret exceedingly this little disturbance, and
the course adopted by the class. We cannot but think that if they had
any real grievances, it would have been better to have approached the
faculty in some other way. It may be considered an innovation to
admit colored men into our colleges ; but when it is remembered for
what purpose tliese were admitted, there really cannot be so much
objection after all. But as to the propriety of admitting females to
medical colleges in common with males, it is a matter in which iIhm'c
is a great diversity of opinion. We should most decidedly object to

i2G Miscellany. [February^

the adoption of the practice, preferring to have all females, who wish
lo become disciples of the healing art, or otherwise assume the mas-
culine professions, attend separate institutions for their education.

"Since writing the above, vre learn that the faculty have announced
to the class, that the lady in question, on hearing that there was a
feeling against her being admitted to the college, has withdrawn her
application. Respecting the colored men, they declined to reject
them from the college, under the circumstances as they have pur-
chased tickets and thereby acquired a right of attendance during the
present year.^'

[We clip the foregoing from the Boston Medical and Surgical
Journal, and cannot refrain from expressing the opinion that the edu-
cation of colored men as physicians and surgeons, for the service of
the Republic of Liberia, on the coast of Africa, is a sacred duty, bind-
ing on our Medical Colleges in America. We deeply regret that
either northern ot southern students should any where object to this
laudable work, and sincerely hope that the Faculty of Harvard may
be sustained for better reasons than that " they have paid for their
tickets, and thus acquired tiie right of attendance for the present year."

The claims of humanity are of paramount obligation, and we see
not how any American can be indifferent to the necessities of our
own colony in Africa, now emerging into a national existence under
circumstances which challenge the admiration ot the world. They
must have colored physicians, for white men cannot endure the cli-
mate, and the want of medical men is one of the most pressing needs
of the colonists.

We would respectfully suggest that the generous and magnanimous
students now in large cities, siiould spontaneously meet, and express
their readiness to welcome to their lecture-rooms all colored students
whom their respective Faculties may see fit to educate for the service
of the American Colonization Society.

They would thus do themselves honor, by recognizing the claims of
humanity upon the profession of their choice, and at the same time
give a gentle admonition to the misguided young men of Harvard,
which is justly merited.] iseio York Medical Gazette,

An appeal to the Medical Society of Rhode Island in hehalfof Wo-
man, to be restored to her natural rights as ^^ Midivife,'' and elevated
hy education to he the physician of her own sex. This is the verbose
title of a z5er_yre^^2oz(<y pamphlet, or rather Tract, "for the author,"
wiio is nameless, and ominously marked " READ AND LEND ; "
and strenuously recommended to be re-printed and published by sub-
scription or otherwise, with the devout prayer of the author, that "God
in his infinite goodness may reward such labor, ibr promulgating the
inighty truth ! "'

The only " mighty truth " we can discover on reading the pam-
phlet is the following, viz :

" Dr. T. L. Nichols, of New York, a regular graduate of the Med-
ical College of the University of that State, in a late periodical speak-

1851.] Miscellany, 127

ing of his wife, Mrs. Gove Nichols, who is a thorough educated
practising physician says : I am proud to say that she has taught me
iar more in connection with Obstetrics, than I could ever have learned
in all our Medical Colleges and Libraries ! "

This is a powerful testimony in behalf of CLINICAL teaching,
and the tract, if reprinted and published to the extent prayed for, will
be an admirable advertisement for this " Mrs. Gove Nichols, the
eminent female physician," and her interesting pupil and husband,
Dr. T. L. Nichols of New York.

As to the project of " restoring to Woman," any " natural right "
of which she may have been deprived, we will go for such restoration
in these days of " Women's rights," with all our might, although we
confess to the private opinion that women, as well as men, would
exhibit higher wisdom by inquiring more into their duties, than into
their rights. Nor have we any objection to the '-elevation" of woman,
if such it be, to the office of Midwite, or the physician of her own sex,
when educated as is here proposed; though if it be a ^^ natural right"
of the sex as here alleged, her education ought to "cum by natur."

But of this pamphlet we must say that we have never read a more
indelicate, immoral, indecent, filthy, and caluminous publication. We
do not marvel that the author concealed his name, for that it has been
written by a man, there is abundant internal evidence ; nor. indeed,
could any decent woman be found who would father or mother the
dirty brat. We doubt whether any woman, worthy the name, will
withhold it from tlie flames, a moment after reading it, lest her sex
should be polluted by its presence. And yet a certain class of editors
have prostituted the press by commending it. Proh pudor ! " It is
enough to make one hide his face, and blush to be a man." \^lUd.

Miss BlackweJl, M. D. The movements of this estimable lady,
and intrepid pioneer in the cause of female education, will continue
to be a subject of interest with the Medical Profession. A private
letter has been transmitted to us by a mutual friend, which we are
not at liberty to insert in full, by which we learn she has continued tc
prosecute her studies in Paris, up to July last. The disease of one
of her eyes, contracted from a patient under her observation, has
proved a serious calamity, the sight being nearly destroyed.

In July she was at Grafenhurg. at the hydropathic establishment
of Priessnitz, partly to try the etiects of his system upon the numcr--
ous patients congregating there, with a view to ascertain what success
is really attained, and to determine how much is to be attributed to
the therapeutic action of water, and how much to thegeneral hygien-
ic conditions under which the patients are placed.

She states that she has received a courteous invitation to pass sever
al months in London, every facility for attending the hospitals and
schools having been promised ; and that it is her intention to avail
herself of this opportunity to institute a comparison between Frcnel*
and British practice. [Buffalo Medical Journal.

128 Miscellany. [February^

Neic York reprint of the London Lancet. -We do not profess to un-^
derstand the principle which guides the publication of this reprints
However much we would like to do so, one thing is clear, that we
should expect in the usual monthly numbers, the matter which the
original contained during the month preceding the day of ostensible
republication at New York. But far otherwise is the ease, and thus
the reprint, far from keeping pace with the original, lags most fearfully
behind, and treats its readers to matter months old. We were not
aware of this until very lately, and having induced an intimate friend
to undertake an analysis of the three or four last numbers^ that gen-
tleman has detected the tbllowing rather strange anomalies:^

The August number (N. Y.) contains papers from the March and
April numbers of the original.

The September number (N. Y.) contains Guthrie's biography of
15th June. Xo reviews at all Macmurdo's lecture on the eye, of
May in the original, and Guthrie's lecture for March.

The October number contains the biography of Mar&hall Hall,
which appeared in the original of 27th July. Macmurdo's lecture,
number 7, of July 6* The review of Spencer Thompson, M. D., on
Temperance, &c., 24th Aug., 1850, is entirely different from the
original, with many omissions ; and in fact many of the papers are so
confused in tlie reprint, that it is almost impossible to compare the two.

Is tills right, oris it wrong? If the latter, then is the reprint, not
what it purports to be ; and if the former, why these omissions, altera-
tions, and delays in the republication of the papers. We say nothing
of the entire omission of the Lancet editorials,- which very frequently
have important medico-political bearings. We ask again, why i
this so ? l^Brit. AmCr. Journ.

The Largest Liberty. -^-The trustees of the Memphis Institute, by
way of conciliating and uniting all sects and parties in medicine, have
adopted the following sage resolutions.'

*' EesoJved, That this school of medicine is not to go under any
sectarian or peculiar denomination; is not to teach any peculiar sys-
tem of medicine ; but all that is believed will throw lighten the nature
of disease, or contribute to its alleviation or cure, and that it profess-
es to be orthodox.

^^ Resolved, That each chair will be expected to inculcate the doc-
trines which its Professor holds to be scientitic truth } and that Pro-
fessor Cro^ will teach the Institutes of Medicine as bis convictions
present, past, and future, shall deem sanctioned by the light of
science, and his own high reputation ami exalted rank in the profes-
sion, and as most conducive to the well-being and character of the
^lemphis Institute. To each Professor should belong the right to
teach his own views and opinions connected with the branch of Med-
ical Science committed to his chair.

" Resolved, That in creating the new chair, over which Professor
W. B. Powell is to preside, ij; shall be designated as that of Cerebral

1851.] Miscellany, 129

Physiology,- Mineralogy, and Geology, and in which Professor Powell
shall have the privilege of treating of the external senses, and of so
much of the nervous system in general, as he n>ay deem requisite to a
proper understanding of the functions and pathology of the brain."

Under the auspices of so liberal a board of trustees, and with such
an exceedingly accommodating faculty, who can doubt for a moment
the speedy and triumphant success of the Memphis Medical Institute !
The school " is not to go under any sectarian or peculiar denomina-
tion," and is " not to teach any peculiar system of medicine." yet
" each chair will be expected to inculcate the doctrines which its pro-
fessor holds to be scientific truth." In other words, they may teach
any thing or nothing, according to their taste or capacity. Dr. Cross
may, if he is so disposed, teach medicine upon scientific principles,
while Dr. Powel has equal right to teach humbuggery to his heart's
content. Verily this is a rare specimen of the largest liberty. But,
seriously speaking, it is the lamest attempt that we have ever seen, to
unite things which are as incompatible as light and darkness, and we
are sorry to see Dr. Cross in such bad company. [S^ Louis Medical
and Surgical Journ.

Remedy for Short Sight. Dr. Turnbull thus describes a process
for treating short sightedness. "In the first instance I applied the
extract of ginger, which was rubbed for five or ten minutes over the
whole forehead, with tlie view of acting upon the branches of the fifth
pair of nerves> Afterwards I substituted a concentrated tincture of
ginger, of the strength of one part of ginger to two parts of spirit o(^
wine, decolorised by animal charcoal. The success of this operation
was remarkable. In many cases it had the effect of doubling the
length of vision. In some persons I found the iris was not much
dilated, but very torpid. In these cases I applied the concentrated
tincture of pepper made of the same strength, and in the same manner
as the tincture of ginger. This I used until I observed that the iris
had obtained a greater power of contraction and dilation, after which
I had again recourse to the tincture of ginger. This plan of treat-
ment has been attended with the most signal success,- and persons
who were extremely short sighted have very soon been enabled to lay
permanently aside their concave glasses." [Boston Medical and
Suri^icalJournal.

Vaginal Speculum. Mr. Haslam, of Harvard Place, Boston, is the
inventor and manufacturer of an improved vaginal speculum. It is
made of glass, and silvered on the outside ; the silvering being cover-
ed over by gutta percha, makes it, of course, perfectly safe. The
inside of the tube is a perfect mirror, and will rellect the light better
than a metalic one ; besides, there cannot be any danger of corrosion,
either by the secretions or the substances used in medication. Tliis
speculum has been used by many of our best physicians for a year or
two past, and lias given the greatest satisfaction. Since the firsyt

130 Miscellany.

ones were manufactured^ the proprietor has nmde impro\'ements i?'pon
them, in form, size and covering, but can still afford them at prices'
extrenpjely moderate. \_llid.

Donation U^ the McLean Asylum. Hon. WillianrF AppletoH, of
Boston, has ^^i the princely sum of ^20,000 to the McLean Asy-
lum for thei*rlShe, located at Somerville, near this city, of which in-
stitution he has for many years been a director, for the purpose of
constructing additional buildings for the more perfect classification of
the inmates of the asylum. [Ihid.

Remedy for Sterility. ^Br. E. Williams lately published in the
London Lancet, some account of a Japanese remedy for sterility which
he had Used with success. In a subsequent number he states that the
communication had brought him upwards of 900 letters requesting a
supply ! He says that he is unable to supply the demand, but hopes to
make arrangements soon that will enable him to do so. [Ihid.

Opcraiionsfor C aiar act ujion Bears. Mr. White Cooper, of London^
has been operating successfully for cataract upon the bears of the
zoological gardens, having previously administered chloroform to
them. V

Professor of Chemistry in Harvard XJniaersiiy.-^yir. J. V, Cooke,
the Prof, of Mineralogy, dtc, in Harvard University, has been ap-
pointed to the Chair of Chemistry in the same institution, i place of
Prof. Horsford.

We learn from the N. Y. Med. Gazette, that two of the Students-
of the University School of Medicine have recently died of Erysipe^
las, and that several others are seriously ill of the same disease.

Dr. Alexin. Stevens has been elected President of the New York-
Academy of Medicine.

Dr. C. G. Comegys, of Cincinftati, reports a case of obstinatef
Sciatica immediately relieved by cauterization of the ear.

We find it stated in the Western Medico-Chirurgical Journal, (pub-
lished at Keokuk, Iowa,) that the Evansville Medical College offer to
admit "Sons of Temperance" at half price and that the "Sons
recommend the School as in every way worthy of public cenfidence.''

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES MARCH, 1851. LNo. .

pabLt first.
Original (Hommuntcations.

ARTICLE VIII.

Fissure of the Anus. By Juki ah Harriss, M. D.,
of Augusta, Ga.

It is somewhat singular that English and American authors
should pass so summarily over this afTection. In some works
it is scarcely regarded, and is certainly not described as a dis-
tinct disease. This neglect is doubtless owing either to the cir-
cumstance that it is badly understood, or to the fact that its im-
portance is not properly appreciated. It cannot be because such
cases are not presented for treatment. This subject has long
since arrested the attention of continental surgeons, and they
have well defined its character and proposed various remedies
for its cure. Those, however, who preceded Boyer, had but
confused ideas of the affection, and attributed its symptoms to
diseases of the bladder, prostate gland, hemorrhoids, &c. This
great surgeon was the first who distinguished it from other
ulcerations of the anus, and described it as a special disease.
(Tome. 4. cap. 2.) He believed that the contraction of the
sphincter, which so uniformly accompanies the fissure, was
its cause and not its effect. The reason he gave for this
opinion was, that he had frequently seen contraction of this
muscle without fissure, but never the fissure without the con-
traction. And hence the remedy he proposed, with which all
surgeons are familiar. M. Blandin, and many others, believe
the contraction to be an effect of the fissure, and that this (the
fissure) is caused by constipation and the passage of indura-

N. S. VOL. VII. i\o. in. 9

132 HslttIss, on Fissure of (he Anu^. [March,

ted faeces which distend and excoriate the parts. He, however,
divides the fissures of the anus into three varieties: 1st, those
situated below the sphincter and occupying principally the
skin ; 2ci, those above the sphincter, and situated entirely in the
mucous membrane; and, 3d, those that are situated in the mu-
cous membrane, upon a level with this muscle. (Diet, de Med.
et Chir. Prat. t. 8.) The first two varieties, he says, are by no
means serious and will heal of themselves, or will require but
little treatment. The 3d variety, however, is a great annoyance
to the patient, and it is therefore important, that some safe reme-
dy should be proposed that would be in some degree certain
in its effects. This variety may with propriety be called ^rwe
and the other iwo false fissures, as they by no means present
the same characters, nor demand the same treatment. In ad-
dition to this, the fissures below the sphincter may be caused
by various agents, and would, therefore, present different char-
acters. They may be induced by ichorous discharges from
the vagina, or from chancres, &c., and therefore require differ-
ent remedies.

The 3d variety is perhaps a distinct affection, presenting
certain symptoms and requiring a special treatment. It is
characterized by a narrow fissure existing between the folds of
the mucous membrane upon a level with the constrictor mus-
cle, and invariably causing intense pain during and after defe-
cation, and according to Boyer, and others, constantly accom-
panied with contraction of the sphincter. It is important here,
to determine whether the contraction of the sphincter ani is the
cause or the effect of the fissure, for the character of the agent
employed to attain a cure, will of course be determined by the
opinion that is entertained of the cause. The correctness of
Bover's views is confirmed by the fact indicated by himself and
others, that these symptoms do exist without any fissure, and
that they are relieved by an incision of the fibres of the sphinc.
terani. The subcutaneous incision of the muscular fibres, pro-
posed by M. Blandin himself, would induce the belief that if the
contraction is not the cause, it is at least the most important
symptom, for this once relieved, the fissure is cured. Indeed,
the suspension of the contraction of this muscle, has been the
aim of nearly all surgeons who have proposed a remedy.

1851.] Heirnss, on Fissure of the Anus. 133

In admitting, then, the theory of Boyer, the occurrence of the
fissure could thus be accounted for. The contraction of the
sphincter ani, of course narrows the anal orifice, and the indura-
ted faecal matters passing over a highly irritable surface, tend
to auorment the contraction and increase the difficulty of their
exit. Under such circumstances, the expulsion of the faeces
cannot be effected without painful distention, friction, excoria-
tion, and even laceration of the mucous membrane, which has
to bear the whole force of the efforts.

Those who oppose Boyer's opinion, assert that it is not pos-
sible for this muscle to contract without some appreciable
cause. It is however, admitted by all, that some muscles do
contract without any known cause ; as those of the eye in
strabismus, those of the extremities, &c. Why, then, may not
this muscle as well as others, be induced to contract by an in-
appreciable influence? M. Velpeau, in his article (Dict.de
Med.) takes the intermediate ground. He asserts, that some-
times the contraction is the cause, and at others, the effect.
That it may exist without a fissure, and is then produced by an
unknown cause ; that it may precede and cause the fissure, or
finally, that it may be a consequence of the fissure. In the
last case, the contraction would be caused by an irritation oc-
casioned by, or commencing in the fissure. In the first two
instances, the contraction of tlie muscle is evidently the cause
of the phenomena that present themselves, and in the third, in
which the contraction is consecutive, it keeps up the fissure by
the opposition that it offers to the exit of the faeces.

Hence, in every case, the attention of the surgeon should
be directed to the condition of the sphincter ani, and, if con-
traction exist, it should be relieved.

Treatment. Various remedies have been proposed in the
treatment of this afTection, some of which, were directed to the
cure of the fissure, without regard to the condition ofthe sphinc-
ter. The three processes most frequently resorted to, are cau-
terization, incision and dilatation.

Cauterization would, in all probability, prove beneficial only
in the first two varieties cited by Blandin, or in simple fissures
without contraction of the muscular fibres. The object of this

134 HsiTuss, on Fissure of the Anus, [March,

process, as declared by Beclard, its author, was to change the
natureof the ulcer, and to increase its tendency to heal. It
has not been very extensively used. Incision was proposed and
regarded by Boyer, as infallible in this affection. In other
hands, however, it has not only failed, but in some instances
has proved fatal. His operation consisted in making a free
incision from the anal orifice through the fibres of the sphincter,
including the skin, the mucous membrane and the adjacent
tissues. These tissues are exceedingly vascular, and by in-
cising them, a large number of blood vessels, and particularly
veins, would necessarily be cut, which would render the patient
very liable to phlebitis. This is then, a serious operation, as
it is sometimes fatal and does not always afford relief. Velpeau
declares that it should be made the last resort.

M. Blandin next proposed and practiced successfully, a sub-
cutaneous incision of the fibres of the sphincter. This, he says,
is attended with a very small wound, which always heals by
the first intention and does not expose the patient to phlebitis.
There is, however, a great objection to this operation, which is,
that the muscular fibres are cut with great difficulty, as there is
nothing to indicate to the surgeon when all the fibres have
been traversed, and when he should withdraw the knife. In
consequence of this difficulty, there have been many cases of
unsuccess attending the operation. Many surgeons still prefer
the operation of Boyer.

Dilatation was recommended by Recamier and practiced by
himself, Marjolin,and others. His process was to distend the
sphincter by means of lint forced into the anal orifice. This
operation was very properly objected to, on account of the in-
tense pain that it caused. It subjected the patient to very
acute suffering during several days, or during the whole time
of its application. For this reason it was abandoned. Dilata-
tion, but upon a different plan, has been revived by M. Maison-
neuvewith much advantage. The process he recommends, is to
introduce the index fingers of both hands into the anal orifice,
and to dilate forcibly the contracted muscle, first in the antero-
posterior diameter, and then transversely. This simple, and
almost instantaneous operation, removes the cause or the, most
important feature of the disease. If this operation proves to be

1851.] KslYYiss, on Fissure of the Alius. 135

effectual, it will combine many advantages. In the first place,
there is no cutting instrument, to frighten the patient ; in the
second, there is' no wound to heal ; in the third, there is no
danger to be apprehended from phlebitis ; and lastly, the ob-
jection against Recamier's process can not be urged here, as
the pain is but momentary, and even this momentary suffering
may be avoided by anesthetics. This operation rids the fissure
of its complication, reduces it to a simple ulcer or excoriation,
and places it in the most favorable condition for healing. These
are no trifling advantages and should not be disregarded by the
surgeon.

Having witnessed two operations of this kind, I will add a
brief account of them from memory :

The first case was that of a middle aged man, who had en-
tered the wards of M. Nelaton (Hospital St. Louis, Paris,) for
treatment. He was a man of good constitution and, save this
affection, was enjoying excellent health. He stated that he
had been thus affected for several months, during which time
a variety of remedies had been proposed and applications
made, without affording relief that at first he suffered intense
pain during and after the act of defecation, but that recently
the pain had increased, and instead of being limited to the pe-
riod of defecation, had become continuous. So annoying had
the pain become, that he could neither stand nor sit, nor could
he lie down, save upon the side, with his legs flexed. M. Ne-
laton administered chloroform and performed the operation of
dilatation as above described. The next day the patient was
better. The continuous pain had diminished to a very great
extent, and he was enabled to go to stool with much less suf-
fering. He continued rapidly to improve, and left the hospital
perfectly relieved in four or five days.

The second, was a man in the ward of M. Michon. (Hopital
de la Pitie.) He had suffered under the affection comparative-
ly a short time. He, however, experienced excruciating pain
during and after defecation. Chloroform was administered,
and the operation performed in the mode above mentioned.
The following day the patient stated that he was entirely re-
lieved, and could go to stool without the least suffering, and
was consequently dismissed.

136 Jeter's Case of CcBsarian Section. [March

It will be seen from what has been stated, that although dila-
tation is not anew practice, the peculiar process of M. Maison-
neuve is both novel and important. The object of this paper is
therefore to direct attention to this improvement in the treat-
ment of an affection often quite intractable under former man-
agement. To relieve the contraction of the sphincter ani has
always been the object of surgeons. It was to attain this end
that Recamier proposed his mode of dilatation that Boyer
proposed his operation of incision that Blandin proposed his
subcutaneous incision; and finally, that Maisonneuve proposes
his new method. The latter operation is the most simple, and
is certainly attended with the least danger to the patient. We
hope, therefore, that its efficacy will be tested by those in our
country who may have an opportunity of doing so.

ARTICLE IX.

Successful Case of Ccesarian Section. By H. M. Jeter, M.D.,
of Buena-Vista, Ga.

On the night of the 4th of December last, Mrs. B., aged 30
years, was taken in labor with her sixth child. I was called
at 3 o'clock in the morning to attend her accouchement. I
found her with weak and irregular pains, and was informed
that such had been their character from the commencement of
labor at 9 o'clock. Soon after, however, her pains began to
increase, and upon examination per vaginam, I found the os
tincse well dilated and the waters collected in large quantity.
The back of the foetus presented, I waited until the mouth of
the uterus was more completely dilated, and ruptured the mem-
branes discharging an immense quantity of water. I proceeded
immediately to turn, so far as to bringdown the breech, making
a breech presentation. The difficulty attending the operation
of turning w^as so great, in consequence of the extraordinary
size of the child, (it being very large,) that 1 regarded it hazard-
ous to attempt to complete the operation, and left it in this
situation, to the natural efforts of the womb. After about two
hours of very hard labor the breech so far advanced as to ena-
ble me to bring down the feet. I essayed by every possible

1851,] Jeter's Case of CcDsarian Section. 137

means to assist the efforts of the uterus, by making all the trac-
tion upon the inferior extremities of the foetus that was war-
rantable, being convinced that the foetus was dead.

Finding all efforts to make any further advance in its de-
livery entirely fruitless, I attempted to perforate the cranium,
but found it impossible, in consequence of the size of the child,
to pass the perforator up to its head. I then eviscerated the
foetus, with the view of passing the instrument up within the
cavity of the foetal thorax to the base of its cranium. This also
failed to make room for the operation, without proceeding at
random and great consequent hazard to the mother, as I could
not insert the hand to give any certain direction to the instru-
ment, the head still being entirely above the superior strait.
Embryotomy was therefore determined upon, and after dissect-
ing away the foetus up to its axillae, which required about two
hours, the mother all the while suffering the most severe labor,
but which at this time had ceased to make any impression upon
the child, and which induced me to conclude that the uterus had
probably ruptured. I found her rapidly sinking, so much so,
indeed, that we did not think that she could survive fifteen min-
utes longer. I determined at once to operate by the caesarian
section. 1 gave my patient a stimulant, and, assisted by Dr.
Reese, proceeded to make an incision along the linea alba six
inches in length, cutting down carefully to the peritoneum, upon
dividing which, the head of the foetus presented, showing that my
apprehensions were correct in the womb's having ruptured some
time previous to the operation. The head of the child was so
large that the incision had to be extended to ten inches in
length to admit its passage. The head measured twenty-nine
inches and four lines in its longitudinal or occipito frontal cir-
cumference, and twenty-eight inches two lines in its perpendi-
cular circumference, being hydrocephalic. The head and
remaining portion of the body being removed, the placenta was
found also without the uterus within the cavity of the abdomen,
and the uterus contracted to about the size of a small cocoa-nut.
This being also removed the cavity of the abdomen was left
filled with coagulated blood, from the hemorrhage which took
place at the time of the rupture of the womb. Havino- care-
fully removed the blood, as completely as possible, the wound

138 Jeter's Case of Ccesarian Section. [March,

was closed by the interrupted suture and adhesive straps,
leaving a space of about two inches at its inferior extremity,
for the discharge of the fluids that might remain or collect in
the cavity of the abdomen.

Stimulants were given, and other applications made, to re-
vive the sinking energies of the patient, which had become
almost extinct. Reaction soon took place, and she was cleansed
and placed in as comfortable a position as the circumstances
would admit. The vital energies having been sufficiently re-
suscitated, opiates were given freely. She was kept quiet, and
rested comfortably during the night and the following day, until
about 9 o'clock on the succeeding night, (the 6th,) when she
was taken with violent vomiting, which continued, with inter-
missions of not more than half an hour, until 10 o'clock the next
day, at which time I arrived, having been called off the even-
ing before, and could not return sooner.

We succeeded in soon checking the vomiting, and she rested
easy, with occasional return of the vomiting during the day and
following night.

Dec. 8th. Patient complains of some soreness about the
womb, and over the abdomen generally, which is considerably
swollen; pulse 132, and very restless. Administered a glyster,
which produced two evacuations; gave her to drink small
quantities of cream of tartar and lemonade.

Dec. 9th. Patient complains of great soreness and tenderness
of the abdomen, which is greatly swollen ; tongue dry and red,
and great thirst ; pulse 140, quick and hard ; lochial dischar-
ges ceased. Put her upon a treatment of calomel and opium ;
gave injections of warm milk and water per vaginam, and ap-
plied flannel, wet with spts. turpentine, to the abdomen.

Dec. 10th. Soreness and tenderness not so great ; dischar-
ges from the wound in the abdomen free ; lochial discharges
also free ; pulse 136. Gave glyster, which produced one eva-
cuation.

Dec. 11th. Soreness and swelling still subsiding; pulse 130,
more soft and full ; lochial discharges and those from the wound
in the abdomen continue freely. Gave small quantities of
Dover's powder.

Dec. 12th. Had one copious alvine discharge during the nighty

1851.] Campbell, on Muscular Fibre. 139

of natural consistence says she feels much relieved since.
The discharges all continue free; pulse 130; wound healing
kindly. From this time, nothing of importance occurred to
require noting. She continued to improve, and by the 18th
day after the operation the wound was entirely healed.

I visited her yesterday for the last time, which was the 29th
day since the operation, and found her sitting up by the fire,
directing the domestic affairs of her family. Mrs. B. is a wo-
man of apparently very feeble constitution, and had been
confined to her bed, for two months previous to her labor, with
general anasarca of the whole system.

ARTICLE X.

Observations on the Law ghverning the Distribution of the
Striped and Unstriped Muscular Fibre. By Henry F.
Campbell, M. D., Demonstrator of Anatomy in the Medical
College of Georgia.

On a review^ of our knowledge concerning the intimate na-
ture of muscle, we find the following facts comparatively well
established: 1st. That a muscle is composed of an immense
number of fibres, bound together by areolar tissue in such a
manner as to constitute fasciculi, presenting the greatest irre-
gularity of dimensions. 2dly. When one of these fasciculi is
torn with pointed instruments, so as to separate it into fine
shreds, and examined under the microscope, some of the ele-
mentary fibres present a great number of transverse markings,
known to microscopists of the present day under the name of
stripes or stricB, giving to the fibre, according to their presence
or absence, the name of striped or unstriped fibre.

In relation to the exact nature of these transverse stria3,
there is even now some dispute, and two theories contend for
the explication of the appearance. The one advanced by Dr.
Barry, in a paper read before the Royal Society,* wherein he
attributes the microscopic phenomena to the existence of a
spiral fibre enclosed within a tubule of certain form, the wind-
ings of this fibre and the intervals between them constituting

Paper on Fibre. (Proceedings of the Royal Society, No. 51.)

140 Campbell, on Muscular Fibre. [March,

the light and dark stripes. The other and more generally re-
ceived theory, is that of Mr. Bowman, of Kings College, who
describes these striae, as the result of the linear arrangement of
particles, which he terms elementary sarcous, within the calibre
of a tubule of peculiar tissue, called by him Sarcolemma, and
that by the unequal refraction of light upon these particles and
their connecting structure,* the striated appearance is present-
ed. In addition to these, there are also longitudinal stripes
which mark the lateral collocation of the sarcous particles, and
which separate the fibre into its component fibrillae. The un-
striped fibre is paler, less developed, and, as indicated by its
name, destitute of the striated appearance characterizing those
above described.

The influence which the existence of one or other of these
kinds of fibre exercise upon the function of the muscles they
constitute, has been variously estimated ; the weight of authori-
ty tends to corroborate the opinion, that the striped fibre is for
voluntary and the unstriped for involuntary motion: hence
their synonyms voluntary and organic fibres. But to this rule,
it is fully agreed by all, there are met several exceptions
wherein the striped (or voluntary fibre, ordinarily) enters fully
into the composition of muscles known to be entirely involun-
tary. These exceptions are the heart, the upper portions of
the oesophagus, and the pharynx. Now, of these three muscu-
lar structures, we find no other disposition made by authors
than the bare statement that they are exceptions to the law ;
that the striatedjibre enters into the formation of voluntary, and
the non- striated into that of the involuntary muscles. The ob-
ject of the present remarks is, with due deference to the views
of others, to attempt an explanation of those exceptions by the
substitution of another law, which, we think, fully as apparent
as the above, and to deduce therefrom conclusions in regard
to the function of those fibres, which will be found to differ from
those ordinarily admitted. According to the view we take of
the respective functions of the striped and unstriped fibres, these

* It seems more probable that the connecting material is less dense, and fills
up every interval ; but I do not pretend to determine what may be its nature,
or whether it differs chemically from the parts it serves to join. (W. E. Bow-
MiN. Philosopliical Transactions, 1840.)

1851.] Campbell, on Muscular Fibre. 141

three structures no longer form exceptions, which are ever
unnatural and inconvenient in the arrangement of the other-
wise consistent and unerring laws of nature, but are thus con-
stituted in obedience to a law, the most constant and invaria-
ble, which law may be thus enunciated. ^Yherever celerity
and quickness of action is required in a muscle, under any
circumstances, we find the striped fibre entering into its com-
position, ituV/iow^ any regard whatever to voluntary or involun-
tary motion; and, further, that the voluntary or involuntary
character of the muscle has no influence at all on the distribu-
tion of these two kinds of fibre. Jn the establishment of this
view, we find arguments abundant throughout the whole mus-
cular system. All the muscles of voluntary motion, it is true,
are constituted of the striped fibre ; for these are liable, at any
time, to be called upon for the most rapid and energetic con-
traction. On the other hand, the involuntary muscles are
found of an unstriped fibre, with the above-mentioned excep-
tions ; but these exceptions, we think, sufficiently important to
invalidate materially the law which refers this distribution to
voluntary and involuntary function. In offering the suggestion
above made, we have in view the substitution of it as a law
which can be of universal application, for one which is embar-
rassed by exceptions, which this readily and, to our mind, satis-
factorily reconciles.

That the heart is strictly an involuntary muscle, no one will,
at the present day, pretend to deny ; for the few, we may say
the single instance on record of its subjection to the will, is not
sufficiently well authenticated to obtain a full admission. Its
contractions, we know, are (for very important interests) of the
most sudden and spasmodic character, and these, attended by
momentary relaxations, are continued during the lifetime of
the individual. The pharynx and oesophagus, other involunta-
ry structures, are also at any time liable to be called upon for
the greatest celerity of action : indeed, at this point in the
alimentary canal, did the bolus move with a tardy and gradual
descent, death would necessarily ensue from prolonged occlu-
sion of the glottis by tlie epiglottis, while in impeded degluti-
tion a somewhat spasmodic action seems necessary for the
removal of the difficulty ; and how fatal would be the result did

142 Campbell, on Muscular Fibre, [March,

the heart's action at all resemble the rhythmical though ener-
getic contractions of the pregnant uterus. Now the function
of the womb is such, that of it is required the most energetic
and prolonged contractions contractions that at no time at all
resemble in any respect the momentary impulses necessary in
the office which the heart performs ; so with the bladder, as
well as the rectum and the rest of the alimentary tube, besides
many other structures, as the dartos, the parenchyma of the
spleen^* and probably the female nipple,t with other fibrous
textures. These latter requiring but a very slight degree of
motion, the fibres are extremely scattered, and resemble more,
both in their appearance and the character of their contractions,
the yellow fibrous tissue, which is found very widely distributed,
than true muscular fibre of either the striped or unstriped va-
riety ; and thus will we find, by an attentive observation of
the subject, that in proportion as any organ is required in the
performance of its functions to exercise rapid or gradual con-
tractions, so will it be constructed of striated or non-striated
fibres. This law, so far as we have observed, is invariable
without exception and we doubt not, will be strengthened and
borne out by a comparison of the muscular systems of various
animals throughout the scale whenever the necessary time and
labor is devoted to this kind of investigation.

*W. Stukely, On the Spleen, its Description and History, Uses and Diseases
London: 1722. Also, Prof. Kolliker, in an article on the Spleen, in the Cyclo-
paedia of Anatomy and Physiology, avows their existence in the Spleen of the
Pig and of the Dog.

t The erection of the Penis may be in part owing to the compression exerted
on the superficial veins of the organ by a continuation of a structure analogous
to the dartos, which is continued over the base of the penis under the skin.
The erection of the nipple also occurs on any mechanical irritation, with a
motion so very like muscular contraction that a layer of these fibres might
perhaps be found under the skin of that region. Todd d^ Bowman^s Physiolo-
gical Anatomy.

1851.] Lecture on the Spinal System. 143

PART II.

^cUrtU D^yartmtnt.

A Synopsis of the Spinal System. Being the Croonian Lec-
tures, delivered at the Royal college of Physicians, London.
By Marshall Hall, M. I)., F. R. S., &c., &c.

LECTURE III.

Gentlemex, I have, in my first and second lectures, treat-
ed my subject experimentally and physiologically. I propose
in the present one to show you how the principles so unfolded
have their part in pathology, and their application in therapeu-
tics and in practice.

The first statement which I have to make is full of practical
importance. If in any animal you denude the brain, the cere-
brum, and the cerebellum, and irritate, puncture, lacerate, or
injure the tissue of these organs in any way, however violent-
ly, there is absolutely no movement of the animal or of its
limbs no spasmodic or convulsive effect !

These organs are in excitor !

Is it so in the human subject? But a few days ago I was
summoned to treat a patient who had just suffered from an at-
tack of decided hemiplegia aflTecting the face, the arm, and the
leg. With x\\\s paralysis of motion, not the slightest spasmodic
movement had occured. The human brain had been lacer-
ated, yet no spasm had been produced. This event is perfect-
ly usual. It is the subject of daily observation.

The same fact has been observed in surgical practice, in ac-
cidents, in operations, in regard to the encephalon. The hu-
man brain, like the brain of animals, is ni-excitor.

How excitable the medulla oblongata and the medulla spina-
lis are, I have already shown you.

From these facts, and from long and careful observation, I
draw this conclusion that

No disease of tfie cerebrum or cerebellum, limited in them-
selves or their effects to the cerebrum or cerebellum or both, is
attended by spasmodic or convulsive movement.

But another fact is not less certain. Diseases of the cere-
brum or cerebellum 6/0 produce spasmodic or convulsive move-
ments.

How are these facts, apparently so contradictory, to be
reconciled and explained ?

Observe these engravings of the base of the brain and of the
cranium. Here are membranes supplied, according to the dis-
covery of Arnold, by roots of the trifacial nerve ; here is the
intra-cranial portion of the trifacial nerve itself. In this spot

144 Lecture on the Spinal System. [March,

you see the intra-cranial portion of the pneumogastric and its
accessory ; and here you see the niedulla oblongata, all portions
of the spinal or st aide system, all most excitable. Now if there
be a disease of the cerebrum or of the cerebellum, which, by
its contact or pressure, or, if distant, by counter-pressure, can
affect any one or more of these structures, spasm, or convulsion
will be the result the inevitable result.

Disease of the cerebrum or cerebellum may therefore in-
duce spasmodic or convulsive affection, through the medium of
the staltic or spinal system ; but it can produce these effects
in no other manner.

I repeat, then, the observation which I have before enun-
ciated,

Disease of the cerebrum or cerebellum cam induce spasm or
convulsion only through the medium of the spinal system.

I may add another important aphorism:

It is in the same manner exclusively that disease of the cere-
brum or cerebellum can be attended by affection of the spinal
system of any kind. It is in this manner, and in this manner
only, that dysphagia, and stertor, and other affections of the
respiratory movements, and affections of the sphincters can be
induced a fact of immense value in the Diagnosis and the
Prognosis of these diseases.

If in apoplectic affections, dysphagia or dyspnoea is the re-
sult, the spinal system is affected ; if, in spite of our remedies
one or both of these symptoms continues, the disease will
prove fatal.

I beg here to draw your attention to the diagnosis between
paralysis and spasmo-paralysis. In the former case it may be
cerebral or spinal, but if spinal the spinal centre must be either
absolutely destroyed, or so affected, as by exhaustion of its pow-
er (as by sexular excesses) as not to be affected by irritation.
In the latter, or spasmo-paralysis, there must be irritation of
the spinal system.

In a recent case of paraplegia, affecting both arms and both
legs there had been the perfect absence of all spasmodic symp-
toms from the very commencement. You will remember,
gentlemen, you can never forget, the effect of stf'ychnine
in inducing exalted excitability and tetanoid paroxysms in the
frog. I believed I had, in the &ase to which I have adverted, a
case of impaired spinal excitability. I prescribed \.\\q fiftieth
part of a grain of the acetate of strychnine to be given four
times a day. In ten days the patient had recovered, in a mark-
ed degree, the power of walking and of writing. The amend-
ment has continued to be progressive.

This case was sent to me by Professor Sharpey. It occured

1851."! Lecture on the Spinal System, 145

in a member of our own profession, Dr. Livingston. It is the
only one in which I have given strychnine with a satisfactory
result.

I imagine the principle which may guide us in the adminis-
tration of this powerful remedy is this : Is there spasm V then
there is irritation, and strychnine could only, by adding to the
excitability, add to the effect, of this cause of morbid action.
But, if there be no spasm, if there have been no spasm from the
beginning, then the paralysis, the paraplegia, may depend ou
mere nervous exaustion of the spinal centre, and strychnine
may repair this exhausted energy, may restore the excitability
and prove a remedy.

The case and the remedy must be equally specific.

I think the mercurial treatment appropriate, on the other
hand, to the case attended with spasm generally speaking.

The next fact, not less important and diagnostic than the
first, is this; no affection of the spinal system, no lesion or irri-
tation, however attended by spasm or convulsion, affects the
cerebral system necessarily. Even in tetanus itself, in which
every muscle in the frame is thrown into spasm, there is, in the
early part of the disease, no cerebral affection. The patient is
perfectly conscious. There is no delirium; no coma; pain,
dreadful spasm keeps the patient from sleep ; but the cerebral
system itself is unaffected.

The same phenomenon is observed in other cases of disease
of the spinal system, as in all experiments, limited in themselves
or their effects, to this system. In chorea, in hysteria, in the
paralysis agitans, there is the absence, in the commencement,
of all cerebral affection.

Hydrophobia, or the effect of strychnine, however violent,
is still unattended by cerebral symptoms.

In experiment, irritation of the spinal system from the me-
dulla oblongata to the lowest part of the medulla spinalis inclu-
sive, induces spasm without any evidence of cerebral symptom.

What, then, are the special cases, in which diseases of the
spinal system are attended by cerebral affection?

In order that the cerebral system may become implicated
in affections of the spinal system, limited in their /^'////s/cfl/ le-
sion to this system, another, and a newly detected element must
be added.

The nerves and muscles of " The Neck" must he so, specifi-
cally implicated as to induce the condition which 1 have desig-
nated Trachelismus with its consequences, compresion of the
veins of the neck, and congestion of the tissue aud organs of the
head.

This is the essential link betwen affections of the spinal sys-
tem and affection of the cerebral svstcm !

146 " Lecture on the Spinal System. [March,

This contraction of the muscles of the neck is absolutely
special. It is not less than that by which, in several cases the
tongue is protruded and bitten. It is not less so than that by
which ihe larynx is so frequently closed. It is especially apt
to produce turning or twisting of the neck to one side a fright-
ful torticollis.

The muscles chiefly affected are the platysma myoides, the
sterno-cleido-mastoid, the trapezius, especially the more deeply
geated omo-hyoid with the splenii, the scaleni and other muscles
of the neck, too deeply seated to be observed.

The nerves principally involved in this action are a descend-
ing branch of the facial, distributed to the platysma, the
accessor!/ to the sterno-cleidomastoid and the trapezius, the
descendens noni to the omo-hyoid, with the recurrent to the
larynx nerves, with the vagus the diaphragmatic, of such
singular course.

By the contraction of these muscles, under the influence of
these nerves, the jugular and the vertebral veins of the neck
are compressed, and the face, the encaphalon, and the medulla
oblongata are congested, with the addition to the other symp-
toms of those which constitute ihe Epileptoid c\q.ss viz., those
which affect the encephalon the cerebrum and the medulla
oblongata^a view which constitutes a remarkable step in the
pathology of this Class of diseases.

It is as obvious that contraction of the posterior portion
of the platysma myoides will compress the external jugular,
and that of the sterno-cleido-mastoid and the omo-hyoid, the in-
ternal jugular, as that the action of the genio-glossal will pro-
trude the tongue, and that of the constrictors of the larynx will
close the glottis.

It is an extraordinary fact, that the same nerve should distri-
bute branches to the genio-glossal and the omo-hyoid Is it thus
that the protrusion of the tongue and the compression of the
jugular wem are accomplished, and the pathognomonic symp-
toms of epileptoid affection are produced ?

How important, with these views, would be anew dissection
of, and new experiments on, the nerves, muscles and veins of
- The Neck:'

Through this region of The Ned,', the Larynx inclusive, all
truly Epileptoid symptoms are produced. These may vary
from the slightest and most transitory ^^ oblivium," to the deep-
est and even fatal coma, with all the agonizing and terrific
symptoms which may intervene from " le petit mal" to *'le
haut mal " of French authors.

There is a gentleman, a physician, now amongst you, who
has crossed the Atlantic to bring his little boy, a twin, that I

1861.] Lecture on the Spinal System. 147

may investigate his malady. The day before yesterday, this
little boy was sitting before me, whilst his father and myself
were conversing earnestly about his case. Suddenly, I ob-
served a flush to steal over his pallid countenance, the head,
eyes, and features to be in a fixed state, the pupils dilated, with
loss of recollection or consciousness. In a few minutes, these
symptoms disappeared as they came on, and the interesting
little patient was as before !

What strange event had occured to induce these phenom-
ena ? What deep and hidden and mysterious agency had
been called into sudden play ? From careful, and carefully re-
peated ohserDatlon, I can affirm, that this agency is that of the
nerves, and muscles and veins of " The Neck /"

This little boy has been, and is still, subject to epileptoid at-
tacks of a most violent character. The difference arises, as
in so many instances, from difference of degree of the actions
of the muscles of the neck, it may almost be said, from differ-
ence in the degree of the torticollis.

Do you ask me what is the rationale of this trachelismus ? I
reply by asking What is the rationale of the closure of the lar-
ynx, or of the bitten wouid of the tongue ? All are equally
the objects of observation. The reason why special muscles
are made to contract in each of these cases is unknown, and
will probably long remain so.

This Class of diseases occurs in all ages from dentition, in
infancy; from gastric, interic, hysteric irritation, in adult age ;
and from peculiarities of the parturient or the puerperal state.

I class all these erases together. I do so advisedly ; I do so
to get rid of the formidable, injurious, and often misapplied
term, epilepsy. I would propose to designate the whole class
by the term

Trachelismus.

This term will speedly be as familiar to us as that of Laryn-
gismus; and I \v\\\ leave it to you, gentlemen, to imagine the
advantages, in every respect, of such a change of nomencla-
ture, merely observing, that whilst the very fact and truth of
the case is so expressed, the patient is preserved from a term
full of painful stigma and ignominy.

The effects of this trachelismus with its phlebismus, divide
themselves into two classes,

1. The Cerebral,

2. The further Spinal.

The first involves every cerebral symptom, from oblivium,
'* falling," every morbid symptom connected with \he senses, a
frightful scream, conia, delirium, or subsequent mania, tran-
sient and paroxysmal paralysis, iScc, tfcc.

N. S. VOL. VII. NO. IH. 10

148 Lecture on the Spinal System, [Marchv

The second, a bitten tongue, laryngismus, terrific and violent
distortion of the features, the neck, the general frame, gen-
eral convulsion, expulsion of urine, faeces, semen, &c.

Whilst the internal cerebral congestion varies, in this man-
ner, in every degree, the countenance is sometimes merely
gentl^^ flushed; sometimes, with the neck, intensely tumid and
livid, and sometimes, especially about the eyelids, affected with
minute ecchymosis the type of what is occurring within !

Besides the well-kno"%vn epileptoid affections " le petit mal,""
"le haut mal,'* &c., there are o\\\qy paroxysmal affections not
usually classed with them. There are paroxysmal paralysis,
paroxysmal mania, paroxysmal syncope, and seizures, which
from occurring in the night, or from home, and passing away,
remain *' hidden," producing effects which are, for a time, mys-
terious and inexplicable. I have no doubt, aberration of mind
or paralytic weakness, the effect of such chidden cause, and I
think crirne, which has been perpetrated without motive, lead-
ing to fearful judicial results may have been of this character.

But I think that apoplexy itself and hemiplegia are not the
unfrequent effect of such action of the muscles of the neck. In
illustration of this remark I may herf adduce a singularly inter-
esting extract from the w'orkofDr. Abercrombie, on a subject
which w^e are now, I think, prepared to understand:

The most simple illustration of the apoplectic state is de^
rived from those cases in which it is distinctly traced to an
external cause, and ceases when that cause is removed. A
boy mentioned by Zitzilius, had drawn his neckcloth remarka-
bly tight, and was whipping his top, stooping and rising alter-
nately, when, after a short time, he fell down apoplectic. The
neckcloth being unloosed,, and blood being drawn from the
jugular vein, he speedily recovered. Strangulation, when th
neck is not dislocated, appears to be simple apoplexy.*

"To such cases as these we may add the numerous exam-
ples in which persons fall down suddenly in a state of perfect
apoplexy, and very speedily recover under the appropriate
treatment, without retaining any trace of so formidable a mal-
ady.

'The apoplectic attack, as it occurs in such examples as these,,
must be supposed to depend upon a cause which acts simply
upon the circulating system of the brain, producing there a de-
rangement which takes place speedily, and is often almost as
speedily removed. What the precise nature of that derange-
ment may be, is a point of the utmost difficulty to determine,.

* It is, ralhcr, apoplexy iu Uie first ir.oments only, afLcrwards it is epilepsy,

M, 11.

1851.] Lecture on the Spinal System, 149

and perhaps, we have no data upon which it can be deter-
mined by legitimate induction."

These data, formerly so obscure, have, I think, been furnish-
ed in this lecture.

Dr. Abercrombie adds, in his interesting work, " This
(apoplectic) attack itself occurs chiefly under three distinct
forms, which it is of importance to distinguish from each other.

" In the first form of the attack, the patiept falls down sudden-
ly, deprived of sense and motion and lies like a person in a deep
sleep; his face generally flushed, his breathing stertorous, his
pulse full and not frequent, sometimes below the natural stand-
ard. In some cases convulsion occurs ; in others, rigid con-
traction of the muscles of the extremities, and sometimes con-
traction of the muscles of the one side, with relaxation of the
other," &c.

Howepileptoid !

" The second form of the disease begins with a sudden attack
of pain in the head; the patient becomes pale, sick, and faint;
generally vomiting, and frequently, though not always, falls
down in a state resembling syncope ; the face pale, the body
cold, and the pulse very feeble. This is sometimes accompa-
nied by slight convulsion," &c. "In some cases, paralysis of
one side occurs ; but in others, and, I think, the greater propor-
tion (jf this class^no paralysis is observed."

Here again how epileptoid is the apoplectic or paralytic seiz-
ure ! The case is, in fact, a formidable kind of" sick headache ;"
such sick headache sometimes issues in decidedly epileptoid
aflection. It is the type indeed of this Class of affections.

But to return to the subject of trachelismus. This is obvious-
ly the condition, the necesity for which Dr. Abercrombie plain-
ly felt, as the essential link betw^een a certain class of causes and
the apoplectic or paralytic aflection. It is not therefore con-
fined to epilepsy. It rather suggests the classification of dif-
ferent forms of Trachelismus according to its more prominent
effects, whether these be apoplectic, paralytic, convulsive,
spasmodic, syncopal, &c.

It is obvious that the whole Class of the diseases of which
trachelismus forms a part, must be distinguished from those
which arise from, or consist in, organic change of structure of
the nervous centres simply.

Disease of the tissues of the cerebrum or of the spinal mar-
row may be of this latter class. They are recognised by a
previous knowledge of anatomy, physiology, and experiment,
and by observation and experience.

Diseases involving trachelismus are of a very different char-
acter. Perhaps I cam^iot conclude these lectures better than

150 Lecture on the Spinal System. [March,

by a brief view of several of them. I will first present you
with a

Sketch of Laryngismus.

Not many years ago this afiection was supposed to be a dis-
ease of the brain. It is now weil known to be a malady of
which the cause is variously seated in the alveoli, the stomach,
the intestine, of which amongst the earlier effects are strabis-
mus, laryngismus, a contracted hand, a contracted foot, spas-
modic affection of the sphincters, &c. ; and amongst the remoter^
distorted features, trachelismus, generally torticollis, actual
closure of the larynx, and convulsion more or less general, dila-
ted pupil, insensibility ; lastly, congestion of the encephalon,
with eventual efiusion, as an ultimate effect

The course of these events is very interesting. It is the re-
verse of that which attends primary disease of the encephalon.
In this, the cerebral symptoms precede the spinal generally.
We fi'equently see strabismus, and especially vomiting, before
any cerebral symptom manifests itself, the cause or source of
irritation being probably seated in the arachnoid.

A very interesting question aiises here. Are children who
have been the subject of convulsive affection peculiarly apt, in
remoter years, to become the subjects of epileptoid affection ?
Does this question involve the question of the special cause of
convulsive affections, whether dentition, or gastric or enteric
irritation.

I am of opinion that the case of convulsive affection arising
from fright is to be totally distinguished from all others (and
how many cases arise from this cause unsuspectedly ?) It is
altogether more difficult to remove, and more apt to return,
and more apt to lead to epileptoid affection in after life, than
the other cases to w^hich I have adverted.

The effect of emotions of a lighter kind in inducing fits of
strabismus and of laryngismus is well known.

The powerful influence of the easterlv or north-east wind on
the ordinary cases of laryngismus shouklbe carefully observed,
as should also the beneficial influence of change of air.

There is one foj-m of this malady which should be borne in
mind. It is very apt to end in sudden death, and this especially
in certain seasons, probably those in which the same north-east
wind prevails.

Does this wind act on the excitable borders of the larynx, in
inducing the repetition of attacks of laryngismus, and of laryn-
gismus in its fatal form? Or is that fatal result a species of
syncope, the effect of a morbid influence exercised by the me-
dulla oblongata on the action of the heart, and similar to the
syncopal seizure in the adult?

1851.] Lecture on the Spinal System. 151

How naturally do these views suggest the proper modes of
treatment ? All sources of irritation, all the exciting causes,
must be carefully removed and avoided.

Sinapisms applied along the spine have proved, in the hands
of Mr. Higginbottom, of signal benefit, acting, as I imagine, by
subduing augmented excitability of the spinal centre; for it is
to be observed, that the nerve irritated in dentition, or gastric
or enteric disorder, is, like the wounded nerve in traumatic
tetanus, not only a source of continued excitement, but of aug-
mented excitability.

It is singular, that in the convulsive affection of infants the
tongue is not thrust out as it so frequently is in those of adults.
The larynx and " the neck,''* however, are not less affected, and
whilst the designation laryngismus (a mere symptom) has alrea-
dy been given to the disease, that of trachelismus, not less
applicable to it, may be reserved and appropriated to designate
the congeneric affections of adult age.

Having thus given a sketch of the former interesting ailment,
I beg to add

A Sketch of Epilepsy or Trachelismus,
not only of that epilepsy which arises from defective develop-
ment of the head, and of that which arises from encephalic
disease, but also of that form of epilepsy which arises from irri-
tation seated at a distance from the centres of the nervous
system.

In the encephalic epilepsy, there is some source of immediate
irritation, or of irritation from counter-pressure of the esodic
nerves in the membranes, or other nerves within the head, or
of the medulla oblongata.

In the epilepsy of distant origin, this irritation is seated in the
esodic nerves of the alveoli, the stomach, the intestine, or the
uterus.

This irritation, like the injury of the nerves in traumatic
tetanus, only in a less degree, constitutes in itself, and in its
effect on the centre of the spinal system, undue excitability,
and the predisposition to the attack; the slightest additional
excitation leads to the attack itself.

This attack exhausts or diminishes the excitability in its
turn, and with it the predisposition to attack, and the patient
is generally secure for a time. But time restores the excita-
bility and the predisposition to attack, and the patient is again
in danger.

The immediate exciting cause acts on esodic nerves, through
these on the centre of the diastaltic system; thence on exodic
nerves, and ultimately on the muscular system ; but not on this
system generally^ as in tetanus, but specijically, inducing spe-
cial phenomena.

152 Lecture on the Spinal System. [March,

The character of this muscular action is expressed in one
word contortion. The eyes, the features, the head itself, are
all variously drawn or contorted to one side ; the limbs are
turned and drawn in the same manner, and not rendered tense
merely, as in tetanus. There is torticollis, or what I have
since termed trachelismus.

This violent action of the muscles of the neck, this trachelis-
mus, compresses the veins of the neck, and arrests or impedes
the return of blood from the head, the external tissues, and the
encephalon. The features, the integuments of the head and
neck, and the encephalon, are livid and tumid, being gorged
with venous blood. The effect is precisely similar to that in-
duced by strangulation by a tightened cord. It is chiefly an
aflection of the jugular veins, though the lower part of the ver-
tebral does not escape. I have hence termed it sphagiasmns.

There are three pathoo^nomonic symptoms of this fearful af-
fection : first, the protrusion of the tongue, which is frequently
severely bitten ; secondly, tl.e closure, more or less complete,
in the larynx, with forcible efforts of expiration ; thirdly,
trachelismus with its consequent sphagiasmus, and its conse-
quences on the encephalon, similar, doubtless, in every respect,
to what we see in the features congestion, tumefaction, venous
lividity, ecchymosis, &lc., &c.

It is just as difficult to explain any one of these symptoms as
the others. They are all equally the suhjecis of obsercation.
The precise muscles afl:ected in trachelismus are not all easily
detectible. But the contraction of the platysma myoides, the
sterno-cleido -mastoid, the trapezius, and even the omo-hyoid,
is frequently either to be seen or felt, especially in thin persons.
It is singular that the same nerve, the ninth of Willis, the
eleventh of Arnold, should supply the genio-glossal and the
omo-hyoid, and that another, the accessory, should supply the
sterno-cleido-mastoid and the trapezius, whilst the intermediate
nerve should supply the larynx. Has this anatomical disposi-
tion anv relation to the phenomena and pathognomic symptoms
of epileptoid disease.

It is obvious that the anatomy oftheneek is fraught with ex-
treme interest to the pathologist and the physician.

Irritation, then, special diastaltic action, trachelismus, sphagi-
asmus, a gorged encephalon, such are the links of the chain of
causes and effects in epileptoid disease. When the paroxysm
is over, and the ligature taken from the jugulars, coma still
remains for a time, gradually passes through delirum, perhaps,
or through oblivium, into returning consciousness. This re-
covery is especially promoted by posture and by the sudden
inspirations excited by dashing cold water in the face, the de-

11851.] Lecture on the Spinal System. 153

gree of excitor influence of which is also a measure of return-
ing healthly condition of the encephalon.

To remove sources of continued excitement of the e^odic
nerves, to diminish excitabiHty by exercise and excited inspi-
ration, to avoid all causes of excitation, to remove I'csidual
congestion by sinapisms, such are the indications for our
treatment.

The mind must be preserved free from agitation, the blood,
if impaired, must be restored to its healthy condition, dental,
gastric, enteric, and uterine irritation, must be avoided.

Then, if ever, trial may be made of empirical remedies, such
as silver, zinc, copper, Baron Sloet, the valerianates, indigo, co-
telydon, sumbul, an issue in the arm, &c., ad wfiniliun : all
which, like mesmerism, homoeopathy, &c., act by inspiring con-
fidence in the patient's mind, being accompanied by assurances
of their efficacy. Esquirol found that his patients were always
better for a time, when he prescribed any new remedy.

But all this is, in reality, untruthful, derogatory from and un-
worthy of our profesion, and belongs to the low art of quackery
and imposition.

I will conclude these remarks by a short sketch :

I was recently called to visit a jzentleman in consultation
with Mr. Martin. He was affected with continuous epleptoid
convulsion of one side one side of the neck, one arm and hand
severely, and one leg slightly; the platysma myoides and the
stemo-cleido-mastoid were seen contracting convulsively, whilst
iheomohyoid could be both seen and felt, in the posterior in-
ferior angle of the neck, pulsating with clonic spasm.

We gave half a drachm of ipecacuanha and of the bicarb-
onate of potass, repeating them in twenty minutes. As nau-
sea, sickness, and faintishncss came on, all spasmodic action
ceased! It returned in a slighter form as they subsided, but
was never severe, as before.

The next day there was no spasm, but paralysis of the arm.
This gradually subsided in its turn.

It must beadmited that this series of events is of the slight-
est interest. The convulsive attacks being only hemiplegic,
there was only partial insensibility.

I must not conclude without adverting to the subject of
Puerperal Convuhion. This form of convulsion is, happily,
not designated by the formidable name of epilepsy, unless, in-
deed, it becomes repeated SlWgy all that relates to the puerpral
state is passed by. Yet it is as much epilepsy as the convul-
sive sttack arising from gastric, enteric, or the catamenial uter-
ine irritation.

As in the case of laryngismus, there is one interesting ques-

154 Lecture on the Spinal System. [March,

tion ? Is the puerperal convulsion apt to lead to subsequent
epileptoid affection ? And there is another question of the
same kind Is the patient previously subject to epileptoid af-
fection particularly liable to become affected with puerperal
convulsion ?

It is obvious that puerperal convulsion, like the laryngismus
of infants, and the epileptoid affections of adults, involves as an
essential link of the chain of cause and effects, that condition of
the muscles of the neck which I have termed trachelisnuis.
There are also the closed larynx and the protruded and bitten
tongue ; the contortion of features, neck, and general frame;
the same cerebral symptoms coma, delirum, hemiplegic para-
lysis.

What an interesting subject for future elaborate research !

But the ultimate and crowning object of these studies is
the Prevention as well as the Treatment of these paroxysmal
Affections. That this can only be based on a knowledge of their
predisposing and exciting causes, and of their mode of action,
must be obvious to every one. The physician becomes what
he ought most to be the watcher and the guide of his patient,
whom he would lead from evei^y danger and to every good.
How does empiricism fade in comparison wuth this only just
proceeding I

I here, then, draw these lectures to a close. I shall do so by
requesting your attention to the following Recapitulation of the
topics which have been laid before you.
Recapitulation.

1. The facts of Haller, and of Redi and Whytt, have been
shown to depend on one and the same motor principles the vis
nervosa of the former author acting according to a newly de-
tected Law, the DiastaJtic unknown to him nay, expressly
denied by him.

2. These facts, previously merely experimental^ having no
application in science, have been shown to be the type of a
Class of Acts in Physiology viz., all those of ingestion, reten-
sion, expulsion, exclusion.

3. I have established, by new experiments,

(1.) A diastaltic Law of Action of the vis nervosa.
(2.) A Diastaltic Nervous Arc, through which the power
acts, consisting of

i. An Esodic nerve,
ii. The Spinal Centre,
iii. An Exodic nerve,
all in essential relation and connexion with each other, and
constituting a new species of Anatomy.

4. I have established a Series o{ s\\c\\ Arcs, guarding

1851,] Lecture on the Spinal System. 155

(1.) The Orifices, ] of the animal frame and governing

(2.) The Sphincters, \ the Acts,
i. Of ingestion,

ii. Of Egestion, and especially of the vital function of
iii. Respiration, and all the important acts of
Generation.

5. I have, in a word, established
(1.) A Diastaltic x\natomy.
(2.) A Diastaltic Physiology.

6. 1 proceeded to show you that the science of Obstetrics is
a branch merely of Diastaltic Physiology.

7. As might be expected, I have traced the same principles
in pathology. I have shown that all spasmodic or convulsive
diseases are diseases of the diastaltic nervous system, and can
only be understood when this system is understood, and that
they assume chieflv three forms

(1.) The Diastaltic,

(2.) The Centro-staltic,

(3.) The Ca^a-staltic,
as their source of action is seated in an esodic nerve, the spinal
centre, or an exodic nerve.

8. I have especially laid before you two propositions in pa-
thology, of great importance :

(1.) That no disease of the cerebrum or cerebellum can in-
duce spasmodic or convulsive symptoms, except through
the medium of the spinal system ;

(2) That no disease of the spinal system can affect the
cerebrum, except through the medium of the larynx and
the nerves, muscles, and veins of " The Necky

9. In short, I have established a new and peculiar diastaltic
pathology.

10. 1 have applied the same principles to therapeutics, the
action of certain remedies, the treatment of a certain class of
diseases.

But I must conclude. In doing so, allow me to invoke the
spirit of cadour amongst you, and ask you, gentlemen, what
you think of the diastaltic nervous system ? Do you know of
any inquiry, any discovery, so extensive, so important in its
apphcations in physiology or in medicine ? any in which so
much has been accomplished, and in which so much remains to
be accomplished? Then accept my e (Torts in our common
cause in good part. Let it be said hereafter, that amidst much
opposition elsewhere, my labours were encouraged and promo-
ted by the Royal College of Physicians of London.

\_London Lancet.

156 Chlorofonn in Midwifery [March,

Observations on the Use of Chloroform in conjunction with
Ergot of Rye in Parturition. By Thgmas Edward Beat-
TY, M.I)., M.R.I. A., President of, and Professor of Midwifery
to the Royal College of Surgeons in Ireland, &c., &c.

The observations contained in the following pages were
communicated to the Dublin Obstetrical Society on two differ-
ent occasions, the last being the monthly meeting held in April
of the present year. From the cases detailed, it will appear
that I have been an early labourer in the field of investigation
respecting the merits of chloroform as an ancesthetic agent in
parturition; but 1 have purposely abstained from publishing
the results of m}' experience in this most interesting and im-
portant research, until I had tested the accuracy of my conclu-
sions by repeated investigations. In a matter like the present,
where a variety of conflicting opinions are entertained, and
where the usual, and even more than the usual amount of scep-
tic'ism that attends the introduction of every improvement
in medicine is found to prevail, it is the imperative duty of all
who have had opportunities of ascertaining the value of the
newly proposed means, to weigh well and consider in all its
bearings the plan, or remedy, before the stamp of approval is
placed upon it.

A^ctuated by such feelings, I have for a long time care-
fully investigated the value of chloroform as an anaesthetic
ai^ent in labour, and I have fullv satisfied mvself that it is
possessed of the powers ascribed to it by the distinguished
Professor, Dr. Simpson, who first employed and recommended
it for this purpose; and moreover, that its employment, when
froj)erli) conducted, is not attended wih any injurious effects
upon either mother or child. I have never seen any unplea-
sant result from it, and I believe that, out of the many thou-
sand cases in which this agent has been employed in par-
turition, not a single case of death has occurred from its use.
The immunity from danger in this class of cases may be as-
cribed to two causes, viz : First, the position of the patient,
and second, the condition of her stomach with respect to re-
pletion. The horizontal posture is that in which the peculiar
effects of chloroform are most easily produced, and in which
consequently the least quantity is required to produce anaes-
thesia. That is the position in which it is always administered
to the parturient woman ; while in many surgical operations, and
particularly in tooth-drawing, the patient is placed in the up-
right position, when a larger quantity of the drug must be
used, and in such cases it is that fatal results have most fre-
quently occurred. With respect to the second cause, viz., the

J 851.] Chlorojorm in Midwiferij, 157

repletion of the stomach, it has Ijeen proved most satisfactorily,
that if chloroform be administered when the stomach is full,
dangerous effects are more readily produced, and fatal conse-
quences are more likely to ensue. Now in cases of parturition,
it seldom happens that the use of chloroform is commenced
until some hours have elapsed after the commencement of la-
bour, and during all that time the patient is little diposed to
lake any food, so that when the time arrives at which it may
be deemed prudent to administer chloroform, the stomach is
mpty, and thus another cause of immunity from danger is se-
cured to the parturient woman. These circumstances have, no
doubt, contributed to save the class of cases under consideration
from injurious effects, and ought to encourage the timid and
wavering to lay aside prejudice, and be guided by sound prin-
ciples and experience. Let it not be forgotten, however, that
the grand desideratum in the use of chloroform is its purity.
Without this there is no security against unpleasant conse-
quences. The pure agent is harmless when properly admin-
istered ; but the impure, with similar precautions in the mode
of using it, is sure to cause cough, spasm of the chest, deli-
rium, and excitement, before the anaesthetic effects are produ-
ced, and headache, with congestion of the brain, after. Various
means have been proposed for testing chloroform, but they
were all difficult in their application, and unlikely to be em-
ployed by persons in active and extensive practice.

To Dr. W. Gi-egory we are indebted for the description of
a method whereby any one, however enq:aged in practice or
unused to chemical investigations, can for himself test every
drop of chloroform he employs by a simple process.

Dr. Gregory's paper was read before the Royal Society of
Edinburgh in March, 1850, and was subsequently printed in
the Monthly Journal of that city.* The paper is of great
value, and should be carefully studied by all who are interested
in the success of anaesthetic treatment. He ascribes the inju-
rious effects of the chloroform in ordinary use to the presence
of certain volatile oily impurities, which must be removed be-
fore it can be safely employed. These oils contain chlorine,
have a disagreeable smell, and when inspired or smelt cause
distressing headach and sickness. It is, therefore, highly pro-
bable that when these symptoms occur as they do with some
individuals, from the use of chloroform of more than the aver-
i\ge goodness of quality, they depend on the presence of a trace
of these poisonous oils. The test which Dr. Gregory recom-
mends for these impurities is agitation of the chloroform with

Monthly Journal of Medical Science, p. 414, May,1850.

158 Chloroform in Midwifery. [March,

sulphuric acid which should ^he quite colourless, pure, and
of the full density of 1.840 at least. This, when agitated with
the impure chloroform, becomes yellow or brown, from its ac-
tion on the oils, which it chars and destroys. Any change of
colour is easily seen by the contact with the colourless chloro-
form that floats above. Pure chloroform gives no colour to
the acid. As this is a subject upon which too much stress
cannot be laid, I will beg leave to transcribe Dr. Gregory's in-
structions for the purifioation of the adulterated drug:

" The chloroform having been tested as above, and found
more or less impure, is to be agitated with oil of vitriol (half
its volume will be sufficient), and allowed to remain in con-
tact with the acid, of course in a clean, dry, stoppered bottle,
and with occasional agitation, till the acid no longer becomes

darker in colour. As long as the action is incomplete there
will be seen after rest at the line of contact a darker ring.
When this no longer appears, the chloroform may be drawn
off, and for greater security once more acted on by a quarter
of its volume of the acid, which should now remain colourless.
It is now to be once, more drawn off, and in a dry, stoppered
bottle mixed with a little powdered peroxide of manganese,
with which it is gently agitated, and left in contact until the
odour of sulphurous acid is entirely destroyed, and the. chloro-
form has acquired a mild, agreeable, fruity smell. It has then
only to be poured off into a proper phial. It will now leave no
disagreeable smell when evaporated on the hand.

" Mr. Kemp has observed, in repeating this process for me,
the very curious fact, that as soon as the action is complete,
and the oily impurities are destroyed, but not sooner, the chlo-
roform, tested with the acid in a tube, exhibits a strongly convex
surface downw^ards, where it rests on the pure acid, or, what
is the same thing, the acid becomes concave at its upper sur-
face. The smallest trace of impurity, not sufficient to affect the
density of the chloroform, we have found to render the line of
junction horizontal."

We have thus in our powder a very simple means of testing
and purifying chloroform before employing it; and if strict
attention be paid to this most important point, I have little doubt
much of the prejudice which still prevails against the use of
this remedy will be removed. The purity of the drug being
secured, the next important consideration is the manner of
using it. I have aiv*'ays administered it on a pocket handker-
chief, as was first advised by Dr. Simpson, and I see every
reason to prefer this mode. It secures a due admixture of
atmospheric air with the vapour of chloroform, a circumstance
of great importance in the commencement of the process; for

1851.] Chloroform in Midwifery, 159

the slow and gradual admission of the vapour into tlie lungs,
when the drug is pure, produces a weak ansesthetic effect at
first, which, however, by a perseverance in the inhalation, be-
comes more and more intense, but by slow degrees, and in a
manner that is quite disccnible by the administrator, and can
be arrested at any moment by withdrawing the handkerchief.
This command over the quantity and quality of the inhaled
vapour cannot, I think, be attained in the use of any of the in-
halers that have been proposed.

The best and simplest of them is that invented by Dr.
Flemincr of this city ; and in operative surgery, where the
deepest form of anaesthesia is required, it answers perfectly,
and with a very small consumption of the fluid. I do not pro-
pose to enter into a detailed description of the method of using
this agent ; this has been done already by Dr. Simpson, and by
Dr. Murphy of London, to the first of whom we are indebted
for the introduction of this valuable addition to obstetric medi-
cine, and to the latter for his able and impartial investigation of
the subject. The practical and candid communication of Dr.
Denham, published in this Journal, contributed in no small de-
gree to place the value of this remedy in its true light.

I may just state generall}^ that in ordinary cases I commence
the administration when the os uteri is nearly dilated ; then I
pour about two drachms, at first, on the folded handkerchief,
which is held at a distance of five or six inches from the pa-
tient's face as she lies on her side, and is slowly approached
nearer and nearer until the edges of the handkerchief overlap
the upper part of the cheek. That in ordinary labour I never
produce insensibility, but as soon as the breathing becomes at all
loud I remove the handkerchief and suffer the effects to sub-
side, and then recommence the process. By this means the
patient is never deprived of consciousness, but she is relieved
irom the agony of her labour pains, and also from that distress-
ing and continuing ache in the back in the interval between
the pains, of which some women complain so loudly. They
are conscious of the uterine eflfort being made, and use the or-
dinary straining to assist it, but they suffer little or no inconve-
nience.

To be able to accomplish this with safety to themoth?r and
her infant, to hear a woman declare immediately after her
delivery that her labour was heaven, is no Fmall tiiumph of
art, and will be a lasting memorial of the genious and persever-
ance of Dr. Simpson. Tlie stage of excitement which has
been observed in some cases wherein chloroform was employed
is, I have no doubt, attributable to the use of an impure speci-
men, and is not to be expected when the pure drug is employed

100 Chloroform in Midwifery. [March,

in the manner just described. As a proof of the happy effect
produced upon patients treated after this fashion, I may state
that those who have once used the inhalation have called loud-
ly and early for it in subsequent labours.

That injurious and fatal results have followed the use of
chloroform in surgical practice I do not mean to deny, though
no fatal case has ever occurred in midwifery, principally for the
reasons already stated; but in the majority of the unfortunate
cases, some satisfactory reason will be discovered to account
for what occurred. The upright position, a full stomach, an
over dose, or an impure medicine, these, or some of them,,
will be found to have been present in such cases, and will be
quite sufficient to satisfy a fair and candid inquirer that the
blame should be laid on the incautious employer rather than
on the agent employed. There is now no excuse if we fall
into the mistakes that others have made, and that have been
discovered and pointed out by the investigations of patient
inquirers. Who now-a-days fears to prescribe opium, arsenic^
or prussic acid to remove disease? and who will deny the
deadly nature of these substances when incautiously used?
All are aware of the powers of these poisons, but have learned
by their own experience and that of others how to prepare
them, and apportion the dose so as to keep within the limits of
danger and yet secure the efiects they wish to produce. And
so it must be with chloroform: it is far too valuable and too'
powerful a substance to escape the strict scrutiny of science >
our acquaintance with it is short, we cannot be supposed as yet
to be familiar with all its properties ; and it is no reason that a
hasty judgment of condemnation should be passed upon it if it
has been awkwardly and rashly employed by some in the infan-
cy of the invention. I do not dwell for one moment upon the
proposition that it is the duty of the obstetric physician to con-
duct his patient through lier labour, with as much speed and
as little suffering as are compatible with the safety of herself
and her offspring. To argue upon a proposition so self evident
would be but waste of time and words. That we are possessed
of an agent w^hereby this great object can be accomplished iS'
proved by the many thousand cases in which chloroform has
been employed.

The use and value of this drug in natural and operative cases
has been fully set forth in the essays already mentioned, and I
do not wish to occupy time and space by quoting from my case
book instances of this description; suffice it to say, that I have
employed it freely and with the greatest satisfaction to myself
and my patients for more than two years. My principle object
in this communication is to show how chloroform can be advan-

1851.] Chloroform in Midwifery, IGI

tageously used in a class of cases that seem almost to forbid its
employment, I allude to tedious labours produced by sluofgish-
ness of the uterus. If the first effect of a good dose of chloro-
form be the arrest of uterine action for a short time, a fact ad-
mited by Dr. Murphy, and borne out by my own experience,
it follows, as a matter of course, that if the pains be slow
and weak, they will be the more surely and effectually inter-
fered with. Now, it has happened to me to have patients un-
der my care who were determined to inhale chloroform du-
ring labour, and who were most clangorous to get it at a time
when the uterus was indisposed to act with vigour and
celerity. To give the vapour, so long as matters thus stood,
would have only increased the evils and protracted the labour;
but by combining the use of ergot of rye with chloroform the
difficulty was quite removed. In order to illustrate this prac-
tice, I will set forth some of the cases in which 1 have derived
the greatest advantage from such a proceeding.

Case I. Mrs. W. was attended by me for the first time in
September, 1848, havin<z had several children previously.
During the last month of her pregnancy she was in a very dis-
tressing state of mental depression, and spoke continually with
apprehension of danger and death in her approaching confine-
ment. She expressed a strong desire to be treated with chlo-
roform, and was quite pleased when I promised to let her have
it. Labour came on at the proper time, commencing with
slight pains, which continued, with little increase in strength
or frequency, from an early hour in the morning until night.
She was in a state of great alarm and solicitude throughout the
day, and remained thus until 10 o'clock, P. M., when, finding
no improvement in the character of the labour, I gave her a
drachm of ergot of rye in two doses, at an interval of a quarter
of an hour. This soon established full uterine action, and in
twenty minutes she was in strong labour. She now became
very much excited and unruly, dashing herself about in the
bed, and could not be prevailed on to remain quiet. To obtain
the promised chloroform was her only object, and she clan70ur-
ed loudly tor its administration. Finding that labour was now
fnlly established, and that the os uteri was nearly dilated, I
commenced the use of chloroform from a pocket-handkerchief,
on which I had poured one drachm of the fiuid. This was at
11 o'clock, P.M., and almost immediately a complete calm
ensued ; she became tranquil and composed, and never after-
wards betrayed the least want of temper. Her consciousness
never deserted her. She continued to speak ralionallv a)I
through, and expressed the greatest delight from the inhalaiioo.

She was safely delivered of u living boy at half past 12

162 Chloroform in Midwifery. [March,

o'clock, A. M. When asked what she thought of the medicine,
she said it was heaven, that she was conscious of every pain,
and could make the effort to bear down, but felt no suffering.
This lady had been subject to intense nervous headachs after
all her previous confinements, on which occasions the pain and
intolerance of light were so great, that she was obliged to have
every ray of light excluded from her chamber, and the most
perfect stillness observed in the house. The attacks usually
lasted from twenty four to thirty-six hours, when they gradual-
ly subsided. On the present occasion, however, nothing of
the kind occurred. When I called to pay my visit the follow-
ing day, I found the shutters open, and the chamber full of
light. My patient lay perfectly free from all pain, happy and
thankful, saying she could scarcely believe it was all over, so
unlike was it to what she used to endure. Her recovery was
the most rapid she ever made.

This case affords some points for remark: first, we observe
the beneficial effects of ergot of rye in inducing uterine action
in a case rendered tedious by inertness of that organ, and thus
bringing the patient into a condition favourable for the use of
chloroform. It was quite manifest at the time I gave the ergot
that the uterus was not disposed to efficient contraction, and
that many hours would in all probability elapse before healthy
action would commence. By the influence of this drug, a
long night of fruitless labour was avoided, and the patient was
speedily relieved trom suffering. Secondly, a remarkable fea-
ture in this case is the immunity from headach subsequently to
delivery. This I think must be attributed to the soothing
effect of the chloroform on the nervous system, acting as a
sedative, and calming the excitement which formerly used to be
so distressing.

Case II. Mrs. F., pregnant for the first time. This lady
was most anxious to use chloroform in her approaching labour,
and I promised it to her if nothing occurred to cause me to
refrain from its employment. When the pains commenced
they were very slow and weak, and continued so for twenty
hours, at the expiration of which time the os uteri was dilated
to the size of a half-crown piece. The pelvis w-as roomy and
the soft parts relaxed. She was most importunate to begin the
inhalation ; but the pains not being sufficiently strong to war-
rant its administration, I gave the ergot of rye, which quickened
uterine action, and in twenty minutes labour was well estab-
lished. I then commenced the use of chloroform, under the
influence of which she was kept for tw^o hours, when she was
delivered of a living boy.

Insensibility was never induced in this lady, she was con-

1851.] Chloroform in Midwifery, 163

scious during the whole time, and frequently held the handker-
chief herself during the pains, soliciting more chloroform, and
expressing the greatest relief and comfort from its use. One
ounce of chloroform was consumed in this case.

Case III. Mrs. C. In this case of first pregnancy, labour
began by rupture of the membranes without pain. In six
hours there was some faint uterine action, which continued to
go on slowly for a long time. At length, at the end of eighteen
hours, finding the os uteri soft and nearly dilated, I adminis-
tered the usual dose of ergot of rye. This soon gave strength
and effect to the pains, and I then began the use of the chloro-
form. It was continued for one hour and twenty minutes,
when delivery of a living girl was accomplished, after a labour
of twenty-one hours' duration. During the whole period of
the inhalation this patient was not insensible, but enjoyed the
happiness of being conscious of the uterine action, without feel-
ing its pain.

Case IY. Mrs. P., second pregnancy. On the occurrence
of labour, the pains assumed a well-marked, steady character,
and continued so for four hours, at w^hich time the os uteri was
nearly dilated, and the vagina cool and moist. Having ex-
pressed a desire to use inhalation, she was now permitted to
commence, and in a short time the labour pains were suspend-
ed. This was followed by sleep, which w^as most sound for
one hour. On awaking from this condition, the pains did not
recommence, so I determined upon giving her a dose of ergot
of rye. She got a drachm in the usual w^ay, which soon pro-
duced a marked change in the pains ; they became more fre-
quent and increased in strength, and when well established the
chloroform was resumed.

There w\as now no interruption to the pains; the labour pro-
gressed most satisfactorily, and at the end of an hour from the
recommencement of the inhalation the delivery was happily
accomplished.

In this case the influence of the chloroform in suspending
uterine action was most clearly shown; but when the contrac-
tions were induced by the artificial assistance of the ergot, it
seemed to have no power to arrest them. This is a point of
great value, for it shows the importance of combining these
two valuable and powerful agents. In cases such as I have
related, by causing the action of the ergot to precede that of
the chloroform, we secure the patient against a suspension of
her labour.

Case A^. ^Irs. A., sixth precrnancy. A severe attack of
uterine hemorrhage had attended this lady's previous confine-
ment, two years before her present labour. Being anxious to

N. S. VOL. Vll. NO. III. 11

164 Chloroform in Midwifery. [March,

prevent a similar event, 1 gave her a dose of ergot, when she
was about seven hours in labour, and the os uteri and soft
parts fully dilated. In tv/enty minutes the pains were very
severe, and the vapour of chloroform was now inhaled with
avidity. From the first time of the inhalation the pains were
materially relieved, and soon disappeared, leaving the patient free
from suffering, but not insensible. At times she appeared to
slumber for a moment, and then woke again, saying she had
a pleasant dream. She said she was conscious of the efforts
which would have been pains, but she felt none ; the child was
born in twenty minutes from the first inhalation, and the dura-
tion of the labour was eight hours. The quantity of chloroform
used was four drachms.

Case VI. Mrs. P., second pregnancy. In this case there
was considerable delay in the first stage of labour, owing to
the head of the child presenting with the face to the pubii?^
and their being a very weak and inefficient amount of uterine
action. After three hours had elapsed, and no evidence of
increasing power being manifested, I administered a drachm of
ergot in the usual manner. By its aid the uterus was stimula-
ted to contraction, and the pains were rendered strong and
efficacious. As soon a's the labour was w^ell established, she
was permitted to commence the inhalation of chloroform. The
labour progressed rapidly from this time, the head came down
well through the pubis, and in half an hour from the first use
of the vapour the child was safely delivered. This lady re-
mained conscious during the entire time of her labour. The
inhalation seemed to exercise a very marked influenced
upon the condition of the soft parts, causing them to be relax-
ed rapidly and freely. The duration of labour in this case
was five hours ; the quantity of chloroform consumed was
three drachms, and the time of its influence was only half an
hour.

These cases will serve as a specimen of those that are met
with in practice, where weak and slow power in the uterus
produces a tedious labour, and where the patient, ill disposed
to bear the pain attendant on even such a feeble uterine effort,
is clamorous for the inhalation, so long looked for as the great
source of relief from suffering. To proceed at once to the
exhibition of chloroform in such cases, would certainly protract
the labour to a great extent, and might also produce very un-
pleasant consequences. It has been said, that uterine hemor-
rhage has occurred more frequently in women who have in-
haled chloroform, than is usual with those treated in the ordi-
nary way; this does not coincide with my experience. How-
ever, it must strike anv one conversant with such matters, that

1851.] Treatment of Traumatic Tetanus. 165

the uterus most likely to be relaxed after delivery is that in
which the pains have been most infrequent and feeble. If
chloroform alone be given in such a case, it would be very
likely to increase the tendency to relaxation after delivery ;
but when its use is preceded by that of the ergot of rye, such
danger is completely guarded against.

It will be seen in the above cases that in none of them were
uterine pains suspended after the dose of ergot had been
taken ; the labour went on vigorously, notwithstanding the use
of the anaesthetic agent; and in all of them delivery was ac-
complished with the most perfect safety to mother and child.
Having thus, I trust, shown how chloroform may be employed
in cases that at first appear to be quite unfit for it, let me again
impress upon those who mav employ these medicines the ab-
solute necessity of making sure that the agents are pure and
fit for use. In papers on the use of ergot of rye, published in
former volumes of this Journal, I have repeatedly expressed
the opinion that when ergot fails to produce its proper effect it is
owing to the use of an impure, spoiled, and therefore inert
specimen. The ergot is a very delicate medicine, and is readi-
ly injured by either age or damp. It should never be kept
more than twelve months, and it ought to be preserved in a
perfectly dry situation. If good at first, and thus treated, it
will not disappoint when brought into operation. The purity
of chloroform is of the greatest importance, and this should be
carefully looked to by the practitioner himself. He has now an
easy method set before him, whereby he can test and purify
the drug, and I feel confident that, if attention be paid to these
important points, the approval of the profession will be given
to the use of anassthetics in midwifery, and a large amount of
human suffering be thereby removed. [Dublin JouniaL

On the Treatment of Traumatic Tetanus. By H. R. De Ricci,
Licentiate of the College of Surgeons of Ireland.

# * * * * * *

The want of success which, up to this time, has attended
the treatment of this malady, has, I conceive, mainly arisen
from its very obscure pathology, but partly also from the ran-
dom manner in which the many remedies for it have been se-
lected and administered. But now that its physiology has
been so beautifiilly illustrated by Marshall Hall, in his discov-
eries regarding the reflex functions of the spinal cord, we cannot
but hope that a plan of treatment, will be found, which, bv

166 Treatment of Traumatic Tetanies. [March,

being more rational in its principles, shall also be more success-
ful in its effects.
* * * * * * *

Two forms of traumatic tetanus have been generally ad-
mitted by all practitioners, the acute and the chronic; the for-
mer almost invariably fatal, the latter somewhat more amena-
ble to treatment.

Acute cases of tetanus may be considered as those in which
the symptoms supervene before the tenth day after the receipt
of the injury, and in which the spasms succeed each other aS
short intervals, and with great violence ; and chronic, those in
which the attack comes on at a later period, and in which the
spasms are less violent and recur at more distant intervals.
But on this all practitioners are not agreed, for many will not
acknowledge as genuine tetanus those cases which have fol-
lowed very quickly the receipt of the injuiy. I think it well,
therefore, before proceeding any further, that we should stop
for a moment, and consid^M' what it is that constitutes leal teta-
nus, and what are the diagnostic differences betw^een it and other
convulsive diseases, which will enable the careful and accurate
practitioner to say, without hesitation, this is or this is not a
case of tetanus.

Many affections are laid down in books as being likely to*
be mistaken for tetanus, and tetanus for them : among the prin-
cipal we may enumerate hydrophobia, different forms of con-
vulsions, hysteria, and muscular rheumatism of the back of the-
neck; but the only one which indeed might for a time lead
astray, and which does in all its minutiae imitate tetanus, is hys-
teria. This far-famed mimic of disease will put on for a time
all the appearances of tetanus, and will deceive even the most
accurate ; but though it will assume even the most pathognomo-
nic symptom, yet it will persist in it only for a timc^ and thus-
the practitioner v^^ill be enabled to correct his diagnosis. What
then is the diagnostic symptom of genuine tetanus, which dis-
tinguishes it from all other diseases, and which, by being pecu-
liar to it, must at once characterize as tetarius every spasmodic
case in which it is prominent ? In my opinion, it is the unyield'
ins: rigiditij of the affected muscles ; these, when once rigidified,
so to say, by tetanic spasm, never relax, except in recovery or
death. In hydrophobia there may be tetanic rigidity during the
paroxysms, but in the intervals there are periods of rest, during
which there is complete relaxation of all muscles. In hysteria
the spastic condition of the muscles will sometimes be continued
for a very considerable time; but it ends at last by relaxing;
and the same occurs in all those different forms of convulsive
affections, which seem more or less to imitate tetanus.

1851,] Treatment of Traumatic Tetanus. 167

Thus, then, the only disease in which this pernfianent rigidity
of muscle is met with is tetanus; and in my mind we are jus-
tified in applying this name to all those spasmodic affections in
which this symptom is prominently developed.

Having thus endeavoured to establish the symptoms by which
this fearful disorder is to be recognized, I will proceed to ex-
amine it in its diderent stages, and then explain the principles
of what I consider to be its rational treatment.

Tetanus seems to bs a more frequent consequence of lacer-
ated wounds and contusions of the extremities than of other
injuries ; but I have seen it arise from a very slight scratch of
the nose ; and many cases are on record where it occurred
after trifling bruises, in which the skin had not been even
wounded: Still it is a remarkable feature in this disease that
it is certainly more frequent after slight than after extensive
injuries, and that it generally bears an inverse ratio to the ex-
tent of the effect of an accident.

One of the first symptoms of approaching tetanus is a cer-
tain unpleasant rigidity in the back of the neck, which may be
easily mistaken for rheumatism, together with a general malaise
accompanied with a sensation of weight and a tendency to
yawn. The wound, when one exists, will also at times give
indication of approaching mischief by the unhealthy aspect it
assumes. These and other indications, coming on shoi'tly after
the receipt of an injury, should be carefully noted, as it is of
the very greatest importance that the first symptoms should be
recognized ; for it is in this, its first stage,- before the spinal
cord has assumed that peculiar condition which induces the
violent spasmodic action constituting confirmed tetanus, that
our treatment will have the best chance of success.

The mode, of treatment I shall venture to recommend, will
meet, I know, with absolute condemnation from the majority,
and with approbation from few, if from any. Yet, as it is
based upon sound physiological principles, it will, in my opinion,
succeed, if tried sufficiently early. I do not mean by this to
say that the plan I propose will cure every case of tetanus, no
more than the most approved treatment can cure every case
of pneumonia; but I believe that I shall thereby blot out teta-
nus from the list of those diseases over which the healing art
has no control.

It would seem that a wound inflicted on the sentient extremi-
ties of the afferent nerves produces, in certain conditions of the
body, such an exalted state of the excito-motory system, that
the power of the will is insufficient to control this condition ;
hence, on the application of a stimulus, for example, the vibra-
tion of the bed from a heavy footstep in tiie room, or a mere

168 Treatment of Traumatic Tetanus. [March,

attempt at deglutition, involuntary spasmodic motions will be
produced, without the patient being in any way able to re-
press them.

It would also seem that lacerated wounds, contusions, and
other injuries of the extremities of nerves, are more often the
cause of tetanus, than the clean wounds inflicted by a sharp,
cutting instrument ; in proof of which we may refer to the rari-
ty of the disease supervening after sabre cuts in battle, or after
wounds inflicted by the surgeon in the operating theatre.

In many 7^05^ mortem examinations of fatal cases of tetanus,
a nerve has been found partially divided, or lacerated, or
stretched across a broken bone ; and w^e have cases on record
(though few indeed) in which the division of the principal
nerve leading to the part, or the amputation of the part itself,
has at once put a stop to all spasm.

I therefore conclude from tiiese facts, that, in the treatment
of this disease, we are justified, with the view of removing the
exciting cause, to amputate the entire part, or to divide the
nerve leading to it. Having once removed the source of the
evil, we shall find it less ditficult to combat the disease; but
before we proceed to consider the treatment, it will be well to
investigate what are the causes of the patient's sufl^erings, and
what the causes of his death. Tlie chief and most severe of
all his slifterings is the constant recurrence of the spasms,
which, in addition to the excruciating pain at the ensiform
cartilage, are so harassing in themselves, that did the patient
sufl^er from no other ailment, he should finally sink, worn out
by these repeated attacks. We must, therefore, endeavour to
check this disordered condition of the nervous system, both by
equalizing the powers of the brain with those of the- excito-
motory apparatus on the one hand, and rendering the muscles
incapable of obeying the erratic dictates of the spinal cord, on
the other. For in tetanus the energies of the brain are minus,
whilst those of the spinal marrow arc plus, and we must, there-
fore, exalt the powers of the encephalon, to enable it to preserve
its normally relative position in reference to the excito-motory
system: this we effect by the free administration of stimulants,
such as wine, brandy, and especially the resin of Indian hemp,
which possesses the property of exciting the brain independently
of other parts of the human frame. And we obtain a passive
condition of the muscles by means of tobacco enemata and
fomentations, the relaxing and paralyzing efl^ects of which are
well known. The use of the latter powerful remedy might, in
unskilful hands, be attended with danger, and its administration
should therefore be solely intrusted to an intelligent and careful
person, whose business it should be to watch narrowly its

1S5J,] Treatment of Traumatic Tetanus. 169

effects; but under certain restrictions it is admirably adapted
to iulfil ihe purpose we require of it, as under its nauseating
influence all the muscles gradually relax from their rigidity,
and become unable to execute any automatic movement, or in
any way to respond to the convulsive impulses of the spinal
cord.

Our patient is now in a state of comparative ease ; his brain
is exalted in its energies, and thus enabled to counteract the
spasmodic motions of the spinal cord; and, when it fails, the
paralysed condition of the muscles comes to its aid, by refusing
to act in compliance with the impulse. The pain at the ensi-
form cartilage too is relieved, and the patient's forces are no
longer exausted by overpowering convulsions. When once the
patient is brought to this condition, his safety is almost a mat-
ter of certainty : for what is the cause of death in tetanus ? it is
either exhaustion or asphyxia, and not any specific action or
morbid poison inherent to the disease itself. Asphyxia is
caused by the persistent rigidity of the respiratory muscles;
exhaustion, by the repeated attacks of spasm. But, by the
treatment I suggest, both these conditions are done away with,
the sufferer is relieved from any immediate danger of impend-
ing death, and his nervous system has now time to correct the
morbid functional condition into which it had lapsed, and by
degrees will resume its normal functions.

In fine, my treatment resolves itself simply into copying the
process of nature; and I believe that successful plans of treat-
ment in every disease have been derived from copying this
great teacher. Experience of centuries has shown us that
cases of acute traumatic tetanus invariably die when left to
themselves; and that cases of the chronic variety generally
recover. Let us bring our patient from the former condition
into that of the latter, and we shall have him in a position in
which his own forces, and the resources of nature, will be suffi-
cient to effect his recovery.
* * * ' * * * * *

These are, therefore, the conclusions I come to. with regard
to the treatment of this disease: to endeavour, if possible, to
combat it at its outset, and commence bv retnovin^ the existintr
cause, either by excision, amputation, or division of the nerve
leading to the part ; to give stimulants, such as brandy, wine and
the tincture of the resin of Indian hemp, in doses of irom ten to
twenty drops every half hour, so as to produce a slight degree
of cerebral excitement ; to support the patient at the same time
by giving beef-tea and eggs; to pay attention to the state of
the bowels, and act upon them with croton oil or any other
powerful purgative, as in this disease, as is well known, ihey are

170 The Spirometer. [March,

extremely torpid and sluggish ; and to bring him under the in-
fluence of tobacco as rapidly as possible. These are the princi-
pal means upon which we have to rely ; but at the same time, I
must not omit to warn every practitioner against the use of
opium, belladonna, and every other narcotic, which it has been
the fashion to administer indiscriminately in every case of
tetanus, both in hospital and in private practice, not so much
with the view of curing the patient as of stupifying his intel-
lect, so as to render his exit from this world less painful.

And now, before I conclude, let me add a few words con-
cerning those individuals who, in consequence of some idio-
syncrasy, cannot be subjected to the continued influence of
tobacco without incurring extreme danger. Those possessing
such an idiosyncrasy are easily distinguished, as a few minutes
after the administration of the first dose symptoms of the most
alarming nature will arise: the countenance will assume a
deadly hue and a ghastly appearance, and the pulse at the wrist
will become quivering and intermittent. I need scarcely say
that in such a case the administration of tobacco should be
at once stopped, ammonia applied to the patient's nostrils, cold
water sprinkled on his face, and every means used for the
excitement of cardiac action.

In these cases, after having discarded the use of tobacco, the
main reliance is to be placed in vapour baths, which should be
applied without removing the patient from his bed, and con-
tinued for a considerable time. The patient will invariably ex-
press himself as much relieved by them, and they generally
diminish the rigidity of the muscles in a very considerable
degree, at the same time that they sooth the patient and allay
the spasms.

By adopting such a method of treatment as I have endea-
voured to describe, we shall not, as I said before, cure ecery
case of acute traumatic tetanus, but we shall certainly give
the unfortunate sufferers a much better chance of recovery than
by abandoning them to the old routine treatment of calomel,
opium, and belladonna. [^Ihid.

The Spirometer,

Mr. Charles McEuen, of Philadelphia, has recently in-
vented a substitute for Hutchinson's Spirometer, by which may
be measured the quantity of air inspired and expired by volun-
tary effort in a given time. Mr. McE's instrument consists of
a cylinder containing water, in which is immersed another

1851.] The Spirometer, 171

cylinder inverted, into ^vhich the expired air finds its way
through a mouth tube. This inner cyUnder is counterpoised
by a weight attached to a cord passing over awheel cf large
diameter, and which rotates with the ascent of the cylinder,
caused by the entrance of the expired air, and on which a
scale indicates the amount that has been introduced. In ex-
hibiting this apparatus to the class, Prof. Jackson, of Philadel-
phia, made the following interesting remarks, which we extract
from the " Medical Examiner :'"'

Inspiration and expiration are performed by muscular power,
and are both voluntary and involuntary actions. The extent
to which they may be carried varies in difierent individuals,
and in the same individual at different times. They have a
limit which cannot be surpassed ; the lungs can never be emp-
tied, by the most strenuous efibrts of expiration.

The air in the lungs is, therefore, divisible into two portions.
The first, vvhich is a fixed quantity, is that over which the will
has no control, but remains after the strongest expiration, and
is contained in healthy lungs alter death. Its amount must
correspond with the size of the thorax. ]Mr. Hutchinson calls
this the residual air.

The second portion is that which is controlled by the will and
muscular action. This portion Mr. Hutchinson divides into
three sub-portions. 1st. Reserve air, or that portion which,
after an ordinary expiration, may still be thrown out by a vol-
untary effort. 2d. Breathing air, or the portion inhaled and
exhaled in ordinary breathing, when at rest: and 8d. Comple-
mental air, or that portion that can be inhaled, by the strongest
effort, beyond the amount of ordinary inspiration.

The three last are included in, and designated by the term,
"Vital Capacity." It is, in fact, the highest efibrt of the mus-
cles producing respiration. The spirometer measures the "vital
capacity" of an individual, and, it appears to me, is the measure
of the muscular respiratory power.

Mr. Hutchinson was struck with the fact, that the vital capa-
city had no relation to the size of the thorax. On the contra-
ry, he found, by experiment, that persons of the largest thorax
possessed a less vital capacity than others with chests much
smaller.

In the course of his observations he remarked that there ap-
peared to prevail a very close relation between the height of
individuals and their vital capacity. This circumstance was
the more strange and unaccountable, as height depends most
commonly on the length of the lower extremities, and not on
that of the chest or trunk alone.

172 The Spirometer, [March,

From observation made on a large number of individuals,
taken indiscriminately from various classes of society, amount-
ing to 2150, he arrived at the conclusion, that the vital capacity-
is a constant quantity, and holds a close relation with the height.
From the result of direct examination, in near 2,000 cases,
Mr. Hutchinson felt authorized to announce the following rule:
"For every inch of height (from 5 feet to 6 feet) eight addi-
tional cubic inches of air, at 60 are given out by a forced ex-
piration."

He further states, *' here is a cruide for the operator, and a
rule given that will enable us to compare men of different
stature and conditions of health, one with another."

If this result should be found accurate, the spirometer would
be unquestionably a most valuable addition, to aid the physi-
cian in deciding the state of health in many cases, that are, by
our common mode of examination, enveloped in great uncer-
tainty.

The following table shows the relation between height and
vital capacity.

Total Capacity.
Cubic Inches.
174
182
190
198
206
214
222
230
238
246
254
262

Before making any further comment on the rule laid down
authoritatively by Mr. Hutchinson, I will test by the instru-
ment the vital capacity of some patients affected with pulmo-
nary diseas;e, who are now present.

(Several patients, cases of chronic pleurisy, phthisis pulmo-
nalis in various stages, and emphysema, were tested, the height
and age being first ascertained.)

They vary, you perceive, from 80 to 120 cubic inches ex-
pired. Not one of the above patients approaches to the normal
vital capacity, in accordance with his height and age.

They are from 80 to 200 cubic inches below the standard,
according to the table.

I must confess, that I have some misgivings as to the accura-

Height.

Ft.

In.

Ft.

In.

5

0 to

5

1

5

1

<(

5

2

5

2

((

5

3

5

3

a

5

4

5

4

<:

5

5

5

5

u

5

6

5

6

((

5

7

5

7

u

5

8

5

8

<(

5

9

5

9

((

5

10

5

10

((

5

11

5

11

((

6

0

1851.] The Spirometer. 173

cy of this rule, and cannot but suspect that another element
than that of height regulates the extent of vital capacity, and
that element is the muscular force of the respiratory muscles.

I express this only as a suspicion. The extent of Mr. Hutch-
inson's inquiries, the evident care, labor, and conscientiousness
with which he pursued his investigations, entitle them to the
highest. consideration, and they should not be Hghtly questioned.

But, in a considerable number of examinations I have made
on healthy individuals, of the same height and age, with slight
difference of weight, there is manifest such wide difference of
vital capacity, that I cannot but hesitate in adopting the rule
as universally applicable.

I have, for instance, examined, within 24 hours, three gen-
tlemen in perfect health, one a member of our profession, who
have all been and are engaged in active pursuits. They are,
respectively, 5 feet 11 inches, 5 feet IH inches, and 6 feet in
height; the vital capacity of the first two is only 170 cubic
inches, and of the last 190 cubic inches. According to Mr.
Hutchinson's table thev ou^ht to have a vital capaciiv of 250
to 260 cubic inches.

Now, these gentlemen have a peculiar, and I may say, an
American conformation. T am under the impression it is not
common in England. They are tall, long limbed, thin, with
very slender muscles.

The highest vital capacity I have met with, as yet, is in a
young gentleman 5 feet 8 inches in height, in whom it is 280
cubic inches. He is of sanguine temperament, large, bony-
framed, and with well developed muscles. So far as about 100
observations have been made, I have not found that uniform
relation, as stated in the rule, between height and vital capaci-
ty. The differences, from 20 to 100 cubic inches, are too great
to be attributed to accidental circumstances. The individuals
1 speak of are all in high health.

More numerous and extended observations are, however,
required, before a positive conclusion on this subject can be
justified.

It has occurred to me that the discrepancies between ^Nfr.
Hutchinson's statements and my own observations, should they
be confirmed by more numerous experiments, may depend on
differences of race. The English are far more homogeneous
than the Americans. In this country races are mingled, and
continue to be more blended every day. As a race the Eng-
lish are bony, muscular, and sinewy. Experiments with the
Dynamometer have shown they possess a superiority of mus-
cular force.

In a homogeneous population the average height and weight

174 Treatment of Acute Rheumatism, [March,

would be in accordance with an average development of the
muscular system. But in a mixed population the same rule
would not apply.

I believe there can hardly be a question as to the very
marked difference in the general aspect and structure of the
native-born Americans, who are generally a mixed race, and
those of the English, Germans, Irish and French.

In examining Mr. Hutchinson's Table A, exhibiting the total
capacity of 15 different classes, there are very striking differences
to be seen. Pugilists, seamen, fire and police-men, and grena-
dier guards, have the greatest vital capacity. This is shown in
the columji of the table for the height of 5 ft. 8 in. to 5 ft. 9 in.,
and from 5 ft. 9 in. to 5 ft. 10 in.

Table of the mean Vital Capacity of fifteen different Classes.

5 ft. 8 in. to 5 ft. 9 in. 5 ft. 9 in. to 5 ft. 10 in.

Seamen,

239

258

Fire Brigade,

231

237

Police Metrop.,

226

248

Ditto Tiiames,

250

240

Paupers,

199

262

Mixed Class,

238

246

Grenadier Guards,

233

240

Compositors,

214

231

Pressmen,

245

239

Draymen,

223

245

Gentlemen, -

^208

236

Pugilists, &c.

243

273

Chatham Recruits,

351

266

Woolwich Marines,

240

246

In this table the vital capacity certainly does not correspond
to height as it respects different classes. Those classes com-
prehending individuals whose occupations require athletic,
robust, and picked men, exhibit a vital capacity varying from
20 to 40 cubic inches higher than paupers, compositors, and
gentlemen.

This table appears to sustain the conclusion which seems to
follow from the observations I have made here with the Spi-
rometer, that it is nmscular power, and not height, that governs
the " vital capacity."

Successful Treatment of Acute Rheumatism by Lemon-Juice.
By Donald Dalyrymple, Esq., M.R.C.S., &c. Norwich.

My attention having been drawn to the treatment of rheu-
matism by lemon-juice, by my friend. Dr. G. O. Rees, and
more recently again by his pamphlet on the subject, I offer a

1851.] Ti^eatment of Acute Rheumatism. 175

cas8 selected from many, as illustrative of its power and
utility.

Mrs. T , a small, delicate woman, aged twenty-six, had

suffered for several winters past, from severe attacks of acute
rheumatism, which lasted during various periods, from five
weeks to two months.

She had been treated in various ways for these attacks, and
they had yielded to either colchicum, or opium, iodide of po-
tassium, or mercury, or to all combined, but always left the
patient very weak, and very susceptible of cold. I was called
to her on the 28th of March, 1850, after she had been ill for .ten
or twelve days. She was suckling an infant of six months old,
and had been in feeble health ever since her accouchement,
which took place at the seventh month of gestation.

I found her with a pulse at ISO ; skin hot, and profusely per-
spiring ; tongue white and coated ; thirst excessive ; urine scan-
ty, clear, and not high coloured ; bowels confined ; pain intense ;
every joint set fast ; and the patient unable to move an inch
without assistance.

From previous experience of the effects of lemon-juice, and
from fear of reducing her powers, I determined to use it in
this case, and gave her half an ounce every four hours, combi-
ned with twenty minims of tincture of hyoscyamus, in a drachni
of water. I orderd her lemonade for drink, and arrowroot for
diet.

March 29th. She has passed a restless, painful night ; no
sleep; symptoms unabated; bowels not relieved. Ordered a
colocynth pill and a draught o*f rhubarb, with tartrate of pot-
ash, next morning. To continue the lemon-juice.

30th. Bowels freely relieved ; the rheumatism unabated ;
pulse still 130; complains of pain over the region of the heart;
the stethoscope gave no indication of pericarditis, but, to re-
lieve the pain, I applied a blister to that region.

31st. Still in great ])ain ; pulse 125; tongue cleaner, and
less thirsty ; ro sleep ; bowels purged four or five times. Or-
dered ten grains of compound powder of ipecacuanha at bed-
time. The infant was also troubled v/ith griping and diarrhoea,
which was easily relieved by an aromatic astringent.

April 1st. The pains somewhat abated ; pulse 120; tongue
cleaner; but the joints of the patient still completely set fast.
Increase the lemon-juice to six drachms every four hours.

2nd. Decidedly better; pulse 108; tongue cleaner; thirst
gone ; pain less, and able to turn in bed without aid. The im-
provement continued through the succeeding days, and on the
5th, the dose of lemon-juice was reduced to four ounces every
five hours.

176 Dislocation of the Lower-Jaw. [March,

From the 7th instant the patient continued to improve rapid-
ly ; her pains left her ; her appetite retm-ned ; her pulse fell to
ninety ; and on the 10th she left her bed.

On the 15th she got down stairs, and I ceased my attendance^
but I visited her on the 25th of May, and found that she was-,
in spite of very cold, wet and un propitious weather, free from
all pain, and in her usual health.

^ Though nothing could be more satisfactory than the pro-
gress of this case, I am unable to point out the modus operandi
of the medicine. As soon as the system came fully under its
influence, the pulse fell, the fever abated, the pains subsided,
and the appetite returned, yet nothing further noticeable took
place. The secretions were but little affected, except that the
urine, from being very scanty, became copious, but there was
no deposit of any kind in it. Here is a patient who usually has
not got quit of her attacks under six or eight weeks, and is
then left weak and emaciated, but who, under lemon-juice, is,
at the end of nineteen days, down stairs, and very little the
worse for her attack.

Should this medicine stand the test of time and hospital prac-
tice, and we be able to avoid either half poisoning our patients
with colchicum, stupefying them wnth opium, or enervating
them with mercury, a great boon will be conferred on the suf-
fering multitudes of this variable climate. [London Lancet.

Dislocation of the Lower-Jaw.

An important addition has b^en made to practical surgery in
the introduction, by M. Nelaton, of a new, simple and efficacious

process for the reduction of dislocation of the lower jaw\

* * * * * * # *

According, then, to M. Nelaton, the obstacle to reduction
existing neither in the resistance offered to the condyle by the
eminence of the transverse apophysis, nor in muscular action,
it must be sought for, not in the articulation itself, but in neigh-
boring parts.

"In front of the tempero-maxilla';y articulation," says M.
Nelaton, '*we find the tempero-zygomatic fossa, in which the
coronoid process is lodged when the mouth is closed. Before
and behind this excavation are placed two eminences, the pos-
terior formed by the transverse root of the zygoma, the anterior
by the articulation of the superior maxillary with the malar
bone. At the inferior part of the suture which results from the
union of these two bones, there exists a tubercle sufficiently
prominent, limited within by a notch formed by the smooth
edge of the malar process of the superior maxillary bone, and

1851.] Dislocation of the Lower- Jaw. 1 77

often on tl\e outer side by a little, elongated, almost oval fossette.
This eminence, to which we may give the name of malar tu-
bercle, is situated at about the distance of a centimetre from
the coronoid process. In place of this tubercle we have some-
times met a plane surface, and even in certain subjects a notch
more or less deep; but the presence of the tubercle is the rule.
With regard to the coronoid process this latter presents great
differences ; very short in some, and elevated scarcely to the
level of the condyle, it is found very much elongated in others;
sometimes directed upwards, at other times obliquely outwards,
so that its summit tends to meet the zygomatic arch ; in some
instances directed forwards, and distant from the condyle ; in
others directed backwards, so as to approach it." " These facts
well established," continues M. Nelaton, "let us examine the
pathological condition. Having, as I have said, undertaken
some experiments on the dead body, with a view to verify the
prevailing doctrine on luxations of the lower jaw, I have ascer-
tained: First, as M. Malgaigne observes, that if the condyle
of the lower jaw is carried forwards without passing the point
which the cavity of the capsule permits it to reach, the dis-
placement disappears forcibly as soon as we approximate the
dental arches, the eminence of the transverse apophysis pre-
senting no obstacle to the return of the condyle. Second, that
if the anterior part of the capsule be cut or torn, so that the
condyle can pass out of it and advance a few millimetres, we
remark that the displacement is permanent, not, as is generally
believed, because of the elevation of the transverse root, nor by
reason of the contraction or tension of the muscles, but because
the summit of the coronoid process comes to butt (arc-bouter)
against the inferior and anterior angle of the malar bone, and is
lodged in the little fossette which we have said exists often at
this point. The contact of the summit of the coronoid process
with the malar bone appears to us, then, to constitute an indis-
pensable condition in the true dislocation ; and for this the dis-
placement need not be extreme ; it suffices that the condyle be
advanced from three to four millimetres. The external lateral
ligament remains intact, the capsule alone is torn at its anterior
part, and the inter-articular cartilage either accompanies the
condyle in its displacement, or remains beneath the transverse
root, according as the rupture is either above or below its ante-
rior edge It results from what precedes that it is not on

the condyle that we must fix attention to find the cause which
renders the dislocation permanent, but on the coronoid process
and the malar bone, since it is in the contact of these two bones

that almost all the difficulty ofredurtion resides."

********

178 Dislocation of the Cervical Vertebra. [March,

To succeed, according to the process of M. N^laton, it is
necessary to act either by the interior of the mouth, taking a
point of support behind the mastoid processes, or external]3%
by the operator taking a position behind the patient, and
making pressure on the coronoid process, pushing it down-
wards and backwards, to disengage it from contact with the
malar bone, at the same time that the patient opens the mouth.
In ordinary cases, a light pressure is sufficient ; but if more
force be requisite, M. Nelaton advises the head to be supported
by an assistant, or a band to be passed around it, in which the
operator can encjage his index and middle fingers, while the
thumb must be brought to bear on the coronoid process.

The method of reduction which we have now described has
been before the profession for more than a year. We have
seen the success which has attended its use in the author's
hands ; and when we reflect on the great difficulties frequent-
ly presented to the surgeon in attempting to restore the lower
jaw to the glenoid cavity, we cannot but feel that M. Nelaton
will have conferred a signal benefit on humanity should the
rigid test of experience prove that his anticipations of the fa-
cility of reduction by the method he has devised are as well
founded as we are confident his views of the pathology of this
luxation are correct. We shall anxiously await the verdict of
the clinical surgeons of Dublin on the subject.

Dislocation of the Cervical Vertebra.
Vrignonneau has reported a case of dislocation of the fifth
cervical vertebra, in which his efforts at reduction were crown-
ed with success. It occurred in a man thirty-three years of
age, who fell from a cherry-tree on his head, becoming imme-
diately senseless, and remaining so for an hour and a half, after
which he complained of intense pain in the vertex and neck.
The head was bent forwards, and the entire body motionless.
After a time, paralysis of the extremities, the sphincters, and the
bladder came on. On the second day, death by suffocation
appeared imminent, yet reduction was attempted in the follow-
ing manner: The patient's shoulders were fixed by assistants,
and traction made on the head by the operator. In proportion
as the parts were extended, the voice became stronger, and the
breathing freer ; as soon as extension appeared to have been
carried to a sufficient degree, the head and the upper cervical
vertebra were directed backwards, when the under surface of
the fifth slipped on the upper surface of the sixth cervical ver-
tebra with a perceptible noise. The unpleasant symptoms
immediately disappeared, the man was soon able to resume his
occupations, and experienced only some stiffness and impedi-
ment in the lateral movements of his neck.

1851.] Caoutchouc Urinal. 179

Caoutchouc UrinaL

The construction of a species of nrinal in caoutchouc, places
in our hands a very simple means for avoiding the unpleasant
and often fatal consequences which I'esult from incontinence
of urine in certain cases of paralysis, and other affections com-
plicated with profound lesion of the voluntary nervous power.
This little instrument is furnished with an aperture of sufficient
diameter to embrace and grasp the penis by a little elastic band
such as that by which a glove encircles the wrist, besides
which there are two small loops by which it may be attached
to a suspensory bandage, while the lower part is supplied with a
stop-cock. The use of this little apparatus will be found to add
much comfort to the patient's existence, and save him from
the unpleasantness of bed-sores in many instances.

[Dublin Journal,

AncBsthetics used Externally.
We notice in the Bulletin General de Therap., a short re-
view of the application of anaesthetic agents in diseases of the
skin accompanied with itching. They are particularly appli-
cable, according to M. Cazenave, where there is itching without
an eruption. He asserts, however, that he is not deterred
from applying them, even when there is an eruption. When
an eruption is present, chloroform produces smarting, but is
soon followed by marked relief Hydrochloric ether is prefer-
able to chloroform, as it does not produce so much smarting
when applied. The preparation that M. Cazenave employs
consists of 2 grammes of hydrochloric ether and 30 of cerate.

Aconite in Lichen and Prurigo. M. Cazenave uses the fol-
lowing prescription, with great success, in lichen and prurigo :
'^^ Ext. Aconite,

Ext. Taraxacum, . . aa \ gramme.
Make forty pills one or two to be taken morning and evening.
The itching soon ceases, and the eruption raf)idly disappears.

A New Adhesive Substance. Dr.Mellez proposes the follow-
ing as a substitute for collodion. Dissolve shell-lac in alcohol
with a moderate heat, in such proportions as to give it the con-
sistence of jelly. This is simply spread upon suitable cloth.
It is not so transparent as collodion, nor does it dry so rapidly.

N. a. VOL. VII. NO, HI. 12

180 Miscellany. [March,

ill X 0 c cl I a n 2 .

Review of Cliemistry for Students, adapted to the Courses as iavghi
in the principal Medical Schools of the United States. By John
G. Murphy, M. D. Philadelphia: Lindsay & Blakiston. 1851.
pp. 328.

We are indebted to the enterprising publishers, (through the house
of J. A. Carrie & Co., of this city) for the above work. As its title
indicates, it is not a treatise on chemistry, but rather a manual in-
tended to aid the medical student in the prosecution of his chemical
studies during the Lecture term. As such it is certainly calculated
to be highly useful. It is divided into three parts, the first treating of
Physics, the second of inorganic Chemistry, and tlie third of organic
Chemistry. We cheerfully recommend it to the attention of students
of medicine.

Diseases of the Uterus. It appears that the excitement attending
the debates of the Parisian Academy of Medicine a few months since,
in relation to the frequency of diseases of the uterus, has crossed
the channel, and, with accumulated intensity, invaded the halls of
the Royal Medico-Chirurgical Society of London, and the pages
of the periodical press. The alleged exaggerations of Dr. Bennet,
are severely animadverted upon, and the frequent and indiscriminate
use of the speculum uteri particularly reprobated as both unnecessary
and demoralizing. The monomania which leads some practitioners
to see nothing but affections of the uterus in all cases of female dis-
ease, originated, we believe, with Lisfranc, who applied the speculum
to almost every woman who came under his charge, and who ampu-
tated the OS tincse for the most trivial ulcerations or abrasions. His
feats filled the Journals, and aspirants to fame or to practice, in the
French metropolis, were not slow, speculum in hand, to emulate the
distinguished surgeon of La Pitie. The London physicians caught
the infection and it was soon tj'ansmitted to our own shores. It is
even now, in some of our great cities, the most successful species of
professional Charlatanism, and ladies of every class flock to these
" womb Doctors" from all parts of the Union. We have heard it
affirmed that such is the celebrity of one of these gentlemen, that his
ante-chambers are daily crowded and that numerous equipages may
be continually seen in front of his residence. It is not surprising
that others should desire to share tlie golden harvest by also making
the uterus their " special study. '^

.1851.] Miscellany. 181

We would not be understood as undervaluing the labors of those
who have so largely contributed to anvance our knowledge of uterine
ailections; but merely as reprobating quackery in the matter. We
know too well the immense advantages derived from the use of the
speculum vagina? to think for a moment of lending our aid to any
effort to discountenance it. In reproducing the letter of Dr. Hall,
we do so because it has attracted much attention both in Europe
and in our countr}*, and not because we believe it applicable to the
respectable professional corps of the United States. Whatever may
be the state of things in England, we feel assured that, except in the
hands of charlatans, neither has the speculum been abused nor the
purity of the sex been tarnished by its use in this country.

On a New and Lamenialh form of Hysteria. By Marshall
Hall, M. D., F. R. S., &;c. I have no doubt that I was one of a
considerable number who, at the last meeting of the Royal Medical
and Chirurgical Society, (a meeting which will long be' memorable
in its annals,) wished to express their sentiments on the subject of the
use of the speculum vagince, without having what they deemed the
pertect opportunity. I regret that the discussion was not adjourned
to another evening.

I think the profession deeply indebted to Dr. Robert Lee for brinor-
ingthis question forward for discussion. It is not one of mere medical
or surgical treatment, but of medical and public ethics ; and I confess
myself astonished at the light manner in which a vaginal examination
was spoken of by one of the gentlemen present at the Society. I
think the challenge of Dr. Bennet should have been accepted at once,
and that a committee should have been, and should now be appointed,
to test the existence or the non-existence of the thousand and one
"ulcers" or "abrasions*' of which so much has been said of late.

The gentleman to whom I have alluded above, huffed the idea of
indecency in making a vaginal examination. There need be no ex-
posure of the person of the patient; surgeons make no scruple about
an examination of the rectum, (as if the two examinations could,
morally speaking, be compared.) But, if there be no exposure of
the person, and if the examination of the rectum be frequently made,
is there, at first, no wounding of the feelings, and is there, afterwards,
no deterioration and blunting of those feelings, by the repeated daily
or weekly use of the speculum vaginae in the virgin, and in the very
young even amongst the married ? I loudly proclaim that there is
such deterioration, and that the female who has been subjected to such
treatment is not the same person in delicacy and purity that she was
before.

I have known cases of the most revolting attachment, on the part
of such patients, to the practice and to tiic practitioner. I have
known them to speak of "the womb" and o( "the uterine or<rans "

182 Miscellany, [Marchj

with a familiarity which was formerly unknown, and which, I trust
will ere long be obsolete. The current of the ideas becomes hypo-
chondriacally directed to these organs. The very mind is poisoned.
A new and lamentable form of hysteria, I had almost saicf, o^ juror
ufermus, is induced, with this aggravation, that the subject of distress
is either concealed by the greatest effort, or explained at the expense
of virgin or female modesty.

There is a case of " poisoned mind" in the male sex, induced by
the quack doings of the day, relative to the existence of impotency,
which all of us must have treated and deplored. A similar case of
" mental poisoning" is now being induced in the other sex by the fre-
quent, constant, and undue reference, on the part of the profession (?)
to the condition of " the uterine organs."

These latter patients become reserved, and moody, and perverse,
and speak unintelligibly in broken sentences ; the peace and happi-
ness of the family circle is broken up ; subjects are discussed at the
domestic hearth which ought never to be mentioned except in the sick
room ; words which wound are spoJcen, and thoughts which are de-
rogatory are expressed, by other, perhaps by the male., members of
the family.

One poor miserable patient comes to me weekly, thus afflicted. She
had been treated by the speculum and the caustic for months, as an
out-pr.tient at University College Hospital. I sent her to Dr. Robert
Lee twice. Twice that gentleman examined and declared that there
was no uterine or vaginal disease. Meanwhile, the miserable pa-
tient's mind is absorbed by this ideal malady, and the peace of her
husband's home is destroyed.

I sent another pdtient to Dr. Robert Lee a few days ago, (whom I
had never seen,) under similar circumstances, but moving in a differ-
ent rank of life. The same opinion was given, the miserable patient
sufiering dire disappointment !

I recently attended a poor curate's wife, who had come to London
for medical aid, at, as I suppose, great inconvenience. During my
short attendance, this patient was constantly urged by a friend, a
titled lady, (the aristocracy always take the lead in quackery,) to send
for her physician, who is a strong abettor of the speculum. The
course which followed may be imagined, and need not be described. A
case of more comj)licated misery for a husband cannot well be con-
ceived a sickly wife, afflicted with uterine hypochondriasis, set upon
by a titled advocate of the uterine quackery, with straitened resources.

The advo'cates of the speculum speak of cases which had resisted
the efficacy of the usual general and local treatment, and which
yielded to the use of the speculum and the caustic. I have seen
cases in which, the speculum and caustic having been employed
and unduly employed, as I believe the patient remained more miser-
ably afflicted in mind and body than ever, and this the effect of that
treatment. Whether the former supposition be as well founded as
the latter, I will not presume to determine ; but I believe the cases
in which the young, and especially the unmarried, are afflicted so as

1851.] Miscellany. 183

really to justify the use of the speculum, to be rare; and the cases
ill which the injection of a solution of the nitrate of silver by her
own hand may not take the place of the application of this valuable
remedy in substance by the hand of the practitioner, to be rare indeed.
I will not advert even to the epithets which have been applied to
the frequent use of the speculum by our French neighbours, who are
so skilled in these matters ; but I will ask, what father amongst us,
after the details which I have given, would allow his virgin daughter
to be subjected to this " pollution " ? Let us then maintain the spot-
less dignity of our profession, with its well-deserved character for
purity of morals, and throw aside this injurious practice v, ith indig-
nant scorn, remembering that it is not mere exposure of the person,
but the dulling of the edge of the virgin modesty, and the degradation
of the pure minds of the daughters of England, which are to be
avoided. [London Lancet.

Cause of Goitre. The French Government bavins^ assirrned to Dr.
Grange the duty of making researches into the history of Goitre, Avith
the view especially of determining its cause, Dr. G. has recently
made an able report, which is contained in the medical periodicals of
that country. The length of the Report will not allow us to reproduce
it in extenso ; but we will translate a tew passages from which may
be obtained the most interesting facts.

*'In drawing up geographical charts of the distribution of Goitre
in France, Switzerland, Savoie and Piedmont, and in looking into the
localization of the disease in England, Germany, America and India,
I have ascertained most positively that the affection is entirely inde-
pendent of latitude, altitude, or climate ; and that it is unconnected
with circumstances of habitation, poverty, &c. Its occurrence seems
connected with the presence of magnesia in the aliments and water
used, and its absence appears often to depend upon the iodine contain-
ed in these ingesta. I am induced from all my observations to conclude
that magnesia predisposes to Goitre, and that iodine prevents it. * * *
By comparing the charts it is evident that Goitre is endemic wherever
magnesian formations preyail. The most distinguished geologists,
MM. Elie de Beaumont, of France, Studer, of Switzerland, de Sis-
monda, of Piedmont, have signally recognized the correctness of these
observations. We have invariably found salts of magnesia in the
waters and in the ashes of grain used in the affected districts ; and
whenever Goitre was endemic in an isolated locality of non-magnesian
formation, the waters used were found decidedly impregnated with
this earth. * * * In most of the Goitre districts, many of the
young men, in order to evade enlistment, acquire the disease bv

184 Miscellany. [March,

drinking freely from certain springs well known to produce it : all
these are strongly magnesian. In those sections of country, some of
the rich exempt themselves from the disease by using exclusively
rain water kept in cisterns. Mountain water resulting from the
melting of snow and ice, alone, never occasions goitre." * * *

Dr. Grange observes that there are in France 450,000 persons
affected with Goitre, and from 35,000 to 40,000 with Cretinism. He
also relates the interesting fact that the inhabitants of the town of
Montmeillan and of the city of Geneva have become exempted from
the disease, formerly very common, by using spring and river water
instead of that from wells.

The learned reporter suggests as a curative, as well as a preven-
tive means, the habitual use of a minute quantity of Iodide of Potas-
sium mixed with common salt. He would* add to every pound of salt
used for culinary purposes from one to five grs. of the iodide.

"In Savoie, for example, where the sale of salt is monopolized by
Government, they might add to it one ten thousandth part of the
Iodide of Potassium, and thus, even without their knowledge, rid of
Goitre a population containing 100,000 casesof this disease, for about
1600 francs, the cost of 40 kilogrammes of the Iodide, which should
be mixed with about 400,000 kilog. of salt, the quantity probably
consumed by 100,000 persons per annum. * * * "I have for
18 months used this plan of treatment in whole families, always with
entire success, and without any inconvenience whatever."

It is worthy of remark that our author treats Goitre with much
smaller quantities of the Iodide than are usually resorted to. Its
beneficial effects in his hands may be attributed to the fact that, thus
administered, the remedy produces its constitutional effects without
impairing the digestive functions, and may consequently be tolerated
a long time. It will be recollected by all who are familiar with Lu-
gol's method of administering Iodine in scrofulous affections, that he
lays great stress upon the necessity of giving it largely diluted in order
to avoid any unpleasant effect upon the gastric surface. It is in this
manner that he not only succeeded in obtaining most astonishing re-
sults, but also avoided the peculiarly distressing efiects so much ap-
prehended by those who used it differently.

What is true in relation to Iodine is equally so with regard to many
other active or irritating agents used with a view to their constitutional
eflect. Arsenical preparations, so valuable as general restoratives
of depraved habits, when given in minute doses and largely diluted,

1851.] Miscellany. 18i

cease to be so when administered in larger quantities and in a more
concentrated vehicle. The enect of 12 drops of Fowler's Solution
given in a spoonful of water is vastly difTerent from that of a similar
dose diluted with a tumblerful of some bland fluid. In the former
case the effect is principally local in the latter, general. Corrosive
L*ublimate, to be advantageously used, should always be largely dilu-
ted. Calomel, when given in large doses, displays its action entirely
upon the alimentary surface, provoking a copious exudation of mucus
in which it becomes wrapped i^p and is can'ied down to be expelled
with the fecal matters ; whereas if administered in small doses, it
remains in the stomach sufncientiv 1od to undero-o the changes nf-
cessary to its introduction into the circulation and to the development
of its constitutional effects.

We do not mean to advocate Hahnemanism by the above remarks,
but merely to signalize an important principle in therapeutics.

New Method of Treating Hydrocele. The "Gazette Medicale de
Paris '* contains a lengthy communication made by M. Baudens to
the Academy of Sciences, upon a new method of treating Hydrocele.
This consists in transfixing the sac with along and slender trocar, the
canula of which has a lateral aperture about its centre. The stylet
being withdrawn leaves the aperture open in the sac, and therefore
permits the escape of the hydropic fluid at both ends of the canula.
The sac being thus emptied, is then inflated with air by closing one
end of the canula and blowing into the other through an elastic ca-
theter inserted into it for this purpose. The object of this inflation
being to add to the irritation occasioned by the presence of the canula,
which is alIov-ed to remain like a seton for one or more days, a blunt
stylet is passed into the canula in order to close the central aperture
and thus to retain the air until some pain be induced.

M. B. dwells with much propriety upon the fact that the irritabil-
ity of the tunica vaginalis varies so much in ditferent individuals, that
it is diflicult, and even impossible, a priori, to determine upon the ac-
tivity of the agent that may be necessary to induce the proper amount
of irritation. He therefore allows the canula to remain introduced
until the proper degree of excitement be induced. In some cases
the mere introduction of air, made once or oftener durinn- the day
will sufiice. If this fail, he throws in tepid water one or more times ;
and finally, if this be insufficient, he resorts to the injection of a weak
solution of Nitrate of Silver (about 1 gr. to 4 oz. of water.) When-
ever the exudation of plastic lymph and the supervention of some

186 Miscellany. [March,

tumefaction are secured, the canula is removed and the case treated
in the usual manner.

M. Bnudens claims for his method the advantages of less danger
of wounding the testicle and of throwing the injected materials into
the cellular tissue,. as well as of greater certainty in the result. He
has used this method for twenty years in which time he has operated
on 200 cases, and found the average duration of treatment to be 19
days for a complete and radical cure. Many were cured in a fort-
night and some in ten days : 39 were^cured by atmospheric inflation
alone, the canula remaining from one to two days; 47 required both
air and water; in the remaining 114 cases a sufficient degree of irri-
tation was not secured until after the use of air, water and the solu-
tion of Nitrate of Silver. In only 20 cases did the inflammatory
symptoms exceed the required limits, and this was readily subdued by
the use of cold lotions. Relapse occurred in but two instances.

From the above abstract, it will be perceived that the plan adopted
by M. Baudens is well worthy of attention. We regret that the great
length of his communication forbids its entire transfer to our pages.

We have long been satisfied that quackery in its multiform manifes-
tations can only be effectually combatted by society at large, and that
all effbVts of our professional brethren to discredit it, do more harm
than good. We are sure to be regarded as parties interested, and
therefore to give the quack all the advantages of persecution. When,
however, members of the regular faculty are detected in base and
dishonorable practices, it becomes the duty of those apprized of the
facts to expose them to public indignation, as using their professional
knowledge for the perpetration of criminal acts. We hope, nay we
believe that the writer of the subjoined letter has exaggerated the ex-
tent of the evil he signalizes as common in New England. We feel
assured that no physician in our section of the country has ever been
guilty of such mischievous conduct. We take the following from
the Boston Medical and Surgical Journal :

Quackery in Abortion. The medical profession takes rank with
the other learned professions ; and is justly regarded by all enlighten-
ed nations as one of the most useful, liberal and noble of the sciences.
Our profession, for centuries, has been advancing. It has, indeed,
accomplished that which its most ardent admirers could not reasona-
bly have expected, and now it is no way inferior to law or theology.
This was not so once ; for in by-gone days, physic ranked lowest in
the scale of the learned professions. Rome had her orators, poets and
generals ; England her statesmen, bishops and barristers. They had

1851.] Miscellany. 187

their physicians also ; but how comparatively small is the space these
di.^ciples of Hippocrates and Sydenham occupy on the page of their
country's history, compared with the volumes which contain the
writings, discoveries and transactions of the distinguished men of other
professions. But when the iiistory of our times shall be recorded, the
names of those who distinguish themselves in medicine and surgery
will shine as brightly as those of the jurist, the divine, the military
chieftain, and others, who have also been useful to their race, and
shed lustre and renown upon the nations of their birth place or adop-
tion.

For the last half century the progress of medicine has been, in all
civilized countries, remarkable ; but no where more marked than in
the United States. The indomitable and enterprising energies of our
countrymen have been manifest in this department. The condition
of our colleges has improved ; our medical societies have taken, and
continue to take higher grounds. The American Medical Association
is annually adding rich and ripe sheaves to the great store-house of
science; /Ae^f; are constantly taking the place of tares, which have
hitherto occupied too much space. This Association has not only for
its object the exjmrglng of worthless material and the supplying of
sound doctrines, but it also aims at tijc establishment of good regula-
tions and ethics, with a view that justice, honorable conduct, and moral
integrity, shall govern and preserve the medical men of this country,
(thus indirectly but really benefiting the sick and all others throughout
the land,) and if possible, eradicate every vestige of quackery with
which our country has been scourged.

While the Association, through its committees, has made excellent
suggestions, pointed out valuable improvements, and discountenanced
quackery in most of its forms and devices, it has not yet struck any
decided blow on that most diabolical kind of quackery, that high-
handed villany, which characterizes the ahortionisl. That this kind
of Charlatanism is rife, and is practised by regular members of the
profession, that is, men who have diplomas, there can be no doubt;
and I believe that some who are promoted to office in our medical socie-
ties are of this order of quacks. That such men are quacks, no one
will question the ejnthei belongs to the vnprincipled as well as to the
ignorant.

It may be thought that the nature of this subject is such as to render
it best to be silent. But I take no such view of the matter; and if I
possess no ability in the way of putting it down, I wish to warn the
young practitioner, who is about to make his debut in his profession,
as he values his future usefulness, as he values principle, as he values
reputation and a good name, to abstain from the infernal performance
under every circumstance, let the inducement be what it may. No
honorable man of experience will for a moment i/iink of such an im-
moral act ; the unprincipled man will do it will do anijlhing, however
mean or \[\ofor?noney. The young man, while he is waiting for
more laudable employment, may be tempted. Such are often applied
to, to procure abortions, especially if thougiit to be in need of money.

188 Miscellany. [March,

The applicants should be spurned, and iheir offers treated with dis-
dain let their money perish with ihem. I insist upon it, that this is
a dangerous situation for many young men, and if they fail here, just
as they are to be introduced into legitimate practice, they fall forever;
their sms will surely find them out.

These abortionists seem not aware that the testimony of their dying
victims is generally elicited by the attending physician and friends ;
or that the throes of parturition, the fear of death, or some other cir-
cumstance, will draw out all the facts in the case, and that they them-
selves will henceforth be considered quacks and murderers by many
whose respect and esteem they would gladly enjoy.

Need I allude to the moral and physical evils this practice produces?
Are they not manifest, fearfully manifest, in this community, evea
within the puritan borders of New England? It increases prostitution
and infjinticides, and breaks down the constitutions of those who are
naturally healthy. Look at the bills of mortality as returned from our
large cities ; see what numbers die of peritoneal inflammation ; mark
the increase of ^iiV/Z/oni children and premature births. (Vide iS'ew
York Medical Gazette, Vol. I., No. 1, p. 6.)

Besides these bills of mortality, the records of criminal courts will
furnish sufficient proof that this crime is every day becoming more
prevalent. It is humiliating to admit that there are a class of physi-
cians who, Herod-like, have waged a war of destruction upon the
innocent. Though their motives are not the same as those which
instigated that cruel king, they are no less murderers for that. If
there is any difierence, they are -worse than Herod. He was influ-
enced by popular clamor and bigotry ; these quacks do all for money,
and such could be hired to burn out the eyes of infant princes.

These menaie better known than they would like to be. It is said
that a woman cannot keep a secret. Whether this is so or not, the
man who procures abortions is generally well known. He needs no
hand-bills, placards, or other advertisement ; he is soon notorious.
Inglorious fame ! Who would have such a disgraceful notoriety ?
Who would thus disgrace his profession ; who would sell his claim
to honor and principle ; who would shed innocent blood for a few
pieces of silver? After a man has thus degraded himself after he
has sunk so low, can he expect to retrieve his character? Whoever
knew such a man to reform ? If he is susceptible to feelings of re-
morse, like Judas he will go out and hang himself to hide his own
shame.

I consider this species of quackery the most abominable and wicked
of all. Anything is Charlatanism wdiich is morally dishonest, though
it may be practised under cover of a diploma ; and therefore that man
is a Charlatan, to all intents and purposes, who, like the notorious
Restell, becomes the executioner of babes in utero. Such a man is
the vilest of quacks, and the meanest of men.

I shall not stop to give the history of those lamentable cases which
have come under my observation, and terminated fatally as the con-
sequence of procured abortion those fatal cases of puerperal peritoni-

1 S 5 1 . ] Miscellany. 189

tis, caused by the blood j hands of doctors and M. D.^s ; but if the
confessions of the dying are to be relied upon, 1 know men who have
carried on this shameful and iniquitous business, and have not only
been the murderers of infants, but the instruments also of consigning
their guilty mothers to premature graves, " unhouselled, unannointed,
unannealed.''

I have heard some of the older members of the profession say that
abortions are of more frequent occurrence now than formerly ; and
they have rightly suspected the increase is owing to criminal hands.
1 need not remark on the evil consequences of this mischief upon
health the health of American women. I need not attempt to por-
tray its blighting and destroying ef/ects upon the strength of tiie fair
daughters of New England, for tlieir withering results are well under-
stood by the majority of your readers. Various instruments are em-
ployed f)r destroying the integrity of the ovum, and I have been
intbrmed that these quacks conceal their weapons from their patrons
as if they were something strange or curious. I was told, not long
since, by a woman who was operated upon recently in a neighboring
city, that the wretch who performed the operation obliged her to take
solemn oath not to expose him. She kept her word, for she would not
give me his name, but left me to guess who he was ! Being a true
Yankee myself, I suppose I can guess with ordinary exactness. This
woman said that at the same time there were several other women ap-
parently waiting for the "slaughter'' in an ante room of the building.

Irregular practitioners, and the women themselves, are addicted to
this kind of criminality ; but, as a general thing, they have learned
their art of some unprincipled doctor, who either purposely or acci-
dentally let slip the secret to the vulgar. The implements which I
have heard of as being used by these irregular quacks, are sharpened
sticks, goose-quills, wires, d:c. ; not those beautifully-polished, tonsil-
lancet insiruments, which some of the regular quacks wield with so
much dexterity and freedom, as "if the assassination could trammel
up the consequence, and catch, with his surcease, success." 1 once
found a wire (then bent at nearly a right angle) in the vagina of a
young girl who had been in the hands of a regular abortionist. At
each extremity of the wire was a leaden ball, about the size 6f a mar-
ble, one end of which had probably been introduced into the os uteris
and there left to remain till contractions of that organ should be estab-
lished. For the information of the villain who was guilty of this dou-
ble massacre, (should his eye fall upon this page.) I will state that the
operation succeeded succeeded in destroying a foetus of five montlis,
and impairing the health of the girl so that she continued to sutler from
uterine disorder, and finally died in about three years afterwards.

Now in view of honoring and improving the condition of our praise-
worthy and liberal calling, as well as that of society at large, I ask tho
co-operation of every respectable physician to aid in putting down
cverytliing and every body that shall appear to be cognizant to the
offence the crime of procuring abortions the massacre of infants.
1 do not think that we should in any case expose our patients, those

1 90 Miscellany. [March,

who place their lives and reputations in our hands. This would be a
breach of confidence a violation of good faith; a principle which
physicians have held inviolable both in ancient and modern times.
'Vhepe?'peirator, and. not the suhject of the crime, should be made re-
sponsible. I leave it for others to prescribe the method and manner of
checking and rebuking these quacks in their criminal progress. Pub-
lic opinion, the indignation of the populace, will not be sufficient to
meet the exigency which the importance of ihis matter demands.
Public justice is slow, and the people who employ these quacks will
not be shocked by any outrage, or be disgusted by any measures,
however revolting they may be to ordinary minds, and moral men;
for they are in truth nothing better than accessories^ and without their
aid and support this class of practitioners could not live. I would
suggest, however, as a starting point towards reform, that medical so-
cieties and associations expel these ' assassinators," and that each
physician take the responsibility of informing against them whenever
opportunity may offer. For one, I am willing to join such a crusade,
however unpleasant the war may be, and do all that I can in the way
sequari vestigia rcriim. The medical profession is bound to take action
in this matter ; if it is not done, if proper measures are not resorted to,
injustice and disgrace will be charged upon us for affording protection
and fellowship to these Charlatans. This evil is not confined to any
particular region or section of country ; it has at length become gen-
eral, and is a national curse.

Every State should render the offence of inducing premature labor
or abortion a penal one (unless it shall be done for the safety of the
mother, where there is a deformed or contracted pelvis, or where some
other cause renders the operation absolutely necessary) ; it should be
a State-prison offence, at least.

The evil is one of such magnitude that I have felt it my duty to make
this communication. If by it any one shall be persuaded from falling
into criminal quackery, certainly good will come out of it. Or if those
who make laws and regulations for medical men shall be induced to
render the crime punishable, and this action be taken any sooner be-
cause the medical public have thus had their attention directed to the
subject, I shall have no cause to regret that I have incurred the dis-
pleasure of those practitioners who have been styled ahortionists, or
that 1 have made the admission, through the medium of your Journal,
that there is criminal quackery in the medical ranks.
Yours respectfully,

GreenvillCf R. 1., Dec. 27th, 1850. J. P. Leonard.

Prof. Beatty on Chloroform and Ergot. Whilst the Editor of a peri-
odical of this kind is not to be held responsible for the views of contribu-
tors to the original department, the case may sometimes be different in
relation to his selections. We, therefore, occasionally take the liberty
of commenting upon articles placed under the Eclectic head. The
paper of Prof. Beatty, which we have transferred entire to our pages, is

1851.] Miscellany, 191

one of decided merit and peculiarly opportune, where the use of chlo-
roform is becoming so much generalized. It is especially valuable
in giving details which should be borne in mind by all who use this
potent agent, for ^^ when properly conducted, ^^ its employment is rarely
injurious. The author dwells upon the importance of using a pure
article, of administering it in a horizontal position and with an empty
stomach, and of not inducing total insensibility or unconsciousness.
There can be no doubt that to these precautions observed by obstetri-
cians, must be attributed the disadvantagious contrast between their
results and those of surgeons, especially of dentists.

But, Prof. Beatty proposes to combine the action of Ergot with that
of Chloroform, in order to avert the influence which he freely acknow-
ledges the latter agent to exert in lessening uterine contractions. This
combination appears to us most felicitous, yet full of mischief in inju-
dicious hands. Looking to the great danger to which the child is
exposed by the untimely use of an agent which induces contractions
characterized by little or no intermission, we have always regarded it
a safe rule not to administer Ergot until the os uteri is fully dilated.
Yet Prof. B. does not insist upon the necessity of this condition. In
his 1st case, the patient having been in labour from an early hour in
the morning until 10 o'clock, P. M., with but slight pains, a drachm
of Ergot was given in two doses, at intervals of a quarter of an hour,
and it was only after " finding that labour was fully established, and
that the os uteri was nearly dilated,'' that chloroform was administered.
In this case, then, the Ergot was given before the os uteri was "nearly
dilated." In the 2d case, the os uteri was dilated to the size of a half-
crown piece before the use of Ergot. In the 3d case, the Ergot was
given when " the os uteri was soft and nearly dilated,'^ and in the 4th
case, when " the os uteri was nearly dilated and the vagina cool and
moist." In the 5th case, "the os uteri and soft parts were fully di-
lated," and in the 6th its condition is not stated.

We do not know the exact value the author gives to the terms
"nearly dilated," and may therefore misinterpret him. If he means
to say that the os uteri was nearly jTw/Zy dilated, we have no objection
to urge ; but if otherwise, we must beg leave, with doe deference to
sucii high authority, to submit whether it would not be more prudent
to withhold tlie Ergot until the complete dilatation of the os uteri.
We firmly believe ihat the injudicious use of Ergot causes the death
of more children than any other circumstance connected with parturi-
tion. Indeed, the number of still-births has so much increased in
France, since the administration of this article has passed into the

192 Miscellany. [March,

hands of mldwiveSj that the Government has recently submittetf to
the Academy of Medicine the propriety of forbidding its use altogether
or of limiting it to special cases. The Academy recommended that
it should be prescribed only by competent physicians.

American Medical Association. The Committee of Arrangements
request ail Societies and other institutions authorized to send dele-
gates, to forward a correct list of those selected to attend the next
annual meeting, to the Secretary, Dr. H. W. DeSaussure, at Charles-
ton, S. C, on or before the 1st day of April.

In consequence of the -resignation of Dr. Stille, one of the Secre-
taries, from ill health, all communications intended tor the next meet-
ing of the Association, must be addressed to the remaining Secretary,
Dr. H. VV. DeSaussure, Charleston, S. C.

The Fourth Annual Meeting of the American Medical Association,
will be held at Charleston, S. C, on the 2d Tuesday of May next.

[Charleston Med, Joiirn.

Colored Students in the Medical College. We understand that the
Medical Faculty of Harvard University have signified their intention
to exclude colored men from their classes hereafter. Although it is
highly desirable that colored men should be properly qualified to act
as physicians in the flourishing colony of blacks at Liberia, it is
doubtless considered by the facuhy inexpedient to admit them into our
public schools of medicine. [Boston Med. Journ.

The St. Louis Prohe. The present number closes the first volume,
and ends the publication, of the Probe. During a year's experience
in journalism, we have been convinced that neither fame nor funds, can
be acquired by conducting a medical monthly, and that many mem-
bers of the medical profession are miserably poor in pocket, and more
are deficient in moral principle, however well they may be imbued
with the principles of their profession. We are inclined to believe
that a large number, who have received our journal without paying
for it, have devoted themselves to the study of scorbutus, with some
success ; for we must say they have treated us most scurvily, and not
a few have shown a thorough acquaintance not with abstract prin-
ciples but with the principles of abstraction, which would entitle
them to the consideration of the judiciary. For the kind favors, and
warm support we have received, however, from the better portion of
our brethren, we return our hearty thanks, and thus take leave of
them. Our hearts are so very full, and our pockets so very empty,
that we are unable to say more. [St. Louis Proie.

Small-Pox in Neio York. Under the above caption, the Editor of
the New York Medical Gazette animadverts with great propriety
upon the neglect of the authorities of that city, to take proper steps
for preventing the introduction and propagation of a disease so emi-

1851.] Miscellanij. 193

nently contagious as the small-pox. After stating that there are 40
cases of this malady at the quarantine Hospital, and that it is being
daily brought into the city by emigrants, the Editor adds : " The report
of the City Inspector for the last week records 8 interments after
death by small-pox in this city. As most of the cases appear in its
modified form, and the mortality of this malady should not ordinarily
exceed 4 per cent., the inference is authorized that there have been at
least 200 cases in the city during the week, which is very probably
less than the truth." We are inclined to believe this estimate of
mortality much too small. The following circumstances are cited in
illustration of the indifference of the authorities on the subject:

" Within a very short time, an estimable lady of this city, who
adorned the relations of daughter, wife, and mother, was cut down in
the vigour of her youth by small-pox, having contracted it by riding
home from a steamboat, in a public hack, in which a patient had just
previously been sent to the small-pox hospital! Very recently, on en-
tering a Broadway omnibus, filled with passengers, one of the number
was recognized as covered with variolous eruptions, and precisely at
that stage which is most likely to spread the infection ; and yet, imme-
diately beside him, sat a young mother with her infant in her arms,
and on the inquiry which humanity prompted, it was ascertained that
neither mother nor child had ever been vaccinated [ Persons have
been seen, not only in all our public conveyances, but at our most
fashionable places of amusement, and even in our churches, who,
though convalescent from small-pox, were nevertheless walking
sources of contagion, the characteristic crusts and scales of recent
eruption still disfiguring their persons, and radiating their poisonous
effluvia wherever they went."

With such a state of things in our great commercial emporium, and
the daily increasing facilities of communication with it, it is not sur-
prising that small-pox should be found now continually recurring in
almost every town in the United States and even in many villages.
The sanitary condttion of New York is of vital interest to the whole
country, and no means should be spared by the authorities of that city
to prevent the extension of contagious diseases.

Another Medical College. We have just received the 1st announce-
ment of the Medical department of the University of Nashville, Ten-
nessee. The 1st course of Lectures will commence on the first
Monday in November next. The Faculty consists of John M. Watson,
M. D., Prof, of Obsteirics and the Diseases of Women and Infants ;
A. IL Buchanan, M. D., Prof, of Surgery ; W. K. Bowling, M. D.,
Prof, of the Inst, and Pract. of Medicine; C. K. Winston, M. D.,
Prof, of Mat. Med. and Clin. ?.Ied.; U. M. Porter, M. D., Prof, of

194 Miscellany,

Anatomy and Physiol., and J. B. Lindsley, M. D., Prof, of Chem.
and Pharm.

New Medical Periodicals. With the opening of the year we re-
ceived the Western Medico-Chirurgical Journal, edited by Drs.
Sandford and Armor, and published monthly at Keokuk, Iowa ; and
the Philadelphia Lancet, edited by T. D. English, M. D., issued
semi-monthly and containing 8 pages, the two last of which are devoted
to advertisements. We have also received the two first Nos. of the
Stethoscope, a very neat monthly of 64 pages, edited by P. C. Gooch,
A.M., M. D., of Richmond, Virginia. From present indications, it
promises to be a valuable addition to Southern Medical Literature,
and will doubtless, be well supported by the Profession. We cordially
wish it a successful career.

Yale College. The Degree of M. D. was conferred upon eleven
candidates at the late annual examination (15th January).

180 persons died of small-pox in Boston, during the last year.

CasUeion Medical College. The number of matriculants at the
spring session was 81 at the fall session 72 graduates 64 for the
year.

The N. Y. Medical Gazette announces the death of John A. Clem-
ents, of Georgia, who was attending the medical lectures in that city.

We learn, with regret, that Prof. J. B. Beck, of the College of Phys.
and Surg., and Prof. A. L. Cox, of the New York Medical College,
have both been compelled, by ill health, to discontinue their Profes-
sional duties for the present session. We indulge the hope, however,
that they may be able to resume their labors next fall.

Dr. J. M. Smith, of Saco, Maine, has been convicted of murder in
the 2d degree, for the killing of Miss Caswell, in his attempt to pro-
duce abortion, and has been sentenced to the Penitentiary for life.
Well done !

At a meeting of the Georgia Medical Society, held on Thursday
last, the following preamble and resolutions were adopted :

Whereas, since our last meeting Dr. Joh^'Son B. Tufts, long a
faithful and efficient officer of this Society, has been removed from
amongst us

Resolved, That we deplore his loss, prematurely cut off in the very
prime of manhood, as that of one whose professional attainments and
high sense of medical honour secured for him our sincere respect,
while his upright character, as a man, endeared him to many of us
as a cherished personal friend.

Resolved, That a copy of the above be furnished the nearest rela-
tive of the deceased, and that it be published in one or more of the
public gazettes, and in the Southern Medical and Surgical Journal of
Augusta. J. B. Read,

Secretary Georgia Medical Socieiy.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. APRIL, 1S51. [No. 4.

PART FIRST,
riginal (Hoiuinuntcations.

ARTICLE XI.

On the Vis Medicatrix Naturce. By W. J. Summer, M. D.,
of Lexington, South Carolina.

Believing that it is both the right and the duty of the student
of any science, to investigate, candidly, fully and fearlessly,
any theory held forth by men or books, no matter how long or
how generally received, and feeling that he upon whose shoul-
ders is laid the responsibility of life or death, should, above all
others, be willing to " prove all things,"' and hold fast only to
" that which is good ;" I have ventured to devote this article to
an inquiry respecting that principle so frequently invoked by
medical writers, and which is perhaps best known as the " vis
medicatrix naturae," or vital principle.

The existence of this principle, the medical man is too prone
to admit upon mere authority. Few can say that they have
investigated the truth of this subject, yet almost all are ready
to defend the principle in question ; and this fact is not without
significance.

I shall endeavor to show that there need not be, and is not
any such principle in living beings, as that styled vis medicatrix
naturae. If I fail in this, I hope at least to prove, that there
are two sides to this, no less than to some other questions which
not long since, it would have been considered heresy to call in
doubt. I am aware that the attempt to disprove the existence
of this almost axiomatic principle of ours, is novel and seem-
ingly adventurous. I can only ask, that this subject be viewed
in the light shed upon it by simple scientific truth.

N. S. VOL. VII. NO. IV. 13

196 Summer, on the Vis Medicairix NaturcB. [April,

Let us not forget, in the outset, that ^vhile there are many
truths relative to the human body, which are beyond all doubt
being attested by the evidence of our own senses, the idea of a
vital jyrinciple is purely a theory, a supposition, which no man
can say he knows to b^ True, but which we infer by the exer-
cise of our reasoning powers. Thus, we have all seen many
solid substances belonging to the li-jman system, and, among
them, such an one as phosphate of lime in the bones : and, con-
sequently, we know^ that all these do exist. But, if an individ-
ual tells me he knows that there is such a thing as a vis medi-
catrix natiwcB, I may ask him how he knows ? has he ever seen
it? Xo ! Heard, smelled, tasted, or felt it? No! Then he
does not know; he merely iiifers, theorizing from certain phe-
nomena which he has witnessed in the system ; and what he
would call a tact, is only an inference a theory. But being a
theory, it may be erroneous ; and hence, until established, must
be received with due caution.

If now we look through the medical works of the past and
present time, we are struck with the diversity of names and
offices with which this supposititious principle has been honored.
Thus, Hippocrates, who was the father of this medical mon-
strositv, and above whose level of vision, we, it seems, have not
been able to raise ourselves after a lapse of two thousand years,
christened his bantling Physic, i. e. Nature; and, subsequent
to it, he had other principles, Dynamics, or Powers. Aristotle
called it the moving or generating principle. Van Helmont
Xidim^d. li Archeus. It was Stahl's anima ; Bcerhaave's impe-
tumfaciens ; Hunters and Hooper's vital principle ; Darwin's
sensorial energy ; Rush's occult cause, (occult to him, no doubt,
not because different i^rom ordinary physical causes, but because
he could not in this instance comprehend their operation); Cul-
\ensautocrateia, or vis med, nat.; Whytt's sentient principle \
Broussais' vital chemistry (and here we seem to have an ap-
proximation towards the truth in the case) ; Culpepper's vital
spirits, (fee. By others, it has been designated the living prin-
ciple, living powers^ powers of life, vital force, vital essence,
vis insita, vis vitce, vis conservatrix, and so on to the end, if
indeed there be any, of the chapter.

Notwithstanding the marked discrepancies thus existing be-

1851.] Summer f on the Vis Medicatrix NalurcB. 197

tween the advocates of this principle, we find them generally
agreeing upon the following points: First, that the vita! prin-
ciple superintends and controls the involuntary functions of the
system ; secondly, that it resists the ordinary chemical affinities
between the elements of tissues during life ; thirdly, that it tends
to resist the encroachments of disease, and to repair injuries
received by the organism.

The question now arises, do the phenomena exhibited by
living bodies, require any such principle as the vis medicatrix
naturae for their explanation ? If not, is not such a principle an
useless burden upon our science ? And can a principle in med-
icine be useless, without being at the same time a positive evil ?
Does not the doctrine alluded to blind the physician as to the
true action of remedial agents, by teaching him that he cannot
cure disease, but can only throw in a may-be assistant of nature ;
while he ought to know that chemical affinities reign in living
as well as in dead matter; and that he can, if he will, learn
what those elements are of which the diseased tissue possesses
too much or too little, and remove or furnish them according-
ly ? While physicians thus err with regard to the very object
and action of remedies, no matter how honest their convictions
or how zealous their efforts, thousands of victims must pay the
forfeit of their ignorance. Nor are these -views unsupported
by authority it is gratifying to find a confirmation of them in
Carpenters Elements of Physiology.

I now ask attention to the four following propositions:

First. The properties of chemical compounds vary according
to their composition. The air we breathe. that happifving
compound, the nitrous oxide, or laughing gas, 'and the corro-
sive and deadly nitric acid, are each composed of precisely the
same elements, nitrogen and oxygen, merely united in different
proportions. Now, this is worth thinking of. Give a man one
mixture of these elements and he laughs or rants like a mad-
man, and then recovers and forgets it. Give him another mix-
ture of the very same elements, and lesions, agony, and death
follow ! What is it, that gives to these almost similar com-
pounds such opposite effects and qualities ? I answer,

Secondly. The new set of actions exhibited by new combina-
tions of material elements^ is due to the evolution, in the latter.

198 Summer, on the Vis Medicatrix NaturcB. [April,

of properties before latent, and the rendering latent of others
before sensible; in other words, the conditions in which an
element is placed, determine the properties it will exhibit.
To illustrate : Carbon is a solid, oxygen a gas : unite them in
certain proportions, and we have another very different gas
carbonic acid ; combine this with still another gas, ammonia^
and we have a white solid,, carbonate of ammonia. Here we
see a change of properties with every change of condition.
Again, oxygen supports combustion and respiration : unite it
with sulphur and it will now support neither, but will power-
fully corrode : combine this new product with magnesia, and
it will cease to corrode, and may be swallowed in large doses
with at least temporary good effects. Most wonderful trans-
formations, we ore ready to exclaim ; and yet there has taken
place no real transformation through all these changes. The
oxygen, which we should expect by this time to have been for-
ever lost in the compound, may be obtained again, precisely
what it was before its union with the sulphur, posses.sed of aM
and only the properties of pure oxygen, and ready to combine
again, or a thousnnd times, or an infinite number of times, with
sulphur or any other substance, and come out unmingled. un-
impaired, genuine oxygen in the end. The same is true of all
other chemical elements. Now if this is so, (and we know it
is.) then it follov.-s, that even in the sulphuric acid, or in the
sulphate of magnesia, the oxygen still remains unchanged and
unchangeable, and that it exhibits new properties, not because
it becomes any thing more or less than oxygen, but because it
is oxygen existing under a new condition. It follows univer-
sally then, that when any chemical element passes from the
state of a simple to that of a compound, or from one compound
into another, it has properties rendered latent which before
were sensible, and others made sensible which before were
latent. Thus, it is a property of oxygen, while a simple, to
produce flame vvhen in contact with combustibles ; but com-
bine it with hydrogen, and although it remains, as I flatter my-
self I have plainly shown, genuine and unchanged oxygen ;
yet, no sooner does it enter upon this new condition of a
hydrogen-compound, than the former property of supporting-
combustion becomes latent, and another, the very reverse cf

1851.] S\immev, 071 the Vis 3Iedicatrix Natures, 199

this, becomes sensible. If it be objected that the result is due
to the hydrogen, which does not, even when uncombined, sup-
port conibusiion, we w^ili take another property of water
against which such an objection cannot be urged. Wnter
manifests the property of combining with the metallic sahs,
almost without exception, as part of tlie process of chryslaliza-
tion ; while neither of its component elen-jents can be made to
perform an office at all aiialogous to this.

Thirdly. T/ie human body is entirely and sohly composed of
chemical elements. It is built up of solid and fluid atoms like
the tree, the mountain, or the great globe itself We are masses
of matter, and, so far as science is concerned, we are nothing
else ! It may be matter of surprise that I insist so urgently upon
this point. It may be said that this is a truth which no one
doubts or questions. But it is one thing to admit the truth of
an assertion quite another to appreciate the bearing of what
we admit. I declare the body to be a great chemical com-
pound. "Granted," says one, "nobody thinks of questioning
it : at least, nobody who has not the hardihood to belie the
evidence of his own senses." But, when I take another step
upon the ground thus granted me, and declare tliat the actions
of the body depend on the properties of its chemical constitu-
ents; and that, consequently, a fever succeeds a chill in the
human mass for the same reason that a new colour comes out
when new compounds are formed in a chemical experiment
i.e., because the simple laws of nature compel such results to
follow such causes under such circumstances, the theorist
straightway objects: ''Fever, I admit," says such a one, " is a
certain condition of a certain chemical mass, the body; but it
cannot be produced by simple chemical laws it is the work
of the vis medicatrix naturae." Now here is an inconsistency
stubborn enough to prove the death of any system. It is grant-
ing a material mass, yet denying tluit it is governed by the laws
of matter. Men say their bodies are material, are but "clay,"
are "dust ;" yet seem not to know what this means when they
have said it. What, then, does it mean? Tiiis: that a flesh-
clad skeleton is a thing like an alkali, or any metallic base, save
in one sole circumstance, and that is its being a higher species
of compound the highest manifestation of aflinities ; no longer

200 Summer, on the Vis Medicatrix Naturce. L^P^^^>

dead-chemical but vito-chemical. With acids and other sub-
stances we can dissolve it, decompose it, form new compounds
out of it, just as Vv^e should do in experimenting upon soda, or
carbonate of lime, or fibrin, or blood ; varying the mode of ex-
perimentation, of course, according to the different chemical
condition of the elementary constituents in each particular case.
The action of acids, alkalies, oxygen, chlorine, etc., upon the
tissues, Uving or dead, is fixed, definite, chemical ; and in many
cases well understood, and wiil yet be understood in all. What
then are the essential elements of the human fabric ? They are
these thirteen : carbon, hydrogen, oxygen, nitrogen, phosphorus,
sulphur, iron, chlorine, sodium, calcium, potassium, magnesium,
and fluorine. Copper, and a few others, are occasionally found.
" But," says an objector, " these substances in the body are
combined according to vital laws; they are vital compounds.''
This brings me to my last proposition :

Fourthly. The component elements of animal bodies are held
together hy no other force than that of ordinary chemical ajfini-
ty. In fact, when we have admitted the body to be a mass of
chemical elements, v.-e have conceded every thing claimed in
this proposition. What ! is not each department of nature
under the control of its own unalterable laws ? And are the
stubborn aflinities implanted by the Creator in any variety of
matter, to yield to the domination of an unknown, intangible,
invisible, indescribable something, which is yet confessedly a
nothing ; an immateriality, a nonentity, which, save a name,
and a shrine in the brain of the theorist, claims no element of
existence?

"But," say the advocates of the potent vis, '-how happens
it, that the elements of the body are united in such peculiar
proportions, forming such peculiar compounds?" Let us see.
Does it require any more '^ vital force"' or " principle,'** to hold
together carbon and oxygen in the fibrin of animal flesh and
blood, in the ratio of 40 equivalants to 12, than it does to unite
the same elements in morphine in the ratio of 35 to 0, or to
unite chlorine and oxygen in hyperchloric acid in the ratio of
7 to 1 ; or, in fact, more than it do^s to unite oxygen and hydro-
gen in water in the simple rauo of 1 to 1 ? Certainly not.
There are, indeed, in fibrin and morphine, other elements be-

1851.] Summer, on the Vis Medicati'ix Natures. 201

sides ihosa just named, but the principle would be the same
were there a score orihem. ''Animal nhrin/' it may be said,
" has six different elements and casein five." I answer, so has
a certain platinum-sa.t si?v elements, and common crystalized
alum five; yet I suppose no one VviU claim any great share of
'^ vital principle^' for these latter.

Again, if we allow that hyperchloric acid exhibits one set of
properties, among which is that of sourness, and morphine ano-
ther set, among which is that of stupefying : shall we not admit
that fibrin may exhibit still another set, among which is con-
tractility ? and this, too, without the necessity of calling to
our aid any other than ordinary physical principles. Instead
of being content to explain the vital phenomena thus simply,
however, the advocates of the vis med. nat. invoke the aid of
a principle ahsolutdy inexplicable in itself, or in its connexion
with the organism which they say it directs. Once more,
take one equivolent of carbon and two of oxygen unite them
chemically, and each is neutralized, saturated, satisfied ; and
will remain satisfied and combined, until dispossessed of its fel-
low by some superior affinity. Xow, take the proximate ele-
ments of gelatin or fibrin, of blood or nerve, and are they not
in every instance, neutralized, saturated, and satisfied, by their
mutual attractions, as certainly and as perfectly as in tlie case
of the most orthodox chemical compound ? And will they not
remain combined until forcibly separated by some superior
affinity ? " Why, then," it may be asked, '' does the body suffer
so rapid a decay after death?" I answer again, on purely
chemical principles. It is a physiological fiict, that among the
particles of all the tissues, some are constantly becoming dead,
and in this state arc selected and carried off by some of the
excretory organs. Now, when death of the body occurs, such
of these particles as have but just become effete, ceasing at
once to be eliminated from among the normal matter of the
tissues, remain in contact with them, act upon them as ferments
or putrefactives, and thus hasten the process of decomposition.
This principle is strikingly exemplified in cases of complete
suppression of urine. Of the u?'ea contained in this fluid, Dr.
Watson says, "it is a mere excrement, wh.ich, in health, is re-
moved from the blood bv the kidnevs. W^hen it is not so

202 Summer, on the Vis' Medlcatrix Naturce, [April,

carried off, it accumulates in the blood and acts as a poison,
especially upon the brain." (Watson's Pract. of Phys., p. 867.)
The effects oi \\\\sj)oisoning he tells us are "coma and death."
That the effete matter, in this case, retained within the system,
has acted as a putrefactive, is proved by the fact that the pa-
tient thus afflicted often becomes gangrenous before death.

Now, if such be the effect of effete matter retained in the
system from the cessation of a single secretion, while all the
others are active, it is easy to see what consequences must
ensue when all the secretions are suddenly and simultaneously
checked. The rapidity of animal decomposition after death,
has long been considered a certain proof of the existence of a
vital principle, which is required during life to resist the natural
tendency of the organism to decay. Since, however, we have
seen that this rapid post-mortem decay is really due to a mere
cessation o^ excretion, we find here no necessity for supposing
the existence of any specific counteracting principle, because
nothing needs be counteracted. In life, decay goes on, and
with it, parrd passu, comes reparation ; in death the former
reigns alone, and its products not being cast forth, gain strength
in the w'ork of disintegration by their own no longer compen-
sated reactions.

From the four preceding propositions, these conclusions
necessarily follow : that all the phenomena of the human organ-
ism, in health or in disease, are chemical phenomena; that all
the animal functions are but modes of chemical action ; and,
finally, that life is but the sum total of all the properties of mat-
ter existins: in that form which we call orfranized.

This doctrine may be startling, but it has a broad and deep
foundation. It is not built upon the superficial and treacherous
sands of common notions and unlearned prejudice ; nor does
its corner stone rest upon the delusive basis of some gaudy
phantom-cloud of theory ; it stands upon simple scientific truth.
It discards theory, and appeals to what we know !

The more we examine this position, the more shall we find
its truthfulness commending it to us. For example : organiza-
tion may exist without life ; therefore, the latter is not essential
to the former. Therefore, again, organization is the pre- exist-
ent, and life the subsequent, in the chain of causation. Take

]851.] SummeVy on the Vis Medicatrix Naturce, 203

another example: according to the views of the advocates of
the vital principle, ''Life is a forced slate, or an assemblage of
functions which resist decay." Then life is s, negative state;
a state of opposition to, or absence of, decay. But death all
admit to be a neo:ative state. Then here w^e have two states,
opposed as widely as human comprehension can conceive, and
yei both negative ; and; most unluckily of all, an individual may
have both lived and died, and yet have enjoyed no positive
state, first or last ! But this is absurd. Life is positive ; we
know and feel this, and so do all that live ; and death is nega-
tive enough, as we also know.

Did time and space permit, I might goon to show the origin
of a notion of a vital principle; refer to, and combat, other
arguments in its favour, and to the influence which such views
exert upon the conduct of the physician. However, I think I
have gone far enough to direct attention to this subject farther
disquisition is useless. In conclusion : these "recuperative ac-
tions," "reparative processes," "efforts of nature," "sympa-
thies," etc., of which we hear so mucii in the medical world,
should be explained on purely chemical principles. I believe
the day is near at hand when they will be so explained. Such
things do exist, but we have erred in assigning the proper
causes of them. We shall one day give them a more consistent
rationale, and more appropriate names.

I have endeavoured to show" that no such principle as the
vis medicatrix naturas is requisite to an explanation of the phe-
nomena of life; if not requisite it is false, for truth is always
requisite to an understanding of the operations of nature; if
false, it is detrimental ; for, as I said before, it blinds the phy-
sician to the true action of therapeutical agents, and destroys
his patient. Those, whose high prerogative it is, to have en-
trusted to their care the health and lives of their fellow-beings,
cannot, it would seem, look with indifference upon results like
these.

204 Campbell, on Seminal Weakness. L^pril,

ARTICLE XII.

Treatment of Se?ninal Weakness, hij Ycratrine and Strychnine,
with Cases. By Hexry F. Campbell, M. D., Demonstrator
of Anatomy in {he Medical College of Georgia.

To the practitioner, the restricted treatment of Spermator-
rhoea is the cause of much embarrassment and dissatisfaction.
When a case of this very delicate disorder is presented, the mind
at once recurs to the treatment by cautery to the seminal ducts,
so successfully practiced by Lallemand, as the great remedy,
and many practitioners, being oi timid character or unacquaint-
ed with the mode of application, temporize with or refuse to
prescribe for the case. The treatment by cauterization is, per-
haps, of all modes, the most valuable nov/ employed for the
generality of cases, and we find it commended by every writer
on the subject, since the time of its introduction. Its efficacy,
however, depends upoa the particular pathological condition
of that portion of the urethra immediately surrounding the
mouths of the seminal ducts, which is generally the result of
inflammation or irritation commencing in parts adjacent to or
sympathetically connected with this locality. Thus gonorrhoe-
al or blenorrhagic inflammation of the urethral mucous mem-
brane, by extension of the phlogosis, will involve this portion;
congestion or irritation, as of piles or ascarides in the rectum,
or enlarged or otherwise diseased prostate, will often be found
to determine the condition necessary for the occurrence of the
seminal waste. In a similar manner, also, do we constantly
observe an indulgence in the pernicious habit of masturbation
give rise to the same irritation by the frequent and prolonged
excitement to which the entire organ is subjected.

In all of the above cases, cauterization, either immediately or
after preliminary treatment, is attended with the most benefi-
cial results, and without it, all other remedies are either entire-
ly nugatory, or aflbrd but a temporary palliation of the disease.

Now, it will be observed that in the above condition of the
parts, the seminal loss depends most frequently, so far as the
ejaculatory orifices are concerned, upon a hypera3mic state of
the surrounding mucous membrane, which, by the alterative
efiect of the cauterv, is either mitigated or efiaced, and thus a

1851.] Campbell, on Seminal Weakness. 205

healthy condition of the parts eslablisf.ed. But there is another
pathology which occasionally obtains, ditfering entirely from
any of the foregoing, indeed exactly averse to them in every
respect; for here the difiiculty depends upon an atonic and
enfeebled innervation of these organs a relaxed state of all
the parts connected with the secretion and elimination of the
seminal fluid, resulting undoubtedly, from a partial paralysis
of the nerves distributed upon these secernent surfaces. From
this condition there often arises impotency of the most incorri-
gible character it may be ^brought about in various ways: a
prolonged state of subacute inflammation, venereal excesses,
masturbation, or the drainage of those parts consequent upon
seminal losses produced by other causes, and thus a case which
in the beginning depended upon exalted innervation, in process
of time, will owe its continuance to an entirely opposite condi-
tion nervous atony, as the following case will illustrate :

Case I. T. J., a 3'oiing man, aged about 27 years ; had been
the subject of seminal losses from an eai'ly age. His nervous
system had become very much impaired indeed he wasaflfected
with chorea. The losses continued daily, and on account of
general prostration he was confined constantly to his bed. He
had been treated for the chorea, but no attention, so far as we
could learn, was given to the seminal waste. When applica-
tion was made to us for treatment, the frequency of his pollu-
tions was really fearful, they occurred generally at night, and
without erection. He would find the semen on his linen in the
morning, or on waking during the night, and was unable to say
when the discharge took place. Being aware of the length of
time the disease had existed, and also of the very low condition
of his general nervous system, we were induced to view his
case as one depending on nervous atony rather than inflamma-
tion or excitement : hence our treatment.

^. Of Strychnine, gr. 1.

Gum acacia) and water, . . q. s.

To make twelve pills. Dose, one pill in the morning and one
at bed-time.

Also r^. Of Yeratria, . . grs. 80.
Lard, ... l\.

200 Campbell, on Seminal Weakness. [April,

Make an ointment, with which rub Vvell over lumbar and sacral
regions, twice daily.

It became necessary to reduce the strength of the ointment,
after a few days, on account of the pain experienced during its
application. At the expiration of eight or ten days, the case
was so much improved, as regarded the seminal lossts, that the
treatment was omitted. Pollutions, however, recurred, and
recourse to the same treatment again put an end to the dis-
charges. When we last heard of the case, the emissions
occurred but once or twice a month, and w^ere attended by
erections and waking from sleep. He was furnished with a
supply of the pills to take on any return of the disease. Al-
though his strength increased, and he much improved in
every respect, he will probably never be free from a tendency
to this disorder.

In addition to the causes above enumerated, there are others
which act more suddenly and directlv in brinf^incr about the
same atonic condition of these organs, of which case 2nd is an
example.

Case II. A. \Y., a gentleman of excitable temperament,
aged about 42 years, had been subject to seminal losses of
rather more frequent occurrence than natural.

On recovery I'rom an attack of the Dengue, which prevailed
in the city during last summer, and at which time he suffered
severely from pain in the lumbar region, he found that the inter-
vals between the pollutions were very short, and that they were
invariably unattended by erections; indeed, he said that he had
not experienced a full erection since his recovery, then about six
weeks. He had become nervous and chilly, his hands were
cold and clammy, and although a man of great vigor and robust-
ness of constitution ordinarily, he was now enervated and
dejected. He had been treated previously to his application
to us, and had taken a preparation of the muriated tincture of
iron and cantharides in conjunction v/ith the cold bath to the
loins, and regular daily exercise. When we saw him he was
suffering from irritable bladder produced by the cantharides;
he passed water frequently, and could retain but little on the
bladder. The cold bath, he said, "chilled him through, and
the exercise (sawing wood) fatigued him beyond all endurance,"

1851.] Dugas, 071 Urinary Calculus. 207

though his principal cause of uneasiness was his inability to
produce an erection his entire vnjiotency, which he consider-
ed, as yet, premature in a man of robust constitution.

Treatment. Prescribed one-twelfth of a grain of strychnine,
in pill, three times a-day, and the application of veratrine oint-
ment, 30 grs. to the ounce of lard, morning and at bed-time, to
the loins and sacrum. After a continuance of this treatment,
for about a month, he entirely recovered, both from the impo-
tency and the seminal losses. Here the cause of the atony is
fully apparent ; the spinal irritation in the lumbar region, during-
the attack of dengue, had doubtless destroyed tlie-tone of those
nerves connected with that portion of the cord, nerves which
assist in forming the hypogastric plexus, and supply the organs
of generation; hence their partial paralysis.

In the foregoing, we would not be understood as recommend-
ing the treatment of spermatorrhoea by veratrine and strych-
nine, as a substitute for any of the modes of treatment now in
use, but have suggested it as applicable only in such cases as
above described, wherein the disorder depends entirely upon
impaired or deficient innervation.

ARTICLE XIII.

A Case of Urinary Calculus^ attended with peculiar circxcm-
stances and treated by Lithotrity. By L. A. Dugas, M. D.^
Prof of Surgery in the Medical College of Georgia.

The follovring case is reported because of certain peculiar
features presented during its progress. The patient, Mr. John
L. B., of Hall county, Ga., is 30 years of age, was kindly di-
rected to my care by Dr. Richard Banks, the distinguished sur-
geon of Gainesville, and arrived here on the 5th of February
last. Having suffered from early childhood with phymosis and
an almost complete closure of the orifice of the prepuce-, (which
he believes was congenital), the difficulty of voiding his urine
caused this to distend the prepuce into a considerable bag, to
accumulate enormously in the bladder, to stagnate in the pelvis
of the kidneys, and to induce very great impairment of the
general iiealtU. The preputial orifice was So small as no4 10

208 Dugas, on Urinary Calculus. [April,

admit, without much dilliculiy, the introduction of a knitting
needle; the urine was therefore never passed off in a jet, but
the patient was subjected to all the inconvenience of a contin-
ual stillicidium ; he had frequent and violent attacks of nephri-
tic pains, attended with protracted chills, fevers, and the usual
concommitanis of retention of urine. Yet it was not until the
20th year of his age that he sought professional aid and was
circumcised by Dr. Banks. From that time his health improv-
ed rapidly ; but he continued subject to occasional paroxysms
of severe nephritic pains, which now became confined to the
left side. These pains would extend down along the course of
the ureter and continue one or more days, leaving him in a
debihtated state, from which he would, however, soon recover.
He is not aware of ever having passed gravel or any thing like
calculous matter, although his urine would sometimes present a
very copious sediment.

This state of things continued until the middle of April last,
when, although in good health and not having had any nephri-
tic pain for about three months, he felt a calculus drop into his
bladder. Attending to his usual avocations, he stepped out to
urinate, did so without any difficulty whatever, and when in the
act of buttoning up his garment, distinctly felt something fall
into the bladder. He immediately mentioned the fact to a
friend, and added that *' it must be a stone, for its fall produced a
sensation like that of a buck-shot allowed to drop into a bag."
A few hours afterwards, on again attempting to urinate, the
stream was suddenly arrested by the engagement cf the calcu-
lus in the urethra the sensation being so distinct that he in-
stinctively carried his hand to the perineum in order to force it
out but in vain ; and the same difficulty has ever since at-
tended his micturition. These details are given as establishing
conclusively the facts that he did know ihe precise moment at
which the stone came into the bladder, and that this occurred
so late as about three months after the last nephritic attack. He
has experienced no pain whatever about the kidney since that.
In Mav he was sounded by Dr. Banks, who readily detected the
stone.

On the arrival of Mr. B. here, I examined him, detected the
calculus, found it to be small and determined to crush it as soon

1851.] Dugas, 07? Urinary Calculus, 209

as circumstances would permit. The patient was directed to
use dilating bougies, to remain quiet, to drink freely of slippery
elm tea and super carbonate of soda, and to take a hip bath
every night. In a week he was found to be sufficiently pre-
pared, and (on the 12th of February) the operation was per-
formed with Heurteloup's " brise pierre,'^ as modified by Char-
]iere. The bladder being filled with tepid water, the calculus
was readily seized and crushed three times, without pain. A
few fragments were passed off with the water and others during
the night with the urine. On the following day, finding the
patient very comfortable, without any symptoms of irritation,
and very anxious to get home as soon as possible, I again intro-
duced the instrument and crushed the remaining fragments,
sufficiently to allow them all to be passed out during the night.
He now expressed himself " entirely relieved, and feeling like a
new man.*' The baths, &c., were continued, and on the 16th
February, I explored the bladder carefully, without being able
to detect any vestige of the stone. The patient was therefore
discharged.

The dimensions of the stone were accurately ascertained by
the crushing instrument to be about one inch in length and half
an inch in thickness. Professor Means having kindly subjected
some of the fragments to analysis, informs me that they consist-
ed of Oxalate of Lime. The stone was exceedingly hard, and
tested to the uttermost the fine temper imparted to the metal
by Charriere's unrivalled skill.

2 1 0 Physiology and Pathology of the [April^

PART II.

Eclectic Department.

On the Physiology and Pathology of the Ganglionic Nervous
System. By Ja:mes George Davey, Licentiate of the Royal
College of Physicians, London, &c., &c., &c.

" There are yet great truths to tell, if we had either the courage to announce,
or the temper to receive them.'* Disraeli.

CHAPTER I.
On the Nlsus Formativus, or the Solar Ganglion. The ganglia
of the sympathetic ; the nervous structures first formed in
thefcetus. Monstrosities. Strictures on the opinions of Drs.
M. Hall and Roget. Mr. Lawrence's case of acephalous
monstrosity. Dr. M. HalTs division of the Nervous sys-
tem; his experiment on the frog. The author^ s experience.
Le Gallois. Hunter. Sir B. Brodie's experiments open to
objection. Animal organization, its arrangement and adap^
tation ; mind and instinct.

The object of the following papers is to prove that Life is the
function of the Solar Plexus^ regarding it as the root of the
ganglionic or sympathetic system. That the Solar plexus is the
impetrinn fuciens of Hypocrates, ox i\^e materia vitcB o^ Yiuxi-
ter; that it is the organ \\\\osq function may be represented as
the principle or stimulus which enables every other and
subordinate part in the animal economy to continue its speci-
fic and allotted labour towards the existence of the individual ;
that both the brain and spinal cord, in common with all the vis-
cera, hold a similar relation to, and dependence on, the solar
ganglion, as the centre of the ganglionic system, that the iris
does to the retina, or the external senses do to particular parts
of the cerebral mass ;-and these opinions the author has pri-
vately circulated for the last /en* years that is, since 1835
as is well known to many medical friends and acquaintances.
I am aware that Dr. Stevens has also advocated some such
views as these; but it cannot be doubted that the priority is
not w^ith him.

INTRODUCTORY REMARKS.

On the Nisus Formativus, or the Solar Ganglion.
The physiologist, if I mistake not, \^ill consider that my po-
sition, as explained in fhe advertisement to the reader, must
derive no inconsiderable confirmation, from the circumstance
that the solar ganglion is that particular portion of our organ-
ic This and the succeeding chapters were written in 1845.

1851.] Ganglionic Nervous System. 211

ism which is first formed in utero, and therefore may be really
considered as the germ of all the phenomena to be afterwards
developed.

Nothing can appear more reasonable than that that portion
of our organism, from which every other takes its vitality,
should enjoy a prior existence. The e^g precedes the chick,
and the specific vitality of the former is impressed on the lat-
ter. The foundation is erected before the house, and the design
of the architect, it may be added, is not unfrequently to be an
ticipated by an early examination of it. Muller says, in his
Physiology, translated by Dr. Baly, that " Ackermann asserts
that the sympathetic nerve is the part first formed in the
foetus." Rolando, moreover, declares what has been usually
considered as the first traces of the vertebrae at the sides of the
spinal cord, in birds, to be the ganglia of the sympathetic nerve.
The assertions of Ackermann and Rolando acquire great
weight from the testimony of such men as Blumenbach and
Gall, both of whom add the authority of their illustrious
names, and confirm the former-named physiologists in their
opinions. Blumenbach says, "the nervous system," meaning
the organic nervous system, "of the chest and abdomen, are ful-
ly formed, while the brain appears still a pulpy mass," and re-
fers to Gall's writings for the same views. He adds, *' these
ganglia and nerves would hardly be formed before the brain and
spinal marrow, but for the sake of the organs which they supplv,
and the functions of which (with the exception of the genitals,)
areas perfect at birth as at adult age, while the mind and brain
are slowly perfected."*

Ackermann, Rolando, Blumenbach and Gall, all maintain,
then, as I have showm, that the ganglionic or organic nerves of
the abdomen and thorax are the first formed in the embryo.
Now it is extremely unlikely that the development and forma-
tion of the solar ganglion the centre and source of the organic
nerves and their anastomozing branches should be preceded
by ^^ organic nerves ;" their dependence on it, it may be said, is
analogous to the dependence of the branches of a tree on its
root ; and therefore I would claim for the solar ganglion a like
precedence. Viewing the matter in this light, it is readily seen
that the solar ganglion itself is, in the embryo, nothing more
nor less than the nisiis formaiivus of Blumenbach, and that,
like it, it excites even in its rudimentary existence the elabora-
ted fluids of the successful coition, and like it, it vivifies and

* Mind undbrain! It is to be hoped that an improved acquaintance with the
brain and its uses, will encourage the physio!oi;ist no longer to give to a mere
lunction an individual existence. The brain happens to be thela^t ol'the bodily
organs so perplexed with the spirit ol" the ancients.

N. 3. VOL. VII. NO. IV. 14

212 Physiology and Fatliolqgy of the [x\priJ,

shapes the hitherto shapeless spermatic matter partly into the
beautiful containing ovum, and partly into the contained em-
bryo.

The nisus format ivus, we are told, occur to the genital mat-
ter, when this is mature, and committed to the uterus in a proper
condition, and under proper circumstances, produces in it the
rudiments of conception, gradually forms organs fitted for par-
ticular purposes, preserves this structure during life by nour-
ishing the body, and reproduces as far as it can, any part
accidentally mutilated.*

The "nisus formativus," says Dr. Eriiotson,in a note, " pro-
duces a being generally resembling the parents, but occasionally
different." It is understood, then, that exactly what Blumen-
bach and Elliotson, in common with other physiologists, claim
for the nisus formativus, I claim for the solar ganglion. I can-
not doubt that it exercises the architectural power which is
employed in man and animals from man downwards, through
the whole of animated nature, to the very lowest link in the
chain of being ; that to its peculiar and vital influence must be
conceded, upon the grounds before stated, the wonderful and
successive metamorphoses or changes w^hich characterize, not
only the intra and extra-uterine existence of the human form,
but also that of animals, whether oviparous or viviparous, and
under circumstances both of normal and abnormal action.
No one, I think, would presume to explain the modus operandi
of this power or influence of the solar ganglion ; it is sufficient
for my purpose that it exists. This question is involved,
equally with that of the caiLse of gravitation or attraction, in
a too Cimmerian darkness for my optics to penetrate.

If, from any cause, the organic affinities in progress in the
foetus be interfered with if the balance which must obtain in
the distribution of the imponderable matters in the organic
tissues be disturbed, the action of the organism and of the
separate organs may be so modified as to give rise to the
formation of some one kind or other of monstrosity. An injury
done to a seed during its germination is seldom unattended
with ill effects. The radicle or the plumule will, the one or the
other, sufier, and perhaps both. The injury done may be confi-
ned to one of these parts, and yet it may very seriously affect the
vital principle in operation, and so modify or aggravate the
original mischief. It is just so with the foetus; any abnormal
change in the component matter of any of its parts, may prove
irremediable, and the efiects of which being then communicated

* Blamenbach's Physiology, translated by Elliotson, p. 492, " Of the ' N'mis
Fonnalivus.'" The word ^' nisus " B-lunieabach says,, lie has ' adopted chiefly
to express an energy truly vital."

1851.] Ganglionic Nervous System, 213

to the solar ganglion,, may excite so altered a vital action in it
as to prove incompatible with the complete or normal devel-
opment of either itself or of those parts dependent on it; and
hence the existence of monstrosities, of acephalous, and other
malformed children, among whom the physical characters of
the biped are more or less substituted by those of beings lower
in the scale of creation. '' Human monsters," says Blumen-
hach, " are not unfrequently met with who strongly resemble
the form of brutes ;" and it is "because the ' nisus formativus'
having been disturbed and obstructed from some cause or the
other, could not reach the highest pitch of the human form, but
rested at a lower point, and produced a bestial shape.'' He adds,
strangely enough "On the contrar}^ I have never once found
among brutes a true example of montrosity which, by a bound
of the nisus formativus, bore any analogy to the human figure."
It may be asked, in the history of montrosities, did any
physiologist ever hear of one in whom there was no ganglionitr
system, no solar ganfrllon ? I answer, no ! Such an occur-
rence is wholly impossible. We have all heard of acephalous
children, and of beings created without either hrain or spinal
cord. What, in such instances sustained intra-uterine life?
what enabled the body of the creature to be nourished and de-
veloped? What, I ask, was the source of all this vitality?
The solar ganglion and its branches, the ganglionic nerves !
*'In foetuses, without hrain or spinal marrow,^' says Blumenbach,
*-the circulation, nutrition, secretion, &c., proceed equally as in
others, which, besides spinal mairow, nerves, and ganglion,
possess a brain," and for the same reason, he might have added,
that after the removal or destruction of the hrain and spinal
marrow in animals, the heart still continues to act, and the
blood to circulate, pi-ovided respiration is artificially supported."
The reason is just this, the solar aanglion and its immediate
dependencies aie unallected. With these facts before us, then,
I must confess I am in ignorance of the '^experience' which
*' shows that when the influence of the brain and spinal marrow
is intercepted, although the afflux of blood may for a time
continue, yet the secretion ceases, and all the functions depen-
dent upon secretion, such as digestion, cense likewise." We
are informed, too, by the same author, strangely enough, that
*Mhe functions of digestion, circulation, absorption, secretion,
and all those included under the class of nutrient or vital func-
tions, are carried on as well during sleep as when we are
awake," that is, as well during the total inaction of the hrain
and spinal marrow, when the ''infiuencc" of both, must of
course be " intercepted." Strange experience this.*

* Rogel's Animal and Vegetable Phystology, vol. il.^ p. 358, GO, SGI.

214 Physiology and Pathology of the [April,

Dr. Marshall Hall, in his Lectures, published in 1842, "On
the Pathology and Treatment of ^V^ervons Diseases, evidently
favours the opinion that the influence of the brain is necessary
to the complete performance of the vital or ganglionic fcinctions.
"We find, says Dr. Hall, "that idiots with small brains are
short-lived;" therefore "the animal functions cannot go on
permanently independent of the brain." I take it that the im-
perfect development of the brain of the idiot must be recrarded,
only, as an indication of the mal-organized condition of the en-
tire nervous system, including the spinal and ganglionic, not less
than the cerebral.

In the very interesting case of acephalous monstrosity pub-
lished by Mr. Lawrence, in which the brain only was wanting,.
we learn that all the excito-motory functions were duly per-
formed ; it gave evidences of pain, and "at first m-oved very
briskly,'' and the sphincters performed their office. Such, of
course, was referrible to the integrity, generally, of the spinal*
cord. "The child's hi^eathing and temperature were natural;
it discharged urine and fceces, and took food." The latter set:
of circumstances indicated the operation of the functions of the
solar ganglion and its collateral parts: and icithout any aid
from a brain. The ganglionic and spinal nervous^ systems
were natural, and they exercised their respective iunctrons ac-
cordingly.

In the remarkable case cited by Dr. M. Hall, of a foetus born
"without either brain or spinal marrow, without a particle of
either of these organs yet perfectly developed^'' we have a very"
satisfactory proof of the independence of the ganglionic func-
tions on either the spinal or cerebj-al nervous systems. The
intra-uterine life may be quite perfect, although there may
be neither brain nor spinal marrow ; but what happens the mo-
ment the child is born ? asks Dr. M. Hall ; it cannot breathe :
it cannot live an instant." It dies truly, but not because the
brain or the spinal marrow, or both, aie directly essential to
the continuance of the function of the solar ganglion, but be-
cause that central organ, in the absence of the motor nerTes
commonly supplied to the respiratory muscles, is deprived of
one most material agency or power with which it, the solar
ganglion, is enabled to perform one of the many indispensable
functions required by the animal economy. The blood cannot,
under such circumstances, be decarbonized, and the circula-
tion of diseased blood paralyzes the vital energies of every
part of the organism. The effect is the same if a person with
his cerebro-spinal and ganglionic systems entire, be made to
breathe carbonic acid, or any other irrespirable gas. Life,
then, in such a case of monstrosity, cannot be said to cease fyotn

1851.] Ganglionic Nervous System. 215

the want of any direct cerebral oy spinal influence. The vital
actions in the lower classes of animals which have no brain, and
in those, too, which have neither brain nor spinal nnarrow,
are not less completely performed than the same in man.
Secretion, circulation, digestion, (fee, are as elaborately and
efficiently executed in the polypus and oyster as in man, and
their breathing apparatus is more simple, and independent of
any addition to the organism, whereby, in man, the nature of
his dependence on, and relations to, the external world are ex-
plained. His responsibility then came to be understood, and
his real position as a moral beinsr to be justly appreciated.

The experiments of Dr. M. Hall, as given in his published
Lectures, appear to me to be anything than satisfactory. He
introduces the subject thus : " Until very recently, we viewed
the contents of the spinal canal as a cord of cerebral nerves,
and the origin of a part of the ganglionic system. Now, gen-
tlemen, it is very possible to remove the cerebrum, the centre
of the cerebral nerves, and the ganglionic system, and yet leave
another kind of nervous influence remaining in the animal
body. I shall take this early opportunity of showing you a
simple experiment. You see here an animal (a frog) from
which the head has been separated, and of course I need not
tell you that with the head the brain has been entirely removed ;
all the viscera have also been removed, and with the viscera
every portion of the ganglionic system. Now I beg here to
repeat, the cerebrum, the centre of the spinal cord of nerves,
and all the ganglionic, have been removed from this animal,
and yet, when I pinch the extremity, it moves so as to be ob-
viously perceptible at the remotest part of this theatre. Thus,
as I said bel'ore, we have here removed the centre of the
cerebral system, and the entire ganglionic system. The brain,
which we know to be the centre of all the sentient and volun-
tary Derves, has been removed, the ganglionic system has been
removed, and yet you observe something remains. Now,
gentlemen, that which remains I venture to call in contra-
distinction from what has been termed a cord of cerebral
nerves, and the origin of the ganglionic system the true spinal
marroxo. It is plain, in the first place, that it is not a mere
cord of nerves; if it were a mere cord of nerves, you might
divide it, and then you would intercept its influence. But, if
you observe here, this influence passes not only from one ex-
tremity to the other, but it also passes from the one set
of extremities to the other set of extremities; thus, it is quite
plain that there is a nucleus of nervous matter between the two
anterior extremities, and another nucleus between the two
posterior extremities by which these nervous links are united

21G Physiology and Pathology of the [April

and associated in their motions one with another. Having
thus, then, clearly laid before you the distinction which I wish
to insist npon namely, that there is not a division of the
nervous system into two parts only, but into three, pervading
all the different parts of the whole animal frame, I shall venture
to term them the cerebral, the true spinal, and the ganglionic
systems."

That Dr. Marshall Hall is perfectly right in considering that
the contents of the spinal canal do not constitute a cord of
cerebral nerves, and the origin of a part of the ganglionic
system, there can be, to my mind, no doubt ; but I cannot
allow this opportunit}' to pass by me without claiming for the
illustrious Gall the honour of being Xhejirst to render this ana-
tomical fact clear and distinct. He it was who demonstrated
that the spinal marrow only communicates with the brain.*

Dr. Hall has endeavoured, as it appears in the preceding ex-
tract, to pi'ove by experiment on the frog, that on the removal
of the viscera with the solar plexus and its ganglia, the spinal
cord will still continue the excitomotory functions, the head
(and of course, brain) being at the same time dissevered from
the body, and which circumstance, of course, would prove, as
the doctor affn^ms it does, "that there is not a division of the
nervous system into two parts, but into three, pervading all the
different parts of the animal frame." I have on many occasions
performed the experiment on the frog as detailed' by Dr.
Marshall Hall, but / have invariably found that the removal or
destruction of the ganglionic system of nerves is fatal- to the
life of the aninial. The vital or ''true spinaF' phenomena, in
that case, continue no longer than the peculiar contractile
irritability of the heart or extremity of the animal after the re-
moval of either from the trunk ; proving, therefore, most
clearly, that the original power possessed by the spinal cord to
perform its peculiar functions is derived fiom the ganglionic
system. If the animal be not decapitated, the same result
follows the removal or destruction of the solar ganglion, and
which could not be the case if the influence of the hi^ain were
directly required by the spinal niarrow. My ow^n experiments,
then, prove not only that there are three distinct nervous sys-

*Gall, "Surles Fonctions du Cerv^ean," t. ii. p. 77, qvioted by Elliotson,
in Blumenbach's Physiologv. "Ir is remarkable," observes Dr. EMiotson,
"how many discoveries of GaU'i? that were denietl or disrc2:ar(ied have been
since made by others, and were treqiienily contested by two p.'iities, he and his
labours been never once thought ot," Mr. Solly in his work " On the human
brain," claims to have discovered that some ot the fibres of the anterior columns
of the spinal cord proceed bac;kwariis to the cerebellum, but it appears from the
authority of Dr. Eliiotson, that Gall taught and published the very same fact so
long since as 18l6, and that these same fibres, ''decussate exactly like the an-
terior pyramids."

3851.] Ganglionic Nei^vous System. 217

terns united in nnan viz., a cerebral, a spinal, and aganprlionic,
but also tiiat both the first and second are dependent on the third
that they derive not only their very existence and integrity
from it, but also perforin their respective functions in virtue
only of the infl'ience they receive from it, and that they are, as
it were, employed by it to establish our dependency on, and re-
lati")nshipto, the external woild, of whicli man forms a part.

The cerebral and spinal systems of nerves together perform
the animal functions, which, in the words of an eminent
physiologist, prove us feeling, thinking, and willing beings ; they
are the actions of the senses, wliich receive impressions of the
brain, which perceives them, reflects upon them, and wills; of
the voluntary muscles, which execute the will in regard to.
motion; and of the nerves, which are the agents of transmis-
sion : the brain is their central organ. But the ganglionic
system of nerves, with the solar plexus for its central organ,
performs the vital or organic functions, or rather, supplies to
each viscus the power which enables it to perform its specific
functions in the animal economy. Secretion, nutrition, exhala-
tion, and absorption, being, then, under its immediate influence
and control, it must preside equally over the brain as the
stomach, equally over the spinal cord as the liver. Jn short,
the vital force of the solar ganglion, the centre of the ganglionic
system, holds the same relation to the whole organism that
steam does to the several parts of an engine. The said " vital
force'" and ''^ steam^' are equally the motive pov^'er and it may
be said, that to their different states or conditions must be at-
tributed every kind of change, however slight, of which either
the animal organism or the machine itself is at any time, and
under any circumstances, susceptible.

Tlie observations already made in reference to acephalous
and other monstrosities, no less than those which relate to the
experiments ofDr, M. Hall and myself, abundantly prove the
physiological position I have here taken \iz., that life, regard-
ed as the "assemblage of all the functions, and the general
result of their exercise,"* has its immediate principle neither in
the brain nor in the spinal marrow, nor in any of the viscera of
the chest or abdomen, but in the solar ganglion ; yet it is no
less certain, that all these parts or organs are necessary to
the maintenance or continuance of life, as it exists in man, and
the great mass of the lower classes of animals. The brain, prin-
cipally, because the mechanical phenomena of respiration
seem to depend upon it ; the spinal marrow, because it ex-
ercises a guardian power over the acts of ingestion and eges-
tion ; and the viscera of the chest and abdomen, because they
are necessary to the formation and circulation of the blood.

Lawrence's Lectures, p. p. 120, 121.

218 Physiology and Pathology of the [April,

The only way that I am enabled to account for the discrepan-
cy stated in the experiment of Dr. M. Hall and myself on the
frog, is, that the excito-motory action which was produced by
pinching or pricking the extremities of the animal, after the re-
moval of the viscera and the ganglionic nervous system, must
have resulted from the influence of that remaining nervous prin-
ciple which exists, for a longer or a shorter period, in any
portion of the animal organism, after, even, its removal from
the trunk or body to which it originally belonged. It is well
known that Le Gallois, Prochaska, and Hunter, taught that the
nervous pou'er is generated throughout the whole extent of
the nervous system, even to the smallest nerves, and that it can
exist, /o?' a certain time, in the nerves of any part, independent-
ly of its source; and there can be, I think, no doubt of it. I
have seen the heart of the shark contract vigorously, for even
many minutes after its removal from the animal a fact which
proves, in the words of Hunter, that the nerves of a part con-
tinue the same action which they receive.*

I may here observe, that the experiments of Sir B. Brodie
to disprove the assertions and opinions of Le Gallois, " that
every part of the body derives its principle of vitality and irri-
tability from that portion of the spinal marrow from which it
receives its nerves," are open to some objection. The experi-
ments of Sir B. Brodie are contained in the late Dr. Cooke's
work on Nervous Diseases, and are as follow :

Experiment 1. Sir B. Brodie divided in a dog the skin and
muscles which lie before the axillary plexus of nerves, and after-
wards the nerves themselves. He then divided the remaining
skin and muscles, the cellular membrane, and every other part
connecting the anterior extremity to the trunk, with the excep-

t Since the above remarks were penned, 1 have many times repeated the
experiment of removing the viscera with the ganglionic system of nerves in the
frog, and I have found much additional reason to form the conclusive opinion I
have viz., that the excito-motory phenomena demonstrated in the experiment
of Dr. M. Hall, must have resulted only from the operation of retained nervous
influence in the limbs of the animal, constituting an exception to the general
rule which goes to show, that on the removal or destruction of the organic sys-
tem of nerves, or ganglionic system, the functions of the brain and spinal cord
as necessarily cease as do those of the other viscera, 1 have found, that, if the
abdominal ganglia only be removed from the animal, the circulation and respi-
ration, together with the spinal functions of the 5i<j!?a7'?* extremities, will be con-
tinued for a time, and much longer than contractions will exist in the heart after
its seperation from the body ; proving, therefore, that the superior or thoracic
ganglia have the power, in some degree, to " continue the same action which
they receive" from the solar ganglion. Le Gallois cut a young rabbit trans-
versely into halves, and because the strictly spinal lunctions ceased with the de-
struction of the cord in either half, he declared that the vital principle was
seated in it. It is unnessary to add, that the destruction of the cord by Le Gal-
lois involved only the loss of o7ic among the many indications or external
signs of a vital principle.

1851.] Ganglionic Nervous System. 219

tion of the axillary arteiy and veins, so that the vessels were
completely insulated, and formed the only connexion between
the limb and tlie trunk. The divided edges of the skin were
united by sutures. Twenty hours afterwards, an incision
having been made in the fore-arm, the arteries bled freely, and
the blood was of a bright scarlet colour. The muscles, by
means of the voltaic battery, were readily made to contract,
and when several pairs of plates were employed, the contrac-
tions of the m.uscles did not appear to be less powerful than
those which arise from the stimulus of the will.

Experiment 2. Sir B. Brodie removed the whole of the
posterior part of tiie spinal marrow of a frog. The wound
readily healed, but the hind legs became, of course, paralyzed.
Five months afterwards, the muscles of the hind legs were found
still capable of powerful contractions under the influence of the
voltaic battery ; at the end of six months more, the muscles
still retained their contractile power. The frog was then
killed. The w^ound was found completely cicatrized ; there
was not the smallest appearance of regeneration of that por-
tion of the spinal marrow which had been destroyed.

I must add, that it appears somewhat strange to me ever to
expect that animal matter should resist the effects of a power
so intense as that employed by Sir B. Brodie. The contractile
power of the muscles when subjected to the voltaic battery, I
am disposed to consider irrespectively of the source of vitality
and irritability.

The above experiments are cited on this occasion, not only
because I consider them illustrative of the position of Hunter
and other physiologists, as above explained, but in order to show,
as particularly as 1 well can, the precise nature of the phenom-
ena elicited by the experiments of Dr. M. Hall on the frog, as
contrasted with the results obtained by myself

From the preceding observations it will appear that the
*^ Formative 'power'" of Blumenbach, or the Materia VitcB of
Hunter, or the Solar Ganglion, call it by what name we will, is
no less universal than the animal organism itself; and there can
be no doubt that, like the animal organism, it observes corres-
ponding varieties and gradations of form. It could hardly be
expected that the "" Formative Power"' of the dog is similar to
that of the man; or that of the first, of the reptile; and so on,
through the whole of living things. The germ and its product
must possess qualities common to both. It is impossible, perhaps,
to demonstrate tlie exterior or physical characters of this "For-
mative power " in man or in animals, peculiar either to the same
or to diilerent species of each genus ; yet is there an abundance
of authority to show that such a specific difference must every-

220 Phijsiology and Patliology of the [April,

where exist. The formative power, or the solar ganglion, re-
pjarded as the germ of all to be afterwards developed, r^ay be
said to represent, in common with the cerebral and other parts,
in its successive changes in %iero, its various and permanent
conditions as they exist throughout the animal kingdom, begin-
ning with the polypus, in which every vital action is conducted
upon the smallest scale, by the least refined methods, and with
the strictest economy ofmeans; its apparatusbeirigthe simplest,
the agents employed the fewest possible, and its various opera-
lions being carried on in one and the same place ; proceeding
in the mollusca, and in worms and i-nsects, in which relations
are exhibited to surrounding objects, and in which animals the
senses and voluntary motion gradually make their appearance,
the organic apparatus necessary to the exercise ofthese func-
tions being superadded; ascending through fishes, reptiles,
birds, and quadrupeds, in which the po\yers of sensation and
motion become much more energetic, much more active, the
internal life at the same time more and more developed, and the
cerebral functions more and more numerous and diversified ;
and ending with man himself, in whom, as Blumenbach ob-
serves, the successive imposition of cerebral matter has
reached its maximum; so that the summit of the nervous sys-
tem, which corresponds with the forehead and vertex, is much
larger in him than in any brute, and his intellect and moral feel-
ings are proportionally greater.

Apropos, the comparative cerebral developement of man
and brutes is, as is well known, employed to mark the rank
any one of either kind may hold in the scale of creation and in-
teligence ; and very properly so; but it appears to me that the
physiologist takes cognizance only of an effect on the devel-
opment of the cerebral organism, which has resulted from the
operation of a cause which he has hitherto failed to appreciate.
Nothing can be more true than that " the higher we ascend,
the more parts exist above the medulla oblongata, till, rising
from fish and reptiles, through the numerous warm-blooded
brutes all distinguished by the relative magnitude of each cere-
bral part we arrive at man,*' the '^ siunmit of terrestrial ob-
jects ;" and it is equally true to my mind, that the successive in-
crease of parts above the medulla oblongata is attributable to
the operation of a preliminary cause viz., the Solar Ganglion,
the source of all animal life, whether cerebral, spinal, or organ-
ic. Surely if the ganglionic system be deemed either necessary
or competent to preside over the vital actions necessary to the
perfect development of the amyencephalous monster of Dr. M.
Hall ; if the secretion, nutrition, circulation, (S;:c., as carried on
in it, in virtue of the said ganglionic system, are sufficient for

1851.] Ganglionic Nervous System, 221

its growth and maturity, and for the perfectibility of its several
organs, as the Hver, spleen, heart, &c., and the consequent exer-
cise of their functions, why should we doubt its powers to pie-
side over the vital actions necessary to the entire foetus ? If
the ganglionic system be sufficient to develop and mature a liv-
er, aheart, and a spleen, and to excite them to the exercise of
their appropriate functions in the animal economy, there is no
reason why it should not do the same for the brain and &f)inal
marrow. There is certainly much reason, as I trust has been
shown, to feel satisfied that it does so ; and that, moreover, to the
modijfied operation of the solar ganglion must be referred all the
varieties of life, psychical, and corporeal, which everywhere
abound.

To proceed: On tracing the animal organization from
abov,e downwards, we observe generally a gradual diminution
or s-ioaplification of parts, and which in every case is propor-
tionate to the wants and adaptations of the animal. The de-
creasing cerebral organism, for instance, marks the downward
progress of the animal in the scale of intelligence and feeling.
This is seen throughout the verlebrated animals, as the mam-
malia, birds, reptiles, and fishes. The insect tribes generally
can hardly be said to have more than a mere rudimentary
brain ; they have certainly a medulla oblongata, in which the
nerves of the external senses take their origin. The spinal
system, so far, is perfect in all its parts, and all the strictly
vital functions are in full operation. In the annelida, however,
we mark a very considerable falling ofif: the absence of every
thing like a brain, and of the external senses, leaves the animal
to exercise only a strictly spinal and ganglionic existence.
The excito-motory function, in itself, seems perfect, and like it,
the organic functions appear on a par with those of the mollus-
ca. The only advantage of the annelida is probably in its
means of progression. One more step downwards, and the
ordinary medusa is seen a mere mass of living gelatinous mat-
ter, without the least indication of even a spinal life, and never-
theless executing the organic functions of assimilation, diges-
tion, secretion, circulation, nutrition, absorption, &c. This
last step of the ladder constitutes the first of the intra-uterine
life of the fcctus; and it may be said, that just so many steps
as it takes the physiologist to trace the successive and organic
changes from man to the medusa, the same are required to
trace the foetus through its various metamorphoses during its
intra-uterine existence ; and there can be no doubt, as has been
before observed, that each diminution or addition of parts, both
in man and animals, is but the visible ellect of a corresponding
variety and gradation of the nisus formatii^ns, or the solar gan-
glion, the germ of all to be afterwards developed.

222 Physiology and Pathology of the L-^P^'i^

"First chain of being, which from God began,

Nature's ethereal, human, angel, man,
Beast, bird, fish, insect, what no eye can see,
No glass can reach, from infinite to thee :
From thee to nothing." Pope,

It may be added that the possession of the tln^ee nervous sys-
tems in man and in the higher order of animals does not pre-
suppose that those which have only tico or even one, have been
insufficiently provided for. The organism of the polypus and
oyster is as nicely adapted to their wants and the circumstan-
ces which surround them, as is the organism of man.

In many instances among the lower classes of animals it ap-
pears that Nature has intended so to economize her means that
one part shall serve the purposes of two or even more, and in
others she has so concentrated her forces that it is really aston-
ishing. The reproduction of lost parts in the lobster and crab,
and many other Crustacea ; and the extraordinary activity of
certain of the external senses in some animals higher in the
scale of organization than the Crustacea, almost make one doubt
on which side to consider the advantages! A division of la-
bour is generally regarded as indispensable to perfectibility,
but among the lowest classes of animals w^e find the opposite
principle in operation : thus the solar ganglion in certain ani-
mals executes the functions of both the spinal cord and the
cerebrum ; for in the absence of the brain and spinal cord, it
is occasionally seen that both sensation and voluntary motion
exist in the zoophytes. In the manner in which the infusoria
and actiniae pursue their prey, and in their selection of it; in
the facility with which they recede from whatever may prove
hurtful to them, and turn aside when they encounter one ano-
ther, together with the highly sensitive and irritable nature of
the organism of the medasuriae generally, " w^e can hardly fail,"
as Dr. Roget truly observes, "to recognize the evidence of
voluntary action." Herein we get at the' nature of animal
instinct, and which, in the absence of everything like a cere-
brum and spinal cord, must be regarded as a specific function
of the ganglionic system. Dr. Roget says, in his chapter on
the "Comparative Physiology of the Nervous* System," p. 538^
*' But whatever may be their extent, it is probable that the sen-
sorial operations of the zoophytes take place without the inter-
vention of any common cquXvq of action," meaning thereby that
the sensorial operations, so-called, are performed independently
of a brain. The same may be said of the molluscaand articu-
lata. There are times, moreover, when the vertebral animals,
as fishes, reptiles, and birds, including the mammalia, and even
man perform actions of an instinctive and intellectual charac-
ter, and that, too, ivithout the intervention of any common centre

1851.] Ganglionic Nervous System, 223

of action. What is the course of that instinctive agency v/hich
determines the 3'Oung among the several classes of animals
above enumerated, including man, to seek each its particular
means of support. In what originates the very keen choice
which is displayed by all of them for that which nature has so
especially predestined for their respective uses? What deter-
mines the peculiar habits and mode of life of any one of them?
The immature condition of the brain in the infant being reiiders
it perfectly impossible that it can exercise any, even the siin^ht-
est, influence in the matter ; and no one could venture to affirm
that the spinal cord took any part in it. There can be no reason
to doubt, but, on the other hand, every reason to feel assured,
that to the same cause of the " sensorial operations^' of the
zoophytes, and of that peculiar instinct which enables the lower
classes of animals generally to provide, not only for all the ne-
cessaries of life, but even to guard against contingencies and
anticipate difficulties, whether they relate to the kind of habi-
tation, the mode of progression, or to the kind of food required
for their sustenance; in a word, to the same cause, the forma-
tive power or solar ganglion, which so beautifully adapts their
individual habits, pursuits, and inclinations, to their peculiar
organic conditions, and so providently harmonizes the natural
laws, must also be referred whatever of nzs^fwc^ is, at any time,
manifested in mc^i, including the vertebrated animals.

The sudden and peculiar shrinking of the hydra when under
the influence of fear, and the extreme caution and dexterity
displayed by the infusory animalculse in avoiding obstacles of
any kind while swimming together in myriads in a single drop,
are instinctive vital actions, arising from an inherent preserva-
tive principle, derived from the solar ganglion, and similar in its
nature to that which induces even us, in the moment of danger
and doubt, to place our extended palm across the praecordia
thus the afl^ected miss, though ignorant of physiology or patholo-
gy, and perhaps of all other ologies, if either alarmed, or profess-
ing to be so, at any sufficient or insufficient cause of personal
danger, quickly applies her hand to the praecordia; as if the
solar plexus screamed " take care of me now.''^ What more
reasonable than to expect that that organ, the sum of whose-
function may be in one word described as life, should preside
over actions of the kind mentioned above, so indispensable as
they are to both its integrity and well being !"*

The instinctive and mental (cerebral) faculties are occasion-
ally seen acting in combination e. g., the martins which, in a
spirit of retaliation and vindictiveness, built up the hole which
had access to the nest that certain sparrows had robbed them
of, and so buried alive the predatory occupiers in a grave of

224 On the Secreting Function of the Colon. L^^P^i^

their own seeking, afford an instance of a clear and distinct
process of thought, of cerebration. The original construction
oflhe nest was instinctive or ganglionic, but the subsequent
act certainly cerebral ; whilst both were perhaps of a de-
cidedly '^ intellectual character/'' Dr. Darwin tells the follow-
ing anecdote : "A wasp on a gravel walk had caught a fly
nearly as large as itself Kneeling upon the ground I observed
him separate the tail and head from the body part, to which
the wings were attached. He then took the body part in his:
paws, and rose about two feet from the ground with it ; but a:
gentle breeze wafting the wings of the fly, turned him round
in the air, and he settled again with his prey on the gravel. I
then distinctly observed him cut off with his mouth, first one of
the wings, and then the other, after which he flew away with
it unmolested by the wind." Now, I take it that the mere pur-
suit and selection of the fly by the wasp as its prey was an act
purely instinctive, whilst the clipping: off of the wings under the
circumstances narrated shows it to have been cerebral.

The constructive habits of the bee, as shown in the mathe-
matical accuracy with which each cell of the honey comb is
formed, are. certainly ganglionic or instinctive in their nature
and origin ; if the same structure had even been conceived and
executed by man, it would have been an act of the brain, and
an equal perfection of it could only have resulted from habit
and experience. Similar observations will apply to the beaver,
and not less so to many birds, &c. Such must be directly seen
to be the legitimate and only conclusion, from the fact, that in
some animals, without even a vestige of brain or spinal mar-
row, analogous phenomena are presented to our attention ; the
ganglionic system in them, as in the amyencephalous monster
of Dr. M. Hall, is the only power of any kind they can com-
mand ; they possess none other, and therefore must it be con-
ceded, that the " sensorial operations," so called, are occasion-
ally performed independently of a brain ; and what is more,
'*the actions which are at one time instinctive, may at another
spring from a different principle." [London Lancet.

On the Secreting Function of the Colon. By .Tas. Paul, M. D.
(Read before the District Medical Society for the County of
Mercer.)

Although great and deserved attention is paid to the secre-
tions in disease, both urinary a fascal, and in a great many of
the diseases to which the human frame is liable, particularly in
fevers, there is no surer criterion to lead us in our prognostica-'

1851.] On the Secreting Function of the Colon, 225

tions, or guide us in our remedial efforts than the appearance of
the excretions. I do not know if we are so through)y ac-
quainted with the philosophy of the faecal discharges as we ^
ought to be, or that we view them altogether in the physiological
bearing to which they propei'ly belong in the animal economy

We are, I think, too much in the habit of viewing the ex-
crements merely as an index of the food having undergone the
proper and necessary process of digestion, and when we see
pieces of undigested aliment mixed up in the faeces, we natural-
ly conclude and say that the substances consumed, whether of
potato, apple, carrot, or whatever else has been partaken of,
has not been digested.

Even this, however, is not without its use for although in
such cases the pressing symptoms, whether of croupy cough,
nervous twitches, or convulsive spasms, are relieved by evacu-
ating the alimentary canal of foreign and irritating substances,
it yet enables us to note what portion of the digestive function
is complete, whether the deficiency lies in the non-rendering
the vegetable food into the saccharine princple, or otherwise,
and so to alter the food to that which can be digested, and direct
our remedial efforts to that portion of the function which is
deficient.

My purpose at this time, however, is not with the function
of digestion, but to direct our attention to the fa3cal secretions
or excretions, and to the colon, or large intestine as a great
secreting organ.

Every practitioner is more or less acquainted with the ap-
pearance of the secretions as they are passed from the body of
a patient laboring under fever the brownish watery discharges
having a cadaverous or fleshy smell, the black or dark green
discharges resembling blubber, or the green fat of turtle, having
a highly oflTensive and putrid odor and the gradual return to
the yellowish watery discharges having as convalescence is
established, more consistence, and the more genial odor of
proper fueces. I do not intend to enter into, neither is it
needful that I should; the various appearances of the faecal dis-
charges in disease, nor the altered appearances caused by
various remedial agents.

It has been a question among physiologists of the older
school, whether absorption takes place in the larger intestines?
On this subject, Blumenbach has the following "It has been
inquired whether lacteals exist also in the large intestines, and
their existence has been contended for from the efiects of par-
ticular injections, nutrients, inebriating, &c., and also by
the circumstance that the feces if retained for any length of
time become hard and dry. Although these arguments do nut

226 On the Secreting Function oj the Colon. [April,

demonstrate the absorptionof genuine chyle below the valve 'of

FallopiLis, nevertheless, it is rendered probable by the visible
existence of an abundance of lymphatics in the large intestines
having the same structure and function with the lacteals, for
these absorb lymph from the intestines during the absence of
chyle.

*' But the very different structure of the internal coat of the
large intestines from that of the villous coat of the small,
strongly argues that they are not naturally intended to absorb
chyle." Blumenbach, 233.

Our present views of the transudation of liquids through
animal texture, will readily enable us to comprehend how ab-
sorption may take place, and nourishment be conveyed into
the system when thrown into the large intestines, and even
only into the rectum by means of injections. Nor is it at all
incompatible with physiological facts that ahsorption and se-
cretion should go on in the same organ, and through the same
texture by different sets of vessels.

The same unsatisfactory knowledge, if I may be allowed the
expression, exists regarding the functions and uses of the
mesenteric glands of the colon. Prof Grant, treating of these
organs, says : " There are nearly a hundred of these organs on
the human lacteals, and about a fourth part of these belong to
the colon ; but the changes they effect on the fluids which are
incessantly passing through them during life, and even for some
time after death, or the uses to which they are subservient in
the economy, are still unknown, like the functions of many
other obvious parts of our most complicated and wonderful
fabric." Prof. GranCs Lectures, Jan. 26, 1824.

Following up the argument of the absorption of chyle, and
its having been seen in the mesenteric veins, Blumenbach says :
*'The assertion that chyle has been seen in the mesenteric
veins requires further investigation and proof; so that I cannot
believe that they carry anything more than blood, being
carbonized and destined for the formation of bile." Blumen-
bach, 234.

Here, then, we find the blood loaded and surcharged with
that principle, of which a great portion of the faeces is com-
posed.

Having thus briefly alluded to the views generally and for-
merly entertained by physiologists, let us enter more minutely
into the structure of that portion of the large intestines in
which this most important function is situate. " A part of the
faeces, however (says Carpenter), may be derived from the
secretions of the enteritic mucous membrane, and of its
glandulae ; the surface of the former, with its simple follicles,

1851.] On the Secreting Function of the Colon, 227

probably secretes notbing but mucus ; but tbe glandulse with
wliicii it is soil. ickly studded appear to serve as the channel for
the elimination of putrescent matter from the blood. 1 here
can be no doubt that a large quantity of fluid is poured out by
these glandulre when they arc in a state of irritation from dis-
ease, or from the stimulus of a purgative medicine ; since the
amount of water discharged from the bowels is often much
greater than that which has been ingested, and must be derived
from the blood." ^Carpenter, 501.

For a description of these glandulae, allow me to transcribe
from the same author the following: "The whole mucous
surface of the intestinal canal is furnished with glandular folli-
cles of a very similar character ; of which some approach
those of the stomach in complexity of structure, whilst others
evidently correspond with the crypts of ordinary mucous mem-
brane. An innumerable multitude of pores are easily seen by
the aid of a simple lens to cover the whole internal surface of
tfie hirge intestines, and these are the entrances to tubular folli-
cles closely resembling those of the stomach, but more simple
in structure. Their coecal extremities shut against the submu-
cous tissue ; towards the end of the rectum, however, they are
much prolonged, and constitute a peculiar layer between the
mucous and muscular coats: the tubes which are there visible
to the naked eye being erect, parallel, and densely crowded.
These glands probably from the peculiarly thick and tenacious
mucus of the large intestine." Carpenter, Q(JS.

And of the functions of this glandular structure, the same au-
thor observes, "Although the particular use of each variety of
the intestinal glandulas cannot yet be determined, there seems
little doubt that their general function is to eliminate from the
blood those putrescent matters which would otherwise accu-
mulate in it ; whether as one of the results of the normal waste
of the system, or as produced by various morbific causes which
act Sisfer?nentSj and thus occasion an imusual tendency to de-
composition in the solids and fluids of the body. That the
putrescent elements of the faeces are not derived from the
food taken in, so much as from the excreting action of the in-
testinal glandular, appears from this consideration among oth-
ers ; that fcEcal matter is still discharged, even in considerable
quantities, long after the intestinal tube has been completely
emptied of its alimentary contents. We see this in the course
ot many diseases where food is not taken for many days, during
which time the bowels have been completely emptied of their
previous contents by repeated evacuations, and whatever then
passes in addition to the biliary and pancreatic fluids must be
derived from the intestmal walls themselves. Sometimes a co-

N. S. VOL. VII. NO. IV. 15

228 On the Secreting Function of the Colon. [ApriT^

pious flux of putrescent matter contiunes to take place sponta-
neously, whilst it is often produced by the agency of purgative
medicine. The 'Colliquative Diarrhoea' which frequently
comes on at the close of exhausting diseases, and which usually
precedes death by starvation,, appears to depend not so mucb
upon a disordered state of the intestinal glandulae themselves,
as upon the Jieneral disintegration of the solids of the body,,
which calls them into extraordinary activity for the purpose of
separating the decomposing matter." Carpenter, 670.

What I have just read is so comprehensive, and brings the
subject so forcibly and powerfully to the mind as to preclude
the necessity almost of entering more fully upon it.

My attention was particularly drawn to this subject by the
frequent occurrence of immense quantities of the morbific and
putrid di^-charges by stool, in tropical fevers immediately before
returning convalescence. At the commencement of the dis-
ease, the alimentary canal would be carefully emptied by re-
peated doses of purgative medicine, the fever would continue,
watery stools would supervene; at this period the patient
would take the simplest nourishment, and that in small quanti-
ties, and in many cases none at all, the stomach rejecting every
particle of food exhibited in the progress of the disease, the
patient prostrated and nearly fainting on the least exertion,
large dejections v.'ould occur of dark-colored gelatinous offen-
sive matter quarts, and I may say gallons on some occasions,
are passed off at repeated operations and although the patient
at this time would be scarcely able to move or speak, yet after
such evacuations he would feel more easy a moisture appear
on the surface the critical moment being seized, and nourish-
ment with wine or brandy exhibited the patient slumbers,
and from that time convalescence progresses.
. And what is the result if this dark offensive matter is not
thrown offl It is more than probable that the fever will con-
tinue, and in more favored climates a slow and dilatory conva-
lescence may ensue, or the whole system becomes corrupted,
and in a tropical climate putrefection succeeds almost ere the
being has ceased to breathe.

In the epidemic which has so lately made such havoc and
run its course in some cities of the Union, causing such fearful
mortality, the non-performance of the proper functions of the
secreting glands of the intestines is no doubt a principal effect.
Without entering into the manner in which the morbific poison
of the cholera acts on the system, we see an obeyance of the
proper secretions of bile, urine, and faecal discharges, and in
their stead a watery secretion is ejected, even with force, from
the stomach and intestines, without straining, and without pain ;

1851.] On the Funclions of the Liver. 229

indeed, so offensive is the presence of this secreted fluid to the
stomach and intestinal canal, that the patient can scarcely con-
trol its ejectment for a few seconds. And this unusual parting
Avith the serous portion of the blood leaves the remaining por-
tion thick, viscid, and incapable of entering the minute or ca-
pillary vessels, and collapse is the consequence but arrest the
serous discharges, and once produce a fiaecal evacuation with
tinges of biliary secretion, and there is every chance of the re-
covery of the patient. Hence, it is obvious that the secreting
organ of the large intestines is seriously affected in this formi-
dable disens'e. I call it formidable from the fatality attending
the visitation, but in my opinion controlable in a great majority
of cases where the patient has been timely put under the care
of the physician, and remedial and energetic measures have
been pursued.

Every practitioner will no doubt bring to his recollection ca-
ses in which the patient, even after repeated and free evacua-
tions, will answer to the inquiry regarding his feelings, " I am
better my medicine has acted very well still I feel as if there
Was yet something to come away." Is it not probable that this
feeling, indescribable to the patient, not amounting to pain, and
relieved by a copious evacuation has been owing to the sur-
charged state of the mesenteric veins, and the relief the con-
sequence of the active secretion from the glandidce which has
been the subject of consideration.

The secretion of the liver is looked for, and the returning ap-
pearance of bile in the fsecal discharges is held in great estima-
tion, and properly so, by most, if not by all practical physicians;
its proper action is absolutely necessary to recovery from
disease and the enjoyment of health. It is not my object to with-
draw attention from that most important organ, but to direct
more particular attention to the colon as a great secreting or-
gan ; that the faeces, which in health may contain that portion
of the food which has not been absorbed into the system, more
especially when a superabundant quantity of aliment has been
consumed, is for the most part secreted by the large intestines,
from which the deleterious and disintegrated portions of the
organic mass is passed away, and the system freed of much of
the superabundant carbon which may not be required for the
purposes of respiration. New Jcrsy "^Medical Reporter.

On the Functions of the Liver. By M. Bernard.

M. Bernard in a recent course of lectures delivered at the
"College of France," reiterated his views respecting the func-
tions of the liver, and endeavoured to confirm them by addi-

230 On the Functions of the Liver. L-^P^i^

tioTial experiments. Although we have already adverted to the
various y)apers he has from time to time published on the sub-
ject, a brief recapitulation of the points he believes proved may
not be uninteresting, and will be best managed by stating them
in the form of propositions.

A. On the Formation of Sugar hy the Liver.

1. In an animal that has been prevented access to saccharine
and amylaceous food, the blood entering the liver contains no
sugar, but that which leaves it always contains it. Dogs fed
for six weeks exclusively on meat present large quantities.

2. It is not only the blood of the organ, but its tissue also,
that contains it in abundance.

3. It is found in the livers of all the domestic animals, in
birds, fish, reptiles, and even oysters and snails. Towards the
fifth month it is found in the fcetal liver, and continues increas-
ing; and it exists even in the embryoes of oviparous animals,

4. The quantity calculated from actual measurement to be
contained in the liver of a healthy adult, who was guillotined
while fasting, was 23 grammes 267 milli-grammes. In a
diabetic subject, the liver contained 57 grammes. In the liver
of an ox the total quantity was calculated at 243 gr.

5. Asa General rule, there is most sugar in the liver of those
animals which consume aliments containing sugar. The long-
er the abstinence the less the quantity.

6. There is more found in adult animals than in younjr.

7. Although repeated experiments constantly confirm M. Ber-
nard's original assertions that irritation of the olivary bodies of
the medulla oblongata induces an almost immediate increase in
the quantity of sugar, yet the supposition it did so by irritating
the origins of the eighth pair of nerves is erroneous; for "if these
nerves be divided, the increased secretion still goes on.

8. Whether the left or right olivary body, or the interval be-
tween them, be pierced, the quantity of sugar is ahke in reased
in tiie urine; but in the first two cases the animal turns continual-
ly to the left or the right, and in the last progression occurs in
a straight line. The quantity produced, within certain limits^
is increased with the size of the instrument used. In rabbits
thesugar-secretion continues for forty-eight hours after, and in
dogs for four or even seven days. The same results follow,
whether the animal is fasting or not.

9. During this increased secretion, the animal is in constant
agitation ; its respiration is accelerated, but its temperature is
diminished some degrees. The quantity of urine is increased,
besides becoming saccharine.

10. The sugar once produced whether by the liver or by
means of aliment, undergoes destruction in the lungs -, but its

1851.] On the Functions of the Liver, 231

disappearance is. not, like its production, under nervous influ-
ence, but is a chemical phenomenon which may take place in
contact with air externally to the lungs. The destruction in
the lungs gives rise to the production of carbonic acid, which
is liberated frcci the air passages. In animals whose olivary
processes are pierced, this is given out in larger quantities, and
their blood become^ blacker.

11. This diabetic sugar is epecially distinguished by the
large quantities w^hich can be destroyed by the lungs, being as
15 to 2|- as compared with grape sugar. Cane sugar intro-
duced into the blood does not disappear by the lungs, but escapes
by the urine.

12. Various circumstances may impede or prevent the
secretion of sugar by the liver, as severe pain or lesion of tha
nervous system (except of the olivary bodies). Diseases may
produce the same effect. Thus sugar has been found to cease
being secreted in diabetics during the paroxysm of ague, in
pneumonia, &c.

13. Additional experiments have shown M. Bernard the
error of the hypothesis he advanced, that glycosuria was due
to an affection of the pneumogastric nerves; and he is now
disposed to regard it as due to a special although unknown
alteration of the liver itself, which is indeed generally hypertro-
phied in this disease.

B. Formation of Fatty Matters by the Liver.

1. In s])ite of the great variety of iatty substances, animal
and vegetable, the animal that consumes them alwavs produces
the same description of fat, owing to the elaboration they have
undergone in the economy.

2. To become absorbed, fatty matter must previously have
become en^ulsioned, and the pancreatic juice is the fluid by
which this is accomplished. Its power of effecting this depends
upon an organic matter analogous to ferments.

3. The amount of fatty matter introduced as food is far from
explaining the quantity possessed or produced by the individual.
There is no tat in the blood which enters the liver, but there is
abundance in the blood that leaves it, and therefore its forma-
tion within this oriian is certain.

4. It is, as in the case of sugar, during digestion that fat is
produced in the liver, and afterabstinence it disappears. Some-
times it is very abundant, especially in suckling women;
whence probably arise the fatty matters of the milk, for the fat
of the liver offers most analogy to butter. In such women, the
blood itself contains much f:n.

5. The fat received in the food after decomposition bv the
pancreatic juice, and the fat from the liver, both enter the

232 On the Functions of the Livej\ [April,

blood, and are not entirely destroyed in the lungs, in as much
as the arterial blood still contains abundance. As the venous
blooJ contains hardly any, and the vena cava none, we must
conclude that the greater part is destroyed in the general
capillary system.

6. The production of fat in the liver seems, like that of the
production of sugar, to be under the influence of the nervous
system; and if this undergoes violent lesion or perturbation,
its production ceases. It is remarkable, too, that in proportion
as the quantity of sugar increases after puncture of the medulla
oblongata, that of the fat diminishes. The same is observed in
diabetes; for from the livers which are loaded with sugar, not
an atom of fat can be extracted.

7. Although healthy urine has been shown to contain some
fat, yet this sometimes predominates so as to constitute a dis-
ease under the name o( fatly or chylous urine^ frequently
coexisting with a similar state of the blood. This is probably
due to the superabundance of fat secreted by the liver, and
constitutes a (so to say) fatty diabetes, just as the excess of
sugar does a saccharine one.

8. The products of digestion may thus be said to induce
three principal diseases the sugar, diabetes; the fat, the so-
called chylous urine ; and albumen, the albuminous diseases.

c. Fibrin formed in the Liver.

1. The blood entering the liver contains little fibrin, and
coagulates with difficulty even when the animal is fed on flesh.
The fibrin of the aliments is dissolved by the gastric juice, and
converted into a matter analogous to albumen, termed by
Mialhe albuminose. But the blood which quits the liver con-
tains much fibrin and therefore the albuminose of the blood of
the abdominal veins has become transformed into fibrinous
matter.

2. It is during digestion that the blood, traversing the liver,
becomes loaded with this abundance of fibrin.

D. Secretion of Bile.

1. The secretion of bile diflfers from those already named, as
it is continuous, while they occur only during digestion.

2. The bile is not a mere excrernentitious fluid, but influences
digestion usefully, contributing with the gastric and pancreatic
juices to constitute that most powerful solvent the intestinal
liquid.

3. The bile seems to be essentially endowed with anti-putre-
factive properties. It regulates the chemical reactions occur-
ing during digestion, prevents fermentation, and opposes the
formation of the gases which result from the decomposition
of azotised and non-azotised aliments.

1851.] On the Functions of the Liver. 233

4. When bile is prevented reacln'ng the intestine, putrefactive
fermentation, no longer opposed by the acids of this fluid,
induces diai-rhoea; which nrsay also be induced by a predomin-
ance of alkali in the intestines, and may be under such
circumstances pdvantageously treated by acids.

D. Resume. From v.liat has preceded, it is evident that sugar,
fat, and fibrin are fabricated in the liver, and thr.t wliatever
the alimentation may be, this organ transforms it into appro-
priate matter of nutrition, so tiiat the great variety of food
taken does not deiange the composition of the blood and
prevent its being identical. In a chemical point of view the
organ is then of great consequence, and is properly regarded as
one o{ sanguification. ^V"hile in the herbivora, whose aliments
furnish much suo:ar, this secretorv or^an furnishes least sucar,
in the carnivora, who ingest much fatty matter, it secretes least
fat. So, too, the liver forms fibi in abundantly, in proportion
as the vena portae contains less. The liver, therefore, while it
is an organ of s^anguification, is always one for adjusting the
equilibrium.

If the above products furnished by the liver serve to keep
the circulating fluid in a composition essentially fit for nutrition,
the bile, acting in opposite direction, contributes to the same
end, by removing the principles that are in excess, especially
carbon ; so that the liver must be considered not only as an or-
gan of sanguification and equilibrium, but aiso one exerting a
depuraiive action on the blood.

E. Circulation of the Liver.

1. Two powerful causes the pressure of the abdominal vis-
cera and the venous aspiration contribute to this; but other
contrivances are required to meet the varying degrees of plen-
itude to Vv'iiich the organ is liable.

2. Certain vessels seen easiest in the horse, communicate
directly between the vena porta3 and vena cava, conveying a
portion of the blood v/ithout its having undergone modification
in the capillary circulation of the liver, and operating as a kind
of dimrticidnm, preventing the organ from being too greatly
and too suddenly engorged.

3. Congestion of the liver and heart, in tl;e case of unusual
afflux of fiuiiJs, is further provided against by the agency of a
special hpvatico-7'enal circulation, not so distinct in man, in
whom the liver is liable to become congested by over-exertion,
as in the horse, in whose liver this does not produce the same
effect. [We have already (Xo. X., p. 24G) described the ap-
paratus by which this is supposed to be carried on, and express-
ed our conviction of the lancifulness of the suggestion.]

4. The active and abundant circulation through the liver is

234 Electro-Physiological Researches. L^^P^''

an important source of animal heat, the blood leaving the organ
having acquired an additional temperature of about 2 Fahr.
L'Uiuou Medicak, 1S50, Nos. 82, 85, 88, 91, 98, 103, 106,
113, 115.

\v^e think that there is quite enough of probability in some of
M. Bernard's assertions, to encourage farther enquiry ; but we
must enter our protest against.the hasty and dogmatic mr.nner
in which he builds up his conclusions on a very slender basis
of evidence. It will be seen, even from his own admissions,
that he has done this in regard to the influence which he sup-
posed to be exerted throuoh the eiglith pair of nerves on the
production of sugar ; and the recent researches of Frerichs and
Lehman on the Chemistry of digestion (of which we shall give
an account in our next Number,) have shown him to have
been no less hasty in his deductions on the agency of the
pancreatic fluid.] Medico Chirurgical Review.

Electro-Physiological Researches. Seventh Series. By Signer
C. Matteucci.

In this memoir, Professor Matteucci, after recapitulating the
results of his previous researches on Electro-physiology, pub-
lished in the ' Philosophical Transactions,' proceeds to the
relation of new experiments. He first shows that nervous
filaments made to conduct an electric current in a liquid are
not capable, like metallic wires, of acting as electroids, and
giving rise to electro-chemical decomposition. The solution
employed was that of iodide of potassium ; the nerves, tvv'o
large ones, taken from a living animal, each of which was
separately attached to the metallic extremities of a pile of fif-
teen couples. No trace of decomposition followed ; and he
concludes from hence, that the conductibility of nervous
matter is due to the liquid part of the matter itself

He then gives further experiments on the relative conducti-
bility of muscles and nerves, with a view to ascertain whether,
wdien a current was impelled through a mass of muscles, any
part of the current might have passed through the nervous
filaments spread through the muscle. For this purpose he
inserted the nerve of a galvanoscopic frog into a hole made in
a piece of dead muscle, through which he then passed a very
powerful current : no contraction followed in the galvanoscopic
frog. When muscles still retaining their irritability were sub-
stituted for the dead muscle, induced contractions occurred in
the galvanoscopic frog during the passage of the current. He
concludes that when the poles of a pile of twenty-five or thirty
elements are applied to the surface of the muscles of a living

1851.] Electro-Fhysiological Researches. 23i

animal, the phenomena produced by the passage of the current
must depend either on the direct action of the current on the
muscular fibre, or on the indirect action or influence oi \\\q
electric current transmitted by the muscular lihre to its own
nervous filaments, or rather to the nervous force existing in
those filaments.

Referring, then, to an experiment related in a preceding
paper, in which tiie lower limbs of a frog, united to the spine
only by the lumbar nerves, are placed astride two glasses con-
taining water, with each foot immersed, and in which a current,
after traversing the two limbs, and consequently the two
nerves, in opposite directions, so modifies at length the excita-
bility of the nei'ves, that on opening the circuit, only the limb
in which the current has been passing inversely contracts, he
shows that if in this state what may be called the "inverse '
nerve be touched by a piece of muscle, although the circuit
is continued, yet the limb contracts as though the circuit had
been broken. In fact, the muscle, by its greater condnctibility,
becomes traversed bv the current in place of the nerve.
Again, if after the former part of the experiment has been per-
formed, the portions of nerve which had hitherto been buried
among the crural muscles be dissected out, it is easily seen that
their excitability has not been afifected like that of the lumbar
nerves, because the current, in place of traversing them, has
traversed only the crural muscles. The nerve has had its exci-
tability modified in only that part of its course in which, being
laid bare and isolated, it has necessarily conducted the current.

M. Dubois Reymond ('Comptes Rendus') has related an ex-
periment seeming to lead to the inference that section of the
spinal marrow increases the excitability of the lumbar nerves,
at least during a certain period of time. In order to test the
accuracy of this conclusion on so important a point, M. Mat-
teucci institutes a number of very accurate experiments, in
which he measures the excitability of the lumbar nerves after
section of the spinal marrow, by means of the apparatus of
Breguet, used and described by him in a former paper. His
first results show that "the contraction excited in the muscles
of a frog, of which the spinal marrow has been divided from
twelve to eighteen hours, is stronger than that obtained under
the same circumstances from the muscles of a frog just killed,
without having been previously subjected to any injury to its
nervous system." But subsequent experiments have satisfied
him that this result depends not on the separation from the spi-
nal marrow, but rather on the repose in which the muscle has
been permitted to remain; for without division of the medulla,
nearly the same force of contraction existed after the same

236 Treatment of Rheumatism by Lemon Juice. [April,

interval of time. He finds, indeed, that the only alteration
which the excitability of a nerve undergoes by separation from
the nervous centres, consists in its being more readily exhausted
under the action of stimulants, the longer the period that has
elapsed since its detachment.

The author then proceeds to relate the nature of the strict
analotry existing between electricity and nervous force. As
electricity is developed under the influence of the nervous cur-
rent in the organs of electrical fishes, ..so, as a converse of this
phenomenon, electricity may developethe nervous force* Af-
ter adverting to the well-known analogy subsisting in every
particular between the phenomena of the electrical organ and
those of muscles, he adverts to the old experiment of passing
a current through the muscles of the thighs of a living anim.al,
the positive pole being placed now above, now below, so that
it may be supposed that the current passes in the two cases of
opposite directions as regards the nervous filament distributed
in the muscles. He then points out that the eflfects of a cur-
rent directed downwards, in the dit-ect course of the nerves, are
a strong contraction of the muscle traversed, and also of the
muscles of the leg below ; while the effect of a current in the
opposite or inverse direction is pain, together with conti'ac-
tions less violent and always confined to the muscles traversed.
The cont?'actions (especially of the parts below) indicate a
current of nervous force propagated tow-ardsthe muscles, while
the pain indicates a current towards the nervous centre.
Now, bearing in mind that it had been proved by direct ex
periments that an electric current traversing a muscle never
quits the muscular fibre to enter the nervous filaments, it seems
clear that the phenomena just spoken of are exclusively owing
to the injlnence exerted by the electricity passing through the
muscles on the nervous force contained in the nerves ; and also
that this nervous force acts peripherador centrad, according to
the direction of the electric current which excites it. The
great importance of the conclusions drawn from these experi-
ments consists in this, that they lead to the same law which
establishes the analogy between nervous force and the electrical
discharge of fishes. Tlie paper concludes with some further
considerations intended to confirm this law. [Philosophical
Transactions, 1850.

On the Treatment of Rheumatism by Lemon Juice. By G.
Owen Rees, M. D., Assistant Physician to Guy's Hospital.

Although the treatment of rheumatic diseases by lemon-juice
has received a considerable amount of favourable notice from

1851 .] Treatment of Rheumatism hy Lemon Juice. 237

the profession, I am still inclined to believe that it has scarcely
gained the credit it deserves. This would appear to depend in
some decree on its use in cases which experience has now
shown me are but ill-adapted for its exhibition, and which are
in all probability improperly placed by our pathology in the
same category with those forms of the disease in which early
benefit is derived from the administration of the remedy.
There is much indeed in the history of those conditions desig-
nated rheumatic to lead us to hope, that as medical science
advances, important distinctions will be made where none are
as yet recognized.

From the experience I have now had in the use of the rem-
edy, I feel I have sufficient evidence before me to justify the
opinion, that there are certainly two forms of rheumatic disease
which cannot be benefited by the administration of lemon-juice.

The first of these is generally observed in cachectic subjects,
and for want of a better name I shall call it cachectic rheuma-
tism. It occurs in all classes of life, but more commonly, I
believe, among the lower orders. It is more frequent in fe-
males than in males. The swelling and redness of the parts
affected are less marked than is generally the case in acutely
painful rheumatism. The pain is, however, very severe, and
occasionally partakes of the neuralgic character. The patient
is sometimes anaemic, and on inquiry we may perhaps discover
a history of long mental or physical suffering. The skin is per-
spirable; the pulse weak and rapid ; the tongue varies, being
sometimes moist and white, and sometimes clean and less moist
than natural. In cases of this description I have not succeeded
in relieveing the patient by the exibitipn of the juice ; and if
occasional relief has been obtained, the disease has shown a
tendency to relapse, and become unmanageable under a con-
tinuance of the remedy. It may perhaps be well to mention,
that in these cases I have derived the greatest benefit from the
exibilion of opium in full doses at frequent intervals. The oth-
er form of rheumatism in which I have failed to obtain relief by
the administration of the juice is that attendant on syphilis.
In all the cases in which I have made trial of it among the fe-
male out-patients at Guy's Hospital, it has failed to exert any
beneficial inlluence. The nature of the disease, so distinct
from that of ordinary rheumatism, never indeed gave me any
great hope of success. If we except the diseases above des-
cribed, and cases simulating rheumatism, but leally connected
with ordinary dyspepsia, or, as is sometimes the case, with the
existence of Bright's disease, my continued experience has but
the more persuaded me of the great value of lemon juice as a
remedy for rheumatism. Its action is most remakable causing

138 *Suppuratio7i in Acute Rheumatism. [April,

cessation of pain and decrease of swelling and redness, such as
we can rarely obtain with colchicum, even when adnninistered
in large and hazardous doses. That lemon juice sometimes
lails to effect this rapidly is certainly true, and that too with
respect to cases apparently identical with those in which early
benefit has been observed; but the history even of these less
favourable instances will generally bear comparison with the
results obtained by the ordinary plans of treatment; and it is
my full conviction, that since lemon juice has been introduced
at Guy's Hospital as a remedy for acute rheumatism, the pe-
riod during which it has become necessary to confine patients
so affected to bed has been very materiall}^ lessened.

I am anxious now to direct attention to a class of chronic
rheumatic cases, in which I have used lemon juice with very
great advantage. I allude to such as are connected with de-
posit of lithate of soda in and about the smaller joints, and
which partake more or lessof the gouty character. 1 have met
with great success in this form of disease by the continued use
of lemon juice in combination with small doses of the tincture
of the sesquichloride of iron, and in several instances have
effected absorption of deposits which have resisted all other
plans of treatment. A case of the above description was lately
reported to me, in which like success attended the administra-
tion of the lemon juice alone. The patient, a lady, had been a
cripple for several years, and was eventually restored by per-
severing in the use of the remedy for six or eip;ht weeks.

Lastiv, with respect to the dose in which the juice ought to
be administered. Experience has shown me that it should be
larger than I was at first inclined to consider necessary. In
acute rheumatism, from one to two ounces should be given
every four or six hours ; and should pain be felt in the bowels,
or diarrhoea occur, which is very rarely the case, four or five
minims of tincture of opium may be added to each dose of the
remedy. \_London Lancet.

Cases of the Termination of Acute Rheumatism in Suppuration.
By MM. Flel'rv, Andral, and Trousseau.

A proloncred and interesting discussion has recently arisen
at the Academic de Medecine, upon the occasion of the presenta-
tion of a report bv M. Martin Solon, upon the proposition of M.
Dechilly to treat acute rheumatism by covering all the affected
joints with large blisters, a plan, as might be supposed, that met
with little favour. The opportunity was taken to enter into
the question of the nature and treatment of the disease at large,
and several sittings were occupied in discussing this. We

]851.] Suppuration in Acute Rheu7natism, 239

have no intention of following the various speakers, since much
that was said consisted of a reiteration of what is already
known, or has been sufficiently refuted. M. Bouillaud defended
his doctrines with his accustomed ability and want of success;
and M. Piorry disputed with him the parentage of the practice
of bleeding coup sur coup, which every one else has abandoned
as mischievous. We will briefly notice a portion of the address
of M. Malgaigne.

M. Malgaigne, after expressing his conviction that physicians
would be less discrepant in their opinions concerning the dis-
ease, if they studied first its monarticular form, as found in the
surfrical wards; and, adverting^ to the fact of the utter ignorance
which prevailed concerning inflammation, until Hunter studied
its phenomena, at the surface of the body, and scattered the
former hypotheses of physicians to the winds ; stated that
suppuration is by no means an uncommon termination of the
disease, but that it .then comes under the care of the surgeon.
He believes that physicians are too easily contented with the
removal of the general symptoms, and allow a patient to leave
the hospital when a considerable amount of pain or debility of
the joint continues. Under favourable circumstances, Nature
herself will complete what is suflicient ; but, at other times, the
patients resort to the surgical wards, "to have their cures
cured." He thinks, too, that in appreciating the employment
of difl*erent remedies, we are too ready to yield them praise as
they successively appear, without reflecting upon the natural
tendency of this, and of all articular inflammations, to a cure,
provided the parts are kept in quietude, and {vee iVom the irrita-
tion of external agents. He believes that amidst the multiplici-
ty of formulae, the natural indications are often neglected ; one
of the principal of which he considers to be, to protect the
perspiring surface from the eflfects of cold, which, in most cases
has indeed been the original cause of the disease. The perusal
of all modern cases proves the great inattention showed to this
point, the patient being allowed to uncover himself to satisfy
every want, or undergo any application : and in this way the
disease may be rendered obstinate and relapsing.

Some of the speakers laid considerable stress upon the rarity
of the terminaiion of rheumatism in suppuration, and this has
led to the publication in the medical journals of some examples
of it. Professor Fleury, of Clermont, states that, up to 1848,
he had always believed with M. Chomel, that rheumatism
never so terminated ; for, practising in a part of the country
wherein the disease is of frequent occurrence, he had never
met with a case of such before, although he had frequently had
cases transferred to his surgical wards from the physicians,'

240 Suppuration in Acute Rheumatism. [April,

under the idea that such was the case. The present case
occurred in a youth, set, 18, of sound constitution, and hitherto
of good health. He was admitted into the Hotel-Dieu, at
Clermont, 2d -October, on account of acute rheumatism of the
shoulder and knee, induced by sleeping in a damp chamber.
Suppuration was set up, notwithstanding active antiphlogistic
treatment, in both joints, the abscesses being left to discharge
themselves; and he died on the 12th of November, of purulent
infection. On examination, the articular surfaces were found
denuded, a metastatic abscess existed in the right lung, but no
other disease of any of the viscera was found.

M. Andral read the next case to the Academy. A woman,
set. 67, of feeble constitution, was admitted into La Charite
early in July last, sufFerinsr from pneumonia, from which she
rapidly recovered by bleeding and tartar emetic, and was in a
state of convalescence, when, from the effect of a current of air,
she became attacked with acute rheumatism of the shoulders,
unattended with complication, the attendant fever being great.
She was bled, which so enfeebled her as to forbid the repeti-
tion ; and next day twelve grains of quinine in the twenty-four
hours were prescribed. The disease proceeded on to a fatal
termination with fearful rapidity, without any complication
occurring, any anormal sound of the heart, or any other joint
participating. She died on the eighth or ninth day, having ex-
hibited no other symptoms than intense pain in both shoulders,
a pulse of constantly increasing frequency, and a state of
general anguish and rapid sinking, resembling that observed in
acute peritonitis. The most careful examination of every organ
failed to elicit any explanation of the issue ; nor were there any
signs of phlebitis or purulent infection. Both shoulder-joints,
however, were found filled with w^liite, homogeneous pus, and
the synovial membrane was of the intensest red, the articular
cartilage retaining its normal colour'. Some of the bursas in
communication with the joints were also filled with pus ; but
external to the joints all was normal, bones, periosteum, and
muscles having undergone no change whatever.

M. Trousseau relates a case also, which occurred in a child
set. 9, who, having always enjoyed good health, and being un-
exposed to privations, was attacked w^'th intense scarlatina, and,
during its prevalence, various of the joints became the seat of
acute rheumatism^ She died on the fifth day of the scarlatina,
and third of the rheumatism. On examination, the various
organs were found in a healthy condition, with the exception of
the pleura, which contained a considerable quantity of serosity.
Both shoulder-joints, and those of the elbow, knees, and ankles,
were filled with considerable quantity of greenish, well-formed

1851.] Results of Revaccination. 241

pus, accompanied by considerable vascularity of the subsynovial
cellular tissue.

M. Trousseau observes, that all practitioners who have much
observed disease in children, must be aware what a powerful
effect the exanthemata exert in engendering a purulent diathesis.
If this child had contracted the rheumatism unconnectedly with
the scarlatina, it would have probably determined the synovial
effusion usually found ; but the scarlatina havingr changed the
a-asis o^ ihe blood, developed the suppurative diathesis, and con-
verted a trifling^ affection into one of an irremediable chaiiicter.
Was not the old woman, whose case is related by M. Andral,
reduced, M. Trousseau inquires, by the debilitating treatment
to which she was subjected, to a condition analogous to that
in which scarlatina so often places children ? Bulletin de
V Academie, xv, pp. 774-785 ; Gazette Medicale, Nos. 26 and
32; L' Union Medicale^ No. 102. British and Foreign Med,
Chir. Review.

Results of Revaccination in the Prussian Army, during 1849.

During the year 1849 there were 51,637 individuals revac-
cinated, of whom 39,116 had distinct cicatrices of the former
vaccination, 8706 had these in an imperfect condition, and 3815
were destitute of them. The vaccination

Pursued a regular course in ... . 30,457

An irregular one in 8467

And failed in 12,713

Succeeded on repetition in .... 2862
Thus, then, of the 51,637 vaccinations, 33,319 were quite suc-
cessful; vesicles running a normal course being produced.
This proportion, amounting to 64 per cent., is nearly 1 per cent,
more than was obtained in 1847 and 1848.

Of the different forms of variolous disease which appeared in
the army throughout 1849, only 62 cases occurred, and were
distributed as follows :

Inpersonsnot Revaccinated Revaccinated

revaccinated, withoutsuccess. with success. Total.

Varicella, 2 6 5 13

Varioloid, 14 17 9 40

Variola, 6 2 1 9

22 25 15 62

In almost every case the disease ran a mild course, and fre-
quently was quite insignificant. One case only was fatal. A
recruit vaccinated when a child had not been yet revaccinated,
and died on the 10th day. 3icc?. Zeitung, 1850, No. 19.

243 Vaccination and Revaccination. [April,

[We have been careful to record abstracts of these annual
official returns, testifying as they do most sti-ikingly to the value
of the practice of revaccination, through the agency of which
smallpox has now for many years been well-nigh extinguished
in the immense Prussian standing army. To the greater prev-
alence of this practice may in part, also, be attributed the much
fewer deaths from variola which take place in Berlin as com-
pared with Prussia at large. Thus, while in 1840 1 death in
2272, was due to smallpox in Berlin, 1 in 173-7 was the propor-
tion for Prussia. Tn 1845, the numbers were 1 in 4.562 to 1 in
171, and in 1848, 1 in 10226 to 1 in 2447. While the average
of 9 years, 1840-8, gave 1 death from smallpox in 289*2 deaths
in Berlin, and 1 in 1597 in the Prussian States. See Med. Zei"
tun^, No 10. Ihid.

On Vaccination and Revaccination. By M. Craninx.

An interestinsf discussion has lately taken place at the Belgian
Academy of Medicine, upon the subject of vaccination. The
following were the conclusions of M. Craninx, the reporter,
which were affirmed by the academy: 1. Variola and vario-
loid are but degrees of the same affection. 2. Simple variola
may attack the same individual twice, but scarcely ever in
rapid succession (coup sitr coup). 3. It may also attack per-
sons who have been properly vaccinated, but it is then generally
mitigated. (M. Lombard observed that the word ''generally"
must be dwelt upon ; for subjects who, to all appearance, have
been well vaccinated, at a distant period occasionally die from
variola. He added, that in the dreadful epidemic which has
just devastated Liege, this was the case, while none of those
who underwent revaccination took the disease.) 4. Variola
after vaccination, is almost without example within the next
ten years; but it is observed from time to time in those who
have been vaccinated for more than twenty years. It is, how-
ever, very rare after forty. 5. It is of more frequent occur-
rence, but, at the same time, milder, in the vaccinated, than in
persons who have already undergone an attack of it. 6. Va-
rioloid is observed oftener than variola after vaccination, and is
not infrequently observed in children ; but it increases both in
frequency and severity from ten to twenty-five or thirty years.
7. Variola and varioloid in the vaccinated, not following the
same course in respect to frequency or intensity as in the non-
vaccinated, the cases in which they are seen among the former
cannot all be explained upon the supposition of a faulty vacci-
nation, but upon that of a diminution of the preservative action
of vaccination. 8. Perhaps we should admit incomplete vacci-

1851.] Vaccination and Revacci7iation. 243

nations possessed of a less degree of preservative power, and
capable of becoming sooner exhausted. In this point of view,
sufficient importance is not attached to the general reaction
which should accompany the vaccine eruption, indicating the
action of the virus upon the general economy. 9. If the pro-
tective power of vaccination has become enfeebled by time, if
not in all, at least in several individuals, there is not sufficient
evidence to show that the vaccine, considered in itself, has lost
its efficacy since the first years of its discovery. While there
is doubt, it is better to revert to the cow-pox whenever the op-
portunity presents itself. (Upon this resolution M. Seutin
remarked that, believing as he did, that the vaccine lymph
which existed is efficient, and that it fails either from not having
been taken well, or owing to individual susceptibilities, he con-
sidered this conclusion would spread needless alarms. M.
Lombard observed, however, that the new cow-pox, recently
imported from England, certainly exhibited a more certain and
more active effect.) 10. As the immunity conferred by vac-
cination is not indefinitely absolute, revaccination, at least for a
great number of individuals, is rationally indicated. 11. Ob-
servation shows, that when it succeeds, the second vaccination
produces phenomena very nearly like the first, so that we would,
a priori, anticipate the same effects from it. 12. Experience
has determined this point : it has proved that a recent revac-
cination preserves from variola and varioloid, and that, prac-
tised on a sufficient scale, conjointly with vaccination, it consti-
tutes a sure means of arresting the progress of this malady
when it appears epidemically. 13. It succeeds best in propor-
tion as it is most required, that is, the more remote the period
is since the individual has had variola, or has been vaccinated.
14. If it does not succeed at a first attempt, it should, if neces-
sary, be repeated several times, l^). During the prevalence of
an epidemic of variola or varioloid, it is prudent to revaccinate
all those whose first vaccination dates ten years back, and all
those whose first vaccination gives rise to any doubt. IG. Re-
vaccination may be performed almost indiflferently with the
lymph of a primary or a secondary vaccination. 17. It is im-
prudent to innoculate with the lymph of spontaneous varioloid ;
nevertheless, in the time of an epidemic, if vaccine Ivmph could
not be possibly obtained, we should be authorized in the em-
ployment of this fluid, and to transmit it as we do vaccine lymph.
18. If revaccination is so useful a thinir, at least for a certain
number of persons, vaccination loses none of its importance ;
and the government and the profession should exert all their
influence to enable the entire population to participate in its
benefits. [6raz. Med., No. 27. Ibid.

N. 8. VOL. Vir. NO. IV. 16

244 Collodion in Smallpox. [April,

Abortive Power of Collodion in Smallpox.

A case has recently occurred in the wards ofM. Aran, at the
Bon Secours, in which the ^ood effect of collodion was proved
to be as decisive in confluent smallpox as it had been found be-
fore in the more simple form. It occurred in the person of an
unvaccinated young man, and the collodion was applied to all
parts of the face but the lips and ears. Through this transpa-
rent covering the progress of the pustules was observed to
become at once arrested, while those uncovered continued en-
larginnr. Moreover, a part of the covering having been destroy-
ed without being observed for some hours, the pustules thus
exposed immediately began to develope themselves until again
arrested by a reapplication. The ears, too, were now covered,
and the progress of the pustules stopped there. In a few days
the collection peeled off, the skin looking as after erysipelas,
but no cicatrices were to be observed, though in other parts of
the body they existed in abundance, the eruption having been
very confluent. \_Bull. de Therap., vol. xxxix, p. 369. Ibid.

Progressive Muscular Atrophy a new disease.

To Dr. F. A. Aran, of Paris, is due the credit of first calling
the attention of the profession to a formidable affection of the
muscular system, to which he has applied the name of Pro-
gressive Muscular Atrophy. That a disease of such striking
features, and so common as to have been observed by the author
eleven times in a comparatively short period, should have been
overlooked or not accurately studied before, can only be ex-
plained by its great resemblance to certain fornis of paralysis,
and by the tendency of the age to refer to the nervous system
all lesions of motion as well as of sensation. We must confess
that this has been our error in one case which came under our
observation, and which we now recognize very clearly as be-
longing to the class of affections treated by M. Aran. The
case to which we allude was that of a much esteemed profes-
sional brother, who, in the prime of life and the possession of a
vigorous constitution, perceived that he was gradually losing
the power to flex the thumb of one hand. The loss of the use
of the thumb having become complete, the finger next to it
be^^an to weaken and also became useless ; the middle finger
followed next, and thus, successively, all the fingers of that hand

1851.] Progressive Muscular Atrophy, 245

became powerless. The loss of voluntary motion invaded the
wrist, then the elbow, and finally all the muscles of the shoulder.
When it reached the elbow of this limb, the thumb of the other
hand began to give way precisely as the first had done, and the
disease progressed in this limb as it did in the other, until both
arms were left dangling as lifeless appendages to a robust
frame. It is worthy of remark, that such vv^as the slow pro-
gress of the malady that its ravages were not complete until
the lapse of, I think, two years ; that during the whole of
this time the patient's general health was perfect; that the
sensibility of the affected parts was entirely normal ; that he
suffered no pain ; and that the loss of motion regularly coinci-
ded with a complete atrophy of the muscles. The limbs and
shoulder blades appear completely emaciated and are soft and
flabby to the touch. Although about ten years have elapsed
since the occurrence of this affliction, he still enjoys fine health
and unimpaired mental powers, and is enabled to discharge
the duties of an active practice in the country. Sensibility
being yet perfect, he judges of the pulse as accurately as ever,
when his fingers are placed upon the artery by the assistant
who accompanies him.

Our friend was not only treated by ourselves, but also sought
the advice of most of the distinguished practitioners of the
United States, in vain. He submitted patiently to the trial of
every remedy and mode of treatment that had ever been re-
commended in paralytic aflTections, without any modification or
check of the disease. M. Aran, as will appear below, thinks
that galvanism will sometimes arrest its progress ; but it proved
unavailing in our case.

The very great length of Dr. Aran's monograph precludes
it from our pages, but we translate from the Archives Gener-
ales de Medecine (Oct. 1850) the following corollaries :

" 1. The muscular system may be affected with atrophy,
perverted nutrition, and probably a cellulo adipose transforma-
tion of the muscular fibre, independently of any lesion of the
central or peripheral nervous system and of impaired circula-
tion."

" 2. This atrophy may be partial, aflTecting a greater or less
number of the muscles of the superior extremities, or general,

246 Progressive Muscular Atrophy. [Aprils

invadinj^ nearly all the muscles of animal life ; but, in whatever
form it may occur, it is attended with the singular circumstance
that, in the affected limb, some of the muscles will retain their
perfect integrity in the midst of a large number of others which
have been destroyed and transformed."

"3. This affection usually shows itself first in the upper
extremities, and is characteirzed first by weakness and subse-
quently by emaciation of the parts implicated, by cramps, by
subsultus of the tendons, and by fibrillar contractions. The
morbid action terminates in the complete destruction f>f the
affected muscles and most probably in the transformation of
these into a cellulo-fatty tissue."

"4. This disease occurs sometimes spontaneously, without
evident cause, and in other cases follows violent and continued
action of certain muscles. It always affects the young, robust
and healthy, and never fails to prove, however limited, a fearful
infirmity."

*' 5. Its duration is usually long, its development slow and
progressive, and its termination almost invariably the com-
plete destruction of the muscular tissue affected. It rarely
remains restricted to the muscles originally invaded, but gen-
erally extends to others in the same limb, or shows itself in the
same muscles of the opposite limb.'^

"6. So long as the muscular tissue of the affected muscles
has not been completely destroyed or transformed into a cellulo-
fatty substance, the muscular fibre will retain its irritability and
electric sensibility. This is an important feature, for it may
serve to distinguish progressive muscular atrophy from other
affections resembling it, especially progressive paralysis unat-
tended with mental alienation and paralysis induced by organic
or traumatic lesions of the nerves."

" 7. When the transformation of the muscular tissue is com-
plete, no treatment will restore its integrity ; but before this,
the progress of the disease may possibly be checked by the
local application of galvanism to the muscles."

From the above, and especially from the first section of M.
Aran's corollaries, it will be perceived that the error into which
we, as well as others, have fallen, consisted in attributing to the
nervous system a lesion which really belongs to the muscular
system. Our author has had the opportunity of verifying his
positions by post-mortem examinations, and affirms that he ha
not been able to detect any lesion whatever of the nervous
centres, nor of the nerves themselves, in these cases. We are
aware that examinations of the kind are rarely satisfactory in

J851.] Collodion in Symbkpharon. 247

nervous disorders ; yet, when taken in connection with the ap-
pearance of the muscular tissue and the history of the disease
m question, we feel strongly disposed to assent to the patholo-
gical inferences of M. Aran. The subject is one eminently
worthy of farther investigation.

Collodion in the Treatment of Symblepharon.

The Bulletin Gen. de Therap. contains an ingenious plan
d-evised by M. Cunier for the relief of adhesions of the eyelid
to the eye. The indication being to maintain the lid everted
after cutting up the adhesions, sufficiently long to allow the
incisions to heal; this is accomplished in the following manner.
In adhesions of the lower eyelid, a narrow strip of linen moist-
ened with collodion is applied just below the eyelashes and
parallel with them, so as to secure two bits of thread placed
transversely beneath the linen with their free extremities hang-
ing down. A similar strip, with threads beneath, is fixed over
the malar bone. When entirely dry, the threads from above
are tied to those from the cheek, sufficiently tight to depress or
evert the lid, and to maintain it so. In adhesions of the upper
eyelid the second strip should be placed upon the forehead, for
the p'urpose of drawing up the eyelid w^hen the threads are tied.
M. C. reports several cases in which this plan was entirely
successful. In two of the cases the eversion was maintained
nine days, and for three weeks after only a few hours each day.
In another, six days sufficed. The eye is to be protected from
dust by a thick veil or shade.

Remarks on the use of Bromide of Iron. By Edward Gil-
lespie, M. D., of Brady's Bend, Pa.

Having been practising medicine for some five years past
in the neighbourhood of Freeport, in Armstrong county, in
this State, where a considerable quantity of Bromine is manu-
factured, I have been led to somewhat extensive employment
of a ferruginous compound of this article, the results of which
have proved so satisfactory, that they may perhaps be not
destitute of interest to the readers of the Examiner. The com
pound which I employ is a bromide of iron of my own
preparation, and this is the only form in which I use the

248 Remarks on the use of Bromide of Iron. [Apri^j

bromine. It has now in nny hands entirely taken the place of
ir:)dine, appearing to me to meet all the indications for which
that medicine has been exhibited, and with much greater
efficiency. Indeed, the bromide has become one of my indis-
pensables in practice, hardly subordinate in importance to my
calomel or opium.

The cases in which I have been in the habit of using it are
scrofulous tumours, inflammations of the glands, both acute and
chronic, erysipelas, suppression of the menses, tetter, and in
most cases where chalybeates are administered. Enlargement
of the parotid, submaxillary, or cervical glands, whether from
scrofula or other causes, I have never yet failed to discuss,
provided they had not progressed to suppuration ; and I may
speak from an experience of not a few cases, and many of them
of long standing. When suppuration does take place, the dis-
charge soon ceases after lancing, and the orifice quickly heals
by apf)lying a solution of the bromide over the surface occu-
pied by the tumour, and keeping a small plaster of basilicon
ointment on the orifice. My method of using it in cases of
tumors is to apply a small portion immediately over the tumour
twice a day by means of a feather, and at the same time to ad-
minister it internally, commencing with eight or ten drops
morning and evening in half a teacup of cold water, in-
creasing a drop or two every day until nausea is produced,
(which may be termed the point of toleration.) The dose is
then to be reduced five or six drops and continued. This is
the invariable rule I lay down for its internal use. I have given
it to advantage in cases of felon, where a red and very painful
streak would run up the arm, causing inflammation of the
axillary glands with general febrile symptoms. Some of these
cases present rather an alarming appearance for a time, but
have always terminated favorably in my hands by a strict
antiphlooisiic treatment, and the use of the solution as a local
application to the inflamed arm and glands.

Last spring an erysipelatous epidemic raged in a district of
the country north-west of this, proving extremely fatal, and
causing considerable alarm in the section where it prevailed.
It exhibited quite a preference for the fair sex, nine-tenths of
those attacked havinf]: been females. The first symptoms were
chills, followed by a high grade of fever and sore throat ; from
24 to 36 hours after the attack, the throat became so much
swollen that deglutition was very painful, and in many cases
entirely impeded. The breathing was very laborious. The
tongue was also much swollen, so mu< h so as in many cases
to protrude from the mouth with an extremely thick black coat
on the upper surface. In this stage it was generally called

1851.] Remarks on the use of Bromide of Iron. 219

" black tongue." In from 48 to 72 hours from the commence-
ment of the attack, when it pursued its 'natural course, the ears
became red and inflamed, the redness and inflammation ex-
tending rapidly over the face, head, neck and shoulders. The
eyes became entirely closed, the nose nearly covered by
the swollen cheeks, the lips puffed out to an enormous extent,
and the head, to use the expression then common, "as big as a
bushel." Perhaps an idea may be conveyed of their appear-
,ance by likening it to that of persons drowned in warm weather,
whose bodies have remained in the water a week or two, with
the face and head painted scarlet after being removed. When
they arrived at this point they were vulgarly termed "swell
heads."

Occasionally the disease Avould appear on one ear and extend
over the face to the median line. When this was the case, one
side of the face would be swollen and the other perfectly
natural, which gave the patient a very grotesque appearance.
it would not remain long in this situation, however, until the
sound ear would become red and the disease would soon hasten
across the face to nieet its companion.

When it did not appear on the skin or could not be brought
out by artificial means, the patient generally died in a short
time from suffocation. But it could in nearly all cases be
brought out by the use of some highly stimulating lotion or the
the application of a fly blister to the neck. Still the danger
was imminent either from sloughing and gangrenous inflamma-
tion of the cellular tissue, or a transfer of the disease to the brain.
The patient, by external revulsion, was generally enabled
to swallow, which of course was a strong point gained, and by
the judicious use of internal remedies and proper local applica-
tions he now generally recovered. I must not omit to state
that I found the fee use of the lancet eminently serviceable
whenever the state of the pulse required it.

With regard to local applications, I may say that I experi-
mented with a variety of articles. In one case I applied
exclusively the acetas plumbi in solution in another the
ethereal tincture of iodine, in another strong mercurial ointment,
in another solution of corrosive sublimate, and finnlly the
bromide of iron in solution. The progress of these diflerent
applications I watched for a couple of days, the internal treat-
ment being the same in all. The acetate of lead appeared to
have no influence on the disease whatever. It progressed as
rapidly as though nothing were applied, although the solution
was as strong as an ounce to a pint and a half of water, and kept
constantly applied by means of muslin dipped in the solution.

The tincture of iodine appeared to do better it retarded but

250 On Lupus, [April,

did not arrest the disease. It was also strong, half an ounce to
a pint of ether. The blue ointment I had tried previously in
sporadic cases with a certain degree of success, but in this
case it appeared to act but feebly.

The solution of corrosive subhmatehad no other effect, than
to produce violent salivation in four or five days after its appli-
cation.

The bromide of iron entirely arrested the disease in forty
hours from its first apphcation. I used it in all cases afterwards
very successfully, by applying it two or three times per day to
the parts affected, and extending it one or two inches over the
sound skin, and the constant application of cloths wrung out of
a solution of acetate of lead.

I have no very accurate formula for the solution of bromide
of iron that I make use of. I put three ounces of bromine into
ten ounces of water, then add four penny nails, which are
about enough to take up all the bromine. If any are left, after
the bromine is all taken up, I take them out, and add free bromine
'as long as it will be absorbed ; if too much is added, I put in a
nail or two to take up the surplus. It makes a dark liquid of an
acid and styptic taste, which turns brick red when applied to
the skin. This is the solution which I use.

[The bromide of iron (which is a a hydrobromate of the
protoxide) is liable, like the iodide, to partial decomposition
from the oxygen of the atmosphere, free bromine being genera-
ted, and sesquioxide of iron deposited. It should, therefore,
for internal exhibition, be protected by saccharine matter. Mr.
Dillwyne Parish, of this city, has made, at our suggestion, a
solution of the salt, with sugar, after the subjoined formula:
"Take of Bromine two hundred grains ; Iron Filings, eighty-
five grains; Distilled Water, fowr and a half fluid ounces;
Sugar, three ounces. Mix properly. Dose, ten minims, to be
repeated and gradually increased, ten minims containing a
grain of the bromide."] Medical Examiner.

On Lupus. By M. Cazenave.

M. Cazenave rejects the term lupus exedens of Rayer, inas-
much as every lupus is exedens, this being the essential charac-
ter of all forms of it. What has given rise to the term is the
fact that there are two principal varieties of lupus, the ulcerated,
and another in which instead of ulceration there is hypertrophy ;
but this latter form is no less destructive, and after a cure,
though no solution of continuity has taken place, there is yet
loss of substance and a cicatrix. With Biett, Cazenave admits
the form of lupus which destroys the surface, that which pene-

1851.] Operation for Ingrowing Toe Nail. 251

trates deeply, and lupus with hypertrophy, forms indeed
which are sufficiently well known. There is, however another
form more rare, hitherto described incompletely and classed
improperly, it being the erythema centrifuga ot"Biett,and since
his time placed among the erythemata by all writers, although
in fact it is a lupus. It especially attacks young women when
appearently. in good health, and affects the face in preference,
commencing by a point, and enlarging excentrically. It gen-
erally exists in the form of red, round patches, of two or three
centimetres in diameter, the edges of which are much raised,
and the centre depressed; the redness is of different shades,
and disappears under pressure. When cured, each patch
becomes a depression (the depression of the cicatrix being
proportionate to the given hypertrophy of the spot) implying
a prior loss of substance, though no breach of surface had
existed ; and it is on this ground that M. Cazenave terms
the diseased Lupiis erytheniatos2is. The disease is to be
treated by sudorifics, as guiacum, and locally by the tar oint-
ment, or by more or less irritating resolvents, in proportion to
the depth of the central depression. One of the best applica-
cations is from 1 to 4 of the iodide of mercury to 30 of oil. applied
to the part every day or every other day with a pencil. The pain
caused by it is great, but the resolution of the tubercle is fre-
quently soon accomplished. Gaz. des Hop, No. 91. Med. Chi.
Review.

Operation for Ingrowing Toe-Nail. By M. Baudens.

M. Baudens states, that he has performed the following opera-
tion more than 200 times without accident of any kind, little
pain being caused and that only for a few seconds. The right
hand is armed with a narrow, straight bistoury, held like a
knife when cutting a pen. The free extremity of the toe is
firmly fixed by the thumb and index finger of the left hand, so
as to render the diseased part prominent. The operator now
carries the edge of his knife (on the outer or inner side of the
phalanx according to the situation of the disease, and equidistant
from the root of the nail and the next phalanx) perpendicularly
down to the bone, and then inclines it towards himself, shaving
the phalanx, and carrying off at one stroke the degenerated
soft parts, the diseased portion of the nail, and the coriespond-
ing portion of the matrix, the removal of this last being
indispensable, in order to render the reproduction of the disease
innpossible. For two or three days he keeps the parts sur-
rounded by ice (which however, is no essential part of the plan,
but his mode of treating recent wounds in general,) when
granulations spring up, and eventually a horny description^ of

252 Varicose Veins Orchitis. [April,

cicatrix, forms an excellent substitute for the naW.Gaz. des
Hopitaux, No. 77. Ibid.

Enlargement of the Aponeurotic Orifice of the internal Saphena
Vein in cases of Varicosed Veins of the Legs.

We condense from the Bulletin Gen. de Therap. the follow-
ing particulars in relation to this operation, which was performed
a few years ago by M. Herapath, of Bristol, but a full report of
which was not made. M. Malgaigne has recently performed
the same operation, and reports the case as follows :

J. D., aged 26, was admitted into the hospital in July, 1850.
The internal saphena vein of the leit side was varicosed, and a
varicocele also existed upon the same side. Both these affec-
tions commenced at the age of seventeen, and had increased to
such an extent as to prevent the patient from pursuing his occu-
pation. The internal saphena was varicosed IVom the internal
malleolus to the point at which this vein passes through the
aponeurotic orifice into the femoral vein. There were several
tumors along the course of the vein, formed by its tortuosities.

The varicocele was quite large, the testicle a little atrophied,
and in the engorged epididymis was a tumor the size of a small
nut. The operation was performed on the 21st of July. The
patient being placed upon his back, the leg flexed and turned a
little outwards, an incision was made over the saphena orifice
and parallel with the course of the vein. The parts were care-
fully dissected until the fibrous band of the orifice could be
distinctly felt. A grooved director was passed beneath the
fibrous band of the ring, and an incision made upwards through
the band. Considerable inflammation and a rupture of the
vein ensued. The wound, however, was cicatrized the twenti-
eth day. The patient left the hospital seven weeks after the
operation, very much relieved, though not entirely cured. The
tumors along the course of the vein had very much diminished
and the varicocele entirely disappeared.

Orchitis treated hy Laudanum externally.
The Journal des Connaissances relates the following cases of
Orchitis, relieved by the application of laudanum :

Case I. M. V., 22 years of age, of good constitution and
sanguine temperament, during the course of an acute urethritis
was attacked with orchitis of the left side. Compresses, moist-
ened with laudanum, were constantly applied to the part. In
two days the pains had entirely disappeared, and upon the
seventh the testicle had resumed its normal volume.

1851.] Miscellany, 253

Case II. J. M. B., a coachman, 43 years old, of a nervous,
sanguine temperament, received a kick upon the right testicle,
from which resulted a traumatic orchitis. Compresses, moist-
ened with laudanum, were applied : the pains ceased the next
day, and the sweUing in six.

Case III. M. Mar, ap:ed 27 years, of a feeble and lymphatic
constitution and bilious temperament, had a double orchitis de-
veloped in consequence of an injury. The testicles were very
large and very painful. The pains ceased in fourteen hours
under the application of laudanum, and upon the fifth day the
patient was entirely relieved.

Case IV. M. S., aged 20 years, of very nervous tempera-
ment, was affected with a blenorrhagic urethritis. The same
treatment was adopted. The pains disappeared upon the third
dav, and a radical cure was accomplished upon the seventh.

Case V. M. F., aged bi; good constitution, nervous tem-
perament, had orchitis of the right side in consequence of an
injury. Same treatment : cessation of the pains in two hours,
aud a radical cure in four davs.

ill i 0 c c 1 1 a n rj .

Notices of New Books. We are indebted to those enterprizing
publishers, Messrs. Lindsay & Blakiston, (through Jos. A. Carrie 6:.
Co., of this city,) for the following works :

Ether and Chloroform : their employment in Surgery, Dentistry, Mid-
wifery. Therapeutics, Sj-c. By J. F. B. Flagg, M. D., Surgeon
Dentist, &c. Philadelphia: Lindsay & Blakiston. 1651. pp.189.
This little book is written in an agreeable style, and well calculated
to produce confidence in the use of anaesthetics, especially of sulphuric
Ether, which the author seems to prefer to all others.

The Medical Student's Guide in extracting Teeih ; tcith numerous
cases in the Sur^iical branch of Dentistry, with Illustrations. By
S. S. HoRNOR, Practical Dentist. Philadelphia: Lindsay &^ Blak-
iston. 1851. pp. 76.

We are here presented in a convenient form the principal instru-
ments used for extracting teeth, an estimate of their relative value,
and directions for using them judiciously.

The Half Yearly Abstract of the Medical Sciences. By W. II.
Ranking, M. D., &c.. &c. July to Dtcembtr, 1650. Lindsay
&; Blakiston's re-print.

This is always a welcome visitor, bringing in a compact form the
doings medical of the last six months. The present number is not as
complete as its prcdecessors, owing to the Editor's domestic atllictions.

254 Miscellany, [April,

We doubt not, however, that the work will sustain its well established
reputation.

Importance of Latin and Greek to the Physician, While it would
be preposterous to deny the great importance of a classical and re-
fined education to physicians as well as to the other learned professions,
and indeed to all men, we must acknowledge our belief that, under
existing circumstances, it is impossible to carry out the recommenda-
tion of the American Medical Association in relation to the dead lan-
guages. The editor of the Transylvania Journal indulges in the fol-
lowing sarcasm on the subject :

" It has always appeared to us as a laughable absurdity for the
Association to be so gravely emphatic on the subject of 'the classics,*
while not a tithe of them can master a chapter of Viri Romae, or
stumble through a forced version of the first paragraph in the " pons
asinorum.' Tiiat the amount of I^atin and Greek which is usually
cudgelled into a boy's brains, through some mysterious route beginning
at the posteriors, may be of no vital disadvantage to him when he has
tossed his Virgil to the jakes, shaken his fist under the pedagogue's
nose, and turned medical student, we cheerfully admit, with a proud
reference to the small stock of Latin maxims which we have preserved
from the ruins of a 'classical education,' and which we refresh when-
ever our pedantic vein approaches, by reference to a dictionary of
quotations.

" We commenced the study of the profession with a full faith in the
extent and profundity of our classical acquirements, and, possibly,
might have passed muster before a committee of the National Asso-
ciation ; but we found to our consternation that Tityrus and Melibeus
were asses in the matter of pukes and purges, and, alas ! not a word
of squirts and clysters, or of medical reform, was to be found from one
end of Tooke's Pantheon to the other, and the naked gods and goddess-
es were utterly worthless even for the purposes of the dissecting room,

" We shall insist, whenever the Greek and Latin clause is brought
before the Association again, upon the members being put through
their moods and tenses, and a parsing 'spell.

" Gentlemen may therefore anticipate an opportunity of displaying
the tattered remnants of schoolboy erudition ; and we would advise
every one to stuff the old, and much sworn-at grammar in his port-
manteau, and to go through a course of sprouts with some strong armed
disciplinarian, in order to revive those early and fresh ' classic' mem-
ories which are so closely allied to the penitential visitations of the
much abused seat of honor."

Diet Drink. In the spirit of our motto, we do not hesitate to " adopt
what is good wherever we may find it." We therefore present our
readers the subjoined recipe, which has been extensively used by the

1851.] Miscellany. 255

unprofessional in this city, and in many instances with the most signal
advantage. It is said to have been first introduced by some of the
emigrants from the French West Indies many years ago. The pro-
fession will recognize in it the principal features of the Lisbon" Diet
Drink and others of the class. We will not stop to canvass the hete-
Togeneousness of the compound nor the apparent incompatibility of
"^he ingredients. It is especially recommended in scrofulous and
syphilitic affections of a chronic character, and also in chronic rheu-
matism and old ulcers ; the calomel being omitted in cases attended
with no syphilitic taint. It is certainly far preferable to the various
nostrums sold at exorbitant prices as "syrup of sarsaparilla,'' and
which for the most part contain not a grain of sarsaparilla.

Sarsaparilla, cut up and bruised ^

Sassafras root, cut up, > of each - - 12 oz.

Guaiacum shavings, j

"Mezereon, ....... ^ oz.

Pour four gallons of boiling water upon the above ingredients, cover
the vessel, let it stand 24 hours, and then add

Carbonate of Potash, 6 drachms

Pulvd. Crude Antimony, ? r u i j u

., " V of each - - - 1 drachm.

Alum, 5

The two last articles to be tied up separately in a bit of old linen

then boil until reduced to one o-allon. About 15 minutes before taking

off the fire, add

Coriander seed, 6 drachms.

Senna, - - - - - - - i oz.

Calomel, (tied up in linen,) - ... 1 drachm.

When the tea is perfectly cold, strain through a cloth, bottle, and

keep in a cool place. Of this the patient should take ^ pint an hour

before each meal. It may be sweetened if desired with sugar-house

syrup. The patient should take it at least 6 weeks and the tea be

made fresh whenever the supply is exhausted.

During this treatment the patient should avoid salted provisions of

all kinds, spices, and all irritating articles of food or drink ; and should

also avoid exposure to cold or wet weather. The best diet is plain

bread and fresh meats of any kind, save pork.

Physicians in Erie County. It seems that in Erie County, (Pa.)
there are 79 practitioners of medicine. " Of that number, twenty are
members of the county medical society. Six are graduates of re-
spectable schools, who are not memhers. Ten who are neither grad-
uates nor licentiates are considered respectable practitioners, as they

256 Miscellany, [April*,

practise the profession to the best of their ability, in accordance with
the principles of the orthodox system, without resorting to any of the
devices of quackery to obtain business. Thirteen who profess to be-
long to the regular system are, both by their education and practice,
the veriest quacks in the country. Four who practise Homoeopathy,
Allopathy, or anything else by which they can obtain a share of the
* loaves and fishes.' Two 'Simon pure' Homoeopathisls. Four
Uroscopists. Three females, who are without any education, but
who pretend to practise the various departments of the profession.
Five ' eclectic or reformed 'practitioners.^ Ten ' Botanic, Thomsonian,
or Herb Doctors.' " Vive la Bagatelle!

The Ravages of Consumption and other leading Diseases in Boston
for Jive years. Mr. Simonds, the City Registrar, states that for five
years ending 1850, 250 persons have been accidentally killed in
Boston, 116 have died of apoplexy, 1.484 of disease of bowels, 26J
of disease of bladder, 156 of congestion of brain, 2,838 of consump-
tion, 461 of convulsions, 449of croup, 101 of cancer, 612 of cholera,
286 of cholera infantum, 148 of canker, 267 of childbed diseases, 310
of diarrhoea, 965 of dysentery, 325 of dropsy, 675 of dropsy on the
brain, 137 drowned. 49 delirium tremens, 166 erysipelas, 728 scarlet
fever, 738 lung fever, 1,237 typhus fever, 108 brain fever, 224 hoop,
ing cough, 296 disease of heart, 103 intemperance, 1 302 infantile
diseases, 113 liver diseases, 434 inflammation lungs, 395 of maras-
mus, 465 measles, 389 old age, 116 pleurisy, 146 palsy, 17 rheu-
matism, 43 disease of spine, 57 scrofula, 59 suicide, 349 small-pox,
463 teething, 74 tumor, 28 ulcers, and 36 worms.

Mortality of Boston in 1850. From the Report of the City Regis-
trar for 1850, it appears that the total number of deaths for that year
was 3667, being about 1 in 38 inhabitants. 586 died of consump-
tion alone.

Mortality of Lowell in 1850. The number of deaths in this ci;y
during the last year was 492.

Davey on the Ganglionic Nerves. Having presented our readers
the views of Marshall Hall on the cerebro-spinal system, we are hap-
py to have it in our power to offer them those of Mr. Davey in relation
tp the Ganglionic Nerves. They constitute a sort of complement to
the studies of Hall, and will doubtless be read with much interest.
Mr. D. is evidently a profound thinker, reasons well, and conveys his
ideas lucidly. The study of the nervous system is so important and
so attractive that we hope to be pardoned for giving to it so many of
our pages.

1851.] Miscellany. 257

American Medical Association. We are requested by the Editors
of the Charleston Medical Journal to state that the American Medical
Association will convene at Charleston on i\\ei first Tuesday of May
next, instead of the second Tuesday, as was erroneously announced
in their advertisement.

Medical Society of the State of Georgia. The annual meeting of
this Society will be held at Atlanta, on the second Wednesday of this
month (April). Dr. Arnold, of Savannah, was appointed to deliver
the Address and Dr. Le Conte, of Macon, the alternate. The well
merited reputation of these gentlemen will secure a literary as well as
a professional treat to those who may attend. The facility with which
Atlanta may be reached from a great portion of the State will enable
a very large number to assemble.

Medical College of Georgia. The course of Lectures in this Insti-
tution was closed on the last day of February, after a session of four
months, during which there occurred not the slightest incident to mar
the good feeling which prevailed between the Faculty and Students,
nor to lessen the high esteem in which the class has ever been held
by the community. There were in attendance 159 gentlemen, of
whom 127 were from Georgia, 13 from Alabama, 12 from South
Carolina, 2 from Mississippi, 1 from Ohio, 1 from Tennessee, 1 from
North Carolina, 1 from Kentucky, and 1 from Arkansas.

Fifty members of the class, having complied with all the requisitions
of the College, were graduated on the 4th day of March. The
Doctorate having been conferred by Ex-Governor Schley, a very ap-
propriate, chaste and creditable address was delivered by Dr. C. T.
Quintard, of Cobb county, and a valedictory full of warm-hearted and
touching sentiments by Dr. R. E. J. Thompson of Burke county.
The following is a list of the Graduates.

J. P. McCord, Columbia County, Georgia.

James T. Reid, Union " "

Rodney Burke, Burke " "

Etheldred E. Jones, Early "

Robert H. Oakman, Augusta, "

John G. Mathis, Burke " *

Wm. Johnson, DeKalb " "

Isaac R. Eskew, Pike " "

A. P. Allday, Lumpkin " "

F. R. Boll, Oglethorpe " **

258

Miscellany,

[April,

A. L. Patten,

Flovd Cou

nty.

Georgia.

Wm. A. J. Anderson,

Cobb

((

((

R. W. Oliver,

Scriven

u

((

J. T. Groves,

Cobb

((

<(

Wm. S. Harden,

Savannah,

((

Green H. Hunter,

Warren

11

c

J. C. Buchanan,

Talbot

n

it

R. E. J. Thompson,

Burke

ii

it

Isaac B. Hall,

Baker

11

n

D'Coucy Antony,

Burke

((

a

Jas. M. Young.

Cobb

((

t(

Sterling B. Simmons,

Augusta,

Wm. A. Roll,

Augusta,

a

Hezekiah Witcher,

Meriwether

((

a

Jno. G. Williams,

Greene

i(

ii

R. A. Dickinson,

Baker

n

ii

N. F. Howard,

Lumpkin

it

a

M. P. Deadwyler,

Madison

((

a

M. Spencer Durham,

Oglethorpe,

ii

Jno. L. Hughes,

Floyd

ii

a

Benj. F. Bentley,

Lincoln

it

Sterling Gibson,

Warren

n

it

John J. Cooper,

do.

ti

it

H. J. Gait,

Cherokee

ii

it

Wm. M. Standifer,

Early

ii

it

F. W. Schley,

Augusta,

it

Berthier B. Bailey,

Columbia

l(

ti

A. A. Jernigan,

Greene

u

it

Z. P. Landrum,

Lexington,

it

Wm. P. Ragland,

Meriwether

ii

ti

Wm. C. Sheridan,

Talbot

ii

ti

Samuel Boyd,

Washington

ii

ti

Wm. L. Miligan,

Dale

ii

Alabama.

R. P. H. Heacock,

Taledaga

ii

((

W. L. Heflin,

Randolph

i(

(

Jas. I. Lamar,

Autauga

ii

it

Oliver P. Mangum,

Henry

ii

ii

Jas. H. Latimer,

Laurens District,

So. Carolina.

Wm. T. West,

Edgefield

ii

((

Thos. J. Young,

Monroe County,

Tenn.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. MAY, 1851. IJVo. .

PART FIRST,
rtginal (Hoinmunirationa.

ARTICLE XIV.

Scarlet Fever its Symptoms, Consequences, Causes, and Treat-
ment. By H. A. Ramsay, M. D., of Calhoun, Geo.

The views promulged in this article are derived from facts
personally observed in more than four hundred cases of the dis-
fease in question. We claim not to he an innovator, but we boldly
aver that much error exists in the therapeutic management
of scarlet fever, attributable, in all probability, to a misconcep-
tion of its pathology. It is quite probable many may take issue
with our views and inductions; to such, we say, try our
suggestions, and if your expectations and my promises are
not verified, after a fair and unbiased trial, condemn the
practice and repudiate the positions assumed. The term
scarlatina which is the technical word for scarlet fever, elicited
at one period a long and spirited controversy among medical
men ; many repudiated it as unmeaning, unclassical and vulgar;
among them stand the names of J. Mason Good, Heberden,
Huxham, and De Haen, while Willan and Swediaur, equally
learned, retained it. This war of words, in reference to terms,
had the good eiTect of drawing; the diagnostic lines of scarlatina
to a focal point, and ere it ended, it would have been deroga-
tory to any physician to have considered it, as formerly,
synonymous with measles. At this day usage and common
consent have affixed to the disease the technical term Scarla-
tina. The history of scarlet fever is interesting alone from its
obscurity. There is said to be some smattering allusion to it m

N. S. VOL. VII. NO. v. 17

269 Ramsay, on Scarlet Fever. [Ma}%

the writings of Paulus Egina, Avicenna, and Rhazes, but as it
was common in those days to confound measles with small-pox,
and scarlet fever, doubtless, with measles, it is extremely dubi-
ous to what they alluded in the vague passages referred to, to
establish this point. The probability is strong that scarlet fever
was transported to Europe fiom Africa. The first epidemic we
know of was in Spain in 1610, and it raged with violence in
Naples in 1618. In 16S5, it begnn its ravages in London, and
in 1735, it made its way to America, here its history is
sufficiently known to merit no notice from our hands. As
previously remarked, there is great obscurity, hovering over
the history of scarlet fever. We have already stated our
surmises in reference to it. Some now suppose that Ingrassias
wrote an article upon it in 1556; there is no kind of evidence
to sustain this presumption, and the most plausible fact as to a
description of the disease, is, that Prosper Martianus, an Italian
physician, wrote an account of its prevalence in Rome, about
the middle of the seventeenth century. We will not pursue
these historic details farther ; they are of no practical utility,
and we will dismiss this part of the subject.

Symptoms. Most writers upon this affection divide it into,
Scarlatina simplex S. anginosa, S. maligna. Here we join
issue with the profession, and denounce the division as non-
existing, unmeaning, and unpractical. There is no such divis-
ion founded upon any facts in the Symptomatology of the
disease. From whence then is it derived ? We challenge
the whole mass of the profession from Maine to Texas, to ex-
hibit a case of scarlet fever free from anginose ailment in some
form or other. No man has ever seen such a case, ii is a non-
descript, in scarlet fever. This name is one of the many
errors of modern conventionalism, which is an odium to medi-
cine, and a disgrace to science, working out no practical
good, but achieving much therapeutic injury. Anginose Scarlet
femr, a distinct form of the disease! oh ! fie I A leopard may
as well undertake to change his spots, as scarlet fever to be
exempt from sore throat. And we aver it, frankly and without
the fear of successful contradiction, that no man in the South
ever saw, or ever \\\\\ see, a case of scarlet fever with an

1851.] Ramsay, on Scarlet Fever. 261

entire freedom from anginose disease in some form. This
symptoni is purely one of the diagnostic signs, and we have
no idea the disease ever existed independent of it, and we envy
no man his discrimination, who would pronounce a case scar-
latinous, in the absence of this symptom. We have a division
of ihe disease, we greatly prefer to any we have seen, but we
do not claim for it, entire immunity from error, but it is cer-
tainly more applicable and expressive of the various j)hases of
scarlet fever, than the old division of varieties. We present
it and act upon it the reader is free to reject or adopt it, in
consonance with his better judgment and tastes. Here it is:

Scarlatina Simplex.
" Gravis.

" Gravior.

Scarlatina Simplex. This is decidedly the mildest form of
Scarlet fever, it rarely confines the patient to bed, indeed the
symptoms are now and then so simple, that it passes ofFvirtually
incognito. The patient complains of a little weariness and is
stretchy, slight nausea sometimes, pain about the head, slight
redness of the eyes, a gentle increase of pulse, with a burning
of the surface and a little soreness of throat ; the tongue is
furred and covered with red dots; in a day or two, often the
first twenty four hours, the fjice, breast and arms, are covered
with a scarlet rash, which is commonly in a short time dif-
fused over the surface. The case passes along for three or
four days, and the pulse- softens, the rash disappears, the skin
begins to peel ofi', and the patient is well, unless some of the
sequelae should come up, or some other issue arise. The patient
does not even retire to bed in many t)f these cases, but is up
about the house, and attending to usual avocations. The most
complained of is usually the throat, it is red inside, swelled, and
swallowing rather difficult.

Scarlatina Gravis. This is an exacerbated form of the pre-
ceding, accompanied with greater intensity of symptoms, and
more retardation of the rash. The patient has chilhness, lan-
guor, pain in the head and eyes, pain in the jaws, sore throat,
impeded respiration, and difficult deglutition ; the fauces and

262 Ramsay, on Scarlet Fever. [May,

tonsils are swollen, the tongue furred, some nausea, the pulse
quick and accelerated, skin hot and burning ; about the fourth
day a scarlet eruption appears upon the face, chest and arms,
which soon difluses itself, intercurrently or distinctly. These
symptoms continue for several days, with excited pulse ; thirst,
pain in the head, slight delirum at night in some cases, highly
colored urine, swelled throat, externally and internally ; the
bowels loose or constipated and appetite perverted when the
pulse will probably begin to decline in velocity, if the case is fa-
vorable, the skin becomes soft, desquamation ensues, the rash
gradually disappearing, and all the functions are restored to
their former balance. This form may, however, run into the
graver form of the affection, assume all its obstinancy and pro-
tean appearances, and confine the sufferer to bed for many
days, or even weeks. The patient is commonly confined to
the house with this variety ; prudence demands that he should
keep in doors, as well as necessity. There is generally a dis-
charge of tough, viscid phlegm in iS. gravis, which is painful to
discharge and hard to extricate from its lodging place ; the
nose also discharges a yellowish fluid, which sometimes cor-
rodes the nostrils, and not unfrequently the nostrils dischaj-ge
blood in the evening paroxysms. While an examination of the
throat will exhibit the fauces and tonsils covered with whitish
yellowish patches, and also the rash, peculiar to the surface,
will be found inhabiting the palate, cheeks (inside), lips, &c.

During the mornings, the paroxysm of fever partially lessens,
but in no case have we fever seen a complete remission of fever
in this disease, during its exanthematous existence.

Scarlatina Gravior. This is the most protean form of
Scarlet fever; there is a.positive increase of all the symptoms
incident to the form just described, with the addition of a
considerable typhoid tendency. The throat is sore, the glands
swollen, sometimes even with the chin ; the tonsils and fauces
covered with dark filthy looking and apparently gangrenous
patches; the breath oflTensive ; the skin hot and burning; pulse
rapid, often from 120 to 160; the efllorescense upon the skin is
evanescent, changing from time to time in color and quantity ;
the system is prostrate ; hands tremulous ; breathing oppressed ;
swallowing quite difficult, and almost impossible ; the skin looks

1851.] Ramsay, on Scarlet Fever. 263

'

purplish in some cases, from a retrocession of the rash ; the
tongue is dark and fissured ; the teeth and gums covered, in
many cases, with sordes. The patient may be delirious or
comatose, oftenest the latter; the cheeks of a dusky red color,
the eyes suffused with a mucous like fihn, the features are often
swollen and distorted, the throat will frequently discharge ex-
tensive sloughs, the nose will discharge, the ears run offensively,
the eyes run and then bleed from the corners ; the skin will
become echymosed and assume a purpura hemorrhagica ap-
pearance, the bowels may take on a diarrhoea, the lungs become
inflamed, the brain hyperaemic or softened ; in short there is
no accounting for w^hat will supervene in every case of scarla-
tina gravior. We have now given, as briefly as possible, all
the most prominent signs of the various grades of scarlet fever :
we may have omitted some few general or unimportant symp-
toms our limits would not suffice for a minute treatise ; but
we have endeavored to record all the usual signs of diagnostic
importance. The sequel of scarlet fever is attended in a large
number of instances with many unpleasent consequences.
Probably no affection in the whole catalogue of diseases has so
many sequelae attached to it. Deafness will follow it in all its
horrors ; neuralgia, with its painful traces, is frequently a sequel ;
swelling ofthe glands of the throat and suppuration follow in their
train, chronic disease ofthe bowels is a very common visitor at
the shrine, while dropsy occurs in a greater number of cases
than all combined ; its usual form is anasarca, but by no means
invariable, as we have seen ascites and hydrothorax in many
instances. There are many anomalous sequences, which will
meet the eye of the physician, while it is not necessary to ad-
vert to, but when seen, can be easily attributed to a motive
principle.

Causes. The causes of scarlet fever, like its history, are
buried in an obscure latitude, and are probably beyond the
reach of legitimate investigation. We have our views upon
this subject, but they may be erroneous. We believe scarle*
fever is dependent upon some morbific, atmospheric principle;
which, when taken into the system, expends its poisonous influ-
ence upon the glandular and sanguiferous systems, inducing

264 Ramsay, on Scarlet Fever. [May,

those glandular enlargements and exanthernatous eruptions,
which we observe in scarlet fever. Tliese are my crude no-
tions of scarlet fever. We may err. Space will not permit us
to discuss the question. If any man doubts our position, let
him refute it, or show a more plausible one. Scarlet fever is a
disease mostly incident to children; they are not exclusively,
however, the victims of attack : we have often seen it in adult
life. The disease is common to winter and spring, but is not
strictly confined to any season. The worst epidemic we ever
witnessed, was in the summer months. The mortality of scar-
let ^QVQY varies very considerably. We remember going
through three epidemics: in the first we lost no case; in up-
wards of 100, in the second, we lost three ; in about 208, in the
third, we lost none. In several epidemics, which have passed
tinder the observation of other physicians, whom we knew to
be men of prudence, the moitality was immense. The mortali-
ty, we think, is mainly attributable to the remedial manage-
ment. Of course some cases will die of any malady, but many
might be preserved by careful discrimination, and a just appli-
cation of pathological facts. The child bears scarlatina tolera-
bly well the adult remarkably well. The mildest cases are
surest to have the worst sequelae, as a general rule. A previous
attack of scarlet fever ensures a secuiity against future attacks ;
we have seen a single exception. We would also remark, an
attack of scarlatina affords a shield from measles, to some ex-
tent, but not vice versa.

The contagiousness of scarlet fever is a mooted point. We
are an advocate of the doctrine, although our credulity has been
staggered. In 1840 we had it, but no other member of our
family, consisting of seveial, among them, two or three chil-
dren. We saw another patient have it in a family of fifty or
more in number ; no one else in the family had it. In our own
case, we feel certain we contracted it from a patient we had,
although we had passed through an epidemic professionally, and
(one before we entered the profession) prior to 1846, intact.
^he second case, in the family of fifty, we feel confident im-
bibed the disease from a patient we had near by the family resi-
dence. There are many conflicting arguments and facts, pro
and con, as to the contagious character of scarlet fever, but we

1851.] Tl^msSiy, on Scarlet Fever. 265

believe the mass of evidence will preponderate in the affirma-
tive. Scarlatina may prevail sporadically or epidemically;
the latter phase is the ordinary appearance it assumes among
us. Now it is said, by some writers, that scarlet fever ever
has an eruption. This we conceive a mistake; it not unfre-
quently happens that cases occur without the semblance of an
eruption, and with but little efflorescence of the surface. It is
true, these cases are rare, but they have doubtless been seen by
all men of experience ; but we venture again to assert, that no
man ever saw a case of scarlet fever exempt from disease of the
throat to some extent. To assert the adverse is a fallacy, and
not to be received only from the highest authority, and we
should question it as a designed subterfuge to gratify some
vain presumption, even from that source.

Having now briefly exemplified the causes, and some of the
collateral circumstances attendant upon scarlet fever, we will
descend to the treatment, with the remark, it has been our pri-
mary object, in this paper, to avoid discussion, to pass by the
relative opinions ot^ others, and to give our own views and ex-
perience in our own style and manner, perfectly regardless of
criticism and entirely careless of the opinion of others. We
believe our opinions are as near correct, yea, nearer, than any
heretofore promulgated: we believe they are not mere vaga-
ries, insusceptible of practical demonstration, but we cordiallv
think they only have to be adopted as a whole to be verified.

Treatment. Here is the rock upon which weshallprobably
split with the profession.

The practice of giving calomel, tartar-emetic, bloodletting and
cold affusions, to the profession, as remedies in scarlet fever, have
produced eflfects as disastrous as war and famine ever did in
some countries, if we consider the number of subjects involved.
We have already said the glandular system was largely in-
volved: we apprehend no sane man doubts it. Where, then,
is the necessity of giving a remedy to excite it ? Calomel
certainly expends its influence in a great measure upon the glan-
dular system ; scarlet fever being partially a disease of that
system, would only be aggravated by the remedy. We never
saw a single instance in which scarlet fever was ever benefited

266 Ramsay, on Scarlet Fever, L^^^y

by the mercurial practice, and we do not believe it a safe, pru-
dent, or even an applicable practice, in general. The tartar-
emetic practice is equally pernicious it prostrates, nauseates,
produces intestinal disease, and the subject rarely recovers from
its effect. The practice of bloodletting is still worse it redu-
ces the pulse to some inconsiderable degree, deprives the patient
of an essential element of cure or at least an adjuvant strength ;
in short, it does no good. The orifices rarely heal, they inflame,
and sometimes become gangrenous; indeed, in none of those
morbific aflTections does bleeding do good, as a common rule.
Blisters have a detrimental effect they aggravate the case,
never or rarely get well, the tissues around them are apt to dis-
organise, and we never saw a case blistt . ed that recovered. No
kind of harsh or drastic treatment will go in scarlet fever, it has
in every form a debilitated tendency. To bleed, purge, blister
and calomelize, is only to kill. We are not opposed to mild
treatment: we believe it essential, and the only plan of cure;
but never add fuel to an already excited and destructive fire, if
you wish to suspend its progress. The true plan of treating
scarlet fever is the mild emetic plan. The puke should be
made of common table salt dissolved in warm water ; the patient
should drink it, and freely. ui;til copious emesis is produced ; it
relieves the throat of all clogging that may exist, it removes
local congestions about the bronchial tubes and their appen-
dages, it never sickens the stomach, and consequently never
prostrates the patient ; indeed, it may be justly denominated
an etneto tonic. The puke should be given at any time when
there is difficulty of swallowing, or much enlargement about the
tonsils, or much phlegm in the throat; it is superior to all gar-
gles, and probably has some solvent effect about the secretions
in the throat. The salt water emetic is never harsh in its effect,
and It seems to buoy up the patient, and apparently exercises as
much influence in control.ng the moibific influence of scarlet fe-
ver, as the common salt does in saving meal from putrescency.
We have given it, and that indiscriminately, in this affection
we know, indeed, of no countervailing circumstances and we
have even done it with the happiest and best effect. The con-
fidence we have in the potency of salt and water, in scarlet fe-
ver, is derived alone from experience, not mere theory ; we are

1851.] Rsimsay, on Scarlet Fever. 2G7

willing to risk our reputation upon the principles of practice
we shnll here lay down, and we challenge a (air and impartial
trial of our deductions. But, says (me, would you puke a child
who has deliium, or is comatose? We answer, emphatically*
jmke it. Thedelirum is not inflammation, hut simply a mohility
of the nervous influence expended u[)()n the brain and emesis
will have moi-e eflfect in restoring it than any thing else, for it
is primarily dependent upon the morbific scarlatinous influence,
and not a primary afl^ection. In the event the salt is not pre-
scribed, we prefer next the ipecac, combined with mustard, or
alone ; but when we can obtain the fiist, we always use it. The
emetic practice is the magnum remedium in scarlet fever ; it is
the anchor sheet of safety; without its adoption, no man can
treat it successfully. Simplicity is a paramount principle in
the treatment of Scarlatina; it is the opprobrium of the pi'o-
fession, that too many remedies have been used in this inahidy
they have only increased its fatality, and disgraced ihe science.
Next to emesis, after a due tiial of it, and the throat con-
tinues to be clogged, we should carefully inspect it, and if we
find it swollen internally f/ee scarif cation should be resorted
to. We are at a loss to know how any man can go through
his cases without resortinij^ to scaiificaiion. We have often
rescued the little sufferers from an impending death, by this
simple remedy, much to the disappointment, and relief of the
weeping mother and disconsolate father. But while the abstrac-
tion of the matter from the throat and scarification is a balm,
we again warn our brethren to avoid the general use of the
lancet, not only as pregnant with evil, but dangerous After
scarification, and even before, the throat should be well gar-
gled with warm water and vinegar, or a sauce composed of
flaxseed, pepper, salt, and vinegar, the patient cannot gargle too
often. A great variety of gargles have been suggested, but
those we have named are about as eflectual as any. After
scarification, sometimes there is a considerable eflusion about
the throat, which even threatens suflocaiion, tlie best remedy is
emesis, or the blowing of powdered alum in the throat, we have
somet m ^s used a solution of Kreosote and Nitrate Silver, but
never with the same success as the alum, and emetic. A most
useful and not to be dispensed with adjuvant in the treatment

268 Ramsay, on Scarlet Fever. L^ay,

of scarlet fever is the application of poultices to the throat ex-
ternally, they should be worn constantly, and should be made
of corn meal and cayenne pepper, and kept warm ; they induce
a distension of the capillary system, thereby removing the local
congestions about the throat. The common onion makes a
most excellent poultice, so also the rhind of the bacon. The
bowels of the patient should be kept open with common epsom
sails, seidlUz, magnesia or enemas: an evacuation should be
secured about every other day.

These are the general outlines of the treatment of scarlet
fever, we have ever adopted with distinguished success, and
we recommend it to our brethren with every confidence of
equal success in their hands. The scarlet fever patient should
ever be kej)t warm ; his drink warm, not hot ; he should avoid
cold drinks, and even should sponging be requisite, it should be
tepid. After convalescence, he should remain in doors for
fourteen or twenty-one days ; for under that period he is not free
of the contagious principle, and prudence, to avoid those un-
pleasant sequelae, demands confinement to home, and an avoid-
ance of exposure. If those sequelae incident to the disease
should arise, they must be treated upon general principles ; and
if the case should be combined with pleuiitis, pneumonia, en-
teritis, or any other affection, we leave the practitioner free to
select his own means for we are writing upon scarlet fever
alone. There is one of the sequelae of scarlet fever which we
will advert to, and we hope with propriety we mean Dropsy.
We have never failed to cure a case of ascites or anasarca
following scarlet fever, with the common sweet shintb tea, given
daily and freely, with an occasional dose of Epsom salts. We
use the root : we give it as a common drink, and every
other day give a dose of salts; and we have never failed to cure
a case. We learned the remedy from Dr. Thomas F. Gibbs,
now of x\ugusta, who is a talented and practical man ; he
has used it for the last fourth of a century or longer, and is
without question, the first physician in Georgia who ever
prescribed it.

We have now accomplished our task : we have not, it is
true, extended our therapeutic views as far as common upon
this disease; we did not deem it necessary, but decidedly unes-

1851.] Rvixnsny, on Scarlet Fever. 269

senlial. We now think, as before remarked much of the fatality
of scarlet fever depends upon the bad treatinents adopted, con-
sisting of calomel, tartar, bleeding, blisters, &lc. We repu-
diate them find challenge a showing of comparative results.
We are a mercurialist justly acfopted, we glory in being one,
but at the same lime we are an eclectic, and stand upon the
impregnable altar of philosophic induction and practical facts.
Having omitted it in the proper place, we will remark here, that
warm mustard pediluvia are good in scarlet fever, and in two
instances we derived the happiest results in scarlatina gravior
from a bath of sal eratus. We suggest it to our readers, as
worthy of trial. The various forms of scarlet fever, are all
treated upon the same principles, hence we have not confused
the reader with an unnecessary and unscientific distinction of
treatment. We will now present tabular views of GO cases
and leave the reader to draw his own deductions.

1. Proportion of Cases in Adults and Children.

Adults have Scarla. Simplex, about 1 in 60

" " " Gravis, " 1 in 5

" " " Gravior, '' 1 in 60

Children " " Simplex, " 1 in 4

" " " Gravis, " 1 in 2

" " " Gravior, " 1 in 14

2. The Rash in Scarlatina Simplex appeared as follows :
In 11 cases, on the 1st day.

((

4

((

" " 2d day.

qu

^lae in

y

cases

was

nothing.

(i

u

1

u

Deafness.

tr

((

2

a

Dropsy.

i(

((

1

(I

Sore eyes.

((

((

1

i(

Glandular.

((

((

1

i(

Diarrhoea.

((

li

1

n

Ophthalmia

3. The Rash in Scarlatina Gravis appeared as follows:
In 14 cases on the 3d day.

((

6

a

<(

4th

((

{(

13

U ((

u

2d

((

((

2

( i(

n

1st

<(

((

4

( ((

n

5th

u

tt

1

U ((

n

6th

44

270 Ramsay, on Scarlet Fever. [May,

The Sequelce of Scarlatina Gravis are as follows
14 cases were Dropsical.

5

u

Glandular enlargements.

1

it

Deafness.

2

u

Ophthalmia.

14

(%

ISothing.

il

Sore ears.

((

Rheumatism.

((

Neuralgia.

((

QEdema.

40

5. The Rash in Scarlafina Gravior appeared as follows :

In 1 case on 5th day. | In 3 cases on 4th day. | In 1 case on 7th day.

6. The Sequelai of Scarlaiina Gravior were as follows :
In 3 cases Dropsy. | In 1 case Deafness. | In 1 case Neuralgia.

From, the above table, it will be seen that the sequelce of scarlet
fever appear in the following proportionate results :
7. Dropsy occurred 20 times, or 1

Deafness " 3 " "1

Ophthalmia " 4 '* "1

Glandular disease " 6 " " 1

Neuralgia " 2 " " 1

Rheuniatism " 1 " " 1

Diarrhoea " 1 " " 1

(Edema " 1 " " 1

n 3
n 20
n 15
n 10
n 30
n 60
n 60
n 60

8. The mean time of the appearance of the Rash was as follows :

In 13 cases on the 1st day.

" 17 " " " 2nd day.

"14 " " " 3rd day.

" 9 " " " 4th day.

" 5 " '< 5th day.

" 1 '' " 6th day.

" 1 " " 7th day.

60
This table is not free from error ; in all probability we may
have made some miscalculations in estimating the relative sta-
tistical facts as to the comparative frequency of the various
sequelae, which the reader will easily correct. It is no small
task, to cast up and prepare a statistical table, and make it cor-
rect in every word and line, and particularly when one is fretted
and called away to attend to his professional calls. The read-
er, we hope, will render us all proper indulgence for these

1851.] Surgical Cases by Prof. Dugas. 271

inconveniences. We know, farther, the tahle is incorrect and
unreh'able in another point of view: the number of cases is not
sufficient to establish a correct basis, but we hope other physi-
cians will continue the record, and pile Pelion upon Ossa, until
we shall have a full and replete mass of reliable evidence in
refrard to this interestinor disease.

We have now done with the subject, and if our article will
be the means of snatching a single individual from the grave,
we are amply paid ; and we sincerely trust, if our views and
suggestions are carried out, but few will die from the disease.

We will now recapitulate our plan, and leave the subject, for
farther conclusions, in the hands of the fraternity.

1st. Puke the [patient, through the whole course of the dis-
ease, with salt and water, or ipecac; never with tartar.

2d. If the tonsils and fauces are much swollen, scarify them
freely, and promote the discharge by gargles of warm water.

3d. Keep warm poultices of corn meal and pepper to the
throat; keep his throat gargled all the while with vinegar and
water, warm ; if there is much exudation of lymph about the
throat, powdei'ed alum should be blown in.

4th. The bowels should be kept mildly open every alternate
day, or longer, if not essential, with salts, magnesia, seidlitz,
rhubarb, or enemas.

5th. A warm pediluvium should be used every night, and the
patient should drink warm sage, balm, or otlier lea, instead of
cold water.

These general regulations, of course, may need some modi-
fication in some instances: the judicious physician can, with
facility, determine this, and adopt the proper premises. Let
the motto be, avoid drastric treatment; too much medication
is officious and hurtful.

Surgical Cases treated by Prof. Dugas Reported by Henry
RossiGNOL, M. D., of Augusta, Geo.

Having had the opportunity of seeing most of the practice
of Dr. Dugas, Professor of Surgery in the Medical College of
Georgia, and having free access to his notes, I beg leave to
furnish, very briefly, the history of some of the most interest-

272

Surgical Cases hy Prof. Dugas.

[May,

ing of the following list of cases, treated during the recent
College session, most of which were seen bv the Class:

Nov. 2. Diffused abscess of the hand
opened.

Caries of tibia excision.

Fracture of radius.

Lumbar abscess opened.

Crushed foot

Abscess of neck opened.

Fistulous ulcers at elbow.

Carcinoma of knee amputa-
tion.

Carcinoma of face.

Inveterate incontinence of u-
rine.

Large abscess of face.

Enlarged prostate.

Symblepharon operation.

Gunshot wound of face.

Syphilitic ulcer of leg.

Cataract couching.

Sprained ankle.

Rigidity of muscles section.
" " Indolent lumor of arm.
" 30. Chronic ophthalmia.
Dec. 4. Fall contusions.

" G. Nasal polypus operation.
" 10. Oiorrhcea deafness.
" 11. Burn of fool.
" 12. Urinary infiltration stricture.
" 14. Severe concussion of brain.
' 18. Burn of foot amputation.
" 19. Cataract couching.
' 20. Cancer of tongue.

14.
15.
16.
17.

18.
20.
28.
29.

Dec. 20.
" 24.
" 27.

28.

" 29.
Jan. 3.

" 6.

" 7.

" 23.

Feb 1.
" 6

Fracture of radius.

While swelling ofknee.

Extensive syphilitic ulcers of
body.

Inflammation of popliteal lym-
phatics.

Acute ophthalmia.

Burn of foot amputation.

Pin in cesophagusremoval.

Scalp-wounddiffased erysip-
elasincisions.

Ulcer ot Knee ampotation,

Lypoma of scalp excision.

Fibroustumor of mamma, do.

Nasal polypus operation.

Pterygium operation.

Double club-foot, do.

Nasal Polypus, do.

Stricture opened perineuna.

Enlarged tonsils operation.

Tumor of eye-lid, do.

Urinary calculus lithoirity.

Strabismus operation.

Nasal polypus, do. 2d time.

Enlarged tonsils, do.
do. do. do.

Bones lodged in the rectum.

Nasal polypus operation 3d
lime.

Clubfoot operation.

Enlarged tonsils, do.

Case I. Encephaloid Onrcinoma Amputation of Thigh.
John, a mulatto, about 15 years of age, the property of Mrs. A^^
of Taliaferro Co., had been suffering six or eight months with
a tumor just above the knee, which continued increasing in
size until his arrival here on the lOth Nov. last. His general
health was now very much impaired ; he was very thin, had no
appetite, and presented all the peculiarities of the hectic state.
The tumor was not very painful, was oblong, and occupied the
anterior surface of the lower end of the femur, being attached
to the tendinous insertion of the quadriceps femoris into the pa-
tella. Upon percusssion it yielded the sensation of a gelatinous
mass, which might be easily mistaken for the fluctuation of a
fluid contained in a very firm cyst. The limb, at this point,
measures nineteen inches in circumference, and the tumor
eleven inches in length. The skin was not implicated in the
disease, but presented many large and prominent veins.

1851.] Surgical Cases hy Prof. Dugas. 273

The encephaloid nature of the tumor having heen diagnosti-
cated, the question of amputation presented itseU"" as alone offer-
ing any chance of recovery from so formidable an atTection.
Yet the general condition of the patient was so bad, and the
liability of a return of the disease so well known, that the opera-
lion was undertaken with but little hope of success. The
circular amputation was performed on the 13lh Nov., and the
section necessarily mode very high up, only a few inches below
the trochanters. The boy having heen put under the influence
of chloroform, bore the operation without pain. Adhesion by
the first intention was only partial, and spongy granulations
springing up around the bone, led to serious apprehensions that
the disease was already returning. These, however, were sub-
dued, and the wound slowly cicatrized. We have recentlv
heard that he was still doing well, and learning the shoe-making
business. My friend, Dr. Harriss, of this city, having subject-
ed a portion of the tumor to microscopic examination, detected
the characteristic carcinomatous cells in great number.

Case II. Extensive Sloughing of the Foot, from an old burn
Amputation below the Knee. The subject of this case was a
negro man called Major, about 40 years of age, and belonging
to Dr. James Oliver, of Burke Co. It appears that in earlv life
Major was stricken by the ''sweep'' of a lumber wagon, which
fractured and depressed slightly a portion of the left parietal
bone, from which time he became affected with convulsions of
an epileptic character. About sixteen years ago, in one of his
"fits," he fell in the fire, and sustained a very serious burn of the
entire left foot, which has never healed ; nor has he had another
convulsion since. On his arrival here (i6th Dec), the foot
presented a hideous appearance, and emitted an insupportable
odour. The toes all destroyed; the remainder of the foot and
ankle nearly double the size of the other; a vascular, spongv,
sloughing surface in lieu of skin, furnishing an abundant dis-
charge of fetid matter, and occasionally bleeding profusely;
the body emaciated ; the system extremely anasmic from the
repeated hemorrhages, which were said to have sometimes
amounted to a pint ; the tongue as white as cotton ; no appetite,
and the pulse- very frequent, though full, as is usually the case in

274 Surgical Cases hy Prof. Dugas, [May,

anaemia. Such was Major's condition when placed under the
care of Prof. Dugas.

It was evident that hfe could not be prolonged much without
a removal of the local disease, and it was equally so, that no
local or general treatment offered any prospect of success ; yet
the sudden removal of an extremity which had been for so many
years suppurating thus abundantly, and whose condition had
acted so revulsively as to arrest the epileptic attacks, could not
be considered without regard to ulterior consequences. In
order, therefcu'e, to accomplish what was necessary to the im-
mediate safety of the patient, and at the same time to prevent
subsequent evils, the diseased foot was amputated (I8th Dec),
and a seton established in the other leg on the following day.
Chloroform having been administered for the amputation, the
patient continued drowsy for some hours after, unconscious of
the fact that his limb had been removed. During the night,
and for about a week after, he was more or less delirious.
Whelher this effect should be ascribed to the chlorof(jrm or not,
is questionable. The circular amputation was performed below
the knee at the usual place: adhesion by the first intention
failed, because of the unruly state of the patient, who was
continually pulling away the dressing. Under the use of
chalybeates the appetite improved, but he was then taken with
diarrhoea. Astringents., combined with the chalybeates, obvi-
ated this difficulty. As convalescence was fully established, he
became extensively oedematous. The stuinp, however, gradu-
ally cicatrized, the seton discharged freely, and he was able to
return to his master in about five weeks. I have recently heard
that he was doing very well. Whether the convulsions will
return remains to be seen.

Case III. Extensive Sloughing of the Knee, from an old
Burn Amputation of the Thigh, Davy, a negro man, 65
years of age, was directed to the care of Prof. Dugas, by Dr.
Beggs, of Columbia Co., and arrived here on the 6th January.
He stated, that in his childhood he sustained a very severe
burn of the knee, which left an extensive cicatrix occupying
the anterior and lateral surfaces of the joint ; that, apart from
the rigidity it occasioned, he suffered no inconvenience from it

1851.] Surgical Cases hy Prof. Dugas. 275

until about six or eight years a^o, when the cicatrix became
sore, ulcerated extensively, and incapacitated him for labor.
The entire surface was very much in the condition of that
described in the second case. The sloughing and discharge
emitted such an intolerable stench that no one could abide near
}im ; the f)ain was constant and occasionally excrntiating ; he
could not flex the limb in the least; the ulcerated surface ex-
tended about six inches above, and as inucli below the patella,
which was exposed and carious on its anterior surface. The
old man's general health, although enfeebled, was by no means
so bad as that of Major.

There was no hesitation as to the proper treatment ; chloro-
form was administered and the limb amputated (circularly) at
about the middle of the thigh, on the 7th January. Adhesion
by the first intention was not complete, but sufficiently so to
allow him to recover very soon, and to return to his friends.

Case IV. Destruction of the Foot hyjire, during ancesthetic
intoxication hy Spts. of Turpentine Amputation helow the
Knee. This is also a case of burn, but under singular circum-
stances. The negro Reuben, aged about 60 years, had long
been in the habit of indulging too freely his appetite for stimu-
lants, and had of late resorted to the use of spirits of turpentine,
when he could not procure the more palatable combinations of
spirits of wine. The festivities of Christmas week had furnish-
ed him a liberal supply of alcoholics, when, on the evening of
the 30th December, he added a full potation of spirits of tur-
pentine, and went to sleep upon the floor with his feet near the
fire, as is very common with this class of people. On tl e fol-
lowing morning his fellow servants found him still soundly
asleep, with one foot upon the burning wood, his shoe, stocking,
and the lower end of the pantaloons having been entirely con-
sumed. He was aroused, and walked out to uiinate, saying that
he felt no pain in his foot, and that he did not believe it was
burnt. On returning into the house, he took another drink of
the turpentine and went to bed. The patient being in Ham-
burg, Dr. Creighton was called to see him, and requested Prof.
Dugas to meet him in consultation at noon on the 31st. The
old man was found asleep, but was easily awakened, when he

N. 9. VOL. VII. NO. v. 18

276 Surgical Cases hy Prof. Dugas. [May,

still denied having any pain in the limb. The surface of the
foot and leg, half way up to the knee, was completely charred*
and the deep seated parts felt as though they had been tho-
roughly desiccated. No sensation was experienced on plunging
a knife into the affected tissue, although he felt it when carried
above.

As it was deemed proper to await the subsidence of the
effects of the intoxication before proceeding to amputate the
limb, this was deferred until the 3d January, when it was re-
moved a little below the knee.

The chloroform did not in this case induce the comatose
state, although it was very freely inhaled. It simply produced
intoxication ; yet insensibility was so complete that the amputa-
tion was effected during his conversation with the bystanders,
and without his knowledge, for he was quite surprised when
informed that the foot held up to his observation was his own.
Prof. Dugas states, that he has repeatedly observed that it is
very difficult to produce the comatose effects of anaesthetics in
persons addicted to intemperance.

On examining the amputated extremity, it was found that the
tissues of the foot and leg, up to about three inches below the
section were completely dried and resembled jerked or smoked
beef. Above this they were tumid and infiltrated with serum.

An opiate was given Reuben at bed-time, but he passed a
very restless night, being much annoyed with strangury, and
seeming still somewhat intoxicated. On the following day he
evinced symptoms of approaching mania a potu, with occa-
sional hiccough. Alcoholics, opiates, and broth, were admin-
istered ; he seemed to improve a little ; but as the strangury
subsided he became troubled with incontinence of urine; mania
a potu was not developed, but he remained fiighty; the hic-
cough increased; his appetite failed ; the energies of the system
gradually sank; and he died on the 13th January, the stump
having only partially healed.

This case is remarkable; it illustrates the extent to which
the taste may be depraved by intemperance; it establishes the
new fact that spts. of turpentine may induce complete insensi-
bility; and it shows the serious and persistent deleterious effects
of this agent upon the urinary apparatus as well as upon the

1851.] Surgical Cases by Prof. Dugas. 211

general system. Reuben never appeared to be entirely re-
lieved from the intoxication during which he was burnt.

Case V. Fall from a height of fifty feet, without serious
injury. On the 4lh day of Decennber, Prof. Dugas was called
to see a negro man (?Nace), who had just fallen from the scaf-
folding of the fourth story of the new cotton factory, a height of
about fifty feet. The patient was found upon the floor, appa-
rently very much chilled, (although well covered,) perfectly
rational, with good pulse, but complaining bitterly of intense
pain in the back, which he thought he had broken. Upon a
careful examination, no other injury was detected than a con-
tusion of the dorsal region, one of the forehead, and one of the
occipital region. He was bled, took an anodyne, and was
quite well in a few days.

It seems that the impetus of the fall was broken by his com-
ing in contact with beams at different distances.

Case VI. Fall from a height of twelve feet, producing ex-
cessive Concussion of the Brain. On the 14th of December, at
8 o'clock A. M., Mr. P.'s negro man Lewis fell from the sleep-
ers of one story of the cotton factory, down to the floor beneath,
about twelve feet. Prof Dugas saw him about half an hour
after the accident, and found him in a state of insensibility and
total unconsciousness, with surface very cold, (the weather
was intensely cold,) pulse almost imperceptible, pupils contract-
ed, and stertorous breathing. His friends had tried to make
him drink, but he could not swallow; no calls could arouse him
in the least, but severe pinching would induce a retraction of
the limb. He was put to bed, covered up waimly, and had hot
bricks applied to his feet. The stertorous breathing gradually
subsided during the day, his pulse became better, and at sunset
he was able to swallow water when put into his mouth. On
the following morning he would groan when called loudly; and
in a week he began to speak freely, but incoherently. The
pulse was still feeble and small, the reaction never having been
febrile in the least. A blister was now applied to the back of
the neck, and a mild saline cathartic administered. His previ-
ous condition had not permitted the use of any depletions, and

278 Surgical Cases hy Prof. Dugas, [May,

revulsives of heat and mustard had alone been resorted to.
His general health and appetite improved rapidly after the
tenth day, and he was sent home (in the country) on the 31st
December. His mind, continued, however, very much aliena-
ted for a fortnight, and then resumed its normal state.

This case offers a striking contrast with the preceding one^
In that, a fall of fifty feet occasioned contusions, but no serious
consequences in this, a fall of only twelve feet, attended with
no visible contusion whatever, was followed by excessive con-
cussion of the brain, by the most alarming train of symptoms,
and by temporary insanity.

This was one of the best cases for studying the differential
diagnosis of concussion and compression we have ever seen.
In his clinical lecture upon it. Prof. D. took occasion to dwell
at length upon this important subject. The stertorous breath-
ing, the unconsciousness, the immobility of the limbs, and the
great degree of insensibility, simulated the phenomena of com-
pression. But the surface was cold; the pulse was almost
imperceptible, instead of being full, strong and slow, as in com-
pression ; when severely pinched on either side the limb would
move ; the features were not drawn to one side. There was
here a resolution of the whole system under the depressing
influence of the shock sustained by the entire encephalic mass.
While compression produces hemiplegic disturbances, those
occasioned by concussion affect the whole system equally.

Case VII. Ulcerated Lipoma over the Occiput Removal.
On the 7th of January, Mr. Oakman's negro man, Ben, (about
50 years of age,) was presented to Prof. D.'s surgical clinic.
He had Ions: carried upon the occipital region a tumor which
gave him but little inconvenience until the last few weeks, when
its surface became ulcerated, and was being continually injured
by his hat. The tumor was now about the size of a hen's egg,
discharged a very offensive matter from its entire surface,
and bled occasionally when irritated. From its induration and
general aspect, the diagnosis was doubtful, especially as the
surgeon had not seen it previously. Its removal was, however,
determined upon, and effected by a double elliptidncision, in-
cluding all the ulcerated portions of the scalp. A small vessel

1851,] CampheW, on Injuries of the Cranium, 279

was ligated, and the edges of the wound drawn by adhesive
strips up to within an inch of each other. Cicatrization gradu-
ally took place without any circumstance worthy of notice.
The true nature of the tumor was revealed by microscopic
inspection, by Dr. Harriss, who detected no sign of carcino-
matous cells.

Case VIII. Fibrous Tumour of the Mamma Extirpa-
tion. This case occurred in the person of Elizabeth, a servant
of Dr. W. H. T., about 22 years of age, and the mother of sev-
eral children. Some three or four months previous to the
operation, and without any known cause, a tumor was observed
in the mamma, which, although not painful, had grown so rapid-
ly as already to have reached the size of a small hen's e^g.
There were no enlarged glands in the axilla. The extirpation
was elfected on the 7th January, under the influence of chlo-
roform. Some hemorrhage supervened in the afternoon, but
nothing worthy of note afterward. The tumor was found to
be purely fibrous, and will therefore probably not return.

ARTICLE \VI.

Injuries of the Cranium Trepanning. By Henry F. Camp-
bell, M. D., Demonstrator of Anatomy in the Med. College
of Georgia,

From the delicate structure of the brain, its abundant supply
of bloodvessels, the proneness of its membranes to inflamma-
tion and withall its importance to the animal economy, injuries
of the cranium have been ever regarded among the most seri-
ous to which the organism is liable. And yet experience
and an attentive observation of cases have left no rule by
which we can prognosticate with certainty the result, or esti-
mate the amount of danger attaching to any particular case ;
the slightest blow on the head, the simplest incision of the scalp,
however trivial it may at first appear, will sometimes unex-
pectedly assume the most alarming asj)ect, and finally terminate
in the death of the patient from a propagation of inflammation
to the brain or its membranes. On tho other hand, how much

280 Campbell, on Injuries of the Cranium. [May

do we find this delicate organ capable of resisting what annount
of injury will it not sustain and yet recover, without even the
manifestation of damage. It is only necessary to refer to the
records of Surgery and we find ample verification of this as-
sertion.* Hennen reports many cases wherein the brain has
been penetrated by balls, (in one case the removal of the ball
was not effected) without causing the death of the patient or
even producing any great amount of cerebral disturbance. In
the second volume of the Lancet, Dr. Cunningham, of Hails-
ham, reports a very remarkable case of a boy 14 years old,
who, on the bursting of a pistol, received the whole breech
into the substance of the brain through an opening in the frontal
bone. He lived twenty-four days in a semi-comatose condi-
tion, and in the post-mortem examination the wound in the
brain was found perfectly healed, and the iron breech, weighing
nine drachms, was resting on the tentorium. But the case
whit'h more than all others is calculated to excite our wonder,
impair the value of prognosis, and even to subvert our physio-
logical doctrines in relation to this important portion of the or-
ganism, is that of Dy. Harlow, reported recently by Prof'. H.
J. Bigelow, (in the American Journal of Medical Sciences,) in
which an iron crowbar, three and a half feet in length and one
and a quarter inch in diameter, passed through the left hemis-
phere of the cerebrum, and yet the patient perfectly recovered
with only the loss of an eye.

The following case, althougjh not by any means so extraordi-
nary as the above, is still sufficiently remarkable to possess, we
hope, some interest to the profession first, on account of the
amount of injury sustained by the brain, without a fatal result,
and secondly, because it, in a measure, serves to corroborate
the physiological possibility of Prof Bigelow's truly wonderful
case; for it will be observed that very nearly the same region
of the brain sustained the injury in each instance.

Fracture, with extensive injury of the brain and membranes.
Tony^ a negro carpenter, aged about 45 years, was brought
into our infirmary, wounded in an afl^ray with two other negroes.
He had a stal in the left thigh, of no serious moment. The

* Military Suigery.

1851.] Cami>he\\, on Injuries of the Cranium. 281

principal injury sustained was that of a chop on the head with
an axe. On examination, it was found that the axe had cleft
the lower portion of the parietal bone just above the attach-
ment of the temporal fascia, penetrating deeply into the right
hemisphere of the brain. The two portions of the skull were
widely separated, bein^^ nearly an inch apart ; between them the
movements of the brain could be distinctly observed. The
wound was nearlv six inches in leneth, extendinsr from near the
vertex to within an inch of the supra-orbitary ridge. The
membranes of the brain w^ere cut through and the medullary
substance of the cerebrum had been sliced in the direction of
the blow. The middle menin^jeal artery was severed, and
yielded a profuse hemorrhage, which of course was external.
The temporal arteries also had bled very freely. We found
him sitting upon a chair before the fire, with his head bound up
in a handkerchief; he spoke rationally, said they had tried to
kill hinrr, and recounted correctly the particulars of the affray.
He complained of no pain, but said he was weak from loss of
blood, though his pulse indicated no great degree of enfeeble-
ment. His appetite was quite remarkable ; we found it neces-
sary to order out of his hands a dish of bread and bacon that
his wife had just brought him, and which he said he could eat,
as he was very hungry.

After proper cleansing and arresting the hemorrhage from the
great meningeal artery, by the pressure of a small pledget of
lint, the wound was dressed by adhesive strips with a compress
and bandage. We found it impossible to bring in contact the
two sides of the opening in the skull, and after approximating
them as closely as practicable, the edges of the wound in the
scalp were brought together over the fissure.

On the second dressing the wound had adhered pretty firmly,
with the exception of about two inches; from this opening, which
was enlarged by a slight slough, the sharp edge of the outer por-
tion of the skull protruded. The suppuration was very profuse.
The impossibility of covering this portion of bone, aiid the fear
that the exposure and continued suppuration would produce ex-
tensive caries or be detrimental to the already injured brain and
membranes, determined us on removing this piece of bone with
the saw. After dissecting the temporal muscle and fascia from

282 Campbell, on Injuries of the Cranium. L^^av,

their altacfimenl, assisted by my brother, Dr. Robert Campbell,
we reiiiovefi, with Hey's saw, a portion of the lower border of
the parietal bone, two and a half inches in length and three
fourths of an inch in width. The operation was completed
without other hemorrhage than that from the branches of the
teinporal artery cut by the incision in the soft parts, though the
piece of bone removed was traversed in three places by fur-
rows for the brandies of the arteria meninfrea magna, which
however escaped during the apphcation of the saw\ After
trepanninir, the flaps were replaced and secured by adhesive
strips with compress and T. bandage. On the fourth day after
the operation, he complained of pain in the occipital region and
some stiffness in the back of the neck; these symptoms, how-
ever readily disappeared after free evacuation of the bowels
and the administration of an oj)iate. This resulted probably
from the constrained position of the head, and not from any te-
tanic tendency. The wound healed- rapidly till within a few
davs of the discharge of the patient from the Infirmary, when
suppuration became more copious, and we extracted a small
piece of detatched bone from the wound, which after this be-
came a firm and healthy cicatrix.

A case very similar to the above is related in a work of one
of the earlier writers, Glandorp, wherein a man had the skull
laid open by a sabre cut, losing even a portion of the brain, and
yet he recovered; though he was affected for some time with
paralysis.*

The remarkable feature in cases like the above, is, that not-
withstanding the extensive injury done the brain, the very or-
gan of sensation and volition, yet not the least impairment of
intellectual power is observed during their whole progress.
From an attentive consideration of such cases, and a compari-

* Hominem, ablata etiam insisrni cerebri porlione,snpervivere posse, seqnens
testai'ir ohservaiio. Viri) alicni rohnsio impinjiebalur gladio vuliius circa anie-
riorem capitis partem, ex quo primis diehus Paretis vieus Lii'lovicus Glandorp
chirurgns magnas ossimn poniones, tandem & lantam cerebri partem, quaniam
vix poterat capcre medietas putamini.s ovi, excepit. Huic adhibuii remedia,
qucc inl'erius pra? scribenlur. Convulsinnibus interirn corieplusluit, quae lamcn
sepiima die eum deserneriint : ubi suborta est paralysis oppositi lateris; a vul-
nere curalns evasit & post duos annos peste obiit: vini portionem exiguam,
post curam, in &. clamores ac funitiis turbaum, tympiinorum, ac tormentorum
bellicorum vix perferre poterat. MatlhicE GicniLorpii^ Spec. Chirurg. Observ. v.,
p. 26.

1851.] CampheWj on Injuries of the Cra7iium. 283

son of them with others of a somewhat different nature, viz.,
cases of compression, we have been long impressed with a
belief, that tlie b ain can much better resist, physiologically, the
effects of actual laceration of its substance, even to a very great
extent, than a comparatively small amount of compression.

That a very sinall degree of compression will produce great
disturbance of function the daily observation of every practi-
tioner will fully establish, yet certainly in the deposition of an
apoplectic clot, the brain cannot sustain as much physical injury
as when it is broken and lacerated with tamping pins and hand
axes. But, strange to say, in the latter cases no intellectual
impairment whatever is manifested, while in the former coma^
paralysis, and often death, are the common consequences of a
small amount of pressure. What then is the explanation of this
unexpected difference in the results? We can only surmise an
explanation: It is probable that the laceration of the cerebral
mass affects only that portion of the brain actually impinged
upon; in this, there may or may not reside some endowment
important to the undisturbed exercise of the various functions,
as volition, sensation, consciousness, &c. ; if important, we have
functional manifestation of injury in those organs over whicii
that portion presides; if unimportant to these functions, of
course these manifestations are not observable On this view,
we would very naturally expect to find lacerations of the brain
without functional manifestation, as the effect of these lacera-
tions does not, it appears, extend beyond its immediate vicinity.

Now, in injuiies with compression, the effect is by no means
so restricted; we cannot compress one portion (however un-
important) of an organ like the brain, without exerting more or
less compression on parts that are of the utmost importance.
That equilibrium of pressure so indispensable to the healthy ex-
ercise of function is thus destroyed in all |)arts of the brain, and
of course a correspondent impairment of function is the result ;
which does not necessarily occur in simple laceration.

284 ^WQ, on Stricture of the (Esophagus. [May,

t

ARTICLE XVII.

Case of Permanent Stricture of the (Esophagus. By Paul F.
Eve, M. D., of Augusta, Ga.

During the course oflectures in the University of Louisville,
Ky., I was invited by Prof. Rogers to see, with him, a case of
dysphagia constricta, which had been under his care for a ftw
weeks. The patient was a mulatto bo}^ aged 3 years, whoj
some four months previously, had swallowed, through inadvert-
ence, a portion of caustic potash. In its deliquescent state he
had taken it for candy. The act was immediately followed
by alarming symptoms, but which unfortunately were attempt-
ed to be combatted exclusively by domestic remedies.

When Dr. Rogers first saw the case, the dysphagia was so
great that fluids could with difficulty be swallowed; and a
bougie was now at once arrested in the oesophagus by an ap-
parently permanent stricture. Various attempts were subse-
quently made to reach the stomach, but without success. We
were not certain that any nourishment ever entered it. The
patient's constant cry was for water, which he would swallow
down to the obstruction, retain it a few minutes, and then re-
ject it from his mouth. He rapidly emaciated. Ice-cream,
milk and water, beef tea, &:c., were recommended ; and if none
of these could be gotten down, nutritious enemata to sustain
his system.

The stricture was situated six inches from the dental arches
below the most usual seat for such affections which is the
connection of the pharynx with the ccso}jhagus.

The middle of December last, this patient becoming daily
more feeble, was presented to the class at the college clinic,
with the view to an operation, should one be deemed advisable.
He was now reduced almost to skin and bones ; neither could
his pulse be discerned at the wrists. It was not until he ar-
rived at this low condition that his master consented to consider
the question of oesophagotomy. It was decided in consultation
not to operate, and the death of the patient was predicted as
probable during the first cold spell of weather.

About ten days after this, a post-mortem revealed a perma-
nent contraction with thickening of the tissues of the oesopha-

1851.] Pliysiological Uses of the Solar Ganglion, ^-c. 285

gus the diameter of the strictured portion being reduced to
about a line for an inch and a quarter, and which was also
quite tortuous in its course. The stomach was contracted and
reduced to a very small capacity; but the ileum, to our sur-
prise, was largely distended with fajces.

It is highly probable that an attempt at ossophagotomy would
have failed.

This is another case added to several noticed in our Journals,
of permanent stricture of the oesophagus produced by caustic
preparations.

PART II.
(Eclectic Department.

On the Physinloiry and Pathology of the Ganglionic Nervous
System. By James Geouge Davev, Licentiate of the Royal
College of Physicians, London, fcc. (Continued from p. 224.)

" There are yet great truths to tell, if we had either the courage to announce,
or the temper to receive them." Disraeli.

CHAPTER II.
On the Physiological Uses of the Solar Ganglion, ^-c.

In the earliest periods to which the history of man refers, we
find that no question has more particularly interested the
philosopher than that of Life. The wish to draw aside the veil
from nature, to display the very essence of the vital properties,
and to penetrate to their first causes, has ostensibly character-
ized the labours of many of the greatest men of both ancient
and modern times. (Tn/e Lawrence, Lectures, p. IGtJ.)

The investigation of the physiology of the nervous svstem,
says Dr. Cooke, in his work on Nervous Diseases, seems to have
been at all times a favourite study. We have some notices of
it in the works of very ancient writers: Hippocrates, Plain,
Aristotle, and others, have speculated upon this subject, though
in obscure and confused languasre. By these early writers, the
brain, the heart, and the blood were each successively claimed
as the seat of life and sensation. Aristotle asserted that the
heart is the or gciu first for 7?ied. Inasmuch as the philosophy of
the ancients, especially Platonism, soared above, or, to speak
more correctly, below the level of nature, {vide Serres on the
**Laws of the Development of Organs or Transcendental Analo-

286 Physiological Uses of the Solar Ganglion, ^c. [May,

my applied to Physiology,") it became reserved for subsequent
investigators to afford any real explanation of the vital phenome-
na, and their relation to the organism. Aristotle, in his ''History
of Animals," was the first, I believe, to give any degree of at-
tention to the study of those organic forms so necessary to be
understood as th^ groundwork of all physiological knowledge.
To Aristotle succeeded Galen, whose work (" De usu Partium*')
must be, at the present day, considered as highly interesting
and instructive. In reference to the labours of Aristotle and
Galen, Serres observes: '"The method of Aristotle, essentially
descriptive, neglected the function for the form ; that of Galen
essentially rational, neglected the form for the function. The
first of these methods carried in its train the descriptive
sciences; the second led to the general sciences: the truth
thus lay in their combination, and to Haller we owe the merit
of first discovering this fact. He founded his arguments and
opinions upon form and function combined ; thus embracing in
his method the descriptive as well as the general sciences."

Among the more mfidern investigators in the science of
physiology Harvey no doubt stands second to none other. The
discovery of the circulation of the blood, in point of importance
and utility, can never be surpassed ; and however much we
may object to the physiological inferences which Harvey
deduced from it, yet we cannot doubt the great claim of Harvey
on our esteem and admiration.

What very materially retarded the progress of physiological
knowledge was the custom, until lately, of treating and consid-
ering the nervous system of man en masse that is, without
reference to its natural divisions. This is plainly seen to be
the case, if we refer to the physiological writings of Gall, Le
Gallois, or Bichat also of Dr. Wilson Phillip.

The brain, spinal cord and organic or ganglionic system of
nerves, have each in the very able hands of these writers been
rescued more or less from that chaos, perplexity, and doubt,
with which their predecessors and contemporaries were ac-
customed to regard the organs and their respective functions in
the animal economy.

The labours of the immortal Gall cannot be suflSciently com-
mended. 'J'his great and illustrious philosopher has practically
demonstrated the absurdities and chimeras of the metaphysical
school. He it is who has given the death-blow to the visionary
speculations of a Descartes, a Leibnitz, and a Malebranche ; or,
to speak of the present day, of a Chalmers, a Roget, a Copland,
and of many like them.*

* Nothing can be more interesting than to trace the progress of truth from the
day.s ol Bacon, Hobbes, Locke, and Condillac, all of whom advocated the

1851.] Physiological Uses of the Solar Ganglion, <^c. 287

On his successors rest the responsibility of rescuing alike the
criminal from perdition, and the legislator from shame. To the
cerebral physiologist must the philanthropist look for the intro-
duclion of so improved a system of education as shall insure
the use. and not the abuse, of the cerebral faculties in man.
The unfortuate lunatic is safe only in his hands, because he
alone can understand the nature of his disease, and thus be
enabled to make choice of the necessary remedies. Cuvier
acknowledged, that to Gall and Spurzheim we were, in his
day, indebted for almost all we knew of the anatomy of the
cerebro spinal system. Gall was certainly the first to describe
the spinal cord as an organ distinct from the biain, and to show
that it did not arise from it, as was taught in the schools. (Vide
Translation of Blumenbnch's Physiology, p. 201)

The labours of Le Gallois certainly contributed to advance
our physiological knowledge of the spinal cord, although he, in
so far as he erred not, to a jrreat extent, it would seem, did but
echo the previous discoveries of Gall. M. Le Gallois says, " If
in a rabbit, which has been decapitated, but kept alive by
pulmonary insufflation, the whole of the spinal marrow be de-
stroyed by a stylet thrust throuiih the whole vertebral canal, life
will inslantly and irrecoverably disappear, irritability alone
remaining, which, we know, remains for some time after death.
If, instead of decapitation, an openinoj be made in the vertebral
canal near to the occiput, and by an instrument introduced
through this opening the whole of the spinal marrow be de-
stroyed, although the brain and its nervous communications
with the trunk remain perfectly untouched, life will be instantly
and irrecoverably destroyed in the trunk, the head alone re-
maining alive, as is apparent from its gapings.''

It will be seen from the preceding extract, that the object of
Le Gallois is to prove that the spinal cord is the seat of life, and
not the brain ; which org:in, as Le Gallois truly observes, has
been erroneously considered as the sole origin of the nervous
power; and consequently the only seat of the principle of life.
As refjnrds the preceding experiments, they cannot, 1 think, be
considered as favourable to the theory entertained. The pos-
session of '' in'iiability,^^ by the decapitated and marrowless

dependenc}' of ihe mental, or rather cerebral, impression on the use of the ex-
ternal senses, in opposition to ihe doctrine of innate ideas, to those of Mirabeau,
Priestley, Blumenbach, Mag-endie, Lawrence, and others of what is called the
modern school of materialism, on to that era when Gall's discoverer ies illurai-
Dated this dull atmosphere of ours. The first class of writers named may be
said to hold a similar relation to the second as the latter does to Gall and his
school. The Reids, Stewarts, and Mills of the present day are. it is to be hoped,
at a discount. Let them only seek fact, and noi mere words, and farewell lo
metaphysics with all its dogmas.

288 Physiological Uses of the Solar Ganglion, ^c. [Mar,

animal, assures me that the solar jranglion was still in the ex-
ercise of its peculiar function. What is the ''irritability,^- of
Haller, the " ?notions without force'^ which belong to the or-
ganism, but the property of the organic nervous system ? The
destruction of the spinal cord through its whole length in the
second experiment, no doubt imphcated the phrenic nerve ; and
if so, there is Utile wonder that the animal continued to gape^
as the experimenter tells us it did.*

Le Gallois has, very evidently to me, considered the cessa-
tion of the excito-motory function as an indication of the
complete suspension of all the vital phenomena.

To Bell and Hall we are not a little indebted for the more
recent information we possess of the spinal cord and its func-
tions; Mr. Grainger, too, must not be forcrotten.

Bichat and Dr. Wilson Phillip have together contributed
largely to our knowledge of the vital or organic functions. It
is certainly strange that the arrangement of the functions into
classes viz., the animal and the vital or organic should have
been deferred to so late a peiiod. Bichat, with all his origin-
ality and acute reasoning, strangely erred, not in saying ''that
hitherto anatomists have considered the nervous system as an
uniform system," such had been unfortunately too true, but
in adding "that the different branches of this system ought to
be viewed as constituting two," and not three, "general sys-
tems, essentially distinct; the one having for its principal
centre the brain and its dependencies, meaning, no doubt, the
spinal cord ; and the other, the ganglions.

The translator of Blumenbach's Physiology describes, in a

Since writing the above, I have performed the following experiment: A
free incision was made through the integuments immediately over the spine on
the bade of the animal; the extensor muscles were then dissected from their at-
tachments, and the spinal column being thus exposed, its posteror parietes were
removed to a sufficient extent to admit freely a moderate size blow-pipe. The
instrument was introduced near the middle of the dorsal spine, and passed
upwards within the spinal canal, through the substance of the brain, to the
anterior and interior part of the cranium The imviedi ate effects were a com-
plete paralysis of the lour extremities, the posterior as well as the anterior, and
an apparent extinction of life ; the heart alo7ie rcmnining alive, as was apparent
from tlie gapings of the animal, to use the expression of Le Gallois. It is now nearly
three hours since the above experiment was performed, and although no attempt
at an artificial respiration has been made, the heart is to be seen at this moment
through the thoracic parietes, contracting as vigorously as in any other animal.
The gapings ceased after about ten minutes. In the absence of the cerebro-
spinal functions, the animal before me is in a condition precisely similar to the
amyencephalous monster of Hall, or to the mere polypus.

The assertion long since made by Le Gallois that every part of the body-
derives its principles of vitality and irritability from that portion of the spinal
marrow from which it receives its nerves, is satisfactorily negatived in the ex-
periment recorded. In connection, too, with the above experiment, we cannot
fail to remark the strong evidence in favour of that opinion which makes the
hearVs action independent of the brain.

1851.] Physiological Uses of the Solar Ganglion, SfC. 289

note, the two classes of functions thus: " The anrz/ia/ functions
prove us feeling, thinking, and willing beings : they are the
actions of the senses which receive impressions; of the brain,
which, perceives them, reflects upon them, and wills; of the
voluntary muscles, which execute the will in regard to motion ;
and of the nerves, which are the agents of transmission. The
brain is their central oi-gan. The vital or organic functions
are independent of mind, and give us simply the notion of
life: they are, digestion, circulation, respiration, exhalation,
absor[)tion, secretion, nutrition, calorification. The heart,"
adds Dr. Elliotson, " is their central organ."

From what I can learn, it appears that Dr. Wilson Philip has
explained himself very much more satisfactorily on the vital or
organic functions, and the reciprocal relations between them
and the brain and spinal cord, than Bichat has done, though
neither the one nor the other has gone so far as he might have
done. With the most extraordinary and convincing facts be-
fore them, 1 am not aware that physiologists have attempted to
show much more than that the vital or organic functions are
*' certainly not dependent on the brain and spinal marrow in the
same degree as the cerebro spinal functions."* If I mistake not,
there have been no writers who have directed their attention
more successfully to the ganglionic system of nerves, and their
functions, than Fletcher, Copland and Breschet, excepting, of
course, Dr. Stevens, whose paper published in the year 1842,
gives much reason to expect yet better things. In them Bichat
and Philip have found very able supporters. Dr. Copland's notes
to his translation of Richerand's Physiology contain here and
there very valuable remarks, physiological and pathological, on
the vital or organic system of nerves. The same may be said
of the articles Fever and Hypocnndriasis in his very valuable
and learned Medical Dictionary. But it is not enough to say
that the ganglionic system of nerves, with the solar plexus for
its central organ, presides over the functions necessary to life,
as digestion, secretion, circulation, nutrition, (fcc, as if the brain
and spinal cord, unlike the stomach, liver, heart, and alimenta-
ry canal, had an existence independently of the organic
nerves. The functions of the brain and spinal cord must of
necessity be regarded as vital functions. Life in man and the
higher order of animals, consists, as iMr. Lawrence says, in the
assemblage of a// the functions; and if so, on what grounds
dare we omit those of cerebration, and sensation, and motion?
I shall hope to prove to the reader, that up to the present time
physiologists have mistaken the cause for effect; they have
looked to the brain, and spinal cord for the animating principle

* Vide MuUer's Physiology, by Baly, p. 208.

290 Physiological Uses of the Solar Ganglion, ^c. [May,

of the gancrlionic system of nerves, instead of looking to the
latter for the integrity of the former.

Jn enumerating the opinions of physiologists, I must not omit
to mention those of Hunter and Lawrence. As may be expected
of those eminent and lenrned surgeons, the question of the nature
oi life was too important and interesting to be passed silently
by. Mr. Hunter's opinions may be best expressed In the
words of Abernethy, contained In a letter to Dr. Cooke, and
published in his " Nature and uses of the Nervous System."
Abernethy writes thus: Mr. Hunter's illustration of his notions
of life, by saying that it was superadded, as electricity and
magnetism may be to substances in which they may inhere,
was given in his lectures, and I have heard it from his own
moulh. It made a strong impression upon my mind, because
it did not affirm what electricity, magneslism, and life were, but
only stated an analogy." Both Hunter and Abernethy strongly
insisted on the importance of not confounding life with organ-
ization, as many did. Mere composition of matter, observes
Hunter, does not give life, for the dead body has all the com-
position it ever had ; nor do organization and life depend in
the least on each other. Organization, he adds, may arise out
of living parts, and produce action, but life can never rise out
of, or depend upon, organization. An organ Is a peculiar con-
formation of matter^ let that matter be what it may, to answer
some purpose, the operation of which is mechanical ; but mere
organization can do nothinir even in mechanics; it must still
have something corresponding to a living principle namely,
some power. This living principle Hunter recognized by the
term " materia vltae ditfusa," and which Mr. Lawrence ridicules
as a mere fancy, an idle speculation, and of no better repute
than the "impetum faciens" of Hippocrates, the "archaeus" of
Van Helmont, or the " anima" of Stahl. In commenting on
these definitions of a living principle, Mr. Lawrence observes :
" Most of them have long lain in cold ab.^traction amongst
the rubbish of past ages; and the more modern ones are has-
tening after their predecessors to the vault of all the Capulets."
Mr. Lawrence's views of life I cannot think are more satisfacto-
rily than those of Hunter. At the same time that it is admitted
that to call life a property of orjianization would be unmeaning,
would be nonsense, he claims for the " primary or elementary
animal substances" those vital pi'operiies which enable the
compounded organs to. carry on their several functions, whlch,^
he adds, being united in the individual, constitute life. Mr."
Lawrence, therefore, literally makes life the property of the
organism just as gravity, elasticity, &c., are the physical
properties of inorganic bodies. Mr. Lawrence, it is seen, has

1851.] Physiological Uses of the Solar Ganglion, <^c. 291

herein adopted the explanation offered b}^ the German phys-
iologist Reil, in reply to whom Miillersays: "It would follow,
that if the elementary composition were alone the cause of the
organic forces, it would be at the same time the formative
principle itself Now, since in organized bodies, immediately-
after death, the elementary composition of the organic matter
does not appear to be different from that of bodies still living,
Reil must admit the existence of other more subtile elements,
not recogizable by chemical analysis, which are present in the
living body, but are wanting after death."

In reference to this matter, Dr. Elliotson has these words:
"As the fluids which form the embryo must be endowed with
life, organization cannot be the cause of life; but in truth
organization is the effect of life, although, when produced it
becomes an instrument of life. The erroneousness of the French
doctrine, that " life is the result of organization," has " been
ably refuted. The error appears to have arisen, in some mea-
sure, from the want of definition, the word life being used,
sometimes properly, for the power; sometimes improperly, for
the result. Even if the result of life the functions of a part
should be called its life, life could not be said to be the result
of organization, but of a power to which organization is an in-
strument." Now both the organization and its functions may
be said to be demonstrable to the senses, but the same cannot
be said of the "power to which organization is an instrument,"
though neither its presence nor its seat can well be doubted.
Granting, for the sake of argument, that the solar ganglion is the
source or origin of this powei% or organizing principle, or crea-
tive force* which is exerted even on itself, and in every animal,
strictly in accordance with what the nature of each requires,
which exists already in the germ, and creates in it the essential
parts of the future animal, and according to an eternal law,
forms the different essential organs of the body, animates them,
and modifies the already existing nervous system, as well as all
the other organs in the laws of insects, during their transforma-
tion, causing the disappearance of several of the ganglia of the
nervous cord, and the coalescence of others, and by its opera-
tion, during the transformation of the tadpole to the frog,
causes the spinal marrow to shorten in [Proportion as the tail
becomes atrophied, and the nerves of the extremities formed,
&c., granting, I say, so much, it remains to show, if possible,
the ultimate cause of this important part of the organism from
whence did it receive its being? It is not in the power of man to
offer anything more than a very general reply to these queries.

Physiologists say it has an existence independcnlly of any special organ. See
MiiUer's Physiology, p. 26, et seq.

X. S. VOL. VII. NO. v. 19

292 Physiological Uses of the Solar Ganglion, <^c. [May,

Mr. Lawrences observe, in his lectures on life " Having
thus proceeded as far as we can in ascertaining the nature of
life by the observation of its effects, we are naturally anxious
to investigate its origin, to see how it is produced, and to in-
quire how it is communicated to the beings in which we find
it. We endeavour, therelore, to observe living bodies in the
moment of their formation, to watch the time when matter may
be supposed to receive the stamp of life, and the inert mass to
be quickened. Hitherto, however, physiologists have not been
able to catch nature in the fact. Living bodies have never
been observed otherwise than completely formed, enjoying
already that vital force, and producing those internal move-
ments, the first cause of which we are desirous of knowing.
However minute and feeble the parts of an embryo may be,
when we are first capable of perceiving them, they then enjoy
a real life, and possess the germ of all the phenomena which
that life may afterwards develop. These observations, ex-
tended to all the classes of living creatures, lead to this general
fact, that there are none which have not heretofore formed part
of others similar to themselves, from which they have been
detached. All have participated in the existence of other
living beings before they exercised the functions of life them-
selves."*

This opinion, so confidently asserted by Mr. Lawrence, is more than likely
to undergo very considerable modification, in consequence of the publication
of the " Vestiges oftke Natural History of Creation'^ wherein it is to my mind
satisfactojily shown that life does not even now only proceed from life. The
experiments of Messrs. Cross and Weekes are conclusive, and clearly negative
the contrary assumption so much insisted on. The appearance of the " Vestiges,
<f.c.," must' be viewed as a great and glorious era in the world's progress." Ii
marks the onward course ol truth and of religion, untainted with that mean and
despicable credulity with which the ignorant delusions of the fanatic, of what-
ever denomination, associate and degrade it. The character of the reviews
which I have seen of this excellent and truly philosophical book bespeak too
plainly so great a preponderance of the low, .the animal propensities, that, it may
be rightly interred, the time is yet lar distant when the constant and unfailing
supremacy of the moral sentiments and the intellect shall find vian in unison
with that nature of which he is but a part, and so no longer deserve the censure
of the poet, as conveyed in the few following lines:

" Hath Nature's soul,
That formed this world so beautiful, that spread
Earth's lap with plenty, and life's smallest cord
Strung to unchanging unison, that gave
The happy birds their dwelling in the grove,
That yielded to the wanderers of the deep
The lovely silence of the unfathomed main,
And filled the meanest worm that crawls in dust
With spirit, thought, and love ; on man alone,
Partial in causeless malice, wantonly
Heaped ruin, vice, and slavery ; his soul
Blasted with withering curses ; placed afar
The meteor happiness, that shuns his grasp,
But serving on the frightful gulph to glare,
Rent wide beneath his footsteps 1" Shelley.

1851.] Cases of Tetanus. 293

"Thus we find that the motion proper to living bodfes, or,
in one word, litis, has its origin in that of their parents. From
these parents they have received the vital in)piilse ; and hence it
is evident, that, in the present state of things, life proceeds only
from life, and their exists no other but that, which has been
transmitted from one living body to another, by an uninter-
rupted succession." If organism or the organized state be
the result of the union of the organic creative powers and
organic matter, it would seem plausible to infer that the first is
supplied by the male animal, whether oviparous or viviparous,
and the second by the female. The peculiar circumstances
which, it may be presumed, attend this union, and the conse-
quent development of the vital properties, will probably remain
a mystery. It would, however, appear, that the first effort of
the vital properties, v/hateverthey may be, are directed towards
the developement of a central organ, the solar ganglion,* pre-
destined to hold a precisely similiar relation to the otherwise
insensible and inert frame, to the dull and unmoving organism,
as the vital fire to the animated statue of Prometheus. f \_Lon-
don Lancet.

Report of cases of Tetanus cured hy the division of the in-
jured Nerve. By Moses Sweat, M. D., of North Parsons-
field, Maine.

Case 1st. Peter Gerrish, a stout athletic mulatto man, aged
24 years, wounded the ball of his right thumb with the point of
a scythe, on the 1st day of August, J 825. The wound healed
kindly by the first intention; but on the ninth day unequivocal
tetanic symptoms developed themselves, in trismus, pain in the
jaws, opisthotonos, rigidity of the upper extremilies, &c. The
paroxysms so increased in violence and in rapidity of recur-
rence, that in 24 hours he became insensible to every thing
around him ; and it constantly required from four to si.x men to
keep him on a mattress on the floor, so violent were the spasms.
It was evident to all who saw him at this time, that he could
not survive but a few hours longer. I proposed to the family
in which he resided, to cut down and divide the injured nerve
in the wrist, to which they gave their consent. An in-

The reader is referred to the commencement of the first chapter, where he
will find it slated that it is the opinion of Ackerniann, Rolando, Blumenbach,
and Gall, that the ganglia of the organic or ganglionic system of nerves are the
first formed in the Idctus,

tSee Lectures on the Study and Practice of Medicine, page 124, by John
Conolly, M. D., late Professor of the Theory and Practice of Medicine at the
London University, and Physician to the Middlesex County Lunatic Asylum,
Hanwell, &c., &c.

294 Cases of Tetanus. [May,

cision of three inches was made accordingly, over the course
of the median nerve, which, by a careful dissection, was soon
found and divided. The spasms ceased instanthj, not a muscle
was seen to move (except those of respiration); he was perfectly
still about an hour ; he then aroused, and looking wildly around,
inquired how he came there what had happened, &c. He
had no recurrence of tetanic symptoms afterwards.

Case 2d. John Johnson (son of David Johnson of this town),
aged 20 years, shot off' one joint of his right thumb with a
musket, on the 16th of January, 1826. It was dressed pro-
perly, and it healed kindly until the seventh day after the
accident, when he was suddenly seized with tetanic symptoms,
his jaws soon became fixed, attended with severe pain and
the phenomena, in short, were the same as those in the preced-
ing case. His parents and friends were unwilling to consent
to the operation for the division of the nerve, until they were all
satisfied that he was fast failing, when they consented. The
operation w^as carefully performed, and the patient was instan-
taneously cured of all tetanic or spasmodic symptoms. The
wounds healed in a short time, and he had no recurrence after-
wards.

Case 3d, Miss Almeda Kimball, of Hollis, aged about 20
years, of slender habit, had a branch of the ulnar nerve punc-
tured at the right wrist, with the point of a needle, about the
1st of January, 1848. Severe pain followed immediately,
which continued to extend until it affected the whole course of
the nerve : inflammation soon followed about the wrist, which
extended over the whole fore-arm, attended with great swelling
and total inability to move the limb. I was called to visit her
on the 25th of that month, found her under the care of Dr. Che-
ney, whose treatment was judicious. She was then affected
with pain in tha side of the neck and jaws, with some rigidity
of the muscles about these parts, as well as severe pain and
inflammation in the injured limb. I suggested the propriety of
dividing the nerve, if tetanic symptoms should increase. On
the 7th February, I visited her again; she had unequivocal
symptoms of tetanus. We divided the ulnar nerve, and took
out an inch, just above the groove in the inner condyle of the
humerus. All symptoms of tetanus ceased and she soon re-
covered. In all cases where I have found it necessary to oper-
ate, I have removed a small section of the injured nerve.

I might mention several other cases, in which I have stopped
spasmodic affections by dividing nerves, in wounds which I

1851.] Cauliflower Excrescence of the Uterus. 295

have been called to operate on, for the security of arteries, in
cases of aneurisms, hemorrhages, &c., improperly managed.
One case I will relate, viz. :

Case IV. On the 3d December, 1810, (while I was in practice

with Dr. B.) I was called to visit J B of Limberick,

who, in a fit of delirium tremens, on the 25lh Nov. struck his
fist through a square of glass and wounded the radial and ulnar
arteries at the wrist. Dr. A. of N. was called, and dressed the
wounds; stopped the bleeding (which was said to be rather
profuse) by means of compresses and bandage, which prevented
external hemorrhage while the compresses were closely applied,
but, whenever they were loosened, the wound over the ulnar
artery, it being rather large, would bleed. The wound in the
integuments over the radial artery was but a mere puncture,
and it had, in fact, healed by the first intention, while the
wounded artery continued to bleed, and formed a large false
consecutive aneurism. He had, that day, began to have some
spasmodic contractions of the muscles of the arm. Dr. A. was
present. It was agreed upon to operate and secure the arte-
ries. The wound of the integuments over the ulnar artery,
was extended to about two inches in length; the artery bound
and secured by ligatures above and below the bleeding orifice
made by the glass. We then made an incision through the
integuments over the aneurismal tumor (which was large) to
the extent of four inches; removed the coagula, found the
artery, and secured it. In this operation, we found several
spiculae of glass, and on examination, found one small piece
which had wounded the median nerve; to this injury of the
nerve we ascribed the spasmodic symptoms which had just be-
gun to develope themselves. We divided it, and all the spas-
modic symptoms ceased at once, and he had no more after-
wards. [N. Y. Journal.

Cauliflower Excrescence of the Uterus. By W. H. Church,
M. D.,*of New York.

A. M. M., aet. 46, born in the state of New York, married,
was admitted into the New York Hospital on ifie 17th of
Dec, 1850. John Watson, M. D. attending surgeon.

The first notice the patient had of the above-named disease
was one year since, when she was attacked with severe pain in
the lumbar region, being aggravated during and after a passage
from the bowels. She had suflered for several years previous
to this time with hemorrhoids, consequently these troubles were
attributed to them, and a course of treatment adopted with

29G Cauliflower Excrescence of the Uterus. [May,

reference to the liemoirhoids. Three months after the com-
mencement of the pains she noticed a small tumor in the
vagina, which has coniinned slowly to increase, until it has
attained the size of a hen's egg. All treatment prior to her
entrance into the hospital has been of a palliative character,
the tumor not having been interfered with, except by the use
of anodyne injections, per vaginam, to relieve the pain.

The patient has always lived upon a farm, and occupied in
the regular habits of that class of people; has had several
children, the youngest being nine years of age. She says that
since the discovery of the tumor there has been a continual
watery discharge from the vagina, which is now so profuse as
to saturate ten or twelve napkins during the twenty-four hours.
Hemorrhage has occurred several times, but in su(!h slight
quantity as to cause her no uneasiness. She is emaciated,
and feels her strength beginning to fail, but during the whole
time the menses have continued to flow pretty regular. To
relieve the pain sufficiently to sleep, she has been obliged to
take from one-eighth to three-eights of a grain of morphine at
bed-time for the last two months. The character of the pain is
that of dragging in the lower region of the back. Upon exam-
ination per vaginam, the os and cervix uteri are felt largely
distended, their walls being thinned and indurated; the cavity
of the uterus is occupied by an irregular mass of a firm con-
sistence, which can be traced up to its middle, and it is there
found attached to the sides of that organ. Upon examining a
piece of the tumor, which can easily be detached with the
fingers, its surface is more florid than flesh color, with an irre-
gular surface of a granular appearance, and from these points
a white cheesy matter can be pressed by the fingers.

Dec. 18th. The speculum vaginae being introduced, portions
of the tumor were removed with the volsella and the raw
surf:ice freely rubbed with the argentum nitratis; pieces were
thus twisted off, and the surface of the tumor coated over with
nit. of silver until the inner surface of the os uteri was brought
into view, when the operation was discontinued. Hemorrhage
during the operation moderate in quantity.

Dec. IDth. Patient quite comfortable; there being slight
hemorrhage, was ordered to use an injection of sulph. of alum
5ij. aqua 3 viij.

Dec. 23d. No hemorrhage has occurred. There is now a
discharge of thin purulent matter of an oflJensive character from
the vagina.

Dec. 26th. Another examination was made, in which the
operation was very much accelerated and a better view of the
parts obtained by separating the walls of the vagina with three

1851.] External Applications in Dropsy. 29"

spatulas in the hands of assistants. A large quantity of detritus
matter was found about the os uteri, which was removed, and
the same course pursued as at the previous examination, the
whole tumor being nearly removed by the instrument when
the remainder was thoioughly coated over with the solid nit. of
silver (which was also used at the previous operation). The
operation was a tedious one, requiring nearly an hour; the
exhaustion and suffering of the patient was much less than could
have been expected. The hemorrhage amounted to !xij.

Dec. 28th. Has been comfortable, but complains of weak-
ness, pulse small, and appetite very delicate. Ordered the bitter
infusion, a wine glass full three times daily, nourishing diet and
porter.

Jan. 2d. Patient is very anxious to leave the hospital and go
to her friends, consequently she was to-day discharged, relieved,
which certainly was the case, as the pain was almost entirely
gone ; could sleep better, appetite and strength had somewhat
returned, and instead of saturating ten or twelve napkins daily,
three or four were found sufficient.

Remarks. Dr. C. M. Clark reports one case in which the
disease had not returned in twelve years; that case was treated
principally by astringents, and no operation was performed.
The astringents had so contracted the vagina that it was almost
impossible to introduce the finger. The case which we have
just reported presents a good opportunity to test the possibility
of a radical cure, as it is comparatively recent, having come
under treatment in less than a year after the appearance of the
first symptoms ; the subject is not much past the middle age,
with a naturally good constitution, upon which the disease has
not yet made much impression. \_lbid.

External Applications in Dropsy.

To the Editor of the Boston Medical and Surgical Journal.

Dear Sir, The article in your Journal of December 25,
" On the Treatment of Ascites by Diuretic^ applied externally,"
reminds me of a little of my own experience in the use of ex-
ternal remedies in dropsy.

Some six years since, I was called to see a child, 2 years old,
with general anasarca and ascites. He had been under treat-
ment some three or four weeks; but was steadily gettinji worse,
and had been left by the attending physician as a hopelcs case.
His whole body was enormously distended ; his features seem-
ing hardly human. Appetite voracious; constant thirst;

298 Diagnosis of Typhoid Fever, [May,

bowels very loose ; urine scanty ; pulse feeble, quick and very
frequent; patient restless, and constantly moaning. The usual
treatment with diuretics and cathartics, would reduce the dis-
tension a little; but what was gained one day would be more
than lost the next; for the patient was evidently losing
strength, while the diseases was steadily gaining ground. As
a forlorn hope, I directed the following liniment, to be applied
to one half the surface of the body, three times a day. R. Vol.
liniment, 2 pts.; tr. cantharides, tr. digitalis, tr. colchicum, tr.
iodine, aa 1 pt. The patient was well in a few days, without
taking a particle of medicine internally.

Since then, I have used the liniment repeatedly with advan-
tage ; several mild cases yielding to this alone, without any
other treatment. The liniment is peculiarly adapted to the
treatment of dropsy in old persons, children, or delicate females ;
where the powers of life are feeble, and the stomach and bowels
too irritable to bear medicine internally.

Since writing the above, I have treated a case slmiliar to
the first one mentioned : the child having been more or less
bloated for several months; legs and body as full "as the skin
could hold." All appearance of disease was removed after a
few days' use of the liniment.

That there is any especial virtue in the particular form or
combination of remedies in the liniment, I do not believe ; but
that external remedies can be used with advantage in most
cases of dropsy, I am sure.

AusableFurks.N, Y.March 1851, Wm. W. Finch.

Diagnosis of Typhoid Fever. By Dr. E. Parkes.

[Dr. Parkes concludes a clinical lecture on the above sub-
ject, by the following propositions :]

1. The diagnosis of typhoid fever is absolute when, on a
febrile disease attended with looseness of the bowels, unequivo-
cal rose-spots appear on the sixth or eighth dav.

2. If there are no rose-spots, or if these are indistinct, the
diagnosis is still ne^ly certain, if in a febrile disease, mild or
severe, which has lasted eight or ten days, there is, or has been,
epistaxis; if there is diarrhoea with alkaline stools, abdominal
pains, bronchiticronchi, with considerable muscular weakness,
delirium, &c., provided that ihe positive symptoms of the dis-
ease above enumerated are absent. If sudamina appear on and
after the twelfth day, the diaci^nosis is strengthened. Hemor-
rhage from the bowels, in such a case, would almost make the
diagnosis absolute, without reference to other affections.

1851.] Diagnosis of Typhoid Fever, 299

3. If in a disease presenting febrile symptonfis similar to those
seen in typhoid fever, it is impossible to obtain any of the
signs usually furnished by the skin and mucous membranes,
viz., rose-spot, diarrhoea, abdominal tenderness, epistaxis, bron-
chitic rhonchi, &;c.,the diagnosis of typhoid fever should never
be given until inquiry has been made into the possibility of the
case being one of those above enumerated. If, in such a case,
the diagnosis of typhoid fever be ultimately given, this can be
done only on the principle of exclusion, viz., by finding that
the symptoms do not accord with the supposition that the dis-
ease is typhus, pyohaen?ia, latent pneumonia (i. e., pneumonia
unmarked by the usual symptoms of cough and expectoration,)
acute tuberculosis, acute glanders, &c. Now, in many of
these diseases, we have special symptoms which are easily rec-
ognised; as in typhus, the mulberry rash, the dusky skin, the
extreme stupor, &c. ; in pyohaemia, the yellowish earthy tint
of the surface, or the absolute jaundice, the severe shiverings,
the intense headache, torpor, and delirium, which, to a practised
eye is, I think, different from the delirium of either typhoid or
typhus fever ; in variola, malignant erysipelas, and in the
gangrenous erysipelas from putrid infection, we have, in the
vast majority of cases, diagnostic eruptions, or symptoms de-
rived from the skin and subcutaneous cellular tissue, &c. In
acute glanders, there is often the tuberiform cutaneous erup-
tion, and the affection of the nasal mucous membrane; in
pneumonia we discover the physical signs, unless the pneumonia
be lobular and much scattered, when physical signs often fail ;
this case, however, is most commonly connected with pyo-
hcemia. All these diseases are usually easily excluded ; a
very little care will enable us to be certain that they do not
constitute the disease before us, and in many cases, even if one
of them, such aspyohasmiaor erysipelas supervenes on typhoid
fever, the fact of there being two diseases present can be made
out if the case has been watched.

It is, unfortunately, different with some other affections,
especially acute tuberculosis, meningitis (tuberculous, purulent,
or simple,) cerebral softening of some kind, and occasionally,
delirium tremens. Any of these diseases may produce symp-
toms which closely simulate an ataxic form of typhoid fever.
You will understand that, in many cases, the distiction of
typhoid fever and these affections can be made easily by aid of
the symptoms derived from the secondary effects on the skin
or mucous membranes in typhoid fever, but we are speaking
now of cases in which these utterly fail, in which we have de-
cided that the case is not one of typhus, pyohaemia, variola,
latent inflammation, &.C., and consequently in which we have

300 Diagnosis of Typhoid Fever. [May,

reduced the problem to the determination of whether the case
is ataxic typhoid fever, or acute tuberculosis, meningitis,
delirium tremens, central cerebral softening, &c. I believe
that error cannot always be avoided with the utmost care.
Acute tuberculosis is most likely to be mistaken when it occurs
in children. Often, however, there is a long initiatory period ;
the abdomen is comparatively unaffected, that is to say, there is
little pain or diarrhoea, but there may be more sickness than in
typhoid ; the head symptoms have a different aspect, i. e., the
headache and delirium do not occur in the regular order, but
observe unusual alterations, and altogether the case does not
exactly square with the symptoms of typhoid fever. The chest
symptoms may be prominent, and afford a clue to the real
nature of the case, although often all physical signs, except
those indicating a general bronchitis, fail. Attention should
also be directed to the absence of the positive signs of typhoid
fever, viz. the rose-spots. In tuberculous meningitis we may
have signs, from the presence of tubercle in the lungs or
elsewhere, and sometimes assistance may be derived from
considering, if it can be learned, the time when the headache
and delirium came on, the contraction of the pupil, the degree
of intolerance of light which is greater in meningitis than in
typhoid fever; the vomiting, which is more marked in menin-
gitis ; the state of the tongue, which is cleaner in meningitis ;
the comparative mildness of the pyrexia, i. e. of the heat
of the skin, quick pulse, &c., in this latter disease. In delirium
tremens we are often guided by the kind of delirium, the
history of the case, &c., and there is not so much difficulty here
as in meningitis. Central cerebral softening is characterised
by the predominance, very early in the disease, of the cerebral
symptoms over the general febrile condition, whereas, in
typhoid fever, although there may be intense headache and
delirium in the first week, these do not assume so predominant
a character as in central softening.

The diseases which resemble typhoid fever by simulating
one or two of it^ symptoms, are some forms of entero-colitis in
children. In primary cases in adults, the local symptoms are
disproportionate to the general febrile state. There is very little
heat of skin, rapidity of pulse, no headache, delirium, or other
cerebral symptoms, the stools are often slimy, with gelatinous
flakes, mixed with more or less greenish fluid, but there is not
the yellow or dark red fluid, and granular curdy substratum of
typhoid fever. The difficulty, however, is greater in children
than in adults, as in them the febrile symptoms run higher.
But the skin is seldom so hot as in typhoid, nor is the prostra-
tion so extreme; the appearance of rose-spots, or sudamina,
will decide the point.

1851.] Symptomatological Value of Palpitation.

301

[The author mentions another symptom which has been
much insisted upon as a diagnostic mark, viz. enlargement of
the spieen in typhoid kvev. He observes that, in fact, the
spleen is seldom so enlarged as to be appreciable by percussion,
and he therefore does not regard it as worthy of confidence.
He continues :

Finally in fixing the diagnosis of typhoid fever in adults, it
should never be forgotten that it is most common under forty ;
and seldom seen above that age. In old people there are many
febrile conditions consequent on latent and subacute inflamma-
tion, or some urinary derangement which may, at first sight, bear
some resemblance to typhoid fever, but the age of the patient
will be an argument against the existence of the disease.]
Medical Times. Raiihing's Abstract.

On the Symptomatological Value of Palpitation. By Dr. 0.
B. Bellingham.

Dr. 0. B. Bellingham thus contrasts palpitation arising from
organic disease of the heart, and that independent of it.

Palpitation depending upon Or- Palpitation independent of Organ-
ganic Disease of the Heart. ic Disease of the Heart.

1. More common in the male
than the female.

2. Palpitation usually comes
on slowly and gradually.

3. Palpitation constant, though
more marked at one period than
at another.

4. Impulse usually stronger
than natural ; sometimes remark-
ably increased, heaving, and pro-
longed ; at others irregular and
unequal.

5. Percussion elicits a dull
fiound over an increased surface,
and the degree of dullness is
greater than natural.

6. Palpitation often accompa-
nied by the auscultatory signs of
diseased valves.

1. More common in the female
than the male.

2. Palpitation usually sets in
suddenly.

3. Palpitation notconstant, hav-
ing perfect intermissions.

4. Impulse neither heaving nor
prolonged ; often abrupt, knock-
ing, and circumscribed, and ac-
companied by a fluttering sensa-
tion in the praicordial region or
epigastrium.

5. The extent of surface in the
region of the heart, wiiich yields
naturally a dull sound on percus-
sion, is not increased.

6. Auscultatory signs of dis-
eased valves absent ; bruit de
soufllct often present in the large
arteries, and a continuous murmur
in the veins.

302

Differential Diagnosis of Gastralgia, <^c. [May,

7. Action of the heart regular,
irregular, or itermittent ; not ne-
cessarily quickened.

8. Palpitation often not much
complained of by the patient ; oc-
casionally attended by severe pain,
extending to the left shoulder and
arm.

9. Lips and cheeks often livid ;
countenance congested; anasarca
of lower extremities common.

10. Palpitation increased by
exercise, by stimulants and tonics,
&c. ; relieved by rest, and fre-
quently also by local or general
bleeding, and an antiphlogistic
regimen.

7. Rhythm of heart usually
regular ; sometimes intermittent ;
its action generally more rapid
than natural.

8. Palpitation often much com-
plained of by the patient; more
readily induced by mental emo-
tion, and frequently accompanied
by pain in the left side.

9. Lips and cheeks never livid ;
countenance often chlorotic ; ana-
sarca absent, except in extreme
cases.

10. Palpitation increased by se-
dentary occupations ; by local
and general bleeding, &c. ; re-
lieved by moderate exercise, and
by stimulants or tonics, particular-
ly the preparations of iron.

[Medical Gazette. Ibid.

Differential Diagnosis of Gastralgia and other more Serious
Affections of the Stomach. By M. Valleix.

The diagnosis of gastralgia is often difficult ; the slighter
forms may be mistaken for the slight gastric disturbance, called
by the French, " Emharras Gastrique," or for acute gastritis;
while the ordinary chronic forms may be mistaken for chronic
gastritis, simple ufcer of the stomach, cancer of the stomach, or
intercostal neuralgia.

The most important distinctive signs are thus given by
Valleix.

GASTRALGIA ACUTE FORM.

Acute pain in the epigastrium.
Appetite preserved.
No headache.

Nausea only after meals, or in the
morning.

GASTRIC DISTURBANCE.

Discomfort rather than pain.
Anorexia.
Headache frequent.
Nausea frequent at all periods of
the Day.

GASTRALGIA ACUTE FORM.

Appetite ^ood.

No pain on pressure.

Vomiting rare^ mucus or of food,

Nofever.

ACUTE GASTRITIS.

Appetite lost.

Acute pain on pressure.

Bilious \omiting frequent,

Disiantfever,

CHRONIC GASTRALGIA.

Usually uncomplicated.
Vomiting rare, mucus or food.

CHRONIC GASTRITIS.

Usually complicated with another
affection.

1851.] Diagnostic Value of Epigastric Pains.

303

CHRONIC GASTRALGIA.

Spontaneous pains often very acute.
Usually no pain on pressure.
Progress of disease irregular.
Absence of fever.

CHRONIC GASTRALGIA.

Appetite more or less preserved.

Vomiting a considerable period af-
ter food.

No vomiting of pure blood or
dark matter.

Progress slow.

CHRONIC GASTRALGIA.

Vomiting as before.
Destroys slowly.
No signs of cancerous cachexy.
Progress irregular.

CHRONIC GASTRITIS.

Bilious vomiting frequent.
Spontaneous pains less acute.
Pain on pressure acute.
Progress Jess irregular.
Fever generally present.

SIMPLE ULCER OF THE STOMACH.

Appetite lost.

Vomiting immediately after food.

Sometimes vomiting of blood or

black matter.
Progress rapid.

CANCER OF THE STOMACH.

Vomiting at long periods after food.
Destroys rapidly.
Signs of cancerous cachexy.
Progress regular.

CHRONIC GASTRALGIA. INTERCOSTAL NEURALGIA.

Pain not increased by pressure Pains on pressure.

Well-marked gastric disturbance. No gastric disturbance.

[Brit, and For. Med. Chir. Review. Ibid.

Diagnostic Nalue of Epigastric Pains.

[According to Wunderlich, (' Handbuch der Pathologie,
und Therapie,') the following points are worthy of attention, in
reference to pains in the epigastric region :]

Gastric pains in persons whose digestion and appetite are
unaffected, and which are not exacerbated by hunger or food,
most probably depend upon the spinal cord, or on some organ
adjacent to the stomach. Pains which are diminished by strong
pressure may be set down to neuralgia. Pains which are dis-
tinctly increased when the hand is placed gently on the stomach,
but which are not proportionally aggravated by firm or ab-
rupt pressure, are either imaginary or sympathetic. Pains
continue for days or weeks, or recurring at definite periods
without any obvious cause; also pains which come on suddenly
with great severity and disappear as rapidly, are probably,
due to gastric neuralgia; they may depend on gaseous disten-
sion. Pains arising in the scrobiculus cordis and radiating in
various directions, may arise from cardialgia, rheumatism of
the abdominal walls, or peritonitis. Gastric pains, which are
suspended by food, depend on neuralgic atTection, or the pres-
ence of parasites. Pains which exist, both while ordinary

304 Inverted Toe-nail [May^

food is taken and when fasting, but which disappear when stim-
ulating food or drink is taken, depend on ana3mia of the stomachs
Pains which are increased by the smallest quantity of food,
indicate probable gastritis or degeneration. If pains super-
vene an hour or two after meal-time, we fear disease of the
pylorus. [This assertion will needlessly alarm a large propor-
tion of dyspeptics. Ed.] Lancinatings are sometimes re-
marked in cancer. \_Brit. andFor. Med. C Mr. Rev. Ibid,

Inverted Toe Nail A new remedy. By Benj. P. Drake, M.D.
of Lexington, Ky. ,

Case. Miss A. E. T., set. about 16, of irritable constitution,
has been for the last three years the subject of inverted toe nail
in the grent toes of both feet. Almost every remedy that has
been suggested for its relief had been resorted to, but without-
success. The nail had been scraped very thin, caustic had
been extensively and frequently applied, the roller had been
worn for months, and lastly, the diseased sides of the nails had
been split down to the glands, and then, with the forceps, torn
out by the roots. The relief following these severe measures
was but partial and temporary, and in the course of a few
weeks or months the disease was as distressing and painful as
ever.

In this state of the case it occurred to me to make trial of the
common tannic acid, which I applied in the following manner:
I placed a portion of the tannin in its dry state on the nail, and
then raising the exuberant granulations, with the tortoise-shell
handle of a lancet, I gently but carefully pressed it down to the
embedded edge of the nail, and filled the cavity with it, after
which I covered the whole of the proud flesh with the same
application, and enveloped the toe wnth a roller bandage. As
no pain followed, the dressing was permitted to remain until the
fourth day. On its removal, the improvement was so manifest
that I had no hesitation in using the remedy again, which I did
precisely as at first. To be brief, six or eight applications of
the tannin, at intervals of three or four days, were made, and
the cure appears to be complete and perfect. [Western Jour-
nal of Medicine and Surgery.

Ingrowing Toe-nail treated by Collodion.

We find in the Bulletin General de Therapeutique (28th Feb.,
1851) a notice of the use of collodion in the treatment of
ingrowing toe-nail, by Dr. Meynier, of Ornaus. The flesh be-

1851.] Miscellany. 305

ing pressed aside, a little collodion is poured between it and the
nail, which soon dries and keeps the parts asunder until cicatri-
zation is effected. M. Larrey states that he has tried this plan
with success in four out of six cases.

iH i 0 1 1 1 a n 2 .

Augusta, April 15th, 1851.
Dr. DuGAS : Dear Sir, With your permission, I will record the
following remarkable anomaly, which your avowed penchant for mon-
strosities will render interesting, at least to the Editor, if not to the
generality of the readers of your Journal.

Very respectfully,

Henry F. Campbell.

Con genital Deficiency of both Patellce. The subject of this most un-
usual defect is a negro boy about twenty years of age, employed as a
hand upon one of the steamboats on the Savannah river. In stature
he is rather poorly developed though not much below the ordinary
size. On examination of the lower extremities, we found the knee
presenting a very remarkable appearance. At the joint there is a
curve outwards, rendering him slightly bow-legged. In the extended
position the contour of the articulation does not differ very materially
from that ordinarily seen ; the defect is only perceptible in this posi-
tion by a manual examination, but on flexion it is at once fully appar-
ent. There is then present on each side of the joint a large promi-
nence caused by the projection of the internal and external condyles
of the femur, which appear much larger than usual at these points,
the integument is indurated from coming in contact with the ground in
kneeling ; normally, this induration is central, over the lower portion
of the patella and its ligament. Between the condyles, instead of the
elevation ordinarily found, there is a depression in which, on the con-
traction of the extensor muscles, the common tendon may be felt to
move under the integument. On complete flexion of the limb, the
front surface of the joint becomes very much flattened, and the
groove and prominences above-mentioned are still more evident. The
tubercle of the tibia is somewhat larger than ordinary, and to it the
ligamentum patella?, or rather the continuation of the common exten.
sor tendon, is attached as usual. This tendon does not differ much
from the ordinary size and is accommodated by and plays in the troch-
lea between the condyles, which, normally, is the situation of the pa.

306 Miscellany. \}^^y.

tella. The articulation is apparently quite as firm as usual. The
boy is active and performs all the movements of the joint necessary
in walking and running with the utmost facility. On the most careful
comparison, we could not detect the least difference in the conforma-
tion of the two extremities.

The above case is, so far as we know, without a precedent. The
mechanical relations of the patella, to the articulation, are such that in
its various movements, it has been always considered of the greatest
importance. Upon its integrity depends the transmission of the whole
action of the powerful extensors of the leg its fracture completely
annihilates extension and progression is completely hindered. On
account of this importance, it has for a great length of time been the
subject of particular interest both to the anatomist and the suigeon.
By the former, it has been traced through the whole vertebrated scale,
a'nd its presence or absence in various animals fully noted,* and by
the surgeon its abnormal conditions have been most thoroughly scru-
tinized: yet by no one of the many writers on this subject can we
find a case reported parallel to the above, or at all approaching it in
character.

Proceedings of the Medical Association of the State of Alahama.

Mobile, December, 1850. pp. 156.

We sincerely congratulate our friends of Alabama upon the pub-
lication of so creditable a production as that above named. These
" proceedings" evince not only much zeal in the cause of science,
but attainments of a high order on the part of the officers and report-
ers. The volume contains, the annual Address, by A. Lopez, M. D.,
President, and the Valedictory Address of Chas. E. Lavender, M. D.,
elected President for the ensuing year ; also Reports, by Dr. C. F.
Percivall, on the Diseases of Lowndes county; by Dr. D. P. Smythe,
on the Medical Botany of Sumter county ; by Dr. W. A. Welch, on the
Medical Botany of Talladega ; by Dr. W. H. Anderson, on the Dis-
eases of Mobile ; by Dr. H. V. Wooten, on the Diseases of Lowndes,
boro' ; by Dr. L. H. Anderson, on the Diseases of Sumter county;
by Dr. T. W. Mason, on the Diseases of Wetumpka ; by Dr. W. P.
Reese, on the Diseases of Lowndes county, and Papers by Dr. W.
P. Reese on Marasmus, Typhoid Fever and Pertussis ; by Dr. W. H.

On this subject, the following summary is not without interest.

The patella exists in all placental animals, bui is absent in many marsupials.
In birds it is usually present; there are sometimes two, one placed above the
other, as in the ostrich. No patella has ever been found in any reptile.

{TodrVs Cychtpedia Anat. <^ Phys. Art. Sesamoid Bones.

1851.] Miscellany. 307

Anderson, on Cod-Liver Oil ; and by Dr. C. E. Lavender, on a wound
of the Heart. During the session, a number of interesting facts were
related, some of which we will reproduce.

Ejfect of the Mother upon the Foetus in utero.

Dr. R. Lee Fearn related the fo'lowing very remarkable particu-
lars of a, case, where the impressions received by a mother, during
pregnancy, affected the child in utero. A gentleman, whilst gunning,
shot through the metacarpal bone of the index finger. The wound
was a bad one, and piece after piece of the bone came away. A few
months after the accident he married, and in due season his wife bore
him a child, perfectly formed in all respects. When about four months
advanced in her second pregnancy, an operation was deemed neces-
sary to remove the last remaining portion of bone in her husband's
finger. She witnessed the operation, and was much shocked and
sickened at the sight. When the child was born, it was found to be
deficient in this very bone, though in all other particulars it was a
well formed child. The Doctor thought this was by no means the
result of chance, but a very conclusive instance of cause and effect.

Dr. DossEY remarked that the relation of this case called to his
mind a similar instance :

Dr. G was thrown from his horse, and broke his leg, mid-

way between the ankle and knee. His wife was about five months
advanced in pregnancy. When the child of which she was pregnant
was born, it had on the leg corresponding with the injured limb of the
father, and at precisely the same spot, the appearance of a fracture of
the limb, and there was also a very decided shortening of the leg.

Wound of the Heart ; penetrating the right ventricle ; from which
the patient recovered. R.ead betbre the Association, by Charles
E. Lavender, M. D.

James H , student, aged 19 years, of good health and sound

constitution, was stabbed, on the inh of April, 1850, in the left breast,
by a fellow student, with a pocket knife, the blad.- of which was about
three inches long and three-fourths of an inch wide in the middle, and
very narrow at the point.

When I saw him, at 4 o'clock, P. M., about five minutes after the
wound was inflicted, he was laid on a long tab!e, on his right side,
with his head slightly raised. He was vomiting, with jaws rather
rigid; cold sweat on his face ; eyes drawn back, pupils much dila-
ted ; countenance pale and deadly; respiration irregular, interrupted
and terminating in deep sighs ; action of the heart entirely suspended ;
clothes dripping with blood. On tearing away the clothes from his
chest, a wound presented itself in the left side, between the sternum
and the nipple, about two inches anterior to, and three-fourths of an
inch below the left nipple, between the fourth and lifih ribs, at the
cartilaginous extremity, the greater extent of wound being between

X. S. VOL. VII. NO. V. 20

308 Miscellany. [May,

the cartilages. The wound, from which venous blood was flowing in
a full, continuous stream, was about one inch in extent, in a direction
across the body ; the edges of the knife having struck the lower side
of the cartilage and the upper side of the rib. The cut edges of the
intercostal muscles were distinctly seen, through wliich a dark open-
ing, about the siza of a man's fore-finger, allowed the blood to flow.
One gallon and a half of blood was supposed to be lost; it could not
have been less than one gallon. The right ventricle of the heart was
evidently opened, and I supposed he could not live fifteen minutes.

I turned him hastily upon his back, raised his right arm, i\ hich was
pendulous, and placed it by his side, dashed a large towel, just dipped
in a bucket of cold water, on his chest: sprinkled cold water and spir-
its of camphor in his face, and secured free ventilation. The bleed-
ing stopped instantly, but the breathing continued oppressed, interrupt-
ed, and somewhat stertorous. About five minutes at'rer the bleeding
ceased, a slight flutter was felt in the heart, and was distinctly appre-
ciable under the palm of my hand, at irregular intervals, for a minute
or more, when pulsation became perceptible, and in a few minutes
more there was pulsation at the wrist. He now swallowed water,
and spoke inc-oherently ; breath during this time cold. A mattress
was drawn under and blankets thrown over him, and he was kept on
his back, with his shoulders slightly elevated. About 5 o'clock, he
recognized persons, spoke hurriedly, called fur persons, and supposed
he was dying; but he afterwards remembered nothing that occurred
before 6 o'clock, at which time he became exceedingly restless, com-
plained of pain in his breast and head, with some thirst. Pulse feeble,
interrupted, and over one hundred.

When the external bleeding ceased, I apprehended internal hemor-
rhage ; but no evidence of this presented itself at that time or subse-
quently. About 9 o'clock, he began to grow warm. At 10, he be-
came exceedingly restless, and complained of intense suffering, but
of no acute pain. Pulse about 120, intermitting; respiration inter-
rupted, and at times as frequent as 60 to the minute. From 12 till
3 A. M., but little hope was entertained of his living till daylight,
when his nervous system yielded to the quieting influences of mor-
phine, about two grains of which had been given, at intervals. To-
wards morning he enjoyed some refreshing sleep.

Fearful of a return of the hemorrhage, or of disturbance to the
nervous centres, I did not allow him to be removed from the academy,
where T first found him. till 3 p. m. on the following day. He was
then removed to his boarding house, with such care as to cause no
disturbance. He suffered somewhat from restlessness and thirst.
The first was remedied by small doses of morphine, the laUer, by
cool sub-acid drinks. At night, he suffered from distension of the
bladder; not being allowed to change position, he had not been able
to empty it. Catheter was used.

11th.' Passed a restless ni^ht; interrupted slumber; frequent
starting; hothead; some delirium. Considerable febrile excitement
ihrouo-h the day; skin hot and dry, but pale ; countenance shrunk,

1851.] Miscellany. 309

and indicative of much distress ; tongue red and dry ; pulse thready
and irregular, about 120 ; complete prostration of muscular power.
Lies on his back ; if turned to the right side, evinces but little pain,
but soon turns back, with a sigh and heavy breathing ; if lurned on
the lelt, suffers pain in direction of the wound, is much distressed, and
rolls back immediately. Bowels inactive, gave enemata. Bladder
so torpid as not to expel the urine, when the catheter is introduced,
without external pressure. Cooling drinks, laxatives, occasionally,
small doses of morphine.

12th. Rested rather belter last night. But little alteration in
symptoms ; rather more thirst. Skin and pulse somewhat softened
by small doses of antim. and morph. Bowels and bladder as before.

13th & 14th. Rests some better. Pulse ranging about 100, rather
light; still some starting in sleep; respiration not so quick, but still
heavy ; some light delirium ; tongue coated with whitish fur; loathing
of food ; no voluntary e/acuations. Use catheter every 12 hours, and
enemata occasionally.

15th & 16th. Slowly improving; rests better. No change in con-
dition of bladder or bowels. Use vspirits turpentine, with mild mercu-
rials, to act on secretions.

17th & 18th. Not doing so well. Constant fever; pulse rather
full, about 100 ; veins full. Can lie on neither side ; occasional
pains, more or less acute, from the external wound through the chest
to the spine. Some action on bowels ; bladder totally inactive, air
passing in through the instrument when pressure is removed, after
empting that viscus. Gave a few grains of quinine, and small doses
of morph. and ipecac.

19th. Rested pretty well last night. Fever subsided; skin cool
and soft; moderate action on bowels. Drew otla pint of urine ; yet
notwithstanding this distension of the bladder, some air rushed in
when the catheter was first introduced. Tongue becoming clean,
no thirst. Uses strawi)errios, which have constituted his only sub-
sistence. Looks more lively ; breathes well.

20th. Improving. Wound healed; no pain ; can lie comfortably
on his right side. Some appetite ; takes tea and toast, and this day
ate a young pigeon broiled. Pulse 84.

21st. Rested well, without anodynes. This day passed urine with-
out help, for the first time. Bowels in a healthy condition ; appetite
good. Sat up in a chair for some minutes, but with much fatigue.
Pulse soft, 82 ; breathing good.

May 1st. Has continued to improve slowly. Sets up for hours,
and walks about the house.

2d. Rode out, without fatigue.

4th. Left for home, on steamer Isabella.

There was a distinct bellows sound in the heart, for about two weeks,
whose swells were not synchronous with arterial pulsation. This
sou id grew less distinct, till it was entirely lost.

I have seen Mr. H. frequently during the summer. He has been
well, and is now enjoying fine health. December, 1850.

310 Miscellany. [May,

Wounds penetrating the cavity of the heart are considered, by most
professional men, as necessarily fatal. In the N. Y. Journ. Med. is
reported a case of wound of the heart the patient living ten days
external wound near the sternal end of the fourth rib. On the 9lh
day, the patient "fell on the floor of the ward, while crossing it."
The pericardium was found perforated within the mediastinal space.
The heart itself was perforated half an inch to the right of the septum ;
perforation passing entirely through the right ventricle, throujih the
septum, into the left ventricle. The orifices were lined with coagula-
ted lymph. The learned editor of the Am. Journ. of Med. Science,
in commenting on this case, which he re-publishes, says : " Wounds
of the heart, when penetrating its cavities, are always fatal, though
the patient often lives for a considerable period after the accident."
He then alluded to large collections of cases, to establish this negative
proposition that penetrating wounds of the heart can not he cured.
Had the case just alluded to been well managed, it might possibly
have been cured ; in which case, our profession never would have
known it. But " he fell on the floor of the ward, while crossing it,"
on the ninth day, died on the tenth, and the knife revealed the surpris-
ing fact, that both ventricles of the heart had been penetrated.

In the Journal of Medical Science, for July, 1850, there is an in-
teresting case of wounds of the left ventricle of the heart, which,
survived five days; reported by Dr. Frugien of Portsmouth, Va. A
young negro man was found lying on the floor, in a state of the most
profound collapse. " A wound was discovered, equi-distant from the
nipple and the left edge of the sternum, and just over the left costo-
sternal cartilage of the fourth rib. There was no hemorrhage from
the wound." " The Doctor's first impression was that the heart had
been wounded, and that the case would terminate fatally. '* The
arrest of the probe by the cartilage," he says, " and its deflection to
the right, caused me to come to an opposite conclusion." The collapse
was then attributed to the presence of crude, indigestible food in the
stomach. The wound was received on Monday night, and the patient
continued to improve till Saturday, when in disobedience of orders,
" he went out, and used other improper exertions." At 8 o'clock he
died. He had been setting up a few minutes previously, and con-
versing cheerfully, when he sunk down from his chair and expired.
Autopsy showed a wound passing through the wall of the right ven-
tricle, without penetrating its cavity, thence through the septum into
the cavity of the left ventricle'. Through the opening thus made, the
blood had escaped into the pericardium, until it put a stop to the
movements of the heart. The wound through the pericardium had
completely cicatrized, as well also as that of the heart for two thirds of
its extent. Had this patient been confined on his back, and restricted
to water gruel for twenty days he possibly might have lived.

It is the recorded opinion of Dorsey, Dupuytren, and others, that
wounds of the heart are not necessarily fatal. But Taylor, in his Medi-
cal Jurisprudence, says, "until some clear instances of recovery from
penetrating wounds of the cavities are reported, the majority of practi-

1851.] Miscellany, 311

tioners will continue to look upon them as necessarily, although not
knmediately fatal." As one instance of such recovery, I offer,
with some diffidence, the above case. It may not be improper to
state, that the youth who suffered was, at the time, a member of my
own household. I was by his side constantly, niijht and day, for two
weeks. The facts were noted down as they occurred, with all the
exactness of which I was capable. The case is deeply interesting,
in many points of view, especially so in a practical one : showinjr,
what the two cases alluded to unfortunately showed before, that, in
wounds of the heart, the horizontal position should be strictly main-
tained, and the utmost quiet and relaxation enjoined, for at least two
or three weeks after the infliction of such injuries.

Southern Medical Literature. The following resolutions were
adopted unanimously by the Association:

Dr. DossEY of Mobile, offered the following resolutions, and
urged their adoption by many very appropriate remarks, disclaiming,
at the same time, all prejudiced political or sectional feeling, averring
that he was actuated solely by the hope of elevating the standard of
our profession in our midst :

Whereas, the Alabama State Medical Convention, feeling deeply
impressed with the importance of encouraging the growth of medical
literature among us, therefore

Resolved, That, as a body, we will sustain by patronage, and as far
as we can, by articles, contribute towards building up and sustaining
the Medical Periodicals of the South and South- West.

Resolved^ That we deem it the duty of this Association to lend its
influence and support, as far as practicable, to the Medicallnstitutions
of our own section, believing that the facilities for acquiring a thorough
medical education are equal to those found elsewhere.

Dr. Percival spoke warmly in favor of these resolutions. He
thought we much needed a Home Medical Literature, and that our*
patients were often the sufferers, by our too closely adhering to the
precepts taught in schools and books by those who know nothing,
practically, of the diseases of the Southern country.

Dr. HiCKLiN, also, spoke in flivor of their adoption.

Dr. Ketchum took this opportunity to call the attention of the Asso-
ciation to a work, that has directly in view the encouragement of
Southern medical literature, "Fenner's Southern Medical Reports."
He stated the difHcultics which the editor had to encounter in bringing
out such a work, and the aid which it was necessary for the profession
to extend towards it, to secure its success. At the close of Dr.
Ketchum's remarks, Dr. Anderson of Mobile, olfered this resolution :

Resolved, That the Alabama State Medical Association highly
appreciate the motives which induced the able editor of the '* South-
ern Medical Reports " to undertake his task ; and being well satis-

312 Miscellany. [May,

fied of the practical utility of the work, and the ability with which it is
edited, they cordially recommend it to the faculty of the State, as a
standard volume for any medical library.

AncBsthetics in Richmond, Virginia. The committee appointed by
the Medical Society of Virginia, to *' enquire into the experience of
the Medical profession of the city of Richmond, in regard to the util-
ity and safety of anaesthetic agents," have recently made a very
elaborate Report, which is inserted in the '-Stethoscope," a valuable
medical journal, now published in Richmond.

We are informed that anaesthetics have been administered since
their introduction in Richmond to 1384 persons, viz: by Physicians,
Chloroform to 291 persons, Ether (sulphuric, we presume. Ed.) to 99,
Ether and Chloroform to 10. By Dentists, Chloroform to 428, Ether
to 556.

" Three cases have been reported, in which fatal or permanently
injurious consequences have been suspected ; but in all oflhese, there
were other palpable causes quite sufficient of themselves to have pro-
duced the results. That the anaesthetic agent used, even co-operated
with these causes, has not been satisfactorily shewn; and without this
evidence we cannot admit a conclusion opposed by all the other evi-
dence which we possess."

From the facts presented, the committee deduce the following pro-
positions :

*' 1st. Of nearly fourteen hundred instances reported, in which an-
aesthesia has been produced, not one has occurred in which either a
fatal or permanently injurious consequence has been proved to have
resulted.

. " 2d. That on every occasion on which it is desirable to use anaes-
thetic agents, we may do so with confidence, observing proper pre-
cautions.

"3d. That chloroform is preferable to ether, and is equally safe.
We would compare its advantages to those of the alkaloids, quinine,
morphine, &c., over the bulky and often nauseous substances from
which they are derived.

" 4th. That in surgical operations the patient is not only saved the
cruel agony which has hitherto been inseparable from many of them,
but is in a more-favorable condition for their successful performance.

"5th. That the process of natural labor is facilitated by anaesthesia.

"6th. That in some cases of a purely medical character, these
agents furnish a most valuable resource to the physician.

"7th. Finally, when we consider the extensive application of these
agents, the diminution of suffering and the preservation of life which
they have effected, and the relief from embarrassment to the operating

1851.] Miscellany. 313

surgeon which they afford, together with their safety, they deservedly
rank among the most valuable resources of the healing art, and their
discovery marks an important era in the history of medical science."'

Inlemjperalt Use of Chloroform, We find in the body of the Re-
port a case of such novelty that we transcribe it in full :

"J., about sixty years of age, blacksmith, of fine athletic form, had
enjoyed such uninterrupted good health, that he had not been known
to lose a day's work during twenty years. It was his habit to work
every day, Sundays included, until a late hour of the night. Every
Saturday night he stopped work earlier than usual, and indulged him-
self in a frolic. About three years since, his mind became suddenly
disordered while he was at work in his shop. He was totally incapa-
ble of applying himself to his usual employment, and imagined that
he had been poisoned. He returned home and went to bed, from
which he has never risen since, except for a short period.

'* While under medical treatment for this hypochondriacal condition,
it wassufrgested to him to use ether, which had then been just intro-
duced, for the purpose of producing ana3sthesia. A few trials were
not satisf ictory to him, and when chloroform was introduced, he soon
substituted it for ether. Since then, he has continued to use it to an
enormous extent. He hns often inhaled a pint in twenty-four hours.
On one occasion, his son left in his room a pound, which he had just
purchased. On returning home six hours after, he found the bottle
empty. On enquiry, his father assured him that he had inhaled the
whole of it, and entreated him for more. Fearing that it would prove
fatal, he refused to procure a further supply, until after an interval of
about twelve hours, when his father's entreaties became so importu-
nate that he yielded, and during the remaining six hours, the old man
inhaled ten ounces more, amountinjr in all to 26 oz. in 24 hours.
Proba)>ly, however, much of this wasted,

" One apothecary of the highest character testifies, that he has sup-
plied him with more than two hundred pounds, and that he has not sold
him any for a considerable time. His son declares, that his father's
use of chloroform has consumed the greater part of the earnings of
himself and brother, in one of the largest and most profitable shops in
the city. He supposes they have expended at least twenty-five liun-
dred dollars in this way during the last three years. Lately, they
have succeeded in reducing the amount used, to four ounces in three
days.

"It is remarkable, that during the period that he has been using
chloroform, he h.-is entirely abandoned the use of ardent spirits.

" About the middle of last February, two members of the committee
visited the patient, in company with his son. He was found occupy-
ing an attic rooom, lyinir upon a pnllet on the floor, in com|)liance
with his own wishes. His appearance was that of a he.uty, fleshy
man, of about sixty years of age. His pulse, respiration, in fact all
his functions, we ascertained were perfectly healthy. His appetite

314 Miscellany. [May,

and digestion were remarkably good. During this inordinate use of
chloroform, he has fattened probably thirty pounds, his weight being
now about one hundred and eighty pounds.

" He has never been unpleasantly affected in any way, either during
ansethesia or afterwards, except once, when, having become insensi-
ble, his head fell upon. the inhaler. Then, a more profound state than
usual, marked by stertorous respiration, was produced, but it was of
short duration.

" We remained in the room about have an hour, conversing with
him most of the time, and wT-re several times interrupted by his
urgent entreaties for more chloroform, although he had just enierged
from the anaesthetic state. His remarks were chiefly on the subject
of his having been poisoned, which is evidently his principal illusion.
He imagines himself unable to walk, und refuses even to be dressed.

"At length his desires were indulged ; and an ounce vial, half full
of chloroform, was brought to him. He eagerly grasped it ; and
having drawn the bed-ciotJies over his face, sufficiently 1o cover his
mouth and nose, he placed the vial to his lips, and took strong, deep
inhalations for ten or fifteen minutes. A slight quivering passed over
his frame, he rolled upon one side, and lay in a state of profound
sleep. We then left him to his strange infatuation.

"This case proves conclusively, that the intemperate use of chloro-
form is attended with far less danger than is the same use of alcohol
or opium. It is a remarkable fact, that in this case it has not been
necessary to increase the dose, which would huve been required, had
any known stimulant or narcotic been used, instead of chloroform."

History of the Southern Medical and Surgical Journal. Judging
from the many changes in the Editorial management of the Southern
Medical and Surgical Journal, its career would seem to have been one
full of vicissitudes; yet its career has been eminently successful.
This Journal owes its origin to the indomitable energy of the late
Professor Milton Antony, the illustrious founder of the Medical Col-
lege of Georgia, who, after having established this school upon a
permanent foundation, determined to encourage Medical Literature
in the South by furnishing a suitable vehicle for the record of facts
and observations. Overcoming all the obstacles to such an under-
taking, he associated with himself, in the Editorial chair. Dr. Joseph
A. Eve, (the present able Professor of Obstetrics,) and published the
first No. of this Journal on the 1st of October, 1836. It was issued,
as it is now, in monthly Nos. of 04 pages each, making an annual
volume of nearly 800 pages. The monthly form was very properly
deemed the most convenient for the active practitioner of medicine.
Prof. Joseph A. Eve withdrew from his cditotial connection at the
termination of the 1st volume, and the 2d and 8d vols, were edited by

1851.] Miscellany. 315

Prof. Antony alone, whose lamented death occasioned a suspension of
the publication until the 1st of January, 1845, when it was resumed
by Professors Paul F. Eve and I. P. Garvin. These gentlemen con-
ducted it jointly during three years; with the last No. for 1847 Prof.
Garvin retired, left it in the hands of Prof. P. F. Eve two years, and
then resumed its supervision alone in 1850. This Journal has there-
fore been edited during the issue of the nine volumes, (old and new
series,) preceding the present one, alternately by Professors M. An-
tony, Joseph A. Eve, Paul F. Eve, and I. P. Garvin. (That these
frequent changes were the result neither of fickleness nor of ill suc-
cess is abundantly established by the progressive increase in the
number of subscribers, and the high estimation in which the work
has been held throughout our country. The true cause is to be found
in the vast amount of labor required for its creditable management,
and in ihe extensive professional engagements of the parties. No
one who has not tried it can justly appreciate the task of editing such
a periodical, and of attending at the same time to the harassing du-
ties of a large practice, a

The multiplicity in our land of medical periodicals is regarded by
many as a decided evil. This, however, is a great error. Every new
medical journal increases the number of readers as well as of writers.
When the Southern Medical and Surgical Journal was first issued, it
was rare that the voice of a Georgian was heard upon medical topics.
By a reference to the original communications it contains, we find that
they number 412, and that they were written by 146 different physi-
cians, the large majority of whom are Georgians, and the remainder
from the adjacent States. With such facts before us, we feel that the
career of our Journal must continue to be one of progressive prosperi-
ty and usefulness. As a native of Georgia, we feel proud of her rapid
advance in refinement and science ; as the Editor of this Journal, we
desire to honor those who have by their contributions made it what it
is.TVVe therefore beg leave to subjoin a list of their names. If any
be omitted, we hope to be corrected.

Antony, M. Bailey, D. F. Branch, Franklin

Antony, E. L. Baldwin, A. C. Bignon, H. A.

Anthony, J. M. Barratt, J. P. Brandon, 1). S.

Arnold,' R. D. Burt, VV. M. Cotting, J. R.

Arnold, A. B. Baker, E- L. Cunninu;ham, A. -

Barrett, C. B. Barr, F. W. Chase, ^H.

Bowen, J. Barton, E. II. Cunningham, S. B.

Bean, A. Bcal, L. B. Cohen, L. L.

Bacon, J. Blackburn, J. C. C. Carpenter, VV. M.

31G

Miscellany,

[May,

Campbell, H. F.
Gumming, W. H.
Carter, '1'. W.
Colley, F. S.
Campbell, R.
Connell, A.
Cooper, G. F.
Cullender, G. D.
Casey, H. R.
Dugas, L. A.
Delony, E.
DeSaussure, H. W.
Davis, Jno.
Eve, J. A.
Eve, P. F.
Eve, E. A.
Erskine & Shefiey,
Ford, L. D.
Fort, Tomlinson
Garvin, I. P.
Grant, G. R.
Gorman, J. B.
Geddinn^s, E.
Gamble, S. D.
Groce, B. W.
Gordon, J. M.
Gardner, J. M.
Greene, A. B.
Gaiiher, H.
Girardey, E.
Green, J. M.
Gautier, VV. J.
Holloway, G. K.
Heustis, J. W.
Hook, D. .
Haynes, C. A.
Harden, J. M. B.
Hammond, D. W.
Holman, J. C.
H olliday, J. S.

Hook, E. B.
Hamilton, T.
Hammond, J. F.
Hard, D. B. VV.
Hitchcock, C. M.
Hammond, A. L.
Harris, J. C.
Harriss, J.
Harper, P. W.
Johnson, W. J.
Johnson, N. B.
Jones, W. L.
Jeter, H. M.
KoUock, P. M.
Kirkpatrick, A. R.
Keckoly, E. C.
King, W. N.
Lee, W. M.
Lee, J. F.
Lake, J.
Levert, H. S.
LeConte, Jno.
Little, R. E.
Leak, W. W.
Long, J. A.
Long, C. VV.
Le Conte, Jos.
Longstreet, A. P.
Mayes, J. A.
Martin & Smith,
Melchoir. R.
Meals, H. H.
Moore, R. D.
Miller, H. V. M.
Macon, E. H.
Meek, S. M.
Means, A.
Mastin, C. II.
McJunkin, D. VV.

Nicoll, A. Y.
Noit, J. C.
Norwood, W. C.
Nisbet,R D.
Oakman, E. PL
Oliver. J. H.
O'Keeffe, D. C.
Pendleton, E. M.
Pearson, B. H.
Parker, VV. P.
Quintard, C. T.
Robertson, F. M.
Robert, VV. H.
Richardson, C. P.
Robertson, J. J.
Riordon, J.
Rossignol, H.
Ramsay, H. A.
Strobel, B. B.
Simmons, T. Y.
Shephard, C. VV.
Smith, G. G.
Stevens, J. P.
Sheflby, L. B.
Summer, VV. J.
Tufts, J. B.
Tutt, G. M.
TvviiTgs J. D.
Wilde, R. H.
VVhitridge, J. B.
Wildman, P. H.
AVooten, H. V.
West, C.
Wooten, G. H.
Westmoreland, J. G.
Williamson, W.
Warren, R. L.
Wilson, J. S.
Word, R. C.

Occlusion of the Vagina. Dr, P. C. Spencer, of Petersburg, Va.,
reports in the April No. of the "Stethoscope" an interesting case of
occlusion of the vagina consequent upon sloughing after parturition,
in which he successfully restored the canal by excision of the cicatrix.
The female has since borne a child without farther accident.

Dr. A. G. Mabry related to the Medical As.sociation of Alabama,

1851.] Miscellamj. 317

a similar case in which "the Doctor commenced the treatment by
making several incisions into this body" (an unyielding cicatrix) "and
introducing bougies, but owing to some bad management the incisions
healed up, and it was necessary to repeat the operation again and
again. After several operations, a bougie was introduced and kept
in its proper place by a T. bandage, which eventually made a perfect
cure. (Proceedings of the Med. Association of the State of Alabama,
December, 1850.)

Dr. Debrou reports in the Gazette Medicale de Paris, 18th Jan.,
1851, a very remarkable case of congenital occlusion of the vagina
and OS uteri, in a female 19 years of age, which was successfully
relieved by incisions and tents. The female subsequently married
and bore a child, but died of puerperal metritis on the 10th day after
delivery.

Chloroform in Infantile Convulsions. The New-Hampshire Journal
of Medicine reports a case of obstinate convulsions occurring in a
child affected with an enormous hydrocephalus. After failure of the
usual means, chloroform was administered by inhalation, promptly ar-
rested the convulsions, and saved the patient's life. The case was
treated by Dr. N. Martin, of Dover, N. H.

Aciionof Ergot inproducing Retention of the Placenta. Dr. Charles
Hasbrouck, of Rockland county, New York, relates in the New Jersey
Medical Reporter, several cases tending to illustrate his belief that
the administration of ergot during parturition may occasion a reten.
tion of the placenta. The subject is new, we believe, and certainly
well worthy of further investigation. We have not room for the en-
tire article, but will simply add the author's preliminary remarks :

"Spasmodic contraction," or "premature contraction " ofthecer-
vix uteri, is referred to by obstetrical writers as an occasional cause
of retention of the placenta; and Dewees, in his system of midwifery,
mentions the fact, tiiat in some instances of this ciiaracter. the body
of the uterus is also found to be "hard and well contracted." But
60 far as my information extends, the frecjuent relation between this
condition of the uterus and the administration of ergot during labor
has never been pointed out. The following cases, it seems to me,
are calculated to show that such relation does occasionally exist ; that
the placenta may, perhaps, not unfrcquenlly, be retained by the per-
manent and uniform contraction of every part of the uterus, excited
by the specific action of ergot upon that organ.

318 Miscellany, L^^ay

Extraordinary Tapping. Dr. T. D. Lee, of New York, reports a
case of ascites, in which he performed paracentesis abdominis 39
times and drew off 141 gallons of water! The case terminated fa-
tally. We recollect removing 10 gallons at one tapping, in a case of
encysted dropsy, and repeatedly afterwards 6 gallons, by which the
life of the patient was prolonged about 18 months.

North-Western Medical and Surgical Journal. Dr. Edwin G.
Meek has retired from the co-editorship of the North-Western Medical
and Surgical Journal, and is about to migrate to California. He will
carry with him the best wishes of the fraternity. The Journal will
continue under the able management of Prof. Evans.

The Ohio Medical 8f SurgicalJournal. This valuable bi-monthly,
heretofore edited by Dr. S. H. Smith, is now conducted by R. L*.
Howard, M. D., Prof, of Surgery in Starling Medical College. We
feel assured that the professor will sustain himself ably in his new
position, and cordially welcome him into the editorial corps.

Dr. Jenner. The British government is about to erect a monu-
ment in honor of Jenner. Better late than never.

Medical men going to Enrope. We learn that the following dis-
tinguished physicians are to visit Europe this season : Professors Silli-
man, father and son ; Professors J. B. S. Jackson and H. J. Bigelow,
of Boston ; Prof. R. L. Howard, of Starling Medical College, Ohio ;
Prof. White, of Buffalo.

Inoculation in Rubeola. By John E. McGirr, A. M., M. D., L. L.

D., Professor of Chemistry, Physiology, &;c., in the University of
St. Mary's, Physician to the Catholic Male and Female Orphan
Asylums, Chicago.

Inoculation in Rubeola is no new experiment. As to the advan-
tange of the process, diversity of opinion exists. Drs. Home, in
Edinburg, Dewees, and Chapman, at the Dispensary in Philadelphia in
1801, practiced inoculation without any satisfactory results, while the
experiments of Prof. Speranza of Mantua, and others, were varied,
decisive and successful. Having no opinion of my own to confirm,
wishing only to arrive at the truth, if possible, I determined when the
very favorable opportunity presented, by the breaking out of Rubeola
in these Asylums, to test this point. The Asylums are situated, (the
female in north, and the male in south Chicago,) without the thickly
settled portion of the city, having the advantage of healthy locations.
The houses are large, well ventilated, and are under the charge of
the Sisters of Mercy; thus the best nursing could be secured, and the
best opportunity which might ever again occur to me of watching every

1851.] Miscellany. 319

stage of the progress of the disease. Early in December the first
case of measles was brought into the female asylum. I proceeded lo
inoculate from this case, when the eruption was at its height. Blood
was drawn from a vivid exanlhematous patch on the diseased child's
arm, and inserted into the arms of the tiiree children first mentioned in
the list below. On the fourth, sixth and seventh day, after the
inoculation, the measles appeared, pursuing a regular and mild
course. The result of these cases determined me to carry the ex-
periment farther, and that the trial might be a fair one, I selected for
comparison those whose physical conformation and constitutional
idiosyncracy, seemed most nearly alike, giving the disadvantage of
age to the inoculation. The following table contains the names, ages, ,
and results of all the cases whether inoculated or not:

NOT INOCULATED,

INOCULATED.

Died

'Age.

Recovered.

Age.

Ellen Brown,

3 yrs.

Ellen Kehoe,

11 yrs,

Katy Russell,

2

Ellen (xrant,

4

Philomena Kehoe,

3

Mary M'Carty,

8

Elizabeth Patton,

2

Rose Mack,

5

Ellen Crowly,

5

Mary Grant,

9

Recovered.

Eliza Hurley,

4

Mary Carroll,

9

Ann Cahill,

8

Ann Brennan,

6

Ella Welsh,

5

l\Iary Patton,

7

Ann Mulhall,

9

Johanna (.'ahill.

5

Ann Hagan,

3

Emeline Hurley,

4

Mary Mulhall,

4

Mary Nugent,

5

Ellen McCarty,

10

Mary Brain,

10

Anna O'Brien,

13

Elvira Gilmartin,

5

Cath. Power,

9

Fanny Moonev,

12

Mary Ann Tell,

10

This table gives us 29 names, 24 recoveries and 5 deaths, all occur-
ring among those not inoculated. The cases of all those inoculated,
commencing from the fourth to the ninth day after inoculation, pro-
ceeded regularly, with the ordinary symptoms of simple measles, to
convalescence, which was speedy and complete, with one exception
viz,, the first case. This child entered the asylum about a year ago,
suffering with violent ophthalmia. She had been cured. On the
disappearance of the measles, the ophthalmia returned, and though
the sight was much endangered, yet there now only remains a little
weakness which is disappearing. All these cases occurred consecu-
tively from the first week of December to the second week of January.

Four children who were known to have had measles in the
spring of 1850, were inoculated ; nothing else was observed than the
inflammation which would follow any ordinary lancet puncture.

Of those not inoculated with four exceptions, the antecedent symp-
toms were very severe The fever was violent ; distressing vomiting
occurred in three cases. The catarrhal symptoms were violent;

320 Miscellany. [May,

tliroat sore, hoarseness, rigors, cough almost continuous, dry, the
whole chest sore, difficult respiration, delirium at night in some of the
cases.

Four had the " congestive modification," ihe eruption appeared
slowly and imperfectly; one of these died. Two others presented
the Typhoid variety; one died of diarrhoea, the other recovered, but
afterwards four dansjerous ulcerations appeared on the limbs, and
gangrenous stomatitis, in the left lower jaw. All of the teeth of that
part of the jaw, fell out, the left side of the tongue and the cheek were
involved in the disease. This case ultimately recovered. Bronchitis
supervened in six cases. Three had partial aphonia, one complete ;
this one died.

When these last mentioned cases attempted to swallow any liquid,
it was thrown back through the mouth and nose with violent expulsive
effort.

In the male Asylum, there were 23 cases and 6 deaths. None
were inocu'ated, hut 3 of the whole number had the disease mildly,
and these were the three first atta.-ked. The others had violent ante-
cedent symptoms, and tedious convalescence. Five of those who died
had the aphonia and difficult deglutition before spoken of, the other
died ofPhthisis.

In Review of these facts much might be said. I have chosen,
however, to give them as they occurred, without comments, leaving to
the readers of the Journal, to estimate them at what they are worth ;
merely adding, tlial if iheie is no advantage in inoculation, the result
which the second column furnishes, would be a strange anomaly. [North
Western Medical and Surgical Journal.

Anatomical Dissections in the State of New York. The following
Act was lately introduced into the New York legislature by Dr.
Tuthill, ofSuffolk, and will probably become a law of the State. It
is copied, nearly verbatim, from the act, in our own State laws, relating
to the practice of physic and surgery.

"Section 1. Any physician or surgeon duly qualified according to
the law of this State, or any medical student, under the authority of
any such physician, may have in his possession, human bodies, or
parts thereof, for the purposes of anatomical inquiry or instruction.

" 2. Either of the following board of officers, to wit : the overseers
of the poor of any town of this state, and the commissioners of health,
the city inspector, or the mayor and aldermen of any city of this
state, may surrender the dead bodies of such persons, as are required
to be buried at the public expense, to any regular physician, duly
qualified according to law, to be by him used for the advancement of
anatomical science; preference being always given to the medical
schools, by law established in this sj^te, for their use in the instruction
of medical students.

" 3. No such dead body shall in any case be surrendered, if the
deceased person, during his last sickness, requested to be buried, or if,
within twenty-four hours after his death, any person claiming to be

1851.] Miscella ny. 32 1

of kindred or a friend to the deceased, and satisfying the proper board
thereof, shall require to have the body buried, or if such deceased
person was a stranger, or traveller, who suddenly died before making
hinaself known ; but the dead body shall in all such cases be buried.

" 4. Every physician shall, before receiving such dead body, give
to the board ot" officers surrendering the same to him, a sufficient bond
that each body, so hy him received, shall be used only for the promo-
tion of anatomical science or instruction, and that it shall be used for
such purpose within this slate only, and so as in no event to outrage
the public feeling." [^Boston Med. and Surg. Jour.

Alleged Uncertainly in Medicine. Dr. Thompson, President of the
New York State Medical Society, in an address at the last annual
meeting of the Society, thus compares the medical with the olher
professions in regard to certainty in its results.

"When compared with the other professions, its character is vin-
dicated, and it rises in our estimation, for it may be questioned whe-
ther the results of its practice are any more doubtful than those of
the law, which also has been stigmatized for its ^glorious uncertain-
ties.' In a subject like theology, which treats of man's eternal
destiny, concurrence of opinion might be expected. Its doctrines,
however, find no more agreement among theologians and polemical
writers than do the accredited principles of medical science among
well-informed and cultivated medical men. In the science of politics,
in the laws which regulate the commerce and mutual intercourse of
nations, in the systems and processes of agriculture, in the arrange-
ment of society, and its government by laws whose principles and
modes of action shall prove most successful in directing its interests
and regulating its business affiiirs, men differ widely in their judo[-
ments and the greatest dissimilarity of opinions prevails. Why, then,
amid this discrepancy of judgments, and difference of opinions, should
medicine b^ held up above all, conspicuous for its uncertainties, or for
its lack of settled principles ?" \Jhid.

On the Extraction of Needles.
To the Editor of the Boston Medical and Surgical Journal.

Sir, Much has lately been said on extraction of needles in the
flesh, and I am goini^ to throw in my mite while the subject is up. 1
have seen much mischief in cutting for a needle, or a portion of one ;
more, in my opinion, than by leaving it to itself; for it has never been
my misfortunate to meet with a case where the foreign body did not
find its way to the surfice." and then it is easily extracted. The in-
side of the hands and soles of the feet are the parts most liable to be
injured; and if the surgeon begins his search in these situations in
the expectation of finding what he is searching aller, he will in most
instances be disappointed. The tendons, fascia, muscles and nerves
of the hands and feet cannot fail of being much injured, and the
surgeon will have the credit of causing the injury. I have had many

322 Miscellany,

patients present themselves to me with such accidents some of them
very much frightened, and insisting on having a search made until the
foreign body was found. Or they had already undergone an opera-
tion, with extensive incisions which exposed the tendons and ligaments,
making a trivial thino- one of a serious character.

One invariable rule should guide the surgeon in such cases. When
the foreign body can be seen or felt, no difficulty will be experienced
in its extraction. A pair of closely-fitting forceps, after cutting down
on to where you have fixed it with our fingers, will generally do it
without trouble. But in all cases where it is out of sight, and cannot
be distinctly felt, let it alone, quiet your patient's fears by assuring
him that no harm will result, and you will not have cause to regret the
course. I never used the scalpel in a case where the needle was not
in sight nor could be felt, but what I regretted it ; and, what is of
more consequence, the patient did the same. On the other hand, I
never left one to nature, but both patient and myself were glad in the
end.

Syracuse N. Y. March 12, 1851. A. B. Ship^ian.

Swallowing a Handkerchief. In the Provincial Surgical and Med-
ical Journal, is the report of a case of a boy, who actually siuallowed
a silk handkerchief nearly a loot square. On the third day it was
dejected from the bowels, perfect in every respect, except a slight dis-
coloration. Probably this is the first instance in which a human sub-
ject has been thoroughly wiped out with a silk handkerchief. It is
said that the boy was subject to epileptic fits, and imbecile in his in-
tellect; and although not cured, was not rendered any worse by this
extraordinary operation. [Boston Med. Jour.

Pension to the Widow of the late Mr. Liston. The Government, as
no doubt most of our readers have observed, has granted to the Widow
of the late Robert Liston a pension of 100 per annum. While it
is a subject of regret that Mrs. Liston should require such an addi-
tion to her income, it is gratifying to know that the just claims to such
aid by the widow of one of the greatest of modern surgeons have been
thus acknowledged by the Government.

Though almost a solitary instance of the kind, it must be satisfacto-
ry to the great body of the surgeons of this kingdom to find, even in
a single instance, that the labors of one of their brethren have been,
even to the extent mentioned, recognized as a national benefit. [Lon-
don Lancet,

Insanity caused hy Tape-worm, and cured hy Kousso. Dr. Wm.
Wood gives an interesting case, tn the London Lancet, of a man, con-
fined in the Bethlem Hospital on account of insanity, who became
completely restored to his health and reason, after a tape-worm had
been discharged by the administration of ihat celebrated anthelmintic
kousso. [Boston Med. and Sur. Journal.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES JUx\E, 181. [No. 6.

PART FIRST.

r i g 111 a I (Communications,

ARTICLE XVlir.

Remarks on Typh'dd Fever. By J. A. Long, M. D., of
McMinn County, Tennessee.

I do not propose writing a treatise on Typhoid fever, but
simply to record my own observations and experience in this
disease. Having no theory to support, or controverted points
to settle, I shall simply state facts as they have occurred to me
in practice from time to time. Since the spring of 1844, (at
which time I entered the practice of medicine,) typhoid fever
has become more prevalent, and periodical fevers less so. In
proportion as the former has increased, the latter have dimin-
ished in frequency, until the past year, which was a productive
one of typhoid fever. Periodical fevers (intermittents and re-
mittents) were almost unknown in this region of country during
that year. Typhoid fever prevails in this section in an endemic
form, raging in certain localities, or on some particular water
course, whilst the adjacent country is entirely free from its
ravages. It is a disease that prevails at all seasons of the year,
but is most common here in autumn and winter, the gravest
cases occurring in cold and damp seasons. It attacks families,
and even whole settlements, without any known or apprecia-
ble cause. In some households, one is taken down after another
in succession, until every form and stage of the disease can be
seen at the same time, and in this way is sometimes prolonged
in the family from three to four and even six months at a time.

X. S. VOL. VII. NO. VI. 21

324 Long, on Typhoid Fever. [June,

The question whether typhoid and other forms of fever belong
to one and the same great family of diseases, or are distinct
forms of disease, is an important one, and I think not yet satis-
factorily settled. It is one that I do not intend on the present
occasion to discuss, but simply to state facts in relation to this
fever. There has been much said in this counti-y about the
name of this disease and some of our oldest and most experi-
enced physicians still cling to the names o^ nervous, winter and
typhus fever, whilst the community in general believe it to be
(from its name, typhoid fever) a new disease that has appeared
among us, as it is so much more common than in former years.
As I intend to write nothing except -what has fallen under my
own observations, I shall pass by all those discussions of the
French and other writers in regard to the different appellations
that have been given to this disease by different authors. I
will only mention (for the benefit of those who have not had an
opportunity of consulting Dr. Bartlett's work on Typhoid and
Typhus fevers) that it has been called entero-mesenteric ; by
Petit and Serres, dothinenterite ; by Bretonneau, fcy/ZzcM/ar e^-
teritis ; and abdominal typhus by others. All these appella-
tions going to point out the peculiar lesion or affection of the
alimentary tube in this disease, and principally that of the small
intestines, which I will notice more fully hereafter. But the
term Typhoid fever, in this section, is coming into general use ;
all others, as nervous, typhus, winter^ continued and slow fevers,
going into disuse. I would here remark, that I am not entirely
settled in my own opinion whether that group of symptoms
which makes up the disease in question is really and strictly a
fever, or whether it should not be classed, as above, with the
diseases of the alimentary canal. The rise and progress of the
disease ; the peculiar character of the pulse, as is also noticed
in other affections of the bowels ; the local symptoms so early
noticed in nearly every case referable to the ileac regions, and
especially to the right ileac fossa ; the great danger of relapses
from taking solid food and other articles of diet after convales-
cenceall point to the latter organ as the seat of the disease.
Why, then, not as well call diseased action in any other part of
the body giving rise to fever, a/ever, (as well as the one under
consideration,) and not an inflammation, with its appropriate

1851.] Long, 071 Typhoid Fevej-. 325

appellation according to its locality ? I am fully persuaded that
the treatment in this disease would have been doubly success-
ful if it had been known under some title pointing out more
fully the disease of the small intestines : then the disease
would have been prescribed for, and not the name, as I fear is
too often the case in the present day.

The result, in this section of country, of a treatment with
calomel and quinine is almost universally fatal. Typhoid fever
generally comes on slowly and gradually. So uniform is it in
this particular mode of access, that it is one of the principal
features in its diagnosis. I cannot at present call to mind a
single well marked case of typhoid fever in which the onset
was sudden or violent, though occasional attacks of this kind
may, and probably do, occur from modifying causes, or from
unusual predisposing states of the system. I have almost uni-
formly been told on my first visit to patients that they had felt
unwell for several days, or perhaps weeks, and indisposed both
to bodily and mental exercise of any kind. They were, how-
ever, unable to tell in what their disease consisted, more than
weakness, or a general sense of languor, disturbed sleep, &c.
A dull headache accompanies or succeeds the above premonitory
symptoms, this being preceded by a chill or a sense of coldness,
with fever, dryness of the mouth and fauces, with the tongue
more or less furred, dry, and occasionally cracked; surface dry
and warm, high colored urine, &c. The febrile symptoms in
typhoid fever are rather of a low grade or type, with slight ex-
acerbations and remissions at some period during the twenty-
four hours. Generally I have found the pulse somewhat accel-
erated at night, accompanied with restlessness and want of sleep,
even in mild cases watchfulness, jactitation and delirium, in
grave ones. One of the most constant and characteristic symp-
toms of typhoid fever is diarrhopa^ and this symptom is to be
found as well in mild as grave cases. It is, however, occasion-
ally absent in both the former and the latter, being uniformly
present in cases of medium severity. This symptom, I believe,
is always accompanied with more or less abdominal soreness,
particularly if pressure be made upon the right ileac region.
Most generally the tenderness is accom|)anied with a gurgling
noise in this part of the abdomen. The latter symptom I have

326 Long, on Typhoid Fever. [June,

sometimes detected even before diarrhoea had set in. My pa-
tients have generally complained of fulness and a dull aching
in the abdomen, sometimes, but rarely amounting to eholic
pains. Some writers, as Wooten of Alabama, have divided
this disease into two general classes, nervous and mucous^ ac-
cording as one or the other of those great systems suffered
most, or as the mucous or nervous symptoms predominated in
the disease. He also gives us a set of mixed cases, w^here both
the mucous and nervous systems suffer equally; and here it is,
he says, we are most apt to meet with those grave cases which,
unfortunately for humanity, are too often to be seen in this as
well as other regions of the globe. It is true, that the cerebro-
spinal system, as well as the mucous, suffers greatly in this
disease ; but in this country those two classes of symptoms are
so uniformly blended in almost every case, that a division of
this kind v/ould be of but little practical importance. It is
equally true, by hair-splitting distinctions, that one or the other
set of symptoms (mucous or nervous) will be found to predom-
inate in nearly every individual case. This I attribute more
to differences in constitution, age, sex, habit, temperament, &c.,
than to any particular variety of the disease. Typhoid fever
is truly a nervous disease, as is manifested by general weak-
ness, headache, delirium, loss of vision, deafness, ringing in
the ears, somnolence, vigilance, jactitation, muscular prostra-
tion, &c.

Epistaxis is a pretty constant symptom in this fever, as well
as occasional hemorrhages from other parts of the body. The
delirium is of the low muttering kind, attended with watchful-
ness, jactitation, and picking of the bed-clothes, though occa-
sionally it is wild and furious ; the patient rising from his bed,
striking at his attendants, or pulling at, scolding, or menacing
some imaginary object about his bed. I have seen them even
leap from their beds, and traverse the room in which they lay,
giving considerable resistance to those who attempted to op-
pose theni. Patients can in general be easily aroused when
distinctly spoken to, and will then answer questions in relation
to their situation or feelings perfectly rationally, but as soon as
left alone will sink back into their former state of stupor, saying
nothing except what is forced from them by repeated questions.

1851.] Long, on Typhoid Fever, 327

They generally reply that they feel better; nothing is the nnat-
ter they are well, and so on. The pulse in this disease is
peculiar and characteristic it is small, quick and frequent,
having a kind of double beat, or, as Dr. Bartlett calls it, the
hesfereus pulse. So constantly have I found this pulse in Ty-
phoid fever, and so seldom in other diseases, that in a locality
where this disease is prevailing, I can almost make out my
diagnosis from this symptom alone. I generally find the pulse
to range from 90 to 110 in men, and from 100 to 120 in women,
in common cases. When uncomplicated with other diseases,
the prognosis is for the most part favorable; but in grave
cases, or where some local disease is present, the pulse ranges
higher, from 110 to 120 in males, and 120 to 140 or 150 in
females. In many cases of typhoid fever, from the extreme
nervousness or twitching of the tendons, {subsullus iendinum.)
the double beat of the pulse, or apparent reaction after every
pulsation, and its almost unparalled frequency, renders it im-
possible to count the pulse with certainty in this disease. I
have seldom seen nausea or vomiting in this disease, or even
much complaint of feeling pain or other disagreeable sensations
in the epigastric region. Much has been said, and many con-
tradictory statements have been made, about the state and
condition of the tongue, some asserting that this organ differed
but little from its natural and healthy state in every stage of
the disease, whilst others contend that the tongue exhibits vari-
ous unhealthy appearances. I have always found the tongue
more or less coated with a white, yeliov/, or brown fur moist,
dry, cracked, or swollen, according to the severity of the dis-
ease. The appearance of the tongue indicates to the experi-
enced practitioner the extent of disease in the alimentary tube.
When there is much soreness oPthe abdomen on pressure,
accompanied with obstinate diarrhoea, the tongue is found
swollen, wnth a dark brown or black coat, with its tip and
edges more or less red. I am ready to admit, however, that in
mild cases the tongue shows only slight deviations from its
natural appearance. Some patients are so slightly attacked
that they never take their bed, whilst others are rapidly hurried
to a fatal issue. At other times (and this is more commonly
the case) the disease is slow, tedious and lingering in its nature,

328 Long, on Typhoid Fever. [June,

and sometimes many days, and perhaps weeks, elapse and pass
off, leaving the friends still in a state of restless suspense as to
whether life or death will finally gain the ascendency.

Typhoid fever is confined to the young and middle aged, or
to those between the ages of 10 and 30 years, rarely attacking
those younger than 10 or over 30. This disease is evidently
contagious. This is strikingly true in the grave forms of the
disease, where large families are crowded together in small
apartments, illy ventillated, and where it is impossible to ob-
serve cleanliness as it should be done in a sick chamber, by re-
moving all unnecessary furniture, clothing, and the discharges
of the patient, requisites so essential to the promotion of health
and avoidance of disease, not only in typhoid fever, but all other
diseases incident to the human family. I have usually found
that the first cases that occurred in a family or neighborhood
were generally the severest. It is unlike periodical fevers in
this respect, as the latter generally come on in their mildest
form, gradually growing severer with the advancement of the
season. I would further remark, in proof of the contagious
nature of this disease, that I have never seen the same individu-
al suffer more than once from typhoid fever, notwithstanding I
have seen the disease in the same family at different times.
Such as had suffered from previous attacks ran no more risk
than those who had suffered from measles, scarlatina, or variola,
and were afterwards exposed to them. There is so much to be
learned in typhoid fever, from the physiognomy that I am always
anxious on my arrival at each visit to catch a glimpse of my
patient's countenance, which never fails to make a decided
impression on my mind, before any further examinations are
made or questions are asked. A rose-colored eruption is spo-
ken of by almost every writer on this disease, but it is seldom
seen unless looked for at a proper stage of the disease. This
eruption is most apt to be found upon the anterior portions of
the chest and abdomen, but occasionally it is thinly scattered
all over the body. In a i^w of my grave cases (I find by con-
sulting my case-book) I have encountered some very obstinate
eschars or bed sores, mostly on the hips and sacrum. I have
also seen deep ulcerations, or obstinate sores, produced from
blistering in typhoid fever. There is generally slight cough,

1851.] Long, 071 Typhoid Fever. 329

with little or no expectoration, though occasiorially it becomes
troublesome, with free expectoration streaked with blood, or of
a rust color. This expectoration is accompanied with dulness
on percussion of the chest and other symptoms, denoting more
or less congestion of the lungs or pneumonitis. The diagnosis
in this disease is attended with some difficulty in sporadic cases,
but in seasons remarkable for the prevalence of typhoid fever,
its mode of access, its attacks on whole families and settle-
ments, raging mostly in an endemic form, its slow and tedious
nature, attended with a diarrhoea, render the diagnosis compara-
tively easy. The discharges are generally watery, of a green or
dark green color, without any traces of bile in them, and most-
ly without smell.* When the above symptoms are accompani-
ed with fever, a quick, frequent and small pulse, with a double
or reacting beat, ranging from 90 to 140 beats in a minute,
soreness on pressure over the right ileac region, with a gurg-
ling noise, occasional tympanitis, with an unusual degree of
weakness, are foufcl in the same patient, they are sufficient to
establish a case of typhoid fever. T\\q prognosis in this disease
is attended with some difficulty, as some grave and prolonged
cases terminate in recovery, whilst we are told that occasional-
ly mild ones terminate rapidly in death, by peritonitis, from
perforation of the intestine. But, as a general rule, where the
disease is not complicated with acute local affections, or chronic
disorders, or in broken down constitutions from previous dis-
ease, arnd where the pulse does not range higher than 100 or
110 in men, 110 to 120 in women, the cases will terminate
favorably, if the treatment be appropriate and not aggravating^
as is too often the case. According to my own experience, the
prognosis in typhoid fever is for the most part favorable, the
disease having a strong tendency to terminate in recovery in
its uncomplicated form, even when left to run its course with-
out treatment. I have frequently seen grave and prolonged
cases terminate favorably, but have not seen mild ones termin-

I am aware that this is a controverted point, but I write only what I itnow
to be facts, and I have almost uniformly found the stools of typhoid lever, when
diarrhaa was present, to be without smell, and I have olten predicted a favora-
ble change while the patient was at stool, by perceiving distinctly a strong
bilious smell to the discharges.

330 Long, on Typhoid Fever. [June,

ate unexpectedly from peritonitis or otherwise. If it were not
for the daily reports of physicians, medical journals and news-
papers, of a large proportion of deaths taking place from this
disease in different portions of the country, I would venture to
speak in more positive and favorable terms in relation to the
prognosis. In low and grave cases, the patient lies on his
back in a state of stupor, and slides down in the bed from mus-
cular weakness. One of the first favorable symptoms to be
noticed in such cases, is a tendency to turn on the side himself,
or even ask to be turned. When this position cannot be main-
tained but for a few moments at a time, but is daily repeated,
it indicates returning muscular strength, consequently a favora-
ble chan2;e in the disease.

Treatment. There areas many modes of treatment of this
disease, in this section of country, as there are physicians. Its
cure has generally been attempted by calomel and quinine, espe-
cially by the older class of physicians. They,have attempted to
cut short the disease in its onset, by bringing the system under
the specific influence of this potent medicine. In this they
have not only failed, but almost universally lost the patient,
especially where the disease was of a grave form and wont to
run a tedious course. Typhoid fever is a disease that cannot
he cured, hut can he safely conducted through its different stages
by a judicious course of treatment. He who attempts to cut
short the disease by strong medicines will lose over ouq half of
his patients. The treatment of typhoid fever must be strictly
eclectic to be successful, for no exclusive or specific mode of
treatment can be laid down that would be applicable even in
a small proportion of cases. We must meet symptoms as they
arise in each and every individual case, and endeavor to con-
nect the morbid functions of the different organs, and keep
them in as healthy a condition as is compatible with the nature
of the case, suffering the disease to run its course as other
specific disorders.

With these remarks, I proceed to give my own mode of
treatment in this disease, which has been entirely successful
up to the present time. My course of treatment is plain, sim-
ple and mild ; in this respect, not unlike the prescription given

1851.] I^ong, 071 Typhoid Fever. 331

to Naaman of old, by the prophet, Elisha. I attack the disease,
not with a view to cure, but to safely conduct the patient
through its different stages. So uniformly is this my course of
practice, and so thoroughly am I convinced of the utility of
such a course, that I speak of conducting my patients safely
through the disease, and not of breaking the fever, as is the
common term, especially among the vulgar. A great man,
and practitioner of medicine, once, on being asked what he
thought of a certain treatise on fever, replied, "he did not like
fever curers. A fever," said he, " can be conducted safely
through its different stages it cannot be cured." These re-
marks on fever, by Pitcairn, are applicable in every particular
to the treatment of typhoid fever. When the patient is stout
and robust, 1 take some blood, not being in the least governed
by the quantity or quality of the fluid drawn, but its effects upon
the heart and arteries. But typhoid fever is a disease so in-
sidious in a great majority of cases that the practitioner is not
called in until the bleeding stage has passed by, (if it ever ex-
isted,) which it does not in a great majority of cases. The
functions of the skin and liver are generally suspended through-
out the entire course of the disease ; the former being dry,
warm, and harsh to the touch, and generally of an unusual yel-
lowish hue, whilst there is no trace of bile in the alvine dis-
charges. After sufficient blood is taken, where blood-letting
is deemed proper, I am governed by the circumstances of the
case. If diarrhoea is present, (which is generally the case,) and
no traces of bile in the alvine evacuations, I give blue pill and
Dover's powders every four or six hours, according to circum-
stances. I watch narrowly the effects of the Dover's powders
in every instance, as that medicine is not borne well by some
patients ; but in a majority of cases it is not only tolerated, but
produces the happiest effects when given in union with blue
nnass in the proportion of from 3 to 5 grs. of the former with
3 or four of the latter every four or six hours, and followed by
castor oil, if it does not act on the bowels once or twice in the
twenty-four hours. But if this prescription does not check the
diarrhoea, I add a small proportion of the sugar of lead to each
dose, until the diarrhoea is effectually checked. The bowels
may be allowed to remain inactive, without risk, for twenty-

332 Long, on Typhoid Fever. [June,

four or even forty-eight hours, when they should be opened by
castor oil, or, what is sometinnes better, a mild injection : gum
arabic or elm water should be used freely from the beginning
of the disease. Nothing should be allowed but the mildest
liquid diet, and that in small quantities. This course of dieting
should be observed throughout convalescence, very gradually
increasing the quantity and quality of the food, to prevent re-
lapses, which are very common and dangerous in this disease.
Purgatives should be avoided, or entirely withheld, as they do
no good, and generally set up obstinate and ungovernable diar-
rhoea. I have more than once seen the system under the
influence of mercury in typhoid fever, in mild cases, without
checking the disease in the least degree ; but in the general
making a more tedious case. But to salivate a patient in a
grave case of typhoid fever, I think (I had like to have said im-
possible) almost impossible, unless the constitution be able to
withstand the disease and the medicine until nature begins to
ameliorate the symptoms; then, and not until then, can ptyal-
ism be induced. If the salivation does not sink the patient
it will add to the tediousness of the case, and render him
more liable to relapse. I could give numerous cases of this kind,
but time and space forbid at present. One of the most com-
mon and dangerous effects of the administration of calomel in
this complaint is haemorrhage from the bowels. Blisters are ex-
cellent remedies in this disease, when indicated and well timed.
They should be applied to the lower portion of the abdomen,
where there is great soreness on pressure, with or without
tympanitis. When this latter symptom is present, they some-
times produce the happiest effects. They may be applied to
the nape of the neck, when the delirium in grave cases is wild
and furious to the side, or other portions of the body where
pain is seated, or even where pain has been complained of, in
the onset of the disease. Under such circumstances they sel-
dom or never fail to produce the most satisfactory results. The
patient will be greatly benefited in all cases by having his hair
cut short, and applying cold to the head, where there is much
heat of this region. The body should be sponged daily with
warm water, or water and vinegar, and the patient's body well
dried. This never fails to add much to his comfort. Daily

1851.] Long, on Typhoid Fever. 333

sponging is too much neglected in the treatment of all fevers,
and especially that of typhoid fever. Strict attention should
be had to changing the patient's clothing and bed clothing, as
this not only contributes greatly to the comfort of the patient,
but is one of the principal means to prevent the spread of the
disease.

ARTICLE XIX-

The Morbific Infiuence of Intestinal Worms. By Robert
Campbell, M. D., Assistant Demonstrator of Anatomy in the
Medical College of Georgia.

Perhaps there is no agency in the whole etiological catalogue,
which has been dignified with more importance than that
under consideration. There are few diseases, or symptoms of
disease, from the first knowledge of intestinal worms until the
present day, which have not found a satisfactory solution in
this prolific source of mischief x\nd while now, many over-
rate its import, there are others who have rebounded beyond
the opposite extreme ascribing sanative properties to these, to
say the least of them, useless and troublesome parasites.

The proposition of some theorists who maintain that worms
are natural to all animals, therefore innocuous, that they are
serviceable as the natural scavengers of the body, feeding upon
ihe excrementitious residuum from which the chyle has been
abstracted, is a vagary which needs but little disputation. Al-
though Nature has generally an eye to the welfare of her
creatures, there are instances which would seem to form
decided exceptions to her general character of beneficence.
Naturalists have furnished innumerable instances of the fatal
efl;ects of parasites upon different animals. The vermin which
infest young poultry are equally natural, still under favorable
circumstances, how frequently do we observe fowl-yards
strewed with the evidences of their disastrous consequences!
Besides, it would seem inconsistent with natural economy, thai
a family of smaller animals should be engendered to devour the
excrement of the larger, while in the body, when very soon,
if they did not impede its progress, it would be gotten rid of by

334 Campbell, on the Morbific Influence of [June,

a process apparently instituted by nature herself. If the fore-
going hypothesis were true, then wormy children should be
fnirer samples of health, than those who are not favored by
their benign influence. Observation and reason prove the
fallacy of this interpretation of the function of these entozoa.

It would occupy too much space and time to enumerate the
thousand and one phenomena which have from time to time,
and in diflferent parts of the world, been attributed to the
presence of worms in the primae vise. The whole parapher-
nalia of symptoms constituting various epidemical diseases,
have by some writers, been charged upon these pernicious ac-
cumulations.

Although the symptoms of worms, as enumerated by authors,
are almost innumerable yet, it is unfortunate, that none of them
can be relied upon as pathognomonic of their presence in any
case, except that of their actual appearance. Many of their
concomitants might legitimately have been attributed to their
agency, were it not for the fact, that their testimony is greatly
invalidated by the same phenomena presenting themselves in
other diseases, imparting to them decided verminous characters,
when upon post-mortem examination, this cause is sought for in
vain. But it is not our province here, to examine into the re-
spective value of their symptoms particularly, but to ascertain
their position as a cause of disease, and to form, if possible, some
rationale of their pernicious action upon the economy, through
principles based upon its constitution and functional endow-
ments.

The question " Why is it so difficult to detect the presence
of worms, by their pathological manifestations?" finds its
solution in this : that inasmuch as the irritation produced by
them is only mechanical, there are various other mechanical
causes operating upon the same sentient surfaces, capable of
producing similar pathological manifestations. Hence, they
can be claimed by their advocates as only one of the many
sources of mechanical irritation and not as imparting any
peculiar poisonous principle to the system ; though Yogel
asserts, that they prove injurious also, " by exerting a specific
action, possibly by fluids which they secrete or in some other
unknown way." And this brings us to calculate the amount of

1851.] Intestinal Worms. 335

irritation, which this excitant is capable of effecting ; although
it is a matter, somewhat involved in obscurity, there being no
way of approaching this result by observation and experiment:
yet reasoning from analogy, we are furnished with satisfactory
grounds, upon which to predicate our inquiry. We must con-
sider worms in the light of a foreign body, superadding tl e
aggravating circumstances of their vital properties. The
presence of a body of adventitious character in the stomach
or intestines, whose weight, size and solidity are equal to those
of fifty lumbricoides or a taenia solium, for instance, must em-
barrass, in some measure, its normal operations. Add to this
the power of motion, (which is known to exist in an eminent
degree,) the operation by which the occupancy of the organ is
maintained whether by adhesion to its coats or by the exer-
cise of activity, together with the draft made upon the system
directly or from its pabulum, for the support of this foreign
object and we can form some idea of the degree of dispara-
ging force which worms are capable of exerting upon the or-
ganism.

The extent of the irritation produced by worms must be
proportioned to their size and number ; and there are also other
circumstances to be taken into consideration which modity the
development of its effects; among which are the difference
in the character of the worms, their varying location, and the
unequal amount of sensibility enjoyed by their several locali-
ties. For instance, the taenial and lumbricoid more frequently
occupy the small intestine, which is possessed of a more Hmited
degree of innervation than the rectum, the site of the ascaris
vermicularis, or the stomach which is often entered by the tape
and lumbricoid worms, and which is endowed with a still more
exalted degree of nervous susceptibility.

There are also constitutional conditions which favor the
morbid action of stimuli generally. It is known that those
subjects termed "nervous" are most susceptible to the effects
of irritants ; and again, this excitability may be induced by a
pathological slate, as that of general excitement of the nervous
system, under the influence of fever, 6zc.

It would appear from the foregoing, that intestinal worms
are not acce^isory to the perlect exercise of the organs of the

336 Campbell, on the Morbific Influence of [Junev

body; but, on the contrary, that through their agency, health
may be more or less deranged, principally in consequence of an
irritation which they are capable of exciting ; that their morbid
influence varies extremely with their number, size and species,
and the sensibility of the parts they occupy, together with the
constitutional or co-incidental excitability of the general system.
We know that the elTects of irritation are in greater or less
degree two-fold topical, or those pertaining to the part upon
which the impression is exerted, and sympathetic, or their re-
action upon the general system. The disease, then, resulting
from vei'rninous irritation, is manifested in local and sympathet-
ic, or general morbid phenomena.

Among the local effects have been enumerated rending or
colic pains in the bowels, from direct irritation of their muscu-
lar coat; diarrhoea or dysentery, from increased secretion or
excited peristaltic action ; painful distension of the bowel; me-
chanical obstruction by a mass of worms; or by intussuscep-
tion, tenesmus, hemorrhoids, etc., etc. The two last effects
cited, pertain to the vermicular species, from their peculiar
location. The post-mortem appearances, which have been
observed, of the tissues in contact with a mass of worms, are
redness and an inordinate quantity of mucus.

In determining the validity of the foregoing morbid efl!ects
assigned to the immediate influence of worms, it is but neces-
sary to make reference to the many cases reported by respecta-
ble authors, in which the size, number and character of the
worms present were amply sufficient, legitimately, to account
for such results. Cases occurring under our own observation,
also, might furnish additional support to this reasonable proba-
bility. Their power to injure the coats of the intestines, or
entirely to perforate them, has been admitted by some and de-
nied by other very respectable authority. Vogel states, in
speaking of the round worm, that '* it appears to be capable of
perforating the intestine, by thrusting asunder with its head the
fibres of the intestinal coats ; it thus passes into the cavity of
the abdomen, where it gives rise to inflammation, suppuration
and abscess. Sometimes it even escapes externally through
the abdominal walls." Condie, on the other hand, although he
confesses that he has seen a lumbricoid worm penetrating the

1851.] Intestinal Worins. 337

intestine, being half way through and held in the opening, yet
denies their power ever to perforate.

Among the sympathetic effects ascribed to this source of in-
testinal irritation by many respectable authors, and which are
said to disappear upon the expulsion of worms, are hacking
cough, symptoms of croup, pneumonic symptoms, asthma, ra^
pidity and irregularity of pulse, convulsions,' chorea, tetanic
symptoms, hydrocephalus, epilepsy, paralysis, delirium, mania,
emaciation, dropsy, and various anomalous disorders.

We now enter upon the more difficult part of our inquiry
the investigation of these more obscure and mysterious effects
of intestinal worms effects though, which are attributed with
as much confidence to this cause, by medical philosophers, as
any of more direct sequence. And here, we are to consider
not only the local manifestations of their influence, with their
echo in some other, perhaps distant part of the organism ; but
to attempt the pursuance of their hidden connections, through
some physical and tangible medium of relationship. To ac-
complish which, we must necessarily discover some chain of
communion, binding all the organs of the body, however dis-
similar their construction and destination, and even the minutest
parts of those organs, into one reciprocating system, each per-
ceiving the impressions directed to each other, and responding
to them by as decided manifestations, though differing in char-
acter and proportion, only in such measure as the peculiar con-
stitution and function of those organs may be compelled to
modify them. This desideratum will be revealed to us, in a
glance at the well-known anatomy of the nervous system, with
its familiar physiological phenomena.

The anatomical relationships of ihe parts in which we are
now interested, comprehend an extensive scope, although of so
general a character as to enable us to rehearse them in but few-
words : We know that the alimentary canal is innervated by
the ganglionic system of nerves the stomach and rectum re-
ceiving in addition supplies from the cerebro-spinal the former
by the eighth pair, the latter from the hypogastric and sacral
plexuses. By means of the branches of the eighth pair, the
stomach is connected to the nesophagus, the lungs, tlie pharynx,
the larynx and the heart. The sympathetic branches supply-

338 Campbell, on the Morbific Infiuence of [June,

ing the stomach are derived from the solar plexus. By means
of this plexus, the stomach is also brought into relation with
the other abdominal viscera. The sympathetic or principal
nerve supplying these organs, is intimately connected with the
cerebro-spinal system by union with all its nerves. Famihar
instances of this conjunction with the cerebral nerves, are the
opthalmic ganglion with the third, the spheno-palatine and otic
ganglia with the fifth, the superior cervical with the sixth nerve,
&c. All the spinal nerves are known also, to have a close
connexion with this nerve, by a branch passing from each root
of every spinal nerve, to a neighboring part of the sympathetic ;
hence the involuntary and voluntary nervous systems are
known to be intimately associated in their anatomy.

It is established, that the intimacy subsisting by anastomosis,
between nerves presiding over different purposes, does not
interfere with the discharge of their respective offices ; the
nerves being but the passive channels through which the oper-
ative force is transmitted, and unassisted, having no more to do
with generating or diverting the influence they convey, than
the telegraphic wires have in charging themselves with, or dis-
posing of, the electric current. Since, then, the nerves are but
passive conductors, they can oppose no obstacle to the passage
of missions, of whatever origin, reversely from their sentient
extremities to the nervous centres ; nor even to their being
reflected from those centres, enhanced in force (for it is known
that, here, power may be engendered or renewed),* to some
distant organ or organs the reflected image there manifest,
not necessarily bearing resemblance in character or degree, to
the original impression, but being transformed into that peculiar
phenomenon, which it is the nature of those organs respective-
ly to produce. It is well known that it is upon the existence
of such a quality in the nervous system, that many of the phys-
iological processes depend for their consummation e. g. the
process of deglutition.

It is obvious, that the same qualities in the nervous system,
which are employed in a physiological state, to produce phe-
nomena subservient to life and health, may be appropriated by

* See Todd's Cyclopcedia of Anatomy and Physiology. Art. " Nervous Cen-
tres."

1851.] Intestinal Worms, 339

morbific influences to efl^ect their destruction ! As in the case
of deglutition, any object comingj in contact with the mucous
membrane of the fauces, by indirect stimulation, excites the
action of the pharyngeal muscles so may baneful influences
operating upon the nervous extremities of a certain portion of
the organism, throutrh the excito-motory or reflex action of the
nervous system, with its all-pervading relationships, discharge
their venom upon some distant, and, apparently, unconnected
organ. And thus may intestinal irritation, and that arising
from the presence of ?^Jorm5, (since this is a source of intestinal
irritation,) manifest itself by morbid phenomena, in difi'erent
and distant organs of the body.

In taking a retrospective glance at our subject in its difl^erent
bearings, we feel authorized in maintaining, that we have in its
history all the necessary elements for the production of such
phenomena as are aftributed to the influence of intestinal
worms! For those which involve disorder in the vohmtary
system of muscles as convulsions, chorea, tetanus, &c. we
have, applied to the sentient extremities of excitor nerves, an
irritant, sufficient, under certain circumstances, to excite in the
nervous centre, a "polarity"' capable of efl^ecting these phe-
nofnena in the muscular system, through the medium of the
motory nerves. For those which result in impairment of the
mental faculties, as delirium, mania, &c., they may be interpret-
ed by referring them to reflected irritation. The brain, being
an organ of peculiar constitution, whose functions are the in-
tellectual faculties &c., this intestinal irritation is reflected
through the medium of nervous communication which we have
already seen to exist, and manifests itself upon that organ, in
excited or perverted function, and we have mania or delirium.
We know that operations of the mind are capable of influencing
the functions of the digestive origans and vice versa, alonrr
the same chain of communication, the brain may be influenced
by causes having their origin in the digestive apparatus.

These few examples may suffice, but in like manner, perhaps
all the diseases which have ever been attributed to intes-
tinal worms as a cause, and the many symptoms popularly r3-
ferred to them, might find a philosophical basis in the anatomy
of the human frame, and the known laws governing its physi-

N. 8. VOL. Vn. NO. VI. 22

310 WiUon, on Nitrate of Silver, [June,

o\ogy and pathology were it not for the fact, that there can
be made no distinction between intestinal irritation from other
sources, and that from worms, unless it be substantiated by
their actual appearance. And it is fortunate that the course
of medication required for their expulsion is such, that it may
be pursued in all suspicious cases without endangering mate-
rially the welfare of the patient.

Finally, we deem it just to deduce from our investigations
the following conclusions, viz : that intestinal worms are not
conducive to health, but, under favorable circumstances, are
capable of exerting an irritation which involves the health and
life of their subject. That the circumstances favorable for its
development, are their existence in great numbers, or of large
size particularly in the stomach or rectum ; and the co-exist-
ence of other diseases, which they principally serve to com-
plicate and render dangerous. That there is no pathogno-
monic symptom of their presence, except their actual apper.r-
ance; and that, where we have resonable grounds for sus-
pecting their existence the proper anthelmintics should be ex-
hibited.

ARTICLE XX.

Nitrate of Silver. By Jno. S. Wilsox, M. D , of Muscogee
County, Georgia.

So much has been written of late years on this potent and
valuable article of the Materia Medica, that I cannot expect to
add anything new. My object in this communication is, to
make some practical remarks on its therapeutic application,
with the hope of extending its use, and removing the prejudices
which may still linger in the minds of many physicians preju-
dices originating in the unfortunate designation, "Lunar Caus-
tic," and its classification among the eschorotics. Those
prejudices no longer exist among physicians who daily witness
its delif^htful sanative effects in wounds, inflammations and
ulcers, and they are fast receding before the light of experience
and observation.

Dr. John Higginbottom, F. R. C. S., says, after twenty years
further experience in the application of this remedy, " There is

1851.] Wilson, on Nitrate of Siloer. 341

no form of acute superficial inflammation, arising from either
constitutional or mechanical causes, where the nitrate of silver
may not be applied with great safety and advantage. 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 destro}-, the part to which
it is applied."* Dr. Hi^ginbottom recommends the nitrate
highly in the following disorders: In recent bruises, in small
and large ulcers, old ulcers of the legs, punctured wounds,
bites and stings, dissection wounds, wounds from rabid ani-
mals, lacerated wounds, hemorrhage from leech bites, in-
cised wounds, erysipelas, cuticular and phlegmonous; ulcers
with varicose veins, (with graduated compression) ; superficial
burns and scalds, and senile fijangrene. This long list, which
might be extended by the addition of other diseases, external
and internal, medical and surgical, such as, herpetic and various
specific cutaneous diseases, aphthae of the mouth and throat,
ulceration of the gums, various forms of ophthalmia, corns,
diarrhoea, dysentery, gonorrhcea, leucorrhcea, &c., serves to
show the varied application of this agent, and its title to our
regard, as one of the greatest and most useful articles of the
Materia Medica. So far as my limited experience goes, with
"the opprobrium of surgery" old ulcers of the lags i feel
justified in saying that all curable forms, whether simple, indo-
lent, irritable or varicose, can be cured by the use of the nitrate
of silver, together with cold water and Bynton's method adhe-
sive strips and graduated compression. I will even go further,
and say, that I believe nine-tenths of such ulcers can be cured
by the persevering application of these remedies, assisted by
proper constitutional treatment. By these local remedies
alone, without the aid of general treatment, I have succeeded
in curing an ulcer in an aged subject, of five years standing,
involving the whole of the dorsum of the foot, and complicated
with caries of the metatarsal bones. My faith in specifics is
limited, and lam very far from believing in the universal appli-
cability of any single remedy; but the happy effects of the
nitrate of silver on ulcers, in conditions apparently diametrical-
ly opposite, seems to form a wonderful exception to the action
* Vide this Journal, Ma}^ 1850, p. 2D3.

342 Wilson, on Nitrate of Silver. [June,

of other remedies, and completely confounds all our theoretical
reasonings. When apph'edto a simple ulcer, an artificial cuti-
cle is formed which protects it from irritation, while the forma-
tive process goes on quietly beneath. When applied to an
indolent ulcer, a constringing and tonic influence is exerted
on the weak and flabby granulations, imparting to them new
life and a healthy recuperative activity. When applied to an
irritable ulcer, it allays the morbid irritability, by substituting
its own peculiar irritation, which naturally tends to resolution
and restoration of the aflTected part. In conclusion, on this
point, I would say, that I consider the nitrate, with graduated
com.pression, su[ierior to all other modes of treatment in ulcers
of every kind and grade, and that they leave us but little to
wish for in this difficult department of surgery. In herpetic
and various forms of localized cutaneous diseases, I esteem it
one of our most certain and effectual remedies. In apthous
siomatiiis oTiginose affections, simple, scrofulous, or exanthe-
matous, it stands unrivalled. I have seen it used in a case of
chronic apthous stomatitis, of several years duration, with the
happiest effect, in a female of feeble and cachectic habit, after
her disease had resisted all other remedies. The only auxiliary
was the mixt. ferri comp. In angina, where the swelling was
sufficiently great to threaten immediate suffTocation, I have
given almost instant relief by mopping the throat with a con-
centrated solution of the nitrate of silver. In that distressing
form of angina accompanying scarlatina, I believe it is now
almost universally admitted to be the best of all local applica-
tions, and I think it fully entitled to the high position it occupies.
In opacity of the cornea and chronic ophthalmia, I consider it
far superior to any or all the salts of lead, zinc, or mercury.
In chronic diarrhcea, of an intractable kind, I have used it in
solution, in doses of i gr. every three hours, with good eflfect.
In dysenteric tenesmus it acts like a charm, when administered
by enema 10 grs. to the oz. of water.

I would particularly invite the attention of the profession to
the valuable properties of the nitrate of silver in this distressing
disease, for I fear that its great virtues are not properly appre-
ciated, and that its use is not at all commensurate with its dis-
tinc^uished merits. I find that, even as late as the year 1848, it

1851.] Wilson, 071 Nitrate of Silver. 343

was considered an entirely new remedy, in this disease, bv a
phys'cianofTennessee, wiio was filled with ''astonishment and
pleasure," when he vviinessed its delightful effects, lor the first
time, 'because he thoucrht he had made a grand and important
discovery !' In dysentery, it is well known that the inflamma-
lion or ulceration is often confined to the lower portion of the
rectum; in this case, we can bring this potent agent immedi-
ately in contact with the diseased surface, and thus cure it,
without the assistance of any other remedy. But I would not
thus restrict its use; for, even admitting that the lesion exists
in the colon, or the upper |)ortion of the rectum, the sympa-
thetic excitement is seated in the sphincter ani muscle and the
lower part of the rectum. By the use of the nitrate, we substi-
tute a peculiar remedial excitement, of transient duration, for a
morbid, persistent irritation, much more painful, and of indefi-
nite duration. Of course the cases now under consideration
will require appropriate general remedies, while the nitrate of
silver still retains its place as an invaluable auxiliary as an
anodyne, while the other remedies are producing their consti-
tutional impression.

I have recently prescribed for a woman who exhibited the
following symptoms: cold skin, pulse almost imperceptible,
bloo;Jy mucous discharges, with excruciating tenesmus every
five or ten minutes, as she lay in bed. Ordeied, cal. grs. v. ;
pulv. Dov. X. But little relief. After the use ol two injec-
tions of the nitrate of silver (10 grs. to the oz.) the tenesmus
was completely relieved. The calomel and Dover's powders
were continued, and in f )ur days she was discharged cured.

In conclusion, I would remark, that I think it best to use the
nitrate in large doses, and uncombined. Should the irritation
be e.Kcessive, an enema of starch and laudanum can be used.
In the case referred to, no complaint whatever was made of the
remedy.

In a case of chronic metritis, combined wiih leucorrhoea,
dysmenorrhoea, uterine hypertrophy and induration, with their
consequences, tenesmus and micturition, I have derived great
advantage from the application of the solid nitrate to the os
uteri, by means of the speculum; and, what is somewhat re-
markable, although 1 considered the tenesmus and micturition

344 Physiological Uses of the Solar Ganglion, ^c. [June,

mostly mechanical, the application of the nitrate of silver gave
more relief to the first mentioned symptom than any remedy
which I could apply to the rectum itself.*

I have extended this article to greater length than I design-
ed, but not greater, I think, than the importance of the subject
demands. If any thing I have written will have any influence
in extending the use of the nitrateof silver, and if others derive
the same happy effects from its use wliich I have had the good
fortune to realize, they will be amply compensated, while the
wtiter will be highly gratified in being able to contribute some-
thing to the usefulness of his profession, and to the relief of
suffering humanity.

PART II.
rlcctic epartnient.

On the Physiology and Pathology of the Ganglionic Nervous
System. By James George Davey, Licentiate of the Royal
College of Physicians, London, &c. (Continued from p. 293.)

" There are yet great truths to tell, if we liad either the courage to announce,
or the temper to receive them." Disraeli.

CHAPTER II.

Before proceeding to consider in detail the physiolocry of the
solar ganorlion and its dependencies, it is perhaps desirable to
offer a few observations on the anatomical relations and depen-
dencies of the three nervous centres. These will, it is hoped,
facilitate the right comprehension of those physiological re-
marks which follow.

The brain, the spinal cord, and the solar ganglion, regarded
respectively as the centres of the several nervous systems of
man and the higher nnimal^^, though executing distinct functions
in the economy of life, are, by means of the innumerable
ramifications of their suboidinate parts, and their union each
with the other brought into so close a connexion, that their
physical separation is a matter of impossibility. Though not
miilunUij dep'tndent, they nevertheless exercise such a re*-
ciprocitv of action, that the health and well-being of man is to
ba regarded as inseparable from their union. The solar

I think I have seen a similar statement made in some of the journals, but

cannot now refer to it.

1851.] Physiological Uses of the Solar Ganglion^ ^c, 345

ganglion, brain, and spinal cord, may be together, not inaptly,
compared to an ordinary tree, the root, trunk, and extremities
of which mny be said to severally represent them ; for the first
has been the source, and continues to be the life of the other
two; it has existed without them, and might again do so, though
during their integrity it fails not to be the recipient of their
toil, so to speak. The root will sometimes live on without the
trunk and its extremities, and so will the paralyzed idiot. By
referring to an engraving of the principal pari of the organic
nervous system, or sympathetic nerve, the anatomical con-
nexions of the ganglionic with the spinal nerves, throughout
the entire length oithe cord, will be distinctly made out. It
will be seen that each of the several ganglia, whether cervical,
dorsal, or lumbar, gives off communicating branches with the
individual spinal nerves, thus uniting the two systems. The
solar plexus, the centre of the organic nervous system, is there-
in demonstrated as formed by the union of the two semilunar
ganglia. It is described by Mr. Erasmus Wilson as '' a gang-
liform circh,^^ from which branches pass off in all directions,
like rays from a centre. It gives off distinct filaments, which
accompany, under the name of plexuses, all the branches given
off by the abdominal aorta. Thus we have derived fronn the
solar plexus the

Phrenic plexuses. Supra-renal plexuses

Gastric plexus. Renal plexuses.

Hepatic plexus. Superior mesenteric plexus.

Splenic plexus. Spermatic plexus.

Inferior mesenteric plexus.
However, the principal nerve of the solar plexus is the great
splanchnic. It arises from the upper and back part of the
organ, and proceeding upwards, pierces the diaphiagm imme-
diately to the outer side of each crus, ascends in front of the
vertebral column, within the posterior mediastinum, and term-
inates by dividing into five branches, which severally proceed
to the sixth, seventh, eight, ninth, and tenth dorsal ganglia. The
pelvic viscera and the lower extremities are supplied with their
ortjanic nerves from the hypogastric plexus and sacral ganglia.
The union of the gan^^lionic and spinal nerves would, in itself,
be sufficient to establish a connexion between the former and
the cerebrum and its nerves. Thev fiave, however, a more
direct communication, by means of the ascending or carotid
branch of the superior cervical ganglion, which, having entered
the carf)tid canal with their internal carotid artery, divides into
two branches, which form several loops of communication
with each other around the artery, which constitutes the
carotid plexiis. Now the carotid plexus is the centre of commu-

346 Physiological Uses of the Solar Ganglion, S^c. [June,

nication between all the crnnial ganglia ; and, being derived from
the superior cervical ganglion, between the cranial ganglia
and those of the trunk ; it also communicates with the greater
part ofihe cerel)ral nerves, and distributes filaments wiih each
of the branches of the internal carotid, which accompany them
in all their ramifications,* As each of the cianial ganglia,
moreover, communicates freely with the cerebral nerves distrib-
uted about the head and face, exteriorly and interiorly, it fol-
lows that nothing more is required to establish the anatomical
position which has been taken. I may ad(i, nevertheless, that
the pneumogastric nerve or vagus, by beinij distributed to the
resjjiratory. and digestive apparatus and heart, where it forms
cojvimunications with the organic or vital nerves, as well as with
the solar ganglion itself, by means of a small branch, which is
represented in Plate 19 of i\Ir. Wilson's work betore quoted, as
being given oft' by the principal trunk, where it turns forward to
be lost on the anterior surface ot" the stomach, yet more effectu-
ally secures the relationship between the cerebrum and the so-
lar ganglion, the centres of their respective systems. f The
phrenic nerve, also, in being formed by the union of (ilaments
from both the cervical and sympathetic nerves, and in being
further distributed to the diaphragm, provides for the same end.
The anatom"cal relations of the several nervous centres, as
above explained, Mayo strangely regards as a reason why the
" sympathetic nerves in human beings can only be regarded as
branches of the cerebral and spinal nerves, destined for particu-
lar uses."

I have before treated of the '' nisus formalivus^'' of its na-
ture and uses, as well as of its general independence ofihe brain
and spinal cord, and I have therefore, to some extent, anticipa-
ted the observations I had to offer ''on the 'physiology of the
solar ganglion."' The reader will, I hope, excuse me if I reca-
pitulate in a general way the line of argument there found.

In the first place, as legards the acephalous and amyence-
phalous monstrosities of Lawrence and Hall, we have the most
conclusive evidence of the independerice of the organic or gan-
glionic system of nerves on the cerebrf)-spinal system. We
have a convincing and irrefragable assurance that the func-
tion of the solar ganglion and its dependencies is in itself as
completely performed without the brain and spinal cord as wiih

Vide Wilson's Practical and Surgical Anatomy.

I I am perfecJly aware that Dr. Sievens mainrains that both the vagus andspi-
nal f-ccessoiv nerves deiive their origins, not from the medulla oblungcta, hut
from the upper part (it the semilunar ganglion. I cannot think so. In ihe first
plac, the direct t-onnexion of the pr.r vaj,Mim wiih the sendlwiar ganglion is by
means only ofasmall nervous branch or filaments. As lo the spinal accessory
nerye, is it not distributed to the sieinomastoid and trapezius muscles 1

1 85 1 .] Physiological Uses of the Solar Ganglion, <^c. 347

them. Who in looking to the acephilous, the brninless mon-
ster reported by Mr. Lawrence, would venture to declare that
the influence of n brain was necessary to life; that it was
an3thing more than an insirument r^fhfe. And who, in look-
ing to the amyencephalous, to the brainless and marrowless
mfnster described by Hall, could dare affirm that either the
brain or the spinal cord ^vere in themselves ir.dispensible to
existence; that is, to life? In both instances we are shown
facts, which demonstrate to us as plainly and conclusively as
can be demonstrated, the perfect and normal operation ot" the
vital principle. We seethe body nourished the viscera peri'ec-
ted, an(i the bony fabric matured ; and w^e are assured, there-
fore, that circulation, absorption, and nutrition, have been in
full operation; in perfect action, without either a brain or
spinal cord. It is truly absurd for Miiller or any other physi-
ologist to declare that " the anatomy of these monsters is not
at present known with sufficient accuracy tor any 'conclusion^
tube drawn from it.'* The same cause which enables the ab-
dominal and thoracic viscera of bi'ainless and mai-rowless mon-
strosities to continue their functions, the identical source from
which the heart and its vessels receive their power to circulate
the blood ; the liver, to secrete its bile; the .stomach, to digest
its contents; the intestinal absorbents, to take up the chyle;
and the kidneys, to secrete their peculiar fluid, also empowers
the organism of the decapitated animal in which the spinal
cord fias been also destroyed, to continue its specific action ;
the '" ultimate causa*' of the several phenomena of ///'e is in both
instances the sanie. *Clift saw the heart of a carp continued
to beat eleven hours after the destruction of the spinal cord ;"
and Miiller tells us that "in fishes the contractions of the fieart
continue for the space of half a day after the destruction of the
brain and spinal maiTow." The same author obstinatelv
adds, "that the brain and spinal marrow must nevertheless be
resarded as the principle source of the nervous influence; the
cardiac nerves, under such circumstances, still retain a portion
of the motor influence."' In the instance of the frog experimen-
ted on by Redi, which lived "six complete months"' after the
*' removal of ihe whole brain," as well as tfiat of the animal
operated on by Sir B. Brodie, in which the posterior j^art of
the spinal marrow was removed without affecting in any degree
the strictly vital actions natural to those parts which receive
their nerves from it, would Miiller venture to assert that, in ei-
ther case, the phenomena observed were referable to the cir-
cumstance of the retention of a certain power or principle of
action, originally derived from either the brain or the lost por-

See Muller's Physiology, vol. i. p. 208, second edition.

349 Physiological Uses of the Solai' Ganglion, ^c. [June,

tion of the spinal cord ? Impossible ! Nothing is more certain
than that the destruction or 7^e?noval of {he sohir ganglion and
i[s dependencies is iinmediateh' fatal to the functions of the
brain and spinal cord, no less than to those of the other corpo-
real o-gans, as the liver, stomach, &c. ; and it is equally true
that the destruction or removal of either the brain or the spinal
cord, or even both of them, if effected with care, may be ac-
complished without impairing the energy of the ganglionic
system. If you destroy the brain and spinal marrow of a frog,
you will not kill the animal: the heart will still continue to
beat, and the digestive process be carried on. A slight blow
on the ef)igastrium, over the solar ganglion, will sometimes kill
a man, but extensive injuries of the brain and spinal marrow are
not unfrequently borne with comparative impunity. Pressure
on the solar crantrlion of a dog or cat or rabbit, will quickly des-
troy life; and if it be carefully made over the upper part of
the lumbar region, where the experimenter will avoid the solar
ganglion, the lower extremeties will beccune completely par-
alyzed ; the animal will merely draw them after him, as if they
were but artificial appendages. Remit the pressure and in a
few minutes the spinal functions are restored and the animal
is as lively as ever. This, in itself, is a beautiful illustration
of the dependence of the vitality of the lumbar spinal cord on
the contiguous ganglia of the sympathetic. In the lowest
classes of animals, we see the existence of the same nervous
organism without the addition of parts which characterize those
higher in the scale of being ; in them there is observed a sran-
glionic system only, and therefore it is that they execute func-
tions purely preservative. We may ask. if a ganglionic system
be deemed sufficient for the vital actions of one class of beings,
\\\\y should it not for another? Digestion, circulation, secre-
tion, absorption, &c., are no more perfectly performed in man
than in the oyster or medusa. Life, then, is identical throujih-
ouf animate nature, and if a particular nervous power be held
sufficient in one instance for the effects observed, why should
it not in another, or even in all ? There is this difference be-
tween the lower and more perfect animals; that whilst in the
latter the vital principle is, it would appear, generated in
a central organ, and from it diffused through the organic ner-
vous system, in the former it is, I apprehend, produced equally
by all the ganglia of the sympathetic; and therefore it is that
*' the division of these animals into separate fragments does
not destroy the organism, but, on the contrarv, gives rise to
the production of several distinct beings." It would seem
that the addition of a spinal system to a ganglionic, as in the
annelidae, constitutes the limit within which Nature allows ibe

1851.] Physiological Uses of the Solar Ganglion, <^c. 349

divisiblity of the vital principle. *' The articulatse, although,
like the annelida;, they have a ganglionated nervous cord, do
not continue to live when thus divided/' The first possesses,
in addition to ganglionic and spinal nerves, a medulla oblon-
gata, irorn which nervous branches arise which furnish the
animal with the use of its external senses; and these establish
so indissoluble a connexion, and so direct a dependence on the
external world, that the facilities which the animal enjoys more
than compensate for the loss of the other propeity. A step is,
moreover, made towards that more perfect organism wherein
the increase in number and complexity of its parts tend, in an
eminent degree, both to establish the responsibility of man, and
lo explain the nature of those physical laws to which man must
submit, if he would avoid the many miseries which now press
on him from all sides.

We may, with much propriety and truth, regard the perma-
nent condition of the medusa, for instance, as characteristic of
the temporary, or accidental, or acquired condition of man.
In the very early period of fcetal life, we observe nothing more
than a gelatinous, shapeless mass, in which the microscope can
nevertheless discover a nervous ganglion or ganglia. Life^
in both, is complete. This is a man's tem[)orary condition ;
the same is permanent in the polype. In the amyencephalous
monster that is, brainless and marrowless foetus we see the
g:angIionic life of the medusa accidentally occurring; and
simiiiarly so in the animal which has been deprived of its brain
and s[)inal marrow ; as well as in the indivifiual under the in-
fluence of animal magnestisn) ; when, as oftentimes happens the
cerebial and spinal functions are completely obliterated, and
the patient, of course lost to all consciousness and feeding,
realizes the precise condition of one in 2i profound sleep.

From the observations already made, both in this and the
preceding chapter, it is seen that the nutrition, growth, and re-
production, no less than the decay, of the organism, must be at-
tributed to the operations of the organic nervous system. That
the nutrition of all parts of the body, in conformity with the
original type, presupposes the persistence of that power which
originally produced all the distinct parts, all the organs, as
" members of one whole," as parts necessary to our idea of the
being; and which is present in the germ l)efore any distinct
organs are formed, while the animal exists merely "poten-
tially."

Nutrition, then, is the continued reproduction, as it were, of
all parts of the animal by its internal power; but in the adult,
the reproduction can be effected only by the process of assim-
ilalioD that is by the union of new mailer with the assimilating

350 Physiological Uses of the Solar Ganglion, ^c, [June,

parts; while in the embryo, in which no orf^anized "ground-
woik" as yet exists, the parts are formed, their "ground-
work" is, in fact, created, by \he formative power, wW\ch is still
undivided. " For although, until the whoie body perishes all
the organs are directed by onefonnativz principle, which pro-
duces the concurrent action of all assimilating tissues, and the
operation of which we admire, as the vis medicatrix natura?, in
the correction of the subtle material changes which are induced
by disease ; yet organized parts of the body, once formed, can-
not, in most cases, if wholly destroyed, be again restored by this
power, this vital organizinir principle," (iMiiller) which em-
anates from the solar ganglion, the central organ of the gangli-
onic nervous system.

The observations made by Muller in treatment of the influ-
ence of the nerves on nutrition, are singularly contradictory.
His argument is to the eflect, that although the nutrition of
monsters "is by no means defective," but their development
up to ihe period of birth, even pejfect, yet "is there no proof
that the sympathetic nerve has a more especial influence on
nutrition than the cerebro-spinal nerves, except, pei'haps the
fact that the nutrition ofa part does not cease when the nerves
which it receives from the brain orspinal cord are divided'' a
fact, which I must ever regard as a sure indication that the
organic nerves can be none other than the nutrient nerves.
Such is the inevitable conclusion. Why, it may be asked, does
an injury or disease of the superior cervical ganglion arrest the
nutritive processes in the eye. The branches of the third, fourth,
fifth, sixth, pairsofne'ves, usually distributed to the contents of
the orbit, are untouched, and nevertheless, the eye loses its
vivacity, and becomes disorganized. We have, then, in these
instances, as in many more, boih positive and negative evidence
of the truth of my position viz., that the solar ganglion is the
SEAT OF life; and that by means of its dependencies the vital
principle is difl^used throu^rh the organism. Further, in order
to show that the organic nerves do not influence nutrition, he,
Muller,says, "Where any organ is wanting, there is always a
coriesponding absence o^' the nerves,'^ meaning their cerebro-
spinal nerves, "absence of the eyes is attended with absence of
their nerves." This is a mere assumption, and to prove it so,
I beg to offer for the consideration of the reader the following
extracts from a report of my own to be found at page 2U3 of
vol. ii. of The Lancet for 1835 and 1836, concerning the post-
mortem examination ofa child born without eyes: "On raising
the anterior lobes of the cerel>rum, but one olfactory nerve was
seen, and that was on the left side ; the optic commissure was
placed more posteriorly than natural, the sella turcica being

1851.] Physiological Uses of the Solar Ganglion, <^c. 351

much anterior to it. From its forepart, and in the median line,
the rudiment of a nerve was continued, it was of a loose texture,
and of a scarlet hue, as if from injection of its vessels. It pro-
ceeded into the substance oft he pituitary body, in which it whs
lost. Several small blood-vessels passed through the foramen
opticum ; the fissura lacera transmitted both into and out of the
orbit the ordinary nerves and the ophthalmic vein." " The or-
bital roofs were then removed, and disclosed the presence
only of condensed celular tissue, which when cautiously dissec-
ted away, exposed the several small muscles which naturally
belong to the organ of vision, supplied with their respective
nerves."

Sir Benjamin Brodie truly says that the processes of nutrition,
growth, &c., must be referred to the same class of functions as
that of secretion generally. The following experiments prove,
not only so much, but also the relative properties of the cerebro-
spinal and ganglionic nerves. In a young cat. the termination
of the "nerves of the eighth pair on the cardia of the sto/n-
ach were carefully divided ; the animal was perfectly well af-
terwards; was lively, ate its food as usual, and the respiration
was not affected. At the end of a week, and three hours after
having been fed with meat, the cat was killed. On dissection,
digestion was found to be going on as usual; the food in the
stomach was in a great measure dissolved ; and the thoracic
duct and the lacteals were distended with chyle, having the
ordinary appearance. The nerves were carefully traced, and
it was ascertained that not the smallest filament had been left
undivided. This experiment was repeated with exactly the
same results.* It was long since asserted, " that the nerves of
the par vagum are by no means necessary to digestion," and
more recent experimenters, including Magendie and Dr. .T lleid,
have arrived at a similar conclusion, provided their division is
made in such a manner as not to effect respiration and the free
oxygenation of the blood. f

A portion of the anterior and posterior crural and sciatic
nerves were removed in a drg in the upper part of the thigh ;
the limb, of course, became immediately benumbed and j)ara-
lyzed. A wound was then made in the leg, and the claws of

See Dr. Cooke on Nervous Diseases, vol. i. p 130,

t It is by no means intended lo affirm that the vitiil organs, as the stomach,
lungs, &( ,are in every respect out of the reach of cerebral injury or irritation.
Such would be non.sense 'J'he urgent dy.spepsia which attends on sindio-seden-
tary habits proves the sympathy existing between the brain and the siomach,
equally with the effects of violent mental emotion on either the stomach or
heart, <fer., and conversely the great digestive powers of the North Ameri-
can savage, to whom letters are unkown. I have, loo, cured a great number of
insane people, whose cerebral di.sease has been exclusively dependent on disor-
cl states ot the abdominal viscera. See the works of Combe and Caldwell.

352 Pancreatic Juice in Digestion, [June,

all the feet were cut so as to make them of the same
lengih. The wounds suppurated and healed as rapidly as if
the nerves had been entire. At the end of seven weeks I mea-
sured the claws of the four feet, and found that those on the
paralyzed litnb had grown equally with those of the others.

The experiment was repeated by Sir B. Brodie on guinea-
pigs, and with the same results. In one of them the tibia
was broken, and the hone readily united.

'i'he posterior ]:)art of the sj)inal marrow of a frog was re-
moved so as to destroy the origin of the nerves of the lower
extremities. In this case the bones of one leg were broken,
and when the animal was killed the bones were found united,
partly by callus and partly bony substance. Experiments, very
similar in their nature and effects, have been performed by Dr.
Sharj)ey ; and Miiller says, by Schroeder. I have also practi-
cally verified the position here taken viz: that nutrition
growth, and reproduction, are equally the functions of the or-
ganic nervous .system, both by experiments on living animals
and by observing the recovery of the demented and paralyzed
among the insane, from various kinds of bodily injuries (includ-
ing fractures) and disease.

Whilst, however, Miiller contends for the reciprocal depend-
ence of the organs, and of the cerebro-spinal nerves, on each
other for their existence, he cautions his readers from conclud-
ing that the production of the former depends on the pre-exis-
ence of the latter. He truly says, "both organs and nerves
are produced by the same power, the nisus fonnativuSy which
resides undivided in the germ." London Lancet.

The Pancreatic Juice in Digestion

Mr. Editor : 1 send you an article upon the importance of
the pancreatic juice in digestion. It was suggested upon look-
ing over notes which I t(^ok whilst attending a course of lec-
tures upon physiology, delivered by C. Bernard of Paris, dur-
ing the year 1848. I am not aware that the views here given
have been hitherto published in this country. Carpenter, in
the last edition of his work, alludes to its property of digesting
fatty matter, but does not take into consideration its other pro-
perties. I take some interest in this subject, as I had the plea-
sure of witnessing the experiments of M. Bernard, which satis-
fied me of the truth of his views.

Yours, &c., M. P. Scott.

Bernard was the first to discover the true functions of the
pancreas, which, if his conclusions are sound, is one of the most

1851.] Pancreatic Juice in Digestion. 353

important organs concerned in the process of digestion. By
his patient investigations and philosophical deductions, he has
cleared up one of the mysteries of physiology, concerning
which all has been heretofore mere sp3culation. It is true that
his conclusions have been deduced from experiments made
upon the lower orders of animals; but by shewincr the identity
of the different fluids concerned in digestion in all of the lower
orders, he was justified in coming to the conclusion, by analogi-
cal reasoning, that the same phenomena exhibited by them
were also performed in the human system. He has proved
thus the importance of searching for truths in medical science,
by experimenting upon animals, and upon the facts thus gained,
establishinii the physiological laws which regulate the human
system. Upon a just and accurate knowledge of these laws, it
is oidy possible to establish a sound system of practice, without
which all must be uncertainty or empiricism.

The old practice, ol first ctmcocting a theory and afterwards
searching for facts to sustain the preconceived opinion, has been
discarded the order is reversed. The inductive system of
reasoning obtains now in this science as in all others, and all
theoretical notions that are not founded upon facts are cast
aside we obtain our facts, and upon them establish our theo-
ries. 'J'his may be a slow method ; but it is the only sure one.
It must be confessed, however unpalatable it may be, that we
are far behind our brethren on the other side of the Atlantic
in our researches in physiology and pathology. We are satis-
fied with folding our arms and quietly wailing for all improve-
ments in our science which may be sent to us. These we re-
ceive and swallow with avidity, or speculate vaguely upon, or
reject if they do not agree with the theories taught when we
attended lectures. None think the experiments upon which
they have been founded worthy to be repeated, or of making
experiments to test the truth of those theories created in the
imaginations of the speculative class of physiologists. But we
have an oflset, and flatter ourselves that if the French excel
us in the science of physiology and are the best pathologists,
vve are the best practitioners. A vain illusion for what kind of
practice must that be that is not founded upon facts drawn from
yjhysiology and pathology, upon a proper knowledge of the func-
tions of the diflercnt systems and organs of the human being,
and the changes which are produced by disease. Jn the same
vein and in the sauje manner the swarm of quacks and charla-
tans who overspread tfie land boast that they excel us. They
point to the results of their systems laugh at physiological
facts, and care not to know whether a human being has a liver,
so that he is possessed of a stomach or sac to receive their

354 Pancreatic Juice in Digestion. [June,

drugs and nostrnms. They go ahead. The French are the
most cautious practitioners, for the same reason which induced
Frere Jacques to give up the operation for stone in the bladder
alter the anatomy of the parts was taught him. He never
knew before the imminent risk his patients ran of losing their
lives if a bkmder was committed. We are more heroic, bolder
practitioners not better.

The process of digestion has always been one of the most in-
teresting subjects in [)hysiology no part of the science has per-
haps so much engaged the attention of the profession in all ages,
and there is none about which there has been so much specula-
tion, nor indeed at the present titne has it ceased to engage the
attention of scientific nien the field for speculation and expe-
riment is still open. Certain facts have, however, been estab-
lished, by which ancient as well as more modern theories have
been overthrown.

The opinions of some of the older writers, that the stomach
was the only organ for digestion, and that the liver and pan-
crens, like the kidneys,* were mere secernants, destined to se-
parate certain noxious principles from the blood, has been long
since exploded. More modern authors haveadopteii the theo-
ry of chemical solution put forth by Spallanzanni. These sup-
pose that all kinds of food are reduced by the action of the gas-
tric juice to one uniform, homogeneous semifluid; that all kinds
of aliment produce the same nutrient principles which, sub-
mitted to the action of the gastric juice, becomes chyme, and
that this chyme is changed by the action of the bile and pan-
creatic juice into chyle, which is now ready for absor[)tion by
the iacteals. This last is the opinion of Beaumont, deduced
from his experiments upon a patient having a fistulous opening
in the stomach. This opinion has been proved l)y modern ex-
peiimenters to be erroneous, as also the opinion that chyle was
formed by the action of the bile and pancreatic juice upon
chyme thus overthrowing the assertion formerly made that
the chyle contains the essence of all kinds of nutriment.

Almande was enabled to establish that all alimentary matters
were not digested in the stomach his observations were made
upon a pntient having an intestinal fistula, through which he
was enabled to see certain kinds of food pass, and to extract
those which had not been afl^ected during their passage through
the stomach. Subsequent experimenters have established this.
Thus the glucose class of aliment is not acted upon by the
gastiic juice; this fluid does indeed act upon cane sugar, chang-
ing it into grape sugar, but here its action ceases, but upon
amidon it has no eflfect. How this class of substances was ul-

This was the opinion of Blondlow.

1851.] Pancreatic Juice in Digestion. 355

timately disposed of has been a subject of much speculation and
experiment. Some have supposed that the saHva was the di-
gestive agent, that by its action the nutritive materials were
separated ; others, that the stomach was the organ for this pur-
pose, andHhat ultimately they were changed into oleaginous
compounds and formed part of the constituents of chyle.

It would appear now that the stomach digests the azotized
class of food, or rather that the first stage of the digestion of
that class is performed in that organ, and that their digestion is
completed in the duodenum by the operation of the bile and
pancreatic fluid. The agency of the pancreatic juice in diges-
tion has been until recently confounded with the bile, and many
of its effects attributed to that secretion. Thus, when it was
ascertained that fats and oils were not dio^ested by the agency
of the gastric juice, it was supposed by Miiller and Brodie that
the digestion of these matters was performed by the bile; it
was not until the experiments of Bernard that its true functions
were discovered. Physiologists for the most part have held the
opinion that the pancreas was merely a salivary gland some
few thought that its office was to supply albumen to the system
when there was a deficiency of this principle in the blood.
They supposed that the pancreatic juice contained albumen, as
it was seen to coagulate when heat was applied, or a strong
acid added. Both of these opinions have been proven to be
erroneous, but that the office of this secretion is to digest cer-
tain alimentary substances which are not acted upon by any
other digestive fluid ; and also by its union with the bile to com-
plete the digestion of the azotized class which have been first
submitted to the gastric juice.

The pancreatic juice is a colorless, slightly viscid fluid, con-
stantly alkaline in its reaction; it is coagulated bv heat. Its
tendency to putrefaction is very great, and, for this reason,
should be always experimented with very soon after being
taken from the duct. After being kept for ashort time, it ceases
to act upon alimentary substances submitted ; its appearance
alters, it loses its consistency, and will not coagulate when
heated. The quantity of the*^ secretion is influenced by the
condition of the organ, as is also its quality ; thus, when the
pancreas is irritated or slightly inflamed, thei-^e is a much larger
flow ; but it will not act as that secreted during a normal con-
dition of the gland ; if, however, the inflammatory action is
great, the secretion will be entirely arrested ; it is similar in
this respect to the stomach.

Those who considered the pancreas as a salivary gland,
founded their opinion upon the similarity of the pancreatic juice
to saliva. The action of each upon amidon was supposed to

.V. 8. VOL. VII. NO. VII. 23

356 Pancreatic Juice in Digestion. [June,

be the same, and referred to as evidence of the- identity of
the two secretions. Had they been more careful in making
their observations, they would have seen that there was some
shght difference in the action of the two secretions upon this
substance. For example, saliva changes amidorw first into
dextrine, and subsequently into sugar of second class or grape
sugar, and, finally, into lactic acid, whereas the pancreatic juice
only changes it into grape sugar. This difference of itself
should have raised some doubt as to the identity of the two.
Magendie, in speaking of the action of saliva, says : *' If by an
opening into the parotid duct, we remove the fluid of the parotid
gland before it reaches the mouth and place it in contact with
starch, no conversion into sugar takes place. It is the same
also with the saliva drawn from the maxillary ducts in the dog.
There is, then, something peculiar in the buccal saliva depend-
ent upon all its constituent principles." Here, then, is a wide
difference between the salivary glands and the pancreas ; for
the pancreatic fluid of itself efl'ects the transformation.

The first class of substances which are acted upon by the
pancreatic fluid to which I shall refer, is the amylaceous, or that
class, which is capable of undergoing transformation into grape
sugar. That the saliva does not, under ordinary circumstances,
effect this change can be easily established ; indeed, that the
action of saliva is mechanical and not chemical, and that its
place could be supplied with pure water, is now, 1 believe, the
received opinion. These substances undergo no change in the
stomach, as may be seen by giving amidon to a dog, and after-
wards extracting the contents of the stomach through a fistu-
lous opening, and testing them. This will also be seen to be
the case, if it is digested out of the body with pure gastric juice.
If this substance be followed, it will be seen that it disappears in
the duodenum. Now^, the only secretions which are poured
into the duodenum, are the bile and the pancreatic juice, and to
one of these must the disappearance of the starch be due.
That it is not owing to any action of the bile, may be proved
by digesting it with pure bile when no transformation takes
place ; and, we might now reason, that it must be the pancre-
atic fluid which digests it, that being the only remaining digis-
tive agent ; but, a more conclusive proof is, that if the duct
leading from the pancreas be tied, and the contents of the
duodenum of an animal previously fed upon starch be exam-
ined, it will be seen that no change has been made upon it;
and, lastly, if starch is digested with pure pancreatic juice, a
transformation into grape sugar will result. That it is now fit
for absorption is most probable ; as If a solution containing
grape sugar be injected into a vein, no trace of it, can be disco-

1851.] Pancreatic Juice in Digestion. 357

vered, either in the blood or in any one of the secretions, thus
shewing that it has been assimilated, so that it is reasonable to
infer that this class of substnnces do not undergo any further
change, as now they are ready tor assimilation.

Of its agency in the digestion of fatty matter. It was, for a
loner time, the received opinion, that the bile was the agent
designed for the digestion of fatty matter. This opinion was
founded upon expeiiments made by Miiller, and it was not until
his experiments were repeated by Bernard, that it was found to
be fallacious; for, if pure bile be added to oil free from acidity,
no emulsion will be formed ; and, if the mixture be allowed to
remain a short time, there will be a complete separation, the oil
floating as pure and unchanged as it was before it was mixed
with the bile. If, now, a small quantity of pancreatic juice be
added, an emulsion \V\\\ be formed immediately, similar in
appearance to chyle. From this it might be inferred that the
bile, experimented upon by Miiller w^as not pure, or that the
oil was rancid ; for bile has a peculiar action upon rancid oils
forming with them a kind of soap. Here may have been a
source of error; most probably, however, that distinguished
physiolocrist obtained the bile from the biliary duct after it had
been joined by a pancreatic duct.* In the dcg there are two
ducts leading from the pancreas, one joining the ductus chole-
docus, the other entering the duodenum an inch lower ; so that
the error was natural enough if the bile was taken from the
biliary duct after beinor joined by the pancreatic duct, giving
as the result all the phenomena justly ascribable to the pancre-
atic juice. In order that the experiment should succeed, it is
necessary that the pancreatic juice should be perfectly fresh,
and the oil ^yqq from acidity. When the experiment is per-
formed out of the body, the emulsion will have an acid reaction.
This is not the case in the intestine, for it does not lose its alka-
linity. This difference is probably due to the oxygen o^ the
air, there being a decomposition of the oil into glycerine and
oleic acid, the latter being free gives to the emulsion an acid
reaction.

The gastric juice has no effect whatever upon the oils as any
one may convince himself by obtaining pure gastric juice from
the stomach of a dog, and subjecting the oil to an artificial
digestion at the common temperature of the body. It will be
seen that the oil will remain unchanged.

Thus it has been shown that neither the gastric juice nor the
bile, when experimented with out of the body, has any power
in digesting the oils, but that the pancreatic' fluid forms with
thein an emulsion similar in appearance to chyle; but, it may
be argued that, although such are the results of lhe experiments

358 Pancreatic Juice in Digestion. [June,

as performed, that in the intestine the action of these fluids may
be different, or that the secretions from the intestine may alter
in some way their operation. The following experiment is, I
think, conclusive :

If a rabbit be fed upon oil, and its abdomen opened during full
digestion, no trace of the oil will be found, but the lacteals will
be seen loaded with chyle.

Now, take another rabbit, ligate the pancreatic duct, and
feed it in like manner upon oil; after a sufficient time has
elapsed, open the abdomen as before, when the oil will be found
unaltered in the intestine, nor will there be seen any appear-
ance of chyle in the lacteals.

From these facts two conclusions may be justly drawn ; first,
that the oils and fatty matters are solely digested by the pan-
creatic juice ; and secondly, that chyle is not the essence of all
kinds of alimentary matter, but is formed by the action of this
fluid upon fatty matter ; for we have seen that none of the
other secretions act upon oil ; that that of the pancreas forms
an emulsion with it similar in appearance to chyle; and lastly,
that no chyle is formed if the duct of the pancreas has been
previously tied.

The pancreas then is the chylopoietic gland.

The pancreatic fluid changes sugar of milk into sugar of
grape; there being this difference between the two, that the
former will not undergo fermentation when yeast is added to a
solution containing it.

The active principle of the pancreatic juice, to which the
changes induced upon the various substances submitted to its
action is due, is an organic matter which can be isolated ; for a
solution containing this organic matter will effect the same
changes as the pure fluid itself; it has been named chylopoiene,
from its property of forming chyle ; it may be precipitated by
'alcohol, and afterwards dissolved by water. There is also
another peculiar principle, which has never been isolated, which
will be alluded to further on.

Pancreatic juice aids also in completing the digestion of the
azotized class of alimentary substances which have been sub-
jected to the action of the gastric juice and bile. This class of
alimentary matter, after being introduced into the stomach, is
dissolved by the gastric juice, and forms a new compound,
the lactate of fibrine. When this compound is introduced into
the duodenum, a further change takes place when it is mixed
with the bile. According to Platner, there is a general play of
chemical affinities, double decomposition takes place, and two
new compounds are formed lactate of soda and a choleate of
fibrine ; the latter is insoluble, and must undergo a further

1851.] Pancreatic Juice in Digestion. 359

change before it is fit for absorption and assimilation. This is
effected by the intestinal juice, which is the result of the union
of the pancreatic and hepatic secretions ; there being two pecu-
liar principles in the former, one chylopoiene, which can be
isolated, the other, mingling with the bile, forms a third liquid,
(intestinal juice,) which completes the digestion of the azotized
substances.

All kinds of food are reduced under the action of the different
fluids concerned in digestion to three classes, viz :

1st Class, Albuminose.

2d Class, Glucose.

3d Class, Fatty matter.

The Albuminose class is absorbed by the veins and are
poured into the general circulation and assimilated. The
glucose is absorbed by the veins which empty into the vena
porta, and traverse the tissue of the liver. The third class,
or fatty matters, having been dissolved by the pancreatic fluid,
are absorbed by the lacteals, and constitute the chyle, which
probably undergoes a further change in traversing the mesen-
teric ganglions ; it is constantly alkaline. Besides the element
already mentioned, chyle contains lymph held in suspension,
which has been erroneously supposed by some to be vegetable
chyle. It is owing to the presence of lymph that chyle coagu-
lates. After passing through the mesenteric glands, it assumes
a rosy hue, which is owing, according to some physiologists,
to the admixture of blood. Tiedeman attributed this color to
the lymphatics of the spleen.

These discoveries are, I think, calculated to shed light upon
certain forms of indigestion, whose seat has heretofore been
placed in the stomach ; and we may be induced to search
elsewhere for those derangements of the functions of digestion
placed under the omnium gatherum head of dyspepsia. A
better plan of treatment may be adopted a more appropriate
diet, one which may leave the suffering organ in a greater state
of repose; thus, there have been cases of dyspepsia reported,
which have been cured by confining the patient to a diet of fat
bacon, which was supposed by most persons to be peculiarly
indigestible; here was a mystery which was explained by
saying that, what was one man's food was another's poison.
Would it not have been more philosophical to say that such a
diet did not tax the stomach ; that organ being left in a state of
repose, nature was enabled to repair the injury induced by the
imprudence of the patient; the pancreas in' the mean 'time
furnishing^ the digestive agent? Again : when the stomach is
the seat of any chronic disease, do we not recommend a farina-
ceous diet, because experience has taught us that these articles

360 Green and Malcenal Discharges from the Bowels. [June,

of food are of easier digestion ? I think that now a better reason
can be given, when we know that the stomach is not called
upon to aid in digesting them, but that this process is carried on
in the duodenum.

We find also in certain forms of dyspepsia, that solid food
is the most appropriate diet ; now, bearing in mind the functions
of the stomach, whose office it is to digest the azotized class of
aliments, should we not be led to ascribe the dyspepsia to a
derangement of some other organ concerned in digestion ; for
assuredly, if the stomach was the seat of disease, it would be
somewhat paradoxical if it digested well that class of food for
which all asjree it is principally designed, and that class in the
digestion of which it is only remotely or not at all concerned
should be rejected. Would it not be more reasonable to refer
the seat of disease to those organs whose especial office it is to
digest the amylaceouG class of substances, and that therefore,
this kind of food was rejected, and that the stomach being free
from disease, digested as usual the nitrogenized matter, for
which it is peculiarly fitted? Stethoscope.

An Inquiry into the character of Green and Melcennl Dis-
charges from the Bowels. By Saml. G. Armor, M. D., Prof,
of Physiology, Pathology, and Clinical Medicine, in the Medi-
cal Department of the Iowa University.

Diseases of the abdominal viscera, from the frequency of
their occurrence either as primitive or consecutive aflfections,
are entitled to much of our consideration; and from the fact of
the obscurity, or the w^ant of reliable data from which to draw
our conclusions, we should duly consider every thought or fact
calculated to throw further light on diseasesof the liver, the in-
testines, and all the other digestive organs.

Of the various secretions poured into the digestive apparatus,
none have been regarded with more interest than that of the
liver; yet the secretions of no gland of the body have, at the
same time, been less accurately studied. A comparatively un-
explored field of inquiry here presents itself to the chemical
pathologist : and we are [ersuaded that chemical analysis of
loilious stools and other stercoral matters, will one day furnish
signs of great value in the diagnosis of diseasesof the liver and
other abdominal viscera.

By common consent, especially in the Western "States, the
liver is thought to be a frequently ofl^ending organ ; it is made the
common " scape goat" for offences of which, in many instan-
ces, it is not guilty; and in accordance with a popular idea, that

1851.] Green and Malcenal Discharges from the Bowels, 36 1

it is the principal outlet through which impurities of the blood
are poured, mecurial and other cholagogue remedies have at-
tained, we think, an undeserved popularity.

That sluggish or perverted action of the liver is soon fol-
lowed bygeneral morbid action, we would readily infer from
the importance of the office it performs in the animal economy.
The blood would be morbidly impressed if its hydro-carbon
were not removed by the liver; and the digestive functions
would also suffer if healthy bilious matter were not duly elabo-
rated. It may be said, then, to have both ^forward and hack-
ward diCXlon, forward on the surface on which the secretion is
poured, and on the contents of the duodenum, and backward on
the gland itself and on the blood from which it is secreted.

The investigations of pathologists, however, into the usual
changes noticed in the biliary secretion and excretion, have had
reierence rather to quantity than quality, to its increase in
bilious flux, or its suppression in cases of jaundice arising from
occlusion of the excretory ducts. But if we push our investi-
gations beyond this, by enquiring into the different modifica-
tions which health and disease may effect in the composition of
the bile, we will find ourselves at once groping in the dark.
Physicians, it is true, have described a multitude of changes in
the bile, by the aid of which they have explained the nature of
many diseases; yet we may search the records of practical
medicine in vain, from the times of Galen to the present, for
well authenticated facts, or positive proof, in support of these
views.

The subject has recently occupied the attention of Dr. Gold-
ing Bird, whose researches in chemical pathology, are always
of the most accurate and interesting character. He has direct-
ed his attention cheifly to \\\q green alvine evacucations of chil-
dren, '*with the view of testing the accuracy of the popular
opinion of their being cheiily composed of bile." This view
has long been maintained, or rather assented to, by the inedical
world. The evacuations, usually termed malcena, have been
also regarded as depending on vitiated bile ; but more recent
investigations favor the view that this character of discharge
is occasioned by a morbid exudation from the intestinal mucous
membrane. It is true that it is frequently, perhaps always,
connected with either functional or structural disease of the liv-
er; and the association being so uniformly present, Langstaff,
in the absence of more positive evidence, was lead to attribute
it to a morbid sympathy between the liver and intestines ; while
others, accommodating themselves to a simple and more com-
monly received opinion, attributed it to an increased activity of
ihe liver in throwing off crude bilious matter ; whereas the true

362 Green and Malcenal Discharges from the Bowels, [June,

cause is referable, according to Dr. Bird, not to sympathy, nor
to excessive action of the liver, but to congestion of the portal
venous system.

It has been demonstrated by frequent experiment, that the
composition of human bile is essentially similar to that.of the ox.
That we may have an accurate idea, then, of the normal con-
stitution of this fluid, I present the following analysis of the bile
of an ox, as given by Berzelius :

Water, 904-4

Bilin, (with fat and coloring principles) - 80*0
Mucus, chiefly from gall bladder, - - 03'0
Salts, 12-6

1000 0

That bile is often present, and even in large quantities in
foscal dejections, cannot admit of a doubt; but that it is neces-
sarily present in the green discharges, so common in early
infancy, is the point in dispute.

A specimen of a green evacuation, passed by a hydroce-
phalic infant whilst under the influence of mercury, was care-
fully analyzed by Dr. Bird. It was a dirty green, turbid fluid,
and by repose, separated into three distinct portions. 1. A
supernatant oily fluid, presenting a brilliant emerald color. 2.
A dense stratum of mucus, coagulated albumen and epithelial
debris. 3. A deposit of large crystals of triple phosphate of
magnesia and ammonia in prisms of an apple green color. The
supernatant green fluid was decanted for examination, and its
chemical elements indicated by the following

Analysis.

1. 1000 grains of the green fluid left, by careful evaporation,
a deep olive green, highly deliquescent extract, weighing 100
grains.

2. This extract (1) being immersed in alcohol of 0.837,
formed a mass like bird lime, which could not be mixed with the
spirit. Even after long boiling, it appeared hardly to diminish
in bulk. The clear tincture being decanted, left, however, an
extract weighing 30 grains. This residue possessed the yel-
lowish green color of faded leaves, an odor of fresh broth, and
a sweet, sub-astringent taste, with a very slight admixture of
bitterness.

3. The alcoholic extract being carefully incinerated, left 5*5
grains of ashes, consisting chiefly of chloride of sodium mixed
with mere traces oftribasic phosphate of soda (3 Na, O, P2 05.)
It was alkaline, but did not effervese with acids.

1 85 1 .] Green and Malcenal Discharges from the Bowels. 863

4. The portion left undissolved by boiling alcohol yielded to
water 13.grains of nearly tasteless matter, which by incineration,
left a powerfully alkaline ash, weighing i'lb grains, not effer-
vescing with ashes, and consisting nearly exclusively of alkaline
tribasic phosphate of soda.

5. The residue, insoluble both in water and alcohol, weighed
57 grains, and consisted almost entirely of coagulated albumen,
dry mucus, and modified blood. It left by incineration 1 grain
only of ashes, consisting almost wholly of brick-red sesquioxide
of iron.

The following is a view of the results of the examination :

Alcoholic extract,

> Organic,
^ Inorganic,

Aqueous extract, > t '
^ ' ) Inorganic,

T 1 ui *. } Orojanic,

Insoluble matter, > r
^ Inorganic

Water and volatile matter,

34-50

5-50

11-25

1-75

56-00

1-00

900-

1000-

The organic portion of the alcoholic extracts consisted chiefly
of fatty matter, cholesterine, and a green substance supposed to
be identical with the so called billverdin, with but a mere trace
of bile, barely sufficient to communicate a bitter taste to the
extract, but not sufficient to leave any carbonate of soda in the
residue of incineration. The aqueous extract consisted chiefly
ofptyalin, with other extractive matters.

The composition of the fluid part of the green evacuation is
thus expressed :

Biliverdin, alcoholjc, extractive, fat, cholesterine, with traces

of bile, ...-.-.

Ptyalin, aqueous extractive colored by biliverdin, -
Mucus, coagulated albumen, and haematosine,
Chloride of sodium, with traces of tribasic phosphate of soda,
Tribasic phosphate of soda, ....

Sesquioxide of iron, ......

Water,

1000-

An analysis of a green calomel evacuation has been recorded
by Simon ; he has not given the proportion of solids and water
present, but merely detailed the composition of the dry extract,
which consisted of

24-5

1521

56-0

,, 5 5

1-75

10

900-

364 Green and Malcenal Discharges from the Bowels. [June,

C Bile, bilifelic acid, biliverdin.

Soluble in alcohol } Fat, containing cholesterine, 10-0 ^ 42.4

f Alcoholic extractive, -

Ptyalin, aqueous extractive, ...... 24*30

Albumen, mucus, epithelial cells, - - - 17*10

Saline matter, . . . - . . . - 12.90

21-4) .
100 V
11-0^

96.7
Loss 3.3

100.

Professor Kerstein, of Freiberg, has published sonne late
researches on the nature of green stools said to be of frequent
occurence in patients who are under a course of certain mineral
waters. He altogether denies that any quantity of bile is pre-
sent in the green evacuations of invalids and others who par-
look of the Carlsbad waters ; but attributes the lint to the green
sulphurel of iron, generated in the stomach and intestines by
ihe reduction of the sulphate of soda of the water, to a sulphuret,
and its subsequent action on the iron held in solution in the
water. He states in confii-mation of his view, that hydro-
chloric acid destroys the green color of the stools, evolving at
the same time sulphuretted hydrogen. Dr. Frankl, however,
of Marienhad, attributes the color of these evacuations to the
*same source' as the green mucous discharges from the vagina
in leuchorrhoea, the urethra in gonorrhoea, and the nasal secre-
tions in some forms of coryza.

The following extract will give the reader a general idea of
Dr. Bird's views :

" I have assumed that the green color of the matter examined was
owing to Biliverdin, a conventional term for a substance very imper-
fectly understood, and very likely applied to sub^ances essentially
distinct in their nature. Berzelius has compared biliverdin to the
chiorophylle, or green coloring matter of leaves, although this must
be regarded as partaking rather of a wax-like nature than as a mere
colored extractive. It must, however, be borne in mind that green
coloring matter may be possibly generated in the animal economy
from the action of certain matters on the haematosine, or coloring matter
of blood. Thus it is well known that when blood is exposed to the
influence of sulphuretted hydrogen gas, it acquires a deep olive-green
color when viewed by reflected ; and a dingy red, by transmitted
light, phenomena identical with those presented by the coloring
matter of bile. Attention has been drawn to this remarkable fact by
Professor Leopold Gmelin. It is now ten years ago since a series of
researches on the action of oxydating agents upon blood were published
in the pages of this journal by Dr. Brett and myself. In that paper

1S51.] Green and MalcBualDncharges from the Bowels. 365

we described two products o^ the action of nitric acid upon clot of
blood, an olive-green sweetish astringent substance, and an intensely
bitter jeliow one ; we applied the conventional term of chloro-hiEmatin
to the former, and xantlie-haematin to the latter.

Since then, the coloring matter of blood is fully capable of being
converted into green pigments under the influence of different agents,
it must, I think, be admitted, that we are not to assume the green color
of an animal excretion as of necessity depending upon the presence
of an excess of bile. And when chemical analysis fails to indicate the
presence of any quantity of this secretion in a bright green evacu-
ation, it is but legitimate to seek for some other cause of this tint. The
proportions of tiie so called biliverdin very closely approach to those
of the xanthe-hasmatin before alluded to, and 1 confess that I am
induced to regard the green color of the emerald and 'chopped
spinach' stools of children as depending upon the presence of modified
blood, rather than on an excess of bile.

Believing that the green stools alluded to are but a form of maloena,
1 have often closely questioned the nurses oi children voiding them,
regarding the appearance of the evacuations before and after the
development of the green color, and have almost constantly been told
that streaks, or even clots of blood had been observed.

1 regard, then, the presence of green stools as indicative not of a
copious secretion of bile, but of a congested state ot the portal system,
in which blood is exuded very slowly, and in small quantities, so as to
allow of the color being affected by the gasses and secretions present
in the intestines ; a state of things capable of readily ending in me-
loena, in which the effusion of blood is so copious and sudden as not
to give time for the occurrence of the changes alluded to.

There is, moreover, a peculiarity in the green dejections of children
and others whose portal circulation is congested, which, so far as I
know, is quite distint from any property presented by mere bile under
similar circumstances I allude to the effect of exposure to the oxyge-
nating influence of the air upon them. When first voided, the
'chopped spinach' stools, are in the majority of cases of a bright
orange color, and they assume their characteristic grass green hue
only after exposure to the air. The time required for this change
varies remarkably. I have seen an orange colored stool become green
in a few minutes ; and in the same patient, only a day or two after-
wards, many hours may have been required to effect the same change. '*

The fact that these discharges most generally take place in
the warm summer months, favors the view of i3r. Bird. The
debilitating efiects of heat, when combined with moisture, very
readily develop diseases of the gastro-intestinal mucous mem-
brane. In the first place there is a direct relation, based on the
general law of identity of structure, between the skin and
mucous membrane; a morbid impression produced on the one,
is frequently communicated to the other. In addition to this,
sudden changes from the extreme heat of mid-day, to the damp

36G A Family Poisoned hy eating a Gar. [June.

chill of evening, produce intropulsions of blood. The abdominal
viscera suffer from this congestion ; their vital properties are
lowered, and tlieir functions illy performed. The liver, over
stimulated by blood largely charged with hydro-carbon, while
it is at the same time deprived of its normal amount of serosity,
does not secrete its usual amount of bile. It is overtasked;
and the result of its engorgement, occasioned as well by a defect
of its natural secretion as by intropulsive congestion, is a
damming up of the venous circulation of the intestinal canal ;
for it will be borne in mind that the abdominal circulation, in
passing to the lungs, first passes through the liver. Whatever,
therefore, arrests a free hepatic circulation must also effect the
abdominal circulation ; and this condition, we could very readily
believe, might, under peculiar circumstances, be followed by
percolation of more or less of the elements of the blood through
the mucous coat of the intestinal canal ; and this very deple-
tion would tend to relieve the congestion of the liver, and
thereby enable it to resume its function. Is this a satisfactory
explanation of the change for the better which generally follows
those dark discharges ? However this may be, in the absence
of more correct knowledge of the changes that bile under-
goes in disease, we should carefully analyze every thought
and fact calculated to throw further light on a subject of ac-
knowledged obscurity. If Dr. Bird's views be correct, (and
they are certainly plausible,) they will very much modify the
popular notion of the pathology of abdominal affections, char-
acterized by these green or meloenal discharges. Western
Medico- Chirurgical Journal.

A Family poisoned hy eating a Gar. By Dr. W. Brooks, of
Circleville, Illinois.

Amid the many and varied forms of diseased action the de-
structive ravages of which, the Physician is called upon to aid
in counteracting, it is rare to meet with such a case as I am
about to relate.

April 27, 1850, I was called at 1^ o'clock A. M., to attend
upon a family residing in this village, said by the messenger to
have been poisoned. I immediately hastened to their assis-
tance, and on entering their apartments the scene that presented
was one well calculated to elicit the sympathies of the most
obdurate heart. There were no less than five persons suffering
in all the agony that pain could inflict. I inquired into the
cause and got the follow'ing history : A party had been on a
fishing excursion the day before, and had been so unsuccessful
as to return with nothing but what is vulgarly called a Gar, (a

1851.] A Family Poisoned by eating a Gar. 361

species of fish quite abundant in many of the western rivers,
which has a long pointed horny mouth like the shark, and a
hard scaly skin.) The family being anxious for fresh fish, the
Gar was skinned, dressed and par-boiled, it together with the
eggs were then fried and served up for the table. The whole
family partook heartily of the rare delicacy and admired the
fish. At 1 1 o'clock in the evening they felt a burning sensation
in the pit of the stomach, which w^as soon succeeded by vomit-
ing, purging, and cramping, in their most aggravated forms.
The pulse was small and frequent. Tongue somewhat swollen,
with a red serrated margin, and a dark yellow fur along its
centre. The matter ejected from the stomach was very green,
and very offensive. Stools not disimilar in appearance from
those of a case of dysentery. Cold sweats, alternating with
flushed and suffused countenance.

Treatment. I ordered a sinapism applied to the epigastrium,
and administered the following: ^ camph. 3 grs., Flos, sulph.
3 grs. opii ^ gr. The first second and third doses were rejected
as soon as they came in contact with the irritated stomach,
the fourth was retained longer. I found that they were effect-
ing some good, and persisted in their use, giving another as soon
as the previous one had been ejected from the stomach. Within
an hour from the time I gave the first dose of the above mix-
ture, all of the alarming symptoms had, excepting one case,
disappeared. I left orders for the powders to be given every
two hours until I should see them again.

At 10 o'clock the same day, all better but the one that seemed
most obstinate to manage in the morning. This patient vomits
and purges still, occasionally, with some fever, furred tongue,
and offensive breath, cpmplains of pain in the stomach and
bowels. Prescribed cal. camph., and sulph. morphia in small
doses every two hours.

28th. Found patient this morning in a comatose state, but
had rested easy all night. Pulse hardly perceptible at the wrist,
free from all pain, the surface of the body, hands and feet very
dry. Tongue slightly furred and a foul breath.

Prescribed cal. camp, and morphia, in order to procure an
action from bowels, as there had been no evacuation from 4
o'clock on the previous evening. This to be followed by
enemata should it be deemed necessary.

29th. Patient this morning suffering only from general pros-
tration, put her on Dover's powders and quinine, and dismissed
her as cured. I had neglected to say that my other patients
were similar in most respects in symptoms and treatment to
the one already described. The foregoining, peculiar and
novel as it is, nevertheless is a true "fish story." Nojth-West-
ern Med. and Sur. Journal.

368 Local AncBsthetic Agents. [June^

Local AncEsfhetic Agents. M. Aran has recently made a
report to the Academie des Sciences upon local anaesthetic
agents, a notice of which we take from the Journal des Connai-
sances, Jan. 1851. The experiments he has made withchlo-
roform to produce local anaesthesia have been very unsatisfac-
tory. Chloroform does not always induce insensibility, and
its application is always attended with a very disagreeable burn-
ing sensation, which sometimes annoys the patient more than
the disease for which it has been applied. M. Aran has found a
large number of agents that possess a local anaesthetic power, and
particularly the classes that are hydro-carbonated and chlaro-
hydro-carbonated. The agent he most prefers is a substance
discovered by M. Regnault, and called chlorated hydrochlorine
ether. It is easily applied, is more certain in its action, and is
less irritating than the others. The sesqui-chloride of carbon
may also be used, but its action is very slow, as it takes about
two hours for insensibility to be produced. Fifteen or thirty
drops of the chlorated hydro-chlorine ether, poured upon a
painful part, or upon a compress, and this applied over the seat
of pain, will soon calm the suffering and produce anaesthesia in
a very few minutes. An ointment may be made of it and
applied:

Chlorated hydro-chlorine ether, 4 grammes,

Cerate, .... 20 "
Or an ointment of sesqui-chloride of carbon may be used:

Sesqui-chloride carbon, 4 grammes,

Cerate, ... 30 "
Anaesthesia produced by these agents extends to the deep-
seated parts. The insensibility produced by them lasts in the
physiological state from half an hour to an hour, but longer when
applied to relieve pain. M. Aran recommends their use very high-
ly in muscular rheumatism or neuralgia. He says they are very
useful in articular diseases, as they annul the pain and thereby
permit surgical manipulations and applications to be made with-
out torturing the patient. He has used them with considerable
success in painful diseases of the viscera, in nervous and lead
colics, in uterine diseases and in pleurisy and pericarditis. In
these diseases he either obtained a complete abolition or a great
amelioration of the pain.

1851,] Aneurisms. 360

Aneurisms. We find in the Archives Generates an inter-
esting communication upon Aneurisms, by M. Chassignac, an
epitome of which we will give. He first speaks of the clots or
coagulation of blood that are sometimes formed in an Aneu-
rismal Tumor. It frequently happens that though these clots
are formed, they do not entirely close the arterial canal, but
there exists a passage for the blood through the substance of
the coagulum. When this is the case the canal does not pass
through the centre of the clot, but invariably to one side, the
canal existing nearer the side that is least dilated. These canals
are frequently lined with a delicate but resisting membrane.

The author next attempts to show that varicosed aneurism
can be readily distinguished in all cases, from all other forms of
aneurisms, by the character of the sounds heard on ausculta-
tion. The sound heard in a varicosed aneurism is harsh, tumul-
tuous, continuous and trembling, and very diflferent from the
fine blowing sound heard in other aneurismal tumors. A pecu-
liarity in the sound produced in a varicosed aneurism is that it
is propagated above and below the tumor in the venous
branches that are connected with the punctured vein. Thus
in a varicosed aneurism of the crural artery and vein, the
characteristic sound will be propagated to and be distinctly
heard in the posterior tibial vein, behind the internal malleola.
In an ordinary aneurism there is a blowing or rasping sound,
purely intermittent that is not propagated above or below the
tumor.

M. Chassignac thinks that perhaps the propagation of the
sound in varicosed aneurisms may be explained by supposing
that there is a chemical change that takes place by the constant
mixture of the arterial and venous blood. He gives this expla-
nation as an hypothesis.

Arteries, says the author, are endowed with considerable
sensibility. In tying arteries, however well isolated they may
be, there is always pain and it is sometimes very acute. This
pain cannot be caused by nervous filaments being included
in the ligature, for it is seated at the point of the ligature,
whereas if nervous filaments had been included the pain would
have been seated along the course and at the extremity of the
nerve.

370 Gastralgia. ' [June,

Gastralgia. The Journal des Connaissances extracts from
the Revue Therap. du Midi, a notice of the prescription that
M. Caizergnes has been in the habit of making in Gastralgia.
The late Professor considered the combination of sub. nitrate
bismuth and the extract of belladona as a veritable specific in
this complaint:

I^. Sub. nitrate bismuth - - 10 grammes,
Ext. belladona . - v . i "

To be made into 40 pills and are administered night and
morning. These pills are believed to relieve, not only the ner-
vous symptoms, but the general derangement of the system
which sonr/etimes accompany them, as chlorosis.

Itch Ointment, M. Bazin recommends, in the Journal des

Connaissances, very highly, an ointment made of chamomile

flowers as a remedy for the itch. He says, that it removes

immediately the itching, and does not produce any eruption

when applied, as do many other ointments.

l^. Powder of Chamomile flowers, ^

Oil, > aa 500 grammes.

Cerate, ;

M. Bazin proposes that, in ordinary cases, the ointment of

Bayard should be used, which is the following :

^. Sulphur sull, ) o

Gunpowder j 8 grammes.

Yolk of an egg,

Olive oil, 40 grammes.

Treatment of Priapism. M. Listach recommends, in a re-
cent report to the Academic de Medecine, a compression of the
prepuce by a ligature or with the fingers, to relieve obstinate
priapism. If the object is to prevent nocturnal erections, the
prepuce should be drawn in front of the gland, and a ligature
passed around it sufliciently tight to retain it in that position.
If it is desired to relieve an existing erection, the prepuce should
be drawn in front of the gland and held in that position for a
short time. Journ. des Connaissances,

1851.] Miscella ny. 371

ill i 0 c 1 1 a n 2 .

AMERICAN MEDICAL ASSOCIATION.

The annual meeting of this Association was held in Charleston, S.
C, on Tuesday, the 6th of May. As the proceedings of this body are
of general interest to the Medical profession, we have given them as
they were reported for the Charleston Courier. The Association
adjourned on Friday afternoon to meet in Richmond, Va., on the first
Tuesday in May, 1852. From the abstract which follows, it will be
perceived that a great and Wghly beneficial change has been made by
the substitution of committees on special subjects for the standing
committees, whose voluminous reports abstracted from the journals,
were the subject of such general and deserved disapprobation.

This Associationmetat St. Andrew's Hall, Broad-street, their Pre-
sident, Dr. Mussey, in the Chair, and Dr. H. W. Desaussure, Secre-
tary.

The Association having been organized, Dr. Thos. Y. Simons, the
Chairman of the Committee of the South Carolina Medical Association,
in a warm and hearty address, welcomed the Delegates present from
the other States, to the city and State, on behalf of his associates,
which was responded to in a becoming manner by the President.

Dr. Frost, on behalf of the Committee of Arrangements, read the
list of Delegates present.

The President of the Association read a letter from Dr. Stile,
resigning his office, in consequence of the impaired state of his health.

On motion of Dr. Arnold, of Savannah, Ga., it was proposed that
the letter of Dr. Stile be placed on record, in compliment to him, for
the interest he has manifested in the Association.

Dr. Arnold offered the following resolution, which was adopted :

Resolved^ That a committee of one from each State represented in
the Association, to be chosen by their respective Delegates, be ap-
pointed to nominate suitable officers to be elected for the ensuino-\'ear.

On motion of Dr. Frost, the Association took a recess of ten
minutes to enable the Delegation to appoint one of their number a
member to constitute the nominating Committee, in compliance with
the above resolution.

The President of the Association, at this stage of the proceedings,
read an address of some length on matters connected with the profes-
sion, and the advancement of Medical science, which circumstances
prevented us from hearing, but which we learn was well received, and
elicited the commendation of those present.

On the re-assembling of the Convention, the President reported the
following gentlemen, as having been selected by said committee from
th& diffi^rent State Delegates, viz : Dr. Geo. Mendenhall, of Ohio ; B.
R. Wellford, of Virginia; Joseph Fithian, of New .lersey ; R. D.
Arnold, of Georgia ; G. W. Miltenberger, of Marj'land : H' R. Frost,

N. S. VOL. VII. NO. VI [. 21

372 Miscellany. [Jane,

of South Carolina ; N. G. Pittman, of North Carolina ; W. H. Ander-
son, of x\labama; A. H. Stephens, of New York; Usher Parsons, of
Rhode Island ; Jos. Carson, of Pennsylvania; H. Adams, of Massa-
chusetts; Thos. Reyburn, of Missouri; Jas. Jones, of Lou siana ; W.
Parsons, of Rhode Island ; J. B. Flint, of Kentucky ; John Sloan, of
Indiana; C. Boyle, of the District of Columbia, and J. B. Lindsley,
of Tennessee.

The nominating committee, through their Chairman, then read the
subjoined names as suitable candidates for officers of the Association
for the ensuing year, viz:

Dr. James Moultrie, of S. C, President.

Dr. Geo. Heyward, of Mass ; Dr. R*. D. AnxoLn, of Geo.; Dr.
B. R. Wellford, oi Ya.; Dr. J. B. Flint, of Kentucky, Yice-Pre-
sidents. Dr. II. W. Desaussure, ofS. C, and Dr. Isaac Hays,
Secretaries. Dr. P. C. Gooch, Treasurer.

On motion of Dr. La Roche, of Penn., the report was accepted, and
the gentlemen thus nominated be the officers of the Association for the
ensuing year. This motion was adopted, and ihe officers uere invited
to take their seats.

The President elect then took the chair, and in a few appropriate
remarks, returned his thanks for the honor thus conferred on him by
the Association.

The Secretary read a report transmitted to him from the committee
of Unfinished Business, appointed at the Session of 1S50.

On motion of Dr. x\rnold, of Georgia, the Report was accepted, and
laid on the table.

On motion of Dr. Gaillard, of South Carolina, the following resolu-
tion, offered by Dr. Drake, of Cincinnati, at the Session of 1850, be
taken up for consideration :

Resolved, That the second section of the Regulations of the Asso-
ciation, be so amended as to require that candidates for membership by
invitation, be nominated in writing by five members ; that when elected
they shall enjoy all the rights of Delegates, and that all permanent
members shall be entitled to vote.

After some discussion, on motion of Dr. A. H. Stevens, of Nev/
York, the Resolution was referred to a Committee, consisting of Drs.
Drake, of Ohio, Wood, of Penn.. and Wellford, of Virginia.

Dr. Stevens, of New York, offered the following resolution, which
was discussed by Drs. Storer, of Mass., and Moore, of Georgia, and
finally rejected.

Resolved, That a committee be appointed to report to i\\e Associa-
tion the business before it, and to offer such suggestions as they may
deem advisable for the due discharge of the same.

On motion, the Association adjourned to meet to-morrow morn'ng at
10 o'clock.

Morning Session. May Tth.
The Convention met this morning pursuant 1o adjournment, the
President in the Chair. The minutes of the previous meeting were
read and confirmed.

J 851.] Miscellany. 373

Dr. Wood asked and obtained leave to read the following report, on
amending the Constitution, on behalf of himself and and Dr. B. R.
Welltbrd:

The committee to whom was referred the Proposition of Dr. Drake,
for an alteration of tiie rules in relation to the admission and rights of
members, have the honor to report as follows:

There are two distinct branches of the proposition; the first of
which, relates to the invitation of medical men, not delegates to parti-
cipate in the proceedings of the Association; the second, lias in view
the extension of the right of voting to permanent members.

The committee agree in the general purport of the first part of the
proposition. As it now stands, the rule admits of a too easy admission
to the privileges of members, and it is susceptible of great abuse. It
might happen, in a place where tiie number of resident Physicians was
very considerable, that sufficient might be introduced to control the
decisions of the delegates. To guard against such a result, the com-
mittee recommend, that, in addition to the provision that none should
be invited by th? Association, unless upon a previous written proposal,
by five delegates, the existing rule should be so altered as not to confer
upon the invited members the privilege of voting.

In relation to the second part of the proposition, that, namely, which
gives the privilege of voting to permanent members, the committee do
not consider its adoption advisable, on the follrfNving grounds: This
Association is essentially a representative Body. Its opinions are
supposed to be those of the Societies or Associations by which the
delegates are appointed, and go forth to the world with the authority
in some degree of the medical profession generally. Now, if perma-
nent members were permitted to vote, they would express their own
individual opinions, and support their own individual preferences ; both
of which might be in direct opposition to those of the delegates, and
not fairly representative of general medical sentiment. It is easy to
conceive, that combinations among permanent members might be
formed, more powerful than the properly delegated body, which mii];ht
thus be overruled in its decisions. The opinions or wishes of a com-
paratively few individuals might thus go forth to the world, as those
of the profession at large; and private purposes might be answered
at the expense of tlie general good. This would defeat the main objects
of the Association, and prevent it from continuing, what it may now
be considered to be, the exponent of enlightened medical sentiment in
this country.

The committee, therefore, recommend that the question on Dr.
Drake's proposition be taken separately upon its two branches ; that
the first be adopted with a modification, withholding the right of voting
from invited members ; and that the second, which confers this right
upon permanent members, be not adopted.

GEO. B. WOOD,

Charleston, S. C, May 7, 1851. B. R. WELLFORD.

Dr. Drake then read the subjoined minority report:

The undersigned, a minority of the committee, to whom was referred

374 Miscellany. [June,

the resolution for amending the second section of the Constitution,
begs leave to I'eport, that in his opinion, it is expedient and will be
found promotive of the great objects for which the Association was
formed, that "members by invitation" should not be admitted, except
under a written nomination, by five members ; that when thus chosen,
they should enjoy all the rights and privileges of Pelegates, including
permanent membership ; and that all permanent members should be
entitled to vote. With these views the undersigned respectfully sub-
mits a revision of the resolution into the following :

Resolved, That members by invitation shall be nominated, in writing,
by five members, which nomination shall be made a matter of record ;
that when elected they shall enjoy the rights and privileges of Dele-
gates, and remain as permanent members of the Association.

Resolved, That all permanent members shall have the right of voting.
Respectfully submitted, DAN. DRAKE.

Dr. J. Hays moved to take up the majority report, which motion
was carried.

Dr. Arnold spoke against the article of the Constitution, authorizing
invited members to vote.

Dr. Wood explained his report, and urged its adoption.

Dr. Davis, of Chicago, said that there was much misunderstanding
in regard to the intention of the Constitution in respect to the members
by invitation. He hoped that the Constitution would be strictly acted
up to, and that members should be invited only "from sections not
otherwise represented."

Dr. Wood said his was an amendment, and not a repeal of the old
provision.

Dr. Drake responded He had waited for arguments against his
resolution, but had heard none. He then entered into a long argu-
ment in favor o^ 'popularizing the Association with the Profession in
the United States, and took ground in favor of a permanent place of
meeting at Washington City.

Dr. W. Atlee, of Lancaster, said he could see no harm in giving
the privilege of voting to invited members who came from unrepre-
sented localities, but was opposed to the right of voting proposed to
be given to permanent members.

Dr. Meigs, of Philadelphia, asked whether a gentleman would be
invited to attend without any privileges, and went on to say that he
hoped the Convention would have five, ten or even twenty thousand in
attendance at some future period.

Dr. Hooker, of Connecticut, begged to be allowed to oflcr the follow-
ing resolution, the resolution of Dr. Drake, having been laid on the
table for the present.

Resolved, That no member be permitted to speak longer than 10
minutes at one time in any one debate.

Dr. Philips, of New York, oflTered to amend the resolution by insert-
ing " 15," which motion was lost.

The resolution as oflTered by Dr. Hooker, was then adopted.

Dr. Hays moved to lay the subject on the table, and added that by
a constitutional provision it was required to lay over one year.

1851.] Miscellany.

The motion was seconded by Dr. Tucker, of Virginia.

Dr. Dickson, of South Carolina, asked if the motion swept off the
whole resolution, and was answered atfirmatively by Dr. Hays.

Dr. , said if the matter was postponed now they would not

be out of difficulty, because all that is necessary to defeat it next year
would be to move to amend it, and it would have to lay over a year
again, d:c.

The matter was finally laid on the table.

Dr. Wood, of Pennsylvania, called up the second part, or that por-
tion friviniT to Permanent Members the ricrht to vote.

The majority committee, accepted the substitute of the minority
committee, which was read as follows, viz :

Resolved^ That all permanent Membersshall have the right of voting.

Dr. Dickson urged the adoption of the above resolution.

Dr. Hays, ot Philadelphia, remarked that the Constitution had not
been studied by the gentleman who had urged the adoption of the
Resolution ; and spoke in opposition to the measure.

Dr. Thompson, of Delaware, supported Dr. Hays, and hoped that
the whole matter would be laid over for a year.

Dr. Dickson observed that be had been accused of ignorance of the
Constitution. He hoped to have these gentlemen always hei'e to in-
struct him.

Dr. Bond, of Maryland, took part in the discussion.

Dr. Adams, of Massachusetts, remarked that they ought to strike out
the words ' Permanent Delegates" from the Constitution, and was
proceeding with his remarks, when the gentleman was called to order.

The question was here taken on the adoption of the Resolution,
which was lost by a large majority.

Dy. I. Hays, the Treasurer of the Association, then read the Report
ofthe Committeeof Publication, and also the Report of the Treasurer.

The subjoined Resolutions, appended, were read and adopted.

1. Resolved, That tl^ assessment for the present year shall be
three dollars.

2. Resolved, That those Delegates who pay the assessments, shall
be entitled to one copy of the transactions for the present year ; and
that the payment of two dollars, in addition, shall entitle them to two
additional copies.

3. Resolved, That permanent members shall be entitled to one copy
of the transactions for the present year on the payment of two dollars,
and three copies on the payment of five dollars.

4. Resolved, That Societies which have been represented in the
Association shall be entitled to copies for their members on the same
terms that copies arc furnished to permanent members.

5. Resolved, That permanent members, unless present at the meet-
ing as Delegates, shall not be subject to any asssessment.

6. Resolved, That any Delegate who is in arrears for his annual
assessment shall not be considered as a permanent member.

7. Resolved, Tliat the several committees be requested to bring to
the meeting of the Association, their reports, correctly and legibly

370 3IisceUany. [June,

transcribed ; and that they be required to hand them to the Secretaries
as soon as they have been read.

All of which is respectfully submitted.

ISAAC HAYS,

Philadelphia, April 20, 1851. D. FRANCIS CONDIE.

Dr. Drake, of Ohio, moved that the Report on Surgery be read
first. Adopted.

Professor Eve, Chairman committee on Surgery, then proceeded to
read his report.

A motion was made by Dr. Davis to commit the same to the com-
mittee on Publication; which was adopted.

Dr. Hays moved to read Dr. Flint's Report by its title Practical
Medicine and refer the same to the Committee on Publication, which
motion was adopted, and several hundred copies printed and furnished
by the author were directed to be distributed.

A motion was then made to adjourn till 5 o'clock, P. M., which was
adopted, and the Convention adjourned.

Afterxoox Session.

The President having organized the meeting, Dr. Boyle, of Wash-
ington, offered a resolution that the Association in futurq meet at
Washington City. Dr. C. P. P. Johnson, of the Virginia Medical So-
ciety, extended an invitation to meet at Richmond ; Dr. Jones, of the
University of Louisiana, to meet in New Orleans ; Dr. J. P. Johnson,
of Missouri, to meet in St. Louis. The resolution and invitations
were referred to the Committee on Nominations.

The President suggested to the Society, the propriety of appointing
the Standing Committees at an early date.

Dr. Wood remarked that there was a proposition to abolish Stand-
ing Committees.

Dr. Hays said he was opposed to those Committees, but would not
press an alteration. #

Dr. Tucker moved that the appointment of the Standing Committees
be referred to the Committee on Nominations, which motion was
adopted.

Dr. Jones, of Louisiana, resigned as a member of the Committee of
Nominations ; and Dr. Fenner, of New Orleans was appointed in his
place.

Dr. Parsons then moved that the Committee on Nominations be
requested to resume its labors, which was adopted.

Dr. Wragg, of Charlest<jn, moved that the Report of the Committee
on I'rize Essays, be read, and then the Obstetric Report be brought up.

The Report on Prize Essays was then read, and certain resolutions
appended thereto were adopted

When, on motion of Dr. Ready of South Carolina, the whole
matter was referred to the Committee of Puljlication.

Dr. Storer, of Boston, Chairman of the Committee on Obstetrics,
read the Report on that .subject He stated that he had received a
letter from Dr. Thompson, of Illinois that he was the only member

1851.] Miscellany. 377

of the committee who had aided him in any degree. He mentioned
this fact, because he liad to hold himselfentirely responsible for all the
inaccuracies, &;c.

Dr. Phelps, ot New York, moved that the Report be referred to the
Committee of Publication.

Dr. Rol>ertson, of South Carolina, moved that the statistics, alluded
to in the Report, be stricken out, as the author was not a reliable man.

Dr. Store r seconded the motion.

Dr. Bond mxoved to postpone the Report until morning which was
seconded by Dr. Gilman.

A short debate here ensued ; when it was finally agreed to re-com-
mit said portion of the Report, to be corrected and laid before the
Association in the morning.

On motion, the Convention adjourned to meet tomorrow morning.

MoRMXG Session. ^^AY 8th.

The President, Dr. James Moultrie in the Chair. The minutes of
the previous meeting were read and after some slight amendments
were confirmed.

Dr. J. ^[. Smith, of Mass., moved that the Report of the Committee
on Medical Education be made the special order, after the disposal of
the Report of the Committee on Obstetrics.

Dr. Gaillard, on behalf of tlie Committee of Arrangements, read a
list of Delegates reported as re^n'stered since the last report.

Dr. Campbell, of Georgia, presented a model of a nial- formation of
the knee joint, the patella being absent.

Dr. Wood, of Penn., offered the following resolution :

Resolved. That Colleges, exclusively of Dentistry and Pharmacy
are not recognized by the Association, as among the bodies authorized
to send Delegates to its meetings.

Dr. Wood, of New York, moved to amend, by dividing the resolu-
tion, so as to take the question, first, on the reception of Delegates
from Colleges of Dentistry; secondly, on the reception of Delegates
from Colleges of Pharmacy.

The amendment having been accepted, the question of the reception
of Delegates from Colleges of Dentistry was debated.

Dr. Lamb moved an indefinite postponement of the Resolution,
which was lost.

Dr. Yardley, of Pennsylvania, asked and obtained leave to read the
subjoined Resolution, presented by the Philadelphia County Medical
Society.

Resolved, That all the Medical Colleges in the United States are
hereby earnestly and respectfully requested to hold a Convention,
through Delegates respectively chosen by them at least once in every
six years, to take into consideration the proper method of harmoniously
elevating the standard of Medical education in the said Colleges.

The discussion of tiie original question was then resumed.

A motion was finally made by Dr. Hays of Pennsylvania, that tho
whole resolution of Dr. Wood, includinir collenjes of Dentistry and

378 Miscellany. [June,

Pharmacy, be referred to a special committee of five members, which
resolution was adopted.

On motion of Dr. Yardley, of Pennsylvania, the resolution pre-
sented by the Philadelphia county Medical Society was also sent to
the same Committee.

Dr. Jones, of North Carolina, offered the following resolution :
Resolved, That all the Medical Colleges in the United States, are
hereby earnestly and respectfully requested to hold a Convention,
through Delegates respectively chosen by them, at least once in every
six years, to take into consideration, the proper method of harmoniously
elevating the standing of Medical Education in the said Colleges.

The order of the day was then called up, when Dr. Storer reported
that he had erased the statistics referred to yesterday, and that he
placed the report in the hands of the Association. Dr. S. said that there
was objections to the remarks on the subject of Dr. Oilman's paper
on the speculem relm. He asked that he be permitted to remove the
unnecessary expression of opinion in regard to that subject. He
further added that he had taken from the journals these facts, &c.,
and was not therefore responsible for the correctness of the papers, &c.
Dr. Bond, of Md., remarked that there were charges in these
reports which he did not individually endorse ; but which go out in a
book, under the sanction of the Association.

On motion of Dr. Davis, the report was referred io the Committee
of Publication.

At this stage of the proceedings. Professor S. S. Holdeman, of
Lancaster, City, Pennsylvania, through Dr. John L. A.tlee. presented
to the Association an Essay on Latin Pronunciation, of which he is
the author ; and which, on motion of Dr. Atlee, was referred to the
Committee on Medical Literature.

On motion, the regular order was suspended for the reception of
the Report of the Committee of Nominations, which was read and laid
on the table.

Dr. Hays then called up the Resolution on page 43, vol. 2, of the
transactions of the Association, and moved to strike out " ail that
relates to Committees," &c.

The motion was seconded by Dr. Stevens, and urged by Dr. Drake,
who read some ten or twelve special points, which he said ought to
occupy the Association instead of being occupied with Epitomes of
Rankin & Braithwate.

Dr. Hooker, of Conn., spoke of the looseness of committees and
editors of the Journals.

Dr. Davis thought that they could decide on the matter at once.
Dr. Hays proposed to dispense with the Standing Committees.
The question was then taken on the resolution, which v/as adopted.

Dr. Wood, of Penn., offered the following resolution, which was
adopted :

Resolved, That a committee be appointed to take into consideration
the arrangement of a committee for future action, to report as speedy
as possible.

1851.] Miscellany, 379

The Chairman of the Committee on Medical Education was about
to read the regular report on that subject, when Dr. Drake moved the
suspension of the reading till after the recess, as it was a very long
report. ,

On motion of Dr. Johnston, of Missouri, the report of the Committee
on Medical Literature was then taken up.

Dr. Desaussure announced that Dr. Davis would read a paper
entitled an experimental enquiry concerning some points connected
with the process of Assimilation and Nutrition.

Dr. Boyburn of Missouri, presented and read the report of the
Committee on Medical Literature. In the course of his reading the
Report, he gave way to a motion to adjourn.

Afternoon Session.

The President took the Chair at half-past 5 o'clock and organized
the meeting.

The Secretary announced the following gentlemen as having been
appointed by the President, under resolution of this morning, concern-
ing a committee for the arrangement of business, for the occupation of
the Association in future : Drs. G. Wood, of Pennsylvania ; J.
Havs, D. Drake, A. H. Stevens, W. Hooker, B. R. Wellford. and
S. H. Dickson.

The following gentlemen were appointed a committee under a
resolution in regard to Schools of Pharmacy and Dental Surgery, viz :
Drs. Hays, Stevens, Yardley, Storer and Jones.

Dr. Dickson moved the following Preamble and Resolutions, which
were seconded by Dr. Bond, and unanimously adopted without debate :

Whereas, efforts are being made to repeal the law of 1847, which
confers protective rank on the members of the Medical Department of
the Army, therefore

Resolved. That the American ]\Iedical Association, views, with
regret, the existence of hostility to the act of Congress, approved Feb-
ruary 11, 1847, which confers legal rights, and equality with other
Staff Departments on the Medical OfHcors of the Army, and gives them
a position to which the importance and character of the profession
entitles them.

Resolved^ That copies of these resolutions, with the resolutions of
the Association, passed at its last annual meeting, on the same subject,
be transmitted to the Secretaries of War and of the Navy, through the
Chiefs of the Medical Department of each service, and to the presiding
officers of the Senate and House of Representatives of the U. States.

The reading of the Report of the Committee of Medical Literature
was then concluded.

On motion, the Report was adopted, and referred to the Committee
on Publication.

The Report of the Committee on Medical Education was then called
for, and as the hour was late, the Chairman read only so much of it as
relates to Demonstrative Midwifery, which had by special resolution
leen referred to the committee.

380 Miscellany. [June,

On motion, the Report was accepted, and referred to the Committee
of Publication.

Dr. Dickson then offered the following resolution which was adopted :

Resolved^ That this Association unanimously^ approve of the opinioi'.j
expressed in the Report of the Committee on Medical Education in
respect to Demonstrative Midwifery.

The Convention then adjourned to meet to-morrow morning at 10
o'clock.

Morning Session. May Oth.

The President. Dr. James Moultrie, in the Chair.

The Minutes of the last meeting were read and confirmed.

The report of the Committee on Medical Education being the spe-
cial order, Dr. Stevens, of New York, asked and obtained leave to
introduce the following resolutions:

Resolved, That the members of this Association cannot separate
without expressing their grateful sense of the hospitalities, and nu-
merous delicate attentions received from their Medical brethren of
South Carolina, and the citizens of Charleston.

Resolved, That a Committee be formed, to procure a tablet with a
suitable inscription, commemorative of this meeting, and the feeling it
has elicited, to be placed at the disposal of the Medical Association
of South Carolina.

This tablet is here placed by the American Medical Association, to
commemorate their annual meeting in the city of Charleston, in May,
1851, and to signalize their gratitude for the extraordinary professional
and social enjoyments that accompanied it.

The resolutions having been seconded were adopted ; and Dr.
Stevens, further moved that Drs. Hay ward, of Mass, and F. xV. Ram-
sey, of Tenn. and himself constitute the Committee.

Dr. Ramsey, of Tenn. asked and obtained leave to read a letter
from Dr. E. I). Fenner, of Louisiana, and offered the following reso-
lution on the subject, which was adopted :

Resolved, That the ettbrts of Dr. Fenner to place on a firm and du-
rable basis, an annual publication, embracing i\Iedical Reports from the
whole Southern portion of the Union, merits the commendation of this
Association and should receive solid support from American physicians.

Dr. Hays, of Pa. asked and obtained leave to call up for consider-
ation, so much of the report of the Nominating Committee, as relates
to the selection of the next place of meeting of the Association, and
the appointment of the Committee of Arrangements and the Commit-
tee of Publication, the other Standing Committees having been abol-
ished. The report bavin jr been read, Dr. Drake, of Ohio, made an
urgent appe'il in favor of Washington City as the next place of meet-
ing. The question being taken on the adoption of that part of the
Report of the Committee, which proposed Richmond, (Va.) as the next
place of meeting, it was adopted by a large majority. The question
being taken on the coniirmation of the Committee of Arrangements
and Publication, the nominations of the Committee were confirmed.

1851.] Miscellany. 381

Richmond, Va., was selected as the next place of meeting by the
Association, and the following gentlemen appointed a Committee of
Arrangements, viz: Drs. R. \V. Haxall, Chairman; Carter P.John-
son, James Beale, Chas. B. Gibson, S. Manpas, R. D. Haskins, C. S.
Mills and M..P. Scott. Committee of Publication Dr.s. Hays, of Pa.,
G. Emerson, of Pa., D. F. Condy, of Penn., H. W. Desaussure, of
So. Ca., J. Parrish, of Penn,, P.C. Gooch, of Va. and G. W. Nor-
ris, of Penn.

Dr. Hooivcr, of Conn., Chairman of the Committee on Medical
Education, completed the reading of the report of the Committee,
and offered the tbllowing resolutions:

Besolced, That the abuses which exist in the modes of Medical
Education pursued in this country, demand the serious consideration
of the profession.

Resolved, That free discussion in relation to these causes is an
important means of effecting their removal.

Resolved, That in the opinion of this Association no effort to re-
move these abuses can succeed, that is not based upon a reform in the
public sentiment, both of the profession and of the community.

Resolved, That this reform, so flir as the profession is concerned, is
to be eijected mainly through its organization, and that it is therefore
incumbent upon every physician to do all that he can to give them
character and etHciency.

Resolved, That this Association have confidence in all proper efforts
which have for their object a retbrm in the sentiments and practice of
the community in relation to Medicine and the Medical profession.

Resolved, That the recommendations of this Association at its for-
mer meetings in regard to Education, both preliminary and medical,
be re-affirmed, and that both the schools and private preceptors be still
urged so to do their duty as to secure to the community a well educated
profession.

Resolved, That in the work of Medical reform, while all precipitate
movements should be avoided, we should aim at a steady advance,
from year to year, till a thorough system of education be established
by the profession throughout our country.

Dr. Wood, of Pennsylvania, asked leave to suspend the order
usually taken with reports. Permission being granted, he read the
following report, which was adopted:

The committee to whom was referred the subject of arranging a plan
of committees, for future action, in place of the standing committees,
abolished by the Association, have the honor to report as follows :

It appears to them that the most feasible plan of accomplishing the
objects of the Association, is to select certain subjects, which may be
considered as suitable for investigation, and to refer these subjects to
special commiHees, to be appointed before the close of the present ses-
sion, and to report to the next. Such a selection the committee have
accordingly niude, and will offer to the consideration of tlie Assoc'ation.

As an additional means of securing valuable contributions, they
propose, rlso, the npnointment of a committee, whose business it shall

382 Miscellany. [June,

be, in the interval between this and the next session, to receive origin-
al volunteer papers, upon any subject which their authors raay choose ;
to decide upon the merits of these papers ; and to present to the Asso-
ciation, at its next session, such of them as they may deem worthy ef
receiving this direction. With a view to increase competition, they
think it advisable that a prize of fifty dollars, or a gold medal of that
value, be awarded to each of the five papers presented to the Associa-
tion, or any smaller number of them, which the committee may con-
sider most meritorious, and the Association may resolve to publish.

In reference to the resolution presented in the report of the Stand-
ing Committee on Medical Literature, and referred to the present
committee, they have only to observe that, as its ends will probably be
most efiectively obtained, by the adoption of the general plan which
they have already brought before the notice of the Association, they do
not consider it expedient to make any further report.

As to the appointment of the special committees referred to, your
committee think tliat the most convenient plan will be to refer to a
special committee, the nomination of a Chairman for each, who shall
then select, at his convenience, two individuals, to aid him, with the
restriction only, that the persons so selected, shall be members of the
Association.

To the same nominating committee, may be referred the appoint-
ment of the general committee, whose business will be to receive and
judge whatever papers, as the members of this general committee
must frequently compare opinions, it will be desirable that they should
reside near each other ; and it is accordingly proposed, that they
should be chosen from one neighborhood. If the plan be found to work
well, this locality may be changed every year, so that each section
of the Union may, in its turn, be charged with this duty. The com-
mittee would suggest that the general committee should be first chosen
from members of the Association, residing in Boston or its neighbor-
hood, as the most northern point.

To embody these suggestions in due form, the committee offer the
following resolutions :

I. Resolved, That committees of three be appointed to investigate
and report severally on the following subjects :

1st. Causesof the Tubercular Diathesis.

2d. Blending and conversion of the types of fever.

3d. The mutual relations of Yellow Fever and Bilious Remittent
Fever.

4th. Epidemic Erysipelas.

5th. Acute and Chronic Diseases of the Neck and of the Uterus.

6th. Dengue.

7th. The Milk Sickness, so called.

8th. Endemic prevalence of Tetanus.

9th. Diseases of Parasitic origin.

10th. Physiological peculiarities and diseases of negroes.

11th. The action of water on lead pipes and tlie diseases which
proceed from it.

1851.] Miscella ny. 383

12lh. The alkaloids which may be substituted for quinia.

13th. Permanent cure of reducible hernia.

14th. Results of Surgical operations for the relief of malignant dis-
eases.

15th. Statistics of operations for removal of stone in the bladder.

16th. Cold water dressings.

17th. The sanitary principles applicable to the construction of
dwellings.

18th. The toxicological and medicinal properties of our cryptogam-
ic plants.

19th. Agency of the refrigeration produced through upward radia-
tion of heat as an exciting cause of disease.

20th. Epidemic diseases of New-England and New York.

21st. Epidemic diseases of Pennsylvania, New Jersey, Delaware
and Maryland.

22d. Epidemic diseases of Virginia and North-Carolina.

28d. Epidemic diseases of South-Carolina, Georgia, Florida and
Alabama.

24th. Epidemic diseases of Mississippi, Louisiana, Texas and Ar-
kansas.

25th. Epidemic diseases of Tennessee and Kentucky.

26th. Epidemic diseases of Missouri, Illinois, Iowa and Wisconsin.

27th. Epidemic diseases of Indiana, Ohio and Michigan.

II. Resolved, That a Committee of Nomination be appointed,
whose duty it shall be to nominate one Chairman for each of the above
committees.

III. Resolved, That each of the Chairmen thus nominated shall
select, at his earliest convenience, the members of the Association to
complete the committee.

IV. Resolved, That a committee of five members be appointed, to
be called the Committee for Volunteer Communications, whose duty
it shall be, in the interval between the present and the next succeeding
sessions, to receive papers upon any subject from any persons who
may choose to send them, to decide upon the merits of these papers,
and to select for presentation to the Association, at its next session,
such as Ihey may deem worthy of being thus presented.

V. Resolved, That the Committee for Volunteer Communications,
shall have the power to form such regulations as the mode in which the
papers are to be presented, and as to the observing of secrecy, or
otherwise, as they may think proper.

VI. Resolved, That the selection of the members of this committee
be referred to the saiTie Nominating Committee, whose duty it will be
to appoint the Chairman of the several Special Committees, as above
directed ; with this restriction, that the individuals composing it shall
reside in the same neighborhood.

VII. Resolved, That a prize of fifty dollars be awarded to each of
the volunteer communications reported on favorably by the committee,
and directed by the Association to be published : Provided, that the
number to which the prize is thus awarded do not exceed five ; and

384 Miscellany. [June,

provided, also, if the number approved and directed to be published
exceed five, that in such case, the prize be awarded to the five which
the committee may determine to be most meritorious. All of which
is respectfully submitted.

Charleston, May 9th, 1851. GEO. B. WOOD, Chairman.

Dr. Hays, ofPenn., gave notice, that at the next meeting of the
Association, he should oiler an amendment to the Constitution, line 4,
so as to read $10 instead of $3.

Dr. Atlee, of Pennsylvania, remarked on the value of the Report of
the Committee on Medical Education, and otfered the following reso-
lution, which was adopted :

Resolved, That it be recommended (o the several State Medical
Societies throughout the Union, to procure a re-publication of the Re-
port of the Committee on Medical Education, for general distribution
among the profession.

Dr. Drake offered the following resolution :

Besolced, That in the opinion of the Association, the students of
our schools should be required to matriculate within the first days after
the opening of the Sessions, and continue their attendance to the end of
the terms, taking with them evidence of the same, to be presented with
tickets of the Professors when they become candidates for the Degrees.

The resolution was adopted, and Dr. Gibson moved to deter the fill-
ing up of the blank. Some discussion arose on tiiis point, when the
resolution was left to read, " within the first days," &c.

The Report of the Committee on Medical Science was then called
up, when a letter was read from Dr. Dowler, Chairman of said com-
mittee, regretting his inability to be present, and the necessity of

sending it.

Dr. Fenner tlien read the outlines of the report, and asked pcrmis-
sion to retain the same for revision, copying, 6ic., which was granted.

Dr. Mauren offered the following resolution, which was adopted :

Resolved, That the Committee on Publication, be instructed to print
conspicuously upon the title page of the forthcoming volume of the
transactions, the following declaration, viz : " 'J'he American Medical
Association, although formally accepting and publishing the Reports
of the various Standing Committees, holds itself wholly irresponsible
for the opinions, theories or criticisms, therein contained."

Dr. Storer moved the following resolution, which was adopted :

Resolved, That the hearty thanks of this Association, be presented
to their late Secretary, A.lfred Stille, M. D., for his constant unwearied
and invaluable services since its first organization.

The report of the committee on Adulterated Drugs was read. A
motion was made to refer the same to the Committee on Publication,
which Avaslost, and a motion to lay it on the table adopted.

Dr. Gaillard, of South Carolina, Chairman of the Committee on
Elygiene, presented an outline of the report on that subject. Referred
to the Committee of Publication, with authority to append thereto, a
papernow in preparation, on the Mortuary Statistics of certain cities.

Dr. Drake, of Ohio, offered the following amendments to the Consti-
tution, which were read and ordered to lie over under the rule.

1851.] Miscellany. 385

All members by invitation, musi be nominated in writing by five
members of the Association, whose names shall be recorded in the
minutes. When elected, they shall enjoy all the rights and privileges
of Delegates, and remain permanent members of the Association.

All permanent members shall be entitled to vote, and when they
attend a meefingof the Association, their respective names shall be
reifistered, and each shall pay the sum required from a delegate.

The Secretary read a Protest from the Iowa University, against the
representation of Rush Medical College in this Asi^ociatio';.

Dr. Jervey moved to refer the Protest to a special committee, to
report at once.

Dr. Wood moved to refer it to the Committee on Colleges of Phar-
macy and Dentistry, which was carried. Dr Jervey v/iihdrawing
his motion.

Dr. Wood read the following report of the Committee of Nomina-
tions, which was adopted.

The committee to whom was referred the nomination oftije Chair-
men of the several Special Committees, to report at the next session,
and also, of the committee for volunteer communications, report that
they have fulfilled the object of their appointment, and offer the follow-
ing list of Chairmen, to the committees first referred to.*

The President read an invitation from the Committee of Reception,
to a steam boat excursion on our waters.

Dr. M'Intyre, of New York, proposed that the Code of Ethics and
Constitution of the Association, be recommended to be published by
the several State Societies. Proposition adopted.

Dr. Grimshaw offered the following resolution :

Resolved, That Medical Colleges, in publishing statements of the
number of Medical and Surgical cases treated at their Dispensaries,
act contrary to the spirit of the Code of Ethics adopted by this body.

Adjourned.

Afternoon Sessiox.

The Association re-assembled at 5 o'clock. Dr. B. R. Wellford, of
Virginia, Vice-President, in the Chair.

The special order was called for, and Dr. Davis, of 111., read a
paper on the infiuence of certain diet on the function of Respiration
and Calorification, &c.

The President, Dr. James Moultrie, resumed the Chair.

Dr. Hays moved to proceed with the consideration of unfinished
business.

Dr. Grimshaw offered the following resolution, which was adopted :

Resolved, That the thanks of the Association be returned to Dr.
Davis, for the paper just presented by him.

Dr. F. A. Ramsey, of Tenn, called up, as unfinished business, the
resolution ofliered yesterday by Dr. Jones, of Tenn., and not then acted

* The names of the gentlemen composing the Committees will appear in our
next number. Editor,

386 Miscellamj.

upon, to which Dr. Grimshavv offered the following Amendment
" And that the first Convention be held before the first of May, 1852."
The question being on taken the Resolution, and the Amendment, they
were both negatived by a large majority.

Dr. Phelps, of New York, offered the following resolutions, which
were unanimously adopted :

Resolved, That the warmest thanks of the Association be tendered
to the Trustees of the St. Andrew's Society, for the gratuitous use of
their very convenient and eligible Hall ; and to all those other Insti-
tutions and Readinfj Rooms, which have been so freely thrown open
for the inspection and use of the members.

Resolved, That the Committee of Arrangements receive our most
grateful acknowledgments for the very handsome, and indeed magni-
ficent manner in which they have provided for the entertainment and
pleasure of the Delegates from abroad, during their sojourn in the city
of Charleston.

Resolved, That not only the Profession of Medicine, but also pri-
vate munificence, and the kind attentions of the citizens generally,
have conspired in manifestation of that urbanity of manner, and that
unwearied and kind attention, which commands not only our profound
admiration, but will be followed by the most pleasing recollections so
long as life and thought shall endure.

On motion of Dr. Stevens, the above resolutions, with those offered
by him at the Morning Session, were ordered to be published in the
city papers.

Dr. Johnston, of St. Louis, moved to adjourn sine die, which was
adopted.

The Vice-President, Dr. Wellford, of Virginia, then congratulated
the Association on the happy termination of its labors, and declared it
adjourned, to meet again in Richmond, Va., on the first Tuesday in
May next.

Medical Professors in Spain. The Faculties of Medicine in Spain
have been organized. The number of Professors in Madrid are
eighteen, three of whom are Specialists. The Specialities are the
syphilitic and cutaneous diseases and affections of the eye. The Col-
leges at Barcelona and Seville have each fourteen Professors in the
schools of Pharmacy. In each of these cities there are five Profes-
sors. Bui. Gen. de Therap., Dec. 1850.

CO' The Editor will be absent a tew months on a visit to Europe,
but is happy to say that he has secured the kind assistance of highly-
competent friends for the supervision of the Journal until his return.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES JULY, mi. [No. 7.

PART FIRST.
CD r i g t n a I (E o m m u n i r a t i o n s .

ARTICLE XXI.

Surgical Cases. By Hexry F. Campbell, M. D., Demonstra-
tor of Anatomy in the Medical^College of Georgia.

What we require for the perfection of ?)iedical science, is
an accumulation of facts * capable of being used as data, and
dealt with in our researches and generalizations as we deal
with the data o^ physical science." We have therefore regard-
ed it by no means an unimportant duty, to record every thing
which can in any way add to that vast amount of comparable
facts, upon the accumulation of which the laws of our science
are to be founded, and from which deductions are made for
remedial treatment. It is more in accordance with this view
of fact-gathering, than on account of any particular novelty
investing them, that the following cases are reported :

Case I. Extensive Injury of the Elbow-joint, with Compound
Fracture of the Olecranon process. Charles, a negro man,
about 60 years of age, was severely beaten with a cudgel, by
another negro. Besides other wounds on the head and about
the body, we found on examination that the principal injuries
had been sustained by the left superior extremity. The radius
was fractured at about its middle third, and the elbow-joint
opened by a blow on the olecranon process of the ulna.- Ex-

N. S. VOL. VII. NO. VII. 25

388 CampbelTs Surgical Cases. [July,

ternally there was but little apparent injury. The fore-arm
was permanently flexed at nearly a right angle with the arm,
and there w^as inabihty to extend it, except by its own weight.
On the posterior surface of the elbow-joint there was a wound
in the integument about three-fourths of an inch in length which
communicated with a fracture of the ulna about the middle of
the greater sigmoid cavity, thus separating the olecranon pro-
cess from the body of the bone. In examining the opening
and fracture, the finger passed between the olecranon and lh(3
upper extremity of the shaft of the bone, and was pushed
forward past the belly of the brachialis anticus muscle, when
the pulsations of the brachial artery were distinctly felt. Tho
trochleated extremity of the humerus was also in contact
with the finger. The olecranon process had been drawn up
about an inch and a half from its natural position by the action
of the triceps extensor muscle. The only muscle connecting
the humerus and ulna on the posterior aspect of the limb was
the anconeus. There was considerable effusion of blood about
the joint, though but little external hemorrhage besides the
large clots removed from the wound by the finger. The orbi-
cular ligament having been ruptured in consequence of the
fracture of the ulna at the point of its attachment, there was a
dislocation of the upper portion of the radius upward and for-
ward upon the anterior surface of the external condyle of the
humerus. In consequence of this luxation, complete extension
could not be effected.

In consultation, it was determined to attempt the treatment
of these injuries without amputation. The luxation of the
radius was reduced without difficulty, and its two fractured
ends brought in contact when the movements of the limb be-
came more extended. Any attempt at union between the
olecranon and the body of the bone was forborne, as we wished
the limb kept in a flexed position in order that in case of
anchylosis, which seemed inevitable, the patient might have the
full use of the hand in eating, and other manipulations about
his own body. Besides, his age still further precluded the hope
of such union. After the removal of the coagula from about
the joint. Roe's apparatus for fractures of the superior extremi-
ty was applied, and the arm kept in the flexed position. The

l8ol.] Campbell's Surgical Cases. 389

bandages were so arranged that the external wound could be
dressed without their renaoval. Fever supervened the limb be-
came very much swollen and painful. Saline cathartics for de-
pletion, and a solution of acetate of lead, as a local application^
appeared to control the inflammation. Suppuration com-
nnenced in a ^qvj days ; the wound was injected frequently
with cold water to wash out the discharge, and afterwards the
nitrate of silver, alternated by chloride of soda, was used as an
injection once a day. Flexion of the limb was frequently made
by varying the length of the extending rod of the apparatus,
and thus anchylosis avoided. The discharge continued for
about a month, at first quite profuse, becoming less and less, it
finally ceased ; the external wound healed completely, leaving
the patient with full use of the joint in every respect, except
that of extension otherwise than by the anconeus, which still
remained perfect, always assisted by the weight of the fore-
arm. Four years have elapsed since the injury : our patient is
still a vigorous old man, and the limb having become better
adapted by time to the altered condition of the joint, is used by
him with great power and efficiency.

Case II. Injury of the Wrist Joint. Murphy, a laborer at
the Georgia Rail Road Depot, while coupling two cars, receiv-
ed the following injury, by the coming together of the two
connecting beams : On the back of the wrist there was a deep
wound down to the tendons of the extensor muscle of the fin-
gers. Anteriorl}^ the laceration was much more extensive,
a corner of the beam appears to have divided the soft parts a
little below the wrist, entirely across the hand. A flap Was
formed of the integument and fat of the palmer surface, which
extended to the centre of the hand ; several of the flexor ten-
dons were cut, and the joint fully exposed ; the ulnar artery
was lacerated, but had not bled much, probably on account of
the violence with which it had been opened. The patient was
in excellent general health at the time of the accident.

The flaps were brought together and retained with sutures
and adhesive strips, after which a bandage was applied. The
suppuration was very profuse at the second dressing ; the flaps
ihen appeared healthy, but subsequently became very dark,

390 Campbell's Sui'gical Cases. [Ju]}v

and finally sloughed away entirely. The granulations, how-
ever, were vigorous and healthy. About the twentieth day a
darkened bone was observed in the orifice at the wrist on
examination, it was found loose : we ren^oved it without difli-
culty, and it proved to be the trapezoides. After this, the sup-
puration gradually diminished ; when we last saw him it was
very slight there is still great tenderness of the palm. The
hand is very much distorted, and wW doubtless be much re-
stricted in its movements, but in many respects it will prove a
valuable and useful member.

The precept inculcated in the above cases is sufiiciently
plain not to require enunciation; and did we exercise more
patience under similar circumstances, delaying amputation as
the dernier resort, it is true, many a brilliant operation would
be lost to the surgeon, but at the same time many a useful
member would be preserved to our patients.

Case III. Occlusion of the Vagina. Charlotte, a negro
woman, aged about 30 years, during a protracted labor sustain-
ed such injury to the vagina that extensive sloughing of the
mucous membrane resulted, and occlusion of this passage su-
pervened. She had been operated on previously, but in con-
sequence of neglect on the part of the nurse to carry out the
instructions of the surgeon, the difficulty had not been remov-
ed. When we saw her the occlusion was almost complete,
there being only space sufficient for the passage of a very
small probe with the exercise of considerable force, which
caused great pain. Menstruation had been obstructed for
many months, and during these periods she always suffered
great pain in the loins and region of the womb and vagina.
Her general health was in apparently good condition.

Finding that our examination verified the history of the case,
viz : that the occlusion resulted from the loss of a considerable
portion of the mucous membrane of the vagina by sloughing,
and that the narrowing extended for more than two inches
from the orifice of the urethra, just below which it commenced,
we concluded not to attempt the restoration of the entire cali-
bre, but only to dilate it sufficiently to admit of the egress of
the menstrual fluid. To effect this object, we adopted the fol^

1851.] Campbell's Surgical Cases. 2\)l

lowing treatment : It being impracticable to introduce even
the smallest sized catheter or bougie, we modified the stricture
knife, by attaching to it a beak much smaller than the ordinary
one, indeed it consisted of a small silver probe soldered on to
the end of the instrument in the place of the ordinary beak.
The patient was put under the influence of chloroform, and the
beak of this instrument pushed steadily into the small opening
left by the stricture. The knife was then protruded from the
sheath with its cutting edge downwards, and thus was the
whole course of the stricture traversed by the instrument.
On withdrawing the knife, some blood and a quantity of dark
grumous fluid were discharged, though the flow was by no
means so large as we had expected, from the length of time
during which raenstriaation had been obstructed. The after
treatment consisted in frequent introduction of bougies of large
size, occasionally substituted by the sponge tent. She remain-
ed at the Infirmary more than two months, during which time
she had three menstruations, two of which were subsequent
to the operation. These were quite profuse, and without any
pain whatever. At the time of her dismissal, the opening in
the vagina was sufliciently large to admit a female catheter of
ordinary size. She was furnished with one, and we directed
its use once a week, to prevent a return of the occlusion.

Occlusions of the vagina are presented in several varieties.
They occur in the form of bridles, occupying only a portion
of the calibre, or the entire calibre, constituting a ring, or
there may be m.ore than one ; or the constriction may be
still more extensive, and constitute a complete tube of dense
indurated lymph deposited in the sub-mucous cellular tissue,
entirely obstructing the passage for one or more inches. In
these cases the knife has proved beneficial ; for when the dense
lymph forming the constriction has been cut through, the mu-
cous membrane is allowed to unfold and occupy nearly its
original expanse ; but in the present case the occlusion was
caused by the actual destruction of a large portion of the mu-
cous membrane, and as this tissue is but little susceptible of
stretching, and as we know of no process by which it can be
reproduced, of course any attempt at restoring the full calibre
of the vagina so as to admit of the exercise of the important

392 Campbell's Surgical Cases. [July,

functions of coition and parturition, would have been altogether
nugatory.*

Case IY. Adhesion of the Ear after almost entire sepa^
ration from the ^e(i. Goldberg, a Hungarian pedlar, was
brought to our Infirmary after having received very severe
injuries at the Georgia Rail Road, by being caught by a car and
jammed against a brick wall. The injury, however, for which
we report the case, was an extensive laceration of the left ear.
It appears that it was caught by the projecting edge of the roof
of the car, and we found it torn entirely off, with the exception
of about one-fourth of an inch of skin at the upper portion of its
attachment, and this narrow neck of skin had been raised for
some distance up from the temporal bone. The cartilage was
torn off from its attachment to the auditory process, the rough
edge of which was observable in the centre of the denuded sur-
face from which the ear had been torn. The ear was cold and
blue apparently without vitality.

Notwithstanding this seemingly hopeless condition, we con-
cluded to attempt union. For this purpose we applied six
sutures of silk, attaching the ear to the scalp, a thick pledget of
lint was placed behind the ear, and another broader one over
it to retain it steadily, and over these a bandage was applied.
We administered a grain of morphine to the patient, for pain
which he suffered from other and more serious injuries. On
the fourth day, the dressings were removed, and to our surprise,
the entire ear had adhered by means ofcoagulable lymph. A
very small portion of the lobe, which had been badly bruised,
had become dark, but the rest of the organ was red and warm,
and in every way manifested sufficient vitality to convince us
that our otoplastic operation had succeeded.

The patient remained with us for nearly two months, during
which time the adhesion became perfectly firm. Although the
ear had become attached, still the meatus was not preserved, in
consequence of the cartilage not becoming attached to the
auditory process. This opening being completely closed, deat-

In the sixteenth volume of the Dublin Medical Journal this subject is treat-
ed by Dr. Kennedy as the disease is found to exist in the unimpregnated female;
and Dr. Doherty, in a more recent number of the same journal, treats of the
affection as it occurs in the impregnated female.

]S51.] Canipbeirs Surgical Cases. 393

ness was the result, this was remedied by an incision over the
meatus, and the introduction of short metallic bougies, which
were worn to dilate the orifice* When he left us he was stiil
wearing the bougie, and could hear distinctly whenever it
was removed temporarily, though we did not consider it pru-
dent at that time, to leave it out permanently, for fear of a re-
turn of the occlusion.

The above case needs no extended remark ; the precept
deducible from it is too plain to require any amplification viz.,
that vv'e should attempt union in cases like the above, even
though the chance of success may be but a forlorn hope.

Case V. Lithotomy. We were kindly called to the follow-
ing case, by our friend, Dr. J. L. Hamilton, of Stone ^Mountain.
The patient, a boy nine years of age, v.as a native of De Kalb
county, and has resided near tiie mountain from his birth : he
had manifested symptoms of Stone from a very early age. For
several weeks previous to the operation, his attacks had been
unusually distressing. They were accompanied by great irri-
tation and bearing down of the rectum, so that he was fre-
quently affected with prolapsus ani. When we saw him, these
paroxysms had become very frequent, and interfered materially
with his sleep at night. We administered morphine to quiet
the irritability of the bladder and rectum, and on sounding, the
stone was easily detected. With the assistance of my friends,
Drs. Quintard and Hamilton, we performed the bilateral opera-
tion, and an oblong calculus, presenting the physical characters
of the oxalate of lime variety, wiih iriegular incrustations of
phosphatic deposit, was removed. On measurement, it was
ascertained to be of the following dimensions : longest diame-
ter, one inch and three-tenths; shortest diameter, seven-tenths
of an inch. The stone is somewhat flattened, and therefore
presents another transverse diameter, which is eight-tenths of
an inch. Its weight, immediately after the operation, was two
drachms and one scruple.

The rectum protruded during the operation ; it was replaced,
and the extraction completed without accident, and with but
little hemorrhage. The patient was left in charge of Dr. Ham-
ilton. A letter from that gentleman, informs us tliat he has
entirelv recovered, without anunplea>:int svm"t(^rii.

394 Pendleton's Case of Hysteria. [July,

We would call attention to the diameters of the stone in the
above case, singularly corresponding with those of a calculus
recently crushed by Dr. Dugas, and reported in the April
number of the present volume of this Journal.

ARTICLE XXII.

A Case of Hysteria, with Clonic Spasms cured by Chloro-
form, By E. M. Pendleton, M. D., of Sparta, Ga.

On Friday, the 16th inst., was called, about 3 P. M., to see
Dinah, a negro woman belonging to Dr. Terrell, some four or
five miles in the country. Learned that she had complained
of a headache during the morning, and had evinced some awk-
wardness in cooking dinner, and made several foolish remarks,
as if absent-minded. After dinner she complained of violent
headach, and laid down. Not long after she was found by a
fellow servant in a speechless condition, breathing hurriedly
and frothing at the mouth. No efHjrt could arouse her, or
make her notice any thing around her. She remained pretty
much in this condition till I arrived, with perhaps the exception
of throwing herself about occasionally. Mr. J., the overseer,
had bled her about a half pint, as he told me was afraid to
take more, as her pulse was almost imperceptible: he found it
became stronger, however, under the bleeding. I found her
pulse nearly as slow and soft as natural, but had not finished
iPiy examination before a paroxysm came on of all the volunta-
ry muscles of the body. It seemed impossible to hold her in
bed, and required three persons to do it. During her exertions
the blood began to flow, which was encouraged until she bled
about three pints. She sank back quite exhausted and fainty,
her pulse giving way, a perspiration breaking out, and she soon
uttered several coherent words, as "let me alone." An effort
to give medicine proved abortive. I directed a large dose of
ol. ricini, as soon as she could take it and injections of salt and
water, per anum pitchers of cold water to be poured on her
head if she was turbulent, and another venesection if her pulse
reacted.

The next morning heard from her by note. She appeared

1851.] Pendleton's Case of Hysteria. 39i

to come to her right mind early in the night and rested tolera-
bly ; the medicine was taken and acted well ; she seemed in a
calm and quiet mood. In the afternoon received another note :
that since 9 o'clock, A. M., she had been running, jumping and
shouting almost incessantly, being wild, turbulant and ungovern-
able. I could not possibly see her till morning, I wrote direc-
tions similar to those formerly given. She was bled by the
overseer, cold water poured on the head, a blister applied to
the nape of the neck, and the ol. ricini repeated until free
evacuations were produced. All, however, to no purpose; she
continued in the same condition all night without sleeping any.
Tiie disease was paroxysmal the intermissions, however, very
brief. I arrived about 9^ o'clock, A. M., found her last pa-
roxysm had just passed off and she was quiet, her eyes closed,
pulse 115 per minute and soft, skin cool and moist, tongue
slightly furred, which she protruded at my request.

In a very few moments her arms and legs began to jerk, the
voluntary muscles being put in action, and she began to shout
as loud as she could (her voice, however, was quite hoarse)
prayers, exhortations, &c., formed the burden of her language ;
she seemed to know every person in the house, calling them by
name and talking in the main coherently. There was however
a dilitation of the pupils and staring of the eyes which indicated
a morbid excitement of the sensorial functions. The paroxysm
lasted about twenty minutes, during which time all the volun-
tary muscles of the extremities seemed to be in constant action,
the pulse running up to 150, and quite feeble. I took advan-
tage of the first calm moments to administer the chloroform by
inhalation, which was continued unremittingly for about half
an hour, during which time no muscular action was exhibited
only on occasional movement of the flexor of the leg elevating
the knees to nearly a right angle. Sleep was not induced at
fu'st. The pulse went down to less than 100. At the time for
the next paroxysm it again went up to 120, and she seemed
threatened with a return. The chloroform was persisted in,
liowever, and at the end of one hour she was sound asleep, and
her pulse down to 92, full and strong. I left her in this condi-
tion, with orders to repeat the chlorolbrni whenever the parox-
ysm seemed likely to ensue.

390 Word, on Treatment of Scarlatina. [July,

Monday, 10 A. M. Found her "as calm as a summer even-
ing," perfectly rational, pulse about 90 and soft : had slept well
during the night; had no return of the paroxysm, though se-
verely threatened at several times, which was always promptly
relieved by the chloroform. There could not be the slightest
doubt left on my mind of the cure being the result of this most
potent narcotic and sedative, and my thoughts instantly recur-
red to several painful instances of a similar character which
had lasted for days together, that might have been relieved by
a similar application, I doubt not. A week has elapsed, and
there has been no return.

She gave me the following history of her uterine functions
for the last five months, which no doubt originated the whole
mischief. Just before Christmas she was delivered of a child
at full time, w^hich died in a few days. Late in February she
had a healthy return of the catamenia, in March there was
none. At 4he regular period in April she was taken with fever,
violent headach, and bearing down uterine pains, which lasted
several days. The headache continued at intervals up to the
16th inst., being then near the time of her next monthly period ;
it then became more violent, and resulted in the severe chronic
spasms as described above.

Believing, as I do, that we have now a remedy for one of the
most distressing diseases to which the female is subject, I have
deemed it my duty to report this case, that others may be in-
duced to give the chloroform a fair trial in nervous spasmodic
affections of a like character with the above.

ARTICLE XXllI.

Remarks on Treatment of Scarlatina. By Robt. C. Word,
M. D., of Cassville, Georgia.

As the frequent and open interchange of opinions by the
members of the profession is useful, and to a great extent neces-
sary in advancing medical science, I trust it will not be deemed
presumptuous or improper to notice an article in the May No.
of the Southern Medical and Surgical Journal, on Scarlatina,
bv Dr. Ramsay, of Calhoun, Ga.

1851.] Word, on Treatment of Scarlatina. 30'

Although claiming no great experience in the treatment of
this affection, I feel that I can scarcely be mistaken in \\\e, con-
viction that he attaches a degree of importance to his plan of
treatment which the future will not realise; that it can not be
resorted to with the success which the fortunate experience of
the writer has led him to believe. ''Puke the patient through
the whole course of the disease with salt and water, or ipecac
never with tartar." Such is the ground work of the treatment
of Scarlatina advised by Dr. R. Now with regard to emetics
in this disease, itinay be affirmed that most wriiers upon the
subject have advocated their use. They have before been
recommended, also, throughout the whole course of treatment.
But the weight of authority, and general experience, indeed,
confirms their employment to the early stages ; none, however,
that I remember use the salt water emetic. In this Dr. R.
seems to think that he has found a specific. If he has I fear that
its unpalatable nature will render it an unfortunate one.

The use of salt as an ernetic, in the manner and to the ex-
tent advised, seems not only injudicious, but impracticable.
In cases unattended with gastric inflammation, and in which it
were practicable to get the patient to swallow the remedy, we
pretend not to say that it would not do well as an emetic ; but
the quantity and exceedingly disagreeable taste of the dose,
especially with children, seems certainly to constitute an in-
surmountable obstacle to its general use. The experience of
the past, with regard to this class of diseases, make it highly
improbable that a remedy will ever be discovered calculated to
cut short the m.alady. Scarlatina, being one of the contagious
-exanthemata, is self limited in its nature, and not likely, by any
course of treatment, to be prevented from running through its
regular stages. Hitherto the practitioner in this disease has
been able to do little else than to accompany it through its
various phases: hie duty being to palliate the severity of the
symptoms, so far as may be, by a mild and unirritating plan of
treatment, combating local inflammation, as in other affections,
and when, in the severer forms of the disease, the excitement
becomes excessive, to moderate the momentum of the circula-
tion, by the/ree use of the lancet.

I am aware that a strong prejudice exists against the lancet

398 Word, on Treatment of Scarlatina. [July,

in this affection but it is without any good reason. The lan-
cet is, has been, and I believe will continue to be, the sheet-
anchor of the profession in all inflammatory affections. And
when in scarlatina, and other anginose diseases, the throat be-
comes very sore, swollen and injected, the breathing laborious
and deglutition almost wholly obstructed, accompanied with
high general excitement, the use of the lancet is indispensable.
Scarifying the throat might give temporary and partial relief;
but so long as the general circulation continues full and active,
the severity of the symptoms will remain, without material
abatement. In many instances, the throat is so swollen and
inflamed, that nourishment cannot be taken, and even water is
ejected, with a strangling sensation, through the posterior nares
when an attempt is made. In such a condition it is difficult to
conceive the practicabiHty of the salt water plan of treatment.
There is no room to swallow, and as little room for delay in the
use of the proper remedial agent, to- wit, the lancet. To refrain
from bleeding the patient under such circumstances, from the
impression that *' it deprives him of an essential element of
cure strength," can find no proper sanction in reason, author-
ity, or experience. Death need seldom be apprehended from
mere debility. Let blood be abstracted freely that the dis-
tended and engorged vessels of the inflamed surfaces may
relieve themselves by contraction, inversely increasing the
rooni for the passage of air while the function of respiration
becomes free the fever diminishes the inflammation abates,
and the relief becomes general. The patient will now be able
to take occasional draughts of cold w^ater, which will usually
be found both beneficial and refreshing in scarlatina as well as
in other febrile affections. To the divisions of scarlatina, by
Dr. Ramsay, I have no special objections to make I am not
prepared to admit, however, that scarlatina never exists without
sore throat. Authors of great learning and experience have
assured us that cases do occur unaccompanied with this symp-
tom (Armstrong and others.) So far as I have been able to
learn, the disease, as it prevails in this country, assumes, usual-
ly, the anginose form of the older writers the '* gravis " of Dr.
Ramsay. Dr. Armstrong uses the word "inflammatory," which
is certainly not inappropriate. Occasionally, when the disease

1831.] Glycei'ljie in the Treatment of Deaf iiess, 399

prevails extensively as an epidemic it assumes the malignant
or typhoid variety. In this latter form the use of the lancet
seems to be greatly dreaded by many latter day practitioners.
Yet experience has, I think, furnished ample proof of its great
utility v^^hen timely resorted to. The early stages of every
form of the disease is unquestionably phlogistic. Speaking of
the malignant form Dr. Eberle remarks, " However rapidly this
form of the disease may pass into a low and malignant slate, its
outset is often characterized by highly inflammatory symptoms.
The attack is vehement, and the febrile excitement at first
tumultuous, tending rapidly to consume the vital energies; and
in proportion to the violence of this exciting, though transient
stage, will be the tendency of the disease to assume a putrid
character. It is therefore of the utmost importance to break
down promptly, by energetic means, the initial febrile commo-
tion." Again, "As this stage is generally short it is of great
importance to draw blood at once in its outset to the extent of
producing a very decided impressien on the system." The
same sentiments are advocated by Burserius, Larry, Rush and
others. As it was not the design of this paper to go into a
prolix account of the nature and treatment recommended of
Scarlatina, but simply to enter an humble protest to some of
the more objectionable features in the plan of treatment recom-
mended by Dr. Ramsay, I will here take leave of the subject.

PART II.
(Eclectic Department.

A Clinical Lecture on the use of Glycerine in the Treatment of
certain forms of Deafness. By Thoimas H. Wakley, Esq.,
F.R.C.S., Surgeon to the Royal Free Hospital.

Nearly two years have now elapsed since I published in the
Lancet,* a paper on the Use of Glycerine in the Treatment of
.Certain Forms of Deafness. Numerous facts justified that
[)ublication. I did not rush into print hastily, and without due
consideration. Tried by the severe and scrutinizing test of
experience, glycerine now takes its place amongst the mos
useful of our remedial agents, in the treatment of several cotTii-

October No. 184i9, p. 304.

400 Ghjcerine in the Treatment of Deafness. [July,

nion varieties of deafness. Speculation on the subject is at an
end : indisputable facts constitute the data whence the opinions
favorable to glycerine have been formed.

The peculiar cliemical properties of this fluid have led to its
use in other complaints beside deafness, and in some with signal
advantage. But the results of its use in afl^ections of the ear
have been even more satisfactory than were anticipated. In
the hands of several surgeons, the remedy has been used with
undoubted benefit: still, its successful employment often de-
mands much care and patience.

I must enforce the '"'oft-told tale," that an accurate diagnosis
is half the cure. With equal truth it may be stated, that the
indiscriminate use of a remedy is calculated to bring many a
valuable medicine into disrepute. The surgeon who would
successfully resist morbid action, of whatsoever kind, must
patiently investigate the character of the malady, before he
decides upon the plan of treatment ; otherwise much perplexity
will ensue, and the intended antidote may become the actual
poison.

A new remedy is sure to be exposed to the misfortune of
being recommended in cases that are not suitable for its adop-
tion : from this cause, an important agent often falls into disre-
pute, and even disuse. In the treatment of deafness, failures
of new remedies are the more likely to happen, as aural mala-
dies find no favor with the majority of the profession. Many
empirics owe all their success and ill-acquired wealth to this
cause.

The introduction of Glycerine into the treatment of ear-dis-
eases has produced some slight change in practice ; and many
cases, which not long since fell to the lot of the " aurists," are
now in the hands of regular practitioners, greatly to the advan-
tage and safety of the sufferers. The examination of the ears
by competent practitioners has led to the discovery of diseases
unsuited for the use of glycerine, but having fallen under the
notice of competent surgeons, unexpected relief has been
afibrded to many desponding patients. Why, it may be asked,
should the surgeon abandon any class of diseases, and thus in-
vite the charlatan to enter a field of practice which legitimately
belongs to the profession ? The impropriety of so doing cannot
be doubted. It is improper, because it is injurious to the pro-
fessional character ; and it is unwise, because it encourages
ignorance, at the expense of a too credulous public.

Soon after my first publication, many unsuccessful cases of
the employment of glycerine in deafness were reported to me.
This was to be expected. Failure were sure to take place,,
from a variety of causes ; the two most fj-equent being, the

1851.] Glycerine in ihe Treatment of Deafness. 401

inaptitude of the cases chosen for the employment of glycerine,
and the impurity of the drug used. Several samples of glyce-
rine were sent to me for examination. In only one instance
was the specific gravity correct, and in several the fluid con-
tained an admixture of lead and oil ; such glycerine as this must
always prove injurious. Sometimes it may, when thus impure,
prove highly irritating, and instances of this kind have been
mentioned to me by both London and country pi'actitioners.
If there exist oily particles in the glycerine, they become ran-
cid, and the whole fluid is speedily vitiated; in this state it
cannot be used with safety. I feel confident that the impurity
of the article has been a frequent cause of failure. In other
instances, the glycerine has not been used with sulncient dili-
gence, nor for the requisite length of time. Structures that are
almost disorganized cannot be restored to a normal state in a
day.

The glycerine has now been employed in some hundreds of
instances of deafness, and data have been collected that indi-
cate the cases in which the remedy should be used, the duration
of the treatment, and the probable or possible permanence of
the cure. In prescribing the use of glycerine, care should be
taken to discriminate betv/een those diseases which are suitable
for its employment, and others where the remedy would be
introduced without the slightest prospect of advantage. In
making this investigation and inquiry, the ///^^orz/ of the malady
cannot be too attentively considered. Did the defective hear-
ing first occur after an eruptive fever ? an abscess in the face,
or fauces? a fall? a blow? a fit? Was there a discharge
from the ear in the first instance ? if so, what was the charac-
ter of the discharge ? Did any sequestra escape? The form
of the ear should be carefully examined, and the auditory canal
and membrane tympani inspected by means of instruments
especially constructed for the purpose. A silver speculum
should be used, through which are reflected the rays of the sun
or of a very strong artTficial light. By these means we are
enabled to examine carefully the auditory cul-de-sac, and espe-
cially the membrane tympani. The quantity and condition of
the cerumen should be ascertained. If a stethoscope be placed
over the external ear, and the patient be directed to close his
mouth and nostrils, and then forcibly expel the air from his lungs,
it will readily be discovered whether the Eustachian tube be
open or not.

If the drum be entire, the air will be heard to strike forcibly
against it. On the other hand, if the drum bo perforated, the-
escape of air through the auditory passage will truly indicate-
the condition of the parts. All these points are entitled to atteiv

402 Glycerine in ike Treatment of Deafness. [July^

lion ; some of them, however, as you will soon discover in
practice, are of much more importance than others. Cathe-
terism of the Eustachian tube should not be practised on slight
grounds. When a necessity for the operation exists, of course
it should be performed, but not otherwise. In unpractised
hands the operation may be productive, not only of annoyanqe,
but of some mischief

If the surface of the auditory canal be hard and inelastic,
shining, and of a whitish appearance : if the natural secretion
be wanting, and the membrana tympanibe not painful to the
touch, the glycerine may be employed with a tolerable certainty
of success, even if a partial deafness has been of many years'
duration. An uneven appearance of the external membrane of
the drum is an unfavorable sign, as in some instances it may be
caused by displacement of the bones of the delicate aural struc-
ture. When besides the sense of hearing, the other senses are
deficient of action, the employment of glycerine alone offers no
hope of success. In such cases the utmost possible attention
should be paid to the general health of the patient, with a view
to restore the activity of the nervous system. The existence
of paralysis in any part, unless from a traumatic cause, is an
adverse indication with respect to the use of glycerine. The
modes of applying the remedy vary according to the state of
the parts, and the effects sought to be produced. When the
surface of the aural canal is dry and shining, the ears are to be
carefully cleansed by means of cotton held within the blades of
a pair of forceps, and moistened with warm water. The canal
is then to be rubbed with dry cotton, held in a like manner.
Next the glycerine is to be applied by the same means, the
cotton, well soaked in it, having been repeatedly passed back-
wards and forwards in the external meatus, care being taken
to diffuse it over the surface of the tympanum.

I shall now^ mention some cases, selected from my note-book,
as furnishing good types of the diseases which have been re-
lieved by this mode of applying glycerine. They might be
multiplied to a very large number.

Mary R , Gray's-in-lane ; Nov. 19, 1850; aged forty-
nine; a strong, healthy-looking woman, an out-patient of this
hospital. Deaf six years ; could not hear the highest power of
sonometer ; ears dry and horny ; membrana tympani of the
right side ulcerated after a discharge, (following scarlet fever,)
lasting six months ; in the other ear the membrane was sound.
The ears were rubbed with glycerine in the usual wa}', and in
a few days she heard successively Nos. 8 and 7 of the sono-
meter. In seven weeks she was quite cured, a healthy secre-
tion of wax having been estabhshed.

1851.] Glycerine in the Treatment of Deafness, 403

Anne M. , Gray's-in-Iane ; aged thirty-three ; a spare

thin woman; had been deaf since the birth of her last child,
X\'hen she had discharge from both ears; this ceased, and left
her very deaf. Her ears presented much the same appearance
as in the last case, the principal feature being the dry condition
of the meatus. Glycerine was applied with the forceps and
wool, and the woman was soon relieved from the unfortunate
impediment.

Louisa R f Hampstead, August, 1850, aged twenty-seven,
deaf nine years. Ten years since, had measles, followed by a
discharge, which lasted four months ; it then ceased in both ears
and she has been deaf ever since that period. Hears better
after washing her ears. The only peculiarity to be observed
was a total want of wax. The glycerine was applied in- the
usual way, and gave almost instant relief. In six weeks her
hearing was quite restored. This was a ver}^ remarkable case.

In other cases, where the ears are plugged with hardened,
impacted wax, and where the membrana tympani is only coated
with vitiated v/ax, the glycerine must be dropped into the ear
three or four times during the day. In twenty-four hours the
hardened mass will generally become sufficiently softened for
removal-^a little operation which requires some caution. If
force be used, a portion of the delicate membrane of the drum
may be torn awa}^ and unpleasant consequences ensue. The
mass will generally separate without force of any kind, if the
means recommended be carefully followed, gentle syringing
will also promote the separation. A pellet of fine sheep's wool,
moistened with glycerine, should be placed in the meatus, in
order that the newly exposed surface may be brought under the
direct operation of the remedial agent. The pellet also would
be of use in protecting the parts from the effects of cold and the
sudden influence of the air. The removal of an impacted mass
of exsiccated cerumen without these precautions may produce
more deafness than the presence of the offending substance.

Master!^ , City-road, aged six years, deaf in the right

ear six months. Has had a constant roaring noise in that ear ;
which was frequently swollen, and very sore ; he had been
ordered purges and lotions, from which no benefit resulted. Oft
examination, the meatus was found completely blocked up with
hardened wax. I filled the ear with glycerine, and then fitted
the plug. The next morning I easily removed the obstruction,
and in it was found a good sized cherrystone. The hearing
\\'as painfully acute for a few days. Sheeps wool was kept
in the ear. I mention this case to show how necessary it is
thoroughly to investigate every case which presents itself to
you. 1 remember another instance occuring in a member of

N* S. VOL. VH. NO. VH. 8G

404 Glycerine in the Treatment of Deafness. [July,

parliament, who was annoyed at intervals for two years by a
discharge from, and painful swelling of, the right ear. At last
the dens sapientice of that side became painful, and the gum
inflamed; this tooth was removed, and the ear was soon well.
This case I consider very instructive; and the close proximity
and anatomical relations of the part justify the supposition,
that the diseased condition of the tooth caused the deatness and
discharge from the ear.

H. R , aged forty-three; Sept. 1850; an out-patient of

this hospital ; very deaf in the right ear ; could not hear No. 3
of the sonometer; cannot refer it to any cause; it appeared
very gradually. He suffers from a " blowing sound" in that
ear ; when masticating his food, each fall of his jaw sounds like
the report of a pistol ; at other times he hears loud crackling
noises. As I suspected in this case, an impacted mass ol" soli-
dified wax was found, filling up the inner third of the meatus.
Glycerine was poured in until the meatus was full ; the bees-
wax plug was then applied. In two days the wax was com-
pletely softened, and could be easily removed. The hearing
was perfectly restored.

Another mode of applying the glycerine consists in soaking
a pellet of sheep's wool in the fluid, and pushing it gently into
the meatus until it rests against the drum. The wool, when
compressed, should be about the size and shape of the aural
cul-de-sae. A plug of prepared bees-wax, w^armed in hot
water, and placed against the external opening, and retained
there, will effectually prevent both the entrance of the atmos-
pheric air and exit of the- glycerine. This proceeding must be
repeated every morning, the meatus being each time carefully
cleansed by means of warm water, and made dry by passing
backwards and forv/ards a small piece of dry cotton ; then there
will be a clear surface for the action of the glycerine.

One of the judges of the superior courts consulted me, with
the concurrence of Sir B. Brodie. The learned judge was suf-
fering from deafness in the right ear. The organ had become
quite useless. The left ear was also partially deaf, but w^ith the
assistance of a very clever instrument, made by Mr. Rien,
Strand, he was enabled to continue his judicial duties. On
examinatian with the speculum auris, assisted by a powerful
reflector, I found the lining membrane of the meatus dry and
polished, the canal open and very straight, and the membrane
of the drum of a pearly whfteness, the central part, projecting
into the meatus, and presenting even more opacity than the
other parts ; no ceruminous secretion whatever. The air could
be heard to strike against the tympanum in both ears ; this-
membrane was intact on both sides. I applied the wool, weii

l85l.] Glycerine in the Treatment of Deafness. 405

saturated with the glycerine, to the membrane, fitting the bees-
wax plug, which effectually prevents the entrance of atmos-
pheric air or the exit of the glycerine, thus keeping the agent
constantly against the part to be acted on. This proceeding
was repeated every morning, the meatus being gently cleansed
with warm water before fresh glycerine was introduced. At
different intervals, four distinct layers of white, pulpy epithe-
lium were removed ; the ear was occasionally swollen and
painful. The treatment was persevered in for more that two
months, and the membrane of the drum was much altered in
appearance, assuming more of the dark look of the healthy
organ. I introduce this case, not as a successful one in its
results, but as illustrating very beautifully the mechanical ac-
tion of the agent in the worst case of epithelial thickening
which I have ever seen. In this case^ had the deafness been
due to the mechanical obstruction, it would have proved bene-
ficial, but the cause was purely nervous, as had been previously
diagnosed by Sir B. Brodie. There can be little doubt, that in
many cases this cuticular deposition is the cause of deficient
hearing, but it may be that the paralysis is the exciting cause
to this morbid action.

M. O -, Clerkenwell, aged fifty-three, August, 1850. Deaf-
ness in both ears ; followed a severe attack of infiuenza; never
had any discharge from either ear; occasional pain in both
ears ; when travelling in a railway carriage, hears better than
other persons. On examination, the aural cul-de-sac was found
to be dry and inelastic, and to have the appearance of parch-
ment; the membrana tympani looked white, and of a cartila-
ginous consistence ; no wax or moisture of any kind ; the
meatus and tympanum painful to the touch. The glycerine
was used as in the last case. From the right ear two pieces
of epithelium, of a pulpy consistence, were removed, and one"
thick piece from the left ear. In seven weeks she discontinued
her attendance, hearing, when at church, the clergvman of the
parish, a blessing which (as she had stated) she never again ex-
pected to enjoy. I had twice to modify the treatment in this
case, as some pain and swelling supervened.

Henry M , Esq., a merchant, aged sixty-two, consulted

me, Oct. IG, 1850. Had been deaf for more than twelve years
in his right ear ; he could not hear the loudest tone of the sono-
meter. The meatus had quite a "parchment appearance."
The ear was filled with glycerine, and the bees-wax plug intro-
duced. This was repeated every day. In fourteen days several
pieces of soft skin-like substance were removed, with evident
improvement to the patient, who could now hear No. 3 of the
sonometer. I was obliged to modify the treatment once, as

406 Ghjcerinc in the Treatment of Deafness. [July,

the patient complained of pain. In this treatment the general
health, especially the secretions, should always be watched.

Mary M ,'^Sept. 15th, 1850; Brentford; aged twenty-
six; deaf in both ears; could not hear the highest tone of the
sonometer ; meatus dry and inelastic ; tympanum much thick-
ened ; not perforated ; not painful to the touch. Treated as in
preceding case ; treatment lasted six weeks. Two portions of
cuticular soft substance came away from the right ear; the left
did not appear much affected by the glycerine. In six weeks
the patient heard No. 3 of the sonometer, at a distance of two
feet from the ear. No improvement whatever in the right ear.
I saw this patient a fevr days since ; she states that the relieved
ear fully answers all the purposes required.

When patients are treated in this way, they of course, require
the careful attention of the surgeon. The modus operandi is
simple enough ; the glycerine being kept continually in contact
with the part, acts mechanically, either absorbing or penetrating
the epithelia coating and separating the individual particles.
The ordinary time required for this treatment varies from two
to eight weeks, according to the method employed. With
respect to the permanence of the relief some cases always
require the presence of glycerine, as the best known substitute
for the natural secretion of the aural membrane. The frequent
introduction of glycerine tends to restore the external meatus
to a healthy condition, and fit it for the proper transmission of
sound. *

I mention the following case as one amongst several which I
have seen, proving that glycerine, if it be not quite pure, and
made according to the proper formula, may cause irritation,
and produce other unpleasant symptoms; and there is little
doubt that from such cause this really valuable remedial agent
has frequently suffered in repute.

A lady, living at the West-end, aged sixty-erfjht, consulted
me two years since for deafness in both ears. They presented
the appearance which indicated the- use of glycerine. During
eighteen months she lubricated her ears with this agent, receiv-
ing considerable assistance and comfort from it, and entirely
laying aside the acoustic instrument which hadbeen previously
ordered. One morning I was hastily summoned to this lady ;
she was in considerable pain ; the right ear greatly swollen and
inflamed ; she was much alarmed. She stated that she had
used the glycerine regularly. The cause of the pain and swel-
ling I soon discovered to be the stale and impure glycerine,,
which appeared quite changed in character, having an offensive
smell, and being too light in color, of thin consistence, and defi-
cient s|:)ecific gravity. This contretemps was treated iu the

1851.] Glycerine in the Treatynent of Deafness, 407

usual way, and she again uses pure glycerine with the same
advantage as before.

In the removal of foreign bodies from the ear the glycerine
is often eminently useful. Some months since a solicitor of
Gray's-inn consulted me respecting pain and deafness in the
right ear ; fie had suffered much pain for five months. The
annoyance had so affected his general health that he was quite
incapacitated from following his professional pursuits. There
was an occasional discharge from the ear. The meatus and
external parts were swollen, sore, and emitted a light muco-
purulent fluid. There was a mass of offensive looking wax.
On being touched with a probe it was found hard and resisting.
The glycerine was dropped into the ear in the manner just
described. On the next day the impacted mass w^as easily
removed. When examined, in the midst of it there was found
a common fly, a foreign body which had evidently been the
cause of the mischief The use of the glycerine was continued
for a few days, the pain ceased, and the hearing was soon re-
stored.

The instrument called a sonometer, has proved of the greatest
value in practice not from any use it possesses as a curative
agent, but that it proves, beyond a doubt, the efl^ects of treat-
ment, both to practitioner and patient. This must always be
satisfactory. Thus you can test the progress of a case at
stated intervals. It has done service to the profession.

It will be seen that sheep's wool is invariably used, instead
of cotton wool. Its advantages are many: its elasticity ena-
bles it always to retain the position in which it is first placed ;
and for the same reason it is more easily withdrawn from the
meatus. Cotton wool, when dry, changes its position, and in
many cases is with great difficulty removed.

The mode of preparing the wool is very simple. The finest
curled wool on the sheep's head is carefully cut with scizzors,
and washed in hot water ; when dry, it is ready for use. The
best wool is that procured from a small German sheep. This,
however, is not always to be procured, and the other answers
every purpose well enough.

In the paper already alluded to at the commencement of this
lecture, I published several reports of cases and amongst thcin
will be found that of a girl, an hospital patient, now living at
Chad's-place, Gray's-inn, and that of a lady living in Adelaide-
terrace, Islington. the former had been deaf eighteen years,
arising from scarlet fever; she was completely cured, and has
not to this day any return of the distressing impediment. The
other case is that of a lady, deaf thirty years, in whom the
glycerine still acts as an artificial aid, and enables her to lake

408 Glycerine in the Treatment of Deajness. [July,

part in conversation. Her son was with me but a few days
since, and he tells me that relief is always afforded by the appli-
cation of the glycerine. These cases 1 have been enabled to
watch for nearly two years, and it is satisfactory to know that
the good effects in them have been permanent.

Glycerine is particularly useful in deafness following erup'
live or other fevers ; also in deafness arising from thickening
of the drum, caused by an epithelial deposit. In the last-noticed
condition, glycerine separates the epithelial excresence, and
thus restores the membrane to its natural state and appearance.
Sir Astley Cooper, who at an early period of his brilliant pro-
fessional career devoted much attention to diseases of the ear,
used nitrate of silver for effecting a separation of the cellular
formations in these cases. But the glycerine, perfectly inno^
cuous, is a more effectual, and at the same time a safe, remedy.
When the drum is perforated, the glycerine must be only
applied to the walls of the meatus, care being taken not to use
a sufficient quantity to admit of its being introduced or forced
into the tympanic cavity. Should sucii an accident occur,
tepid water ought to be immediately syringed into the ear, and
the operation repeated three or four times. In this way the
glycerine would be quickly removed.

In only one instance have I seen the glycerine produce pain
or annoyance on its first application. A gentleman whom I
saw in consultation with Mr. Guthrie suffered most acutely
from the introduction of the remedy into his ear. A repetition
of the operation was attended with a similar result. This is
the only instance of the kind that I have witnessed. ^ There
was in that case a thickened tympanum, and an absence of
cerumen. Apparently there was neither excoriation nor in-
flammation. The second application of the glycerine was made
two days after the first. The effect precisely corresponded
with the result in the first instance. It is almost needless to
observe, that there was no repetition of the operation. The
patient was highly nervous and excitable. Still I must con-
fess that the cause of the pain felt by that gentleman remains
entirely unexplained. In not another instance have I known
any untoward event result from the introduction of glycerine
into the human ear.

In old age there is usually a deficiency of cerumen, and the
action of the glycerine is then very marked. It affords much
comfort by allaying "irritation," whicli is the invariable dis-
tressing accompaniment of a dry meatus. The tinnitus in the
ears is also frequently relieved by the soothing effects of glyce^
rine, where that noise is occasioned by a dry meatus. At the
game time, it must be remembered that many distressing cases

1851.] Functional Affection of the Spine, ^-c. 409

are due to abnormal conditions of the brain, nerves, heart, or
bloodvessels.

The object of delivering this lecture is simply to confirm the
reputation of Glycerine, and enlarge the boundary of its use-
fulness. For the relief and removal of some forms of deafness,
Glycerine stands alone as a remedial agent. With a due per-
severance in its employment by careful practitioners, it will
often be the means of removing a distressing affliction.

It has been stated by some writers that Glycerine is an oily
fluid, and therefore that is open to the objections that have been
urged against oils. But you well know that it is not an oil, and
cannot be classed with oleaginous substances. Let me remind
you of its chemical properties, and of the method adopted for
obtaining it. It is found in fatty oils combined with oleic,
stearic, and margaric acids; its specific gravity is 1.252. Gly-
cerine is a syrupy liquid, miscible both with alcohol and water,
insoluble in ether, slightly inflammable, inodorous and of a sweet
taste.

The most convenient mode of preparing it is by the saponi-
fication of oilve oil, by means of litharge and a little water.
Sulphuric acid will separate the oily matters, leaving an aque-
ous solution containing the alkaline salt along with the glyce-
rine. The mixture is evaporated to dryness, and treated with
alcohol, which again dissolves the glycerine, and leaves the
alkaline sulphate undissolved. The glycerine may be purified
from oxide of lead, by passing through it a current of sulphur-
retted hydrogen. ILondon Lancet.

On a Functional Affection of the Spine, liable to he mistaken for
Organic Disease. By Hexry Kennedy, A. B., M. R. I. A.

The time of the society will be taken up but for a very few
minutes while their attention is directed to an affection of the
spine, of which several instances have now come under my
notice, but which I do not recollect to have seen described iii
any work treating of the diseases of this part of the body.

One of the most striking features which practical medicine
exhibits at the present day is the great advance which has been
made in the diagnosis of disease. No part of the frame but has
shared in this improvement ; and though diagnosis, like every-
thing else, may be carried too far, and so be useless for prac-
tical purposes, still it must be allowed to be one of the means by
which we may hope to render medicine a more certain science
than it at present is. It is with this impression that I venture
to bring forward the following remarks.

410 Functional Affection of the Spine, ^c. [Jub%

The diseases of the spine are both numerous and important,
and may be divided into the organic and functional. To even
glance at these would be foreign to my present purpose, which is
merely to speak of one in particular, and which may be arranged
in the second class that is, amongst the functional.

The affection I allude to is essentially a disease of the young,
being seen most frequently between twelve and twenty years
of age. I have, however, met with it as early as nine years,
and as late as twenty-five. For so far I have only seen it in
private practice, and it is more common amongst males than
females, in the proportion of at least two to one. Its essence
consists in a pain in the back, combined with a sense of weak-
ness, and this is always referred to the lumbar region ; at least
I have never seen it higher up. The pain commences gradu-
ally, and may or may not be attended with feelings of weakness;
and occasionally it is only the latter that is complained of.
The patients will say that if they have occasion to stoop as,
for instance, to tie their shoe the rising up gives the feeling
as if the back would break. When we come to examine the
spine, the patient is nearly always able to refer the suffering to
a particular part ; but I have seen cases where they could not
clo so, the feeling being then more diffused ; and it is particu-
larly worthy of notice that a rough examination of the part
may be made the spine may be twisted, or percussion strongly
iised, and yet the patient will not complain of it. When left to
their own feelings, they invariably prefer the recumbent posture.
Walking is much less irksome than sitting, and particularly
when they have no support for the back. In addition to an
ordinary chair, they will use a cushion, so as that it may press
on the spine where they complain ; and even when rechning at
full length, it is not uncommon to see a cushion placed in the
hollow of the back, and in this way to cause direct pressure.
In fact the feeling of support is one they cannot do without,
and they will use many devices to attain it.

But some may here ask, what is there of moment in the
affection I have been speaking of; it is nothing but a pain in
the back, They will probably think differently when they
chance to meet a case of the sort I allude to. It has happed to
me to have seen several instances where the individuals were
obliged to give up their business, not only for weeks but for
months, and owing to this pain ; and the fact is enough itself to
show that it is worthy of our notice. Those whose business
leads them to stand and work at a desk, seem peculiarly liable to
the affection. But probably an outline of one or tw^o instances
of the sort will give a better idea of the matter.

Case 1, Mr. ^ ^, a young gentleman of 18, whose em-

1851.] Functional Affection of the Spine, ^-c. 411

ployment was in an office in Dublin, where he spent six to
seven hours a day, partly standing and partly sitting, at a desk,
began to suffer /rom pain, in the small of the back. He was
a person of small size, but of a highly developed nervous system,
as w^as shown when he labored under any common indisposi-
tion ; as, for instance, a cold. The pain in the back was trifling
at first, though constant ; so that he was able to pursue his
usual avocations for about four months, when it became so dis-
tressing that he was compelled to confine himself to a sofa the
greater portion of the day, and when he did sit up he always
used a cushion between his back and the chair. On examina-
tion, nothing could be detected with the part of the spine ot
which he complained most .; which was about the third lumbar
vertebra. It could be twisted, and otherwise roughly handled,
without causing any inconvenience, but to sit without support
could not be endured beyond a few moments. And it is par-
ticularly to be observed, that when he had any inducement he
could go through an amount of exertion on his feet, w^hich
seemed totally incompatible with the other symptoms present.
His general health appeared good ; his tongue clean ; his appe-
tite not impaired ; and, in fact, except for the complaint of the
back, he was otherwise well.

He continued in this state for four months, during which
time he was seen by the late lamented Mr. Carmichael, and a
variety of treatment was adopted ; but I could not say that
any means used was of decisive benefit. On this part of the
subject I shall, however, speak again. In two months more he
had recovered so far as to be able to resume his business,
and at a still later period recovered completely ; nor has he
ever since, though some years have passed, suffered from the
same affection.

Case 2. A brother of the last patient, at the age of 21, be-
.gan to suffer from pain in the b'ack, attended by a feeling of
weakness. He was also in an office where there was both
standing and sitting, at a desk, necessary ; but it was in a coun-
try town. At first it was merely an inconvenience; by de-
grees, however, it became worse, so that he could scarcely go
through his duties, and finally he had to leave, and come to
Dublin for advice. He was here seen by Mr. Cusack and
myself and the symptoms were exactly those detailed in the last
case, except that they were not of so severe a character. In
this instance, too, there were some signs of dyspepsia present.
After a certain period, but not so long as in the former instance,
this patient also got well, and has remained free of any suffer-
ing from his back since, a period of five years having now
.elapsed.

412 Functional Affection of the Sjrine, ^c. [July,

Several other cases of a similar kind have come under my
notice, but they are really so like the one to the other, thaf it
appears to me quite unnecessary to do more than allude to
them.

Of the exact nature of this affection I must confess my igno-
rance. At times I have thought that there might be some
connexion between its causes and the remarkable changes
which occur in the constitution at the period of life at which it
is most usually seen that is, between boyhood and manhood.
On the other hand, I have seen it at a time of life when it might
be supposed that these <'hanges had all ceased. Thus, in the
last case given the patient's age was 21 ; and I have seen the
affection in persons even older than this. Again, I have
thought that there might have existed some derangement of the
general health, which though not tangible, was not the less real ;
for I presume few will question the fact that there frequently
is deranged health without its being cognizable to our senses.
In support of this view of the matter some reasons will be
adduced further on. As a whole, then, I would be inclined to
say though it be anything but proved that this affection
arises from causes incident to the period of life at which it
occurs, conjoined with some obscure derangement of the gen-
eral health. But I must again repeat that this is but conjecture.

The diagnosis of this affection is of some moment ; for the
symptoms are of such a character as to lead one to dread the
existence of serious disease ; or it may be confounded a func-
tional with an organic disease a mistake of no little moment,
and which has, I know, occurred. A young lady while abroad
got the affection to which I have been directing my attention.
She was advised to keep the recumbent posture, and to have
issues put in. This advice was persevered in for some months,
when she was brought home, and seen by Sir Philip Crampton,
who at once ordered the issues to be dried, and the patient to get
up, and go about. This was done, and the lady recovered,
though slowly; for her general health had been injured by her
long confinement. Similar cases have, I believe, come under
the notice of others. The diagnosis is then of importance,
and will, I rather think, be found to turn on the presence or
absence of constitutional symptoms; such as a quick pulse,
night sweats, &c. I have not met any of those in the affection
now under notice ; nor indeed any marked derangement what-
ever of the general health ; such as exists in the great majority
at least of the cases where organic disease either exists or is
about to exist. But in addition, we have also the fact, that
even a rough examination of the spine does not cause any pain
to the patient a marked contrast as I take it between the two

1851.] Functional Affection of the Sjnne, ^-c. 413

.cases; and lastly, we have the situation as affording us some
assistance ; for in the one affection it is, as far as I have seen,
always in the lumbar region, and sometimes even at one side of
the vertebral column : while in the other, organic disease is not
probably so common here as higher up ; but on this point I am
doubtful-

From what has preceded, it may be guessed what our prog-
nosis, in the class of eases under consideration, should be. The
patient may be assured that he will get well ; but the important
point to keep in mind is this, that his recovery will occupy some
time. I have seen no instance where the affection was com-
pletely got rid of till six months had elapsed ; and in some of the
cases it was much longer than even this. It is an affection, too,
that I have known return, after the patient had appeared to be
well for months. ' To say that no case could run into more
serious disease, would be going further than common prudence
would justify ; for in truth this affection, when well marked, is
sufficiently distressing. But I may state that I have not met
any case of the sort. In one instance, indeed, a patient labored
under it when she was between eleven and twelve years of
age. She recovered perfectly, but about two years subse-
quently was attacked with caries of the cervical vertebrae, which
ultimately proved fatal by the disease extending to the mem-
branes of the brain. With this exception and it is not, you
will observe, a case exactly in point I have known no fatal
result in connexion with any of the cases of that form of spinal
affection now under the notice of the meeting. In some in-
stances, however, I confess serious apprehensions occupied my
mind, and it was only the complete recovery of the patient dis-
pelled them.

On the subject of treatment, I have nothing of a very definite
nature to offer. A considerable variety of means have been
used, of both a local and constitutional kind. The former in-
clude local bleeding, dry cupping, blisters, frictions, the cold
douche, and galvanism ; and the latter aperients, tonics, change
of air, and relaxation from business. Of these two, the latter
have, in my experience, proved by much the most useful. I
should state, however, that I have seen benefit follow the appli-
cation of small and repeated blisters, as also the use of a weak
stream of galvanism, applied daily, or every second day, accor-
ding to circumstances. The patient, too, has often got great
relief from wearing a stiff belt ; indeed, this is a measure which
should not, in any case, be forgotten. Still the general mea-
sures are the more important. In all the severer cases the
patient will have to give up his business for a time ; two or
three months complete relaxation must be enjoined, and if the

414 Functional Affection of the Spine, 6fC. [J^-y,

patient can change his air so much the better. In one case
which I saw with Mr. Cusack, he advised the patient going to
one of the watering places in England for some weeks ; and
great benefit followed this measure. With this was advised a
strict attention to the bowels, and also a course of dry cupping.
It is only due to Mr. Cusack to state that he seemed to be per-
fectly familiar with the affection.

With these means is connected the question how far the
patient is to be advised confinement in the first instance. As
the result of the experience I have had, I,should say that exer-
cise, more or less, according to circumstances, should be advised
to be taken daily ; not of course to be carried to fatigue : at
the same time that the patient, while at rest, may with advan-
tage assume the horizontal position, propped up or supported
m the way most agreeable to him. I have already alluded to
a case where strict confi:nement was enforced, and certainly
with no improvement to the patient, and I believe that such will
do much more harm than good in the class of cases that I wish
more particularly to bring under notice.

Besides the relaxation from business, and change of air al-
ready spoken of, there are other general measures, such as the
cold douche, frictions, &c., all of which are worthy of trial ; but
which need not be enlarged upon here. As to medicines, I have
tried a number, more particularly those of the tonic class; ex-
cepting strychnine, however, from which in some of the cases
benefit has arisen, the others have appeared to produce little or
no effect.

Such are the observations I have to ofTer on this affection. I
have been induced to bring them forward here, though it is
highly probable that several gentlemen, whom I address, are
quite familiar with the affection itself. In looking over the
several works, however, which treat of the diseases of the spine,
I do not find this one noticed ; it appears to myself to present
features of a distinct character, while it is certainly of impor-
tance to be aware that such an aflfection exists, and that it may
be readily confounded with other and more serious diseases.

A discussion followed, in which Messrs. Bagot, Rumley,
Fleming, Egan, and others, took part. Cases were adduced in
which symptoms similar to those mentioned by Dr. Kennedy
were the result of nocturnal emissions, and similar discharges.
But it was acknowledged that in some instances no such causes
could be assigned. [Dublin Medical Press.

1851.] Phagedenic Chancre. 415

Detail of a Case of Phagedenic Chancre, icilh some remarks
on that Disease. Taken from the Lectures of Ricord. By
William H. Anderson, M. D., of Mobile, Ala.

No man is belter known to the medical profession throughout
the world, than the distinguished surgeon of the Hopital du
Midi. His deep researches into the most disgusting diseases
that afflict civilized society, and the clearness and accuracy
with which he describes the results of his investigations, induce
us to seize with avidity, and treasure up, as eminently useful,
all scientific matter that escapes from his pen, and from his
lips. They who have followed him up in his wards, can well
attest to the great benefit which he has been to mankind, and
if they remember, with pain, the loathsome objects of human
suflTering which they have seen, they must at the same time
recall with pride the triumphs of modern Medicine, and have
the most pleasing recollections of the personal vivacity, lively
style and agreeable bon mots of the distinguished lecturer.
While there is no branch of venereal disease which he has not
elucidated by his researches, there is certainly none for the
correct treatment of which he has done more, than for the
one which heads this article. Having lately had under treat-
ment a case of this nature, I proceed to detail the case and
make some remarks upon it.

J. F., a man of 22 years of age, consulted me in October
last, to get advice about the treatment of a syphilitic phagede-
nic chancre, of which he had been, for the previous four months,
the unfortunate victim. He was of sanguine and lymphatic
temperament, with a predominance of the former ; had enjoyed
from childhood excellent health, and, until lately, was rather
robust than otherwise. His general condition, when he pre-
sented himself, was pitiable in the extreme : body, much emaci-
ated; countenance, pale; eyes, sunken; expression, languid:
strength, feeble, and appetite gone to which symptoms I
may add general anaemia and protracted diarrhoea. He had
contracted syphilis eight months previous, and had been under
treatment from the first appearance of the chancre. The usual
quantity of mercury had been administered, without removing,
or even benefiting, the disease, and he had taken large quanti-
ties of sarsaparilla and hydriodate of potash. On examining
his chest, to ascertain the cause of a slig*ht cough, I found that
he had a distinct souffle, produced at the aortic orifice, and
continuing itself into the carotids, where it might be distinctly
heard.

The chancre itself occupied a large portion of the dorsum'
of the penis, was oblong and irregular, and gave rise to a fjMid*

416 Phagedenic Chancre, [July,,-

but rather scanty discharge. Its size was about that of a dollar.
The edges were ragged and burrowed ; the bottom of the sore
was irregular but not granulated, and the depth did not reach
beyond the subcutaneous cellular tissue. From the bottom, a
foetid pultaceous fluid constantly exuded, and formed itself into
tough masses, about the consistence of the half-dried secretion
of the Schniderian membrane. This chancre had been burned
with caustic repeatedly, and had exhausted a variety of local
applications, such as the black wash, the yellow wash, calomel
aromatic wine, opiated solutions, etc. From a close examina-
tion into the history of the case, 1 felt satisfied that there was
notf.ing left for me to do, but to put him on a new course of
general and local remedies. I had no reason to believe that
the constitution of the patient was aflfected with the syphilitic
taint. He had never had bubo of the groin, nor had he suffered
with any of the cutaneous eruptions, with ulcerated throat, or
rheumatism. I considered the disease, therefore, as one essen-
tially local, which, by the continued discharge and ill condition
of the ulcer, had impaired the blood, dejected the spirits, and un-
dermined the constitution. I gladly embraced the opportunity of
using the tartrate of iron and potassa, a remedy which I had
seen used in phagedena with great success, and on the adminis-
tration of which I heard a lecture by Ricord, which, on account
of its practical value, I will subjoin to this paper. Under the
general and local treatment of this remedy, the patient im-
proved, and was discharged at the end of three months, cured
of his chancre and restored to general health.

That form of chancre called 'phagedenic,' according to
Ricord, does not belong to the class oi primitive ulcers. It is
always the result of some vice which owes its origin to a local
cause, or to a predisposition, either general or acquired. The
local vice which occasions it, may be either simple or inflam-
matory oedema, inflammation without oedema, or strangulation.
It is sometimes owing to dressings which have been ill-timed
and badly applied. The cause is sometimes very difficult to
appreciate, but come from whatever source it may, it always
brings about the same results. As a general rule, one of the fol-
lowing causes will be found, in any given case of phagedena, to
exist: Weak constitution, chloro-anoemia, great privations,
excesses of any kind, living in damp, unwholesome districts,
lymphatic temperament, scrofula, abuse of n>ercury, scorbutis,
old or recent syphilis. The local condition, already mentioned,
may be joined to any of these general cases.

In rare cases, any of these causes may exist, and yet produce
no appreciable effect on the constitution of the patient. In
such cases, the only phenomena observable are those which \h&

1851.] Phagedenic Chancre. 41'

ulceration presents, and on these local appearances, the treat-
ment with tartrate of iron and potassa is based. No practi-
tioner is ignorant of the obstinacy of these phagedenic ulcers,
and of the uncertainty of the remedies which have been opposed
to tliem. The object of this paper is merely to present a resume
of the results obtained by means of the remedy in question.
To this end, an investigation into the nature of phagedenic
ulcers will the better enable us to appreciate the sanitory influ-
ence which the martial preparations exert over them.

In the first place, phagedena is by no means a proof of con-
stitutional infection. On the contrary, when it is not a
sequence o^ indurated chd^ncre, it is almost always a guarantee
against this infection. Acting on this principle, Ricord never
administers mercury as an antiphlogistic, in the treatment of
this modification of syphilitic ulcer, excepting only in those
cases where the phagedenic state is owing to an anterior syphi-
litic affection.

The ulcer may take on several different forms : it may be
gangrenous, serpiginous, pultaceous or diphtheritic; but is
always covered with a pultaceous layer, of greater or less
thickness. Without describing, minutely, each one of these
varieties, it may be well to give a description of that which we
most frequently meet with.

Phagedenic ulcer, then, is more or less large, generally super-
ficial, rarely extending in depth beneath the subcutanaous cel-
lular tissue. Its shape, sometimes round, is more often irre-
gular; its edges are of a brownish color, and are so much bur-
rowed as to fall into the ulcer. Their base is a little engorged.
The bottom of the ulcer is irregular ; it presents here and there
little cicatrized spots, but the greater part of its surface is
covered with a tough greenish-yellow matter, which it is some-
times difficult to detach, and which comes off in distinct flaps.
Fleshy granulations, are rarely seen, and if they do exists they
are pale, flabby, without color, and resemble vesicles. Most
generally, the surface is of a grayish color, and scattered over
with little red points, which easily bleed ; the pus is thin, grayish
and foetid, and holds in suspension the debris o{ \.\\q tissues, and
little flocculi of pultaceous matter. In the progressive stage
of the ulcer, this pus will answer the purpose of inoculation.
The duration of the ulcer is always long, and cicatrization,
under any treatment, is slowly accomplished.

Ricord maintains that individuals affected with phagedenic
ulcer are most generally exempt from constitutional infection.
Often they have no other symptoms or lesions than those be-
longing to the local disease ; but it is not to be denied, that
cases do exist where the same poison which has produced the

418 Phagedenic Chancre. [July

phagedena, has told, also, severely on the general health.
Hence, we sometimes see patients suffering with great languor,
headache, palpitation of the heart, carotid murmurs, neuralgic
pains in the stomach, pallor of the skin and of the mucous tissues,
cutaneous eruptions, both general and immediately around the
sore. When the ulcer is very large, and furnishes an abundant
suppuration, there is a great wasting away of the body, which
adds to the difficulty, and sometimes renders the cure protracted
and uncertain.

Phagedenic ulcer, such as has been described, has always
been considered a very serious disorder. We need no better
})roof of this than the accounts which the best authors give of
it, and particularly the great variety of treatment which has
been recommended for the treatment of it. It is unnecessary
to refer to all these therapeutical remedies; suffice it to say,
that they are all feeble and unimportant, when compared with
the tartrate of iron and potassa. The administration of iron
in phagedena is not of recent date, but hitherto it has been
given only in small doses, at least when compared to the quan-
tity which Ricord now thinks it necessary to administer. Pre-
vious to the last two or three years, fifty or sixty grains a-day
was considered sufficient, but at the present time it is well
ascertained that We may commence with half an ounce, and
reach, gradually, double that quantity. The effect of such doses
on the ulceration soon begins to display itself ; even as early
as the third day the benefit has been appreciated, and the ulcer
has shown evident signs of improvement. The pultaceous
matter which covers the bottom of it, first commences to
be more easily detached. The suppuration assumes a more
healthy appearance, and does not coagulate on the surface of
the wound ; the fleshy granulations, from being pale and trans-
parent, become more red ; the pus, which was thin and serous,
and loaded with the detritus of the ulcei*, is more homogeneous ;
the edges of the ulcer take on a more natural color, become by
degrees absorbed, and rounded off, as it were. This latter is
the first sign of cicatrization, and indicates a return of the pha-
gedena to a simple sore, and a disposition to heal without delay.
The method of cure, however, is subject to some variations,
worthy of mentioning. It sometimes happens, for instance,
that the cicatrization takes place with great difficulty, com-
mencing late in the course of treatment. In such cases, the
borders of the ulcer draw up, as it were, towards the centre;
the wound undergoes a sort of crisping process, which greatly
reduces its size, and the surface, deprived of its flabby granula-
tions, seems to draw up rather than to cicatrize. Occasionally,
too, the wound will undergo a process of cure by regular granu-

1851.] Phagedenic Chancre* 419

lation ; but that is exceedingly rare. When the ulcer covers
a very large extent of the penis, the cicatrix will form at several
points, and proceed from centre to circumference. Finally, in
that variety of phagedenic ulcer called serpiginous, cicatriza-
tion will be going on in one place, while ulceration is extending
in another. This, however, should not give the physician un-
easiness, because the one process always goes on faster than
the other, and the wound heals.

The local treatment of these ulcers has been very variable.
It has been the custom to dress the surface with aromatic wine
with the decoction of poppy heads, the solution of iodine, the
powder of charcoal, of Peruvian bark, etc. But lately, Ricord
uses, exclusively, the solution of the tartrate of iron and potassa.
The first effect of this dressing may discourage the physician
w^ho has never seen it employed, for it gives to the wound a
very bad appearance, owing to the color it imparts to the
tissues ; a little perseverance, however, soon manifests a marked
difference in the general appearance of the ulcer. Without
denying the healing property of other local means, in conjunc-
tion with the internal use of the iron, we feel justified in saying
that they can claim only a secondary reputation, when com-
pared with the curative agency of the remedy in question.

An accidental circumstance which twice presented itself to
Ricord, furnished incontestible proof of the utility of the tartrate
of iron. He was obliged to suspend its employment at two
different times, and once for the period of eight or nine days.
In both instances the sores retrograded, and the patients com-
plained bitterly of renewed appearances of phagedena. The
wounds returned to their original state ; the bottom resumed
its pultaceous, grayish appearance, and the discharge became
sanious and unhealthy. The re-administration of the remedy
did not fail to produce decided improvement. .

The length of time during which this ferruginous treatment
should be employed, cannot be definitely stated ; and, indeed,
it must be based on the actual state of the ulcer. In general,
it is best to continue the treatment until cicatrization is com-
plete. If there be the smallest point of a phagedenic ulcer still
unhealed, and we omit the use of remedies, it will soon spread
itself in the newly cicatrized tissue around it, and will be the
more difficult to heal, from the very fact of its having invaded
this peculiar tissue. It is besj, then, to push the remedy to a
complete cure. The shortest continuation of a phagedenic
ulcer, after the commencement of the use of the iron, is seven-
teen days. This relates to a case of phagedena occupying the
extremity of the penis. In other patients, the cure does not go
on so rapidly. Three patients were upwards of three months

N. 3. VOL. VII. NO. vii. 27

420 Treatment of Ophthalmia, L*^^'y

in regaining their health, but in all three it was necessary, once
or twice, to suspend the remedy, in order to combat other
symptoms of importance.

The pathological effects produced by the tartrate, in large
doses, are scarcely ever serious enough to suspend its employ-
ment. All the patients, even the most prostrate, seem to bear
it well. At the end of the third or fourth day, sometimes later,
the skin and mucous membrane regains its healthy appearance,
the patients suffer with a little heaviness about the head, the
pulse becomes stronger, and the vitality of the system is evi-
dently augmented. The arterial souffle, which existed before
administration of the medicine, disappears by degrees. A very
large dose sometimes produces pain, and a sense of weight
about the stomach, but rarely occasions vomiting. As a general
rule, the appetite increases, the evacuations become dark, and
sometimes there is a disposition to diarrhoea. The color of the
teeth is in no wise affected, but they retain their whiteness
throughout the treatment.

The daily dose of the tartrate is from half an ounce to an
ounce, dissolved in water. It is best to begin with about two
drachms, and at the end of ten days to arrive at the full dose.

In investigating the rationale of the treatment above alluded
to, I must confess that I am at a loss to account for the reasons
why the remedy in question possesses such a controling influ-
ence over phagedenic chancre. It coincides, to be sure, with
our experience as to the therapeutical effects of the ferrugi-
nous preparations, but then other salts of iron seem to be so far
inferior to the tartrate, that we are naturally led to believe that
there is something specific in this preparation. The carbonate
of iron, the sulphate, the muriated tincture, have all been tried,
and although each has its effect in restoring, to a certain extent,
the general health, yet no one of them can claim the same effi-
cacy as the tartrate. What virtue the potash contained in the
preparation is entitled to, is a subject of speculation. Probably
it is productive of no important results, since potash has been
given along with the other preparations, without increasing their
power. [New Orleans Med. and Surg. Journal.

On the Treatment of Ophthalmia in general. By Professor
Langenbeck.

Professor Langenbeck, of Erlangen, lays down some general
principles for the treatment of inflammation of the eyes, which
may be often usefully borne in mind.

1. A slight revulsion on the intestinal canal or skin suffices
for the cure of mild inflammations of the eyelids and conjunc-

1851.] Treatment of Ophthalmia. 421

tiva, especially in children, provided that neither the inflamed
part nor the patient's constitution have undergone any material
change. When the inflammation is consequent on the irrita-
tion of foreign or chemical bodies, or is sympathetic of a dis-
ordered state of the general economy, active exercise in the
air for some hours, an antiphlogistic regimen, and care in using
the orf]:an, are required.

2. When the inflammation is more active, but the constitu-
tion still sound, a more active revulsion is required, and may be
procured by strong purges and enemata, and the frequent ap-
plication of large blisters or sinapisms to the calves, thighs,
sacrum, or nucha. Friction of the feet with Spt. sinapismi
cethereus^ and then covering them up, soon induces revulsion.
In blenorrhoeal, scrofulous opthalmia, &c., these means are still
of use, though not alone curative.

3. The irritation of the nasal mucous membrane is an ex-
cellent means when the disease is not removed in a few days,
and is inclined to become chronic or relapsing, and especially
if it assumes a distinct catarrhal character. A pinch of Span-
ish snuff may be taken every two hours, a little black pepper
applied, or the infusion of chamomile inhaled. This last,
accompanied by a blister to the neck, soon disperses very ob-
stinate cases, occurring in persons predisposed to angina.

(We may observe that M. Tavignot is a strong advocate for
exciting revulsive action on the Schneiderian membrane, in the
subacute stage of scrofulous, and some other forms of ophthal-
mia. To this end he either touches the mucous membrane
daily with a pencil of nitrate of silver, or with a little ointment
containing 1-lOth of this substance. But to these means he
prefers, when the patient is old enough to know" how to use
them, stimulating substances mixed up with iris powder, and
taken as snuffs. Thus he uses a powder formed of 30 parts of
iris powder, camphor 1 part, and sulph. zinc or copper from
2 to 8 parts. Or 2 parts of nitr. silver, or 1 of cantharides
may be substituted for these salts, retaining the camphor. (See
UtJnion Medicale^ No. Ixxix.)

4. Special excitejnent of the functions rf the shin. -Suppose
the disease takes on the form of sclerotitis or rheumatic oph-
thalmia, with great irritability of the eye, and disposition to
relapse on slight atmospheric changes. In such cases, besides
the local treatment to be adverted to, great benefit accrues
from exciting the functions of the skin by tartar emetic vomit-
ings, repeated three or four times, continuing the medicine in
smaller doses for a while afterwards, and keeping the patient in
as warm a medium as possible. In other cases great benefit
results from administering the Sp. mindereri in bland fluids,

422 Treatment of Ophthalmia, [July,

and keeping the body hot for twenty-four or forty-eight hours,
frequently the while applying friction to it with a flesh brush,
or passing a hot domestic iron over it when covered with a
blanket.

5. Derivation to the glands. In scrofulous ophthalmia, which
is very frequent in the author's neighborhood, he finds great
advantage from exciting inflammation or even suppuration by
repeated blisters, or other revulsives in glands liable easily to
become inflamed.

6. Derivation by issues. This is especially indicated in those
forms of ophthalmia, in which opacity of the vitreous humour
is a common result, as hyaloiditis, keratitis, iritis, uvitis, and
periphakitis. In such, into an issue opened in front of the ear
or on the temple, a little powder of equal parts of salt and borax
may be placed several times a day, and forms a powerful adju-
vant to antiphlogistics.

7. Revulsion on the joints is a powerful adjuvant in persons
who have already suftered from gout or rheumatism, or who
by age or constitution seem especially predisposed to them, the
joints being covered by flying blisters, or strong sinapisms.
Dr. Langenbeck has frequently had recourse to this means prior
to operations for cataract or artificial pupil, in order to prevent
subsequent inflammations in such subjects.

8. Bleedins^, whether local or general, is usually useless in
superficial inflammations of the eye, unless they acquire great
intensity, and threaten to implicate the deeper structures, when
small general bleedings or leeches are necessary. In children
even, bleeding from one to three oz. is usually better than
leeches, which when used should not be applied to the cheeks,
temples, or mastoid processes, where they may even do mis-
chief, but at a distance, and especially along the course of the
carotids.

9. Local application of cold. Upon this subject Dr. Lan-
genbeck ofliers some very minute directions, not only in respect
to the cases to be chosen for its use, but its mode of application.
He observes, that in many cases wherein cold is useful, wet is
mischievous, and in others where this is not the case, it becomes
so through faulty management. If merely permanent cold is
required, he employs hollow horn rings, into which pieces of
ice wrapped up in rag are introduced, which are replaced, when
melted, by other pieCes. When applied, the apparatus looks
like a monster pair of spectacles, and is large enough to be
supported on the orbit without compressing the globe of the
eye at all. A piece of sponge is laid on the cheek to receive
the fluid as it melts. Another plan of producing great cold, to
which he gives a preference, is to place the patient on his back.

1851.] Treatment of Ophthalmia, 423

with his eyes shut, and having deposited a small portion of a
powder, formed of equal parts of nitre and sal ammoniac, in the
inner angle of the eye, to allow water to fall on it guttatim
until it is dissolved ; the fluid so formed may be retained on the
eye until heated, and then renewed. The author attributes the
production of the good results which follow this plan, not only
to the intense cold which is produced, but to the antiphlogistic
effect of the salts which gain admission into the eye, on the par-
tial opening of the eyelid. Repetition of this from four to eight
times, at intervals of from ten to twenty minutes, is equivalent
to glacial applications for twenty-four or forty-eight hours ;
and, indeed, the two, if necessary, maybe combined. Persons
who have no assistance, may manage the powder by inclosing
a certain quantity in linen rags, and moistening it. So too glass
globules may be filled with ice or this refrigerant.

As a general rule, the local use of cold is proper in all cases
which are not dependent upon evident constitutional cause or
dyscrasis. Certain exceptions to this must, however, be ob-
served ; as 1. When inflammation of the fibrous textures of
the eye has extended to expansions of the motor apparatus of
the globe. Recent rheumatic ophthalmia is, however, bene-
fitted by cold affusions, lasting from three to ten minutes, and
chronic cases by dry cold. 2. In erysf/>e/fl^ows inflammations,
cold affusion is interdicted. The temporary application of dry
cold, and the covering up the forehead and cheek with taflfetas,
induces active transpiration. 3. Blennor rhapMl inflammations
are not dangerous to the internal structure of the eye in general,
only inasmuch as the cornea becomes injured by the irritating
discharges ; and it is chiefly for the purpose of cleansing these
from it, that washes are resorted to. In acute ophthalmia of
infants, the author opens the eye every ten minutes and inserts
a piece of ice within, or a few drops of a concentrated solution
of alum and tannin; and how-ever long the disease may last,
no injury will accrue to the cornea if the discharge is removed
as fast as formed by cold water. 4. Chronic ophthalmias, and
especially in the aged, are far more favorably influenced by the
use of cold from time to time than by its continuous use, the
dilated vessels and exudations being thus more advantageously
modified; and exudations are sometimes much influenced by
sudden douches propelled with force, even if composed of warm
water. These form, too, one of the best stimulants in nervous
affections of the eye.

A second general rule is, that in the treatment of all ophthal-
mias, dependent on a constitutional cause, but not on a dyscrasis
or cachsemia (as ha3morrhoidal, menstrual, abdominal ophthal-
mias,) the local use of cold, applied as energetically as possible,

424 Nature and Treatment of Various Diseases. [July,

is the best means. If severe the douche may be continued for
six or eight hours. It is especially when there is a varicose
state of the vessels of the eye left, or that engorgement of the
choroid accompanies conjuctivitis, that these douches are so
useful. So in a tonic injection of the conjunctiva, especially
the palpebral, the douche, repeated several times daily, is far
more useful than any astringent injection.

A third rule is that in ophthalmias, seated on a tissue in a
state of dycrasis from evident alteration of the blood, whether
it is a mere local symptom of such altered condition, or whether
it has been induced by external agency, dry permanent cold,
not moist cold, which would favor softening of the cornea, is
indicated. \_Annals d'Oculistique. Med. Chir. Rev.

Observations on the Nature and Treatment of Various Diseases.
By Robert J. Graves, M.D.,'F.R.S.

Singular Defect and Impotence of Memory after Paralysis.
A farmer in the county of Wicklow, in comfortable circum-
stances, when fifty years of age, had a paralytic fit, in the year
1839 ; since that time he never recovered the use of the affected
side, and still labors under a painful degree of hesitation of
speech. He is, however, able to walk about, take a great deal
of active exercise, and superintend the business of his farm.
His memory seems to be tolerably good for all parts of speech
except noun-substantives and proper names ; the latter he can-
not at all retain; and this defect is accompanied by the follow-
ing singular peculiarity that he perfectly recollects the initial
letter of every substantive or proper name for which he has
occasion in conversation, though he cannot recall to his memo-
ry the word itself. Experience, therefore, has taught him the
utility of having written in manuscript a list of the things he is in
the habit of calling for or speaking about, including the proper
names of his children, servants and acquaintances: all these he
has arranged alphabetically in a little pocket dictionary, which
lie uses as follows: If he wishes to ask any thing about a cow,
before he commences the sentence he turns to the letter C, and
looks out for the word ' cow,' and keeps his finger and eye fixed
on the word until he has finished the sentence. He can pro-
nounce the word ' cow,' in its proper place, so long as he has
his eye fixed upon the written letters ; but the moment he shuts
the book it passes out of his memory, and cannot be recalled,
although he recollects its initial, andean refer to it again when
necessary. In the same way when he comes to Dublin, and
wishes to consult me, (for my name is among the indispensable
proper names in his dictionary,) he comes with his dictionary

1851.] Nature and Treatment of Various Diseases. 425

open to the hall-door, and asks to see Dr. Graves; but if, by
accident, he has forgotten his dictionary, as happened on one
occasion, he is totally unable to tell the servant what or whom
he wants. He cannot recollect his own name unless he looks
out for it, nor the name of any person of his acquaintance; but
he is never for a moment at a loss for the initial which is to
guide him in his search for the word he seeks.

His is a remarkably exaggerated degree of the common de-
fect of memory, observed in the diseases of old age, and in
which the names of persons and things are frequently forgotten,
although their initials are recollected. It is strange that sub-
stantives and proper names, words w^hich are the first acquired
by the memory in childhood, are sooner forgotten than verbs,
adjectives, and other parts of speech, which are a much later
acquisition.

A lady, about fifty years of age, who was laboring under
what is popularly termed a breaking-up of the system, that is,
a simultaneous decrease in the energy of all the vital func-
tions, showed among the first symptoms a defect of memory
similar to that which I have related above. The first name
which she w^as perceived frequently to forget was that of a
family with whom she was very intimate, and whom she saw
almost every day, and she was much tormented by this defect,
whenever she had occasion to refer to any of its members in
conversation. After a time this defect extended to the names
of other persons and things ; in the course of a few months she
lapsed into a general want of memory, and weakness of intel-
lect.

It is interesting to compare such cases with the temporary
loss of memory which is produced by inebriety, and the per-
manent loss of the same faculty that shows itself in old ao-e.
Such a comparison proves that diseases of the brain occasion
a defect of memory, which is but an exaggeration of that ob-
served in old age and in inebriety; and it is, therefore, to be
attributed, not to any affection of any particular portion of the
brain, but to a general derangement of the cerebral functions.
Some medical men are inclined to think that where, under such
circumstances, the memory is very deficient and the intellect
weak, softening of the brain exists -, but the preceding observa-
tions show that such a conclusion is derived from a very par-
tial view of the subject, inasmuch as the patient, whose case I
have first referred to, is still living, and is much in the same
state that followed the paralytic stroke eleven years ago.

The effects produced on the memory by paralvsis are by no
means proportionate to the loss of muscular power that the
disease gives rise to; and the same disproportion exists also

426 Nature and Treatment of Various Diseases, [July,

with respect to the generative powers^ Thus I have knowu
several cases in which young men who were attacked with
apoplexy and hemiplegia, from which they recovered with a
very imperfectly restored muscular power of the limbs and
speech, became subsequently the fathers of several healthy
children. On the other hand, I have seen two cases where the
cerebral attack was so slight as not to produce more than a
transitory giddiness, a passing feeling of terror, and some hesi-
tation of speech with a little subsequent numbness in the arm
and cheek, and slight weakness of the leg at the same side. All
these palpable symptoms passed away within twenty-four hours,
leaving behind scarcely an evident trace of diminished power
in the limbs, and no impairment of any of the senses, articula-
tion, or memory ; yet the cerebral attack occasioned, from the
very moment of its occurrence, a complete impotency, which
in both cases has been for many years permanent, although, as
I have said before, both individuals are in other respects quite
healthy.

Paralysis affecting the Teeth. In' a former paper I remark-
ed that although the teeth are possessed of an exquisite sense of
touch, and are frequently the seat of intense pain, yet no one
(as far as I could ascertain) had observed in paralysis a loss of
sensation in the teeth. I have been for years on the watch for
this symptom, and have at length detected it in a gentleman
who has had several attacks of hemiplegia, each accompanied
by complete numbness of all the teeth at one side of his mouth.

Lethargy. It is curious how certain derangements of the
functions of the brain occur without being accompanied by
other notable symptoms of disease. Thus, I know a gentleman
advanced in life, and of plethoric habits, who has been for sev-
eral years affected with lethargic symptoms, but without any
headache, tendency to paralysis, or impairment of his general
mental energies. He is frequently attacked, however, even at
his meals, with unconquerable sleepiness, and it is surprising
how suddenly it comes on ; thus, he will be sitting, talking quite
cheerfully, and unexpectedly he drops into a sleep, which lasts
for about half a minute or a minute, and then he arouses him-
self, and continues awake for a few minutes longer. This
happens so often that he cannot now venture to go into com-
pany. And, as I have said before, this drowsiness comes on
so quickly that at one meal he has broken three or four glasses
by becoming unconscious after the act of filling the glass, and
during the time he was raising it to his mouth. He was con-
sequently obliged to have an attendant to watch him going to

1851.] Poisoning from Op ium, 427

bed, lest he might fall asleep in an inconvenient place or posi-
tion, or might endanger the safety of the house by allowing the
candle to fall. Whether his immunity from other symptoms
arises from a seton in his neck, which he was advised in Lon-
don to have inserted, I cannot tell ; but this state of the cerebral
functions, existing so long, and without any additional symp-
toms, is very curious. [Dublin Quarterly Journal.

A Case of Poisoning from Opium, successfully treated by
Electro-Magnetism. By J. B. Biddle, M. D.

The following case illustrates, I think, very strikingly, the
value of the electro-magnetic current as a means of relieving
the coma produced by narcotic poisoning.

At about half-past twelve o'clock of the night of the twenty-
eighth of April last, I was called to visit a woman, described by
the messenger as being in a fit. No history or explanation of
the case could be obtained, except that the patient had gone out
at about half-past seven o'clock to get something at an apothe-
cary's for a cramp colic ; that she had upon her return home
eaten her supper as usual, then gone to bed, soon fallen into
deep sleep, and finally, at about midnight, from her unusual
respiration and the impossibility of rousing her, excited the
alarm of her husband and family.

I found her in a state of profound torpor ; her breathing ex-
tremely slow and interrupted, stertorous and gasping, with
spasm of the throat, lividity of the countenance, inability to
swallow, utter insensibility to the most violent agitation, pupil
contracted to the size of a pin's head, pulse scarcely perceptible
at the wrist in short, all the symptoms of an advanced stage
of asphyxia. That it was a case of narcotic poisoning, rapidly
approaching a fatal termination, was, I thought, evident, and I
at once so expressed myself the family, however, still profess-
ing themselves unable to explain or account for it.

Acting, however, upon this opinion, I obtained the assistance
of my friend. Dr. Goddard, who lives in the neighborhood, and
the use of his electro-magnetic apparatus ; and, the doctor coin-
ciding in my view of the case, we determined, although with
no very strong hope of saving the woman's life, to resort to this
agent. An attempt was made to introduce the stomach tube,
but was unsuccessful, owing to spasm of the pharynx, and its
introduction could have been of no service, as, at the lapse of
more than five hours, the poison must have been altogether
absorbed from the stomach.

The electro-magnetic machine employed consists of two coils

428 Poisoning from Opium. [July,

rotatino^ between the poles of two horse-shoe magnets an
unusually large and powerful instrument, producing a rapid
succession of violent shocks. One pole was applied to the nape
of the neck, the other to the pit of the stomach. For about
two minutes after the batter}^ was started no effect was pro-
duced. The patient then began to make convulsive efforts
with her hands, as if to put away something annoying her, and,
in perhaps half a minute more, she opened her eyes with a
ghastly stare. The battery being still kept in action, she rose
up in bed, and was able to mutter some indistinct answers to
questions put her.

Upon withdrawing the electric current, the woman imme-
diately sank back into the state of torpor in which I had found
her. But, as soon as it was renewed, artificial vitality was
again restored. When the current was a second time stopped,
after about the same period of application as at first, the woman
continued for some two or three minutes awake, gradually,
however, relapsing into como. After each application of
the battery, the interval of consciousness became longer,
and, at the end of two hours, she remained roused for a full
half hour, in which she was able to let us know what she had
taken.

It appears that she had bought " three cents" worth of lauda-
num, and, never having taken it before, she supposed it was a
proper dose, and swallowed it all. It amounted, as she said, to
some three tea-spoonfuls probably two fluid drachms, as this
is, I believe, the quantity usually sold for that price. I think it
probable that she was also previously somewhat under the in-
fluence of whiskey, as we detected it on her breath, and this
must have increased the narcotic efl^ect of the laudanum.

We now gave her some volatile alkali, and strong coffee, but
they were not long retained. After half an hour's conscious-
ness, stupor slowly crept on again, and a further resort was had
to the battery, which was followed with rapid, and, as it proved,
a final revival.

The patient now got up, walked about, conversed clearly,
was able to keep some coffee on her stomach, and it was appa-
rent that she had at last struggled through the efl^ects of the
narcotic. Some disposition to somnolence remained, but this
was easily overcome, without recourse to the battery. I re-
mained with her till half-past four an hour and a half from
the last application of the electricity, and then left her in charge
of her friends, directing them not to sufl?er her to sleep until I
saw her again.

Between eight and nine I found her very comfortable and
completely awake, although begging hard to be allowed a nap.

1851.] Poisoning from Opium. 429

Three or four hours natural sleep now took place, and left her
completely recovered.

It may be worth mentioning, that in the successive applica-
tions of the poles of the battery, while one was kept constantly
to the nape of the neck, the other was placed indifferently at the
pit of the stomach, the arm-pit, and in the hand ; and the effect
did not appear to vary.

Since drawing up the notes of this case, upon mentioning to
my friend, Dr. Mutter, I found that he had lately resorted to
electro-magnetism with success under similar circumstances ;
and he kindly offered the history of his case for publication with
the foregoing.

May 14th, 1851.

Dear Doctor : In accordance with your request, I send a
brief outline of the case of *' poisoning with opium," to which
I referred in our interview the other day.

Last spring, my colleague, Prof Pancoast, and myself, were
summoned about 11 o'clock, P. M., to visit a young gentleman
residing at the corner of Ninth and Market streets. On our
arrival we found that a large quantity of laudanum had been
swallowed accidentally, and although strong and very appro-
priate means had been immediately taken by several medical
students who lodged in the same house, no impression seemed
to be made upon the influence of the drug. All the evidences
of rapidly approaching death were manifest, and as all other
measures had been unsuccessfully employed, we determined to
employ electro-magnetism. An instrument was accordingly
obtained, one pole placed upon the nape of the neck, and the
other over the epigastrium. Almost on the instant, the mus-
cles of respiration were violently agitated, and the patient
sprang up in bed, opened his eyes, and answered questions.
The pain in a few moments was so severe, that we were obliged
to change the position of the poles of the machine. Keeping
one steadily applied to the back of the neck, the other was
made to touch different points of the thorax, throat, abbomen
and upper extremities. The burning sensation occasioned by
the fluid, was almost intolerable, causing the patient to com-
plain loudly, and effectually preventing any return to the
lethargy from which he had so happily been aroused. We
deemed it most prudent to continue our efforts, even after the
patient was fully restored to consciousness, but I think not more
than an hour elapsed between the first application of the reme-
dy and the complete relief of our young friend. [^Medical Ex-
aminer.

430 Chylous Urine. [July,

On so-called Chylous Urine. By H. B. Jones, m.d., a.m.f.r.s.

The definition given of chylous urine is, that it is urine which
is white from the suspension of fatty matter in it. An oppor-
tunity of observing a case ol this disease having occurred to
the author, he was led to make the experiments described in
this paper. A harness-maker, ast. 32, half-caste, who had lived
in London for twelve years, had been passing such water for
nine months. On examination of the water made at 2 p.m. it
solidified, looking in ten minutes like blanc-mange. It was
very feebly acid, contained fibrin, albumen, blood-globules, and
fat; specific gravity = 1015. 1000 grs. of this urine gave
44*42 grs. total solid residue.
8*01 grs. total ash.
14*03 grs. albumen.

8-37 grs. fat.
13*26 grs. urea and extractive matter.
*75 grs. loss.
955*58 grs. water.

In order to watch the variations produced by food and exer-
cise in the appearance of the urine, every time the urine was
made, for five days and nights, it was passed into bottles mark-
ed with the hour. From these observations, and more parti-
cularly from the third, fourth, and sixth days, it was evident
that the fibrin and albumen appear in the urine when no fat is
there, and that the albuminous urine occurs before food has
been taken, and disappears during the night with perfect rest.
Thus the fourth da}^ at 7h. 15m. a. m., on first getting up, the
urine contained the slightest trace of albumen. The specific
gravity = 1027 ; the precipitate by alcohol = 0*8 gr. per 1000
grs. urine.

At 9h. 50m. a. m., just before breakfast, the urine formed a
solid coagulum, free from fatty matter, but contained a visible
deposit of blood. Specific gravity, := 1015"6; the precipitate
by alcohol = 14'1 grs. per 1000 grs. of urine.

At 1 1 A. M,, the urine was chylous or white from fatty matter.

Further experiments on the influence of rest and motion in
lessening or increasing the albumen in the urine previous to
food, are then given.

On five different mornings, by rising early or late, and by
collecting the precipitate from the urine by alcohol, the influ-
ence of rest and motion was determined. The author states
that he could fix beforehand whether the urine should be albu-
minous or not, by directing the patient to get up, or to lie still.

The patient was bled, and the serum was opalescent, but did
not clear with aether ; the blood contained no excess of fat.
1000 parts of blood gave

1851.] Chijlous Urine. 481

2-63 grs. fibrin.
159*3 grs. blood-globules.
78*1 grs. solids of serum.
240-03 grs. total residue.
759'97 grs. water.
The urine made the same day was examined at different
hours ; that made immediately before the bleeding was quite
white, and that made an hour and a half afterwards was very
milky also. Specific gravity = 1018. 1000 grs. of urine gave
56*87 grs. total residue.
10-88 grs. total ash.
13*95 grs. albumen.
7-46 grs. fat.
24-06 grs. urea, &c.
'60 grs. loss.
943-13 grs. water.
The conclusions from these experiments are,

1. That so-called chylous urine, besides fat, may contain
albumen, fibrin, and healthy blood-globules.

2. That, although the fat passes oflTin the urine after food is
taken, yet the albumen, fibrin, and blood-globules are thrown
out before any food has been taken. During perfect rest the
albumen ceases to be excreted ; and it does not appear in quan-
tity in the urine even after food is taken, provided there is per-
fect rest. A short time after rising early the urine may coagu-
late spontaneously, although no fat is present ; and this may
happen previous to food, when the urine is free from fat.

3. Though the urine made just before and a sliort time after
bleeding was as milky as it usually was at that hour of the day,
yet the serum of the blood was not milky : it did not contain
a larger quantity of fat than healthy blood does.

The general results are,

1. That the most important changes in the urine in this dis-
ease take place independently of the influence of digestion.

2. That the urine in one respect only resembles chyle, and
that is in containing, after digestion, a large quantity of fat in
a very fine state of division. The supposition that the disease
consists in an accumulation of fat in the blood, which is thrown
out by the kidneys, carrying with it albumen, fibrin, blood-
globules and salts, is altogether disproved, both by actual analy-
sis of the blood, and by the frequent occurrence of a jelly-like
coagulum in the urine when no white fatty matter can be seen
to be present.

3. The disease consists in some change in the kidney by
which fibrin, albumen, blood-globules and salts are allowed to
pass out, whenever the circulation through the kidneys is in-

432 Vesico'Vaginal Fistula. [July,

creased ; and if at the same time fat is present in the blood, it
escapes also into the urine. That this change of structure is
not visible to the naked eye on post-mortem examination, Dr.
Prout long since demonstrated : and in a case of this disease
which was in St. George's Hospital, and was examined at Ply-
mouth, no disease of the kidney was observed. From the total
absence of fibrinous casts of the tubes from the urine, it is not
improbable that by the microscope a difference may be detect-
ed in the structure of the mamniary processes, rather than in
that of the cortical part of the kidneys. [Philosophical Trans-
actions, 1850. Brit, and For. Med. Chir. Rev.

Vesico-Vaginal Fistula.

We find in the Boston Medical and Surgical Journal an inter-
esting article from Dr. Geo. Hayvvard, detailing a number of
cases of Yesico-vaginal Fistula treated by operation, from which
we make the following extract :

Before the discovery of the anaesthetic powers of ether, I
found that the most difficult and painful part of the operation
consisted in bringing the bladder down to the os externum.
It is now done with comparative ease, and without causing the
slightest suffering to the patient. I have administered the ether
in the three last operations of this kind, and have been able to
bring the bladder down, pare the edges of the fistula, introduce
the ligatures and the catheter, and restore the bladder to its
place, in twenty minutes ; when in all the cases before, in
which I did not use it, the same process required an hour, and
during the most of that time the patient was suffering severely.
Besides, the fistula is sometimes in such a situation, as when it
is near the fundus of the bladder, that without this agent, or
some similar one, it would be impossible to bring it in view.

The patient being thoroughly etherized, the bladder can be
brought down by introducing a large sized bougie (one made
of whalebone, highly polished, is to be preferred) into the
urethra, to the very fundus of the bladder, and carrying the
other end up to the pubis. In this way the fistula is readily
brought in sight. Its edges can be pared with the scissors or a
knife, though usually both these instruments are required ; and
this part of the operation is much facilitated by holding the
edges by means of a double hook. In all the cases that I have
examined, these edges are thick, hard, and usually of a white
color. It is not difficult, therefore, to dissect up the outer cover-
ing from the mucous coat of the bladder to the distance of two

1851.] VesicO'Vaginal Fistula. 433

or three lines. The needles are then to be passed through the
outer covering only, and as many stitches must be introduced
as may be found necessary to bring the edges of the fistula in
close contact.

Since my first operation, I have used a short needle with the
eye near the point, made to fit on to a long handle. The inst ru-
ment, when the two parts are together, looks not much unlike
a tenaculum, though not so much curved, and considerably
broader near the point.

As soon as the needle is passed through one side of the fistula,
it is immediately seized by a forceps, the handle is withdrawn,
and the needle is then carried through. It is to be then again
fitted to the handle, and carried through to the other side in
the same way. As many stitches as may be thought necessary
to bring the parts into close contact can in this way be taken
with great ease. One thread of each stitch is to be cut ofl^;
it is convenient to leave the other, as it enables the operator
and patient to know when the ligatures have separated from the
bladder.

A large sized female catheter is then to be introduced into
the bladder, and secured there by means of a T bandage.
The patient should be laid on her side, with the upper part of
the body somewhat raised, so as to facilitate the flow of water
through the catheter. This should be removed at least once
in every twenty-four hours, as it is very likely to be obstructed
by mucus, coagula of blood, and occasionally calculous concre-
tions. In three days I think it safe to remove it altogether, but
then it should be introduced at least once every three hours,
for ten or twelve days more, so as to prevent any accumulation
of urine in the bladder, and consequent strain on that organ.

The diet should consist entirely of liquid, mucilaginous food ;
such as an infusion of slippery elm, gum Arabic and water,
flax-seed tea, arrow-root, and milk and water. This diet, in
my opinion, should be continued till the ligatures come away.

The bowels should be opened by some mild laxative a few
hours before the operation ; but it is desirable that they should
not be moved again till some days after.

I think it best for the patient to use the catheter once or twice
a day for several weeks, and at any rate during that time to
avoid making any strong eflforts to expel the urine by the con-
traction of the bladder.

It may be proper to add, that I have never had any trouble-
some hemorrhage from the operation, nor any alarming symp-
toms after it. In some cases the pain has been severe for two
or three days, and once or twice it has run down the limb,
apparently in the course of the sciatic nerve. When performed

434 Fistula in Alio. U^^Y,

in the way that I have recommended, I believe it to be attended
with very little if any danger, -as the bladder is not subjected
to any considerable degree of violence, nor any part injured to
a great extent.

Fistula in Ano in a Child three years and a half old.

We have had several opportunities of pointing out how in-
teresting a branch of surgery is that which takes cognizance
of the ailments of children, and we ventured to state that the
surgical diseases of childhood were important enough, and
sufficiently distinct from those of adult life, to warrant the
special attention of an experienced surgeon. The more we
come in contact with the practice of hospitals, the more we
are convinced that our idea is worthy of some attention. There
are certain affections which generally come "under the care of
the surgeon, to which it is not exactly known whether children
are liable or not ; and others, with which they are often afflict-
ed, but which are treated on general principles, modified of
course according to circumstances, and the judgment of the
practitioner. Could not certain rules be laid down for the
treatment of infantile surgical ailments, as has been done with
the medical affections of the same class of patients? These
rules every practitioner carries about him in his head, but they
are yet awaiting system and arrangement by a good and faith-
ful hand.

We beg to put upon record a case of an infantile surgical
affection, which, as far as we are able to judge, has not been
frequently met with, and we hope thereby to be making an in-
teresting addition to the facts mentioned above. The case is
one of fistula in ano in a very young child, and runs as follows :

The patient is a stout, healthy-looking boy, three years and
a half old, who was brought to Mr. Forster at the Surrey Dis-
pensary, with a small opening on the left side of the anus, about
one inch distant from the anal orifice. The child's parents are
healthy, and previous to this opening forming, he had not suffer-
ed from any infantile disorder, though he has had measles and
hooping-cough since. The mother stated that about fourteen
months ago (the child being then only twenty-eight months
old) she found, without any premonitory symptom, a hard lump
forming in the left ischio rectal fossa, and a small pimple, which
after swelling considerably, broke and discharged a tablespoon-
ful of pus. There was no constitutional disturbance, and the
abscess to all appearance healed shortly afterwards; but the
scab which had formed fell off, more discharge came away,

1851.] Pruritus of the Vitha in Children. 435

and from that time until the present the opening has been some-
times closed, and at others discharging profusely. Several
applications were advised, but the true nature of the affection
seems scarcely to have been suspected, judging from the
means employed for its cure.

Mr. Forster passed a small probe very readily along the
track of a sinus, the walls of which were dense and callous,
up into the cavity of the rectum. The sinus seemed to com-
municate freely with the intestine, as the probe entered the
latter without any force being used. Upon introducing the
finger into the anus, the end of the probe was easily felt and
brouorht out, and Mr. Forster divided the sphincter and inter-
mediate parts, thus completely freeing the probe.

The haemorrhage was very slight ; a piece of lint was put
into the wound in the usual manner, and the child had two
motions before sufficient suppuration to free the lint had taken
place. Mr. Forster is not in the habit of using any applications
after the lint ; he merely takes care that the parts bje kept clean
and considers the practice of passing a piece of lint daily into
the wound quite unnecessary, unless the latter be very sluggish.
The wound healed very rapidly, as might be expected in a pa-
tient of such tender years.

We leave this case to the'consideration of our readers ; sim-
ilar ones may perhaps have occurred here and there in practice,
but we do not recollect having heard or read of fistula in ano
in so young a child. London Lancet.

Pruritus of the Vulva in Children. By M. Vallez.

It is not very uncommon to find young children complaining
of distressing itching of the vulva and anus. This forces them
to rub these parts, which leads sometimes to violent irritation
in them. The affection is serious in consequence of its occa-
sionally inducing bad habits which may continue to be prac-
ticed after the original cause of the itching has disappeared,
namely, the presence of the genital regions of small ascarides,
designated by Rudolphi by the name of oxyures.

Of this affection M. Vallez has observed two cases. In one,
after having unsuccessfully used a local treatment for some
days, he carefully examined the parts, and was astonished to
find in the fossa navicularis, and around the fourchette, a quan-
tity of small worms which, by their motions, produced the
irritation. He immediately prescribed hip-baths, each con-
taining in solution half a pound of saltpetre. After the third
bath, the child was quite cured.

In the other case, the patient, a young girl, had for two years

N. S. VOL. VII. NO. VII. 28

436 Blue Suppuration, [July

endured great suffering from the irritation of the vulva. A
great variety of means had been resorted to in order to relieve
her, but with no effect. On examination, M. Vallez detected
the presence of the oxyures. Two of the saltpetre hip-baths
effected a cure. \_Bul. Gen. de Therap. Buffalo Med, Jour,

M. Sedillot on Blue Suppuration.

The matter discharged from suppurating wounds, the urine,
milk, perspiration, &c., have occasionally presented a blueish
color, the cause of which remains unknown. M. Dumas sup-
posed that it arose from the production of hydrocyanic acid,
but this was soon shown to be an error. It was also thought
that the color arose from the development of a peculiar fungus,
the agaricus nosocomiorum : but Professor Fee, of Strasbourg,
was unable to detect any such organic matter in the blue pus
submitted by him to the microscope. Nine cases of blue sup-
puration ha^ve occurred in the practice of M. Sedillot. After
various experinients and careful observation, it was discovered
that the blue color did not arise from the pus, but from an acci-
dental coloring matter which was developed and acted on the
dressings. This coloring matter is probably formed by the
serum of the blood ; indeed this w'^uld appear to be certain, for
the blue color was produced when all the other elements of pus
were eliminated. The various experiments performed by the
chemical professors at Strasbourg to ascertain the nature of
this coloring matter, show that it is probably of vegetable origin.
It does not arise from the formation of Prussian blue or phos-
phate of iron ; it is soluble in water, and, at the same lime, ex-
tremely stable, not being altered by sulphurous acid.

M. Sedillot inclines to think that blue perspiration, urine, &c.,
depend on the same cause, viz : some change in the serum of
the blood. [Gaz. Med. de Paris,

1851.] Miscellany. 437

JH 1 0 c e 1 1 a n 2 *

To the Editors pro tern.

Justice to an absent friend Professor Dugas, Editor of this Jour,
nal now in Europe, demands a notice of some *' Remarks" upon
his Case of Lithotrity, found in the April No. of the Western Jour-
nal of Medicine and Surgery, published at Louisville, Ky. Please
re-publish the case with the ' Remarks" from the accompanying
Journal.

A Case of Urinary Calculus, attended with peculiar circumstances and
treated by Lithotrity. ByL.A. Dugas, M. D.,Prof. of Surgery in
the Medical College of Georgia.

The following case is reported because of certain peculiar features
presented during its progress. The patient, Mr. John L. B., of Hall
county, Ga., is 30 years of age, was kindly directed to my care by
Dr. Richard Banks, the distinguished surgeon of Gainesville, and
arrived here on the 5th of February last. Having suffered from early
childhood with phymosis and an almost complete closure of the orifice
of the prepuce, (which he believes was congenital,) the difficulty of
voiding his urine caused this to distend the prepuce into a considerable
bag, to accumulate enormously in the bladder, to stagnate in the pelvis
of the kidneys, and to induce very great impairment of the general
health. The preputial orifice was so small as not to admit, without
much difficulty, the introduction of a knitting needle ; the urine was
therefore never passed off in a jet, but the patient was subjected to all
the inconvenience of a continual stillicidium ; he had frequent and
violent attacks of nephritic pains, attended with protracted chills, fevers,
and the ususual concomitants of retention of urine. Yet it was
not until the 20th year of his age that he sought professional aid and
was circumcised by Dr. Banks. From that time his health improved
rapidly; but he continued subject to occasional paroxysms of severe
nephritic pains, which now became confined to the left side. These
pains would extend down along the course of the ureter and continue
one or more days, leaving him in a debilitated state, from which he
would, however, soon recover. He is not aware of ever having
passed gravel or anything like calculous matter, although his urine
would sometimes present a very copious sediment.

This state of things continued until the middle of April last, when,
although in good health and not having had any nephritic pain for
about three months, he felt a calculus drop into his bladder. Atten-
ding to his usual avocations, he stepped out to urinate, did so without
any difficulty whatever, and when in the act of buttoning up his gar-
ment, distinctly felt something fall into the bladder. He immediately
mentioned the fact to a friend, and added that " it must be a stone, for
its fall produced a sensation like that of a buckshot allowed to drop
into a bag." A few hours afterwards, on again attempting to urinate,
the stream was suddenly arrested by the engagement of the calculus

438 Miscellany. [July,

in the urethra ^the sensation being so distinct that he instinctively
earned his hand to the perineum in order to force it out but in
vain ; and the same difficulty has ever since attended his micturi-
tion. These details are given as establishing conclusively the facts
that he did know the precise moment at which the stone came into the
bladder, and that this occurred so late as about three months after the,
last nephritic attack. He has experienced no pain whatever about the
kidney since that. In May he was sounded by Dr. Banks, who read-
ily detected the stone.

On the arrival of Mr. B. here, I examined him, detected the calcu-
lus, found it to be small and determined to crush it as soon as circum-
stances would permit. The patient was directed to use dilating
bougies, to remain quiet, to drink t>eely of slippery elm tea and super
carbonate of soda, and to take a hip bath every night. In a week he
was found to be sufficiently prepared, and (on the 12th of February)
the operation was performed with Heurteloup's " hrise pierre^^ as
modified by Charriere. The bladder being filled with tepid water, the
calculus was readily seized and crushed three times, without pain. A
few fragments were passed off with the water and others during the
night with the urine. On the following day, finding the patient very
comfortable, without any symptoms of irritation, and very anxious to
get home as soon as possible, I again introduced the instrument and
crushed the remaining fragments, sufficiently to allow them all to be
passed out during the night. He now expressed himself " entirely
relieved, and feeling like a new man." The baths, etc., were con-
tinued and on the 16th February, I explored the bladder carefully,
without being able to detect any vestige of the stone. The patient
was therefore discharged.

The dimensions of the stone were accurately ascertained by the
crushing instrument to be about one inch in length and half an inch in
thickness. Professor Means having kindly subjected some of the
fragments to analysis, informs me that they consisted of Oxalate of
Lime. The stone was exceedingly hard, and tested to the uttermost
the fine temper imparted to the metal by Charriere's unrivalled skill.

[Southern Med. and Szirg. Journal.

"Remarks. This certainly presents 'certain peculiar features,"
both in anatomy and surgery, and we are utterly at a loss to under-
stand some of them. The fault may be ours, but there can be no
wrong in stating the difficulties.

a 1st. It is somewhat remarkable that a phymosis should have
created so great a resisting power in the prepuce as to dilate even the
ureters. This strikes us as a very remarkable peculiarity. The
wonder is increased considerably when we find that notwithstanding
the ureters were thus dilated so as to permit the passage of a stone of
novel dimensions, the urethra, which should have synchronised liber-
ally in the dilatation of the ureters, was so little inclined towards
anything of the kind, that it stopped the stone which had fallen through
the ureter ! The extravagant dilatation of the ureter is inexplicable;

1851.] Miscellany. 439

but, assuming the claim as a fact, the dilatoriness of the urethra is
rather marvellous.

" 2d. The statement of the patient that he " heard something
drop," and therefore knew the exact moment of the entrance of the
calculus into the bladder, seems to have made a profound impression
upon Professor Dugas, for he unhesitatinorly gave credence to the
statement. The patient may be ex-cused for thinking that a calculus
could fall from the ureter into the bladder, but we have some difficul-
ties in our faith. The ureters enter the has fond of the bladder, very
obliquely, and a stone would have to fall up in falling from the ureter
into the bladder. And then when we remember the pathological
truths of Mr. Aldridge, which seem to show that the oxalate of lime is
not secreted in the kidneys, when we remember that there is no kind
of evidence that the ureters in this case were dilated even in the slight-
est degree, and that the passage of a mulberry calculus through the
ureter would have made a man feel a multitude of other things be-
sides the falling of the calculus, we must remember that we have
before us what may be called the difficulties of faith.

" 3d. We feel some difficulty about the dimensions of the calculus.
We have seen between two and three hundred specimens of calculi,
and have heard from various other collections, and we have neither
seen nor heard of any calculus, except this one in Georgia, that was
just one inch in length, and a half inch in thickness. These dimen-
sions are such a wide departure from that uniformity of proportion
found in calculi, that we think there must be some mistake in Pro-
fessor Dugas's measurements. There must be a want of accuracy.
Did it not strike the Professor that the growth of his specimen was
altogether too rapid for a case of oxalate of lime calculus? There
seems to us a wonderful celerity in every branch of this case.

"4th. The calculus in this case was * oxalate of lime,' and the
stone was crushed with Heurteloup's ' hrise jnerre,'' at two sittings,
on two consecutive days, and the fragments were allowed to be pass-
ed off during the night. This is certainly the most remarkable
achievement yet effected by Heurteloup's instrument. It is enough
to excite the envy of Civiale, and put an end to the lateral operation.
If a calculus of oxalate of lime, one inch long, and a half inch thick,
can be utterly crushed in two sittings, in two successive days, so that
no vestige of it is left, what apology can there be for cutting instru-
ments for lithotomy ? We have seen various efforts with Heurte-
loup's instrument, and have been sometimes surprised with the result,
but this success in breaking down, in two sittings, a stone of oxalate
of lime, of the size of the one recorded by Professor Dugas, certainly
takes the lead of all achievements we know of in lithotrity. We have
seen vesicle stones of oxalate of lime removed by the lateral operation
after lithotrity had failed, and in wiiich the most persistent eflbrts with
the drill for many sittings had failed to make any more impression
than if it had been used on a piece of Syenite. But if the improved
apparatus of Heurteloup can break up at two sittings, a mass of oxa-
late of lime, and remove it entirely in two days, lithotrity is making

440 Miscellany. L^^^y*

rapid strides, and M. Roux is an accredited prophet, when he says :
* lithotrity has assumed her function, and no surgeon hereafter will
attain sufficient experience to reach the highest degree of adroitness
in lithotomy.'

"We suppose these new claims of lithotrity will come before the
American Medical Association, and if they receive the endorsement
of that body, we may expect to see renewed evidences of the envy
felt by European surgeons for the rising reputation of American Sur-
gery, and we shall hear them again denouncing American surgeons
for a proneness to exaggeration. B."

[ Western Journ, of Med. and Surg.

Were the Reporter of the case here present, he probably would
leave it to the Profession of this country, without suggestion, to give
their condemnation to a criticism so manifestly dictated by a censorious,
unjust, and ungenerous spirit ; but the writer cannot withhold this
passing notice.

The dilatation of the ureter is evidently referred to by Professor
Dugas, as a state necessarily to be inferred, in order to account for
the fact that a calculus, which in February measured " about one
inch in length and half an inch in thickness," did pass into the blad-
der, only ten months before. Is not the evidence given by the patient
fairly presuming that to be true and detailed by the reporter, suffi-
cient to establish the tact, that a calculus did pass from the ureter
into the bladder, on the occasion indicated by the patient ? About
the middle of April, at a well -recollected occasion viz., at the end
of a micturition the patient represents that he distinctly felt some-
thing fall into the bladder : before the time of this marked sensation,
he was subject to occasional paroxysms of severe nephritic pains ;
since then these have ceased, and instead of them the patient experi-
ences sudden interruptions to the stream of urine during micturition,
which he never did before said occasion. This critic can find no ev-
idence of dilatation of the ureter, under the circumstances of this ex-
traordinary case his ideas cannot travel out of the usual course as
violent pain attending the passage of a calculus through the ureter ;
the better man, the Reporter justly infers this state to account for the
confessedly unusual fact the passage of a large mulberry calculus
from the ureter into the bladder, without pain.

If the writer could sufficiently command his patience, he would
teach this critic how much greater the probability, that the circum-
stances of this case should produce dilatation of the ureter rather
than of the urethra. Suffice it to say the fact that the stone was in
the bladder for 10 months, and did not pass the urethra, is worth more

1851.] Miscellany. 441

than all the exclammation marks and all the shallow wonderings of
the critic. The attempt by the Remarker to hold the Reporter re-
sponsible for the terms in which the ^patient declared his sensations,
is as unfair as his reference to the anatomy of the organs is puerile ;
the Reporter makes the legitimate use of the patient's facts, to infer
that the patient knew the moment of the entrance of the stone into
the bladder.

"Difficulty about the dimensions of the calculus." The writer
has not seen three nor two hundred specimens of calculi ; but it is
not a little remarkable, that within a few days, he has seen one cal-
culus, of the mulberry variety, extracted from a child nine years old,
by Dr. Henry F. Campbell, Demonstrator in the Medical College of
Georgia,* the longer and shorter diameters of which, although a little
greater, were yet very nearly in the same ratio with those of the one
in question. Those familiar with the philosophic character of Pro-
fessor Dugas, will find the whole sentence describing the stone, to be
strikingly characteristic of the man. He says ''The dimensions of
the stone were accurately ascertained, by the crushing instrument, to
be about one inch in length and half an inch in thickness." Yes,
accurately ascertained, because, as is fairly presumable, the stone
being caught at different times, during the exploration, between the
jaws of the instrument, each measurement was accurately made, be-
cause plainly shewn by a graduated scale upon the moveable branch
of the instrument; but as it was not within the positive knowledge of
the Reporter, that he at any time caught the stone, by the very longest
orrery shortest of its diameters, he writes, "about an inch," &;c.
Even strangers, on the strength of this single point of intrinsic evi-
dence, shall mark the Reporter as the exact and careful man. How
shall this critic fare, when thus tried by strangers, on the internal
evidence of his own Remarks ?

The Reporter, with philosophic exactness, writes, ^^ about one inch
in length and half an inch in thickness." The critic represents him
to say, "JM5i one inch in length and a half inch in thickness." But,
see here again : " The statement of the patient, that he ' heard
something drop,' and therefore knew," &c. The quotation marks,
embracing the words heard something drop, are those of the critic
himself; yet no where can they be found in the reported case ! The
reporter writes that the patient ^^felt something fall into the bladder."

The writer calls no man names, but the Record brands this critic

Jalse quotator. In the light of that maxim settled by the learned legal
See Case in ihe present No. of this Journah ~ '

442 Miscellany. [Jul}',

profession, as a part of the law of evidence faisus in uno^falsus in
omnibus of what value becomes the flourish of the critic about his
two or three hundred stones, and the cases he has seen of lithotrity
amended by lithotomy !

But, further : He says, " We think there must be some mistake
in Professor Dugas's measurements. There must be a want of accu-
racy." He thus charges a want of accuracy of measurement upon
a man, who has in his hands an instrument capable of measuring
with mathematical exactness ; so that, if there is a mistake, as
charged, it must be a wilful mistake a mistake in spite of the figures
and marks upon the graduated scale before his eyes; so that the
record marks this critic, the insinuator of the charge of falsehood
that is, if he knew that Heurteloup's instrument has such scale upon
it ; if he did not know this, the charge on this count is not fully made
out. But the simple record, without the aid of argument, fixes this
charge upon the critic. Let the candid reader only answer to himself,
what is the force of these words? " There seems to us a wonderful
celerity in every branch of this case." In what stronger terms could
such insinuation be expressed than these "If a calculus of oxalate
of lime, one inch long and a half inch thick, can be utterly crushed,
in two sittings and in two successive days," &;c., and repeated again,
' But if the improved apparatus of Heurteloup can break up at two
sittings," &;c. Indeed, this insinuation of the charge of falsehood,
pervades the whole of these " Remarks."

Let not the critic be surprised at the manifestation, in these quar-
ters, of indignation at these insinuations against the veracity of Pro-
fessor Dugas ; who, be the insinuator hereby certified, is known, in
his place, as the true gentleman.

Pity that this critic had not yielded to the whisperings of his better
spirit, which seems to have warned him against this doubtful labor,
rather than to have wrought himself to full assurance, by the an-
swer "there can be no wrong!"

The writer might well feel satisfied with this vindication of his
absent friend, from such an unaccountable attack from him who fills
the critic's chair, in this Louisville Journal ; but as it could not have
been suggested by malignant feelings engendered by personal rivalry,
seeing that the parties are widely separated and have no relations
whatsoever, personal or professional, it must therefore be inferred that
this criticism is a fair manifestation of the spirit and character of the
Remarker. In this point of view, the Profession generally has an
interest in this subject. Let this critic, therefore, come to the bar of

1851.] Miscellany. 443

the Profession and answer. He who assumes the position of the
critic, does not place himself beyond the reach of impeachment, but
becomes responsible to the Profession for the manner in which he dis-
charges its high duties. Nor shall he escape its censures, if he be
found lacking in the qualities of the critic's character which that pro-
fession demands, or exhibiting those which it condemns. Whilst it
demands an independence, which fears not to attack and expose
error, even in high places and shadowed by authority, it also demands
the manliness of truth that stern integrity which fears also to misre-
present even an enemy. It demands of him who holds the Judge's
seat "Nothing extenuate nor set down aught in malice." It de-
mands candor, fair dealing and justice which is proof against all
seduction. It demands of him intelligence to estimate justly, the
value of the subjects upon which he passes judgment, and their bear-
ing upon the general interests of the science or upon its special ques-
tions. Has this critic discharged himself aright of this last obliga-
tion, in seeking to discredit this case, so strikingly valuable in relation
to that question of nice judgement, the choice between Lithotrity and
Lithotomy, in specific cases ? to brand with the suggestion of false-
hood, this most remarkable case of successful Lithotrity on the records
of the Profession.

Does this critic of the Louisville Western Journal fulfil the requi-
sitions of the Profession upon their critics 1 Let him await, at the
bar, its just judgment L. D. F.

Case of Quintuple Birth of Living Children. By Dr. Serlo. Dr.
Serlo, of Krossen, relates the following remarkable case. The mo-
ther, set. 34, had had five favourable labours, and was now pregnant
for the sixth time. During the last few weeks, she had become so
large and cumbersome as to be obliged to keep her bed. Dr. Serlo
.saw her the day before her delivery, and found her abdomen enor-
mously distended in every direction, and hard, and projecting much
towards the right. The foetal movements were feeble. She was
weak, and had a small, rapid pulse, with oedema of the thighs and
legs. On examination the os was found partly open, and the mem-
branes flaccid ; but no part of the child could be ielt. As the pains
proved very inefficient. Dr. Serlo next day delivered her, by the for-
ceps, of a small living child, and soon after of another, which pre-
sented by the feet. In like manner three others were successively
delivered by the feet, the accoucher breaking the bag of waters in
each which presented while he was in searcb of the placenta. .Con-
traction of the uterus was produced after some minutes.

All the children were alive and crying, but the 2d died in three
hours, the 4lh in twelve, the 3d in seventeen, the 5th in twenty-five ;

444 Miscellany. [July,

and the 1st, which had been delivered by the forceps, in nine days.
The author supplies the weights and admeasurements of the children
and the funes ; but we are not aware of the exact relation which
those of that part of Germany bear to our own.

LENGTH. WEIGHT.

Child. Funis. Child. Placenta.

1st child 15 inches 24 inches 3^ civil pounds 28 oz.

2d " 12 " 11 2i " 14 "

3d " 13 " .....15 " 3i 25 "

4th " 14 " 14 " 3 " 20 "

5th " 14 " 11 " 3 " 20 "

IMed. Zeit., 1850. Brit, and For. Med. Cliir. Rev.

On the Duration of Life among the Clergy. By Dr. Schneider.
In this paper Dr. Schneider furnishes an account of the ages of 794
of the clergy who have died within the bishoprick of VViirsburg since
1824. They belonged to the Catholic religion, and may be compared
with the 637, almost all Protestants, recorded by Casper in his work.
In the diocese of Wiirsburg, including priests, professors and students,
the mean annual number of this profession amounts to 1050; and
between 1824-47, there have died 800. The ages of 794 persons are
indicated, and are thus compared with Casper's numbers :

Ages.

From

21 to 30

30 '' 40

40 " 50

50 " 60

60 " 70

70 70

80 " 90

90 " 97

Schneider.

Casper.

. 45 .

21

. 66 .

33

. 57 .

39

. 102 .

95

. 188 .

191

. 217 .

188

. Ill .

62

8 .

8

794 637

Casper, speaking of the high age which the priestly order attains,
refers in explanation to the regularity and sobriety of their lives, the
absence of excess of mental or bodily stimulus and efforts, freedom
from anxiety, and the wholesome alternation of moderate mental ac-
tivity with corporeal exertion in the open air. Most of these condi-
tions apply likewise to the Catholic priesthood, and their celibacy
constitutes their only peculiarity ; but this, contrary to what is ob-
served in other positions of life, does not shorten their lives, inasmuch
as so large a proportion as 217 out of 794 lived to between 70 and 80.
On the contrary, they live longer than the Protestant clergy ; for
while, according to Casper, the mean duration of life with them is 65,
and therefore higher tlian any other class, that of the Catholics of
Wurzburg is 70^. The Protestant clergy have, owing to their fami-
lies, more cares and anxieties, without better incomes in proportion,
[Casper's Woclmischrift, 1850. Ibid.

1851.] Miscellany. 445

Case of Small-Pox occurring a third time after Vaccination,
when it proved fatal. Dr. Webster, after alluding to the fact, that
whooping-cough, measles, and scarlatina, generally occur only once
during the lifetinne of an individual, exceptions, nevertheless, to the
above rule, as well in these complaints as in small-pox, have been re-
corded by authors. Three well marked examples, of the recurrence
of small-pox, met with in the same family, are related, one of which
terminated fatally. The case especially referred to by Dr. Webster

was that of H. A. N , who had been vaccinated satisfactorily in

1827, when three months old. Notwithstanding this circumstance,
he became attacked by small-pox in 1833, along with an elder bro-
ther, who had been likewise vaccinated. Both patients recovered,
and nothing more was thought of the matter till 1838, when the two
lads were again attacked by variola, along with another that is, a
third brother, likewise regularly vaccinated. However, all three

got quite well in due time. Subsequently, Mr. H. N. N , whose

case is now just mentioned, went to India in the Company's service,
where he was seized, in April last, with the usual and well-marked
symptoms of small-pox, which soon became confluent, and proved fatal
at Dharwarinth, on the 13th of that month ; this making the third
time this gentleman had been attacked by variola, although previously
vaccinated. [^London Lancet,

Impermeable applications in Inflammations of the Viscera. We
find in the Union Medicale, (April, 1851,) an article by M. R. Latour,
in which he recommends very highly impermeable applications in
visceral inflammations. He states that, having found these applica-
tions so unquestionably beneficial in rheumatism, gout, &c., that he
was induced to apply it in inflammations of the viscera, and in peri-
tonitis. In the latter diseases the applications have always exercised
a beneficial influence, and relieve the patients in from one to three
days. M. Latour explains the modus operandi of these agents in this
way. Heat is one of the essential elements of inflammation, and
under its influence the blood-vessels dilate, which admits of an in-
crease in the quantity of circulating fluid, causing redness. The
increase in the amount of blood also produces a distention of the ves-
sels and an efliision through their coats, which causes swelling. The
writer thinks that the development of heat, in part, is dependent upon
the presence of air. If, therefore, the air can be cut ofli'from the dis-
eased tissue, heat and the other characteristics of inflammation cannot
be developed. It is a powerful antiphlogistic. He states that he has
combatted successfully with these agents many cases of ovaritis and
peritonitis, one of which we will relate.

A girl, 22 years of age, was taken with a chill that lasted an hour,
and was succeeded by high fever, pain in the head and abdomen.

446 Miscellany. U^W,

The abdominal pain continued to increase and extend until the whole
abdomen became extremely painful to the touch. The respiration
was hurried, the abdomen swollen ; there was high fever, and finally
vomiting set in. This then was a veritable case of peritonitis. Not
a drop of blood was drawn, but the abdomen was simply covered with
a coating of collodion. The vomiting was immediately arrested, and
in a few houi-s the anxiety passed away, and the abdominal pain was
sensibly diminished. In short, in less than a day the skin regained
its natural freshness, and the pulsations resumed their normal fre-
quency.

Treatment of Ascites in Children. The Journal des Connaissances,
March, 1851, contains the details of the treatment of this disease in
children, as practiced by M. Trousseau. He administers fractional
doses of calomel and applies poultices of powdered conium macula-
tum to the abdomen. The dose of calomel for each day is half a
grain, divided into six parts. In a few days salivation supervenes,
and the calomel is stopped. Diarrhoea is sometimes induced by the
calomel. When salivation comes on the hemlock poultices are had
recourse to. On account of the cost of the article, the poultices are
not made entirely of hemlock. M. Trousseau recommends them to
be made in the following way : Take two table-spoonfuls of the pow-
dered hemlock, and mix it with a sufficient quantity of thick flax-seed
tea to form a consistence nearly equal to that of paste. This is
spread upon the surface of a flax-seed poultice, and applied to the ab-
domen. M. Trousseau has long since recommended this application
in phthisis pulmonalis. He has found the calomel and hemlock very
serviceable even in ascites dependent upon an organic lesion, as ab-
dominal tubercles.

Tannin in affections of the Eye. The Journal des Connaissances
relates the treatment of occular diseases with tannin, by M. Hairon,
Tannin has been advised in catarrhal ophthalmia in the form of a
weak solution. M. Hairon asserts that this solution is inert. He
employs it in a concentrated solution, one part of tannin to three parts
of distilled water. This solution has been found serviceable in gon-
orrhoea, both acute and chronic, in granulations of the eye lids, in
vascular and ulcerated cornitis, and especially in pannus. Tannin
differs from most of the astringents, in the fact that it does not cause
pain, that it does not act as a caustic, nor does it leave any durable
incrustations. It is simply a styptic, and to this property is attributa-
ble its efficacy in diseases of the eye.

1851.] Miscellany. 447

Hysteria. A very singular scene recently occurred in one of the
national manufactories of Tobacco at Lyons. About sixty women
were at work in one of the rooms, when one of the number in conse-
quence of a violent paroxysm of passion, went into hysterical convul-
sions, many of her companions rushed to her assistance, but one after
another were attacked with the same nervous symptoms until the
number attacked amounted to twenty. The other women were ordered
out of the room or others would in all probability have been similarly
affected. Boerhaave, in the commencement of the last century, upon
a similar occasion had some heated irons brought into the room and
threatened to cauterize the first who should fall into hysterical con-
vulsions. This threat produced the desired effect and the singular
contagion immediately ceased. Bui. Gen. de Therap, Feb. 1851.

Poisoning hy Strychnine cured by inhalations of Chloroform The
Journal des Connaissances, March, 1851, extracts a case from the
Medical Gazette of poisoning by strychnine, that was cured by inhala-
tions of chloroform. A.11 the remedies recommended in such cases
were tried without success. Chloroform was then given in inhala-
tion, and an immediate amelioration and a subsequent cure was ob-
tained.

Medical Statistics of Paris. The number of Physicians in Paris
has diminished this year, but not in as great a proportion as in 1848.
There are now in Paris 1351 Physicians; in 1849 there were 1389,
making a diminution of 38. Among the 1389 Physicians of 1849, 68
are dead and 86 have left Paris ; of these 86, 12 have gone to California.
Among the 1351 Physicians that compose the list of 1851, there are
113 new names ; there were 114 new names in the list of 1848.

There are now 178 officers of health, which are more than the
number of Medical men during the reign of Louis XIV. The number
of Druggists is 381, and the Sages-fcmmes number 380. The num-
ber of Graduates slightly increased in 1851 there were then 236,
whilst in 1849 there were 230. Jour, des Connaissances Jan, 1851.

At the late meeting of the American Medical Association, the fol-
lowing gentlemen were appointed Chairmen of the several Special
Committees. The Committees are to consist of two other members,
to be selected by the Chairman.

1st. Dr. D. F. Condie, of Philadelphia, chairman to the committee
on the causes of the Tubercular Diathesis.

2d. Dr. S. H. Dickson, of Charleston, S. C, on the blending and
conversion of the Typhes of Fever.

448 Miscellany. [July,

3cl. Dr. James Jones, of New Orleans, on the mutual relations of
Yellow and Bilious Remittent Fever.

4th. Dr. Jno. B. Johnson, of St. Louis, Mo., on Epidemic Erysipelas.

5th. Dr. Charles D. Meigs, of Philadelphia, Acute and Chronic
diseases of the Neck of the Uterus.

6th. Dr. J. P. Jervey, of Charleston, S. C, on Dengue.

7th. Dr. Daniel Drake, of Cincinnati, Milk Sickness so called.

8th. Dr. Lopes, of Mobile, Ala., Epidemic prevalence of Tetanus.

9th. Dr. Geo. B. Wood, of Philadelphia, on diseases of Parasitic
Origin.

10th. Dr. R. D. Arnold, of Savannah, Geo., on the Physiological
Peculiarities, and diseases of Negroes.

llth. Dr. Horatio Adams, of Waltham, Mass., on the action of
Water on lead pipes, and the diseases which proceed from it.

12th. Dr. Jos. Carson, of Philadelphia, on the Alkaloids, which may
be substituted for quinia.

13th. Dr. Geo. Hayward, of Boston, Mass., on the Permanent Cure
of Reducible Hernia.

14th. Dr. S. D. Gross, of Louisville, Ky., on results of Surgical
Operations for the relief of Malignant Diseases.

15th. Dr. James R. Wood, of New York, Statistics of the Opera-
tion for the Removal of Stone in the Bladder.

18th. Dr. Charles A. Pope, of St. Louis, Missouri, Water, its topical
uses in Surgery.

17th. Dr. Alex. H. Stevens, of New York, Sanitary principles
applicable to the Construction of Dwellings.

18th. Dr. Porcher, of Charleston, S. C, Toxicological and Medi-
cinal Properties of our Crytogamic Plants.

19th. Dr. G Emerson, of Philadelphia, Agency of the Refrigeration
produced through upward Radiation of Heat, as an exciting cause of
disease.

20th. Dr. Worthington Hooker, of Connecticut, on the Epidemics
of New England and New York.

21st. Dr. John L. Atlee, of Lancaster, Penn., on the Epidemics of
New Jersey, Pennsylvania, Delaware and Maryland.

22d. Dr. Robert W. Haxall of Richmond, Va., on the Epidemics of
Virginia and North Carolina.

23d. Dr. Wm. M. Boling, ot Montgomery, Ala., on the Epidemics
of South Carolina, Georgia, Florida and Alabama.

24th. Dr. Ed. H. Barton, of Louisiana, on the Epidemics of Missis-
sippi, Louisiana, Texas and Arkansas.

25th. Dr. Sutton, of Georgetown, Ky., on the Epidemics of Tennes-
see and Kentucky.

26th. Dr. Thos. Reyburn, of Missouri, on the Epidemics of Mis-
souri, Illinois, Iowa and Wisconsin.

27th. Dr. Geo. Mendenhall, of Ohio, on the Epidemics of Ohio,
Indiana and Michigan.

The following gentlemen were appointed on the Committee for
Volunteer Communications, viz : Drs. Geo. Hayward, J. B. J.

1851.] Miscellany. 440

Jackson, D. H. Storer, and Jacob Bigelow, of Boston, and Dr. Usher
Parsons, of Providence, R. I.

Signed in behalf of the committee,

GEO. B. WOOD, Chairman.
Charleston, Friday, May 9th, 1851.

BIBLIOGRAPHICAL.

The Pharmacopeia of the United States of America. By authority
of the National Medical Convention held at Washington, A. D.,
1850, Philadelphia, Lippincott, Grambo &; Co. 1851. 1 vol.,
8vo. pp. 317.

We have received from the publishers the new issue of our National
Pharmacopoeia. As our readers are probably aware this work is
the result of the labors of a Convention of Physicians and Pharma-
ceutists from all sections of the United States, which met in Wash-
ington City in May, 1850. The present edition is doubtless thoroughly
accommodated to the improvements which the medical sciences have
undergone during the last decennial period. The plan of the work is
that adopted at the revision of 1840. '' The changes have been alto-
gether in the individual contents of the Pharmacopoeia. A few names
have been altered ; definitions and references have been modified in
numerous instances ; some medicines have been transferred from one
of the two catalogues of the Materia Medica to the other; new medi-
cines and preparations have been introduced; and many of the pro-
cesses have been amended, replaced by others, or altogether omitted.
The section of fluid extracts is quite new."

The present edition is handsomely printed, but the price is so high
as to restrict its circulation, whii^ is certainly unfortunate, as it is a
work that should be in the hands of every practitioner.

Operative Surgery. By Frederick C. Skey, F. R. S. pp. 661.
Octavo, 1 vol. Philadelphia: Blanchard & Lea. 1851.

In a monthly journal, like the present, an extended review of
works submitted to our notice is not appropriate, and hardly to be ex-
pected. It is therefore our habit to give such works a careful exam-
ination, and to express such an opinion as their character and merits,
in our humble judgement, may entitle them to.

The work before us is one which although we cannot recommend
as containing all required in operative surgery is still of the most
useful character. The subjects are treated in a most definite, we
might say, graphic manner ; the Surgeon and Anatomist have com-
bined in all his directions. That vagueness and indefinileness so

450 Miscellany.

common and so embarrassing in the instructions of many teachers
are not found in those of Mr. Skey. His object seems to have been
to produce a practical work which is reliable and which would em-
body in a few words, all the principles required in emergency. The
work is practical, and certainly reliable ; but there are many subjects
in which he has sacrificed clearness and completeness of description
to a terse and compendious design. While we would regret these
defects in a work, otherwise unexceptionable, we cannot in justice
withhold our recommendation of it as one of great value to the student
and practitioner in Surgery, an art, the library of which cannot be
comprised in one, but must be in many treatises.

H. F. C.

A Treatise on Fractures and Dislocations of the Joints. By Sir
AsTLEY CooPEK, Bart., F. R. S. Edited by B. Cooper, F. R. S.,
&c., &c., with additional observations, and a memoir of the author.
A new and enlarged American Edition, pp. 496. Blanchard <k;
Lea, Philadelphia. 1851.

In presenting this standard work to our readers we find no difficul-
ty in giving an opinion. Its reputation is too long and too well estab-
lished to require any commendation of ours. In this enlarged edition,
it will be found that the interest and value of the original work has
been much enhanced, while the style and execution do credit to its
enterprising publishers. h. f. c.

Nashville Journal of Medicine and Surgery. We have received
the first numbers of this new bi-monlhly journal, published at Nash-
ville, Tenn., and edited by W. K. Bowling, M. D., Professor of the
Institutes and Practice of Medicine in the Medical Department of the
University of Nashville. From the specimen before us, we think it
bids fair to become a valuable laborer in the field of medical science.

We have received a communication from Dr. H. A. Ramsay, just
as this number was going to press, requesting a suspension of public
opinion in relation to charges made against him at the late meeting of
the American Medical Association, which he states are *'in a train o^
investigation, and will be given to the medical public in due season."

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. AUGUST, 1851. [No. 8.

PART FIRST.
r t g t tt a I o in m u n i r a 1 1 o n 5 .

ARTICLE XXIV.

Physiology of the Pneuvio gastric Nerve and Spinal Accessory
of Willis. By Juriah Harriss, M. D., of Augusta, Ga.

The varied distributions of the pneumogastric, and its
intimate connections with many of the vital functions of our
organic system, place it among the most important and inter-
esting nerves in the economy. It is, perhaps, to be equaled in
interest only by the great sympathetic. The immediate rela-
tion that it has with many of the vital functions of the body,
renders it imperative upon every one to study, with particular
attention, its anatomy and physiology, who may wish to under-
stand, perhaps, the most beautiful branch of our science, the
operation of the economy in health. It is rather a trite saying,
but one that cannot be too often repeated, that it is essential to
understand the functions of the system in health, else it will be
impossible to interpret the phenomena that are presented to us
in disease. Understand the healthy man, and then undertake
to explain and medicate the morbid conditions of the economy.
Probably much that we shall say, will not be entirely new to
some, yet we feel assured that the subject will prove interest-
ing to many: first, on account of its importance, and secondly,
because the nervous system is too generally neglected in this
country. The spinal accessory is so intimately connected
anatomically and physiologically, with the pneumogastric, that
it will be impossible to understand one properly, without study-

N. S. VOL. VII. NO. VIII. 29

452 Harriss, on Physiology of the Pneumo gastric [August,

ingthe other. It would be impracticable in the limited space
that I have, and would probably prove uninteresting, for me to
trace out the relations and functions of all the branches of the
accessory and pneumogastric nerves. I shall therefore con-
fine myself to the most important branches and their functions.

The pneumogastric arises by eight or ten filaments, from
the restiform bodies, which are but continuations of the posterior
spinal columns. These fibres soon unite and form one nerve,
which enters a common sheath of the dura mater, with the
spinal accessory to pass out of^e cranium through the fora-
men lacerum.* At the point of exit from the cranium the
pneumogastric presents an enlargement resembling a ganglion,
(ganglion of the pneumogastric). Some anatomists do not
believe this to be a ganglion. This ganglion should not be
confounded with the plexiform ei#irgement, (renflement,) that
exists below, and after the nerve has passed out of the cranial
cavity. It is at this gangliform plexus that the spinal accesso-
ry gives distinct filaments to the pneumogastric. From this
point, also, the pneumogastric gives branches to- the glosso-
pharyngeal, facial and carotidean branch of the superior cervi-
cal ganglion.

The spinal accessory nerve arises from the kteral columns
of the spinal cord, passes up into the cranium, anastomosis
with the two superior cervical nerves,t and sends a few fila-
ments to the pneumogastric, in company with which nerve it
passes out of the cranium. The accessory then passes behind
the pneumogastric and divides into two branches the external
and internal. The external branch passes to the sterno-cleido-
mastoid and trapezius muscles, and the internal unites to form
a common trunk with the pneumogastric. In the cervical re-
gion the pneumogastric and the internal branch of the spinal
accessory give off*, 1st. a pharyngeal branch, and 2d, the supe-
rior laryngeal nerve. In the tharacic region the pneumogas-
tric and spinal accessory are intimately connected, and give
off, 1st, the inferior laryngeal or recurrent nerves; 2d, the

Claain aad Wilson say they do not pass out in a common sheath. Cru-
veilhier, Longet, &c., affirm they do.
t Cruveilhier says, this anastomosis with cervical, nerves is not constant.

1851.] Nerde and Spinal Accessory of Willis 453

cardiac branches; 3d, the pulmonary^ and 4th, the oesophageal
nerves.

Thus, the pneumogastric unites with three nerves of motion :
1st, spinal accessory; 2d,fadal ; 3d, hypoglossal ; and with one
of sensation, the glosso-pharyngeal. It also unites with the
great sympathetic, to form the pharyngeal, inter-carotidean,
lingual, pulmonary, and solar or epigastric plexuses.* It will be
seen, then, that these two nerves, after they have united in the
neck, are distributed with the sympathetic to the principal
organs of the functions of digestion, circulation and respira-*
lion viz., stomach, liver, heart and lungs. This pair of nerves
is also distributed to the larynx, trachea, pharynx and oesopha^
gus. They have never been traced to the spleen or kidneys.

Willis described the spinal accessory as a distinct nerve,
and believed that its use was to assist in respiration, Bischoff,
however, looked upon it and the pneumogastric in the light of
a spinal pair of nerves. He supposed the pneumogastric to be
the sensitive, and the spinal accessory the motor branch.
Bischoff instituted experiments upon animals to prove that
these two nerves were at least physiologically similar to the
spinal nerves. All of his experiments failed, except one, which
was upon a bird. He cut the spinal accessory, and the bird
lost its voice ; from which he concluded that this nerve was
for jnotion, and the pneumogastric for sensation. The experi-
ments of M.M. Gaerres, Arnold, Sarpa, and Longet,-|- go appa-
rently to substantiate the opinion advanced by Bischoff.

These experimenters affirm that the origin, union and distri-
bution of these nerves resembled very much the spinal pairs.
M. Longet gives the results of his experiments, which would
seem to corroborate the opinion of Bischoff. He says, "When
in my experiments upon dogs and horses, I applied galvanism
to the spinal accessory, very evident contractions were ob-
served in the larynx, pharynx, and upper part of the oesopha-
gus. No motion was perceptible in the lower part of this tube,
nor in the stomach. When galvanism was applied to the
pneumogastric, no muscular contractions were perceived."
M. Longet concludes, as the pneumogastric arises as do the
spinal sensitive nerves, from the posterior columns, or rcstiforin

* Longet, Anat. and Phys., p. 261, vol. 2 t Longet, Anat. and Phys.

454 Harrlss,. on Physiology of the Pneumogastric [August,

bodies, as it is provided with a ganglion, like these nerves, and
finally, as galvanism applied to this nerve does not cause mus-
cular contractions in the organs to which it is distributed, that
it is sinf>ply a nerve of sensation. And upon the other hand, as
the spinal accessory arises from the lateral columns, and as a
galvanic stimulus applied to it will induce muscular contrac-
tions, he believes that it is a nerve of motion, and that these
two nerves stand in the same relation to each other as do the
spinal pairs that is, that the pneumogastric furnishes sensibili-
ty to the mucous membrane of the larynx, trachea, bronchia,
pharynx, oesophagus and stomach, and perhaps influences the
secretion of bile. And the accessory of Willis supplies the
muscles of the larynx, the contractile tissue of the trachea and
bronchia, the constrictor muscles of the pharynx, and finally
the sterno-cleido-mastoid and trapezius muscles. M. Bernard
thinks that Bischoff and Longet generalized too much from the
experiment of cutting the spinal accessory and destroying the
voice. His experiments led him to the conclusion that the
motor power of the spinal accessory stopped at the larynx, and
did not extend to all the organs to which the pneumogastric was
distributed. The spinal accessory is not senstive at its origin,
but soon becomes so by anastomosing with sensitive nerves.

External branch of the Spinal Accessory. This nerve is
distributed to, and controls the movements of the sterno-
cleido-mastoid and trapezius muscles. According to Sir C.
Bell, these muscles are influenced in their movenients in
respiration by the external branch of the spinal accessory,
but their contractions in the movements of the head are
caused by the cervical nerves. Bell exposed this branch
in an ass, and after accelerating the respiration he cut the
nerve. The sterno-cleido-mastoid and trapezius lost all mo-
tion in respiration, but retained their power of contraction in
the movements of the head. Bernard states that this nerve is
not one of respiration, save through the will, but is simply a
nerve of motion. He thinks that the spinal accessory is a
spinal nerve, presiding over the voice, and a voluntary one, as
the voice is produced by the exercise of the will. The exter-
nal branch assists in the production of vocal sounds, by acting

1851.] Nerve and Spinal Accessory of Willis. 455

in concert with the internal branch, and arresting respiration.
It is essential to the production of voice, that the glottis should
be contracted and respiration stopped. If, then, the external
branch be cut, the respiration cannot be arrested, and voice
cannot be produced. A harsh, raucous sound may be heard,
but not a clear, distinct voice. If the internal branch, be cut
at the same time, a similar noise may be produced. The two
spinal nerves of Willis may be cut, and yet the pneumogastrics
will carry on respiration, circulation and digestion. An animal
tlms experimented upon will live, as he has only lost the power
of producing vocal sounds.

Superior Laiyngeal Nerves. This is a mixed nerve, com-
posed of fibres from the pneumogastric and spinal accessory.
It is distributed to the crico-thyroidean muscles and the laryn-
geal mucous membrane, and is principally a sensitive nerve.
If it be cut, says Longet, just above the thyroid cartilage the
voice is not modified, but if it is cut before it divides into the
external and internal branches, ihe voice always becomes harsh.
This alteration in the voice is caused by cutting the external
branch of the superior laryngeal nerve, and there by paralyzing
the crico-thyroidean muscles. The internal branch does not
influence the voice. The same result will be obtained by cut-
ting the external branch, as by severing the superior laryngeal
itself. The mechanism in the production of aphony is very dif-
ferent in this case from that that causes the same eflfect when
the external branch of the spinal accessory is cut. In one, the
crico-thyroidean muscles are paralyzed, and the vocal cords
cannot be put upon the stretch; in the other, the respiration
cannot be stopped, in consequence of the paralysisof the sterno-
cleido-mastoid and trapezius nmscles. When the superior
laryngeal is cut, the sensibiHty of the glottis, epiglottis and
larynx, up to the base of the tongue, is destroyed. The respi-
ration continues, though there is more or less complete aphony.

Inferior Laryngeal or Recurrent Nei'ves. These nerves
exercise a very decided influence upon the voice and respira-
tion. Their influence upon these functions has been seen in
tumours, and other pathological changes that implicated these

456 Harriss, on Physiology of the Pneumogastric [August,

nerves. Their ageney in the production of the voice and res-
piration is easily demonstrated by cutting them.

Galen, two thousand years ago, cut these nerves in animals,
and invariably destroyed the power of producing voice ; hence
he styled them vocal nerves. Their agency in producing vocal
phenomena has been observed by all succeeding experiment-
ers, but their influence upon respiration was reserved for
Lagallois to discover. M. Magendie thinks that cutting the
recurrent nerves does not modify the voice, or, at least, such
has not been the result of his experiments. Sedillot says that,
sometimes aphony is induced, and at others it is not, but he
does not give any explanation as to the cause of this diversity
in the results. Longet admits the assertion of Sedillot, in re-
gard to the divers effects observed. He, however, offers the
same explanation as did Lagallois, to explain the different re-
sults obtained in connection with the respiration, when the
recurrent nerves were cut. The results are not in every
instance the same, in consequence of the difference in the form
of the glottis in the old and young animal. Longet has kept
animals, after cutting these nerves, for five or six weeks with-
out a reproduction of voice, and in others he has not been able
to abolish this function at all. The glottis presents an anterior
or vocal part, bordered by the vocal cords, and a posterior or
respiratory part. The anterior part is proportionally more
developed as the age approaches the period of birth. In the
young, the crico-thyroidean muscles contract, make tense the
vocal cords, and approximate the cartilages of the same name^
to produce sound : but in the old, the posterior or respiratory
part of the glottis is very large, and cannot be narrowed, as the
arytenoidean muscles are under the control of the recurrent
nerves, and are consequently paralyzed. In the young, it is
not necessary for the posterior part of the glottis to be narrow-
ed, as it is much smaller than in the older animal.

The production of vocal phenomena is then under the influ-
ence of three nervous branches : 1st, the external branch of the
accessory of Willis; 2d, the superior laryngeal; and 3d, the
inferior laryngeal or recurrent nerves. The concurrence of
all these nerves is necessary to the production of a clear and
distinct voice. In order that articulation or a distinct vocal

1S51.] Nerve and Spinal Accessory of Willis. 457

sound may be produced, it is necessary that the respiration
should be arrested and the vocal cords be put upon the stretch,
svhich is done by the concurrence of the external branch of the
spinal accessory and the inferior laryngeal nerves. In addition
to this, the arytenoidean muscles must contract to approxi-
mate the cai'tilages of this name, which will narrow the poste-
rior or respiratory part of the glottis, and enlarge the anterior
or vocal part of the same organ. These muscles are supplied
hy tiie inferior laryngeal nerves.

[To be coDtinued.J

ARTICLE XXV.

A Case of Senile Gangrene of the Inferior Extremities. By
Robert Campbell, M. D., Assistant Demonstrator in the
Medical College of Georgia.

The rareness in our region of this disease, will perhaps invest
the subjoined case with some interest:

E. C, aged about 50 years ; of spare habit and florid com-
plexion ; carriage maker by trade was brought from Anderson
C. IL, South Carolina, and admitted into the Augusta Hospital
on the 11th May last. I saw him at 4 P.M., in consultation
with Prof. Jos. k. Eve, the attending physician. Found the
whole of the right and the anterior third and heel of the left
foot, perfectly black, without sensation or sensibility, with ves-
sications studding their upper surface, and yielding the peculiar
oflensive ''mortification odoiir:'' indeed these parts were in a
completely sphacelated condition. He complained, when the
extremities were handled, of pain only about the ankle joints ;
the legs were cedematous almost to the knee joints pitting on
pressure. Extremities cold and dry ; pulse small, unresisting,
and 150 in frequency; tongue coated with thick, yellow fur;
appetite deficient ; mental faculties somewhat impaired.

All we could gather concerning the history of the case was,
that a short time prior to this he had gotten his feet very wet
in a rain, having to travel some distance in the rail-road car,

't)

and not being able to change his boots, suffered extremely with
swelling and a burning sensation in the feet. He had been a

458 Campbell's Case of Senile Gangrene. [August,

man of intemperate habits, and had, at a former time, lost sev-
eral of the toes of the left foot from a previous attack of morti-
fication.

Diagnosis. Mortification by ossification of the arteries.

Prognosis. Of course, very unfavorable.

Treatment. Amputation presented to our minds the only
possible hope of staying the dilapidation so fast ensuing.
Hence the immediate removal of the right (the worst) leg was
determined upon; and at 6 o'clock I amputated the leg by the
circular operation at about the junction of the upper with the
middle third the patient under chloroform. The arteries op-
posed a considerable resistance to the knife, the passage of
which conveyed an unusual, grating sensation, as from collis-
ion with petrified, rather than ossified vessels. Their ligation
was effected with more than usual facility, inasmuch as they
protruded beyond the contracted surrounding tissues, instead
of retracting within them.

We left the patient comfortable, having lost very little blood,
and experienced no pain during the operation; nor would he
be convinced of its execution until his attention was directed
to the absence of the limb.

Prescription. Port Wine, . . f!ij.
Quinine, ... 5 grs.
To be repeated every six hours. Diet Chicken soup, freely
administered.

12th. Patient under the influence of quinine; complains of
some pain in the stump ; extremities still cold ; pulse rather
more resisting, and only 100 in frequency; will take but little
nourishment.

Prescription. Continue wine every three hours, and quinine
three times a-day, in doses as before. Enemata to relieve the
bowels; and should pain continue, laudanum 30 gtts., repeated
pro-re-nata. Left foot treated with cloths saturated with the
chloride of soda.

13th. Much weaker ; extremities of still lower temperature ;
pulse very feeble and intermittent ; delirium complete.

14th. Died at 7 A. M.

It would have been an interesting investigation to have as-
certained 10 what extent the arterial system had been subjected

1851.] Campbell, on Lithotomy. 459

to this ossific deposition. This I intended to have accomplish-
ed, had not my own indisposition at the time prevented. But
the perfect character of the ossification at the point examined,
the slight eftect of the stimulus, and the apparent absence of
any recuperative energy in the constitution of the patient, not-
withstanding so large a proportion of the contaminating mass
had been removed, and without the loss of blood or the shock
of pain are circumstances which seem to indicate the circu-
latory apparatus to have been much embarrassed in its func-
tions, from the extensive pervasion of the disease.

ARTICLE XXVI.

The Removal of an ounce and a half of Calculous matter from
the Bladder, by Lithotomy. By Henry F. Campbell, M.D.,
Demonstrator of Anatomy in the Medical College of Georgia.

Mr. B., a young man aged about 20 years, had from early
childhood manifested symptoms of calculous disease. Some
months ago, he applied for relief to our friend Professor Miller,
of Rome, who kindly referred the case to us. On sounding, a
stone was readily detected ; but on account of the irritability
of the bladder, together with the patient's general low state of
health at the time, we were unwilling to distress him with often
repeated examinations. The fact being well ascertained that
a stone, which was very movable, existed, we proceeded to
prepare him for the operation of lithotomy lithotrity being
impracticable, on account of the contracted state of the urethra
and the enfeebled condition of the patient. The patient was
put under the influence of chloroform, and assisted by my
friends, Drs. IMiller and Word, we operated by the bilateral
method. On cutting into the bladder, we found that, instead
of one, there were three calculi, each of which were so large
that when grasped in the forceps they presented such a diame-
ter as to prevent their passing without great difficulty through
the opening made in the perineum. One of them was ex-
tracted whole with the forceps, but the others, being larger,
were crushed and removed piece-meal. The bladder was
thoroughly washed out with a syringe and warm water, so that
nothing of the debris remained. A catheter was left in the

40 Diagnosis of Yellow and Bilious Fevers, [August,

urethra for a short time, but was afterwards removed. The
urine continued to flow from the wound, as is usual, for a few
days, but finally resumed its natural passage, and the wound
cicatrized completely without any irregularity. Dr. Miller
informs us, by letter, that he is entirely well, and that no un-
pleasant symptom has succeeded the operation.

The amount of calculous matter removed weighed one ounce
and a half, and consisted, most probably, (we did not analyze it,)
of the uric acid deposit. The stone which we succeeded in
removing entire, weighed three drachms and twelve grains,
and was very rough and nodulated, which was the case with
the larger pieces of the two that were broken. To this fea-
ture in our case we find it difficult to give a satisfactory expla-
nation. It is usual, when more than one calculus exists, to find
them of a smootfj, even of a polished surface, from the tritura-
tion to which they are subjected during the constant shaking
of the bladder in ualkirig and other niovements of the bod3%
whereas in our case, notwithstanding the number, size, and
softness of the calculi, they each presented as complete mul-
berry surfaces as we have ever seen in any solitary stone. On
this account this case may be considered somewhat instructive,
as it tends to establish the precept that on the removal of one
stone, we must not feel certain that another does not remain,
merely because the first presented a rough and granular sur-
face, but should ascertain by more positive proof that our
patient has been entirely cleared before we end the operation.

PART II.
(Eclectic Department.

On the Diagnosis of Yellow and Bilious Fevers. By A sub el
Smith, M. D , of Texas, M. A., formerly Surgeon-General
of the Armv of the late Republic of Texas, &c., &c. Read
Sept. 6, 1848.

I shall trace the differences between bilious and yellow
fevers, first by reference to some general laws which govern
these diseases, and afterwards by a comparison of their symp-
toms and pathology.

Those persons who maintain the identity of yellow and mias-
matic fevers, generally hold the former to be an aggravated

1851.] Diagnosis of Yellow and Bilious Fevers. 461

type of the latter. If this opinion be correct, then it would
seem that every case of yellow fever should be necessarily of
great severity or malignity. 'J'his is not the fact ; so far from
it, that after the first period of a yellow fever epidemic, a large
proportion of the cases, often more than half, are of a very
mild character, sometimes only a febricula of a few or several
hours' duration, or a brisk ephemera. It would be scarcely ^
accurate to say that these mild cases are only some general
effects of the prevailing epidemic influences; for such mild at-
tacks afford immunity against the disease during the same
epidemic, and also in subsequent epidemics, so far as my obser-
vation and information extend. Besides, these very slight or
mild cases are in their physiognomy as distinctly characterized
to the practitioner familiar with yellow (ever, as are the most
malignant cases. Perhaps my meaning will be more explicit
by stating at length a parallel between yellow and bilious fe-
vers. From the mildest intermittent, amounting only to a
sensation of indisposition or 7?z<7/fl25e, recurring at regular inter-
vals, to the most ferocious congestive fever, we trace a regular,
uninterrupted gradation. And in my section of country it is
common to see in the same individual, one grade converted
into or succeeded by another within the period of a single
interval ; that is, a mild intermittent become congestive, or as-
sume the form of a malignant remittent; and, vice versd,^ the
two latter forms disappear in the shape of a common ague and
fever, or a mild remittent. So in yellow fever there is a regu-
lar gradation from the exceedingly mild febricula through all
stages of severity to the most ferocious black vomit. We also
see sudden conversions of grade in yellow fever similar to
those mentioned as occurring in miasmatic fevers. The inex-
perienced practitioner is surprised to find the stomach deluged
with black vomit in a 'case which some hours previously had
given him no apprehension ; and an invasion of excruciating
severity may be succeeded by a state of extreme mildness,
with scarcely a symptom of diseased action. To sum up, in-
stead of malarial fever running into yellow ^qxqy^ the same
parallelism from great mildness to extreme severity, with sud-
den conversions not into each other, but into different grades
of the same disease respectively, subsists in the two diseases.

I now pioceed to another point. In places subject to epi-
demic yellow fever, sporadic cases do indeed sometimes occur
in healthy seasons; but as a general fact, yellow fever is an
epidemic. In Galveston, the disease prevailed epidemically in
1839, 1844, and 1847; nor have I ever known a case ol' do-
mestic origin occurring in that city, except during seasons of
its epidemic existence. When miasmatic diseases exist, they

4G2 Diagnosis of Yellow and Billoits Fevers. [August,

are endemic and occur more or less every 3'ear, no year being
wholly exempt from cases.

Bilious or miasmatic fevers pervade broad districts of coun-
try, and persons residing anywhere therein are subject to
attacks of the same. Yellow fever is confined to the narrow
limits of towns, which limits may be easily learned, and the
disease avoided. In the State of Texas, throughout the level
prairie country, intermittents and remittents are endemic.
Few, indeed, are the plantations and farms, if any, that have
not been the habitat of this endemic; most of them present
cases every year. But I never heard it even suspected by any
medical gentleman that a case of yellow fever had originated
anywhere in the interior out of the towns. If yellow fever
Avere an aggravated or modified form of bilious fever, we should
occasionally meet cases of the former in those sections of the
interior country where bilious diseases in all their varieties
prevail.

In my section of the Union, and I believe it is a general fact,
villages and towns are more exempt from miasmatic disase,
though not wholly so, than the surrounding country ; on the
contrary, yellow fever aflfecting concentrated populations, the
farm-house and plantation are perfectly secure from its visits.
Indeed, yellow fever is still more circumscribed ; it very gener-
ally makes its appearance in a particular quarter of a town, in
a district consisting of a single street, or a few streets, to which
for the time being it is confined, thence extending more or less
gradually over adjacent districts, and so regularly that its pro-
gress can be pretty accurately marked. No such rule obtains
in regard to intermittents and remittents.

It has been alleged that, though miasmatic diseases prevail
in regions exempt from the visitation of yellow fever, never-
theless the latter is developed only in a malarious atmosphere ;
and the conclusion is thence deduced, that common miasmata
are essential to the f)roduction of yellow {ever. What causes,
if any, yellow and malarial fevers have in common, I am unable
to decide. Nor am I sure that the following fact will be deemed
relevant to this part of my subject. Galveston is situated on
an island, and has been thrice visited by yellow fever in ten
years ; yet residents in the city who do not visit the country or
interior are, so far as my observation extends, quite exempt
from agues, fevers, and all forms of missmatic disease. There
are apparently sources of miasmata within and adjacent to the
city ; perhaps the level site of the town and the regular trade
winds of the warm season may prevent the collection and con-
densation of miasmata. It seems scarcely necessary to repeat,
on the other hand, that yellow fever at times prevails epidemi-

1851.1 Diagnosis of Yellow and Bilious Fevei's, 463

cally in towns which are every year the habitat of endemic
mararial fevers. ' In the city of Houston, bilious fevers are fre-
quent and endemic. Yellow fever also has raged epidemically
in that city equally as in Galveston, this disease having hitherto
occurred in these two cities at the same periods. By com-
paring, then, the general hygienic state of Galveston and Hous-
ton, we have yellow fever epidemics and absence of miasmatic
fevers in Galveston and yellow fever epidemics with annual
endemic miasmatic fever in Houston. It hence seems that the
two fevers in question are, for their origin and development,
governed by laws, and produced by causes, irrespective and
independent, to some extent at least, of each other. This po-
sition could be further corroborated by appealing to facts col-
lected by other observers ; but I limit myself to what has come
within my personal observation.

In the yellow fever epidemics which I have witnessed, most
of the first cases which occurred were malignant, and proved
fatal. This fact is not noted as peculiar to epidemics of this
disease; the same was true- of the epidemic cholera which I
observed in Paris in 1832. Whether the awful mortality in
the first period of that epidemic is attributable to treatment, I
shall not pretend to determine absolutely. In my opinion the
disease was more malignant in its nature and rapid in its course
in the earlier than during the later periods of its epidemic pre-
valence. So in scarlatine epidemics, I have remarked extreme
malignity and rapid fatality of the early cases, wMth compara-
tive mildness of those occurring in subsequent periods. Herein
yellow fever is assimilated to other specific epidemics ; while
no such character is impressed on miasmatic endemics.

Yellow fever requires as an essential condition for its first
development a high range of the thermometer. Allow me to
make my meaning clear. In a city where cases of yellow
fever do not exist, the disease is not excited, the epidemic is
not kindled, cases cannot originate unless beneath *an ardent
sun. According to my observation, the thermometer has
marked at 3 P. M., upwards of 80, more accurately 84 to
88 for several days in succession previously to the first appear-
ance of yellow fever. When, however, the epidemic has been
established, it continues to rage, though the thermometer fall per-
manently to a point at which the disease could not be originally
developed. Now bilious fevers occur continually at tempera-
tures too low for the origination of yellow fever, as wellas during
the extremest heats of summer and autumn. At first blush one
might be led to think that the supervention of an ardent sun to
the causes of bilious fever would convert this latter disease
into yellow fever. But this cause alone is insufficient, for then

464 Diagnosis of Bilious and Yellow Fevers. [Aagusf^

we should find such conversions taking place in the country
districts ; which, as we have seen, never happens.

It may be noted among the general points of difference be-
tween the diseases in question, that it was once commonly held,
and not a few still entertain -the opinion, that yellow fever is
contagious and importable, while no suspicion of a similar
quality attaches to bilious diseases.

I have made incidental allusion to causes or rather conditions
necessary for the production of yellow fever, without attempt-
ing to define them. We are fully authorized to declare that
several causes or conditions must co-exist ; the present state of
our knowledge does not authorize us to say that some of these
causes may not be common to bilious and yellov/ fevers.

Having thus set forth some general points concerning yellow
and bilious fever, I now proceed to consider those symptoms
which strogly and definitely distinguish the two diseases from
each other. It would seem at first blush that my purpose
would be best accomplished by grouping together the symp-
toms of these diseases respectively*; but as they are well known
to all of you, I proceed at once to note their peculiar and dis-
criminating symptoms.

Bilious fever is intermittent, remittent, or continued. The
continued type cannot in strictness be so called ; for there are
marked exacerbations or remissions every day or every other
day.* Yellow fever is neither intermittent, remittent, nor
continued ; there are never two similar recurring paroxysms
or exacerbations. It is essentially and uniformly a disease or
fever of one single paroxysm. This paroxysm consists of
states or stages, as follows : first, of depression ; second^ of vas-
cular excitement, which subsides of itself, if not rendered ataxic
by injudicious medication, into a state of apyrexia, terminating
at once in convalescence or in the third stage of prostration
with new and peculiar symptoms ; this last is the stage of
haemorrha'ge or black vomit. The state of vascular excitement
is never renewed or repeated any more than is the eruptive
fever in the succeeding stages of small pox. I have indeed
seen cases when the subsidence of the vascular excitement was
prevented, and the disease converted into a fierce continued
cavsus, obviously the effect of injudicious medication. Fre-
quently also, there is a feverish state continuing to the close of
the disease, but it bears no likeness to the stage of vascular

* I cannot recall any case of continued bilious fever with quartan exacerba-
tions. The periodical character of this fever sometimes nearl}'- disappears in-
cases which assume a nervous form towards their termination. But in all such
cases which have fallen under my observation, the fever has been irritative,
and dependent on some anatomical lesion generally of the mucous coat of the
alimentary canal; the lesion being a sequela of the previous periodic fevep*

1851.] Diagnosis of Bilious and Yellow Feirers. 465

excitement alluded to. On the contrary, if an artificial febri-
cula is not kept up by medication, the patient falls into a con-
dition the most opposite to pyrectic. In many hundreds of
cases of yellow fever which have fallen under my observation,
I have never witnessed a second febrile paroxysm in the same
case, like the first. I have indeed seen yellow fever supervene
on an intermittent in persons affected v/ith the latter coming
into a district where the former prevailed ; but in these cases
the yellow fever occupied at once the whole ground, if I may
so speak, and marched its course to its termination, regardless
of the paroxysmal disposition of the disease which it had thrust
out. In like manner I have seen the mali^fnant miasmatic or
congestive fever seize a person convalescent from yellow fever^
who had been previously exposed to concentrated miasmata in
the country districts; but the march of the two diseases was
distinct, nor could they be confounded. Yellow fever, as has
been stated, is sometimes rendered ataxic by injudicious treat-
ment or neglect; but a second paroxysm similar to the first is
not reproduced. To sum up: hillious fever consists of similar
paroxysms or similar exacerbations ; yellow fever never repeats
itself, is not paroxysmal, has no character of periodicity.

Relapses and second attacks are frequent in malarial fevers,
and the liability of the system ta these forms of fever is in-
creased by previous attacks. Not unfrequently it is impossible
for a patient to become firmly convalescent but by removal fro?n
the malarious district. Herein are to be noted striking differ-
ences between the two diseases whose diagnosis I have under-
taken to set forth. Relapses, properly so called, do not occur
at all in yellow fever, and second attacks are very rare, and
especially in the same locality ; and the immunity may be
regarded as absolutely complete, provided the patient remains^
permanently and continually in the epidemic district. In this
disease, however, patients imperfectly or seemingly convales-
cent do by imprudence in eating or exposure fall into the last
stage or that of prostration, characterized by black vomit,
haemorrhages, etc. There is a deceitful pause between the
subsidence of the vascular excitement and the setting in of the
period of prostration which may last even for several days ;.
during this time the patient may eat, walk about, and be appa-
rently convalescent, when black vomit may suddenly supervene
and the caseterminate fatally. In such cases, however, the vas-
cular excitement, or in one word the whole paroxysm, is not
renewed as in periodic fevers, but the fatal symptoms supervene
without prelude upon the delusive pause. The hcetnorrhagic
state of the system subsists during all the time of the delusive
pause, is easily cognisable, and distini^uishable from established)
convalescence by practitioners familiar with the di^jease.

466 Diagnosis of Yellow and Bilious Fevers. [August,

As already stated, second attacks of yellow fever are rare,
and when they do occur, it is only on exposure in different
epidemics. I have seen and treated several hundreds of cases
without a single relapse, and at most but one ascertained case
of second attack.

This is not the place to enter upon the consideration of how
far and under what circumstances an attack of yellow fever
in one section of country furnishes immunity against the dis-
ease on exposure afterwards in other habits of this epidemic.

One attack of yellow fever protects a person against a sub-
sequent one, as we have seen ; but yellow and billious fevers
afford no reciprocal immunity against each other. I am here
led to remark that persons born and reared in southern mala-
rious districts, who have never visited a cold climate, are as
liable to yellow fever on entering an infected district as any
other persons whatever. A pretty numerous family, all born
and reared in the vicinity of Mobile, but who had never been
exposed to yellow fever in that city or elsewhere, removed to
Galveston. They all had attacks during our last epidemic,
two of which proved fatal. The disease was as violent as in
persons coming from the highest northern latitudes.

Black vomit is the natural and regular termination of fatal
cases of yellow fever, when the disease has been allowed to
run its course unchecked or unmodified by treatment. 1 have
been called to see a considerable number of persons in the last
stage of this disease who had previously taken no medicine
whatever. In every instance I found them pouring forth black
vomit. And in general, an examination after death of those
who ejected black vomit during life, almost always reveals in
the stomach this matter, where death took place within ten
days after the invasion of the disease.

Several authors mention black vomit as being of not very
uncommon occurrence in other diseases than yellow fever.
This does not correspond with my own experience. I have
indeed many times seen a brownish saburral matter vomited
in malarial fevers, but it would be a great error to confound
this with black vomit, from which it is easily discriminated.
Matters have been twice brought to me, which it was very
difficult if not impossible to distinguish from genuine black
vomit, ejected from the stomachs of patients laboring under
other disease than epidemic yellow fever. But I am bound to
declare that during a most extensive practice in the malignant
and congestive bilious fevers of the southern country, I never
saw genuine black vomit, in my own practice, out of the pale
of well characterized yellow fever. Of the extent of my
observations in malignant bilious fevers, some notion may be

1851.] Diagnosis of Yellow and Bilious Fevers, 467

formed from the fact that in 1837 I prescribed for 1 19 cases of
this disease in one dny; most of them being soldiers of the old
Texns army. So extensive a practi(!e ought to have furnished
at least one case of black vomit, if it is of frequent occurrence
in paludal fevers.

Black vomit is so peculiar and distinctive a symptom of
yellow fever that I have chosen to consider it separately ; it
may nevertheless be perhaps regarded as part of or resulting
from a genei'al hsemorrhagic disposition which exists in this
disease; which general hcEmorrliagic disposition or character
is eminentl}' diagnostic between bilious and yellow fevers.
Haemorrhages are rare, quite rare in bilious fevers ; they are
extremely common in yellow hxQ\\ much more common than
is usually supposed; often occurring unsuspected either by pa-
tient or physician. My attention has been much directed to
this characteristic hsemorrhage. Autopsies have revealed to
me numerous and copious internal hsemorrhages whose exis-
tence was wholly unsuspected during life. I have found them
everywhere in the abdominal cavity ; in the large and small
intestines and stomach ; beneath the peritoneum ; in the cellular
substance investing the kidneys and renal capsules ; between
the laminae o^ the ac of Willis; into the kidneys; into the
substance of the liver; into the bladder of urine; from the
uterus; from the surface of the scrotum ; from the gums, nose
and ears; into the subcutaneous cellular substance of nearly
every portion of the surf;ce. The internal ha?morrhages
alluded to as being revealed only on dissection are not of a few
drops or a teaspoonful or two ; I found them in quantities of a
gill, half pint, pint, and quart. I have stated that these haemor-
rhages are often unsuspected ; they occur, moreover, in cases
which though severe, present no immediately alarming symp-
tom. I have drawn off bloody urine where the patient did not
complain of the slightest uneasiness; I have learned, on inquir-
ing the existence of free uterine haemorrhage which the patient
had not mentioned, supposing it to be a return of her catame-
nia. On examination in cases not regarded as dangerous, J
have found extensive infiltrations of blood into the cellular
substance of the lower extremities, giving them a marbled
appearance, which, nevertheless, had escaped the notice of the
patients. Haemorrhage from the gums is common wh^re not
a grain of mercury has been administi-red. Now, haemorrhage
from any part of the system is extremely rare in miasmatic
diseases ; I do not remember at this time a case of haemorrhage
from the gums in paludal fevers without mercurial salivation
or a strongly, marked scorbutic diather^is.

In illustration of the frequency of haemorrhage in yellow

N. S. VOL. VII. NO. viii. 30

468 Diagnosis of Yellow and Bilious Fevers. [August,

fever, I will state that at my recent visits to Staten Island,
among ten patients I saw in the hospital and village, there were
three cases of haemorrhage from the gums ; one from the bow-
els ; one of ulcerated scrotum ; five of black vomit. It is
proper to state that some of the patients had bleeding from
different parts of the system at the same time.

The peculiar, and not easily describable physiognomy of
yellow fever is so constant that it ought not to be omitted. To
one familiar with the disease, it is as striking and unmistakable
as are the ways and physiognomy of a drunken man.

There are several symptoms, which, though not of them-
selves characteristic of yellow ^qvqy, should nevertheless be
mentioned in contrasting this disease with malarial fever, from
their frequent occurrence in the former, and their infrequency
in the latter disease.

In a majority of fatal cases of yellow fever, the pulse in the
last stage is preternaturally slow, unless quickened by stimu-
lants, and sometimes in despite of stimulants. On merely look-
ing at the patient in the Quarantine Hospital, I remarked im-
mediately to Dr. Whiting, that man must have a slow pulse, it
cannot be over fifty. Being counted, it was thirty-two it fell
in a few hours to eighteen, several hours before his death. An
intervenient feeble pulsation was sought for in vain. In bilious
fevers it is rare to find the pulse below the healthy standard of
frequency, except after the complete abatement of the disease.

In yellow fever, the skin, after the subsidence of the vascular
excitement of the setting in of the third stage, is dry, has a
peculiar harsh feel, and its temperature sinks below the healthy
standard ; when cerebral congestion co-exists, there is mois-
ture about the wrists and ancles. In advanced stages of bilious
fever, or in severe congestion, if the surface is cool, the extre-
mities are bedewed with sweat, more or less clammy and
copious.

In severe cases of yellow fever, the urine is generally of an
intense saflfron yellow, not unfrequently deposits blood on stand-
ing, as heretofore stated, and the bladder is often insensible to
distension. In bilious fever the urine is more commonly of a
reddish hue, and scanty, or copious and limpid ; nor have I
remarked insensibility of the bladder to its presence.

There is an occasional, symptom in yellow fever which I
have not met with in any other febrile affection; it is sponta-
neous and genuine venereal appetite in the stage of extreme
prostation, and indeed of irremediable danger. Memoria teneo
meipsum hoc morbo graviter laborantem, momento quidem
periculosissimo, ignibus veneris insolitis vehementer arsisse.

Great serenity of mind, or rather sluggish indiflference, marks

1851.] Diagnosis of Yellow and Bilious Fevers. 4G9

the final fatal stage of yellow fever; this, though not peculiar
to the disease in question, is not quite observable as contradis-
tinguished from the usual condition of the nriental faculties of
persons verging to death in bilious fevers.

Among the less characteristic symptoms deserving remark,
is the frequency of attacks in the night by yellow fever, and
the comparative infrequency of nocturnal attacks of paludal
fevers.

Yellowness commencing commonly before death, and be-
coming more intense after that event, is so frequent as to have
given name to the disease; yellow suffusion is, nevertheless,
occasionally met with in bilious levers ; but my observations
lead me to think that t very noticeable increase in intensity
after death is of rare occurence in the latter disease.

I now proceed to note briefly the pathological distinctions
between the two diseases under consideration. These are in
yellow fever, the general hasmorrhagic disposition, black vomit,
yellow or fawn colored liver, and a pathological condition of
the mucous membrane of the stomach. Much that I should
have to say on the haemorrUages and black vomit has been
anticipated under symptomatology, and need not be here re-
peated. From the frequency of black vomit in fatal cases the
Spaniards have thence called this disease vomito prieto, or
negro. This matter is seldom found to be wanting in the
stomach in such cases, that though some may have been ejected
during life, I have met with it in all the autopsies I have made,
with perhaps a single exception. This exception was in the
autopsy of an individual whom I never saw during life, but
who died, I have reason to believe, of yellow fever. In a very
few cases which were fatal from the twelfth to the twentieth
day after attack, I suspected the stomach would be found to
contain no black vomit, but opportunity was not afforded me
to ascertain the fact by dissection. So, also, in the body not
examined of a person whose case was rendered ataxic, by
treatment, and terminated fatally on the eighth day, I did not
suspect the presence of black vomit in the stomach. I note
these conjectural opinions in order to qualify the general state-
ment of the results of my autopsies. I have never met with
black vomit in my dissections in paludal fevers.

I have always found the gastric mucous coat in a pathological
condition in yellow fever. In the formation of black vomit,
portions of the gastric mucous membrane are congested or
gorged with blood, which is poured into the cavity of the
stomach possibly by simple effusion, or, as I believe, by an
imperfect or diseased vital process. The portions of the coat
which furnished the black vomit are softened and generally

473 Diagnosis of Yellow and Bilious Fevsrs. [August,

thickened ; but in the present state of patholonjical science and
language, these effects cannot be distinguished fronry the effects
of other diseases upon the same tissue. They will not, there-
fore, serve the purpose oi" practical diagnosis. I have, however,
had opportunity in several cases to observe portions of tfie
mucous coat in the state of sanguineous engorgement previous to
the formation nf black vomit other portionsof the tissue having
furnished this fluid and being in the condition above mention-
ed and I do not hesitate to say that I can distinguish the san-
f^uineous en^orf^ement in this disease from the conjxestion in
anv other disease I have yet witnessed. Common gastritis can
occupy one portion of the mucous coat, while another [)ortion
of the same furnishes black vomit. I shall not here pursue
this point further, as n">y present object is practical diagnosis.

The liver in yellow fever is paler than natural, varying from
a pale straw to a bri(zht coffee and milk color ; the hue is uniform
or mottled ; in a few rare cases it is of a deep dark color. The
intensely dark liver, of which I have seen two cases, was owing
to a haemorrhage into its parenchyma. In all my other dissec-
tions, the fawn <'olor of Louis Ivcks been distinctly noted, with
the exception of one liver which was not remarked on. Three
autopsies were made atthe Quarantine Hospital on Sunday last ;
two of yellow fever cases, and one of dysentery. The livers
of the first two vvere of bright coffee and milk hue, and their
stomachs contained black vomit ; these livers contrasted strong-
ly with the mahogany colored liverof the dysenteric body which
was emaciated and exsanguineous. I beg here to state that this
yellow discoloration was noted by me in six out of eii^ht yellow
fever autopsies published before the publication of M. Louis's
book, and before I had heard of his observations. But to him
alone belongs, so far as I know, the merit of calling the special
attention of medical men to this pathological appearance.

I have not seen black vomit in the stomach nor the yellowish
discoloration of the liver, nor the internal hcemorrhages m my
dissections of bodies dead of bilious diseases. It does not seem
necessary for our present purpose to describe minutely the
pathological appearances in bilious fevers. It is possible that
in dissections made years ago of fatal cases of bilious fevers, I
may have noted as natural, livers which more careful observa-
tion should have described as bronze colored. In the autopsy
of a case (Capt. ThoFnpson,) of malignant congestive fever
coming frotn Tampico, last year, the bronze colored liver as
described by Drs. Stewardson, Swett, and others, was very
strongly marked.

I will here state the 'present year, I have seen a distinctly
marked straw colored, liver in a child that died of cholera infan-
tum with metastasis to the brain.

1851.] Diagnosis cf Yellow and Bilious Fevers. 471

I have not deemed it necessary to establish a formal diagnosis
between yellow and typhoid fevers. The fact that yellow fever
requires an ardent sun for its development, while the typhoid
atlection prevails most in colder temperatures, as well as the
universally known symptomatology of the two diseases, suffi-
ciently distinguish them from each other. Still it may be pro-
per to add, under the head of pathology, that in my numerous
dissections in yellow fever, I never met with the anatomical
lesinn of typhoid fever, to wit, ulceration of the elliptic patches
of Peyer. Typhoid fever, though extremely rare in the coast
district of Texas, is nevertheless sometimes met with. I was
invited last August by a medical gentleman to Galveston to
see a lad seven years of age, a native of Texas, and always
resident there, laboring under fever. The case presented un-
mistakable symptoms of ilie typhoid affection ; he died the 15th
day from the attack; the autopsy made by me exhibited nu-
merous and large ulcerations of Peyer's glands. For many
days preceding, the weather had been dry and warm, the ther-
mometer at 3 P. M., rangino: from 84 to 90^; the barometer
at 10 A.M., from 30-1(3 to 30-20 inches.

I have thus nearly completed, how imperfectly I am very
sensible, the task I imposed on myself of setting forth the dis-
tinctive characteristics of bilious and yellow fevers. My main
difficulty, as already intimated, has lain in my inability to paint
adequately the physiognomy of the assemblage of symptoms
which constitute the two diseases respectively. To my mind's
eye, they neither blend with nor run into each other; but the
prominent features of demarcation can be clearly and fully
appreciated only by personal observation. A person must see
with his own eyes in an inter mi ttenL the chill, the fever, and
complete intermission to be succeeded the following day or
some subsequent day, at regular intervals, by a similar chill,
fever, and intermission, and this state to continue for days,
months, and even years. In a remittent, he will see chilliness,
exacerbation of the fever, great remission and these symp-
toms repeated with great legularity, with diurnal or double
tertian regularly for a number of days. If the bilious {Q\'e\' bs
of a continued tyf^e, he will witness exacerbations and remis-
sions occurring with the regularity of remittent, and like it lor
days ip succession. If he encounters a malignant intermittent
or remittent, usually called cnngestim^Qvev, the patient is ot'ten
comatose or deliiious, his extremities and part of his body are
dank and colder than a corpse, in an atmosphere perhaps of
from 80 to !)5. With this deadly coldness of the surface
there is a burning heat of the entrails^ shown by unquenchable
thirst aud incessant cries of the sick man for cold drinks, unless

472 Diagnosis of Yellow and Bilious Fevers. [August,

the stupor be so complete as to mask all sensation. In an hour
or two, or a few hours, the scene is changed, and if reaction be
complete, a burning heat of the surface has succeeded to the
algid dankness. This state in its turn gives place in a few
hours to an intermission or remission, as in the milder forms of
bilious disease, with perhaps scarcely a symptom of urgent
danger. But on the following day, or a subsequent one, a
paroxysm similar to the first is repeated. After a few repeti-
tions, if the disease be not arrested by art, or converted into a
milder form, it terminates fatally in the cold stage.

If a case o[^ typhoid fever be presented, he sees a febrile dis-
ease coming on slowly and stealthily, requiring days to reach
its acme, and days for its subsidence. Changes which take
place in hours in bilious or periodical fevers, require as many
days in typhoid fever. Exacerbations are wanting or scarcely
distinguishable; nervous and other symptoms rare in other
diseases are common in this ; convalescence is slow ; tardiness
is impressed on all its stages. If fatal, ulcerations in the lower
part of the small intestines are found on examination after death.

In yellow fever, in a case not rendered ataxic, one sees the
depression or chill, the fever with the agonizing pains of the
forehead and loins; these subside spontaneously within three
or four days into a state of apyrexia. This is the only parox-
ism ; there will be no subsequent vascular excitement. The
patient may now become convalescent without further adverse
symptom ; but he is very liable to sink into a state of mental
sluggishness, he kicks otTthe bed-clothes, sits up on the edge of
the bed, or walks about the chamber with a peculiar unconscious
indifference; suddenly a turbid dark fluid gushes from his
mouth, or the black vomit makes its approach more insidiously,
first an occasional slight eructation of air, then a hiccup with the
ejection of a teaspoonful or two of a thin whey-looking fluid ;
the fluid is ejected more frequently, in larger quanitities, and
darker and more turbid ; haemorrhages have taken place from
his gums, or other parts of his system ; his pulse become slow
and sluggish ; his respiration infrequent and protracted, becom-
ing more infrequent, protracted, and feeble, so that you can
scarcely tell when he breathes his last ; or he dies suddenly
with a copious gush of black vomit ; or he drops dead while
walkinc: about. An examination after death reveals the^black
vomit, the haemorrhages, the ravages in the stomach and liver
already noted.

I have spoken of yellow fever as a disease of pretty uniform
character. Such has been my observation ; and the descrip-
tions of those practitioners whose treatment has seemed to me
most judicious and least perturbating, present a similar and

1851.] On the Phosphate of Lime, ^c, 473

pretty uniform symptomatology ; quite as much as any disease
with which I am acquainted. Cases have been rendered ataxic
by injudicious treatment, and nosological varieties have been
thus multiplied at the expense of true science and of patients
too. In the commencement of my practice, I made bad ataxic
cases. Such cases do, indeed, occur without any fault of the
practitioner, or exposure of the patient ; sometimes they are
produced by the overwhelming violence of some symptoms,
marking or ruling out others. Slight modications are, it is
true, presented in different epidemics and in different periods
of the same epidemic, but it is chiefly in the minor symptoms,
or in the comparative seventy of the leading symptoms ; so
that I regard the formal division of yellow fever into different
species, types, and forms, as being unphilosophical and attended
with no practical advantages. [Transactions of the N. Y.
Academy of Medicine.

On the Physiology and Pathology of the Phosphate and Oxa-
late of Lime, and their relation to the forination of cells. By
William Beneke, M. D., Resident-physician at the German
Hospital, Dalston.

In a small work, which I have lately published in Germany,
entitled "Der Phosphosaure Kalk in physiologischer und the
rapeutischer Beziehung," Goettingen, 1850, I have established
the following results :

1st. Just as in plants and inferior animals the phosphate of
lime is indispensably necessary in man for the formation oi
cells; this formation does not only depend upon the presence of
albumen and fat, but likewise upon the presence of phosphate
of lime.

2ndly. The want of phosphate of lime, either in plants or
animals or men, causes a deficient formation of cells; and a
great many pathological states of the system really seem to
depend upon a deficiency of phosphate of lime.

Srdly. In accordance with these general laws, we must sup-
pose that we are enabled to cure, or at least to alleviate, by
the internal administration of phosphate of lime, diseases mark-
ed by emaciation, formation of ulcers, in one word, by a defi-
cient formation of cells.

4thly. I have shown by my experiments, that such really is
the effect of the administration of phosphate of lime, that is
to say, I have produced, by the internal administration of phos-
phate of lime, an undoubted increase of the cell-formation in
diseases evidently showing a diminished formation of cells.

474 On Phosphate of Lime ^ <^c. [August,

5thly. As diseases or affections of this kind, which have
come under my observation, I have to mention,

a. Ulcerations of" any part of the system, which are based

upon general dyscrasia, such as scrofula, and which are
not merely local affections.

b. Infantile atrophy, especially the well-known atrophic slate

of children, suffering from rickets, and its accompanying
symptoms, as diarrhoea, &c.

c. Tuberculous disease, more especially of the lungs, in its

earliest stages.

Gthly. There seems to be a remarkable connexion between
scrofula and deficiency of phosphate of lime. But as it gener-
ally ought to be mentioned, that we never shall be able to pro-
duce an increase of the formation of cells, unless we administer
a wholesome, preferably nitrogenous diet ; so it must be con-
sidered that the deficiency of phosphate of lime is only a con-
stituent part of these diseases; and by its mere use we are
very well enabled to remove symptoms, which depend on its
deficiency, but by no means shall we cure thereby the dyscrasia
in toto.

These are the results to which I have drawn the attention
of the profession in the paper above alluded to ; and as I can-
not expect it to be known in this country, before proceeding
further I shall give a short extract of the chief points of the
facts on which I have founded my conclusions.

It is only a few years since we became acquainted with the
great importance of inorganic substances in the formation of
organic compounds. Liebig first established the fact, that in
plants the formation of vegetable acids, of seeds, &c., does not
only depend upon the [nesence of carbonic acid and water, or
caibonic acid, nitrogen and water, but likewise on the presence
of the inorganic iTonstituent parts of the soil. This really being
a fact, based upon observation and experiment, we must be
induced to suppose that a similar relation between organic and
inorganic parts exists in animals, and even in men. These
inorganic parts of the economy, both of men and the inferior
animals, are by no means mere incidental substances, they
ore by no means unim[)orfant ; on the contrary, the time
has come when we are far from admitting the least doubt of
their necessity for the chemical processes wliich take [)lace in
these organizations; in one word, the inorcjanic parts are quite
as essential as the organic compounds. This undoubted fact
having been hitherto overlooked, we may judi^e of the correct-
ness of the views applied to organic chemistry until within a
few years, and especially of the analysis of blood, which have
been performed principally in France and Germany ; in nearly

1851.] On Phosphate of Lime, <^. 475

all of ihemare exclusively considered the organic compounds,
the inorganic parts being set aside.

It is not liere the place to enier more deeply into these views.
I have only to show how far we are acquainted with the rela-
tion of phosphate of lime to organic compounds, and even to
the formation of cells.

In first considering plants, we have been informed by Liebig
that the salts of phosphoric acid are indispensably necessary
for the formation of nitrogenous compounds as well as of cells.
In his elaborate, "Organic Chemistry in its Application to
Agiiculture and Physiology,'' the author affords a great many
proofs of this result, out of which I beg to select a few. *' JXone
of our plants," as we read at page 100, fifth German edition,
"can bear perfect seeds that is, seeds yielding farina, without
a large sup[)ly of phosphates and even ammonia, substances
which they require for their maturity. In the stems and leaves
of plants we find salts with alkaline bases; the azotic com-
pounds we find always accompanied by salts of phosphoric
acid, and we therefore must suppose that they are of the great-
est importance in the economy of plants. The alkaline bases
are principally wanted for producing sugar, gum, pectine, and
amylum substances which do not contain nitrogen ; on the
other hand, the salts of phosphoric acid are principally necessa-
ry for the formation of azoiic compounds.'' (p. 251.) These
interesting remarks are based upon facts which do not admit
of any doubt; they apparently prove the remarkable relation
between the salts of phosphoric acid and azotic compounds in
plants. But there is another point we have to direct our atten-
tion to, and this is the most important with respect to my pre-
sent purpose. At page 1 38, Professor Liebig says : " We know
that the quantity of starch in potatoes increases when the soil
contains much humus, but decreases when the soil is manured
with strong animal manure, allhous^h in this case the number of
cells increases, the potatoes acquiring in the first place a niealy,
in the second, a soa[)y consistence. Beet-roots taken from a
barren, sandy soil, contains a maxitnum of sugar, and no am-
moniacal salts, and the Teltowa turnip loses its mealy state in
a manured land, because all the circumstances necessary for
the formation of cells are there united." Well, then, we must
trace the causes of the peculiar influence of the nianure on the
formation of cells, and referring to its constituent parts, and the
cxpeiiments which have been made on their relative power,
we shall be far from admitting the least doubt that the salts of
phosphoric acid are tl^ose materials, upon the presence of which
the formation of cells depends. This view is still farther prov-
ed to be correct by our finding that ior manure of animul ex-

476 On Phosphate of Lime, ^c, [August,

cretions, other substances containing their essential constituents,
may be substituted. "In Flanders (Liebig, 'On Agricultural
Chemistry,' English translation by Playfliir, 1840, page 182)
the yearly loss of the necessary matters in the soil is complete-
ly restored by covering the fields with ashes of wood or bones,
which may or may not have been lixiviated, and of which the
greatest part consist of phosphate of lime and magnesia. The
great importance of manuring with ashes has long been recog-
nized b}^ agriculturalists as the result of experience. Its use
will be at once perceived when it is considered that the ashes,
after having been washed with water, contain silicate of potash
in the same proportion as in straw, and that their only other
constituents are salts of phosphoric acid." Finally, Liebig adds
the important remark, (German edition, page 245,) that we
may furnish a plant with carbonic acid and all the materials
that it requires ; that we may supply it with humus and ammo-
nia in the most abundant quantity, but that it will not produce
albumen, fibrine, and caseine, unless the salts of sulphuric and
phosphoric acid are afforded to it. " We ought to suppose
that without their co-operation, the ammonia does not influence
in the least the formation of the nitrogenous substances."

This, then, is the result of the foregoing remarks : that the
azotic compounds in plants are not produced without the
co-operation of the phosphates; that the produce of cells in-
creases proportionally to the power and quantity of the manure
afforded to the soil, and that this power particularly depends
upon the presence of phosphates, the other salts really being
oi no great importance in this respect.

But there are different sorts of phosphates contained in the
soil, such as phosphate of soda, phosphate of lime, phosphate of
magnesia, and phosphate of iron. Is there any reason to be-
lieve one of these several substances to be more important for
the produce of nitrogenous substances and cells than the others ?
Facts are not wanting which afford an affirmative answer to
this question. The single experience that we may considera-
bly increase the produce of nitrogenous substances and cells
by manuring the land wiih ashes of bones, is quite sufficient
to prove that the phosphate of lime is of the greatest im-
portance in this respect. A great many analyses of ashes
of bones, communicated in the "Annalen fiir Pharmacie und
Chemie von Liebig und Wohler," by Ederlin, Fresenius
and Will, and the analyses of bones by Berzelius, evidently
show that the phosphate of lime is always present in ashes in a
certain proportion, according to the nutritive power of the
plants and the soil from which they are taken ; and that, on the
other hand, the proportion of phosphate of magnesia and soda

1851.] On Phosphate of Lime, ^. All

in bones themselves is too small to partake of the influence
exerted upon the soil by manuring it with bones. Berzelius
found in 1000 parts of dry bones, 53-04 phosphate of lime MG
phosphate (carbonate?) of man^nesia, and 1*20 soda, with a
small quantity of chloride of sodium.

On these facts, then, I have founded the conclusion, that the
phosphate of lime is indispensably necessary for the formation
of cells in plants.

With regard to the inferior animals, and the part which is
performed in their economy by the phosphate of lime, I have
only to mention an excellent paper by Dr. Carl Schmidt, " Zur
vergleichenden Physiologic der wirbellosen Thiere. Braunch-
weig, 1845." In this paper Dr. Schmidt communicates most
interesting experiments, from which it becomes evident, that in
inferior animals the phosphate of lime has an intimate relation
to the formation of cells. Dr. Schmidt ascertained beyond a
doubt, that in the articulata the quantity of phosphate of lime
increases or decreases proportionally to the quantity of chitin,
a sort of colourless transparent tissue, which is not soluble in
water, alcohol, ether, and liquor potassse, and forms the prin-
cipal constituent part of the skeleton of all the invertebrata.
Now, this tissue is the result of an active formation of cells
during the period of changing the integuments in these animals,
and so it results that the quantity of cells formed is propor-
tionate to the quantity of phosphate of lime present. This
result becomes still more evident from the experiment which
Dr. Schmidt describes in the following words : By carefully and
gradually scraping ofl* the outside of the hard scales of the
thorax and of the claws of crabs to the upper pigment-layer of
the subjacent membrane, I produced an exudation of new mat-
ter. This quickly took place, and, after the lapse of eight
hours, a ihickish, viscid, transparent mass (cyto-blastema) was
to be ibund. This masscontaineda large quantity of corpuscles,
which did not dissolve in water, nor in acetic acid (fat,) and
others, which were soluble in water and acetic acid (albumen.)
No other corpuscles were present. When this mass was inci-
nerated, a remarkable quantity of phosphate of lime (about
eight per cent.) resulted, besides a small quantity of alkaline
phosphates and carbonate of lime, the latter being the result
of the incineration. The phosphate of lime was held in solution
in the mass it.self, as was proved by the turbidity resulting from
the addition of a drop of ammonia to a drop of the liquid placed
under the microscope. After the lapse of fourteen to sixteen
hours the soluble molecules (albumen, and very likely phosphate
of lime) surrounded the fat-globules, exhibiting in this way
globular masses. Some of these masses were covered already

478 On Phosphate of Lime, ^^c. [August,

by a membrane, so as to form cells, others not. At the same
time numerous rhomboedic crystals (carbonate of lime) ap-
peared. By the addition of liquor pota^soc a swelling of the
cells and iheir molecular contents took place* afterwards they
became transparent and dissolved.; the iat globules were lecog-
nized as forming the nuclei of these cells. The cells did not
yet present themselves as chit in. But after twenty-four to
thirty-six hours several of these cells were extended, spindle*
like; they swelled still by the addition of liquor potassae. but
they did not dissolve more in this stage, and appeared to be
of the chitinous composition." These experiments aie follow-
ed by others, which atlbrd a negative proof in favor of Dr.
Schmidt's views alluded to. In examining, namely, the calca-
reous scales of helix, and their interior, transparent, structure'
less membranes, he observed that no phosphate of lime was
present, and accordingly no cells were found ; nothing could be
detected but amorphous, hardened, mucous masses, separated
by layers of carbonate of lime. Dr. Schmidt himself says:
These observations really are so striking as fully to confirm the
opinion before advanced ; and he iurther adds, as his firm be-
lief, that a certain combination of albumen and phosphate of
lime, or better, that a solution of albumen, which is saturated
with the phosphate of lime, is particularly enabled to coagulate
by the contact of heterogenous substances, and to form mem-
branes around them that is to say, walls of primary cells.

Well, then, having become acquainted with these remarka-
ble facts, I put forward the question, whether the phosphate of
lime might not have the same relation to the formation of cells
in the higher classes of animals, and even in men, as it has been
shown to have in inferior animals and plants ? I have been
fortunate enough to obtain satisfictory and affirmative results.

The way in which I tried to solve the question was a double
one first, I had to prove that wherever we find a formation of
cells, the phosphate of lime is present, and vice versa, that the
phosphate of lime is wanting where no formation of cells takes
place; secondly, I had to show that the phosphate of lime is
indispensably necessary for, and that it really influences, the
formation of cells.

With respect to the first point, I examined a great many
pathological exudations, such as the serum produced by blisters,
the exudations and secretions of wounds and ulcers, &c., &c.;
and I have shortly to state that wherever a formation <>f cells
took place, the phos[)hatc of lime was found in considerable
quantity, and wherever it was absent, 1 could scarcely find
traces of phosphates. In order to detect the smallest quanti-
ties phosphate of lime, I used the micioscope, which sliows the

1851.] On Phosphate of Lime, ^c. 47&

most beautiful crystals of sulphate of lime, if a preparation, con-
taining the phosphate, is mixed with a small (Irop of sulphuric
acid, and no crystals at all where no lime is present. How-
ever, it is requisite for a microscopical examination of this kind
to he well acquainted with all sta;]^es of the formation of the
sulphate-of-lime crystals, so as to be enabled thereby to judge
whether the quantity of phosphate present is a large or small
one; the former beinir the case, we shall observe a rapid and
splendid formation of large crystals; the latter taking place, only
the former stages of the crystal formation are to be detected.
First, I examined the serun) which was drawn by blisters.
It is rather difficult to detect the phosphate in a single drop of
the unaltered serum in the way described, the quantity of lime
really l)eing a very small one. However in a single drop I
detected crystals of the smallest size, by the addition of sulphu-
ric acid, and by continued examinations, I found that the crys-
tals presented themselves the more quickly and well marked
the sooner the efformation of pus-globules took place in the
serum, which was left beneath the skin. But from twelve to
twenty-four hours are often required for the formation of crys-
tals, and the pieparation should not be judged of until during
the lapse of this time repeated observations have been made.
If, on the other hand, I slightly evaporated the serum in a hot-
water bath, and now mixed a drop of the evaporated serum
with sulphuric acid, a rapid formation of crystals generally took
place, which undoubtedly showed the phosphate of lime to be
present in large quantity. I then ' examined exudation-matter
of wounds and ulcers, and these observations really afforded
the greatest interest ; they decidedly proved the relation of the
phosphate of lime to the formation of cells. It will be well
known to every accurate observer, that during the time of
cicatrization of wounds and ulcers, two different sorts of exu-
dation generally take place. First, an exudation appears, which
I should like to call *' spurious exudation, '^ and which really
exhibits nothing but a natural cover for the part affected or
wounded, being far different from what we call ''spurious
granulations ;" this exudation is subsequently thrown off; after-
wards beneath this covering the real blastema is produced,
affording the materials ibr the tissue which is to be formed,
and undergoing the well-known changes to cells, tissue, &c.
Well, then, if we examine microscopically what 1 have called
the spurious exudation, we shall observe it to consist of amor-
phous structureless masses ; no cells are to be detected ; it only
seems to consist of molecules ; no organization takes place.
And even in those masses, by the addition of sulphuric acid, I
have never observed the formation of sulphate-of-linie crystals.

480 On Phosphate of Lime, ^c. [August,

and consequent!}' no phosphate of lime could be present. If,
on the contrary, I examined in the same way the blastema
produced beneath the spurious exudation, after the lapse of
about twenty-four hours, I not only met with beautiful exuda-
tion-cells and pus-globules, but also, by adding a drop of sulphu-
ric acid, could observe a rapid formation of crystals, so as to
be led to the conclusion that the phosphate of lime is present in
a large quantity, where cells are produced, and that it is want-
ing where we find nothing but amorphous masses. Lastly,
with respect to this point, I have to draw the attention to the
muscular tissue itself; and it will become evident, from my
observations, how small a quantity of phosphate of lime we are
able to detect by the kind of examination alluded to. The
muscular tissue is well known to contain a certain quantity of
phosphate of lime; it was the result of Liebig's inquiries, that
when the formation of muscular tissue from the constituents of
the blood takes place, nearly the whole quantity of alkaline
phosphates returns into the blood, and that at the same time a
certain quantity of phosphate of lime becomes chemically fixed
in the organs themselves. This quantity, then, however small
it may be in a muscular fibre, which is so fine, as, by microscopi-
cal examination, to show the transverse stripes, I have detect-
ed, in the above described way, in a few muscular fibres which
I had submitted to the action of sulphuric acidfor about twenty-
four hours. I observed, after this time, by the microscope,
cr3'stals of sulphate of lime of course only in very small quan-
tity, but beautifully formed. ' Especially in this kind of prepa-
ration the different stages of crystal-formation are to be well
observed.

After these experiences, the other question remained whether
the phosphate of lime really influences and increases the pro-
duce of cells? I have tried to solve this question in a double
way, first by experiments, and, on the other hand by practical
inquiry.

With repect to the experiments, it is my firm belief that I
succeeded in artificially producing cells, which did not show
any distinction from pus globules and what we call exudation-
cells. For this purpose I mixed together a part of the albumen
of a hen-egg, some pure fat, a small quantity of phosphate of
lime, and a very few drops of water ; put the mixture, which
was contained in an evaporatingdish, into a hot sandbath, at
a temperature of 104 F., and then microscopically examined
the changes which took place in the mixture itself After the
lapse of from four to six hours, I observed that an accumulation
of albumen and phosphate had already taken place around the
fat-globules ; and after another period equally long, I found

1851.] On Phosphate of Lime, <^c. 481

those forms of cells which I have figured in the first plate of
paper alluded to. In another preparation I distinctly observed
the gradual process of the formation itself by the simultaneous
appearance of all the stages of formation of cells. Considering
as the first stage the pure fat-globules, I observed, as the second,
fat-globules, which presented a turbid appearance, in conse-
quence of an accumulation of albumen and of phosphate of
lime on their outside; and this accumulation increasing more
and more, produced cells, w^hich did not differ in their appear-
ance from real exudation-cells. By the addition of sulphuric
acid to these cells, I obtained the same results as by treating
exudation-cells or pus-globules with it : there appeared on the
outside of the cells very small and dark forms of crystals, which
I considered to be crystals of sulphate of lime. I further ob-
served some larger cells, which included a smaller one, so as
to exhibit the appearance of what is called the "ovum primiti-
vum," the observations and communications of which are com-
municated by Rud. Wagner in his splendid work, " Prodromus
Historiae Generationis." It appeared to me, that in these cases
an accumulation of fat took place on a ready-formed cell" and
that this fat-accumulation became surrounded again by the
combined albumen and phosphate of lime. By the addition of
acetic acid the cells became clearer, and dark molecules ap-
peared on their surface.

Now with respect to the natural combination of the albumen
of a hen-egg with a small quantity of phosphate of lime, I
inquired whether the formation of cells should not take place
by the mere addition of fat to it, and its continued exposure to
a temperature of 104 F. I have instituted experiments with
respect to this point ; and I have found, that after the lapse of
about eight hours some forms of cells could be detected, but
their quantity was much smaller than in the above described
experiments a result which was to have been expected, if
the theoretical views upon which I founded my observations
were correct. In conclusion, I have to state, that I obtained
the same results by repeatedly performing the same experiments,
and I only hope that they may soon be repeated by physiolo-
gists who are known to be authorities in this kind of observation.

With regard to the above mentioned practical inquiries I
equally obtained satisfactory results, which evidently showed
that phosphate of lime increases the formation of cells, suppos-
ing a sufficient quantity of albumen and fat to be present. I
must refer to my former publications with respect to the indi-
vidual cases ; here I only beg to mention the general results.

First I tried the phosphate of lime in patients who suffered
from chronic ulcers, resulting from the scrofulous diathesis, and

482 On Phosphate of Lime, 6fC. [August,

exhibiting]: a want of fornnation of cells in the highest degree.
These patients had been for a long tinne under medical treat-
ment, inclusive of my own, but all remedies had been fruitless,
such ascod-liver oil, ointments of lead and zinc, lotions of nitrate
ofsdver, &c. Being myself quite sure, that no influence of
the former kind of treatment could be still remaining in opera-
tion, and even after having left off all treatment for a long time,
I then ordered the phosphate of lime to about four or eight, to
twenty grains per diem, and after a few days the ulcers evi-
dently showed themselves in another state. The suppuration
improved ; instead of an ichorous secretion, a pus bonum et
laudabile was produced, and after a few days lousier the cica-
trizuion begun. In children, in particular, I obtained very
stiiking results, and there was not the least doubt, that the
effect must be ascribed to the phosphate of lime. Generally I
ordered it to be taken with the breakfast, dinner, and supper,
in order to have it mixed as well as possible with the food taken ;
it is certain, that the phosphate of lime easily disolves in albu-
minous solutions as well as in mineral acids, and in the acid of
the stomach. But I have especially to mention, that in several
cases, some time after having left off the use of the phosphate
of lime, I observed a fresh outbreak of the ulcers, for the real
cause of which circumstance I could scarcely account at the
time; I only supposed that the bad living of the patients, the
food exclusively consisting of potatoes and bread, the abode in
a damp unhealthy air, &c., caused the continuance of the gen-
eral dyscrasia, and the repeated breakinixout of the local affec-
tion. I am able now to account for it better than I could
before, and with respect to this point, I must refer to the follow-
ing parts of these communications.

As most of these ulcers occurred in patients afflicted with
scrofula, the question arose, whether the phosphate of lime
really cured the scrofulous dyscrasia, or only a part of it.
With regard to this point from many observations, the number
of which has much increased since, it resulted that there exists
an undoubted intimate relation between scrofula and want of
phosphate of lime, but that we are not able to cure the dyscrasia
by the mere use of the phosphate. The same is the case with
tuberculosis, a disease which is well known to be intimately
related to, if not identical with, scrofula. In both kinds of
disease, however, we shall promote the cure in the most efficient
manner by the administration of the phosphate of lime, and I
cannot forbear recommendinor its use as much as possible. In
the following pages I shall give the explanation of these facts,
which I hope will at once prove, that the effect of the phos-
phate ought to be such an one as I imagined and really found

1851.] On Phosphate of Lime, Sf^. 483

it to be. I have especially to mention, that the waste of tissues,
or, in other words, the want of formation of cells, was appa-
rently less in many cases of tuberculosis and scrofula, which
were treated with phosphate of lime, besides other remedies,
than in those which were treated without the phosphate; that
the cure of tuberculous ulcers of the intestines was evidently
promoted and even effected by the administration of the phos-
phate, and this remedy proved most efficient in cases of inci-
pient acute tuberculosis, and even those which are well known
to manifest at their commencement nearly all the symptoms of
typhus. I need not enter here more deeply upon the special
effects of the administration of the phosphate in these cases, if
the one general fact is always kept in mind, that it increases
the formation of cells, or prevents the rapid and fearful waste
of tissues.

In accordance \vith those facts, the phosphate of lime proved
most beneficial in children who suffered from scrofula, diar-
rhoea, ulcerations and excoriations of the skin and bowels, gen-
eral waste of the cellular tissue, loss of power, &c. In these
cases, the mere use of six to ten grains per diem was often quite
sufficient to effect the cure, and I have met with such striking
and satisfactory results, as to leave no doubt that the w^ant of
the phosphate of lime was the real cause of the symptoms
alluded to. These results, too, are confirmed by many physi-
ological observations. Chossat, for instance, observed that
pigeons, in consequence of an artificial want of phosphate of
lime in their food, became affficted with diarrhoea and softening
of the bones; children, in the period of dentition, or when
afflicted with rickets, which disease positively shows a want
of phosphate of lime, are especially well known to suffer from
diarrhoea, sores, &c. Still I have to mention the interesting
observation, that in patients who were afflicted with diseases,
in which the phosphate of lime proved beneficial, and who con-
sequently were supposed to suffer from a want of phosphate of
lime in their economy, wounds of occasionally applied blisters
healed much more slowly than was the case in other patients,
and the more so the more distinctly those symptoms appeared
which should he referred to a want of phosphate of lime.

In syphilis I also tried the phosphate of lime, and even in
persons who had for a long time already suffered from secon-
dary ulcers, ulcers of the bones, &c., and became emaciated
and extremely weak during^ that time. These cases likewise
showed a most beneficial effect of the phosphate on the forma-
tion of cells. It ought to be mentioned, that besides the phos-
phates, the iodide of mercury was administered, but I never
have met with such a rapid cicatrization of syphilitic ulcers,

\. 8. VOL. VII. NO. viir. 31

484 Casein in the Blood, ^c [August,

as was the case in these persons, and I could not help thinking
that the cure was promoted in a remarkable degree by the
internal exhibition of the phosphate. With respect to this
point, 1 have drawn attention to the relation between scrofula
and syphilis, and I think there are many symptoms in both of
these diseases, and many facts besides which evidently show an
intimate relationship between them, and require a more accu-
rate study than has been given to them hitherto.

As to other affections, in which I have tried the phosphate
of lime, I have to mention rickets, caries, inflammations, and
consecutive abundant suppurations of the cellular tissue, and
also fracture of the bones. In all these cases the administra-
tion proved most beneficial, and I would stronfjly advocate its
further experimental use. With respect to fractures of the
bones, 1 have to state in particular, that the consolidation of
the callus took place in a much shorter period than is generally
the case; however, loo large doses of phosphate of lime must
be shunned in these cases, as I have observed an abundant
callus, causing a deformity of the bones, produced by the daily
administration of twenty-four grains of the phosphate for a
fortnight.

With regard to the fact that phosphoric acid is always pro-
duced in the economy by the changes of albuminous substances
and supposing that this phosphoric acid might combine with
the lime, if carbonate of lime has been given, I tried also the
carbonate; but the results of its administration were not so
favorable as those' which followed the administration of the
phosphate, unless in some cases where the urine presented a
high degree of acidity. This even was the case in many
children afflicted with scrofula, and it must be decided by future
experiments, whether the carbonate of lime is preferable to
the phosphate in these patients. \_London Lancet,

Casein in the Blood ; Synthetical Proof hy Formation of Arti-
ficial Milk,

Dr. Panum, of Copenhagen, of whose interesting accounts
of the discovery of Casein in the Blood, we gave a translation
in the July number of this Journal for 1850, has published two
additional articles on the subject in the Bibliothek for LcBger
for April and July 1850.

In his article in the April number, after recapitulating the
facts broucrht forward in his previous paper, and pointing out
the difficulty of establishing a chemical or a physiological dis-
tinction between casein and coagulated albumen, the author
observes :

1851.] Casein in the Blood, <^c. 485

"If we institute a comparison between the substance preci-
pitated from blood-serum by means of water and diluted acetic
acid, and albumen, separated in the same manner from its com-
bination with soda, tee find iru\y orreater differences than can be
distinguished between casein and coagulated albumen. * * *

'* Before the publication of my former contribution, I had
already performed various experiments with the view of insti-
tuting a more accurate comparison between the material under
consideration and albumen separated from its combination with
soda. To procure albuminate of soda, I separated the albumen
from the serum, then added soda, and applied slight warmth.
A greater or less quantity of albumen (according to the quan-
tity of soda employed) entered into combination with the alkali
as albuminate of soda, and was precipitated by acetic acid. A
difference was here observed between the albumen of serum
and that of an egg. For while albumen from an egg required
nn warming to promote its entering into combination with soda,
or its precipitation by means of acetic acid, the albumen of
serum had to be slightly warmed before it would unite with an
alkali, or give a precipitate with acetic acid.

"The albumen which was precipitated from albuminate of
soda, as above described, was always soluble with difficulty,
even in a considerable excess of acetic acid ; eight or ten parts
of acetic acid to one of albumen produced no solution. On the
other hand, the material originally present in the serum, and
precipitated from it by acetic acid, was soluble in so slight an
excess of acetic acid, that it is almost di finer test of the acid,
alkaline, or neutral properties of the liquid, than litmus paper.
This difference seems important; and can scarcely be without
essential influence on the organic economy.

*'The precipitate thrown down by acetic acid from albumi-
nate of soda, appears us firm flocks, which are not changed by
shaking, and which resemble what is seen when a not too hio^hly
diluted solution of albumen is boiled. The other matter pro-
duces a perfectly homogeneous opacity in the liquid, and only
after some time forms something like a solid deposit in the
bottom of the vessel, which, however, immediately disappears,
and is resolved into a general opacity, when the liquid is slightly
moved.

"Moreover, if the albumen precipitated from a somewhat
diluted solution by boiling, or from a solution of albuminate of
soda by acetic acid, be collected in a filter, it forms, when half
dry, an elastic mass, by no means glutinous The other sub-
stance, on the contrary, when half dry, forn^s a very glutinous
mass, almost like turpentine or bird-lime.

" The albumen, when collected in a filter, has, when dry, a

486 Casein in the Blood, <SfC. [August,

dirty yellow brown colour. In my previous contribution, I
referred to the circumstance, that the substance I am describing
sometimes assumed a beautiful green colour when thoroughly-
dried. At that time, I attributed it more to accidental circum-
stances than to any essential difference, that the substance
became green or yellow-brown on drying, as from the same
serum I sometimes procured a green and sometimes a yellow
product. I now find, that the substance is always of a beauti-
ful green colour when the serum is perfectly clean and free
from red blood corpuscles. But if serum be used, in which
there is found a greater or less number of blood-corpuscles, the
green colour is efl^aced by the accompanying redness of the
blood, and the product becomes either dirty yellow or dirty
brown, according to the number of blood-corpuscles. The
green colour is removed neither by alcohol, ether, nor water,
and seems to belong essentially to the casein.

*' However lightly these differences may be thought of, they
are yet not less important than the distinction already referred
to, between the so-called soluble casein and albuminate of soda.
The preconceived opinion that the material under considera-
tion must be albuminate of soda can thus no longer serve as a
proof against its identity with what is called casein, or the
essential nitrogenous constituent of milk."

Relative Quantity in the Blood. Dr. Panum states that he
engaged in a quantitative analysis of the casein in different
individuals. He does not yet attempt to draw conclusions;
but states that in 1000 parts of dried serum he has found in
men, in 3 cases, from 4 to 7 parts ; in 8 cases of women, from
5-5 to 12-5 parts. The greatest quantities (9'9 11-4 12*5)
were in lying-in women shortly after parturition. In nurses
there was an average of from G'5 to 7'4 parts.

Formation of Artificial Milk. In the July number of the
Bibliotheli for Lceger, Dr. Panum writes as follows: "It
occurred to me that the question of the identity of the material
I have been describing with casein, might be solved by the
synthetical method, which, though it can seldom be satisfacto-
rily employed in scientific diagnosis, yet in the inability of
analytical chemistry with regard to the protein compounds, is
not to be despised. If it were possible, by adding the necessary
constituents, to form from the substance under consideration
some universally known product containing casein, such as
milk or cheese, we should have a striking proof of the identity
of the substance with casein.

I obtained a quamity of serum from bullock's blood. To
this I added acetic acid, in the proportion of six drops of con-
centrated acid to an ounce of serum, and then a considerable

1851.] Casein in the Blood, ^c. 487

quantity of water. The substance described in my former
contributions sank, on standing, to the bottom of the vessel, so
that the superabundant clear fluid could be poured off. On
again adding water and letting the substance sink to the bottom,
it w\is rendered almost perfectly free from soluble albumen, etc.
After it had settled as much as possible, the water was poured
off, so as not to waste the substance, which remained suspended
in a greater quantity of water than casein is diluted within
mi.k. It was now my object to find out, whether the solution
of this substance produced by salts or an alkali could be brought
to coagulate by contact with the mucous membrane of the
stomach of kittens or puppies ; and whether it were possible to
produce a substance which, in taste and other circumstances,
should agree with milk. But as it would probably be difficult
to make animals use the solution as milk, unless the other con-
stituents of milk, namely butter and sugar, were mixed with it,
and as the taste and peculiarities ol cheese might be modified
by them, I first tried, by adding these substances, to produce a
liquid which should have some resemblance to milk. At a
temperature of 80 Raumur, I added to the milky liquid, phos-
phate of soda, till all the supposed casein was dissolved. I then
added butter and sugar in the proportions in which they are
usually contained in milk, and, after the butter was melted, I
shook the whole mixture in a flask. The liquid, at first greyish
or dirty yellow, became of the colour of egg-flip, and, as it
cooled, became more and more like milk. The clearer and the
less mixed with red blood-corpuscles the serum was, the clearer
was the solution and the whiter the milk-fluid. If the serum was
perfectly free from blood-corpuscles, the emulsion, when diluted
with water, had the same bluish colour as milk and water; but if
there was a strong blood-red tinge in the serum, the solution in
phosphate of soda had a reddish and the emulsion a weak yellow-
ish tint. The product had a taste which bore a most strinking
resemblance to that of true milk; only it was a little more
sweet, and left a feeble, though recognisable, bitter after-taste.
Under the microscope, I observed in the emulsion innumer-
able small globules, exactly like those in milk. On comparing
them with those found in milk, scarcely any difference could
be perceived, except that their average size in the artificial milk
was somewhat greater than in the natural. The globules in
the artificial milk were surrounded by a covering, and not simple
drops of oil ; this covering often showed a distinct though very
fine folding, especially on the larger globules. The globules
(like those of true milk) were not dissolved in ether, until the
covering had been removed by treating them with nitric acid.
But by the side of these small globules there were some which

488 Casein in the Blood, <^c. [August,

were somewhat greater, and presented in their interior appear-
ances which, if they had been lurnished from the organised .
body, would have been certainly considered as nuclei, granular
cell-contents, etc.

As the difficulties, which might have been expected to arise
in the microscopic comparison of the artificial and the true
milk, had so unexpectedly disappeared, I felt myself called on
to inquire whether any more perfect imitation could be attained.
The most striking difference, which the artificial milk presented
on a superficial examination, was that it required a far shorter
time than real milk to form a layer of cream on the surface, and
that, after standing some time longer, a layer of clear liquid
was formed at the bottom of the vessel. I ascribed this failure
to the greater average size of the globules in the emulsion, as
compared with true milk-globules. When I employed sugar of
milk in place of common sugar, the emulsion was uniform, and
showed no layer of clear liquid at the bottom of the vessel,
even when more water was added. At the same time, the
average size of the corpuscles became less, so that they could
not be distinguished by their size from the true milk-globules,
and they were now free from any appearance of nuclei or
granular cell-contents. The cream was longer in rising to the
surface ; and the great sweetness which the emulsion had, when
made with common sugar, was no longer prominent, so that
the liquid tasted still more like milk. A slight smack of salt
disappeared, when the butter was washed in water; and a
slightly harsh taste of the butter was still farther removed when
unsalted butter was used, which had been freshly churned, and
washed with water. There was still a slightly bitter after-
taste, but this was removed by using carbonate instead of
phosphate pf soda; a much smaller quantity of the former salt
being required to produce the required solution. It was now
impossible for me to recognise, by the taste, any difl^erence
between artificial and real milk. As, however, it might be said
that '^ de gustibus nonest disputandum,'" I submitted the liquid
to the taste of others, with tlie same result.

It now only remained, to render the agreement perfect be-
tween the artificial and true milk, that the former should coagu-
late when brought into contact with the mucous membrane of
the stomach. When I used common sugar, it was not won-
derful that my attempts thus to make the liquid coagulate, failed ;
for it is well known, that the addition of sugar to milk retards
or prevents its coagulation. But, even after I had used sugar
of milk, I could not perfectly succeed in making the milk coagu-
late. Instead of fresh calf s stomach, I used the artificially
prepared swine's stomach, which is commonly used in the

1851.] Diagnosis of Asthma, ^c. 489

dairies, with or without a temperature of 40 R.; and I also gave
the hquid to two kittens, who drank it greedily, and whom I then
killed. Under these circumstances, as well as by mere stand-
ing, the artificial milk turned, and separated into a clear liquid,
and a thick curdy mass, which had very strongly the well
known smell of sour milk ; but I could not produce a consis-
tent coagulum, which could be collected in linen, and pressed
out. But when the original substance separated from the
serum, after being washed from soluble albumen, was warmed,
it formed masses resembling pressed curds, and could be col-
lected on a cloth, while the liquid ran through quite clear.

The identity of artificial with natural milk, and of the sub-
stance found in the blood with casein, may seem to be not
proved ; yet the resemblance is so great as to strengthen the
probability of their being identical. I have in vain endeavor-
ed to produce from albumen, precipitated from albuminate of
soda by acetic acid, and dissolved in phosphate or carbonate of
soda, a liquid having the slightest resemblance in taste to milk.
\_London Journal of Medicine. Med. Examiner.

Diagnosis between Spasmodic Asthma, and other Affections
IV hie h are accompanied by Asthmatic Paroxysms. By Dr.
J. Bergson.

L Between it and Axgixa Pectoris.

A. Symptoms in Common. The accessions coming on sud-
denh% with distress of breathing. The countenance, during
the accessions, equally altered and anxious, the eyes prominent,
and the cheeks colourless ; the pulse weak and small.

B. Distinguishing Symptoms.

In Angina Pectoris. In Asthxa.

1. The distress overpowering 1. The distress not so intense
and accompanied by a feeling as and not limited to any one point,
of approaching death. The anxi- but extending throughout the
ety indescribable, and the seat of whole chest.

it under the sternum at the pit of
the stomach.

2. The distress, however, vio- 2. The breathing confined, and
lent, yet not interfering with res- the constriction producing a sense
piration. ofapproaching sufibcation.

3. Tiie paroxysms usually oc- 3. The paroxysms almost al.
curring in the day time, andcom- ways occurring at night, when
ing on while the patient is walking, the patient is in bed.

standing, or speaking.

490

Diagnosis between Spasmodic Asthma [August,

4. The respiratory motions ir-
regular and laborious ; the thorax
impelled up and down, but with-
out having its capacity expanded.
Hollows formed above and be-
neath the clavicles. The patient,
even with the strongest efforts,
cannot take a deep inspiration.
Respiration seems at times to be-
come almost impossible.

5. No such phenomenon oc-
curring.

6. The action of the heart un-
changed, but there is a sibilant
ronchus, with failure of the respi-
ratory murmur.

7. The accession terminating
with copious bronchial secretion.

4. The respiratory motions ne-
ver violent, and not visibly dis-
turbed, except inasmuch as it may
arise from the general state of dis-
tress. No peculiar dyspnoea, and
the patient can often, by a strong
effort, take a deep inspiration, even
while the paroxysm is most se-
vere.

5. The painful sensation which
is at first confined to the cardiac
region extending in all directions,
and especially lodging in the left
arm.

6. The heart's action but little
changed. No alteration appreci-
able to auscultation or percussion.

7. The accession terminating
with eructations or yawning, but
with no vomiting.

II. Between it and Spasm of the Thorax (i. e. of the Ex-
ternal Muscles concerned in Respiration).

A. Symptoms in Common between asthma, which is a
spasm of the bronchial tubes, and spasm of the external muscles,
are, that in both respiration is affected suddenly and in parox-
ysms; the chest and shoulders are convulsively raised and de-
pressed ; and the difficulty of breathing approaches suffocation.
The patients in both are unable to speak, but once the parox-
ysm has terminated, are then completely freed from all pain or
obstruction in breathing.

B. Distinguishing Symptoms.
In Spasm of the Thorax. In Asthma.

1. Respiratory murmur per- 1. Respiratory murmur almost
fectly natural. extinct.

2. Dyspnoga to such a degree
that both inspiration and expira-
tion become equally constrained,
with a feeling of internal oppres-
sion.

3. The paroxysms at night.

2. Dyspnoea present only in
proportion to the degree in which
inspiration is impeded by the spas-
modic action of the external mus-
cles.

3. The paroxysms mostly du-
ring the day.

4. The spasm never occupying
more than one-half of the chest.

5. The spasm ceasing without
any critical evacuation.

4. Asthmatic oppression over
the whole chest.

5. The paroxysm terminating
with an abundant expectoration.

1851.]

and some other affections.

491

III. Between it and Paralysis of the Thorax.
A. Symptoms in Common. Dyspnoea coming on in a par-
oxysm at night during the first sleep. In both cases the patient
complains of inability to expand the chest in respiration. .

B. Distinguishing Symptoms,
In Paralysis of the Thorax. In Asthma.

1. Some degree of deformity in 1. No necessary deformity, ex-
the breast or back, from defect in cept that the chest appears dis-
the action of the nerves supplying tended like a barrel.

these parts. Hence arise curva-
tures, inequality in tiie height of
the shoulders, or chicken- breast.

2. Laborious respiration can be
produced merely by pressing on
the abdomen, which renders evi-
dent the deficient action of the
muscles of the chest.

3. The most frequent subjects
of the disease are delicate young
persons before puberty, and it of-
ten arises from hooping cough.

IV. Between it and Intercostal Neuralgia

In Intercostal Neuralgia.

1. The pain is in the space be-
tween the ribs, and follows the
course of the intercostal nerves
from their origin at the vertebrae
to their termination at the ster-
num.

2. Pressure at the origin of the
affected nerve always produces
pam.

2. During the intervals pres-
sure on the abdomen produces no
approach to asthma.

3. Asthma generally attacks
men of strong constitution, and
without any previous disease.

In Asthma.
1. The painful sensation dif-
fused indefinitely over the whole
chest, and not confined to the
course of any nerve.

3. The disease occurs especial-
ly in females, and principally in
women of sensitive habit.

4. No morbid phenomena de-
tected by auscultation or percus-
sion.

V.

2. Pressure on the spine, unless
spinal irritation be present, is un-
accompanied by any painful sen-
sation.

3. It mostly attacks men of ro-
bust constitution.

4. During the accession there
is either a mucous or sibilant ron-
chus.

Between it and Hyper^esthesia of the Pulmonary
Plexus.
Laennec distinguished this kind of asthma, in which, not-
withstanding a sensation of inability of adequately breathing,
which is felt in the highest degree, yet the expansion of the
chest goes on well, and the respiratory murmur is not only un-
diminished, but rather assumes the character of puerile respi-

492 Diagnosis between Spasmodic Asthma [August ,

ration. This he designated as asthma with respiration. Along
with Canstatt and Romberg (BerHn, 1846), our author is in-
cHned to consider this asthma as a hypcrsesthesia of the lungs,
and as having its seat in the sensitive portion of the par vagum,
in the same way as he considers spasmodic asthma to have its
seat in the motor portion of the same nerve.

A. Symptoms in Common. Accessions coming on sudden-
ly and characterized by violent dyspnoea, incapacitating the
patient from doing anything as long as it lasts. In both there
are often catarrhal symptoms.

B. Distinguishing Symptoms.

In Hyperesthesia of the Pul- In Asthma.
MONARY Plexus.

1. The accessions occurring 1. The accessions coming on
mostly in the day, and aggravated at night, and relieved in some
by any movement of the body. measure, by pressing down the

arms.

2. Respiration goes on well, 2. The respiratory murmur is
and on auscultation is discovered oppressed.

to be puerile.

3. The expression of the coun- 3. During the accession the
lenance unaltered. countenance is contracted and

anxious.

4. Expectoration during the ac- 4. Expectoration not occurring
cession is easy, but yet not attend- till toward the termination of the
cd with any relief. accession, and always attended

with relief.

VI. Between it and Respiratory Paralysis of the Par

Yagum.

Respiratory paralysis was first pointed out by Romberg,*
and he made two divisions of it, viz., the first paralysis of the
vagum, which influences the respiratory muscles of the larynx ;
and the second, paralysis of the spinal nerves supplying the
respiratory muscles of the trunk. The last is the paralysis of
thorax of No. 3. The disease now before us is occasioned
generally by pressure of indurated glands, or other tumours on
the par vagum or some of its branches, and presents symptoms
which may readily be mistaken for those of asthma.

A. Symptoms in Common. Accessions coming on sudden-
ly, and having intervals perfectly free from oppression. In the
paroxysms the distress often amounts to approaching suflx)ca-
tion, with the formation of various bronchial sounds, while the
respiratory murmur is enfeebled.

* De Paralysi Respiratoria, Berol, 1845.

1851.]

and some other affections.

493

B. Distinguishing Symptoms.

In Respiratory Paralysis of
THE Par Vagum.

1. The attacks come on after
any considerable motion of the
body, and cease as soon as the pa-
tient lies down again.

2. The voice in the course of
the disease assumes a whispering
or hoarse sound, or is reduced to
complete aphonia.

3. The disease mostly attacks
scrofulous children, arising from
pressure of tumours in the neck.

VII.-

In Asthma.

1. The paroxysms coming on
duringsleep and when lying down,
and are relieved by sitting up.

2. No change of the voice or
of speech.

3. Occurring rarely, except in
adult age, and without any traces
of lymphatic swellings in the
throat or neck.

-Between it and NightiMAre (Incubus).

A. Floyer had already recognised a resemblance between
asthma and nightmare, inasmuch as the latter comes on in
sleep, and produces lacorious respiration with moans, the chest
being compressed as by a superincumbent weight, and the pa-
tient in all the horrors of approaching suffocation ; and Rom-
berg, in his late work, has placed it amongst his hyponeuroses.

B. Distinguishing Symptoms.
In Nightmare.

1, As soon as the patient is
completely awakened, all the feel-
ings of approaching suffocation
are at an end.

2. While in the fit, notwith-
standing the greatest difficulty of
breathing, yet the patient is una-
ble to move his limbs or to call for
help.

3. Auscultation detects no ab-
normal sound.

1. The asthmatic fit at once
wakens the patient out of sleep,
who, though completely roused
up, yet has to seek the upright
posture in order to breathe more
freely.

2. The patient gets up, and is
able to assunie the easiest posi-
tion.

VIII.

3. The respiratory murmur is
oppressed.

Between it and Pneumotyposis.

A. Symptoms in Common. Pneumonia, bronchitis, and
pleurisy, when occurring in an intermittent form, are included
by our author under the one name, pneumotyposis, and in this
form they agree in resembling asthma, by reason of the sud-
denness of their accessions, and from their recurring in par-
oxysms.

494

Diagnosis of Asthma, <^.

[August,

B. Distinguishing Symptoms.

In Pneumotyposis.
1. The paroxysm commencing
with a rigor, and the oppression in
the chest not decidedly manifest

till the hot stage.

2. The paroxysm occurring at
regular periods, and thus assum.-
ing the character of quotidian,
tertian, &:c.

3. Auscultation and percussion
reveal the existence of pneumonia,
bronchitis, or pleuritis, which still
continues in some degree during
the intervals.

In Asthma.

1. The paroxysm commencing
without any change of tempera-
ture, and the severest difficulty of
breathing coming on from the be-
ginning.

2. A much inferior tendency
to regularity in the return of the
paroxysms.

3. The symptoms to be detect-
ed by auscultation, and especially
the mucous sounds coming on
chiefly towards the end of the par.
oxysm.

IX. Between it and Submucous Laryngitis or CEdema of
THB Glottis.

A. Symptoms in Common. The patient is seized with a
fit of suffocation, which soon attains its highest degree. The
countenance becomes congested, the eyes starting from the
orbits, and at the same time the extremities become cold ; in
short, presenting the appearance of asthma in its severest form.

B. Distinguishing Symptoms.
In CEdema of the Glottis. In Asthma.

1. Inspiraiion produces no pain- 1. The impediment to inspira-
ful sensation in the chesf, but only tion is proved to be not so much in

in the larynx, to which the patient
refers all his difficulty of breath-
ing.

2. Every eflbrt to draw in the
breath is accompanied by a whee-
zing sound.

3. Expiration goes on uninter-
ruptedly.

4. The patient thinks there is
some large foreign body in his
larynx, which he would gladly get
rid of.

5. The suffocative attack lasts
only from two to four minutes.

6. It returns in fi'om five to ten
minutes.

7. The cough is dry and of a
croupy sound.

the larynx as in the chest.

2. Inspiration takes place with-
out any peculiar sound in the
larynx.

3. Expiration and inspiration
are equally difficult.

4. No sensation as of a foreign
body in the larynx.

5. The asthmatic attack lasts
several hours.

6. It returns at the utmost in
about every twenty-four hours.

7. The cough moist and with
the usual sound.

[Dublin Journal.

1851.] Coup de Soleil or Suii-Slroke. 495

Coup de Soleil or Sun-Sir oke,

III "a summary of the transactions of the Coll. of Phys. of
Philadelphia," published in the last number of the American
Journal of Medical Sciences, are some remarks by Dr. Pepper,
one of the physicians of the Pennsylvania Hospital, on the
above disease. " He considered it a remarkable circumstance
that this affection has received so little attention from medical
writers." " In consulting the standard authorities, we find but
little said in reference, and that generally vague and unsatis-
factory." This fact is, in our opinion, easily accounted for.
The disease seldom occurs except in crowded communities, as
in large cities ; and in these, only among a particular class, the
common laborers, who earn their daily bread by their daily
work, and are consequently compelled, usually, to labor during
the intensest heat of the day, when the thermometer, in the
shade, ranges from 9G to 100 degrees and over, with not only
the direct rays of the sun playing full upon them, but also the
reflected rays from pavements and buildings. Added to this, as
the efficient and exciting cause, we liave fatigue, intemperance,
and often insutlicient or improper food as predisposing agencies ;
these causes do not usually exist in the country, and in small
communities, where, if labor is performed in the heat of the day,
and under exposure to the sun, it is with a supply of fresh,
wholesome air, with none of the other predisposing causes ; the
powers of the constitution will, under such circumstances, gen-
erally resist its baleful influence. The members of this class,
when any accident befalls them, are almost always conveyed
immediately to the hospital ; and therefore it is rather rare for
a private physician to be called to treat a single case of coup
de soleil, and of course nothing can be furnished by him on the
subject in the way of practical experience. When brought to
the hospital, it is generally at an hour when the attending phy-
sician is absent, and the case usually dies before his next visit,
or is so far recovered as not to call for his particular notice, so
that he knows but little personally of the phenomena of the
disease. It is thus only seen by the resident physician, who, in
the discharge of his multitudinous duties takes no particular
note of the symptoms or history of the cascf but sees the patient
die in a few hours, perhaps in a few minutes, after his admis-
sion, and thinks no more of it.

Private physicians are sometimes called suddenly in the heat
of the summer, to a man who has "fallen down in a fit, while
at work," and regarding the case as one of apoplexy, he pulls
out his lancet, bleeds him and sends him to the hospital. This
is almost universally the practice. Dr. Pepper says, of twenty

496 Coup de Soleil or Sun-Stroke, [August,

hospital patients, all had been bled previous to admission.' This
fact is, of itself, a strong indication that some knowledge of
pathology of the disease is much needed in the medical com-
munity ; for it is well known to those who have had much ex-
perience in this disease, that venesection, if it succeeds, is almost
certain death.

In this city, the disease is quite common in the months of
July and August, commencing sometimes as early as the mid-
dle of June and ending as late as the first week in September.
In the summer of 1847, if I remember rightly, there were thirty-
seven cases in four days. Most of them died so promptly, that
there was not time to convey them to the hospital, the coroner
being usually the only physician who saw them. Not only
were men affected, but animals, omnibus horses especially, it
being quite common to see them fall and die in the street.
During the last fiv^e years, according to our records, forty-two
cases were admitted into the hospital. Of these, twenty-four
died, and eighteen survived. Fourteen occurred in the month
of August, twelve in July, twelve in June, and four in September.

The prognosis in this disease, as in cholera, depends almost
entirely upon the stage in which the disease is seen. If in the
stage of collapse, the stage is almost hopeless. So that one
physician might have ten cases, and all might recover ; another
micijht have the same nuinber, and the treatment be equally
judicious, yet nine out of the ten might die.

Nearly half of the cases that have been brought to this hos-
pital, as far as my own experience extends, have been in the
stage of collapse, or bordering upon it. They were usually
brought in late in the afternoon, and, of course, some hours
after the inception of the attack. They have then been coma-
tose, with cold surface, except that of the head, which is often
very hot, feeble, frequent and fluttering pulse- scarcely percep-
tible at the wrist, dilated and inactive pupils, respiration labored,
sometimes stertorous. Sometimes they ha\e lain perfectly
motionless and paralyzed, sometimes restless, sometimes in con-
vulsions. Often, when in this state, under the application of a
powerful stimulus to the surface, as burning alcohol to the legs,
a patient has sprung up in bed, stared at those around him for a
moment, asked for ^ drink, taken it, and then fallen back again
into his former condition. In a less advanced or less severe
stage of the disease, the patient has presented pretty much the
same symptoms, but in a less marked degree. The pulse is
frequent but not so feeble and irregular, the pupils act feebly,
the surface is cool, the head perhaps burning hot ; patient is
perhaps in a state of partial coma, from which he can be arous-
ed, however, by addressing him by name, in a loud tone ; the

1851.] Coup^de Scleil or Sun-Stroke. 497

respiration is quick and labored, but not stertorous ; sometimes
he has convulsions, quasi epileptic; sometimes he is extremly
restless, requiring to be held in bed. In a still earlier or less
severe stage, the patient is perhaps able to walk witli assistance,
complains of intense pain in the head, which is usually hot.
The extremities are cool ; pulse not much altered, not hard or
bounding; no infection of eyes; pupils rather dilated, if altered
at all.

Perhaps one or two cases by way of illustration, and briefly
stated, would not be amiss here.

C. 1st. A man, name unknown, about forty years of age,
was brought to the hospital about noon, July 27th, 1848, and
admitted under Dr. H. D. Bulkley. He had fallen in the street
a short time previous to admission. Was in a state of complete
cotna, with labored and irregular respiration, quick and flutter-
ing pulse, head hot, pupils immovably dilated.

Treatment. Sinapisms to feet, legs and stomach. Ice ta
head' and stimulants. He survived but a few hours.

Autopsy, eighteen hours after death. Brain normal : lungs
slightly congested crepitant. Other internal organs healthy.

C. 2d. Michael Collyer, native of Ireland, laborer, was ad-
mitted under Dr. Griscom, Aug. Uth, 1848, in a state of in-
sensibility, having fallen down in the street, respiration sterto-
rous, pupils dilated, pulse quick, feeble and irregular.

Treatment.. Turpentine enema. Sinapisms to chest and
limbs stimulants freely. Patient survived but a short time.

Autopsy, eighteen hours after death. Brain slightly con-
gested ; lungs emphysematous at some points ; other organs
healthy.

In these cases, as has been seen, there was no marked con-
gestion of the internal organs. In nearly all the cases that
occurred in 1850, there was well-marked congestion of these
organs; sometimes of the lungs, sometimes of the brain. Thus,
out of eight cases recorded in our books, there was congestion
of the lungs in two, and of the brain in four. In one of the
remaining two, there was apoplexy, and this man was bled in
the hospital, being the only case out of the forty-two in-which
the lancet was considered admissible; the case proved fatal.

In the remaining case, there were well marked epileptic con-
vulsions; this case, terminated favorably. The congestion of
the brain in two of the four cases was inferred from the symp-
toms as the cases recovered. In the others, it was revealed
by a post mortem inspection. In no case was inflammation of
the brain or its membrane observed ; and in all the cases the
same course of treatment was pursued, with the above men-
tioned exception. Cups were applied to the temples in the

498 Treatment of Erysipelqs, [August,

cases suffering from head symptoms, such as heat, dilated pupils,
stertorous breathing, pain, but external and internal stimulation
of the most active kind was indicated in all, except perhaps in
those admitted in the first degree or stage of the disease.
Sometimes the patient was placed in the warm bath, and at the
same time, the cold douch was applied to the head ; this usually
seemed to have some effect, though but temporary. In the
cases which showed congestion of the brain, at the autopsy,
the symptoms were still such as to require prompt stimulation,
the only difference in the treatment being the local abstraction
of blood from the temples, and the application of ice to the
head. I knew of one case in private practice in the year 1847,
which occurred in a high liver, of apoplectic build, and showed
marked symptoms of apoplexy. The attack yielded with some
difficulty to large bleedings.

Insolation is almost uniformly nervous exhaustion, and is to
be treated as such. We are not to bleed because the patient
is a robust man, and has fallen in a fit at his work, which seems
to be the only circumstance taken into consideration usually
by the physician who is hurriedly summoned to such a case.
The pulse is always a sure guide. [New York Journal of
Medicine.

The Treatment of Erysipelas by the Muriated Tincture of Iron.
By G. Hamilton Bell, Surgeon, F.S.CS.E.

It will be generally admitted that practical observations on
the treatment of diseases of daily occurrence are more valuable
to the medical practitioner than the most interesting descrip-
tions of anomalous cases, however extraordinary in their char-
acter, or successful in their treatment. I am convinced, indeed,
that the publication of the journals of well-employed medical
men, giving in detail the treatment of every case occurring in
their private practice, would prove most useful to the young
practitioner, and be a valuable contribution to our medical
literature.

In furtherance of such views, I am anxious to bring to the
knowledge of my professional brethren a mode of treating ery-
sipelas, differing from that usually resorted to, but which I have
found invariably successful. I have no intention, however, of
writing a treatise on a disease so well known, and on which so
much has been recently published, because I think my object
will be fully attained by reporting a few cases from my own
journals, illustrative of my experience.

My purpose, then, being purely practical, it would be out of

1S51.] Treatment of Erysipelas, 499

place to premise with a disquisition on the nature and causes
of inflammation ; but in order to explain in some measure the
principle by which I have been actuated in employing a pow-
erful tonic in a disease generally occasioning so much fever
and cerebral excitement as erysipelas, I consider it necessary
to repeat the opinion I have elsewhere expressed viz., that
"in inflammation, the capillnry vessels having apparently lost
the power of separating or electing the component parts of the
blood which are necessary for functional purposes, and become
to a certain extent inert tubes, a stream of blood is admitted,
for the circulation of which they are not calculated." In other
words, I consider that in erysipelas the capillary vessels are in
an atonic state.

This hypothesis appears to me to be supported by the effect
of the treatment I have adopted in erysipelas the cases demon-
strating that when an extensive portion of the surface of the
body is violently inflamed, producing a high degree of fever
and cerebral excitement ; on the system being rapidly sur-
charged with, or brought under the influence of, the muriated
tincture of iron, while the cerebral afl^ection and other symptoms
of fever subside, the local pain is relieved, and the redness and
swelling gradually disappear; and, so far as the tonic medicine
appears to be concerned, all this is efl^ected without any appre-
ciable evacuation from the emunctories of the system.

But refraining from theory or speculation, and in the hope
that I shall lead to the general adoption of the practice I have
suggested, and which I shall illustrate by a few cases, I shall
proceed at once to state shortly the mode of treatment I have
resorted to, in every case of erysipelas I have attended for up-
wards of a quarter of a century, without having in a single
instance failed of success. I have found that my remedy is
not only effectual in removing erysipelas, but that it generally
renders the patient more healthy and robust than before the
attack of the disease ; and in no instance in which I have had
the charge from the commencement of the disease, lias suppu-
ration taken place. I have for a series of years pressed pri-
vately on the attention of the senior members of the profession
the value of this remedy in the treatment of this always trouble-
some and often flital disease ; and I have taught many of my
junior brethren successfully to combat it. But my prolonged
experience of the invariable success of my practice, justifies
me, I think, in thus bringing it to the notice of the profession
generally, trusting that, in the hands of others, it may prove as
great a blessing as it has in mine.

Mode of administering the Remedy. Of course the first
object is to have the bowels freely acted on. If the erysipelas

N. s. VOL. vn. NO. viii. 32

600 JEthereal Solution of Iodine. [August,

be mild, fifteen drops of the muriated tincture of iron are ad-
ministered in water every two hours until the disease is com-
pletely removed. When the attack threatens to he more seveie,
the dose of the tincture is increased to twenty-five drops every
two hours, and persevered in night and day, however liifrh the
fever and delirium. The only local applications I ever find
necessary, are hair powder and cotton waddinir. VVhile I
depend for the removal of the disease on the chalybeate, it ij
necessary that the bowels should be attended to througliout the
treatment.

I have in my journals several cases in which erysipelas wns
combined with f^Dut. Two of these occurred in gouty subjects,
and in both the health was restored by the chalybeate, as in
the above case of Mi-. C. This iientleman had, two years ag \
an attack of erysipelas in his thi^jh, and was cure.d by the steel
drops. He never had gout bcibre, but I understand his father
liarl suffered from it.

With regard to the diet of tlie patient under erysipelas, unles:?
when there is much fever, I always rccoinmend it to be gener-
ous, and of easy digestion. In a case at present convalescent,
in which the attack was very similar to Mr. ('.'s, while the
great toe and foot were violently inflamed, the knee of the
other leg was also afiected. From the habits of the p;tient
a constitution broken from intem|)erance I was obliged to
allow, along with the drops, nearly a bottle of port a-dny. In
this case the ])odagral erysipelas has disappeared, and my
patient is in better herdth than he has had fur many months.
\ Edinburgh Mont/nj Jour, of Med. Scince. Boston Med. and
Sur. Jour.

JEthereal Solution of Iodine.

I beg to offer to your notice a preparation of iodine, which
is as yet unknown to the profession, except to a few in this
locality whose attention I have directed to its efficiency as a
counter-irritant. I have employed it in my practice for upwards
often vears, and generally with the most satisfactory results,
in the most of those cases where the use of the tincture is com-
monly indicated. It is applied in the same way as the tincture,
by means of a camel-hair pencfd rubbed over the part, until it
begins to produce a buining sensation in the part; then cover
it with a pledget of wadding, so as to prevent evaporation. For
the first fifteen minutes the burning sensation is pretty severe,
so as to alarm some patients. Yet it soon becomes tolerable,
but usually continues to be felt Tor several hours. The next
day ihe cuticle has a dry hardened feel, having the iodine color ;

1851.] Creasote in Diarrhcea. 501

and great relief to rieep-seated pain is obtnined. In the course
of two, three or four days, vesication will be observed around
the edges of the superficial eschar which has now commenced
to suppurate; and as the destroyed cuticle cleans off, a very
copious discharjze of purulent matter takes place, and may be
kept up for two or three weeks under the popular application of
a cabbacre leaf, or oiied silk, which 1 usually apply on the second
day. The surface of the sore assumes a fine granular appear-
ance, and heals without leavins: a cicatrix. I have often thought
that, in cases of chronic inflammation of the joints, this appli-
cation is more efficient than the caustic issue, relieves pain
quicker, and can sooner be repeated.

I have frequently derived great benefit from keeping up a
discharge from the chest in chronic affections of the lungs,
making a sore the size of a quarter or half dollar at a time, and
opening a new sore as the other heals.

This solution is very simply prepared. I commonly use the
sulphuric ether of the shops; but the stronser the ether, the
more efficient is the preparation. Hence the importance of
obtaining a good article and in full strength.

I commonly put a quantity of pure iodine into a phial, and
add sulphuric ether until dissolved; that is, the ether must be
perfectly saturated. To make the solution as stronjj as possi-
ble, I have added a few grains of the iodide of potassium, which
furthers the capability of the ether to take up more of the
iodine. There are different modes by which this can be pre-
pared, that will be readily sugi^ested to your several readers.
All of them, however, will tend to the same result.

In some cases it may be used at a reduced strength, accord-
infj to the amount of counter-irritation or stimulation which
individual cases may seem to require.

I am yours trulv, Robert Thompson.

Dover, N. H., June 27, 1851. ""[Bos, Med. and Sur. Jour.

Creasote in Diarrhcea.

M. Kesteven extols (London Med. Gaz., Feb. 1851) the effi-
efficacy of creasote in the cure of diarrhoea. The form in
which he used it was: ^. Creasoti n]j to tt|v; Spt. ammon.
arom. ^.xv to 5j; Aq. !j to 5 iss. Where pain iias been se-
vere, Tine, camph. cd. has been added.

In no single case, Mr. K. says, has creasote failed to be of
signal benefit; in most cases one single dose was sufficient to
arrest the course of the disease; in very few instances has it
been requisite to administer more than the second dose.

\^Anier. Jour, Med, Sciences.

502

Miscellany.

[August,

ill i 3 c c 1 1 a n 2 .

Value of Vaccination. Dr. Guy, in his interesting lectures on
public health, now in course of publication in the Medical Times, has
brought forward the following striking statements illustrative of the
great value of vaccination, and of the vast saving of human life and
human suffering it has been the means of effecting :

In the history of small-pox, we have three different periods to
compare with each other: a period anterior to the introduction of
inoculation ; a period during which inoculation was practiced and
a period during which inoculation was superseded by vaccination.
As inoculation was introduced into England in 1721, the deaths
from small-pox during the ten years ending 1719 will fairly re-
present the mortality occasioned by small-pox, unmodified by the
practice of inoculation. Now, as I have already stated, the practice
of inoculation did not gain much ground till towards the middle of the
18th century, and did not become general in England till the last
quarter of that century. Hence the ten years from 1740 to 1749,
inclusive, will correspond to the introduction of inoculation into par-
tial use ; and the ten years from 1790 to 1799, inclusive, will mark
the time when it was largely and generally practiced. In like man-
ner, the ten years from 1810 to 1819, inclusive, will represent a period
during which inoculation was to a great extent, though by no means
altogether, superseded by vaccination. The ten years from 1840 to
1849, inclusive, will represent a period when smallpox inoculation,
having fallen into entire disuse, and been even declared an illegal
practice, vaccination has come to be the only preventive of small-
pox employed or permitted. It must not, however, be forgotten, that
large numbers of persons still remain unvaccinated, though the
greatest possible facilities are offered for the performance of the oper-
ation, and that without charge to the poor.

I have arranged the deaths by small-pox for the five periods often
years each to which I have just referred, in a tabular form, so that
the numbers may admit of easy comparison.

Deaths from
Small-pox.

1. Ten years ending 1719, ) ^i 228
before inoculation ) '

2. Ten years ending 1749, 1
inoculation partially > 20,029
practiced )

3. Ten years ending 1799, }
inoculation in general use 3

4. Ten years ending 1819, )
vaccination in general use )

5. Ten years ending 1849,"^

Estimated Populatiou
within the Bills of

Mortality
(limits in 11-26.)

675,691

708,188

inoculation superseded by

vaccination
tropolis)

(whole

me-

17,685

773,344

8,334

1,035,865

9,174

1,912,172

Deaths

from Small-pox

in a million

inhabitants.

31,416

28,282

22,863

8,045

4,798

1851.] Miscellany. 503

A small decrease in the number of deaths from small-pox, coinci-
dent with the partial practice of inoculation ; a still more marked
decrease under the more general use of that palliative ; but a far
more remarkable falling off in the number of deaths from small-pox,
concurrently with the introduction and extension of vaccination : such
are the results stamped on the very face of the table which you have
before you, results fully borne out by Mr. Farr, who says that " In
1771 to 1780, not less than 5 in 1000 died annually from small-pox ;
while in 1801 to 1810, the mortality sank to 2 ; and in 1831 to 1835,
to 0 83," or less than 1 in 1000.

The decrease in the number of deaths from small-pox in the second
and third periods of ten years, is a circumstance in favor of the views
of the supporters of inoculation, who affirm that that practice, though
objectionable in one point of view, was on the whole beneficial.

That inoculation may really have been the means of saving life to
some extent does not seem altogether improbable, when we bear in
mind that in place of the mortality of one in four, which attended the
small-pox caught in the usual way, the loss under inoculation, when
skilfully and carefully practiced, did not exceed owe in 500. So that
it is quite possible that the mischief which inoculation wrought by
spreading the disease among those who might never have caught the
natural small-pox, was counteracted by the good it effected in redu-
cing the danger to a very insigniticant amount. But even admitting
the justice of this compensation, the benefit really due to inoculation
does not exceed the saving of 8500 lives in 31,500 ; whereas the boon
conferred by vaccination is represented by a reduction of the mortality
from nearly 23,000 in the ten years ending 1799 (the very heyday of
inoculation) to 8000, and then to less than 5000, being a saving of life
more than twice as great as that effected by inoculation.

But the superiority of vaccination over inoculation is only partially
and imperfectly represented by the greater saving of life which it
effects. It has the great additional merit of requiring no preparation
or confinement, of producing very trifling indisposition, and of en-
tailing no danger. Above all, it is free from the great objection to
inoculation, that, while it mitigates the disease in the individual,
it brings the infection home to those who may happen to be unprotect-
ed, and who might never have been exposed to the contagion of the
natural small-pox.

% Taking all these considerations into the account, there can be no
doubt that the legislature was perfectly justified in rendering the
performance of inoculation a legal offence, and in giving, by the ap-
pointment of public vaccinators, to be remunerated by a moderate
fixed charge, large facilities for carrying the blessing of vaccination
to the very doors of the poor.

But, undisputed as is the superiority of vaccination, and undoubted
as are the benefits it has conferred, they are small indeed compared
to those which it was calculated to bestow if the practice of it had
been as universal as it ought to have been. It was the cherished
opinion of Jenner himself that we possess in vaccination a means of

504 Miscellany, [August,

entirely eradicating the small-pox, and some facts are on record which
seem fully to bear him out in that view of the case. Thus, Sir
Gilbert Blane tells us that he was informed, on good authority, " that
vaccination had been practiced with so much energy and success in
Lima that for the last twelve months there had occurred not only no
deaths from, but no cases of small-pox ; that the new-born children
of all ranks are carried as regularly to the vaccination house as to
the font of baptism ; that the small-pox is entirely extinguished all
over Peru, nearly so in Chili, and that there has been no compulsorv
interference on the part of the Government to promote vaccination."
Sir Gilbert Blane goes on to say, *'It is now matter of irrefragable
historical evidence, that vaccinulion possesses powers adequate to the
great end proposed by its meritorious discoverer in his first promulga-
tion of it in 1798, namely, the total extirpation of small-pox. The
tirst proof of this was at Vienna, where, in 1804, no cases occurred
except two strangers, who came into the city with the disease upon
them. In 1805, there did not occur a single death from it in Copen-
hagen."

1 quote this more detailed account of the progress of the small-pox
in Denmark from a MS. of Jenner's, published by Dr. Baron in his
Life of Jenner. " From the year 1762 to 1792, the number that diid
of smalUpox in the Danish dominions amounted to 9728. About the
year 1802, vaccination was first introduced, and the practice liecame
general, but not universal ; however, lifly-eight persons only died of
the small pox to the year 1810. Vaccination, i)y command of the
kino-, was now universally adopted, and small-pox inoculation prohib-
ited. And from the year 1810 to the year 1819, not a single case of
small-pox has occurred." From the same ^IS. I quote the following
passage : " From Bombay, I learn the small-pox is there completely
subdued, not a single case having occurred for ihe last two years."

" Dr. Sacco, the indefatigable superintendent of vaccination, in
Lombardy (I resume my quotation from Sir Gilbert Blane), stated in
his annual report, 3(1 of January, 1808, that small-pox had entirely
disappeared in all the large towns in that country; and that in the
great city of Milan it had not appeared tor several years. Dr. Odier,
of Geneva, so favorably known for his high professional, scicntiiic,
and literary acquirements, testifies that, after a vigorous perseverance
in vaccination for six years, the small pox had disappeared in that
city and the whole surrounding districts, and that, when casually in-
troduced bv strangers, it did not spread, the inhabitants not being sus-
ceptible. The central committee in Paris testify, in their report of
1809, that the small pox had been extinguished at Lyons and other
districts of France." "These (I still quote from Sir Gilbert Blane)
are selected as some of the earliest and most remarkable preofs of
the extirpating power. But it is demonstrable that if at the first
moment of this singular discovery, at any moment since, at the pre-
senter any future moment, mankind were sufficiently wise and de-
cided to vaccinate the whole of the human species who have not gone
through the small-pox, from that moment would this most loathsome

1851.] Miscellany. 505

and afflicting oT all the scourrjes of hunaanity be instantaneously and
forever banished from the earth." If for this somewhat too enthusi.
astic view of the case, we substitute (what Sir Gilbert Blane probably
intended to affirm) that if in any Wiiy ii could be brought about that
every man, woman, and child, for a term of years, could be vaccina-
ted, small-pox would gradually die out, and ultimately disappear, like
a fire extinguished for want of fuel, we should be stating what all
experience and analogy seem to warrant. Jn our own country, we
bavc not, that I am aware, had any proof atlorded us of the extirpa-
ting power of vaccination. But we have had some striking and en-
couraging iliustiations of the power of vaccination when systemati-
cally practiced. The army ufli^rds us one such instance. In Her
Majcsry's dragoon guards and dragoon regiments, which, in common
witn the rest of the army, are submitted to inspection, and vaccinated
without exception, it that operatio.'i is found to have been omitted,
"the deaths from small-pox during a period of seven and a quaiter
years, in an average annual strength of 6in5 men, wc-e only three
a piopo tion which would represent an annual mortality of 1 in 14,900
adult males !"

The value of vaccination is shown in a very remarkable manner
by the experience of certain severe epidemics of small-pox, which
have taken place since vaccination came into general use in thiscoun-
try. Tljr;re was such an epidemic in Scotland in 1818-1819, Mhen
a careful analvsis of the eases sliowcd that, out of 20") cases occurring-
in persons unprotected either by vaccinatii n or previous small pox,
50 died, being one death in every ybtzr cases ; out of 71 cases in
which small-pox had occurred a second time, there were ilwee deaths,
or one in 23; while out of 810 cases, occurring after vaccination,
one only died ! In this instance, then, the protecting power of vaccin-
ation proved to be more than 13 tiniesas great as the protecting power
of smallpox itself. A similar result was established in the ej)idemic
ofsmall-|-ox wliich occurred at Mari-eilles in 1828. It was es imated
that the pof)ulation consisted of 8dOJ unprolecled persons; of 2000
who had been inocvluted, and of 30,000 wlio had been vaccinaled.
Now, of these 8000 unprotected persons, 4000, or one-haif were at.
tacked by small pox ; of the 2000 who had been inoculated, 20 were
a tacked, being 1 in 100 ; and of the 30,000 who had been vaccina,
ted, 2000, or I in 15, were attacked, 'Jhe mortality of the several
classes was as fo.lows : Of the 4000 unpiotected persons. 1000, or 1
in 4, died; of the 20 inoculated person:!, 4, or 1 in 5 ; rf the 2000
vaccinatc-d persons, 20, or 1 in 1000 ! It would seem, then, that the
practice of vaccinatif>n is less effeclual in preventing small pox than
that of inoculation; but that at the same time, the dis(.'ase, when it
does occur after vacc'nation, is of so mild a character as to destroy only
1 life for every 20 sacrificed by small pox oecuring after inoculation.

The relative value of vaccination and inocolalicm, and the propor.
lional risk of the protected and unprotected, will be best seen by sup-
posing 15,000 unprotected, inoculated, and vaccinated, persons, re-
spectively, to be exposed to the danger of catching small.pox. The

506 Miscellany. [August,

result as regards these several parties are shown in the annexed
table :

Unprotected. Inoculated. Vaccinated.
15000 15000 15000

Attacks 7500 150 1000

Deaths 1875 30 10

Ratio of attacks 1 in 2 1 in 100 1 in 15

Ratio of death to attacks 1 in 4 1 in 5 1 in 100

In order to form a just idea of the superiority of vaccination, we
must not forget to add to the lives saved by it, the blindness, deformity
and lingering debility which it is the means of preventing in those
cases which do not prove fatal ; for it may safely be assumed that
these untoward consequences bear a certain relation to the fatality of
the disease, being of more frequent occurrence where the mortality is
highest. [American Journal of Medical Sciences.

Congenital Variola in Twins. By James Ayer, M. D., Boston.
I was called, in haste, last week, to Mrs. P., and found her lying on the
bed, in great pain. On examination, the head of a small foetus was
found born. The uterine contractions were active, and its full delive-
ry effected in a moment, attended by a feeble cry. The pains con-
tinued, a bag of fluid was felt protruding, and soon a second foetus was
expelled dead. Two separate placentcs were afterwards removed, and
the patient made comfortable.

The infants were found of the size and developement of six months.
The living one had a dozen or more of pustules, on the face, head and
breast ; one or two were noticed on the abdomen, but none on the
limbs. Three or four were good sized, plump and well-defined pus-
tules of small-pox. The remainder were not so full, but evidently
of the same character. This one survived its birth two hours.

The dead child had no offensive odor ; the abdomen was dark purple,
and the cuticle quite loose. Its whole body, especially the abdomen,
was marked with depressions, similar to those of variola in infants,
after death. No elevations or pustules were noticed ; these marks
only remained.

Three weeks before the abortion, the mother, I was informed, had
broken out with varioloid, after the usual premonitory symptoms, and
had just recovered when I saw her. The disease was so mild that a
physician was not called. She could not trace her miscarriage to any
over exertion, or any cause, except the attack of varioloid. Whether
the mother infected the two at the same period, and the death of one
caused the expulsion of both : or one had the disease first, and the se-
cond received it from him, are questions of some interest, but difficult,
from the evidence, to decide. [^05/071 Med. and Surg. Journ.

Result of the Use of Chloroform in 9000 Cases at Bartholomew's
Hospital. By Mr. Skey. One of the most interesting questions con-
nected with the subject of operative surgery relates to the use of
anesthetic agents employed for the purpose of sus.pending the function

1851.] Miscellany. 507

of sensation. This question has assumed a naoral as well as a medical
type. It has been urged, that sensation is a natural function of the
living organism, and that to suspend it by artificial agency, is to set at
nought the ordinances of nature ; and that man is born to suffering, as
evidenced by the sensibilities of his body. If the soundness of this
argument be admitted, it M'ould be difficult to draw a line which would
define the boundary at which moral and immoral suffering meet; or
to say, in what form of suffering our remedial agents may be justifia-
bly resorted to. The sensibilities of our frame are not given us by
nature to the end of promoting pain, but to enable us to avoid it. Cor-
poral suffering is no part of the discipline of the mind ; nor can it even
be generally asserted that its excess exercises a salutary influence on
the character. Every movement of our body instinctively points lo
the avoidance of bodily suffering; why, therefore, should we not as
readily and unobjectionably employ the agency of anesthetic medi-
cines for the purpose of suspending bodily pain, under the circumstan-
ces of an otherwise painful operation, as we endeavor to mitigate the
bodily suffering of any other patient cast down on a bed of sickness ?
Will not the objection to the anesthetic action of opium to a region
affected by a neuralgic pain, or to the system generally, hold as strongly
as that of another agent of the same principle given to avert the pain
of an operation ?

The medical arguments against the use of anesthetic agents have a
somewhat better foundation. That great and sudden determinatio.^
to the brain, and an unnatural circulation of venous blood, result from
their employment, is undeniable.

It is undeniable, if the quantity administered be large, and long
continued, that symptoms resembling those of apoplexy present them-
selves, in the form of extreme congestion of the vessels of the face,
stertorous respiration, and total insensibility ; and it cannot be denied,
that occasionally its full administration leads to headache, vertigo, and
languor of some days duration ; and cases are recorded in which death
itself has followed in the course of an hour or more after its employ-
ment. It must be observed, however, in pursuing this question in
strict accordance with the laws of evidence, that we have no yroof, in
the cases above referred to, that death was the direct effect of the sup-
posed cause. The parties administering it were not fully experienced
in the mode of its application. They entertain the opinion that death
was referable to it, while it cannot be disputed that the fatal issue may
be attributable to other causes; and, in one example, it appears more
reasonable to refer the death of the individual to a suspension of the
function of respiration by violence, than to any obnoxious agent cir-
culating through the lungs or brain. On the other hand, the records
of St. Bartholomew's Hospital point to its successful administration in
upwards of 9000 cases ; in not one of which, including the aged and
the young, the healthy, the infirm, and tlie asthmatic, has its employ-
ment left a stain on its character, as an innocuous agent of good.
Under all circumstances, its careful employment may be unhesita-
tingly resorted to in all cases, excepting only such as are marked by

508 Miscellany. [August,

determination to the brain of an apoplectic type ; secondly, under
circumstances of great and serious exhaus'ion from loss of blood ; and,
thirdly, in diseases of the heart. In these conditions of the system, it
is perhaps better avoided.

Tue agent in general use is chloroform and one word may be added
as to its administration. It appears indisputable, that its influence on
sensation precedes that on consciousness. T have employed it on
several occasions, in which a patient has been conscious of all that
ha? been passing around, and yet who has declared himself to have
]een totally insensible to pain. This state of his sysem has arisen
Xrom the moderate use of the agent, ample, indeed, for all purposes of
utility, though somewhat difficult to regulate in quantity sufiicient tijr
the required object.

I prefer its gradual administration. I do not think it desirable to
exclude atmospheric air, cmjdoyed as a diluent during the process of
inhalation. Its influence sliould be gradual, not sudden 1 consider
its application through the m.dium of a cambric handkerchief laid on
the face, preferable to the use of instruments made for the purpose
of excluding atmosj)heric air, and food should be rigidly avoided before
its administration, otherwise sickness will frcquenliy follow.

Against the occasional convictions or olyeclions of others to its em-
p'loyment, I place the strong, and to my own mind the unanswer.blc
fac , that it has been successfully u.scd in so large a number of ca-es
in St. Bartholomew's Hosjjita', since the period of its introduction;
that these cases liavc been indiscriminately taken, and that its objec-
tions have not yet cuade their appearance before the observant eyes of
the medical staff of that institution, either by promoting danger during
the oi)eralion, or prutractitig the recovery of the patient aft- r it. la
one class of cases its ensp'oyment is especially applicable, viz , in that
form (if disease in which the pain of an operation is the chief warrant
f r its non.prrf)rM>ance, and in which the recovery from a chronic
disease is left to na'ure, that might be greatly hastened by the hand of
art ; such, fur e.xamp'e, as the removal of a j)iece of dead hone.

Up to the period of the introduction of chloroform, a surgeon was
very unwiding to subject a patient to the painful process of sawing
and chipping away portions of dead bone, witli a view to reach the
medulary cavity, because the operation was both a painful and pro-
tract(Hl one. The consequence was, that an hospital bed was oc{-upied
by a patient thus affected, lor many months, to the exclusion, p<M'hnp3,
of three or more claimants, who would have .successively occupied it.
But by the aid ofchlorofoim tlic operation is m.w j;erformed u- coi-
sciouslv to the patient, and the period of his recovery greatly abridged.
With the three exceptions above mentioned, 1 cannot hesitate in
stroniiW recommending its administration i.n all cases of large surgical
operations; believing its discovery to oe the greatest blessing confc r-
red on the profession of surgery during t'lc last century ; and although
I have seen its employment pushed, on many occasions, aj)panntly to
the verge of apoplexy, I cannot say, even in such examples, that the
good has not largely predominated. [O^T/-a//L'C iSurgenj. Buffalo
Medical JouniaL

1851.] Miscellany. 509

On a Successful Case of Transfusion. By G. Eellasis Masfen,
Esq., House Surgeon to the Stattordshire InHrmaiy. On tlie 30ihof

July, 1848, at one p.m., I was called in to attend Airs. B , a lady of

particularly delicate appearance, in her thirty-eightii year. It appears
that on the evening of the 29lh she had perceived some sligh san-
guineous discharge from the vagina, and had consulted my father, to
whom she described herself as being four months advanced in her
tenth pregnancy, but thougiit that the ciiild had not grown for the last
month or two. He ordered a mixture containing diluted sulphuric
acid with Batley's sedative ; but the discharge continued to increase
until about seven o'clock this morning, when it became quite alarming.
PiUgging and injections of oak-bark were tried, but with noeflcct, and
a dose of ergot was administered, which jiroduced a severe pain, and
the expulsion of a two-months' foetus; but the haemorrhage continued
to increase till one p. m., when I first saw her.

I found her excessively weak, from loss of blood ; not the slight-
est pulse was to be felt at the wrist ; and siie became at last insensi-
ble. The stomach rejected everything, and though the haemorrhage
had in a great njeasure stopped, there was every symptom of sinking
and speedy dissolution.

About three o'clock, it being the opinion of every one present that it
was the only possible means of saving her life, the operation of trans-
fusion was decided upon, w hicii 1 peiformed in the presence of Dr.
Knight and my father, I immersed a four-ounce brass syrinofe in
water at the temperature of 110 Fahr., and drew a full stream of blood
into it from the arm of a stout buxom-lo(jking seivant-maid. '1 his 1
injected into a vein on the left arm, taking every precaution to prevent
the admission of any air bubbles. As the operation was going on
consciousness appeareil to be somewhat roused, and the pu'se became
slightly perceptible at the other arm, but in the course of half an hour
the pulse had again disappeared, and she remained still unconscious. I
then a second time injected three ounces of blood into the right arm, (the
veins were so small and empty that there wa^ difficulty in finding the
same op'?ning twice ;) this was again attended with a rcturnr of pulse
and sensibility, which, however, gradually disappeared as before.
After an interval of nearly an hour, I injected a third three ounces of
blood, which produced more permanent good eCects : the pulse gradu-
ally rose as the injection went on, color made its appearance in her
face, and she inquired if we had been bleeding her. iJuringthe even-
ing she complained much of thirst and she had occasionally a tea-
spoonful of wine-and water. Eight p. m. : The pulse was slightly
perceptible, but was not to be counted ; she attempted to take a cup of
lea, but it was immediately rejected, as was also even a tcaspoonful of
water, and she remained all night awake and thirsty, but afraid to
drink even a little water.

31st. Six A. M. : the pulse was 150, and very much increased in
strength ; thetongue dark brown, hard, anrl dry. Ordered three drops
of creosote in form of a pill. She vomited almost innnediately after
taking it but did not throw up the pill, which from that lime appear-

510 Miscellany. [August,

ed to allay the sickness. She then took a table-spoonful of brandy-
mixture every hour. In the evening she still complained of thirst,
and was ordered the following mixture ; Sesquicarbonate of soda, two
and a halfdrachms ; sesquicarbonate of ammonia, half a drachm ; com-
pound tincture of cardamoms, two drachms; oil of lemon, six drops;
distilled-water to six ounces. Two table-spoonfuls to be taken every
three or four hours in a state of effervescence, with twelve grains of
citric acid. There was a great extravasation of blood for six or
eight inches above and below the elbow in both arms, probably the
effect of the injection. Ordered warm-water dressing.

Aug. 1st & 2d She continued gradually improving in appearance ;
her pulse was slower, and she was better aide to take slight nourish-
ment. The arms were becoming more ecchymosed, and she complain-
ed of great pain in them. The warm-water dressing was continued.

3rd. Her health is gradually improving, and she is taking no medi-
cine; complains of great pain in the right arm, which w^as much in-
flamed, and very hard just below the elbow, and seemed likely to
suppurate. Ordered castor-oil and the water-dressing.

4th. The arms rather better; the swelling abated.

5th. Continues to improve, both in health and as regards her arm.s.
Ordered tincture of sesquichloride of iron, one drachm ; infusion of
quassia and camphor mixture, of each three ounces ; to take two table-
spoonfuls three times a day.

14th. The arms have been gradually improving, and the discol-
oration is nearly gone, but they remain very weak, and she is not able
to write.

28th. She has now quite recovered the use of her arms, and is in
general good health. From this time I discontinued attendance.

In June, 1849, she miscarried again, but otherwise she has re-
mained perfectly well up to the present time. [^London Lancet.

Presence of Iodine in Sarsaparilla. By M. A. GuILLIERMo^'D, Apo-
thecary. The experiments upon the presence of iodine in sundry
plants, as recently published by Prof. Chatin, have induced me to
inquire whether sarsaparilla did not owe its anti-syphilitic qualities
to the presence of this substance among its constituents. Tiie pecu.
liar odor of the decoction, also, having frequently struck me, 1 con-
ceived the idea, which has been confirmed by chemical analysis. My
mode of procedure was as follows :

Five hundred grammes of Honduras sarsaparilla were incinerated
and washed with water, which liquid was then evaporated to dryness,
giving an alkaline product which was digested in alcohol. Upon the
application of the usual tests for iodine, its presence, in considerable
quantity in the state of iodide of potassium was evident. I found no
iodine in the root, after it had been exhausted with water, although I
found it present in the extract ; thus proving that it passes into the
aqueous preparations of sarsaparilla in the state of a soluble salt.

It is reasonable to suppose that these results are not unimportant in
a therapeutic point of view. They confirm the opinion offered by M.

1851.] Miscellany. 511

Chatin upon the presence of iodine in plants employed as anti-scrofu-
lous remedies.

This fact being acknowledged it would prove interesting to ascer.
tain the connection existing between the amount of iodine contained in
these plants, and the greater or less activity attributed to them. Sar-
sapariila may yet become a valuable auxiliary, and in certain cases
even a succedaneum of iodide of potassium UAbeille Medicale.
Jan. 15, 1851,/ro/7i Gaz. Med. de Lyons. American Journ. Fharm.

Eau de Cologne. By Professor Varrextrapi\ This well-known
perturne is a solution of different volatile oils in pure strong spirit.
The principal condition for the preparation of a fine water, is the em-
ployment of a spirit quite devoid of fuseloil (oil of grain) and of all
foreign odor.

In respect to the proportion and kind of oils employed, we have
numerous formulse. It is of importance that these oils, wliich are
usually purchased of the druggists of the South of France, sliould be
of the finest quality, and that no oil should be used in sufficient quan-
tity to allow of its pecuh'ar odor being recognisable in the mixture.
The oils are to be dissolved in spirit, and the mixture allowed to stand
for some weeks (or still better for some months) to improve its odor.
Distillation does not effect this ; on the contrary, a fresh distilled
water requires to be kept a much longer time. Distillation is indeed
objectionable, for on account of the greater volatility of the spirit,
the oils in part remain behind in the still. Distillation can improve
the odor only when the less volatile oil has been used in too large a
quantity, and we wish to obtain a better proportion. Before all things,
we should employ a pure, old, strong spirit, and not too much of, nor
a too strongly smelling, oil.

The difierent sorts of volatile oil which are obtained from varieties
of citrons, oranges, and lemons, in different states of maturity, are
the most important, a!id, therefore, it is most important to ascertain
their purity and goodness.

Forster gives the following formula for the preparation of a fine
Eau de Cologne : Take of rectified spirit of 82 per cent, of Tralles
(=sp. gr. 0-855) 6 [wine] quarts; essence of oranges, essence of
bergamot, essence of citron, essence of limette, and essence of petits
grains, of each ^j ; essence of cedro, essence of cedrat, essence de
Portugal, and essence de neroli, of each ss; oil of rosemery, 3ij ;
andoil of thyme, 5j.

Otto gives the following formula for a good Eau de Cologne ; Rec-
tified spirit of 86 per cent, of Tralles (= 0-84G sp. gr.) 200 [wine]
quarts; oil of citrons, Ib.iv ; oil of bergamot Ib.ij ; oil of neroli fib.;
oil of lavender lb. ss ; oil of rosemary, ^Ib.; and spirit of ammonia,
^ss. Mix. Pharia. Journal March, 1851. Ibid.

Curious effects of Fire arms held close to the Body. From a very
interesting communication of M. Rigal (de Gaillac) to the Surgical
Society of Paris it appears that when the muzzle of a pistol was held

512 Miscellany, [August,

tighlly to the chest, so as to prevent the ingress of air into the barrel,
the ball couhJ not penetrate the walls of the thorax, but be deflected at
a considerable angle. In a case of attempted suicide, related by JVI.
Riga], the ball raboiinded from the chest, and struck the ceiling.
Another strange fact connected with gunshot wounds, was mentioned
by the same surgeon viz., two distinct shots fired by an insane man
upon his wife, with two distinct perforaiions of the clothes, and two
tracks of the charge within the chest, and only one aperture of en-
trance. [London Lancet.

Sixth Meeting of the Association of Medical Superintendents of
American Listitidions for the Lisane. Dr. Kirkbridp, from the stand-
ing committee on the construction of Hospitals for the Insane, in com-
pliance with the re-o!ution adopted last year, read a report, containing
a " series of Resolutions or Propositions, affirming the well ascertained
opinions of this body in reference to the fundamental principles which
should regulate the erection and internal arrangements of American
Hospitals tor the insane."

I. Every Hospital for the Insane should be in the country, not
within less than two miles of a large town, and easily accessible at all
sea.sonj?.

II. No Hospital for the Insane, however limited its capacity, should
liave less than fifty acres of land, devoted to gardens and pleasure
grounds for its patients. At least one hundred acres should be pos-
sessed by every State Hospital, or other Institution for 200 patients, to
which number these propositions apply, unless otherwise mentioned.

HI Means shoiild be provided to raise ten thousand gallons of water,
daily, to reservoirs that will supply the highest parts of the building.

IV. No Hospital for the Insane should be built, without the plan
having been first submitted to some Physician or Physicians, who
have had charge of a similar establishment, or are practically ac-
quaited with all the details of their arrangements, and received his or
their full approbation.

V. The highest number that can with propriety be treated in one
building is two hundred and fifty, while two hundred is a preferable
maximum.

VI. All such buildings should be constructed of stone or brick,
have slate or metallic roofs, and as far as possible be made secure from
accidents by fire.

VII. Every Hospital, having provision for two hundred or more
patients, shou'd have in it at lea.st eight distinct wards for each sex,
makintr sixteen clas.ses in the entire establishment.

VIII. Each ward should have in it a parlour, a corridor, single
lodfrings for patients, an associate dormitory, communicating with a
chamber for two attendants; a clothes room, a bath room, a water
closet, a dining room, a dumb waiter, and a speaking tube leading to
the kitchen or other central part of the building.

IX. No apartments should ever be provided for the confinement of
patients, or as their lodging rooms, that are not entirely above ground.

1831.] Miscellany. 513

X. No class ofrooms slioiild ever bo con;truct'd, witlioiit some kind
of window in each, communicLiling dlrect'y with the external atmos-
phere.

XI. No chamber for the use of a sinfjle patient should ever be less
than e\^\\l \>y ten feet, nor should the ceiling uf any story occupied by
patients be less than twelve in lieiuht.

XII. The floors of patients' apartments should always be of wo"d.

Xill The staiiWiiys should always be of iron, stone, or other inde-
structible material, ample in size and number, and easy of ascent, to
afford convenient efjress in case ot accident from li e.

XIV. A large Hospital should consist of a main central building
with winffs.

XV. 'J'he main central building s])ould contain the offices, receiving
roonjs for company, and apartments entirely private, fjr the Superin-
tending Physician and his family, in case that officer resides in the
Hosj)iial building.

XVI. The win<rs should lie so arranged, that if rooms are placed 0:1
both sides of a corrider, the corriders should be furnished at both ends
with moveable glazed sashes for the free admissinn of both light and air.

XVM The lightini should be by gas, on account of its coiivc-
nicnc(\ cleanliness, safety, and economy.

XVlif. The apartments fir washing clothing, (fcc, should be dc-
tach''d from the tlospita! building.

XiX. The drainage should be underground, and all the inlets to the
sewers should be properly secured to prevent offensive emanations.

XX. Ad []osj)i(a!s should be warmed by passing an abundance of
pure fresh air from the external atmosphere, over pipes or plates, con-
taining steam under low pressure, or hot water, the te nperatu:c of
A\hich at the builerdoes not exceed 212 degrees F., and placed in tho
ba-ement or cellar of the building to be heated.

XXI. ,\ complete sy.st'-m of forced ventilation, in connection with
the healing is indispensable to give |)uriy to the air of a hosp tal for the
Insane, and no expense that is required to effect this object thoroughly,
can be deemed either misplaf-ed or injudicious.

XXII. 'i'he boilers for generating steam for warming the building
should be in a detached structure, connected with which may be the
engine for pumping water, driving the washing apparatus, and other
iiia'hinery,

XXIII. All wa'er closets shotdd as far as possible be made of inde.
structihle materials be simple in their arrangement, and have a
st/onir downward ventilation connected with them.

XXIV. The floors of balh rooms, water closets, and basement
stories should as far as possible be made of materials that will not
absorb moisture.

XXV. The wards for the most excited class shou'd be constructed
with rooms on but one side of a corridor, not less than ten feet wide,
the external windows of which should be large, and having pleasant
views from them.

XXVI. Wherever practicable, the pleasure grounds of a Hospital

514 Miscellany.

for the Insane should be surrounded by a substantial wall so placed
as not to be unpleasantly visible from the building.

Which propositions having been duly read and maturely consider-
ed, were adopted by the Association.

On motion of Dr. Hanbury Smith, it was

Resolved, That the Secretary be instructed to cause the proposi-
tions now adopted, in reference to the construction and arrangements
of Hospitals for the Insane to be published in the Medical Journals of
this Continent, as the sentiments of this Association, on the subject
referred to.

To the Medical Profession of the United States :

The undersigned having been appointed, at the last meeting of the
American Medical Associntion, Chairman of the Committee on the
"Results of Surgical Operations in Malignant Diseases," respectfully
solicits contributions to the subject, founded upon personal observa-
tion. To place the subject in as tangible a form as possible, he begs
leave to direct attention to the following points :

1. The difference between cancerous and cancroid diseases, or
those affections which are truly malignant, and those which are only
partially so. In the former category are comprised scirrhus, encepha-
loid, and melanosis ; in the latter, certain maladies of the skin and mu-
cous tissues, as lupus, cheloid, eiloid, and cancer of the lip.

2. The precise seat of the disease, as the skin and subcutaneous
cellular tissue ; the eye, ears, nose, face, lips, tongue, salivary glands,
jaws, and gums; the lymphatic ganglions of the neck, axilla, groin,
and other regions ; the mammary gland, uterus, ovary, vulva and
vagina, penis and testis; the anus and rectum; and, finally, the ex-
tremities.

3. The age, sex, temperament, residence, and occupation of the
patient.

4. The cause of the disease, its progress, and the state of the part
and of the system at the time of the operation.

5. Mode of operation ; whether by the knife, caustic or ligature.

6. Time of death, or relapse, after operation.

7. Examination of the morbid product; how conducted whether
by the unassisted eye alone, or by means of the microscope, and
chemical tests. ^

The undersigned hopes that the importance of the subject confided
to him, as chairman of the committee above referred to, will be suffi-
ciently appreciated by his professional brethren to induce them to aid
him in carrying out the wishes of the American Medical Association.
The subject is one of absorbing interest, and cannot fail, if properly
treated, to elicit matter of the greatest benefit. It is very necessary
that all communications upon the subject should be sent to the chair-
man of the committee by the 1st of January, 1852.

Medical journals and newspapers friendly to the interest of medical
science, will confer a favor upon the undersigned by inserting the
above notice. S. D. GROSS, M, D.

University of Louisville^ June 29, 1851.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. SEPTEMBER, 18al. [No. 9.

PART FIRST.

rigtnal (Hommunuations.

ARTICLE XXVir.

Typhoid Fever. By John S. Wilson, M. D., of Muscogee
County, Georgia.

The extensive prevalence of this disease, together with the
unsettled state of opinion in the profession, in reference to its
pathology and treatment, will, I hope, be a sufficient apology
for introducing it again, so soon after the "Remarks" of L)r.
Long, contained in the June No. of this Journal. I shall, in
this communication, endeavor to follow his excellent example,
and shall make my remarks mostly practical. But, before
recording my experience in the treatment of this disease, I will
make a few general remarks in reference to its pathology, and
some other points, which have so much divided the profession
and given rise to so much discussion.

A great many of the difficulties involved in the consideration
of continued fevers, originate in a confusion of terms, and in
the attempts of writers on this side of the Atlantic "to give a
European coloring to the pathology of our fever." Almost all
our treatises on Continued fever are but transcripts from Eu-
ropean writers, with their endless discussions as to the identity
of typhoid and typhus fevers, or of typhoid fever and folli-
cular enteritis. The history of continued fevers in the United
States is yet to be written, (unless this has been done by Dr.
Bartlett,) and it is to be hoped that our future investigations
will be conducted with more independence ; for I feel assured

N. S. VOL. VII. NO. TX. 33

516 Wilson, 071 Typhoid Fever. [September,

that the solution of the difficult problems presented to us, will
be much facilitated by recording our own facts, and drawing
from them our own conclusions, instead of trying to find a com-
munity of symptoms and organic lesion, in fevers originating
under such dissimilar circumstances as the fevers of this coun-
try and those of Europe. We are much more interested in a
correct pathology than in names ; still it is very unfortunate
that writers have used the same terms so differently, and thus
rendered it almost impossible for them to understand each
other ; for if this were not so, a great many of the dissensions
which now divide the medical world, and perplex the student,
would cease. To say nothing of the discussions as to the pro-
per application of the terms typhus and typhoid, it seems
that European writers are not even agreed as to the use of the
prefix continued, when used in a generic sense " some taking
one of its types, some another, from which to draw a descrip-
tion." The best means of obviating such difficulties is, to
make continued fever a generic term, and apply it to all fevers
not periodical ; and 1 think it would be sufficient to embrace
under this head only three varieties, viz : Synocha or inflam-
matory fever, typhus and typhoid ; with subdivisions founded
on the prominence of the particular symptoms, or, if possible,
on the organic lesions. I have included the Synocha of Cullen,
not because I think it will be often met with in practice, but
because it may serve as a type or standard of comparison, as
the antipode of typhus, or the typhus gravior, of systematic
writers : the term Synochus, as used by Cullen, is certainly
useless, if the word typhoid is retained ; for he defines it to
be "jPe6m ex Synochu et typho composita,^'^ which means a
fever partaking of the nature of typhus, or in other words, a
typhoid fever ; or a synochus in the beginning, and a typhus in
the end.

It is not my design to enter into a discussion of the identity
or non-identity of typhus and typhoid fevers ; nor shall I at-
tempt to say whether the latter shall be considered primarily,
as an idiopathic fever, with consecutive intestinal inflamma-
tion, or essentially a follicular enteritis. On the first point
the identity of typhoid and typhus I will quote from Dr. Bell,
(Bell & Stokes' Lectures, vol. ii. p. 669,) merely remarking

1851.] Wilson, 071 TypJioid Fever. 517

that I fully coincide in the conclusion to which he has arrived.
He says, after quoting numerous authors, and patiently inves-
tigating the whole subject, "If we were to institute a compari-
scJn between the two fevers, typhus and typhoid, we should
find many more features of resemblance than of difference," &c.
The second point the symptomatic or idiopathic nature of
typhoid fever is one of vast importance, one worthy of the
most serious consideration and the most studious investigation ;
for the settlement of this important question would have an
important bearing not only on the treatment of this fever, but
also on this whole class of fevers. It is generally admitted,
even by those who do not adopt the French pathology, that
inflammation and ulceration of the intestinal mucous mem-
brane, and especially of the glands of Peyer and Brunner, are
frequent concomitants of typhoid and typhus fevers: still we
are not prepared to admit that this is an es5e7z^7<2/ feature of the
disease, for Andral has shown, that patients have perished with
all the symptoms of typhoid fever, without any lesion whatever
in this membrane. In the present state of our knowledge, I
think it safest to assume the following positions viz :

1st. There is no fixed anatomical lesion either in typhoid or
typhus fever.

2d. Inflammation and ulceration are frequently found in the
intestinal mucous membrane (Peyerian glands)* of typhus.

3d. Typhoid fever is only a milder form of typhus.

4th. That inflammation and ulceration of the intestinal mu-
cous membrane, and especially of the glands of Peyer and
Brunner, occur in the vast majority of cases, in typhoid fever,
either as an essential feature or as a consecutive phenomenon.

5th. That typhoid, like typhus fever, is, under favorable cir-
cumstances, contagious.

I do not intend to discuss these propositions in extenso : I
will only make a few remarks on the two last, and refer the read-
er to the work already quoted (Bell & Stokes, p. 659, et seq.)
for a full exposition of the whole subject. One of the earliest

Dr. Tweedie found these to exist in 24 out of 54 cases of typhus fever.
Dr. Anderson reports G8 cases of innamniaiion and ulceration, in 74 fatal cases
occurring at Glasgow; and a greater proportion than this even has been re-
ported in Ed in burg

518 Wilson, on Typhoid Fever, [September,

and most characteristic symptoms of typhoid fever is abdomi-
nal tenderness, (on pressure,) together with increased force in
the pulsation of the abdominal aorta, and other symptoms of
inflammation in the viscera of this cavity. Post-mortem ex-
aminations made by Louis, Chomel, Gerhard, and others, show
that this inflammation does exist, in the vast majority of fatal
cases, in the fever, and that its seat is the follicular glands of
Peyer and Brunner. Now, are we justified in drawing the
conclusion from these facts, that this inflammation h pre-exist-
ent, and that the fever is only symptomatic ? that the term
typhoid fever should be discarded, and that of follicular enteri-
tis substituted ? I think not ; because it has already been
shown from high authority, (Andral,) that all the symptoms of
typhoid fever may exist without the lesion referred to; and it
is declared by other observers that there is no uniformity in
the violence of the abdominal lesions ; and still less correspond-
ence between the symptoms of the disease and the extent of
the Peyerian lesion. But while I oppose the exclusion of the
term "typhoid," and the substitution of follicular enteritis, I
would not by any means under-rate the importance of the lat-
ter; for though we may not be prepared to admit that it is
absolutely essential to the existence of the group of symptoms
termed typhoid that it is the ipse morbus^ the proximate cause
of those symptoms still we know that it is one of the earliest
and most constant companions of typhoid fever ; and whether
we admit it to be the essential feature of this fever, or not, we
should regard it as one of the most dangerous and uniform
features, and treat it accordingly. So far as my experience
goes, I can assert that I have never seen a case of typhoid fever
in which there was not more or less evidence of intestinal
inflammation, early in the disease ; and I have always treated
it accordingly, acting on the presumption that this is the dis-
ease ; and while w^e do this, paying due attention, in the mean
time, to all the symptoms as they arise, I think it matters but
little whether we consider the fever idiopathic or sympto-
tomatic typhus or typhoid.

The contagiousness of this disease, though it be one of the
most interesting questions connected with it, 1 shall pass over
slightly, because it involves the argument as to the identity of

1851.] Wilson, on Typhoid Fever. 519

typhus and typhoid fever, which I do not intend to discuss. It
could be proved, if necessary, by quotations from numerous
authors, that even typhus fever is not contagious, except under
such circumstances as are found to exist in camps, jails, hos-
pitals, and crowded, illy ventilated and filthy apartments.
Now if this be true, in reference to typhus fever, it will apply
a fortiori to typhoid fever, admitting that this is only a mild
or modified form of the former disease. I will dismiss this
subject, then, by admitting that typhoid fever mai^ be commu-
nicated by human effluvia under very favorable circumstances,
such as those mentioned in connexion with typhus fever ; but
that it is not contagious, in the absence of such circumstances.
AVith a brief record of my own observations and experience in
this disease, I conclude.

My observation in this fever fully confirms the declaration
of Dr. Long and others, that the disease "generally comes on
slowly and gradually." I also coincide with him in the value
of this circumstance as a diagnostic; and not only as a diag-
nostic, but likewise as one of the elements of prognosis, for I
have generally found that the gravity and obstinacy of the dis-
ease, bore some relation, or were in direct ratio with the
duration of the premonitory symptoms. But while this is gen-
erally true, the invasion of this fever is sometimes sudden, and
its progress to a fatal termination rapid. I have seldom been
able to trace the onset of the disease to a distinct chill^head-
ache I have found invariably in its beginning, but this symptom
generally yielded either spontaneously, or to the treatment,
during the first week, notwithstanding the gravity of the other
symptoms might have increased. (Vide Watson's Practice,
p. 938.) The skin is hot and dry, with some moisture fre-
quently about the head ; the tongue is coated with a dark brown
fur, sometimes black, and in some of the worst cases it is red
and clean, having a glazed appearance, as if it had been var-
nished sometimes it is furred and cracked. Sordes are some-
times seen on the teeth, in the very inception of the disease,
but generally this symptom does not appear until it has con-
tinued several days. I consider the early appearance of sordes
an unfavorable symptom. I have found great variation in the
pulse, so much, in well-marked cases of typhoid fever, that I

520 Wilson, on Typhoid Fever. [September,

cannot assent to the declaration that it is " peculiar and char-
acteristic" I have frequently found it "small, quick and fre-
quent," and I have sometimes observed the "double beat/*
mentioned by Dr. Long, but I have often found it slow and
full, running from 75 to 100, and in some cases I have even
found it helow the natural standard in frequency in others, it
varies but little from the standard of health in frequency, hav-
ing nothing morbid about it, except a little sharpness. These
slow-pulse cases I do not consider so dangerous as the others,
but I have always found them remarkably tedious they will
not die, nor will they get well soon. In conclusion, I would
remark that I believe the pulse described by Dr. Long is the
most common in this fever, while I cannot admit that it "is
peculiar and characteristic."

Diarrhoea I have not found to be a constant symptom, and
never an early one: it is occasionally absent during the whole
progress of the disease, but there is generally diarrhoea, or a
tendency to it during the second or third week. This will be
explained when I come to the treatment.

The next and most important symptom belonging to this
fever, which I shall review, is "abdominal soreness." This, so
far as my observation extends, is an invariable symptom, so
much so that I look for it as a matter of Course, as one of the
essentials* of the disease. I have generally discovered this
soreness first in the epigastric region, even in the absence of
nausea and vomiting; which latter symptoms I have most fre-
quently found absent, as well as other direct symptoms of
gastric irritation, save this soreness this I have always found,
in cases of all grades, from the mildest to the gravest, I think
that this soreness hasoftener extended towards the right hypo-
chondrium than the left, and as this corresponds with the course,
of the duodenum, (the seat of the glands of Brunner,) I have
been induced from this circumstance, and from the absence of
gastiic symptoms, to conclude that this was the real seat of
disease, instead of the stomach ; and that the sensibility of this
organ was increased by sympathy with the duodenum. But
it is my design to record facts, leaving theories to others. I do
not wish to be understood as saying that I have never disco-
* I do not use this term in a pathological sense.

1851. [Wilson, on Typhoid Fever. 521

vered this soreness any where besides in the epigastrium,
because 1 ham traced it to the right ileac region, but I have
always found it existing first in the epigastrium. This tender-
ness is accompanied frequently by the gurgling sound men-
tioned by all writers, and I have been able to locate it by this
sign alone, without any expression of pain on the part of the
patient. As before observed, this soreness is one of the earliest
and most constant symptoms it is among the first to appear
and sometimes one of the very last to leave ; and I have noticed
that the patient W\\\ not convalesce so long as it remains he
may stand still, but he will not advance. This soreness is
seldom complained of except on pressure sometimes it is felt
on making a full inspiration. The eruption mentioned by au-
thors, I have seen only in one case ; this was accompanied also
with anginose symptoms, and was rapidly fatal.

Pulmonary symptoms, according to my observations, have
been equally rare. I have seen a few cases complicated v^^ith
slight bronchitis. My experience has taught me, that our
prognosis in this disease should be very guarded; and it has
also taught me the sad lesson, that this fever will sometimes
prove fatal under the most favorable circumstances of age,
constitution, &c., even when the treatment is not ''aggra-
vating.^^ I know of no disease more fallacious than the one
under consideration: '*grave and prolonged cases" will fre-
quently terminate favorably, contrary to all expectation ; on
the other hand, the disease may commence without any unto-
ward symptoms, and continue thus for several days, when the
pulse will suddenly rise to 150 or 160, delirium and coma will
supervene, and death soon close the scene.

In other cases all the graver symptoms may yield, but still
they will not improve they remain stationary for days, and
even weeks, and may finally die. Even in these cases the
chances are in favor of the patient, if we can keep the disease
in abeyance without having resort to very active remedies.
It is in such cases as these that we should act on the aphorism
of Celsus " Muhi morhi curantur,''' &c. To conclude on this
point: If the pulse rise to 150, and creeping or jerky if the
skin and tongue become more dry, or if the former be bedew-
ed with a viscid sweat if the delirium becomes furious, or

522 Wilson, on Typhoid Fever. [September,

the stupor merges into coma if the bowels are evacuated in-
voluntarily, the case is almost hopeless.

I cannot leave this subject, without repeating my warning
against a decided prognosis, for my experience fully confirms
the declaration made by Dr. Watson, (op. cit., p, 957,) that the
disease is "liable to sudden and remarkable change in the
symptoms,'^'

Treatment. It has been remarked, with much truth, by
the distinguished physician just quoted, that the treatment of
continued fever has always been "a stumbling block to young
practitioners," and I think I might add, with equal truth, to old
practitioners too ; for certainly there is no disease in which the
practice is more unsettled ; and it is equally true, that the most
judicious treatment is too often unavailing. Before proceed-
ing to the detail of treatment, I assume the two following
positions, which I think will be granted by all, and therefore
need not be defended they are these : 1. This disease cannot
be materially abbreviated by treatment, after it is fully form-
ed : it "can be conducted safely through its different stages
it cannot be cured." 2. We have no specific remedy, nor have
we any specific and established mode of treatment ; this must
be modified by the peculiar circumstances of each case, and
the predominance of certain symptoms.

It will be readily inferred from the above that I have but
little faith in emetics and other active measures recommended
by some, for the cure of this fever ; still I believe that emetics
might be used with great advantage, in the voy beginnings
while the nervous system alone is, as yet, implicated ; but un-
fortunately for the patient, the time for their use is generally
past, when the physician is called, the disease being then ''rooted
and grounded^

Bleeding. No remedy has given rise to more discussion
than this, while the Armstrong and Mcintosh school extol it
too highly and use it perhaps too freely, their opponents go
into the opposite extreme; and not satisfied with withholding
it, they commit as great an error by the too early and free use
of stimulants. In this, as in all other disputed points in medi-
cine, we should ever bear in mind that sound maxim, '' in medio
tutisimus ibis."

1S51.] Wilson, on Typhoid Fever. 523

As with emetics, the bleeding stage has frequently passed
when the physician is called, but I think the remedy should
never be withheld, when the pain in the head is severe, and
the fever high, with evidence of actual or imminent inflam-
mation in any organ, for fear of subsequent debility ; for I con-
tend that we can remedy debility attended with a subdued
inflammation, with much more ease than we can subdue an
inflammation after it has prostrated the vital powers. My
plan is to bleed moderately and very cautiously under the cir-
cumstances mentioned ; and if I have any thing to regret in
this connexion, it is because I have not done so oftener, and a
little more freely; for I confess that I have been afraid of the
remedy ; so much so that I have only of late adopted the plan
of bleeding under any circumstances, in this fever. I will
conclude on this point, by saying that no remedy requires more
caution and sound discretion, than the use of the lancet in
typhoid fever that it may, as a general rule, be dispensed
with, but in some cases, early in the disease, it is decidedly in-
dicated, and should be used in such cases; for I believe where
it is indicated, the salvation of the patient often depends upon
it.

Local Bleeding. Of the advantages of local bleeding in
typhoid fever, I can speak in terms of decided commendation :
the application of scarified cups to the epigastrium, or where
ever abdominal soreness predominates, is one of my first rem-
edies; and I repeat them again and again, until this soreness
yields, or until the blistering period arrives. 1 have used this
remedy as many as twelve times, in one case, with marked
advantage, the patient expressing relief from the "fulness
about the abdomen" and *' shortness of breath," before the
application was concluded. I never treat a case of this fever
without applying cups to the abdomen; for they are always
indicated by the soreness in this region. If there be much
headache or cerebral disturbance, 1 also apply cups to the
temples in this way, 1 think they are more indicated, in active
delirium than in coma.

Cathartics. Some writers of crreat eminence recommend
the use of active cathartics in the beginning of this disease, in
decided terms, and I am acquainted with physicians who adopt

524 Quintard's Surgical Cases. [September,

this plan ; but I consider this more dangerous and objectiona-
ble than even the indiscriminate use of the lancet; because
we cannot hope to cut short the disease by such measures,
and they tend only to increase the intestinal irritation and set
up an uncontrollable diarrhoea. So well am I convinced of
this, that I withhold all active cathartics from the very begin-
ning, and thus avoid the diarrhoea it is to this plan I attribute
the fact that I have seldom been annoyed by this troublesome
complication. I commence generally by giving a small dose of
calomel combined with Dover's powder, with the intention of
having it to remain from 24 to 48 hours I then follow it by
castor oil, giving directions to check the bowels if the evacua-
tions are thin and watery.

Opium. The use of this remedy requires much caution, on
account of the tendency to coma ; but it may be used with the
happiest effect, where the excitement is more nervous than
vascular, with more vigilance than coma. In doubtful cases
it should be commenced in small doses, and increased pro re
nata. I generally withhold it, unless there be some decided
indications for it, and when I use it, I prefer the Pulv. Dov.
It is best to give this at night, and let the patient rest undis-
turbed, if he will. I think the plan of arousing patients from
a quiet sleep, to give them medicine, very objectionable ; for
this is a better remedy to the exhausted powers than any we
can apply.

I did intend to review several other remedies, and conclude
with a general summary of my experience in their use, but as
the limits of this article will not admit of it, this design must
be postponed to some future time.

ARTICLE XXVIII.

Surgical Cases. By C. T. Quixtard, M. D., of Roswell, Ga.

The following case is reported, as illustrative of the princi-
ples, adduced in a paper on "Injuries of the Cranium," read
before the Medical Society of the State of Georgia, at its last
session, by Henry F. Campbell, M. D., of Augusta, and subse-
quently published in the Southern Med. and Surg. Journal :

Wm. H., ffit 38 years, was, during an affray on the 1st Jan.
1850, struck by a stone (weighing two pounds) on the left

1851.] Quintard's Surgical Cases. 525

frontal region, near the coronal suture ; which produced a frac-
ture, with depression of a portion of the bone, attended by
considerable hemorrhage. Coma immediately supervened, in
which condition he lay several days ; at the end of which time
the coma subsided, and of his own accord he got up and walk-
ed about; seemed conscious ofsurrounding objects and events,
but had lost the power to articulate. At the end of eight
weeks the wound of the scalp had healed, with the exception
of a fistulous opening through which a profuse discharge of pus
was flowing, and which gave passage at successive intervals to
nine spiculee of bone, varying from a line to a haff inch in
length. At the time of our seeing him, there was a fistulous
opening through the scalp, communicating with a triangular
opening in the skull, having its base above and on a line with
the suture, its apex downwards, through which the pulsations
of the brain were discernable. To the left of this opening the
probe detected a large spicula of bone, and also an ossific de-
posite pressing upon the dura mater. The patient had, to a
certain extent, lost his memory and hearing which last defect
was marked by a " constant roaring in the head." His general
health was tolerably good. The operation (April, 1851) con-
sisted of a crucial incision over the depressed bone, and the
flaps of integument being freely dissected up, the trephine was
applied, and the bone, which had partially re-united, was re-
moved. At the point of bony union there were numbers of
ossific points protruding downwards into the substance of the
brain, and also a loose piece of carious bone floating loosely
in the pus with which all the parts were suflused. Immedi-
ately instantly on the removal of the bone, the roaring in
the head ceased and all disagreeable symptoms subsided. The
wound was dressed bv adhesive plasters, and a simple bandage
applied adhesion went on rapidly, and the patient in a few
days returned to his home.

The phenomena presented in the above case are somewhat
remarkable. The long continued coma the aphonia and loss
of memory, together with the decided aberration in the function
of audition are symptoms which fully establish the rationale
of these eflects, developed and commented upon by my friend
Dr. Campbell.

526 Quintard's Surgical Cases. [September,

Dr. C- accounts for similar results of pressure on the brain
by a destruction of equilibrium of pressure.

Osteo- sarcoma of the Inferior Maxillary Exsection and
Recovery. Miss D. S., aet about 21 years, had had a slight
enlargement on the base of the lower-jaw, from the period of
her second dentition, which had remained nearly stationary till
she arrived at the age of 14, when on the appearance of the
menstrual phenomena, this tumour suddenly evinced a dispo-
sition to an increase of activity, which was attended by periods
of pain and uneasiness. Two years subsequently, its growth
became more rapid and the tumor continued to extend to-
wards the symphysis, though not at all in the direction of the
ascending ramus. At the time of our seeing her, she was very
much disfigured by a large tumor over the left side, extending
from the angle of the lower jaw, quite to the symphysis. Pro-
truding from the mouth, was a large, red sarcomatous tumor,
about an inch in diameter, which prevented the closure of the
lips. On examining within the mouth there was discovered a
considerable enlargement in the form of a firm fleshy mass,
with a reticulated structure of bone on its posterior portion.
This v/as easily crushi-d by pressure with the finger.

Notwithstanding her general health was unpromising, and
bore the usual features of carcinomatous cachexia, we deter-
mined upon the operation of exsection as the only possible
method of relief

The patient was subjected to the influence of chloroform,
and the operation performed in the ordinary mode, viz., an
incision was made along the base, commencing a little abo%'e
the angle and terminating about half an inch to the right of
the symphysis. This was met by a perpendicular incision
from near the vermillion border of the lower lip to the termin-
ation of the first incision. The flap was raised and the bone
divided with Hey's saw% first above the angle, and afterwards
at a point to the right of the symphysis. It was then dissect-
ed from the muscles and other attachments, and removed.
Besides the facial, but one small artery required the ligature,
and withal, the hemorrhage w^as but trivial. A piece of sponge
was placed in the position of the removed bone the lips of

1851.] O'Keefle's Clinical Reports. 527

the wound brought together and retained by three sutures, and
adhesive straps, and rendered secure by the application of the
bandage. The wound healed rapidly in every respect, and the
case progressed finely tov^rards recovery. Eight months have
elapsed since the operation, and as yet there is no disposition to a
return exhibited. The deformity is very slight, and the patient
enjoys excellent health and spirits. In relation to this case,
there is perhaps but one practical rernark to be suggested, and
it is from the low condition of the patient at the time of the
operation, and also the advanced stage Of the disease. Should
this terrible affection return, we have the satisfaction of hav-
ing secured to our patient a considerable period of actual com.-
fort and health.

ARTICLE XXIX.

CLINICAL REPORTS, No. 1.

On a Case of Obscure Uterine Tumor terminating fatally -
with remarks. By D. C. O'Keeffe, M. D., of Penfield, Ga.

Under the above caption it is proposed to give, from time to
time, a series of articles comprising details of cases as they occur
in the sick room. The term *' Clinical Reports,'^ has been usu-
ally applied to the practical instruction imparted to students at
Medical Schools when the subject of the disease lectured on is
before them, while clinical instruction is used to designate the
hospital clinique. Should the clinical reports appear in print,
as they frequently do, they would be to the reader in the same
light as a record made at the bed-side of the patient and com-
municated to him through the journals. There can be no
impropriety then in extending the use of this term to reports
made in the sick room by a physician in private practice, since
the literal and etymological meaning of it is bed-side report.
As regards the necessity or utility of making such reports I
would introduce the series with Surgeon Bell's opinion :

"It will be geniirally admitted that practical observations on
the treatment of diseases of daily occurrence are more valuable
to the medical practitioner than the most interesting descrip-
tions of anamolous cases, however extraordinary in their char-
acter, or successful in their treatment. I am convinced, indeed,

528 O'Keeffe's Clinical Reports. [September,

that the publications of the journals of well-employed medical
men, giving in detail the treatment of every case occurring in
their private practice, would prove most useful to the young
practitioner, and be a valuable contribution to our medical
literature."

To promote such views, the appended report is humbly sub-
mitted :

Case 1. June 1st, 1850. The subject of the following notes
was a negro w^oman aet. 35, of full habit and plethoric temper-
ament. Up to the invasion of her last illness, she enjoyed
excellent health and had given birth to twelve children without
any impediment in parturition.

After the birth of her last child, a period of eight months,
she has suffered from occasional uterine hemorrhage, sometimes
very profuse, at others not so much. These hemorrhages in
conjunction with a tumor, she distinctly felt in her left side, made
serious inroads upon her constitution, and caused her a few
months ago to relinquish her usual employment of field labor.
A physician who was called upon to arrest the hemorrhage, under
the impression of its being a case of menorrhagia, prescribed
vaginal injections of alum water and some astringent tea. This
course being persisted in for a week or longer without any
mitigation of the hemorrhage, and the patient very reasonably
becoming more enfeebled every day, I was requested by her
owner to see her, and inform him of the true nature of her
disease, for my predecessor had made neither digital nor instru-
mental examination, therefore he was not prepared to give an
opinion of any diagnostic value.

I found the patient lying upon her back in a great deal of
pain and considerably emaciated ; the whole train of symptoms
that usually characterize the anemic state was presented. She
complained of constant pain in the uterine region, and could
but illy bear pressure on the hypogastric region. She could
get no rest at night, her bowels were usually constipated and
her appetite was well nigh gone.

A vaginal digital examination revealed to me a soft tumor,
the size of a hen's egg, of an oval form, filling up the vaginal
cul-de-sac to the left, and leaving scarcely room to pass up two

1851.] O'KeefTe's Clinical Reports. 529

fingers to the os uteri along the right side of it. Its consistende
was not very dense, being soft, somewhat spongy and easily
broken down between the fin^rers. By exercising slight pres-
sure on it with the extremities of the fingers, I could bring
away large portions of the morbid mass without inflicting any
pain or exciting any sensation whatever in the patient.
This heterologous mass apparently consisted of coagulated
blood interspersed here and there with pieces the size of a pea
(some larger) of a dingy white color, and soft, resembling
adipose matter. Considerable quantities of this mass could be
extracted with the fingers, thus infringing on the spheroidal
form of the tumor ; but in a day or two it w^ould reproduce
itself and again assume its former shape. It grew from the
left half of the circumference of the uterine lip, its peduncle
embracing from half an inch to an inch of the external surface
of the cervix of the same side. About four-fifths of the capa-
city of the vaginal cul-de-sac was blocked up with the tumor,
impeding the movement of the uterus in any direction. The
OS uteri was sufficiently patulous to admit the first phalanx of
the middle finger; the lips, hard and rendered uneven by sev-
eral notches, presented a cartilaginous feel. There was more
sensation manifested when the lips were touched, or the finger
introduced within the cervical cavity, than by any manipula-
tions with the tumor itself Its peduncle (if its attachment to
the OS and cervix could be so called) was many degrees lar-
ger than that usually assigned to polypus; indeed the plain of
the tumor on its upper surface was inclined to an angle of about
23, the inclination commencing at its attachment to the cervix
and extending to its convexity, while inferiorly its neck was
as well defined as the neck of the ordinary brass knob of a
door. The tumor bled, though not freely, when touched, so
that when examined the hand was smeared with blood. The
surface of the tumor was neither rough nor granulated, but
smooth ; and the parts detached differed in no respect from
the uniform appearance of coagulated blood. The parts torn
off had a slight unpleasant odor, but none of that which usually
attends a malignant growth in these parts.

Without coming to a definite conclusion as to its nature, I
prescribed vaginal injections of sulph. of zinc, opiates at night.

530 O'Keeffe's Clinical Reports. [September,

allid quinine and iron to retrieve her lost strength. These
means arrested the hemorrhage to a very great extent, and
her heahh recruited considerably for two veeeks, when she
suffered from another attack of hemorrhage that counteracted
what improvement she had made.

In the mean time, I had satisfied myself, as I thought, of the
nature of the tumor by repeated vaginal examinations, digital
and with the specuhim ; and was corroborated in my opinion
by two gentlemen of extensive experience in the diseases of
females, wdio were consulted by letter.* Regarding the tumor
to be a polypus, Gooch's canu'a was procured, and several
attempts were made to throw the ligature round the neck
of the tumor, to no effect. Efforts were made with liga-
tures of different materials, viz : cat-gut, whip-cord and
silk, wrapped round with fine metallic wire. The greatest
difficulty in the way was the retention of the ligature on the
neck of the tumor in consequence of the thickness of the stalk
and the inclined plane of its superior surface ; for as soon as
the slightest force was used in tightening the ligature, it would
slip from the sloping surface aforementioned over the cavity of
the tumor. After three or four unsuccessful attempts in this
way, I was convinced that at least 1 could not remove it with
the ligature ; so I requested three neighboring physicians to
see the case with me. Each one examined for himself, and it
was determined in consultation to make a final effort for its
removal with the ligature, w^hich was attended with no better
success than the others. In this event, it was agreed to put
her on a palliative course of treatment, and wait for further
developments of the tumor, in the hope that its form might
become more favorable for removal. It was also frankly an-
nounced to the owner, that if the tumor could not be removed
the issue would prove an unfavorable one.

A short time after the last effort for removal was made, her
master, harrassed by the patient's importunities, and as a
placebo to her sufferings, put her under the charge of a certain
non-descript practitioner, who continued to treat her until her
death.

In April of the year (1851) I was in attendance on another
* Drs. J. A. Eve and H. F. Campbell, of Augusta. Vide seq.

1851.] O'Keeffe's Clinical Reports. 531

case on the plantation where the subject of these notes resided,
si ill takinix medicine from the '* 7*00/ doctor,^' as the non-desciipt
is popularly denominated. In view of the lively interest I felt
in the case, I was induced to see it ; and lo, what a loathsome
spectacle of human suffering was before me ! As soon as I
entered the cabin where she lay, I was instantly assailed with
the most offensive odor 1 ever had perception of. She lay on
her back in the utmost agony and could not move but with the
greatest caution on account of the pain she endured. She was
not as much emaciated as she is described at the head of these
remarks; but her round features and plump appearance were
owing to anasarca. The left extremity was the part most
affected, being nearly one half larger than its natural size.
About the middle of the left leg was a sore that continually
discharged a thin serum.

I made but a very unsatisfactory vaginal examination in con-
sequence of the foul odor emitted ; and from the same cause
my desire of examining with the speculum was frustrated. The
condition of the morbid region was far different from what I
have already described it. The spheroidal tumor was replaced
by a hard cartilaginous mass of irregular surface ; or rather,
the tumor had disappeared and somewhat of an irregular cavity
was left in its place. Much of the uterine substance was lost
by ulceration ; the os uteri had lost its outlines, and as well as I
could judge, the morbid action had taken possession of the
uterine body. The pulse at this time was 120 per m., and
her nights were sleepless. In about three weeks death closed
the suffering scene.

Remarks. The first enquiry that occurs to the reader's
mind after the perusal of the foregoing details is : what is the
nature of the tumor in question? I am not certain that I can
answer this enquiry satisfactorily, inasmuch as the nature of
the tumor is involved in some obscurity. Instead, therefore,
of endeavoring to point out what it is, I will proceed to its in-
vestigation negatively, (" par voie d'exclusion," as the French
term it,) in order to arrive at its real character.

The tumor under notice exhibits many features common \o
polypus in this region, which it may not be amiss to enumerate.

N. S. VOL. VII. NO. IX. 34

532 O'KecfTe's Clinical Reports. [Sepfember

Istly. Its somewhat pedunculated form and smoothness. 2diy.
The absence of ulceration at the time the diagnosis was made
out, and insensibility to the touch. 3rdly. Ilemorrlicige and a
correspondence of their places of attachment. 4thly. The
manner of its connection to the uterus. Thus it is said that
polypus, instead of being imbedded in the substance of the ute-
rus, is attached to some part of it by a neck or pedicle, of a less
diameter than the body of the polypus; so it was with the
tumor under consideration. In this connection I will take the
liberty of quoting the opinions of my esteemed friends, Drs. J.
A. Eve and II. L\ Campbell, of Augusta, Ga., in relation to the
diagnosis of the present case. And it is but justice to these
gentlemen to state that the data from which they drew their
conclusions were meagre in the extreme, from the circumstance
that the written description I gave them was necessarily scanty
and unsatisfactory.

Dr. Campbell says: ''I have examined the portion of tumor
as well as it would admit of, not however with the microscope ;
it is too dry to ascertain any thing certain about it. It is in
all probability a polypous or encephaloid growth. If cancerous,
I would be inclined to the opinion of its being of encephaloid
rather than scirrhus form, from the youth of the patient and
the softness of the tumor. But the strong probability is that it
is a poll/pus, from its pediculated form, and also from the fact
that malignant growths seldom form upon the healthy tissues,
but among them ; while the non-malignant, to which class po-
lypus belongs, are found invariably upon them, or in an isolated
space by themselves, but not having their tissue mixed with
healthy tissue, as in malignant grow^ths."*

Prof. J. A. Eve says: "With respect to the nature of the
tumor, I believe it is a polypus. I gave your specimen and
letter to Dr. Campbell, that he might examine by microscope ;
his reply expresses my opinion. I have not the slightest hesi-
tation in advising the removal of the tumor by ligature and cau-
terization of tlie point from which it sprung, by nitrate of

silver."!

Again: In a note in Churchill's Diseases of Females, p. 177,
Dr. Lee describes a variety of polypus strongly resembling in

* Extract of Dr. C.'s letter to writer. t Extract of Dr. Eve's letter to writer.

1851.] O'Keefle's Clinical Rqwrts. 533

substance the one under notice. lie says, "a fourth variety
of tumor of the uterus, to wliich the term polypus has also been
applied by writers, is produced by ^ morbid enlargement of the
glandulasor ovulae nabothi. One of these two bodies is some-
times converted into a cyst, as large as a walnut, or even a
hen's eg^, and hangs by a slender peduncle from the cervix or
lip of tl;e OS uteri. It is smooth, and vascular, and contains in
some instances a curdJy matter, or yellowish colored viscid Jliiid.
The tumor produces great irritation, and gives rise to copious
sanguineous and mucous discharges from the vagina.'*'*

Another case from the same authority extracted from a paper
byM. Langstaff, in the 17th vol. of the Medico-Chirug. Trans.

p. 63., and the affirmative evidence is at an end. "Mrs. ,

aged 59, in whom, a few days previous to death, there was a
large polypus in the uterus projecting into the vagina, died of
hemorrhage, before a ligature was applied.

" Dissection. The body of the uterus and its parietes were
much larger than natural, yet there were not any signs of
scirrhus or fungus hematodes.

''A polypus had formed at the superior part of the fundus of
the uterus, which seemed to have had its origin in the muscu-
lar coat, it had projected into the mucous surface, and pro-
ceeded along the cavity in the form of a large pedicle, nearly
equal in size to its base; and the growth had passed through
the OS uteri into the vagina, where it had acquired the magni-
tude of a large peach, and assumed the appearance of a fungoid
tumor.

"The mucous surface of the tumor, in the vagina had been
destroyed by ulcerative absorption ; it mas coated with coagu-
lated blood, which appearance induced me to suppose that the
hemorrhage had proceeded principally from this part, and not
found the vessels belonging to the internal surface of the uterus.
On cutting through the whole extent of the polypus, I found the
cervix of a dense structure, exactly similar to that of the uterus ;
but to my astonishment, when the incision was extended
through that part of it which had entered the vagina, I found
in its centre grumous blood contained in a dense cyst, sur-
rounded bv coagulated lilood."t

The italics in this report are the writerV t The italics are the writer's.

534 O'Keeffe's Clinical Reports. [September,

The substance of the tumor described in the former case as
polypus corresponds somewhat with the description I have
given of the tumor in the present instance. Mark the record:
" This heterologous mass apparently consisted of coagulated
blood interspersed here and there with pieces the size of a pea,
of a dingy white color, soft, resembling adipose matter." Dr.
Lee's tumor is "smooth and vascular, and contains, in some
instances, a curdly matter, or yellow colored viscid fluid."
Thus the fourth variety of polypus described in Dr. Lee's paper
furnishes a prallel to the present in some of the particulars that
present a disparity from the ordinary appearances of polypus
viz: the heterogenous nature of the tumor. And M. Lang-
stafTs case exhibits a polypus coated with coagulated blood a
condition that existed in our tumor, as has been stated in the
fact that by the pressure of the fingers considerable quantities
of the tumor could be detached, difl^ering in no respect from
coagulated blood, save in the interspersion here and there of
fatty matter.

Thus we see that the tumor we have been considering has
many symptoms in common with polypus: we will next give
the negative facts. Dr. Churchill assures us that polypi are
seldom or never attacked by inflammation or ulceration, and
they never degenerate into malignant disease* Our tumor,
therefore, was not a polypus, for the fatal result certainly proves
that it was not otherwise than malignant ; the patient died, not
of hemorrhage, nor from mechanical inconvenience, but from
constitutional irritation. Dr. Hamilton, speaking of Dr.
Gooch's opinion concerning the source of hemorrhage in poly-
pus, says: '"But the experience of the author leads him to
entertain a very different opinion on this subject ; for, in the
first place, in no instance to which he has been called has there
been any bloody discharge from the surface of the polypus,
notwithstanding any liberty he might have taken in pressing
upon it, and in attempting to twirl it round."

The italics are the writers. "The nature of non-malignant tumors con-
sists essentially in this, that they are formed of the persistent elements of the
body, and as such maintain their existence and participate in the general meta-
morphosis of the tissues. They may indeed be destroyed by softening and
ulceration, bat this is effected through the agency of causes which are not inhe-
rent in their nature, but are only accidental and exoteric." (Vogel, Path.
Anat., p. 240.

1851.] O'Keeffe's Clinical Reports. 535

It will be remembered, that whenever the tumor of the case
we have been noticing w^as touched, it bled some, though not
freely, and a vaginal examination was always attended with
more or less of a sanguineous discharge. According to Dr.
Hamilton's experience, then, this could not have been a poly-
pus. It differs from simple induration in being better defined,
more distinct, less dense, more disposed to bleed and more
easily broken down. Yvom fibrous tumor in being less dense,
and ultimately by the ulceration and foetid discharge. From
simple ulceration, attended with chronic enlargement and
induration in the well defined form of the tumor, its size and
softness, and the termination of the two diseases. Yvom pro-
lapsus utei'i in its distinct "attachment to the os and cervix;
the repeated hemorrhages and the presence of the os alongside
of the tumor. From inversion of the uterus in the absence of
sensibility when touched, and the presence of the os in situ.

There are other morbid changes which may occur in the
region where this tumor was developed, but of such distinctive
characters that it is deemed unnecessary to touch on them.
The pain enumerated among the symptoms present when I
first saw the patient is somewhat difficult to reconcile. The
surface of the tumor was insensible to the touch, while she suf-
fered considerably from pain in the uterine region which was
amenable to opiates.

The diagnostician will, I hope, profit by 1 he gross neglect of
the physician who treated this case one week without making
a vaginal examination ; and it will add value to Dr. Churchill's
maxim that no case of uterine hemorrhage should be mana^red
without making a \aginal examination. In conclusion I must
express regret that I am unable to determine with what vari-
ety of malignant disease to class this case. I had determined
at the beginning of my notes to trace it to its variety, but I
cannot find a parallel, so I will leave the subject sub judice.
[to be continued.]

536 Lectures on Diseases of the Chest. [SeptCLiib^fr,

PART II.
(Eclectic D |i a r t m e n t .

Clinical Lectures on Diseases of the Chest. Delivered at the
Hospital for Consumption and Diseases of the Chest. By
Theophilus Tpiompson, M. D., F. R. S., Physician to the
Hospital.

LECTURE I.

Importance of general symptoms. Physical signs. Hooke^in
the seventeenth century, the proposer of auscultation. Laen-
nee. Importance of visible signs. Hydatids expectorated
Cracked-pipkin sound. Modifications of movement of Chest
by Phthisis. Pleurisy. Emphysema. Causes and treat-
ment of asthma.

The hospital in which I have the honour of addressing you
was founded for the relief of individuals suffering trom a class
of diseases, to which nnore than one-sixth of the annual mortal-
ity in this country is attributable. The opportunity for study-
ing this class of diseases has hitherto been lamentably deficient,
and no argument can he requisite lo pi-ove the desirableness of
rendering this institution available for the communication of
knowledge on the subject which it is specially adapted to illus-
trate. With this impression, it has been determined to deliver
a course of clinical lectures; and whilst conscious of my own
deficiency for the share of the task which I have undertaken, I
am encouraged by the reflection, that my duty is not so much
to communicate opinions as to assist you in the observation
of facts, and by the conviction that knowledge acquired by
your own attention, and made to fructify by the energy of your
own mind, will take root witli more certainty, and prove more
productive, than any opinions which I might attempt to trans-
fer to you complete and mature.

Let me remind you, at the onset, that lectures on the diseases
of the chest involve far wider considerations than tho?e con-
nected with the science of auscultation alone. The probable
duration of the disease, and the chances of its relief, have no
exclusive reUrtion to the extent of the local physical conditions.
The various circumstances which characterize or modify the
general constitutional state of the individual patient must be
carefullv considered before we can form a reasonable progno-
sis, or adopt a judicious treatment. Nevertheless, the various
modes of physical investigation will, with propriety, engage a'
large proportion of attention, for it will well repay your careful
study, and will. lose its seeming complication, only .by the devo-
tion of patient care.

1851.] Lectures on Diseases of the Chest.

The systematic application of the ear to the investigation of
the thoracic diseases is of modern introduction ; but it is not
generally known that tlie suggestion of such a method of in-
quiry was really made by one of our own countrymen, about
two centuiies ago.

Robert Hooke, surveyor to the city of London in the middle
of the seventeenth century, who is said to have been the inven-
tor of spring watches, and even in his boyhood to have exhibit-
ed great ingenuity in the construction of clocks, records his
opinion that some modes of ascertaining the condition of the
works of machinery might be extended with advantage to the
investigation of the mechanism of animal lite. The passage is
worth your attention, and is at once so philosophical and defin-
ite, that you will probably feel some suiprise tliat suo^i a sug-
gestion should have remained* so long unnoticed.

"There may be a possibility/' says Hooke, '-'of discovering
the internal motions and actions of bodies by the sound they
make. Who knows but that as in a watch we may hear the
beating of the balance, and the running of the wheels, and the
striking of the hammers, and the grating of the teeth, and a
multitude of other noises who knows, I say, but that it may
be possible to discover the motions of internal parts of bodies,
whether animal, vegetable or mineral, by the sounds they
make ; that one may discover the works performed in the sev-
eral offices and shops of a man's body, and thereby discover
what engine is out of order, what works are going on at
several times, and lie still at others, and the like. I have
this encouragement, not to think all these things impossible,
though never so much derided by the generality of men,
and never so seemingly mad, foolish, and fantastic, that as the
thinking them impossible cannot much improv^e my knowledge,
so the believing them possible may perhaps be an occasion lor
taking notice of such things as another would pass by without
regard as useless. And somewhat more of encouragement I
have also from experience, that I have been able to hear very
plainly the beating of a man's heart; and 'lis common to hear
the motion of the wind to and fro in the guts- and other small
vessels; the stopping of the lungs is easily discovered by the
wheezing. As to the motions of the parts, one among the either,
to their becoming sensible, they require either that their mo-
tions be increased, or that the organ be made more nice and
powerful, to sensate and distinguish them as they are ; for the
doing of both which, I think it is not impossible but that in many
cases there may be helps found."

It may be interesting to you to hear a few particulars of this
ingenious philosopher, a short notice of whom may not be
thought inappropriate to the occasion of our meetin'^'

Lectures on Diseases of the Chest. [September,

Robert Hooke was born in 1635, and died in 1702. He was
intended for the ciiurch, but a liability to headache interrupted
his studies; and on attempting to become a painter, under the
instruction of Sir Peter Lely, the same affliction, aggravated
by the smell of paint, again changed his destination. He was
for a time pupil to Dr. Busby. In 1G55, he assisted Dr. Willis
in his chemical illustrations at Oxford, and probably took a part
in constructing the first air-pump, introduced by that eminent
philosopher, Mr. Boyle. He stated some ideas regarding gravi-
tation, approaching so nearly to those which immortalized Sir
Isaac Newton, that this great man, with the ingenuousness of
true philosophy, gave Hooke full credit for an approximation to
that great discovery.

Robeyt Hooke, in his suggestions for an improved plan of
building London, may be said to have anticipated some im-
portant measures of sanitary reform. He obtained through
Cornelius Drebbel the first microscope used in England, and in
1629 discovered the cellular structure of plants, applying to
the separate cells the name of utriculi. It is remarkable how
little additional knowledge of importance was attained in this
direction until 1833, when Robert Brown, in his work on Or-
chidese, described the cytoblastema, or cell nucleus.

You will agree with me that Dr. Tilotson, the Archbishop of
Canterbury, exercised a sound discretion in making Hooke, by
patent. Doctor of Medicine.

This short account of the observations and intellectual char-
acter of Hooke, will not be unseasonable, if it serve to impress
you with the conviction, appreciating as we do the ingenuity
of his suggestions of helps to auscultation of the living body,
that the rules for physical investigation are not arbitrary and
mystical, but distinctly deducible from scientific laws.

The credit fairly due to Hooke in no measure detracts from
the merit of Laenec. That distinguished physician, with
scarcely a hint to help him from previous observers, excepting
an erroneous statement of Hippocrates, that a sound like boil-
ing water could be heard in the chest of patients with watery
eflusion, and also a general remark by Double, the author of
the Semeiologie, in two short years of observation produced
the first edition of that immortal work on Diseases of the Chest,
which constitutes the solid groundwork of our knowledge of
thoracic diagnosis. Laennec, however, was fallible, and made
one important error: engrossed too much with the instruction
derived through the ear, he disregarded the information obvi-
ous to the eye. To the great value of indications afforded by
inspection, let me now make it the object of this lecture to call
your special attention. The two sides of the chest, when in

1851.] Lectures on Diseases of the Chest. 539

the healthy condition, appear symnnetrical in form, and similar
in movement. A change in these respects, obvious to the
practised eye, is usually induced by any serious disease of the
luno^s or pleura. Let me show you proofs of this statement.

The patient now before you was sent into this hospital under
the idea that "one lung was gone from consumption." But
although he had rapidly become thin, suffered irom profuse
night perspirations, and expectorated great quantities of ' puru-
lent matter," the aspect of the chest made me doubt the cor-
rectness of the opinion. You see that during inspiration the
expansion on the two sides is equal, and that it is quite U'i^Q even
in the sub-clavicular regions. Your eye witnesses truly.

This patient, George S , aged eighteen, a musician, is of

phlegmatic temperament and orderly habits, but obliged, by his
profession to keep late hours. He was admitted Nov. 5th,
1850. At the age of six, and several limes subsequently, he
is said to have had considerable enlargement in the region of
the liver, which subsided, but seventeen months since recurred
to an unusual extent, and did not yield to remedies. About eight
months ago, he had violent attacks of cough, attended with ex-
pectoration of frothy yellow matter ; in about three days the
humour subsided, but he still continued to expectorate ; the ex-
pectoration containinfT pieces of skin which he compares to
gooseberry husks. Five months ago, fresh exasperation of his
cougli occured, with expectoration of bags of humour "the size
of a chestnut. When the cough was tolerably easy, these bags
came up whole ; when the cough was hard, they broke, their
contents being first ejected, and their skins afterwards." He
asserts that he could feel the bags come from the region of
the liver. About two months since, fresh exasperation of
his cough occurred, with imminent danger of suffocation. He
says he felt a tearing sensation about the liver, as if something
required to be ejected.

He soon began to throw up skins and a piece of what he
called gut, about a foot long, and was obliged to tear these
from his mouth to prevent suffocation. A week afterwards he
had a fresh attack of cough, with expectoration of matter like
yellow jelly covered with blood. He then brought up several
pieces of shrivelled reddish skin, which, when stretched out,
would each have covered the first. There was more blood
mixed with them this time than before. For three or four days
after, he continued spitting up a reddish humour containing
small fragments of skin^ Five weeks ago, during a period of
two days, he spat up a large quantity of black congealed blood.
Three days previously, and tw'o days subsequently, to his admis-
sion, he expectorated a peculiar peach-coloured matter, which,

)40 Lectures on Diseases of the Chest. [Septembei

when submitted to the microscope, was found to contain pus
and mucous globules, but no ecchinococci. He has always
eaten much vegetable food, and been particularly fond of cab-
bages; has never had jaundice. His father was asthmatical ;
one of his brothers died of phthisis, another brother died at the
age of four, three days at\er the bursting of a tumour, immedi-
ately below the ear. w^hich in the course of a month had gradu-
ally acquired the dimensions of a goose's egg, and on bursting
gave exit to a fluid resembling water. A fortnight before death,
"a film formed over the sight of both eyes," and four days be-
fore his death lie became " stone blind.''

S is five feet seven inches high, his weight nine stone

four pounds and a half. He sleeps well, but still has nightly
perspirations. Expectorates about an ounce and a half daily,
more easily on stooping or lying-down.

There can be little doubt that this case is one of hydatids of
the liver, which have by absorption found their way into the
lungs, and been expectorated. Every circumstance, particu-
larly the improvement in his strength :md the absence of ecchi-
nococci in the expectoration, may encourage the expectation
of his p rfect recovery. In the cases of hydatids which have
come under my observation, I have generally ascertained one
or more of the following circumstances hereditary liability,
vegetable diet, or blows. This patient cannot recollect receiv-
ing any blow on the side. He has, however, taken much
vegetable food, and the brother's history is remarkable in rela-
tion to hereditary tendency. Two inquiries present themselves
in reference to the origin of these hydatid cases: First, what is
the mode of introduction of the ova? Secondly, is there im-
paired vitality of some organ, rendering it apt to harbour these
animalcules? The influence of moist food on sheep and rab-
bits, as increasing their liability to hydatids, is a matter of
observation, and from analogy w^e should recommend in the
human subject, when affected with these parasites, a nouiishing
animal diet. The promotion of the hepatic secretion is also
desirable ; the introduction of bile into acephalocysts seeming
to be destructive to these parasites, and favourable to their

elimination. The treatment of S has consisted chiefly in

a generous diet, the administration of tonics, wnihtaraxacum,
and the application to the hypochondriac region, of an ointment
of iodide of potassium. His general strength is much improv-
ed, and the fulness in the hepatic region is subsiding.

The next patient whom I place befcire you has a very differ-
ent aspect of chest. Even those of my audience who are at a
distance can tell me at once that the lower half of the right side
of the chest is flattened, and scarcely moves in inspiration.

1851.] Lectures on Diseases of Ute ChesL 541

You see also that the apex of the heart .beats close to the left
nipple, instead of its proper situation, namely, two inches below,
and, an inch within that part. You form a surmise that the
cause of these conditions is contraction from pleurisy, and fur-
ther observation confirms the correctness of the suspicion con-
veyed through the eye. If the heart were displaced by existing
effusion, you would probably see bulging rather than depression.
You put your hand on the flattened portion of the chest as the
man speaks, and the vibration of the voice is distinctly perceiv-
ed ; effusion therefore does not exist, for that would interrupt
tlie communication of the vocal thrill. You make percussion,
and find dulness greater than false membrane en the pleura
alone would produce, but liie dulness lessens as you proceed
upwards to the apex. The cardiac dulness is displaced, but
not extended ; that from the liver extends too much on the left.
Accompanying the fiist sound of the heart, a loud murmur is
heard near the apex, but not in the epigastrium or to the right
of the sternum above the cartilage of the fourth rib.

This patient, Thomas C , a sign-painter, aged nineteen,

was admitted on the 23d of December; lieight, five feet,
two inches, and three-quarters; weight, seven stone, thirteen
pounds; vital capacity by spirometer, 114. He has always
lived well till lately, and has usually resided in London ; has no
hereditary tendency to phthisis ; his father died of dropsy at the
age of sixty-tw^o, and his mother of jaundice at sixty. He en-
joyed good health till three and a lialf years ago, whilst on a
voyage, when he received a sevei'e blow on tlie right side of
the chest, after which he expectorated about four ounces of
blood. Six months afterwards he had rheumatic fever and
inflammation of the lungs, and his sputa were streaked with
blood. About eighteen months since he had a recurrence of
ha3mopty?is, he thinks to the amount of two quarts in a week,
and since that time his breathing has been oppressed, and some
degree of ha3moptysis has occurred whenever he has attempt-
ed to resume his occupation. He complains of a sensation of
tightness of the chest on the right side; relieved by making
pressure on the lelt ; cough slight; expectoi-ation froihy ; res-
^pirations 32; pulse 88, not strong; digestive organs natural ;
enjoys exercise, but sleeps badly, and perspires at night.

In this case the cardiac murmur obviously indicates regur-
gitation from the left ventricle into the corresponding auricle.
This regurgitation, however, is probably not considerable, for
the circulation in the radial artery is not disturbed or irregular.
There are various circumstances in this man's condition, en-
couraging us to hope that he will escape ])hthisis. The mitral
ilisea.se is probably due to rheumatism, and such disease is ra-

542 Lectures on Diseases of the Chest. [September,

ther inapt to occur in phthisical subjects. The dulness on
percussion is least at the apex of the lungs, where tubercular
disease is most common, and greatest at the part corresponding
to the blow, which, by inducing inflammation and occasioning
consolidation of the pulmonary structure, may have rendered
tlie thrill of the voice more than usually observable. The fre-
quent occurrence of hsemoptysis might excite suspicions of a
tubercular tendencv, but any such apprehension is qualified by
the fact that this occurrence was preceded and probably in-
duced by a blow. Some friction sound at the border of the
contracted part of the chest announces that some inflammation
of the pleura still exists. A blister has been inconsequence
applied, and the patient is improving under the use of iodide
of potassium.

The next patient, George vS , you observe, moves the

right side of the chest moderately during inspiration, especially
at the upper part, but the left side scarcely at all ; you suspect
tubercular disease from this fact, and further examinatit)n con-
firms that opinion. ' Percussion yields a dull sound over the
whole of the left side, and in the sub-clavicular region a sound
is elicited "which some of you will recognise as amphoric, like
that produced by filliping the distended check, and doubtless
arising from the proximity of a considerable cavity almost full
of air. If a smart stroke be given whilst the patient's mouth
is open, you hear the sound denominated by the French, bruit
depot fele, resembling, as the desifrnation implies, the noise
produced by striking a cracked-pipkin. You may imitate the
cracked-pipkin sound by doubling the hands together rather
loosely, and striking the back of one of them against the knee
in such a manner as to allow some escape of air. The pro-
duction of this particular sound by percussion of the chest, is
doubtless owing to the proximity of a considerable cavity, hav-
ing yielding walls and free communication with one or more
large bronchial tubes. If, whilst the patient's mouth is open,
you strike smartly over such a cavity, air escapes freely and
suddenly from it into the bronchus, and thus the peculiar sound

in question is produced. S has no hereditary tendency to

phthisis, but for fifteen years has been scarcely free from either^
syphilis or gonorrhoea. The free use of mercury, an unset-
tled life, and, we may suppose, an uneasy conscience, may
have proved adequate for inducing the disease. He began to
cough three years since, and a year afterwards to lose flesh ;
ten months ago he expectorated about four ounces of blood ;
his sputa green and viscid, average in quantity ten ounces in
the twentv-four hours. Occasionally the cracked-metal sound
is suspended, probably in consequence of plugging of thebron-

1851.] Lectures on Diseases of the Chest. 543

chial tube by the viscid secretion. Pulse 84 ; respirations 32.
There is a chronic ulcer on the leg, which we shall not attennpt
to heal, for he always feels better when it discharges freely.
He has fluctuated considerably, but on the whole improved in
strength under the use of cod-liver oil. Belladonna pills and
various measures have been adopted for the cough, but the only
medicine which relieves him is the following linctus: Hydro-
chlorate of irjorphia, one grain ; diluted hydrochloric acid, fine
minims; diluted hydrocyanic acid, half a fluid drachm ; syrup
of squills, one fluid ounce. Water, one fluid ounce. Mix.
One drachm to be taken when the cough is troublesome.
The last patient I have to introduce to you to-day is Charles

B . As you watch the movement of his chest, let me

remind you that the advance of either of the five upper or
"thoracic ribs'' in ordinary inspiration varies from *02 to '07
of an inch, and in an extraordinary effort may extend to about
two inches; whilst the four or five inferior ribs, which obey
the influence of the diaphragm, move outwards ordinarily from
25 to "3 of an inch, or in an extreme inspiration about an inch

and a half You will observe that the upper part of B 's

chest moves in correspondence with this rule ; but that the
lower part, instead of advancing according to this rule, abso-
lutely recedes. By means of Dr. Sibson's chest-measurer,
(Medico-Chirurgical Transactions, vol. xxxi.) we may deter-
mine the exact amount of this deficiency of movement ; or if
you have not had sufficient practice for the dexterous manage-
ment of this instrument, try that of Dr. Quain, in which the
sliding joints are dispensed with. Even this instrument, how-
ever, excepting to those practised in its use, is not more trust-
worthy than the eye. In practice, the attentive eye soon
detects the difference of form and movement associated with
the diseases to which I have referred ; but it is doubtless a great
advantage to be able to state to others, by the aid of a gradu-
ated instrument, the exact amount of difference. If you strike
this patient's chest, the sound elicited is clear; and you have
already recognised the characteristic movement of emphysema.
The diaphragm in contracting aflx)rds space for the expansion
of the lungs, but the pulmonary cells already filled cannot admit
more air ; atmospheric pressure, therefore, takes effect, and the
ribs are forced inwards. Th'is patient is a tailor. He has been
subject to colds for ten years, owing, he thinks, to transitions
from hot workshops lighted with gas into the cold air. During
the last three years these colds have become almost incessant.
He has sufl^ered from shortness of breath and cough, and occa-
sional paroxysms of dyspn(Ea. For the last ten months he has
kept his room ; sleeps in the sitting posture, with the body

544 Lectures on Diseases of the Chest. [September,

bent forwards: expectoration partly viscid, partly frothy; so-
norous and sibilous rhonchi heard al! over the chest ; pulse 88 ;
respirations 26. He has no hereditary tendency to phthisis or
to gout, and has never had haemoptysis. Asthma would seem
in this case to be a consequence of chronic bronchitis and em-
physema. It is a disorder depending probably on a peculiar
susceptibility of. that part of the nervous system which supplies
the bronchial tubes and pulmonary cells, but a susceptibility
"Cvhich is rarely manifested in a decided manner until some ad-
ditional influence is exerted, such as indigestion, gout, bronchi-
tis, or cardiac disturbance. The emphysematous condition of
ihe lungs, which frequently accompanies asthma, is well entitled
to your careful study. It is connected with an atrophied con-
(fition of the pulmonary cells. If at any early period of the
disease you make a microscopical examination of the affected
lungs, you will observe a number of little bright dots, like oil-
globules, on the menrbrane which sustains the vessels. At a
later period you will find the membrane cribriform, and its
meshes of vessels more widely separated than in the natural
condition. Partly in consequence of the deficient supply of
blood, and partly, it may be, from venosity of the circulating
fluid, diminished liability to phthisis is characteristic of emphy-
sema. When cicatrized cavities are found in any part of the
lungs, it is common to discover emphysematous portions in the
adjoining structure, probably beccCuse the obliteration of vessels
which attends such cicatrization tends to diminish the supply
of blood to the neighbouring cells. Even when you have rea-
son to suspect the existence of phthisis in emphysematous sub-
jects, you have ground to hope that the tubercular disease will
be slow in its progress.

There is something very capricious in the asthmatic suscep-
tibility. Some individuals have paroxysms only in town, some
only in the country ; others indifferently in town or country,
but experience relief from the attack by immediate change
either to one or the other. The late duke of Sussex, who be-
came asthmatical at a very early age, always escaped the par-
oxsyms when at the foot of Vesuvius, but suffered repeatedly
when residing in Naples. Measures which immediately re-
lieve the fit in one individual are useless in another. Some-
times, indeed, in the same subject a remedy at one time effica-
cious will at another time utterly fail. Thus, in our patient

B , smoking stramonium at first afforded instantaneous

relief, but subsequently failed. The inhalation of chloroform
almost invariably relieves the asthmatical paroxysm, but its

use is not to be indiscriminately recommended. In B the

pulsation of the heart can be seen at the epigastrium, indicating,

185 J.] Lectures on Diseases of l/ic Cht'sf. 515

what is very common in such cases, some dilatation of the
right side of the heSrt, as a consequence of the obstruction in
the pulmonary circulation; and what you know of the influ-
ence of chloroform on the heart should make you cautious of
its administration under such a complication.

It is theref(n-c satisfactory to have other measures in reserve,
and in many instances I have found remarkable relief experi-
enced from the use of blotting-paper dipped in a saturated so-
lution of nitrate of potash, dried, and then set fire to on a plate
so placed as to expose the patient to the vapour. Wfiether the
efficacy of this measure be owing to empyreumatic bituminous
vapour or to nitrogenous fumes, I cannot tell. I can neither
explain its remarkable efficacy, in some instances, nor its fail-
ure in others; but it is a remedy of real value ; and I ihink I
owe the suggestion to Mv. Harrison, of Broughton, near Man-
chester.

fr But it is not enough to relieve the paroxysms: you must
aim to accomplish permanent amendment, and with this view
must not be satisfied till you have rectified every disordered
function, and improved to the greatest possible extent the
nervous tone of your patient. Above all, endeavour to subdue
any accompanying bronchitis. In many instances grain doses
of mercurial pill with antimony, when watchfully regulated so
as to avoid salivation, and gradually suspended, as the rhonchus
moistens, are with this view singularly efficacious. When,
however, there is the least threatening of consumption, it is
desirable to find a substitute for the mercurial pill, and the
combination most similar in effect is probably iodide of potas-
sium mixed with antimony, which latter medicine would seem
to have a tendency to direct the influence of the iodide of po-
tassium to the bronchial tubes. B has therefore taken a

mixture according to the following prescription: iodide of
potassium, three grains; potassio-tartrate of antimonial wine,
ten minims; tincture of henbane, fifteen minims; decoction of
sarsaparilla, one fluid ounce ; make a draught, to be taken three
times a day ; and the benefit has been obvious ; the breathing
having become easier, the paroxysms no longer recurring, and
the sibilant rhonchus, which was formerly audible during both
inspiration and expiration, being confined to the latter, thus
showing that the more minute tubes, into which the air was
noisily forced by inspiration, have recovered their natural
condition.

Is it probable that alum might prove useful as a remedy in
asthma? It is almost a specific in lead colic and in hooping-
coughdiseases not without analogy to asthma, in the parox-
ysmal OTaracter of the attacks, and perhaps in the correspond-

546 Treatment of Typhoid Fever. [September,

ence of the nervous fibres through which the morbid influence
is conveyed.

When a medicine is proved to have remarkable efficacy in
any one disease, we may often extend its use to the treatment
of other affections, if we can succeed in discovering what par-
ticular condition the remedy modifies, and in 'classifying to-
gether such other disorders as present a distinct analogy in
reference to this condition. [London Laiicet.

On the Employment of Mercurials in the Treatment of Typhoid
Fever, {Black Sulphuret of Mercury and frictions of Mer-
curial Ointment,) after M. Serres' method. By M. Bec-
QUEREL. Translated from the French, with additions, by
James Byran, M. D., Prof of Institutes of Medicine in the
Philadelphia College of Medicine. ^

In 1847, Dr. Serres presented to the Institute a series of
memoirs designated to elucidate the nature and treatment of
typhoid fever. It is on these two points of the histor}^ of this
disease that the learned member of the Institute desires again
to call the attention of the medical profession, to point out a
new method of treatment, destined to prevent the most formi-
dable accidents, to moderate the most dangerous symptoms,
and, in fine, to change the malignant typhoid fever into a mild
form of disease.

Instructed by the administration of the hospitals, to replace,
temporarily. Dr. Serres in the Hospital de la Petie, I have
thought that I could not do better than continue his treatment
of this fever and to submit it to new experiments. The follow-
ing is the result :

It is proper to state Dr. Serres' treatment, and the eflfects
obtained. The mercurial treatment consists in the use of the
black sulphuret of mercur}^ internally, (yEthiop's mineral,) in
doses which vary from sixty grains to two drachms; and in
the external use of mercurial friction on the abdomen, (onguent
Napolitain.) in doses which vary from fifteen to sixty grains
per diem. This treatment was continued eight, ten, or twelve
days, or until the symptoms of the disease ceased.

The following are the results as stated by Dr. Serres in his
communication to the Institute: The employment of the black
sulphuret of mercury in the above doses, may nearly always be
continued eight, ten, or twelve days, before salivation will occur ;
and when it does take place, it never is so severe as to be dan-
gerous. Mercurial frictions on the abdomen alwaysj^sperse
the sore patches, and rapidly diminish tympanitis of the abdo-

1851.] Treatment of Tijphoid Fever. 547

men. Under the combined influence of these two means, the
diarrhoea is ameliorated, the frequency of the pulse is diminish-
ed, the fever subsides, the headache and dehrium are much
lessened.

The duration of the disease is not always abridged, it gener-
ally continues its usual course, that is to say, it lasts three or
four weeks : but it comes without any serious complications,
and especially without that adynamic condition which is so dan-
gerous. Such, are, in a few words, the conclusions of the
learned physician of La Petie.

Before stating the results which I have obtained in the treat-
ment of fifteen cases of typhoid fever, all very bad cases, and
subjected to this treatment, I must add that I have followed
closely the above formulary entirely, so that to no other causes
can the results obtained by me, more fortunate perhaps than
evQq those of Serres, be attributed. The black sulphuret was
used as soon as the patients entered. I commenced wqth one
gramme (about 154- grains) per day, in powder or in pills made
with gum. This amount was given in five or six doses. If
the improvement did not commence at the second or third day,
I increased the amount up to one and a half grammes, or even
to two grammes. I have never exceeded the latter quantity.
I suspended its use as soon as convalescence commenced, nor
did the intensity of the salivation ever make it necessary to
remit the use of the medicine.

Frictions on the abdomen, with the Napolitain ointment,
were made of the strength of one gramme of sulphuret to 16
grammes of mercurial ointment in two frictions, with the appli-
cation of a poultice to favor absorption, one gramme of sulphu-
ret to 24 grammes of mercurial ointment, used in three appli-
cations, and, finally, two grammes of black sulphuret to thirty
grammes of ointment, also in three applications.

Every two days the abdomen was w^ashed with soap, in
order to favor the process of absorption.

The rest of the treatment was, 1st. Ice seltzer water, or
lemonade, for drink. 2d. Laxatives or mild clysters where the
bowels were constipated. Sd. In adynamic cases, of which
there were five, I added to the use of black sulphuret that of
musk, in doses of from one to twenty-five or thirtv grammes
per day. This medicine was discontinued when the delirum
and general agitation diminished. Fifteen patients, affected
with low typhoid fever, were fully subjected to the eftects of
the mercurials. There were ten males and five females. The
ten males were aged : two of sixteen, two of seventeen, two
of eighteen, one of twenty, two of twenty-two, and one of
thirtyHfx years of age. The ages of the five females were as

N. 3. VOL. VII. NO. IX. 35

548 Treatment of Typhoid Fever. [September,

follows : one of fifteen, one of eighteen, one of twenty, and two
of twenty-one years of age.

The period of life at which this disease usually appears, is a
very striking feature in its character. According to Louis and
Chomel, of 255 cases, 78 were from fifteen to twenty years,
95 from twenty to twenty-five, 54 from twenty-five to thirty,
22 from thirty to forty, and five only from forty to fifty years
of age, while but one was above fifty. [As to the cause of the
disease, may it not be connected with certain evolutions of the
system at this time ? May not the mucous diathesis which
so commonly exists under the circumstances in which this
fever is developed, be, if not a cause of the disease, an
aggravating circumstance ? May not the general depravation
of the nutritive functions, the blood and the tissues, be traced
more or less to this depraved condition of the mucous mem-
branes, thus developed? Does not both the prophylactic find
curative mode of treatment, usually found effective, add strength
to this belief, viz. change of air, diet, and occupation, with the
use of nitrate of silver, oil of turpentine, or, as in the above
cases, mercury ? J. B.]

The ten males, continues our author, afl[ected with typhoid
fever, presented the following forms : four, the ordinary abdo-
minal form, with stupor, cephalalgia, &c.; five, the adynamic
form, of the lowest kind ; one, the ataxic form, with delirium
and general agitation. The five females presented twice the
ataxic form, once the ataxo-adynamic ; once, the adynamic ;
and once, the ordinary abdominal form. These fifteen cases
entered the hospital some time after the first attack, having
been probably without any treatment at their homes. In all,
ihe treatment was commenced on the day after they entered :
the following are the effects it produced on the principal symp-
toms, and the general disease.

The Fever. Under the influence of the first doses of the
black sulphur and of the frictions, the skin always became
cooler, less dry, and in some cases, it became moist, or per-
spired. At the same time, the pulse diminished in force and
frequency; this occurred even in the only case of death that
took place, which was from perforation of the intestine.

The Tongue. At first dry, rough, and the gums and lips
dark and sooty continued thus until the advent of salivation.
Of the fifteen cases, salivation took place in twelve; in two it
did not occur, and the patients recovered very well : in these
two cases, the tongue did not become moist until the cessation
of the fever. In the case of perforation of the intestine, the
tongue remained dry to the end. [This, however, is not always
the case, as we well know. We well remember a case that

1851.] Treatment of Tt/p hold Fever. 549

was pronounced, from the general improvement of the symp-
toms, (he moisture of the tongue among them, convalescent, by
a distinguished clinical teacher of our city, which, however,
was brought in on the next clinic day dead. A perforation
having taken place in the small intestine, which caused death
very suddenly. This, in fact, is the great danger in the disease,
and it occurs not unfrequently when least expected. J. B.]

In the twelve cases where salivation w^as developed, it took
place twice on the sixth day of the treatment ; three times on
the seventh day; four times on the eighth day; once on the
twelfth ; and once on the thirteenth. Except one case, in
which the salivation and swelling of the gums were intense,
and continued fur twelve days, it was in all the rest very
light and unimportant. In no other case did it continue be-
yond four or five days, and required no medical treatment.
We may, in reference to the salivation, establish the following
propositions :

1. In cases of typhoid fever in its ordinary form of medium,
intensity, salivation takes place rapidly, it is decided, and con-
tinues during a considerable portion of the time of convales-
cence ; in general, it announces the occurrence of the latter.

2. In more serious cases, salivation occurs at a later period;
it is in general less severe, and continues only during the first
days of convalescence ; it precedes by a few days the cessa-
tion of the fever, and constitutes a sign which indicates an
early cure. Sometimes, however, it does not occur until the
instant that the fever ceases.

3. In extremely low cases, salivation is induced with great
difficulty; and until it takes place, the case must be considered
as dangerous. It is in these cases that we must insist for a
long time on large doses of the black sulphuret and mercurial
frictions.

4. In some cases of medium intensity, salivation is not in-
duced at all. The treatment was continued in each of the
fifteen cases, not only until the supervention of salivation, but
to the cessation of the fever, and the amelioration of all the
symptoms.

The Tympanitic Abdomen, except in the case of perforation
of the intestine, always diminished rapidly, even from the com-
mencement of the treatment; this result must he attributed to
the combined influence of the black sulphuret.

In reference to the stools, in the fifteen patients, there were
two affected with constipation, which clysters alone removed.
The black sulphuret was ineflectual in reliving the system. In
two otiier cases, the black sulphuret produced a diarrhoea, which
did not exist before, and which since itscm[jloyment produced

550 Treatment of Typhoid Fever. [September,

one or two stools per day. The diarrhoea, which was always
ushered in by fxve or six liquid stools, diminished at once when
the black sulphuret was taken. In eight cases, finally, the
diarrhoea was neither augmented or diminished ; it continued
its course, and diminished only as the other symptoms subsided.

Whenever the mercurial frictions were used on a part where
the sore spots existed (abdomen,) they disappeared in from
twenty-four to thirty-six hours ; none remained but those on
the lower part of the thorax, on the chest, or elsewhere.

In relation to the ceplialalgia, no appreciable effect was pro-
duced in those cases; it did present a very severe symptom.

Where delirium existed pretty severe (four patients,) musk,
in doses of 25 to 30 grains, with black sulphuret, was given,
until this symptom ceased. In these four cases the improve-
ment was rapid, and five days was the longest period of its
existence. In one patient, in which cold water on the head
was applied for three days, the delirium v/as very violent, and
,we were obliged to resort to the straight waistcoat.

Tke expression of the face did not disappear until the other
symptoms had diminished; the black sulphuret acted upon it
only secondarily.

The same may be said of the cough, the sibilant rale ; there
were, for the rest, no serious symptoms connected with the
chest. The patient who died on account of intestinal perfora-
tion must be excepted from this list, having had, when he enter-
ed, symptoms of severe bronchial engorgement. The mercu-
rials did not affect these symptoms, except as they affected the
general disease. In no case was there serious haemorrhage.

The duration of the treatment was, in four cases seven days,
in three eight, in one nine, in three ten, in one twelve, in. one
fifteen, one sixteen, and one seventeen. The medium dura-
tion was ten days.

The minimum of the black sulphuret used in the treatment
was seven grammes (a little over 15 grs. each), the maximum
was 24 grammes. The minimum of mercurial ointment used
was 112 grammes, and the maximum 360 grammes ; the me-
dium was 12 gr., 30 in each case, and 200 grammes of Napoli-
tan ointment.

The whole duration of the disease varied somewhat. The
table added to my memoir gives the following results: one
case twelve days, two thirteen, three fourteen, three fifteen, one
sixteen, one eighteen, one twenty, and one twenty-three days.
The medium duration of the fever was sixteen days.

The patient that died of the perforation was a male of 36
years, strong and robust, who v/as admitted on the eighteenth
day of the disease; the symptoms of the typhoid fever were

1851.] Treatment of Ti/phoid Fever, 551

marked by those of a very severe bronchitis^ which for the first
few days entirely concealed the principal cMsease ; he was
treated during five days, from the 8th to the I2tti, by two gen-
eral bleedings, ipecacuanha, and a cathartic. The bronchial
engorgement, improved by this energetic treatment, precluded
the use of the mercurials, either internal or external, before the
twelfth day; it produced happy results as\isual. Tiie symp-
toms improved, and he was getting better, when, without
known cause, the patient, on the nineteenth day, was seized
with symptoms of acute peritonitis, and died on the twentieth
day. The autopsy detected the intestinal perforation.

Duration of the convalescence. In all the cases it was simple,
without complication or accident. In one female there was an
escar on the sacrum, which required a month to get well.
With this exception, the patients remained in the hospital from
eight to twenty-three days.

[In reference to the duration of the disease, we quote the fol-
lowing from Dr. Wood's " Practice :" " Even the mildest cases
run on to the fourteenth and fifteenth day : those of a severer
character seldom become convalescent before the end of the
third or fourth week: and not unfrequently we witness reco-
veries even after the sixth week. The average duration of
cases may be stated at from twenty to thirty days. The dis-
ease seldom lasts longer than sixty days, though it has no fixed
limits." This statement does not agree with that of Becquerel,
who places the average at sixteen days. Doubtless, there is
much difference in this respect between hospital and private
practice. The latter can never be altogether safe for the
general practitioner to follow, for several reasons. 1. The
patients are frequently paupers and broken-down constitutions,
either from their poverty or their vices. 2. The atmospheric
and other conditions of a general or fever hospital can never
be equal in salubrity to those of a respectable private residence.
Unfortunately for the general practitioner, especially in our
country, the writers on these and kindred diseases are mostly
liospital physicians. It is much to be regretted that our coun-
try practitioners do not more frequently write out the result of
their ample experience. We quote with pleasure the following
remarks made by a practitioner of the latter class. He is not
alone in recommending opium for these cases of disease.

" For the last twelve years, opium, in four and jive grain
doses, has been my main remedy in all forms of typhoid fever.
In fact, when I use it at all in fever it is in four or five grain
doses. I claim to have demonstrated beyond all reasonable
doubt, by a long and careful observation and experience, that
while the maximum doses of the schools arc of doubtful utility,

552 Treatment of Typhoid Fecer. [September,

and often prove injurious in fever, by increasing the dryness
of the skin, ag^-avating the pain in the head, &c., &c., a five
grain dose wiW, nineteen times in twenty, produce free perspi-
ration and relieve every unpleasant symptom. The notion that
so generally prevails among the profession that opium cannot
be used to advantage in fever while there is determination to
the brain, is certainly erroneous, if it is given in the doses
which I recommend, unless there is oc^waZ inflammation of the
membranes, and cases of this kind are extremely rare, in my
opinion, Dr. Clutterbuck to the contrary notwithstanding."
Dr. A. G. Henrv, Boston Med. and Surg. Journal, vol. xii.,
p. 13.

Professor J. K, Mitchell, of this city, relies chiefly on nitrate
of silver, which he uses until the stools assume the "metallic
lustre" produced by this remedy. Those who are familiar
with Dr. M.'s practice know that he is very successful in his
treatment of typhoid fever by the- nitrate. On the other hand,
a respectable country practitioner, Dr. John L. Altee, of Lan-
caster, Pa., says: "Should the fever be prolonged beyond the
third or fourth day, and its character become fairly established,
I then resort to the acetate of lead, in doses of from one to three
grains, carefully and perfectly dissolved in a few drops of vine-
gar and half an once of river or distilled water, and given every
two, three, or four hours, according to the urgency of the
symptoms; and the treatment is steadily persevered in as long
as the enteric symptoms continue. He adds : "I do not know
that I have ever lost a patient where the case was treated from
the commencement as above indicated." (Wood's Practice.)
It must not be forgotten that in all these cases the bowels are
first moved, and their contents more or less evacuated. My
late friend. Dr. Parisli, depended almost entirely on the use of
the oil of turpentine, together with carbonate of ammonia and
neutral mixture. He generally formed what he denominated
his " Turpentine Julep," by rubbing it up with gum acacia,
loaf sugar, and water, adding sometimes tincture of opium,
especially when the oil disturbed the bowels. This practice
is followed pretty generally by his pupils, who are now the
prominent writers and practitioners of our city. For ourselves,
we have resorted to all these measures, and find that what
Hippocrates calls the "temperament" of the year or season,
or some other cause, influences very much the efl;ects of these
as well as other remedies. The last cases of severe typhoid
fever which we treated, nothing w^as so efl^ectual, under proper
restrictions, as good port wine, of which the patients consumed
about a pint daily, sometimes more. J. B.] N. Y. Journal
of Medicine.

1851.] Strangulation or Hanging, Apoplexy, ^-c. 55'

Pathological Appearances in cases of Strangulation or Hang-
ing, Apoplexy, <^c , (from Professor J. H*. Bexnet's Clinical
Lectures.) The Pathological Laws which Regulate Dis-
eased Functions of the Nervous System. For the purpose
of diagnosis and treatment, it is a nnatter of great importance
to attend to the following generalizations :

(1.) The amount of fluids within the cranium ?nust always
he the same so long as its osseous walls are capable of resisting
the pressure of the atmosphere. There are few principles in
medicine of greater practical importance than the one we are
about to consider the more so, as many able practitioners
have lately abandoned their former opinions on this head, and
on what 1 consider to be very insufficient grounds. On this
point, therefore, I cannot do better than condense and endea-
vour to put clearly before you the forcible arguments of the late
Dr. John Reid, with such other considerations as have occurred
to myself.

That the circulation within the cranium is different from that
in other parts of the body, was first pointed out by the second
Monro. It was tested experimentally by Dr. Kellie of Leith,
ably illustrated by Dr. Abercrombie, and successfully defended
by Dr. John Reid. The views adopted by these distinguished
men were, that the cranium forms a spherical bony case, capa-
ble of resisting the atmospheric })ressure, the only openings
into it being the diflJerent foramina by which the vessels, nerves,
and spinal cord pass. The encephalon, its membranes and
blood-vessels, with perhaps a small portion of the cerebro-
spinal fluid, completely fill up the interior of the cranium, so
that no substance can be dislodged from it without some equi-
valent in bulk taking its place. Dr. Monro used to point out
that ajar, or any other vessel similar to the cranium, with un-
yielding walls, if filled with any substance, cannot be emptied
without air or some other substance taking its place. To use
the illustration of Dr. Watson, the contents of the cranium are
like beer in a barrel, which will not flow out of one opening,
unless provision be made at the same time that air rushes in.
The same kind of reasoning ap[)lies to the spinal canal, which,
with the interior of the cranium, may be said to constitute one
large cavity, incompressible by tlie atmospheric air.

Before proceeding further, we must draw a distinction be-
tween pressure on, and compression of, an organ. Many bodies
are capable of undergoing a great amount of pressure without
undergoing any sensible decrease in bulk. By compression
must be understood, that a substance occupies less space from
tile application of external Ibrce, as when we scpieeze aspono^e,

554 Strangulation or Hanging, Apoj^lexy, <^c. [September,

or compress a bladder filled with air. Fluids generally are not
absolutely incompressible, yet it .requires the weight of one
atmosphere, or fifteen pounds on the square inch, to produce a
diminution equal to 2 o,Voo^h part of the whole. Now this is
so exceedingly small a charge upon a mass equal in bulk to the
brain, as not to be appreciable to our senses. Besides, the
pressure on the internal surface of th blood-vessels never
exceeds ten or tw^elve pounds on the square inch, during the
most violent exertion, so that, under no possible circumstances,
can the contents of the cranium be diminished even the
2 o.Vo" o^'^ part. When the brain is taken out of the cranium, it
may, like a sponge, be compressed, by squeezing fluid out of the
blood-vessels ; but during life, surrounded, as it is, by unyield-
ing walls, this is impossible. For let us, with Abercrombie, say
that the whole quantity of blood circulating within the cranium
is equal to 10 ; 5 in the veins, and 5 in the arteries: if one of
these be inci-eased to 6, the other must be diminished to 4, so
that the same amount, 10, is always preserved. It follows that,
when fluids, are effused, blood extravasated, or tumours grow^
a corresponding amount of fluid must be pressed out, or of
brain absorbed, from the physical impossibility of the cranium
holding more matter. At the same time, it must be evident
that an increased or diminished amount of pressure may be
exerted on the brain, proportioned to the power of the heart's
contraction, the eflect of which will be, not to alter the amount
of fluids within the cranium, but to cause, using the words of
Abercrombie, "a change of circulation" there.

Dr. Kellie performed numerous experiments on cats and
dogs, in order to elucidate this subject. Some of these animals
were bled to death by opening the carotid or femoral ateries;
others by opening the jugular veins. In some the carotids were
first tied, to diminish the quantity of blood sent to the brain,
and the jugulars w^ere then opened, with the view of emptying
the vessels of the brain to the greatest possible extent ; while,
in others, the jugulars were first secured, to prevent as much
as possible the return of the blood from the brain, and one of
the carotids was then opened. He inferred, from the whole
inquiry, which was conducted with extreme care, " That Vv^e
cannot, in fact, lessen, to any considerable extent, the quantity
of blood within the cranium by arteriotomy or venesection ;
and that when, by profuse hemorrhages destructive of life, w^e
do succeed in draining the vessels within the cranium of any
sensible portion of red blood, there is commonly found an
equivalent to this spoliation in the increased circulation or
effusion of serum, serving to maintain the plenitude of the
cranium."

1851,] Strangulation or Hanging, Apoplexy, ^-c.

Dr. Kellie made other experiments upon the effects of posi-
tion immediately after death from strangulation or hangino;.
He also removed a portion of the unyielding walls of the cra-
nium in some animals, by means of a trephine, and then bled
them to death; and the differences between the appearances
of the brain in these cases, and in those where the cranium
was entire, were very great. One of the most remarkable of
these differences was its shrunken appearance in those animals
in which a portion of the skull was removed, and the air allow-
ed to gravitate upon its inner surface. He ^ays : ' The brain
was sensibly depressed below the cranium, and a space left,
which was Ibund capable of containing a teaspoonful of water."

It I'esults, from these inquiries, that there must always be the
same amount of fluids within the cranium so long as it is unin-
jured. In morbid conditions these fluids may be blood, serum,
or pus ; but in health, as blood is almost the only fiuid present
(the cerebro-spinal fluid being very trilling), its quantity can
undergo only very slight alterations. There are many circum-
stances, however, which occasion local congestions in the brain,
and consequently unequal pressure on its structure, in which
case another portion of its substance must contain less blood,
so that the amount of the whole, as to quantity, is always pre-
served. These circumstances are mental emotions, hemor-
rhages, efiusiohs of serum, and morbid growths. Some. con-
gestions, or local hypersemias, in themselves constitute morbid
conditions ; and nature has, to a great extent, provided against
their occurrence, under ordinary circumstances, by the tortu-
osity of the arteries and the cerebro-s[)inal fluid, described by
Magendie.

The views now detailed had been very extensively admitted
into pathology, when Dr. Burrows, of St. Bartholomew's Hos-
pital, endeavoured to controvert them, first in the Lumleain
Lectures of 1843, and subsequently in a work published in 1846,
entitled, "On Disorders of the Cerebral Circulation, and on
the Connection betw^een Affections of the Brain and Diseases
of the Heart." Dr. Burrows, however, evidently formed the
most confused notions of the doctrine we are advocating; for,
instecd of stating it as propounded by its authors, he actually
'/iiisrcprasented it, as Dr. Reid pointed out. Thus, he is ailways
combatting the idea that blood-letting, position, strangulation,
&c., cannot affect the blood in the In-aln ; whereas the real pro-
j)osition is, that they cannot aller {he fluids ivithi7i the cranium.
By thus confounding blood with fluid, and brain with cranium,
he has only contrived to overthrow a theory of his own creation.

Dr. Burrows has brought forward several observations and
experiments, which he considers opposed to the theory now

556 Strangulation or Hanging, Apoplexy, ^-c. [September,

advocated. His facts are perfectly correct. 1 myself have
repealed his experiments on rabbits, and can confirm his de-
scriptions. It is the inferences he drav^s from them that are
erroneous. For the paleness which results from hemorrhage,
and the difference observable in the color of the brain, when
animals, immediately after death, are suspended by their ears
or by their heels, is explicable by the diminished number of
coloured blood particles in the one case, and by their gravita-
tion downwards in the other. That the amount of fluid within
the cranium was "in no way afl^ected, is proved by the plump
appearance of the brains figured by Dr. Burrows, and the total
absence of that shrunken appearance so well described by Dr.
Kellie.

Neither does our observation of what occurs in asphyxia or
apncea oppose the doctrine in question, as Dr. Burrows ima-
gines, but rather confirms it. On this point the followincr ob-
servatious by Dr. John lleid are valuable. He says: '"If any
circumstance could produce congestion of the vessels within
the cranium, it would be that of death by hanging; for then the
vessels going to and coming from the brain are, with the ex-
ception of the vertebral arteries, compressed and then obstruct-
ed. These two arteries, which are protected by the peculiarity
of their course through the foramina of the transverse processes
of the cervical vertebrae, must continue for a time to force
their blood upon the brain, while a comparatively small quan-
tity only can escape by the veins. Indeed, the greater quantity
of blood carried to the encephalon by the vertebrals returns by
the internal jugulars, and not by the vertebral veins, which are
supplied from the occipital veins of the spinal cord; and the
anastomoses, between the cranial and vertebral sinuses, could
carry oflfa small quantity of the blood only, transmitted along
such large arteries as the vertebrals. And yet it is well known
that there is no congestion of the vessels within the cranium
after death by hanging, however gorged the external parts of
the head may be by blood and serum." This is admitted by
Dr. Burrows, although he endeavors to get rid of so trouble-
some a fact by a gratuitous hypothesis, which will not bear a
moment's examination, but for the refutation of which I must
refer to the works of Dr. Reid.*

On the whole, whether we adopt the expressions of local
congestion, of change of circulation within the cranium (Aber-
crombie), or of unequal pressure (Burrows), our explanation of
the pathological phenomena may be made equally correct, be-
cause each term implies pretty much the same thing. But if

* Monthly Journal, August, l84Cr Phj'siulogical, Anatomical, and Patholo-
gical Researches, No. XXV.

ISSl.] Strangulation or Hanging, Apoplexy, <^c. 557

we imagine that venesection will enable us to diminish the
amount of blood in the cerebral vessels, the theory points out
that this is impossible, and that the effects of bleeding are ex-
plained by the influence produced on the heart, the altered
pressure on tlie brain, exei'cised by its diminished conti-actions,
and the change oi circulation within the cranium thereby oc-
casioned.

I have entered somewhat fully into this theory, because, in-
dependent of its vast importance in a practical point of view,
it is one which originated in, and has always been maintained
by, the Edinburgh School of Medicine. Singular to say, not-
withstanding the obvious errors and fallacies in Dr. Burrows'
\voi-k, no sooner did it appear than the whole medical press of
England and Ireland adopted its conclusions, and even Dr.
Watson, in the last edition of his excellent work, also abandon-
ed the theory of Monro, Kelly, and Abercrombie. But so far
is this theory, concerning the circulation within the cranium,
from being shaken by the attack of Dr. Burrows, that it may
be said now to stand on a firmer basis than ever, owing to that
attack having drawn forth the convincing reasoning and unan-
swerable arguments of so sound an anatomist, physiologist, and
pathologist as the late Dr. John Reid.

(2.) All the functions of the nervous system may he increased,
perverted, or destroyed, according to tlie degree of stimulus or
disease operating on its various parts. Thus, as a general
rule, it may be said that a slight stimulus produces increased
or perverted action ; whilst the same stimulus, long continued
or much augmented, causes loss of function. All the various
stimuli, whether meclianical, chemical, electrical, or psychical,
produce the same effects, and in different degrees. Circum-
stances influencing the heart's action, stimulating drinks or food,
act in like manner. Thus, if we take the effects of alcoholic
drink, fur the purpose of illustration, we observe that, as re-
gards combined movements, a slight amount causes increased
vigour and activity in the muscular system. As the stimulus
augments in intensity, we see irregular movements occasioned,
staggering, and inability of directing the limbs. Lastly, when
the stimulus is excessive, there is complete inability to move,
and the power of doing so is temporarily annihilated. With
regard to sensibility and sensation, we observe cephalalgia,
tingling, and heat of skin, tinnitus aurium, confusion of vision,
musca) volilantes, double sight, and lastly, complete insensibility
and coma. As regards intelligence, we observe at first rapid
flow^ of ideas, then c(mfusion of mind, delirium, and lastly, sopor
and perfect unconsciousness. In the same manner pressure,
mechanical irritation, and the various organic diseases produce

558 Strangulation or Hanging, Apoplexy, ^-c. [September,

augmented, perverted, or diminished function, according to
the intensity of the stimulus applied, or amount of structure
destroyed.

Thus it has been shown, that excess or diminution of stimulus,
too much or too little blood, very violent or very weak cardiac
contractions, and inflammation or extreme exhaustion, will, so
far as the nervous functions are concerned, produce similar
alterations of motion, sensation, and intelligence. Excessive
hemorrhage causes muscular weakness, convulsions, and loss
of motor power, perversions of all the sensations, and lastly,
unconsciousness from syncope. Hence the general strength
of the frame cannot be judged of by the nervous symptoms,
although the treatment of these will be altogether different,
according as the individual is robust or weak, has a full or
small pulse, &c. These similar effects on the nervous centres
from apparently such opposite exciting causes, can, it seems to
me, only be explained by the peculiarity of the circulation pre-
viously noticed. A change of circulation within the cranium
takes place, and whether arterial or venous congestion occurs,
pressure on the organ is equally the result. The importance
of paying attention to this point in the treatment must be ob-
vious.

(3.) The seat of the disease in the nervous system influences
the nature of the phenomena or symptoms produced. It is a
matter of very great importance to ascertain how far certitude
in diagnosis may be arrived at, and the seat of the disease as-
certained. On this subject it may be affirmed that, although
clinical observation combined with pathology has done much,
more requires to be accomplished. As a general rule, it may
be stated that disease or injury of one side of the encephalon,
above the decussation in the medulla oblongata, especially
influences the opposite side of the body; whilst, if the spinal
cord be affected below the decussation, the influence produced
is not crossed, but direct. It is said that some very striking
exceptions have occurred to this rule, but these at any rate
are remarkably rare. Besides, it has always appeared to me
probable that, inasmuch as extensive organic disease, if occur-
ring slowly, may exist without producing symotoms, whilst it is
certain most important symptoms may be occasioned without
organic disease, even these few exceptional cases are really
not opposed to the general law. Then, as a general rule, it
may be said that diseases of the brain proper are more espe-
cially connected with perversion and alteration of the intelli-
gence ; whilst disease of the cranial portion of the spinal cord
and base of the cranium is more particularly evinced by altera-
tions of sensation and motion. In the vertebral portion of the

185 J .] Strangulation or Hanging, Apoplexy, <^c. 550

cord, the intensity of pain and of spasm, or want of conducting
power, necessary to sensation and voluntary motion, indicates
the amount to which the motor and sensitive columns are
affected. Further than this we can scarcely generalize Vv'ith
prudence, although there are some cases, as we shall subse-
quently see, where careful observation has enabled us to arrive
at more positive results.

The fatality of lesions affecting various parts of the nervous
centres varies greatly. Thus the hemispheres may be exten-
sively diseased, often without injury to life, or even permanent
alteration of function. ConvulsioHs and paralysis are the com-
mon results of disease of the ganglia, in the cranial portion of
the cord. The same results from lesion of the pons Varolii.
But this, if it affect the medulla oblongata, where the eighth
pair originates, or injury to this centre itself, is almost always
immediately fatal.

(4.) The rapidity or slowness with ichich the lesion occurs
influences the pJienomen or symptoms produced. It may be
said, as a general rule, that a small lesion, for instance a small
hemorrhagic extravasation, occurring suddenly, and with force,
produces, even in the same situation, more violent effects than a
very extensive organic disease which comes on slowly. Here,
however, much will depend upon the seat of the lesion. Very
extraordinary cases are on record, where large portic-ns of the
nervous centres have been much disorganized, without pro-
ducing anything like such violent symptoms as have been oc-
casioned at other times by a small extravasation in the same
place. Here again the nature of the circulation within the
cranium offers the only explanation, for the encephalon must
undergo a certain amount of pressure, if no time be allowed for
it to adapt itself to a foreign body ; whereas any lesion coming
on slowly enables the amount of blood in the vessels to be
diminished according to circumstances, whereby pressure is
avoided.

(5.) The various lesions and injuries of the nervous system
produce phenomena similar in kind. The injuries which may
be inflicted on the nervous system, as well as the morbid ap-
pearances discovered after death, are various. For instance,
there maybe an extravasation of blood, exudation of lymph, a
softening, a cancerous tumour, or tubercular deposit, and yet
they give rise to the same phenomena, and are modified only
by the circuhistanccs formerly mentioned, of degree, seat, sud-
denness, &c. Certain nervous phenomena also are of a par-
oxysmal character, whilst the lesions supposed to occasion
them are stationary or slowly increasing. It follows that the
effects cannot be explained by the nature of llie lesions, but to

560 Extraordinary Appetite and Digestion. [September,

something which they all have in common ; and this, it appears
to me, may consist of 1st, Pressure with or without organic
change; 2d, More or less destruction or disorganization of
nervous texture. Further, when we consider that the same
nervous symptoms arise from irregularities in the circulation
from increased as w^ell as diminished action, sometimes when
no appreciable change is found, as Vv'ell as when disorganiza-
tion has occurred, the theory of local congestions in the ner-
vous centres seems to me the most consistent with known
facts. That such local congestions do frequently occur during
life, without leaving traces detectable after death, is certain ;
wliilst the occurrence of molecular changes, or other hypo-
thetical conditions which have been supposed to exist, have
never yet been shown to take place under any circumstan-
ces. [^Amer. Journ. of Med. Sciences. T. R. B.

As many of our readers have doubtless met with cases, to a
certain degree similar, we place before them the following from
the Medical Examiner. Ed.

Account of a man who lives upon large quantities of raw flesh.
In a letter from Dr. Johnston, Commissioner of Sick and
Wounded Seamen, to Dr. Blane.

Somerset Place, Oct. 18, 1798.

My Dear Sir, Having in August and September last been
engaged in a tour of public duty, for the purpose of selecting
from among the prisoners of war such men as, from their infir-
mities, were fit objects for being released without equivalent, I
heard, upon my arrival at Liverpool, an account of one of those
prisoners being endowed with an appetite and digestion so far
beyond anything that had ever occurred to me, either in my
observation, reading, or by report, that I was desirous of ascer-
taining the particulars of it by ocular proof or undeniable tes-
timony. Dr. Cochrane, Fellow of the College of Physicians of
Edinburgh., and our medical agent at Liverpool, is fortunately
a gentleman upon whose fidelity and accuracy I could perfectly
depend, and I requested him to institute an inquiry upon this
subject during my stay at that place. I enclose you an attested
copy of the result of this and as it may probably appear to
you, as it does to me, a document containing facts extremely
interestinji, both in a natural and medical view, I will beg you
to procure its insertion in some respectable periodical work.

Some farther points of inquiry respecting this extraordinary
person having occurred to me since my arrival in town, I sent
them in the form of queries to Dr. Cochrane, who has obligingly

1851.] Extraordinary Appetite and Digestion. 5G1

returned satisfactory answers. These I send along with the
above mentioned attested statements, to which I beg you to
subjoin such reflections as may occur to you on this subject.

I am, my dear Sir, your most obedient humble servant,

J. Johnston,
To Gilbert Blane, M. D., F. R. S., and one of the Commissioners

of Sick and Wounded Seamen.

Charles Demery, a native of Benche, on the frontiers of Po-
land, aged 21, was brought to the prison of Liverpool, in Feb-
ruary, 1799, having been a soldier in the French service on
board the Hoche, captured by the squadron under the command
of Sir John B. Warren, off Ireland.

He is one of nine brothers, who, with their father, have been
remarkable for the voraciousness of their appetites. They
were all placed early in the army and the peculiar craving
for food with this young man, began at thirteen years of age.

He was allowed two rations in the army, and by his earnings
or the indulgence of his comrades, procured an additional supply.

When in the camp, if bread or meat was scarce, he made up
the deficiency by eating four or five pounds of grass daily and
in one year, devoured 174 cats (not their skins) dead or alive
and says he had several severe conflicts in the act of destroy-
ing them, by feeling the effects of their torments on his face and
hands sometimes he killed them before eating, but when very
hungry he did not wait to perform this humane office.

Dogs and rats equally sufl'ered from his merciless jaws and
if much pinched by famine, the entrails of animals indiscrimi-
nately become his prey. The above facts are attested by
Picard, a respectable man, who was his comrade in the same
regiment on board the Hoche, and is now present and who
assures me, he has often seen him feed on those animals.

When the ship on board of which he was, had surrendered
after an obstinate action, finding himself, as usual, hungry, and
nothing else in his way but a man's leg, which was shot oW,
lying before him, he attacked it greedily, and was feeding
heartily, when a sailor snatched it from him, and threw it over-
board.

Since he came to this prison, he has eat one dead cat and
about twenty rats. But what he delights most in, is raw meat,
beef or mutton, of which though plentifully supplied by eating
the rations of ten men daily,* he complains he has not the same

The French prisoners of war are at this lime, maintained at the expense of
their own nation, and are eacii allowed the following dail}' ration twenty-six
ounces of bread, half a pound of beef, half a pound of greens, two ounces of
butler, or'six ounces of cheese.

562 Extraordinary Appetite and Digestion. [September,

quantity, nor indulged in eating so much as he used to do, when
in France*

lie often devours a bullock's liver, raw, three pounds of can-
dles and a few pounds of raw beef in one day, without tasting
bread or vegetables, washing it down with water, if his allow-
ance of beer is expended.

His subsistence at present, independent of his own rations,
arises from the generosity of the prisoners, who give him a share
of their allowance. Nor is his stomach confined to meat, for
when in the hospital, where some of the patients refused to take
their medicines, Demery had no objection to perform this for
them and his stomach never rejected anything, as he never
vomits, whatever be the contents, or however large.

Wishing fairly to try how much he actually could eat in one
day ; on the 7th of September, 1799, at 4 o'clock in the morn-
ing, he breakfasted on four pounds of raw cow's udder at half
past 9, in presence of Dr. Johnston, commissioner of sick and
wounded seamen, Admiral Child and his son, Mr. Foster agent
for prisoners, and several respectable gentlemen, he exhibited
his powers as follows : There was set before him five pounds
of raw beef, and twelve tallow candles of a pound weight, and
one bottle of porter these he finished by half past 10 o'clock.
At 1 o'clock there was again put before him, five pounds of
beef, and one pound of candles, with three bottles of porter, at
which time he was locked up in the room, and sentries placed at
the windows to prevent his throwing away any of his provi-
sions. At 2 o'clock, when I again saw him with two friends,
he had nearly finished the whole of the candles, and great part
of the beef, but had neither evacuation by vomiting, stool, or
urine ; his skin was cool and pulse regular, and in good spirits.
At a quarter past 6, when he was to be returned to his prison,
he had devoured the whole, and declared he could have eat
more, but from the prisoners without telling him we wished to
make some experiments on him he began to be alarmed. It is
also to be observed, that the day was hot, and not having his
usual exercise in the yard, it may be presumed he vv'ould other-
wise have had a better appetite. On recapitulating the whole
consumption of this day, it stands thus: raw cow's udder, 4
lbs.; raw beef, 10; candles, 2. Total, 16 lbs. besides 5 bottles
of porter.

The eagerness with which he attacks his beef when his sto-
mach is not gorged, resembles the voracity of a hungry wolf,
tearing oflf and swallowing them with canine greediness. When
his throat is dry from continued exercise, he lubricates it by
stripping the grease off the candle between his teeth, which he
generally finishes at three mouthsful, and wrapping tJfe wick

1851.] Extraordinary Appetite and Digestion. 563

like a ball (string and all) sends it after at a swallow. He can,
when no choice is left, make shift to dine on immense quanti-
ties of raw potatoes or turnips ; but from choice would never
desire to taste bread or vegetables. He is in every respect
healthy, his tongue clean, and his eyes lively.

After he went to the prison, he danced, smoked his pipe, and
drank a bottle of porter and, by four next morning, he awoke
with his usual ravenous appetite which he quieted by a few
pounds of raw beef

He is six feet three inches high, pale complexion, grey eyes,
long brown hair, well made but thin, his countenance rather
pleasant, and is good tempered.

Destauban, French Surgeon.
Le Fournier, Steward of the Hospital.
Revet, Commissaire de la Prison.
Le Flem, Soldat de la ser Demi Brigade.
Thomas Cochrane, M. D., Inspector and Surgeon of
the Prison, and Agent, &c., for sick and wounded Seamen.
Liverpool, Sept.dth, 1799

A true copy, John Bynon,

Clerk in the office for sick and wounded Seamen.

Queries and Answers.

1. What are the circumstances of his sleep and perspiration?
He gets to bed about 8 o'clock at night, immediately after

which he begins to sweat, and that so profusely as to be obliged
to throw off his shirt. He feels extremely hot, and in an hour
or two after he goes to sleep, which lasts until one in the morn-
ing, after which he always feels himself hungry, even though
he had laid down with a full stomach. He then eats bread or
beef, or whatever provision he may have reserved through the
day ; and if he has none, he beguiles the time in smoking tobac-
co. About 2 o'clock he goes to sleep again, and awakes at 5 or
6 o'clock in the morning in a violent perspiration, with great
heat. This quits him on getting up ; and when he has laid in
a fresh cargo of raw meat (to use his own expression) he feels
his body in a good state. He sweats while he is eating ; and it
is probable owing to this constant propensity to exhalation from
the surface of the body, that his skin is commonly found to be
cool.

2. What is his heat by the thermometer ?

I have often tried it, and found it to be of the standard tem-
perature of the human body. His pulse is now 84, full and
regular.

3. Can this ravenous appetite be traced higher than his
father ?

N. S. VOL. VII. NO. IX. 36

664 Extraordinary Appetite and Digestion. [September,

He knows nothing of his ancestors beyond his father. When
he left the country, eleven years ago, his father was alive, aged
about 50, a tall, stout man, always healthy ; and he can remem-
ber he was a great eater, but was too young to recollect the
quantity, but that he eat his meat half boiled. He does not
recollect that either himself, or his brothers, had any ailnient,
excepting the small pox, which ended favorably with them all.
He was then an infant. His face is perfectly smooth.

4. Is his muscular strength greater or less than that of other
men of his time of life?

'j'hough his muscles are pretty firm, I do not think they are
so full or plump as those of most other men. He has, however,
by his own declaration, carried a load of 300 weight of flour in
France, and marched 14 leagues in a day.

5. Is he dull or intelligent ?

He can neither read nor write, but is very intelligent and
conversable, and can give a distinct and consistent answer to
any question put to him. I have put a variety at different times
and in different shapes, tending to throw all the light possible
on his history, and never found that he varied, so that I am
inclined to believe that he adheres to the truth.

6. Under what circumstances did his voracious di^osition
first come on ?

It came on at the age of thirteen, as has been already stated.
He was then in the service of Prussia at the siege of Thionville ;
they were at that time much straightened for provisions, and
as he found this did not suit him, he deserted into the town.
He was conducted to the French General, who presented him
with a large melon, which he devoured, rind and all, and then
an immense quantity and variety of other species of food, to the
great entertainment of that officer and his suite. From that
lime he has preferred raw to dressed meat; and when he eats
a moderate quantity of what has been roasted or boiled, ho
throws it up immediately. What is stated above, therefore,
respecting hi? never vomiting, is not to be understood literally,
but imports merely that those things which are most nauseous
to others, had no effect upon his stomach.

There is nothing farther to remark, but that since the attest-
ed narrative was drawn up, he has repeatedly indulged himself
in the cruel repasts there described, devouring the whole animal,
except the skin, bones, and bowels ; but this has been put a stop
to, on account of the scandal it justly excited.

In considering this case, it seems to afford some matters for
reflection, which are not only objects of considerable novelty
and curiosity, but interesting and important, by throwing light
on the process by which the food is digested and disposed of.

1851.] Diarrhoea which succeeds Typhoid Fever. 565

Monstrosity and disease, whether in the structure of parts or

in the functions of appetite, illustrate particular points of the
animal economy, by exhibiting them in certain relations in
which they are met with in the common course of nature. The
power of tlie stomach in so quickly dissolving, assimilating and
disposing of the aliment in ordinary cases, must strike every
reflecting person with wonder, but the history of this case
affords a more palpable proof, and more clear conception of
these processes, just as objects of sight become sensible and
striking, when viewed by a magnifying glass, or when exhibited
on a larger scale.

The facts here set forth, tend also to place in a strong light,
the great importance of the discharge by the skin, and to prove
that it is by this outlet, more than by the bowels, that the excre-
mentitious parts of the aliment are evacuated ; that there is an
admirable co-operation established between the skin and the
stomach, by means of that consent of parts so observable ; and
so necessary, in the other functions of the animal economy ;
and that the purpose of aliment is not merely to administer to
the growth and repair of the body, but by its bulk and peculiar
stimulus to maintain the play of the organs essential to life.

Large doses of Sub. Nit. Bismuth in Diarrhoea which succeeds
Typhoid Fever.

Diarrhoea being at first produced by a lesion of the glands
of Peyer, and by an irritable condition of the mucous mem-
brane of the intestines, it would be chimerical at this period to
attempt to check it; and even if it were checked it would be
without advantage, and even dangerous to the patient ; besides,
the constipation which is found in some forms of this disease
is far from being a favorable symptom. The utility of alvine
evacuations then shoukl not be doubted, purgatives having the
property, ifnot to abridge its course, at least to prevent, and
to render less intense the complications with other organs. But
though the diarrhoea, when it confines itself to certain linn'ts,
presents nothing peculiar in the beginning, should not pass un-
noticed beyond a certain period, during convalescence.

It sometimes happens that after a number of days the disease
loses its intensity : the fever diminishes, the appetite appears,
the tongue becomes moist, the face becomes natural, the bow-
els indolent, without meteorism, and nevertheless tfie stools
remain liquid and fiequent, so that it would seem necessarv to
nourish the patient, were it not feared by so doing the diarrhoea
would be increased, or enteritis established. On the other
hand, during convalescence, alter the patient has passed the

566 DiarrhcEa which succeeds Typhoid Fever. [September,

most dangerous period of the disease, the alimentary canal not
being accustomed to the contact of the food, the diarrhoea re-
appears, and it is with the greatest difficulty that the lightest
and most digestible food can be borne. It is at this period of
typhoid fever that the good effects of sub. nit. bismuth is seen.

M. Monneret first noticed in this journal the remarkable
effects of large doses of sub. nit. bismuth in choleriform diar-
rhoea and in that of children. We are not aware that this
physician used it in the diarrhoea of typhoid fever ; but we are
certain of the good effects of it in the practice of M. Briquet
at La Charite and at the Hotel Dieu. We report the follow-
ing case, which shows the period of the disease at which the
remedy may be used, and the circumstances which render its
effects most sure.

Case. Dorville, 29 years of age, entered the Hotel Dieu on
the 26th January last. This woman, although of a feeble con-
stitution, thin and delicate, enjoyed good general health, when
about the 5th or 6th of January, she felt pain about the umbil-
icus, which soon spread over the whole of the abdomen, intense
fever, cephalalgia and desire to vomit. She was greatly pros-
trated, mentally and physically ; face altered and yellowish ;
cheeks colored ; the mucous membrane of the buccal cavity
injected ; tongue gluey ; thirst, anorexia, nausea; borborygmus
in various parts of the abdomen ; pains above the umbilicus ;
superior portion of abdomen rather tense ; stools composed oi
greenish matter, with whitish granules ; some rhonchus about
the chest ; buzzing in the ears ; giddiness as soon as the patient
sat up; pulse 116, weak; skin hot; no lenticular spots noi
headache ; there was besides diminution of sonorousness on
the left side, with feeble respiration and ringing of the voice
at this point.

Though some of the principal symptoms of typhoid fever
were absent in this case, there were still enough to form an
immediate diagnosis, and two days after, it was confirmed by
the appearance of the lenticular spots. The feeble condition
of the patient induced M. Aran to adopt a mild treatment.
Baths, cataplasms, emollient injections and bland drinks were
used. For three days there was delirium at night. Without
other treatment the delirium disappeared. After each bath
the fever was diminished for several hours, but diarrhoea con-
tinued, the tongue remained gluey, thirst great, skin hot, bor-
borygmus continued and abdomen tense.

On the 3d January, the tongue became moist, the skin soft
and the patient slept ; there were however three watery stools
during the night; pulse 108. M. Aran now began the sub-
nitrate of bismuth in large doses (10 grammes in 24 hours), al

1851.] Miscellanij. 567

the same time continuing the warm baths. On the next day
the stools had diminished and the pulse had fallen to 100. On
the 5th January the stools were still less, though there was
still some borborygmus about the abdomen, particularly about
the right false ribs ; the face more natural, and tongue moist.
On the 8th January, there was but one stool during the day,
and another at night ; pulse 96 ; tongue moist. On the 9th
January, the bowels were entirely checked ; no stool during
the 24 hours. On the 17th January the patient was dischar-
ged, doing well. \_Bul. Gen de Therap.

in i 5 : cl I a n s .

Cases of an unusual form of Fever and Dysentery. By Hexry F.
Campbell, M. D. The present season has been marked by great
heat and unusual drought, the thermometer I'anging from 82 to 96,
for nearly two months, and any thing like general rains being almost
unknown daring the months of June and July. In June, we heard
frequently of a ^^ Dysenteric Fever ^^ that prevailed more or less in
the upper portions of this State, but as to its exact character, we are
unable to affirm, as our letters of inquiry to physicians, in these locali-
ties, have failed of reply. We therefore only refer to the rumor as
evidence of the atmospheric tendency in other localities than our
own. On the 12th of July, we were called about three miles from
this city, over the river, to a case of dysentery. It was that of a
child sixteen months old, in its first dentition. It had been attacked
on the day before with diarrhoea and slight fever. During the night
previous to our seeing it, the passages had become bloody, were attend-
ed with considerable tormina and the fever was quite violent. When
we saw it, the pulse was rapid, the skin hot and dry, especially over
the abdomen. The passages were not very frequent, were of a pink-
ish, bloody color, and consisted principally of mucus. The gums
were incised freely, and we prescribed 5 grs. of blue mass, dissolved
in syrup ; and an injection of starch wath 8 drops laudanum after each
evacuation. Emolient poultices were directed to the abdomen, and
occasional doses of camphor water administered. Shortly after our
first visit, we were again called to see the patient which had had a
convulsion. We found it in a state of great agitation, the pulse rapid
and depressed and the passages very frequent. As the injections were
not retained, opiates were administered by the mouth. A blister was
applied over the abdomen, but with no good effect. The convulsive

568 Miscellany. [September,

movements were controlled by chloroform, but the child never appeared
fully to recover from the depression and agitation induced by them.
Calomel in one grain doses was administered every two hours. The
pessages became very copious and were watery in their character.
It died about the middle of the second night from that on which it had
been attacked.*

Case 2d. In the same neighborhood as the above, we saw Thomas,
a lad aged about 12 years. He had dysentery, with the discharge of
considerable quantities of blood and mucus. The passages were fre-
quent and attended with great straining and distress. The pulse,
when we first saw him, was natural. The tongue slightly furred.
The skin cool, soft and pleasant. His father had administered about
12 grs. of calomel previous to our seeing him. Our prescription was
3 grs. of calomel every three hours, in combination with injections of
starch and laudanum after each passage. Mustard poultices were
applied to the abdomen and moderate doses of Chloric ^Ether and
champhor water were prescribed to allay the pain of which he com-
plained. On the second day he had taken 18 grs. of calomel besides
the twelve grs. given previously. He had had slight fever the night
before but had rested well after the administration of laudanum. The
passages were of a dark bilious character, with portions perfectly dis-
tinct from the general mass, which were dysenteric and bloody.
R. Calomel grs. 12.
Opii. P. " 3.
Gallae P. " 6.
Acet Plumb, grs. 4.
M. and F. 6 powders dose 1 powder every 3 hours.
On the fifth day the passages were less frequent and much improv-
ed in character. The exacerbation of fever the night previous had
been more decided. The skin still pleasant and suffused with a
copious moisture. The opium, lead and galls were continued three
times daily, the calomel being omitted ftpm the prescription. Also
prescribed 12 grs. of quinine during the morning in anticipation of
the paroxysm. On the fifth and sixth days the passages continued of
a foECulent character, but on the seventh day, small quantities of bloody
mucus were again apparent in the discharges. There was no return
of fever. Prescribed two grs. of calomel each night. Diet, gelatin
rice gruel and chicken broth. The passages became more and more
natural, though always bearing the marks of considerable intestinal
irritation, and the patient very slowly recovered.
* Dr. Paul F. Eve was called in consultation in this case at a late period.

18.51.] Miscellany. 569

Case 3d. Mr. E. A., aged about 35 years, was attacked with dys-
entery o:ithe 14th of July. The passages were frequent and bloody,
but not attended with much pain ; skin hot and dry ', pulse somewhat
depressed, and 90 per minute. He manifested great depression of
spirits. Prescribed 5 grs. of calomel with one gr. of opium every
three hours, with laudanum and camphor in the intervals when the
passages were frequent. The passages became less frequent, were
dark and very offensive, but were followed by great prostration of
strength. The calomel v/as omitted and 5 grs. of blue mass substi-
tuted, with acetate of lead, nut galls and opium after each passage.
The discharges became less frequent, and the quantity of blood and
bloody mucus was greatly diminished, but the prostration of strength
was still very great. Fever continued without remission : pulse 110
per minute. On tl)e fourth day the skin is bot and dry. Thirst very
urgent. The dysenteric appearances had subsided from the passages,
but they were thinner than previous. On the fifth day the pulse is
more rapid and weaker, the skin cooler and clammy ; the passages
are very frequent and watery, having the appearance of the washings
of bloody beef, though sometimes darker, resembling muddy coffee ;
they contained no mucus or foecal matter whatever. After consultation
with Dr. J. A. Eve, we prescribed a large blister to the abdomen,
and directed laudanum injections with starch in combination with
acetate of lead after each evacuation. These injections were speed-
ily rejected : the passages were very copious and passed involuntarily,
often unconsciously. The pulse ranged from 130 to 140 per minute
every thing marked a state of actual collapse. Brandy and other
stimulants were administered in large quantities, but the pulse did not
respond. The passages continued large and were often of clear
water. A blister was applied over the sacrum, but without effect.
All stimulants were of no avail, only serving to distract the last mo-
ments of the patient, which without them were characterized by o-rcat
calmness and coUcctcdness of mind. He died on the morninr^ of the
7th day.

Case 4th. P., a boy aged 8 years, was attacked with dysentery on
the evening after the above case. On examination, we found him
remarkably free from excitement, the skin cool and moist. The pas-
sages produced but little pain, were very frequent, and invariably
composed of blood and mucus. Prescribed, 10 grs. of calomel, to be
given in two doses, one that night and the other in the morning, with
15 drops of laudanum in one oz. camphor water after each passao-e.
On the second day, fever became apparent, and in the cvenino-, the

Miscellany. [September,

pulse was very rapid, 130 beats per minute. The passages continued
of a bloody character mixed with mucus. He complained of great
pain immediately before and during the evacuation of the bowels, but
atother times appeared quite easy. Injections of laudanum 30 gtt.,
acetas plumbi grs. 10, with starch were administered after each pas-
sage, but without effect. The passages were still very frequent and
unchanged in character. We applied a large blister over the abdo-
men and continued the administration of the calomel in two grain
doses three times daily. On thefourth day the fever had not abated,
though the pulse was much more feeble and the skin cooler : during the
night he became restless and tossed constantly ; the bowels were evacua-
ted involuntarily and the stools had now assumed the appearance of
bloody water. The skin was cold and clammy, the pulse being very
rapid. Mustard poultices, brandy and other stimulants failed to arouse
him from this state of collapse, though he still lingered till the sixth
day, Avhen he died. For nearly twelve hours previous to his death
he suffered from the greatest restlessness, and only remained quieten
the administration of chloroform.

We might here report the particulars of two other cases very simi-
lar to this last ; the one occurring in a child of 3 years of age, treated
by myself in company with Dr. Ford, and the other, a boy of six
years of age, treated by Dr. Ford, but in their course as well as the
result of treatment, they were so exactly similar that it is entirely
unnecessary to dwell upon them. In both, the fever was of a con-
tinued character, with great prostration of strength, and the passages
also presented the same serous character as in the above case. Both
these also died on the sixth day.

Case 5th. Mr. L. A., a young man aged about 20 years, was
affected v*'ith dysentery similar to the above cases, complicated with
fever of a remittent type. On the second day of the disease we saw
him and prescribed 20 grs. of blue mass and ^ gr. morphine in cam-
phor after each evacuation. The passages on the next day presented a
very dark appearance and were offensive, but there were still lumps of
thick mucus with blood scattered through some of them. Calomel
in combination with the acetate of lead and nut galls, was administer-
ed three times during this day, with laudanum and starch injections
after each evacuation. On the fourth day, the dysenteric character
was not manifest in any of the passages, which were not very frequent.
The calomel was discontinued and 10 grs. of quinine was given during
the remission in the earlier part of the day. The passages were re-
strained by the laudanum and starch injections. On the 6th day, he

1851.] Miscellany. 571

suffered great pain during the evacuation of the bowels, and the pas-
sages had again assumed all the characters of dysentery, and were
also very frequent. Prescribed at night a large blister to the abdo-
men and to continue injections. Seventh day ; blister had drawn well,
passages again consistent and dark, though ^attended with considerable
pain. Prescribed 3 grs. of blue mass every three hours, and to
continue injections ; also to take chloric ether and camphor to allay
pain. After the administration of the quinine there was no return of
fever. The character of the passages improved slowly, but for many
days continued interspersed with small portions of whitish lymph.
He has recovered, but is still feeble and enervated from the depressing
disease through which he has so recently passed.

The location in which occurred the above cases was usually free
from disease of any kind. The neighborhood is the summer residence
of several families, having been selected for the salubrity and pleasant-
ness of the situation. Five of the cases were fatal and occurred in one
family, while the two others whose termination was favorable, took
place in other houses. It will be observed from our report that the
disease attacked only the white residents of the neighborhood, and
although a number of negroes were subjected to exactly the same
morbid influences as those whites, still not one of them that we are
aware, was the subject of this form of dysentery.

Above, we have given a simple statement of the facts connected
with the prevalence of this disease, and as our intention is to make an
historical record, rather than to discuss or promulgate a theory, our
remarks in relation to it will be neither copious or diffuse. There
are but few points in our record that admit of any debate or observa-
tion. As to the cause, it is evident that the invasion of this ordinarily
salubrious region by an unusual form of disease must be attributable
(judging from its suddenness and partiality), to some peculiar and
recent agent having its origin within the limits circumscribed by the
extent of its manifestations. We must also perceive that the charac-
terof its effects is identical wherever manifested, only varying in their
intensity and that this deleterious agent, of whatever nature, must have
been more favorably situated by proximity or otherwise for the full
development of its effects upon that location where its fatality was so
marked. In reference to the indications for treatment, we have been
strongly impressed that too much importance cannot be attached to the
early and vigorous application of remedial means during the period of
the hloody discliarges ; for, from our observation, it is only during this
stage that any treatment is available. After the occurrence of the

572 Miscellany. [September,

serous dejections and their attendant rapid and feeble pulse, cold ex-
tremities and sunken countenance, we have, in no instance, seen
the least benefit derived from stimulants astringents or revulsives.
The disease must be resolved during the dysenteric period, as the suc-
ceeding state is one of collajjse, in which the impressibility of the
system, to remedies of any kind, is almost null. In the two cases which
terminated favorably, it will be observed that the principal difference
in the treatment from that of the others, consisted in the continued
administration of small doses of calomel in combination with opium.
Inone of these a blister was early applied with excellent effect, while
i'.i the other, which was milder, no blister was applied during any
stage. In several of the cases, the fever having assumed a remittent
type, quinine prevented the return of the paroxysm; though given
with any other view, (that is specifically,) we cannot speak well of its
effects. As it is our object only to illustrate the peculiarity of the
disease, we think it unnecessary to dwell longer on the treatment and
with these brief remarks we leave the subject to the observation of
those v;ho have had better opportunities for witnessing and treating this
formidable variety of dysentery and its accompanying fever.

Treatment of Asphyxia from Drowning and Hanging. From Dr.
(D. li. Storeu's Address before the xMassachusetts Medical Society.)
Ilow little understood, among many ofthe well-educated and intelligent
in our community, is the treatment for the restoration ofthe drowned !
How many lives must have been sacrificed by the barbarous custom of
suspending the asphyxied by the feet, or rudely rolling them upon bar-
rels with the head dependent, for the purpose of freeing the lungs ofthe
water with which they were supposed to be filled ! a custom which,
within a few years has fallen under my immediate observation.

How many, apparently dead, have been restored to their afflicted
friends by means of long-continued, scientific efforts ; by having their
bodies carefully dried, and exposed to a moderate temperature their
heads and shoulders elevated their lungs artificially inflated ; by the
exhibition of external and internal stimulants and judicious venesec-
tion !

How many have thus been resuscitated, after all human means seem-
ed unavailing long after the by-standers have ceased their efforts,
and none saved the almost frantic parent or child, have in silent prayer
continued their exertions ! Numerous cases might be cited to show
that life has been re-called after a body has been immersed for a very
long period. These instances should cheer the desponding, and en-
courage them to labour while there seems the slightest possibility of
restoration. Allow me to illustrate this remark with a single exam-
ple, which was published during the last year in the " Nothern Lan-
cet and Gazette of Legal Medicine." It was communicated by Charles

1851.] Miscellany.

McNeil, Esq., of Charlotte, Vt., and is the touching story of a grateful
father. " One of my sons, 9 or 10 years of age, ^vas on Sunday after-
noon, in Auzust, 1830, found to be missing. On inquiry, I ascertained
that he had last been seen playing on a boat lying at the wharf. The
day was calm, and tlie waters of Lake Champlain still and unruffled
by a ripple ; but, knowing that he had been on the boat, his brother
"svas sent to search for him, but he returned without any tidings. Once
more he returned to the boat, and, looking carefully in e\er\ direction,
discovered him ])'\nu, on the bottom of the lake in eight feet of water,
where he must have lain half an hour, if not longer, when he was
brought to the surface. I received the body : it w as rigid and cold,
as also were the limbs : a bluish cast was spread over the countenance :
the deep solicitude of a father discovered no signs of life no heat :
the heart was stilled, and tlie lungs quiescent. No more would 1 have
anticipated the presence of life, if he had l)een submerged for several
years; arid had 1 not, some days previous to the accident, providen-
tially read in an old paper an article by Dr. Buchanan, of Pliiladel-
l)hia. on the subject of restoring suspended animation after submersion,
we should have consigned the body to the grave, as it was recovered
from the lake. The body beinn; placed on a bed, some of the
neighbors were directed to rub it briskly with flannel cloths an order
which they obeyed with great reluctance, from the thought of perform-
ing this office on a corpse ; and I will adniit that I somewhat enter-
tained the same opinion. Still, I would fain hope, and urge on my
friends the continuance of their exertions; the friction was persevered
in ; warm flannel sheets were applied in rapid succession. This treat-
ment was continued for thirty or forty minutes, when we were gratified
b}" hearing a feeble murmer in the throat, followed soon after by a slight
quivering of the lips. The case, however, was inveloped in doubt and
obscurity for a long time, as the recovery was extremely slow."

The above remarks might, with equal propriety, be applied to the
subject of hangiijg. Many judicious general practitioners entertain
the most vague and unsatisfactory notions regarding its phenomena.
They not only are unacquainted with the several appearances produced
in individual cases of suspension, but they really are not aware how
death is produced ; and, cerebral apoplexy not unfrequently being
considered the cause, copious depletion, employed instead of artificial
respiration, checks the vital current forever. [Boston Medical and
Surgical Journal.

Compression of Aorta at the Sacro-vertehral Angle, for Uterine
Hemorrhage M. Duhamel reports three cases in which compres-
sion was successfully employed. The two first instances presented
thems^^lvesin a woman aged 30 years, one immediatelyatler parturition,
tiie other two years after. In the last, the hemorrhage came on 16
days after parturition. The third case was in a woman, eight months
and a half advanced in her second preunancy, in wi)om a little hem-
orrhage appeared at intervals during filteen or twenty days, which
confined her to bed. Believing the placenta to be attached to the neck

574 Miscellany. [September,

of the uterus, M. Duhamel brought on labor. In one hour after, the
uterus had contracted greatly, and all hemorrhage had ceased, but
in another hour the hemorrhage reappeared, and became so abundant
that it caused frequent syncope, and when M. Duhamel returned the
woman was absolutely exsanguine. The compression of the aorta
was alone tried, and the hemorrhage was immediately stopped. Com-
pression was continued nine hours. The hemorrhage had been so
great, that it was not until 24 or 30 hours after its suppression that
the pulse began to be felt at the wrist. [^Arcli, Gen. de Med.

Successful Ccesarian Operation. M. Bonchacourt, chief surgeon
of the Maternity of Lyons, has just published, in the Bulletinde The-
rapeutigue, the case of a deformed woman, thirty-two years of age,
upon whom he performed the Caesarian section with complete success.
The patient's sacro-pubic diameter was only two inches and two lines ;
embryotomy had been performed in a former confinement, four years
previously, and in October, 1850, she again presented herself on the
point of parturition. In about seventeen hours from the beginning of
labour the cord and one arm were expulsed by very powerful contrac-
tions, but the head could evidently not pass. M. Bonchacourt, finding
that the heart of the foetus and the cord pulsated strongly, resolved,
after consulting with his colleagues, to perform the Ccesarian operation.
Chloroform was used, the child extracted alive, and the operation, with
the dressing, did not last more than twenty-five minutes. The child
died five days afterwards from ordinary causes, and the mother left the
hospital twenty-four days after the operation, the wound being com-
pletely cicatrized, and all the functions performed in the most satis-
factory manner. The patient was seen in April, 1851, five months
and a half after the Caesarian section, and found quite well; the only
remains of the operation being a slight and easily reducible hernia, a
little distance below the umbilicus. [London Lancet.

Ages of Animals. A bear will seldom live beyond 20 years, dogs
and "wolves live 20 years, a fox 14 to 16. The ordinary age of cats
is 17 years; that of a squirrel, hare or rabbit, 5 to 8 years. Ele-
phants, it is said, live 400 years ; the rhinoceros 50 years ; horses
may live 72 years, but their ordinary age is from 25 to 30 years : the
chamois live sometimes 100 years. An eagle died at Vienna at the
age of 104 years. Ravens live 100 ; swans 300. A tortois lived
more than 190 years. A sheep seldom lives more than 10, and a
cow more than 15 years.

On the Proportions of the Human Skeleton. M. Carus, of Dresden,
has been endeavoring to discover the standard measure upon which
the human frame is constructed, and considers that he has found it in
the vertebral column. lie states that the spine in a new-born child
is just one-third of what it becomes in the adult; and he therefore

1851.] Miscellany. 575

takes the third part of the vertebral column as the abovementioned
standard. The head, for instance, its length and breadth taken to-
j:jether (without the lower jaw, which is a sort of extremity of head,)
is just the size of the standard measure ; on the trunk each clavicle,
with the acromion, the sternum, and each scapula, may be measured
upon the same suit. Such is likwise the case with the pelvis. The
normal length of the arm is three measures, the hand one, the foot
one, the tibia two, the femur two and a half, &c. The whole length
of the body comprises in the normal state nine and a half of the stand-
ard measure. M. Carus has had a small figure constructed upon
which these various proportions are accurately marked. [London
Lancet.

More Wonders in Medicine. A very short time since, the French
medical papers were very busy in discussing a new method of curing
sciatica, which consisted in cauterizing the lobe of the ear. Very
respectable names, and numej-ous cases, supported this extraordinary
procedure. We have now another startling manner of dispelling
both neuralgia in the face and toothache ; it consists in merely touch-
ing with a blunt probe the membrana tympani. The author of this
method is M. Desterne, who has published in ' L'Union Medicale,' the
rise and progress of his discovery, accompanied with numerous cases,
which are extremely surprising. The most intense toothache con-
nected with decayed teeth, is relieved in a moment by the magic
touch of the membrana tympani ; agonizing neuralgia of the face, one
of six months, the other of two years and a half standing, were cured
in an instant by the same means ; hemicrania vanishes, and quinine
is left far in the background. These sudden effects are supposed to
be obtained by the agency of the corda tympani nerve. [Ibid.

Instrument for arresting Epistaxis. By M. Gariel. This is a tube
made of caoutchouc, carrying at its axtremity a dilatable balloon, which,
when introduced into the nostrils in its undistended state, may, by the
process of insufflation, be made to assume such dimensions, and exer-
erting such pressure as completely to arrest the hemorrhage.

A simple method of plugging the posterior nares suggests itself in
examining this tube with dilatable extremity. This operation as at
present performed, whether with a special apparatus, or with an ordi-
nary catheter, is frequently very troublesome, though simple in ap-
pearance. If the tube be introduced from before backwards through
the cavities of the nose, until it has quite cleared the posterior nares and
arrived in the pharynx, and be then dilated and drawn forwards, we
obtain a more complete and manageable plug than that usually made
of lint. [Dublin Quarterly Journal of Medical Science.

Disgusting Remedies. If our homoeopathic friends are in the habit
of using in their practice such disgusting and absurd remedies as are
recommended in Jahr's Pharmacopoeia, the sooner aline of distinction
is drawn between them and the regular practitioners, the better. We

57G Miscellany. [September,

know not whether any of Hahnemann's disciples have demonstrated,
on scientific principles, the action or properties of such remedies.
They certainly bring to mind the absurd ingredients used in the old
treacle of Andromichus. The following, from the London "Institute"
of Jan. 5th, will present the matter to our readers.

' Jahr's Nouvelic Pharmacopee Homoeopaihiqiie, published at Paris
in 1841, contains, in the list of materia medica, various disgusting
absurdities, among which are lachesis, the poison of the rattlesnake;
formica ruf a, the red ?int ; aradea diadema, a species of spider ; rana
bufo, the toad; lacerta agilis, the lizard ; scarabcetis meloloniha, the
cockchafer; inverra putorius, stinking polecat, of which the officinal
part is the fetid secretion from the glands near the anus. The ecrivis-
suSt or fresh-water crabs, are directed to be pounded alive in a mortar
until reduced to a fine paste. This is diluted with about twice its vo-
lume of alcohol, then strained, and the liquor preserved for dilution in
the usual way. Toads, lizards, ccckrhaters, and other reptiles and
insects, are brayed (ah've) in the same manner!

" We also learn from a contemporary that to such an extent is the
doctrine similia simUihus curaniur carried, that ' sVphiline ' is admin-
istered to patients sufiering under secondary syphilis; and blennor-
rhin,' which is gonnorrhoeal matter manipulated according to the rules
of homoeopathic confectionary, is mentioned in the Homoeopathic Ar-
chives (published at Leipsic, 1841) as a remedy for gonorrhoea and
gleet !" [Boston Med. and Surg. Journal.

Remarks on (he Cooking and Preserving of Meat. By Prof Liebig.
The view that broth derives its nourishing properties essentially from
the dissolved gelatin an opinion which has frequently been discoun-
tenanced in practice is shown by this investigation to be completely
untenable. The gelatin imparts no taste to broth, and forms by far
too insignificant a portion to allow ofits nutritious properties being de-
pendent upon it. Chopped beef, or veal, previously exhausted in the
cold, when boiled for live hours, yielded to the broth, the former 0.5
percent, and the latter 1.5 per cent, of soluble constituents, of which
gelatine formed, at most, but one-half. On the contrary, this investi-
gation confirms the view of Prout, that the peculiar constituents of
broth exist ready formed in the flesh, and are by no means merely pro-
ducts of the process of ebulition. The residue of the chopped mus-
cular fiesh of difierent animals as of the fox and ox after having
been exhausted in the cold, cannot be distinguished the one from the
other; all the peculiarities of the flesh, especially its flavour, depend-
ing entirely upon the soluble constituents which are found in the broth.

The researches of Liebig offer a simple and convenient method of
preparing, in a few minutes, a broth of the highest nutritive proper-
ties. Finely-chopped lean beef is mixed with an equal weight of
cold-water, and left, if possible, to inacerate for a short lime, and the
whole then slowly heated to ebulition. After gently boiling for some
minutes, the clear broth separates from the coagulated albumen, and
from the muscular fibre, which has now assumed a sinewy appear-

1851.] Miscellany.

ance. After straining, it requires only to be seasoned, and slightly
coloured with burnt onions, or with caramel. The colouring of tho
broth is nothing but a concession to the common prejudice, which
cannot, however, be well dispensed with. By evaporation in a water-
bath, or at a still lower temperature, the broth becomes spontaneously
coloured, and leaves behind a brown extract, possessing a delicate
odour of roasted meat ; this extract, when dissolved in about thirty
parts of water, and flavoured with salt, yields, at any moment, a most
excellent broth. The advantage ofextract of flesh for the nutrition of
invalids, its use in hospitals, or in field service, as well as in domestic
economy, is sufficiently obvious. We see, likewise, that bone-broth,
broth-tablets, &:c., being preparations essentially different from a true
broth from flesh, cannot enter into competition with it as articles of
food.

As an article of commerce, extract of flesh bears somewhat too
high a price. It appears, however, to offer a new source of profit to
the inhabitants of the different settlements in America and Australia,
who might successfully prepare it from their cattle at a cheaper rate
and send it to the markets of our crowded populations.

As to the cooking of meat, it follows that to prepare, by boiling, a rich
broth, and, at the same time, a savoury houilll. is perfectly impossible.
After preparing broth to the above directions, the meat which remains
is perfectly unpalatable, tasteless and tuugh, and as dissimilar as pos-
sible to boiled beef of our tables. If, on the other hand, it be desirable
to leave in the boiled meat the greatest amount of nutrition and flavour,
it must be at once plunged into boiling water. If the temperature,
after some minutes, be reduced to about 158 Fahr. by the addition of
cold water, and the water maintained at that temperature until the
meat is thoroughly cooked, all the conditions necessary for this pur-
pose will have been fulfilled. If it be perfectly established that pure
fleshy fibre viewed independently of the juice instead of being
softened by boiling, is converted into a horny or sinewy mass, it is
evident that this change is prevented by two different means in the
ordinary mode of cooking meat : in the first place, by the temperature
in the interior of the piece of meat never reaching the boiling heat;
and, in the second place, by its being, nevertheless, sufliciently high
to coagulate the albumen which surrounds, and, to a certain extent,
protect the fibre. The temperature in the interior of the meat is not
only sufficient to coagulate the albumen (132 Fahr.,) but must attain
even the point necessary for the coagulation of the colouring matter
of the blood (from 149 to 1.58 Fahr.)

The investigation of Liebig exhibits the process of salting meat
under a perfectly new aspect. The "brine," which meat and dry
salt form when together, amounts to from one-third to one-half of the
juice of the meat, and contains the chief constituents of concentrated
broth. The brine presents an acid reaction, and, owing to the quantity
of albumen present, coagulates when boiled; it contains, moreover,
phosphoric acid, lactic acid, a large amount of potassa,kreatinine, and,
doubtlessly, also kreatine. There can be no doubt, therefore, that

578 Miscellany.

salting diminishes the nutritious properties of meat, by the amount of
constituents which pass into the brine ; hence the explanation of the
well-known injurious effect on health produced by the continued con-
sumption of salt meat. Liehig's Report, vol. ii.

Tincture of Iodine in the Treatment of External Poisoning, Dr.
T. Smith, of Cincinnati, has used the tincture of iodine, with much
success, in several cases of poisoning, the result of contact with the
Rhus Toxicodendron (Poison Oak), Rhus Radicans (Poison Vine),
Rhus Vernx (Swamp Sumac), &c. Having been frequently called
upon to prescribe for this affection, Dr. Smith was led to the trial
of local remedies, likely to prove more prompt than the ordinary
antiphlogistic treatment resorted to on such occasions. Within the
last two years, he has used the tincture of iodine as a local applica-
tion, in some half dozen cases, and with such striking good eilects, that
he confidently recommends it to the profession. [Abridged from the
Western Lancet. Med. Examiner.

Southern Medical Reports ; consisting of General and Special Re-
ports on the ]\Iedicai Topography, Meteorology and Prevalent Dis-
eases of the States of Louisiana, Alabama, Mississippi, North
Carolina, South Carolina, Georgia, Florida, Arkansas, Tennessee,
Texas, and California. Edited by E. D. FE^-NER, M. D., of New
Orleans, Member of the American Medical Association, dec, &c.
Vol. II. 1850. New Orleans: D. Davies, Son & Co. New-
York : Samuel S. &; Wm. Wood.

We hail wdth pleasure the appearance of the second volume of
these Reports. The success and popularity of the first volume was
good earnest of a favorable reception for the second, and since its
appearance we feel greatly encouraged from the ability and unremit-
ting industry of which it bears the marks. The work must now go
on, and as it has to depend for its support upon the sustaining aid of
our profession, we hope that, for the honor as well as the benefit of
that profession, its members will come out promptly and give their
succor freely and liberally. As yet, we have not had an opportunity
to give this volume such a perusal as would warrant an extended
review : indeed this would be unnecessary, as the character of the
work, the ability of its accomplished and indefatigable author, as well
as the importance of the enterprize to the profession, has been suffi-
ciently dwelt on elsewhere in reviews of the first volume. It is suf-
ficient to say that this compares advantageously with it, and will well
repay the trouble of a careful and thorough perusal.

H. F. c.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES.-OCTOBER, ISal. L^o. 10.

PART FIRST.
r i g X n a I ( o m tn u n i c a t i o n 0 .

ARTICLE XXX.

Veratrum Viride. By C. T. Qcixtard, M. D., of Roswell, Ga.

Our attention was first directed to this plant as a remedial
agent, by Dr. Norwood, (vide Southern Med. and Sarg. Jour.,
June, 1850.) and although our experience with it has not been
such as to warrant or justify any exact conclusions, as to its
power over the arterial system, it has nevertheless been suffi-
cient to authorize us in calling the attention of tlie profession to
it, as an agent whose powers have never yet been thoroughly
examined.

The American hellebore, swamp hellebore, Indian poke, In-
dian uncas, poke weed, bear weed, itch w^eed, tickle weed, as it
is variously denominated, flourishes abundantly from Canada
to Carolina, and, according to Joscelyn, was known to the
Aborigines. It appears to have been known to them, rather
as a poison than a remedial agent. According to Joscelyn, a
decoction of it was employed in the election of their chiefs.
That individual whose stomach was least susceptible to its
deleterious effects was regarded as the "strongest of the party,
and entitled to command the rest." Dr. Osgood informs us
that it has long been extensively used for the destruction of
vermin and birds. "Among many of the farmers of New
England," says Dr. O., '*it still continues a common practice
to protect their corn-fields from the havoc of birds, by scatter-
ing the ground with kernels of corn saturated in a strong infu-

N. S. VOL. VII. NO. X. 37

580 Quintard, on Veratrum Viride. [October,

sion of the root ; this is done just as the corn is springing from
the ground, it being then most liable to depredations from the
feathered tribe. With many it is customary to subject their
seed corn to the same process before planting. A short time
after partaking of corn thus prepared, muscular action becomes
so much paralyzed as to prevent either flying or walking, and
in this torpid state they are readily taken and killed. Unless
caught while thus narcotized many of them recover and fly
away."

The Veratrum viride belongs to the Linnasan class and order
Polygamia monoecia, and to the natural family Colchicaceael, of
De Candolle, and Melanthaceae, of Lindley.

V. viride foliis lato-ovalibus, plicatis; racemis paniculatis;
corollse laciniis ablongo, ovalibus, acutis.*

It usually grows in low, moist and swampy situations, is
from three to six feet high, and flowers from May to July. The
rhizoma is thick, fleshy, tunicated above, but solid below, with
numerous whitish radicles. The stem is tall, roundish, striated,
and pubescent. Early in the spring, before the stem rises, it
bears a slight resemblance to the Ictodes foetidus, with which
it is not unfrequently associated. In its botanical characters it
is closely allied to the Veratrum album, a distinguished medi-
cinal plant, a native of the mountainous regions of continental
Europe, and abounding in the Alps and Pyrennees. The analo-
gy in external appearance between the V. viride and V. album,
first led to an investigation of the properties of the former, and
it was found, notwithstanding the analogy in botanical aiBnities,
that there was a decided difference in their operation. The
medicinal efl^ects of the V. viride, have been very diflerenlly
estimated. Bigelow says, that it is an acrid, emetic, and pow-
erful stimulant, followed by sedative efl^ects ; and in the U.S.
Dispensatory, it is represented as agreeing in its effects with
Veratrum album, while others do not find its operation attend-
ed, even in large doses, by so severe a train of symptoms as
follow the administration of the V. album. Prof. Tully, of
Yale College, who used this article extensively, was of the
opinion that it ought entirely to supercede, not only the other
species of the genus, but also the Colchicum autumnale. There
M^idePurshl., p.243. Elliott, p. 419. Darby, 25h '

1851.] Quintard, on Veratrum Viride. 581

are certainly fewer objections to its use. It is not liable to
produce the uncontrolable purgin^r, which often results from the
exhibition of the colchicum ; it is far more certain, and produ-
ces no irritation, in proper doses, on the mucous coat of the
alimentary canal. On the contrary, it operates with as much
certainty as any article in the materia niedica, is never cathar-
tic, and always leaves the bowels in good condition. Dr. Os-
good states, that it requires but a moderate degree of attention
to render the operation of the V. viride perfectly safe while
Dr. Norwood has never found any unpleasant effect resulting
from its administration, other than nausea. It has produced
vomiting, once, in the cases in which we administered it, after
twelve drops had been twice given at an interval of tw^o hours.
But its operation was mild more so even than ipecac. Prof.
Tully thus enumerates the effects of this plant: 1st. Deob-
struent or alterative; 2d. Acrid narcotic; 3d. Emetic; 4th.
Epispastic; 5th. Errhine.

Dr. Osgood and others hav^e noticed an emmenagogue effect
while Dr. Peabody found, in one instance, the continued inter-
nal use of this medicine produce as powerful salivation as is
w'itnessed from the use of mercury. " This, however, passed off
directly with the discontinuance of the medicine, leaving no
unpleasant effects. Of the different operative effects of this
medicine, its alterative has, heretofore, been considered the
most important. When the system is brought fully under its
influence its narcotic properties are manifested by faintness,
somnolency, dimness of sight, dilation of the pupils, vertigo,
headache, impaired muscular action, hiccough, cold, clammy
sweat, small, unfrequent and compressible pulse. These effects
may always be counteracted by the use of laudanum and bran-
dy. We shall give a synopsis of the experiments of Dr. Osgood,
as detailed in the American Jour. Med. Sci., and see how far
they go to support the conclusions of Dr. Norwood, and the
experience we have had.

The experiments of Dr. 0. were made with the extract of
this plant, immediately after the preparation was formed, and
befoj-e it had been at all used as a medicine.

At 12 o'clock, M., Dr. O. took two grs. of the fmely pulver-
ized extract. " At one," he says, " I began to experience a

582 Quintard, on Veratrum Viride. [October,

slight sense of uneasiness at the stomach, but not amounting to
nausea. This uneasiness at the stomach, though so slight as to
be attended v/ith very little inconvenience, continued until
about half-past one, when vomiting commenced. The contents
of the stomach were thrown off without nausea, but with a
sense of rising in the ossophagus, which perhaps might be
compared to the rum.ination of animals. Judging from my
sensations at the time, 1 should suppose the muscular fibres of
the stomach steadily, gradually contracted upon its contents,
until they were expelled, the diaphragm and abdominal mus-
cles remaining entirely inactive. After the vomiting had con-
tinued a considerable length of time, it appeared to be more
the efiect of spasmodic action, and was attended with chills
and coldness of the whole body, but moisture of the skin. At
the expiration of about an hour the vomiting ceased, and was
followed by dimness of sight, dilatation of pupils, vertigo, faint-
ness and somnolency ; pulse, at the wrist, 40 in the minute, and
scarcely perceptible. I then took 25 Til laudanum, and fell
asleep. After the lapse of an hour, awoke with the continu-
ance of the same symptoms, together with a dull pain in the
epigastrium, and immediately repeated the laudanum. But
finding no relief, the dimness of sight increasing, and on mo-
tion of the body, or turning the head, amounting almost to
blindness a sensation of stiffness in the voluntary muscles
supervening, particular) 3^ the temporal and extensors of the
head, together with considerable general prostration, the dose
of laudanum was doubled. This produced a partial abatement
of the symptoms, and after another sim.ilar interval was repeat-
ed, with half a gill of brandy, which now effected entire relief."
In connexion with these symptoms. Dr. O. observes, "I am
unusually susceptible to the operation both of emetics and nar-
cotics." A friend of Dr. O.'s, much less susceptible to the
operation of medicinal agents, commenced at 9 o'clock in the
evening, with two grs. This, in ten or fifteen minutes, pro-
duced slight uneasiness at the stomach. In a half hour from
the first dose, he took four grains more ; at 10, a sensation was
felt as of a ball rising in the oesophagus, which extended up as
far as the top of the sternum, as if propelled by a gradual tonic
contraction of the stomach; at a quarter past 10, vomiting

1851,] Quintard, on Vcratrum Viride. 583

commenced. This was attended with very little inconvenience
at first, but after continuing a short time became more severe,
the ejections consisting principally of bile; together with the
vomiting there was much ineffectual retching, almost constant
hiccough, chilliness, dimness of sight, vertigo, inability to con-
trol the voluntary muscles, distress at the stomach; pulse,
small and creeping, and 34: in a minute ; the ordinary frequen-
cy ranging from 56-58. As these symptoms were becoming
more aggravated, he took 5ss. tr. opii., and went to bed scarce-
ly able to walk. In ten or fifteen minutes the laudanum was
repeated, which soon produced sleep. In the morning he was
apparently in better health than he had been for several months.
At 7, the same morning, three grains more were taken ; at 9,
complained of a confused sensation in the head, and almost an
entire loss of power of the gastrochriemii muscles. At 12 M.,
three grains more were taken, and at half- past 12, all the mus-
cles of the forearm were affected in the same manner. At 1,
vomiting ; pulse 40, and other symptoms essentially as the day
preceding, excepting a less degree of chilliness. At half-past 2,
took 45^ laudanum, and in the course of two hours theefiects
of the medicine entirely subsided, excepting the inability of
using the gastrochnemii muscles. At 11 in the evening, two
grs. more were taken, which, in about three-quarters of an hour,
produced vomiting like the other cases, but without any appre-
ciable narcotic effect.

This gentleman afterwards experimented with smaller doses,
and at regular intervals. Doses of half a grain, once in three
hours, after being repeated three or four times, were followed
by an uneasiness of the stomach, with the same paralyzed con-
dition of the extensors of the feet. The dose was then dimin-
ished to a quarter of a grain, and continued three days, at the
same intervals. With these doses, muscular action was not so
constantly interrupted, this eflect occurring only after consid-
erable exercise, as walking or jumping. By continuing this
article three or four days, in doses of one-eigth of a grain, once
intliree hours, moderate diuresis was produced.

Dr. Osgood states that, " in no single instance in the experi-
ments with the article upon myself or others, did it operate in
the least as a cathartic."

584 Quinlard, on Veratrum Viride. [October,

Dr. John Ware, of Boston, who experimented with it in the
form of a powder of the root, slates that he administered it in
thirty cases, and, "in no instance was it very clear that purg-
ing was produced."

This remedy has long been used in the treatment of arthritic
inflammations. In the hands of the late Dr. Bnyard, of Savan-
nah, it was successfully applied as a remedy in severe cases of
chronic rheumatism as early as 1811, and probably before that
period, it had frequently been used with success in the treat-
ment of this and kindred diseases. It is not our intention to
point out the various thei-apeutic applications of this remedy,
or to enumerate the various diseases in which it has been em-
ployed.

The first case in which we administered the remedy w^as
one of pneumonia, which had been subjected to the ordinary
treatment, but which was accompanied and followed by a very
troublesome cough. It evidently relieved the irritable condi-
tion of the lungs, although comparatively small doses were
given eight drops, at intervals of three hours.

The second case, was that of a young and stout laboring
man, aged twenty-three years. He had been working at a
mill-dam had been wet, and heated, and in the evening was
seized with a severe chill, and pains in various parts of his
body. We saw him the following morning: his pulse was
full, hard, and bounding; tongue coated w^ith a white fur ; skin
hot and dry ; pain across his brow, and an almost entire sup-
pression of urine. This was an admirable case for testing the
action of the Y. viride, and we determined to use it, notwith-
standing the circulating system was in so phlogistic a condition,
as to present what is known as a " bleeding pulse." Ten drops
of the remedy were given at intervals of two hours, to which
were added five drops of laudanum. The third dose had been
taken about half an hour, when a manifest abatement was no-
ticed in the severity of the symptoms. At the fourth dose,
twelve drops were administered, without the laudanum, and
the pulse, which had been gradually approaching the natural
standard, fell to about GO. The tongue was moist, the skin
soi't and at its natural temperature, and we concluded to give
no more of the remedy. The result was truly surprising, and

1851.] Quintard, on Yeratrum Viride. 585

we were anxious to see if the medicine had indeed achieved,
in so short a time, what the lancet, and more energetic, or,
rather, severer measures would not accomplish in a much
longer period. The patient slept tolerably well that night ; he
had felt no nausea, but had taken some light food in the even-
ing. There had been no action on the bowels. The next
morning his fever had returned, but only partially: and it oc-
curred to us at the time that the action of a dose of castor oil
would relieve him entirely; but it was witheld and the vera-
trum resorted to. Its operation was as favorable as on the day
preceding, and it was persevered in until six doses had been
taken, when the patient, beginning to feel some uneasiness at
his epigastrium,, at first slight, but gradually increasing, vomited
freely. His pulse was at this time lower than at the first ex-
hibition of the remedy, and a cold perspiration stood out in
large drops over his chest, neck and forehead. Twenty-five
drops of laudanum were administered, and the patient went
quietly to sleep. He awoke greatly refreshed, and feeling
quite well. There was not left a single unpleasant symptom.
A dose of oil was, however administered, and the patient soon
after returned- to his occupation

This case is parallel, if we recollect rightly, (we have not
the first paper of Dr. Norwood at hand,) to some published by
Dr. Norwood in the South. Med. and Surg. Jour., and finely
illustrates the powers of the remedy over febrile excitement.

Dr. Norwood feels confid-jnt that it is an agent by which
arterial excitement can be at all times controlled. "It is," he
says, "the only article or agent known that will control cer-
tainly, and without disappointment, the action of the heart and
arteries that it is the only therapeutic agent known, through
which we can say to- the heart and arteries 'so fast shalt thou
beat and no faster;' " and again, he says,* " we unhesitatingly
assert, that it has not failed us in a single case to reduce the
action of the heart, and down to any point we wished, as to
the number and frequency of the pulsations."

In the experiment of Dr. Osgood, made upon himself, the
pulse was reduced, in two and a half hours, to 40 in the min-
ute, and was "scarcely perceptible." This was from a two
Vide Southern Med. and Sursr. Journ., Jan. '51.

586 Quintard, on Veratrum Viride. [October,

grain dose of pure extract. Six grains reduced the pulse of
the other experimenter, in one hour and a quarter, to thirty-
four in a* minute "the ordinary frequency ranging from
50-58." On another occasion the pulse fell to 40: and Dr. O.
states that he has frequently known it reduced from 75 to 80
in the minute, to 35 or 40. It must be remembered that, in
the cases given by Dr. Norwood, the dose never if we recol-
lect exceeded 12 or 20 drops of the tincture, always beginning
with the minimum, and increasing drop by drop ; but in the
experiments recorded by Dr. Osgood, much larger doses were
used.

There are so many circumstances which modify the dose of
any remedy, that we are obliged in all cases to have our wits
about us in the administration of medicines. The age, sex,
and temperament, idiosyncracy all are to be kept in view in
prescribing. Who among us has not been so unfortunate as,
unintentional!}^ to salivate, with minute doses, persons unusual-
ly susceptible to the action of calomel ? There are very many
important circumstances to which the mind of every practi-
tioner is directed, and in giving tlie V. viride a trial, it is
important that facts only should be put on record. In one
instance in which it was administered by us, two doses of
twelve (12) drops of the tincture, at an interval of three hours,
produced vomiting. This, we beHeve, was an accidental cir-
cumstance, depending upon the particular condition of the
patient's stomach. We shall not, with our trifling experience,
do more than urge a trial of the remedy upon the members of
the profession. W^e have used it sufficiently, to warrant this
recommendation, and properly administered, not the slightest
danger is to be anticipated. We need, however, more facts
we need undoubted testimony in a great number of cases w^e
need information as to its peculiar action on the system : we
must have a methodical arrangement of all that has been ob-
served with regard to this remedy. "Facts can only," says
Whewell, "become portions of knowledge, as they become
classed and connected."

If the Veratrum viride really does possess the power of con-
trolling arterial action, it is important that the profession should
be put in possession of the fact. Dr. Osgood's experiments

1851.] Quintard, on Veratrum Viride. 587

were made about the year 1833-4, and his papers may be
found in the American Jour. Med. Science, vol. IX. ; ^and in the
Amer. Jour, of Pharm, N. S., vol. I. In the Amer. Jour, of
Pharm., N. S., vol. HI., may also be found a paper on the sub-
ject by Mr. Marshall ; and in the same journal, vol. IV., an
^ article by Mr. Worthington, who found it to contain veratria,
gallic acid, extractive, &c. The analysis of Mr. W., though
far more accurate and complete than any previous one, re-
quires repeated examinations. As the Hellebore is abundant
all over this region, and as the season most favorable for gather-
ing it is at hand, we cannot but hope that the professsion will
give it a fair trial.

ARTICLE XXXr.

Physiology of the Pnenmogastric Nerve and Spinal Accessory
of Willis. By Juriah Harriss, M.D., of Augusta, Ga.

(COXCLUDED.)

It will perhaps be remembered that I attempted to give, in
the August No. of this journal, the relations of the pneumo-
gastric and spinal accessory nerves and their agency in the
production of voice. I shall now endeavor to show the influ-
ence of the par vagum upon the functions of i-espiration. cir-
culation and digestion. It Vv'ill be seen from references made,
that I have derived most of the ^acts from Longei* and Ber-
nard.f I will also add that all the experiments referred to, I
have seen performed by IM. Bernard in his course of lectures.
Respiration is beyond all doubt influenced by the pneumogas-
tric nerve. If the connections of the pneumogastric nerves
wii4i the brain are destroyed, the respiration will immediately
diminish in frequency. In a dog the respiration is normally
20 or 25 per minute, but after these nerves are incised, the
respiration amounts only to 15 or IG in the same length of
time. An animal rarely lives after this operation more than
four or five days. Animal heat rapidly diminishes and con-
tinues to do so until death. The most important lesions, how-
ever, occur in the lungs. These organs become ecchymosed
Uonget's Anat. and Physiology. t Bernard's Lecture.J

588 Harriss, on Physiology of the Pneumogastric [October,

and congested, and very considerable effusions of serosity and
mucus take place in the vesicles and bronchial tubes. These
lesions of course prevent the free admission of air into the
pulmonary cells and greatly obstruct the arterialization of the
blood, and hence suffocation to a more or less extent occurs.
These effects, as shown by Bernard, are induced much more
rapidly in the rabbit than in the dog.

Bernard has seen dogs perish, after cutting the pneumogas-
tric nerves, and yet the post-mortem did not reveal the lesions
already spoken of, as having occurred in the lungs. He there-
fore concluded that there must be other causes that operate in
inducing death. He believes that in these cases, death is par-
tially due to the absence of sugar in the blood.* He says, as
will be seen by the reference, that the secretion of sugar by
the liver (now uncontroverted) is influenced by the par vagum.
If, then, the pneumogastrics are cut, the secretion of sugar
will be arrested, and the fuel for the production of animal heat
will cease to be furnished to the economy. As then the sec-
tion of the pneumogastrics arrests the secretion of sugar, and
as the heat of the body diminishes so rapidly after these nerves
are cut, Bernard concludes that the absence of sugar in the
circulating fluid is one of the causes of death. The absence
of sugar and the diminution of animal heat is at least a striking
coincidence.

After the section of the pneumogastric nerves, the move-
ments of the oesophagus are arrested and the tube is paralysed.
The lower portion of the tube, however, has a peculiar peris-
taltic action, and is not paralysed until after the lapse of some
hours or a day. After the section of the nerves the animal
will swallow, but nothing can penetrate into the stomach, the
food being arrested at the cardiac orifice. When an animal
has taken a certain amount of food, a few boluses may pass
into the stomach in a purely mechanical way ; one bolus push-
ing down the other. They are not passed into the stomach by
the contractions of the oesophagus, as this tube is paralysed.
If the animal contiuues to eat until the oesophagus is filled, the
respiration will be embarrassed by pressure upon the pharynx

Production of Sugar in the human system. See Med. and Surg. Journal,
vol. vi., May, 1850.

1851.] Nerve and Spinal Accessory of Willis. 589

and trachea, and the animal will attempt to relieve himself by
vomiting. M. Bernard discovered the arrest of food in the
CESophngiis in a dog. He made a fistula in the stomach of an
animal for the purpose of observing the effects that cutting the
pneumogastrics would have upon digestion. He severed the
nerves and gave the animal food, but to his astonishment none
passed into the stomach until the next day. The few boluses
that did enter the stomach were pushed down by mere me-
chanical force.

M. Longet with many other physiologists entertains the
opinion that the movements of the stomach are dependent upon
the par vagi. The experiment upon which he principally rehes,
is galvanizing these nerves after they have been cut. He has
always succeeded in inducing stomachal contractions with this
stimulus.

According to the experiments of M. Bernard the influence
of the par vagi is essential to stomachal digestion. Their influ-
ence is the sine qua non, of the function, as it is by their ner-
vous power alone, that the gastric juice is secreted.

In order to determine the effects that cutting the pneumo-
gastrics would produce upon the stomach, Bernard form-
ed a fistula in this viscus of a dog. Previously to severing the
nerves, if the stomach was irritated, the mucous membrane
would become red and congested and as secretion of gastric
juice would take place. This effect can be more plainly seen,
if the animal is made to fast a short time, before the stomach is
irritated. If after the mucous membrane has been coni^ested
by irritation, the par vagi are severed, the membrane will be
relieved of its cogestion, its surface will become pale and the
secretion of gastric juice will be arrested. If food is now put
into the stomach, it will not be digested and if allowed to
remain it will decompose, which result can not occur in the
normal State. In making this experiment care should be taken
not to introduce food into the stomach before the nerves have
been severed. If food is placed in the stomach previously to
cutting the nerves, a certain amount of gastric juice will be
created, and a partial digestion will be accomplished before the
nerves can be exposed and severed.

M. Breschet in opposition to many authors, believes that the

590 Harriss, on Physiology of the Pneumo gastric [October,

sensation of hunger is dependent upon the pneumogastrics.
His opponents aver that this cannot be, since animals eat after
these nervous cords are cut. M. Longet, hov^'ever, coin-
cides with Breschet and thinks that animals under such cir-
cumstances do not eat, because they feel a local sensation of
hunger, but from a general demand on the part of the whole
system. He says that after a few days of fasting, debility,
exhaustion and emaciation occur and the whole economy suf-
fers for the want of nourishment. The desire for food then is
not stomachal or a local hunger, but a general desire on the
part of the whole organism.

The circulation is as manifestly under the control of the
pneumogastric nerves as respiration or digestion. The nor-
mal pulsations in a dog amount to 80 or 90 per minute ; they
amount to 140 or 150 after severing the pneumogastrics. Nar-
cotin when given to an animal, produces very decided trouble
in the circulation and respiration. If the pneumogastrics are
cut previously to administering the poison, the trouble in these
two functions will not be produced. Bernard supposes that
this substance acts first upon the brain and its influence is
afterwards conducted to the lungs and heart by the pneumo-
gastic nerves. If then the connections of the brain, with the
lungs and heart are severed, the influence of thenarcotine will
be intercepted and cannot reach these organs to derange their
functions. When this pair of nerves is cut the heart beats
much more rapidly, but its force of impulsion is diminished
and continues to decrease until it ceases to beat. The central
organ of circulation, the heart, is but gradually paralyzed, as it
is only after the lapse of several days that it ceases to perform
its function. In order to determine the effects that would be
produced upon the circulation, by destroying the connections
of the pneumogastrics with the brain and heart, Bernard
is in the habit of introducing into one of the large arteries,
what he calls a hygrometer, (Magendie's instrument) different,
of course, from the ordinary instrument of that name. This
instrument is composed of a cup filled with mercury ; from the
top of the cup passes out a short, pointed tube, curved down-
wards. When the instrument is used, this tube is placed in
the open extremity of an artery. Another tube, which is grad-

1851.] Nerve and Spinal Accessonj of Willis. 591

uated, passes up vertically from the top of the cup, with its
lower end in commuuication with the mercury. When the
instrument is applied, the blood is forced up the curved tube,
presses upon the mercury and forces a column up the vertical
or graduated tube. M. Bernai*d applied this instrument before
the class, to the carotid of a dog. A column of mercury was
forced up the graduated tube and sustained at a certain point
by the contractility of the arteries. The blood oscillated from
two to three inches above the fixed point by the contractions
of the heart. The point to which the column of mercury was
raised by the arterial contractility and the distance of the os-
cillations caused by the impulsions of the heart, being determ-
ined, one pneumogastric was cut; immediately the column of
mercury was raised to a higher point, but the distance of the
oscillations (the heart's force) was diminished. The oscilla-
tions, however, though smaller in extent, were more rapid.
The latter points were determined and the other nerve was
cut. The fixed column from arterial pressure rose still higher
in the tube, but the oscillations occupied less space and were
more rapid than before. The augmentation in constant pres-
sure of the arteries, was owing to the collapse of the thoracic
walls. The collapse of the walls of the chest always occurs
after cutting the pneumogastric nerves. In the normal state,
the arterial pressure augments during expiration, and after
these nerves are severed, the same cause comes into operation
to produce the same effect. In the latter case, tfie force is
only increased. Galvanism applied to these nerves, or to the
heart, after their connections with the brain have been severed,
will immediately arrest the contractions of this viscus. This
shows that the galvanic stimulus acts very differently upon the
heart, from what it does upon the voluntary muscles.

ARTICLE XXXir.

A Case of Monstrosity, By Wm. C. Brandon, M. D., of
Hermitage, Floyd Co., Georgia.

It should be the object of every one who writes for a public
journal, not only to interest, but also to benefit the reader.
The writer of this article, however, does not expect that it will

592 Brandon's Case of Monstrosity, [Octobsr,

prove of any practical utility to the profession. But, from the
infrequency of the occurrence of cases such as that given be-
low, he hopes that it may not prove altogether uninteresting
to the reader.

On the IGth of June, ult., I was called to Mrs. N , in

parturition. On my arrival at the house, I found that she had
been dehvered, some fifteen or twenty minutes, of a male child.
Immediately on my entering the room, one of the ladies pre-
sent informed me that "there was something very strange
about the child, and wished it examined immediately:" she
supposing that it had sustained some injury during labour. * To
my great horroi', upon uncovering the child, I found a large
portion of the intestine lying out upon its pubis and thighs.
Upon a further examination of the case,' I found a considerable
opening in the abdomen, to the right of the umbilicus. The di-
ameter of the opening was near an inch and a half, and almost
entirely circular. The peritoneum, the entire body of the rectus
at that point, and those portions of the transversalis and obliqui
muscles that approach the umbilicus, and also the external
integuments, were entirely wanting. The umbilical vessels,
which seemed to be natural in size, position, (fee, formed a
portion of the left border of the opening. The skin and peri-
toneum appeared to have united upon the edges of the opening,
the surface being smooth and entire, as the lips on other
natural openings. The stomach impinged upon the upper border
of the opening. The small intestines, beginning at the upper
portion of the duodenum even as far as the caecum protruded
through the opening, and were (as remarked above) lying upon
the pubis and thighs of the child. They were, or appeared to
be much larger than natural at birth. From the size of the
child and size of the protruded viscera, it did not seem that the
cavity of the abdomen could possibly have contained more
than half of them. This I find to be the ordinary condition of
the parts in congenital umbilical hernia. In Todd's Cyclopae-
dia of Anatomy and Physiology, vol. 2, p. 762, it is remarked,
*' In this affection, (speaking of umbilical hernia.) there seems
to be a want of correspondence between the size of the viscera
and that of the abdominal cavity, the former appearing enlarg-
ed and swollen." The protruding mesentery and bowel were

1851.] Brandon's Case of Monstrosity. 593

pretty firmly, and irregularly agglutinated, so as to present the
appearance almost of a solid body. I made a slight effort to
return them to their natural positions ;. but from the adhesions
and size of the protruded mass, and srnallness of the opening,
it was impossible to succeed even in the least degree.

The other viscera of the abdomen, colon, liver, &c., seemed
to occupy their natural positions ; but I have been informed by
the father of the child, that after a few hours other portions of
bowel protruded. I was not able to detect any thing abnor-
mal in relation to either the cord or placenta ; nor could I per-
ceive any other deficiency, or redundancy of development in
the child. According to the calculation of the parents, the
child was born at eight months gestation ; and from its gencal
appearance I would believe ttiem to be correct. It was belov7
the ordinary size, and quite feeble, and that plumpness which
we usually see, even in small children, was wanting in this.
Its breathing was not difficult, though the movements of the
diaphragm appeared to be much more extensive than in an
ordinary condition. This I supposed to be owing, in some
degree, to a great portion of the resistance offered to the
diaphragm in a normal condition, being taken off from below,
as well as the inability of a portion of the abdominal muscles
to perform their part in this function.

Deeming it impossible to save the child, or even benefit it in
the least, I had it placed in as comfortable a condition as pos-
sible, and left it to the results of nature. It lived about twenty-
four hours. I did not have an opportunity of seeing the case
any more. No post-mortem examination was allowed.

This case, I suppose, would come under Dr. Denman's se-
cond class of monsters, namely : "Monstrosity from deficiency
of parts." And under Vogle's third class, viz: " Malformations,
in which parts normally united are separated from each other
fissures." Here we have a case of arrest of development; but
at what period of gestation it may have commenced, or the
causes or circumstances which produced it been in operation,
is uncertain. In this article we shall not enter into any argu-
ment in regard to what physiological law may have been sus-
pended or perverted, or what pathological condition may have
existed to produce the results in the case. The reader will.

594 Campbell, on Ooarian Tumor, [October,

however, pardon me for introduf^inglhe opinions of the parents,
as to the cause of the condition of their child not that I, by
any means, subsci-ibe to their opinions; but as the reader is
aware, whenever a child is born with any preternatural devel-
opment or defect, the parent can then always refer to some
particular circumstance or condition, as fright, "longing," &c.,
as the cause by which it was produced. In this instance it
was attributed to the mother having been exposed for several
days, at an early period of gestation, to the annoyance of a dog
which had been shot through the abdomen, but still living and
going about the yard \vith the wound exposed to view. It
may not be improper to state that the mother's general health
had been very feeble during the whole period of gestation.
This was her sixth child. Her temperament is lymphatic:
that of the father sanguineous.

ARTICLE XXXIII.

Death from Ovarian Tumor in a Child. By Robert Camp-
bell, M. D., Assistant Demonstrator in the Medical College
of Georgia.

Sidny, a mulatto girl, aged about 10 years, had been for the
last six months (thus far only could be traced in the history of
the case) the subject of general emaciation, with excessive ab-
dominal protuberance. She had been treated, doniestically,
time and again, for intestinal worms, upon the presumption
of their being the cause of her unsightly peculiarity; but
whatever success might crown the anthelmintic exhibition,
there would be no parallel mitigation in the abdominal en-
largement.

On the 6th of July ult., she was attacked with {qvq\\ attended
with obstinate irritability of stomach and great intestinal dis-
tress ; which condition, after several days' duration, terminated
fatally.

Autopsy, fourteen hours after death, revealed the following
facts, viz : Peritoneal cavity filled with whitish serum ; stom-
ach exhibiting no traces of inflammation nor extraordinary
congestion of its coats ; spleen about thrice the size of the
healthy adult spleen ; bowels apparently norma), except those

1851.] Campbell, on Ovarian Tumor, 595

portions occupying the right iliac and hypochondriac regions,
and proximate to a large, dark-colored body resting about the
right brim of the pelvis, poFsessing a portion of that cavity and
extending into the right iliac region of the abdomen. Here,
the ascending colon, caecum and lower portion of the ilium,
present a mottled aspect : in those portions lying contiguous
to the tumor are extensive blackish spots, giving the appear-
ance of partial decomposition ; peritoneum generally very much
injected, though especially in the neighborhood of the diseased
mass, and also evincing this discoloration ; the omentum majus
containing but little fat, exhibits an inordinate degree of vascu-
larity, which condition characterizes all the tissues in this
vicinity ; mesenteric glands are much enlarged, although appa-
rently unaltered in structure ; lumbar lymphatic glands also
enlarged, resemble in appearance and structure the diseased
organ.

Its attachments having been distinctly ascertained, the tu-
mor was carefully dissected out, pains being taken to preserve
its connections the uterus and its appendages. Thus freed
from all embarrassment, it was possible to study particularly
the nature and relations of this object, which is the size of a
man's fist, weighing 36 drachms ; the color, externally, of or-
dinary liver, somewhat of a reniform shape, and presenting
several nodules or rounded protuberances upon its circumfer-
ence, which latter are much softer than the body of the mass
almost fluctuating to the touch. It appears to possess several
serous tunics, acquired by adhesions contracted with the broad
ligament of the uterus, and through its intervention with the
greater omentum ; and is connected by one portion of its sur-
face to the upper angle of the uterus, by the right utero-ovarian
ligament, and by another portion with the fimbriated extremity
of the right Fallopian tube, by its Fallopio-ovarian ligament
which facts conclusively demonstrate it to bo the right ovary.
Upon this side, the ligaments are in a state of hypertrophy, as
also is the Fallopian tube, the coats of which are much thick-
ened, and the area of whose canal is greatly expanded. On
the left side, these seem to have undergone a proportionate
diminution. The uterus exhibits no mark of disease.

Aftr^r th's f^oth lungs were removed and submitted to care-

N. S. VOL. vn, N'O. X. 38

596 Campbell, on Ovarian Tumor. [October,

ful inspection, in quest of tubercular deposition, but no abnor-
naal alteration could be detected", each portion being permeable
and crepitant on compression.

The diseased ovarium, on being cut into, presents a variega-
ted or mosaical appearance, containing several shades of pur-
ple, brown and red, interspersed with white matter, which in
some places seems to predominate, being disposed in a semi-
lunar manner. These structures are of a cellular character,
and the cut surface is soon moistened by a dirty brown fluid,
which appears to exude from the darker and more vascular
portions of these section.

The tuberosities described upon the organ consist, internally,
of a homogeneous brownish-red pultaceous matter as if the
process of softening had commenced at these points.

We have been thus minute in the delineation of the patho*
logical appearances presented in the foregoing case, for the
purpose of establishing, without the aid of the microscope,
(which opportunity did not furnish) the histological nature of
this tumor. And in a review of the most prominent features
therein portrayed, we recognize satisfactorily the lineaments of
carcinomatous disease. For in proof of its malignancy, we
have the marked sympathetic condition of the constitution, as
evinced in the emaciation, ascites, enlarged spleen and mesen-
teric glands, the enlargement and structural alteration in the
neighboring lymphatics, the vascularity and melanotic appear-
ance of the adjoining viscera, which latter, indeed, is not an
unusual concomitant o{ en cep haloid cancer. Besides, we have
the more immediate evidences of the precise nature of the dis-
ease, in the physical characteristics of the local phenomena
viz., the immense development of the organ, the irregular tu-
berose condition of its surface, its cellulo-vascular constitu-
tion, brainlike consistence, peculiar colors, and the sofleningoi
certain portions of the mass, which gives some insight into the
historical relations of the disease. Hence, we deem it impro-
bable that we should err in the diagnosis of this case, with the
testimony of these data before us, when we determine of them,
that they are the conditions constituting cerehnfortn carcinoma
of the ovarium.

The one fact in its history, which appears to invest it with

1851.] Digitaline. 597

peculiar interest is the invasion by disease of this organ, at
a period in its development, generally unobnoxious to morbi-
fic influences : diseased action ordinarily depending upon or
being in some way connected with, the state of activity of an
organ in the ovaria, with the procreative stage of life. So
far as our inquiry has extended, we have been unable to find on
record, one instance wherein the ovarium has been the site of
morbific action in so very youthful a subject. The occurrence
of this disease, in this locality, so early in life, must be regarded
as merely accidental, and not as resulting from the ordinary,
conservative operation of the laws governing the natural
economy.

We did not attend this case, consequently know no more of
its particulars ante mortem, than heretofore cursorily described ;
but its fatal termination is probably attributable to the mechani-
cal embarrassment or irritation exerted upon the abdominal
viscera.

PART II.
(Eclectic Department.

Digitaline. Reports of MM. Rayer, Soubeiran and Bouil-
LAUD. Translated for the Neio York Journal of Medicine
by H. N. Bennett,' M. D., of Bethel, Ct.

[The following Reports (of which this translation is an
abridgment), presented to the A^'ational Academy of Medicine
by the distinguished gentlemen whose names are at the head
of this article, have reference to the "Memoirs upon Digitaline
by MM. Homolle and Quevenne," and were made by them in
the capacity of a commission deputed by the Academy for
this special purpose. The first Report was made at the session
of the 8ih January, 1850, the second the 4th February of the
present year.]

Chemical and PharmacexUical Part.

The authors of the Reports, after presenting to the Acade-
my some extracts from the work of MM. Homolle and Que-
venne, showing the motives which induced these gentlemen to
prosecute their labor, proceed to their own task, which is set
forth in the following paragraph. Now that we have laid

598 Bigitaline, [October,

before the Academy the reasons for which MM. Homolle and
Quevenne have devoted themselves to new investigations upon
one of those plants whose physiological and therapeutic power
excites in the highest degree the curiosity, not to say the admi-
ration of all true observers, we pass to the analysis of the
memoir upon which we have been desired to report. This
work is naturally divided into two parts ; the one relative only
to Digitaline, the other exclusively devoted to all the other
principles which are found in digitalis. According to the de-
claration of the authors, the first part, that which treats of
digitaline, is the only one which presents any interest in a
practical point of view. They add, that it is only to this that
they have wished to call the attention of the Academy, and
that they have handed in the second part only as collateral
information.

Be that as it may, MM. Homolle and Quevenne investigate in
so many separate paragraphs ; 1st, the purification of digitaline
and its chemical properties ; 2d, the exhibition of digitaline ;
3d, the medicinal form in winch digitaline is best administered.

To purify crude digitaline, our authors treat it by ether
slightly alcolhised (density 780,) which separates the digitaline.
But this liquor dissolves also the digitalose, and leaves the
digitalin. To separate the former from digitaline, the solution
is submitted to evaporation, and the residue treated by alcohol
at 60 degrees, which dissolves digitaline, and eliminates digita-
lose. Evaporated by a mild heal, this solution in weak alcohol
finally gives digitaline jowre, or at least retaining but very little
of the two substances just mentioned, which cannot be com-
pletely isolated, so great, say MM. Homolle and Quevenne, is
the obstinacy with which digitaline retains the last traces of
these principles. These able experimenters have in vain made
numerous attempts to crystallise digitaline thus obtained in a
purer state than that described anteriorly by one of them.

This purification produced, digitaline appears under the form
of scaly striae or masses (according to the quantity of this sub-
stance) of a straw yellow, or resinoid aspect, more or less trans-
parent, broken up with ease, and forming then a pale yellowish
powder. Once isolated, digitaline is unalterable in the air, it
gives out a slight aromatic odor sui generis, and has a very
marked bitter taste.

Digitaline is dissolved in small quantity in the serum of the
blood, without producing in it any apparent change. The pro-
portion dissolved appears to be the same as in water. It is
also dissolved in the filtered gastric juice. (If an attempt is
made to dissolve digitaline in the crude gastric broth or chyme,
it is absorbed by the alimentary matters, and its bitter taste

1851.] Digitaline. 599

disappears, as is the case when animal carbon is thrown into
its aqueous solution.)

Digitaline exerts no action upon either of the test papers. It
is dissolved in small quantity in water, and, so to speak, in all
proportions in feeble or concentrated alcohol.

The characteristic and distinctive property of digitaline is
that of producing an emerald green color with concentrated
hydrochloric acid, and forming a muddy solution.

Digitaline belongs, as has been said, above, to the class of
immediate neutral principles. It combines neither with acids
(tannin excepted) nor with alkalies.

To be certain of the identity or of the quality of digitaline,
so important and truly capital a matter in a therapeutic point of
view, MM. Homolle and Quevenne have had regard to the
different degrees of bitterness of this substance ; because, say
they, "we believe it incostestable that its degree of bitterness
is its degree of energy." To succeed in this test, it is neces-
sary to proceed in the following manner:

" Dissolve a given quantity of digitaline, one centigramme in
two grammes of alcohol, and dilute with water progressively
until the complete disappearance of the bitter taste. If the
digitaline is good it should require for this quantity the em-
ployment of two quarts of water."

"With a little practice, and with the aid of a pattern speci-
men which serves for comparison, the degree of bitterness may
be appreciated in a very exact manner. According to the
result obtained, it is admitted as good, or requires purification."

This means of appreciating the intensity of the taste of sub-
stances, (called the method of progressive dilution,) already
employed by other observers to judgeof the richness of certain
medicinal preparations, has been considered by MM. Homolle
and Quevenne as a proper manner of obtaining digitaline
always of equal strength.

MM. Homolle and Quevenne having thus succeeded in ob-
taining digitaline in that state which they call identical, it re-
mained for them to determine what pharmaceutical form should
be given to this medicine, having a fourfold reference to safety,
convenience, good preservation, and easy administration.

The solution of this problem was the more important, since it
concerned a product which possesses very great activity, an
activity so great that it ought only to be administered by mili-
grammes, or, so to speak, in infinitesimal doses. It could not
then, like sulphate of quinine, for example, and some other me-
dicines, be prescribed in a direct manner and without a medium.

Among the diflerent pharmaceutic forms, the choice of which
might be a matter of dispute, MM. Homolle and Quevenne

600 Digitaline. [October,

adopted that o^ pill, and to this they think the preference should
be given. This form itself includes, as every one knows,
several varieties. The variety " which has appeared to us to
excel," say MM. Honnolle and Quevenne, *'is that of very
small comfits, in which the active matter is enveloped under a
layer of sugar, in such a manner that the patient, by reason of
their very small volume, may swallow them easily without mas-
tication, and consequently without perceiving any thingexcept
the sugar which covers them." By reason of their small vol-
ume, these comfits have been designated by the name o^ gran-
ules. Two great advantages, among others, are found in this
medicinal form; 1st, a certain dose, easily controlled both by
the physician and patient, since it is only necessary to count
the number of granules, each of which contains a milligramme
of digitaline ; 2d, a preservation to which MM. Homolle and
Quevenne do not thus far know any limit.

Piiysiological and Therapeutic Action of Digitaline.

MM. Homolle and Quevenne have not been tardy in com-
municating to the Academy the desired compliment of their first
researches, under the title of "Third Memoir upon Dicritaline."

In this new Memoir, the authors propose to establish, "that
digitaline is the sole active principle of digitalis ; that it presents
all its physiological and therapeutic properties, and that the
constancy of its effects, as well as its inalterability, give to it an
incontestable advantage over the pharmaceutic preparations of
digitalis.'*

But let us see what are the physiological and therapeutic
properties attributed to digitalis by the numerous observers who
have devoted more or less important labors to its investigation.

1st. A constant emetico-cathartic action when it is admin-
istered in a sufficiently large dose.

2d. A diuretic action generally observed, although more rare.

8d. A very remarkable and altogether special action upon
the circulation.

Besides, it provokes a slight cerebral irritation, characterized
by dimness of vision, vertigo, cephalalgia, sleeplessness, and
delirium.

Insisting, then, more particularly upon the special property
of digitalis, we might say almost specijic, our authors endeavor
to determine the mode of action which digitalis exerts upon the
central organ of the circulation, and afterwards the indications
which this therapeutic agent is called to fulfil.

The French physicians in general, they say, consider digitalis
as a sedative of the circulation ; the English physicians recog-
nize in it a primitively excitant action upon the circulatory

1851.] Digitaline. 601

centre, which is depressed only secondarily. Rasori places
digitalis in the first rank of contra-stimulantc, and makes it a
succedaneum of blood-letting.

Joerg, of Leipzig, concludes from his researches upon digi-
talis, that it determines depression of the vascular system only
consecutively.

" W. Hutchinson, who made conscientious and persevering
experiments upon himself, verified the primitive increase of the
action of the heart, followed by depression and disorder of this
function."

To fulfil, as worthily and as completely as possible, the im-
portant and delicate task which the Academy lias confided to
us, we have not limited ourselves to presenting merely an ac-
curate analysis of this new portion of the work of MM. Ho-
molle and Quevenne. It seemed necessary for us to remind
our colleagues of the actual state of science in regard to the
properties of digitalis, and to render an accout of the clinical
experiments to wliich we have devoted ourselves, in order to
appreciate as rigorously as our methods of observation at the
present time permit, the action of the new active principle of
digitalis, the discovery of which belongs to the authors just
named. This is the manner in which we have proceeded, and
thence naturall}^ the division of our report into three parts ; the
first, devoted to a rapid historical sketch of the opinions ad-
vanced upon the properties of digitah's; the second, relative to
the exposition of the researches of the authors of the memoir
upon the properties of digitaline ; and the third, containing the
experiments of the commission.

Analylical Exposition of the Physiological and Clinical Ex-
periments of the Authors of the Memoir vpon the Properties
of Digitaline, compared with those of the other preparations
of Digitalis.

Article First. Physiological Experiments upon Man and
Dogs. One of the authors made a trial of digitalis upon him-
self, with a truly exemplary precision, and repeated it seven
times, leaving sufficient intervals between the trials.

From the analysis of the six first experiments made in the
course of the years from 1842 to 1850, the result is, that the
mean of the diminution of the pulsations of the heart and arte-
ries was about four pulsations during, and five after, the admin-
istration of the medicine (sometimes digitalis, sometimes digi-
taline.)

But we should note here the symptoms of intoxication wliich
were manifested during the 5th experiment, under the influence
of two grammes and one decigramme of the powder of ditrita-

602 Digitaline. [October,

lis, of a superior quality, taken in the course of nine da3^s, and
the very notable diminution of the pulse which supervened at
the same time. (From 72 it fell to 53 during the continuance
of the symptoms, and to 55 after their disappearance; thus
giving the differences, 19 and 17, that is to say, a mean differ-
ence which represents exactly one-fourth of the normal pul-
sations.)

We think it necessary to report, with some details, the
seventh and last experiment, made in the month of Nov. last
(1850,) with the syrup of digitaline, 20 grammes of which con-
tain a milligramme of this substance.

The experimenter administered, in eight days, 33 milligram-
mes of digitaline in syrup (4 milligrammes during four days, 2
one day, 5 one day, 6 one day.)

Mean of the pulse during six days, counted at different hours of

the day, before the experiment, ... - 67*47

Maximum, 73*00

Minimum, -------- 63'00

Meanoi the pulse during the eight days of administration, 64-64

3Iean during die ten days after administration, - - 59'88

Minimum during the administration - - . - 54*00

Maximum, - 74-00

Minimum after the administration, - - - - 50-00

Maximum, 72-00

Comparing the mean of the normal pulse (67-47) with the
minimum of the same pulse, after the administration of the me-
dicine (50,) we find a difference of 17*47, a difference equal to
one-fourth of the pulsations in the normal state, the same as in
the case of intoxication which we have noted above.

The patient suffered rather a sense of weakness than of pain
in the stomach, and he observed that his appetite did not in-
crease, as often happened to him after the use of the granules ;
slight disturbance of vision : nothing appreciable on the part of
the kidneys. The experimenter remarked that the pulse re-
turned suddenly to the normal state, or nearly so, under the
influence of a long walk made the tenth day after the cessation
of the exhibition of the syrup.

From the whole of the experiments, the result is, that the
action of digitaline is nearly the same, whether we administer
it in the state of syrup, that is to say, in previous solution, or
in the state of granules, in which case it is dissolved gradually
but with sufficTent promptness in the gastric juice. If any dif-
ferences exist, they are slight, and do not appear to declare in
favor of the syrup, which gives rise to nausea and more marked
cerebral symptoms.

Let us pass now to the experiments made upon two dogs,

1851.] Digitaline. 603

with the same precision as those the results of which we have
just made known.

The first dog took- interruptedly, but at six not very distant
intervals (from the 10th of May to the 8d Sept., 1849,) 552
granules or milligrammes of digitaline, in a daily dose of from
two to ten milligrammes.

The mean of the pulse, before the experiment, was 59'94.
This mean after the sixth successive administration, was 51*22.
being a diminution of 8"72.

The second dog took in the same manner (from the 13th
June to the 8th Sept., 1849,) 398 granules of digitaline in the
same daily dose.

The mean of the pulse, before the experiment, was 87.80.
This mean, after the administration at four approximate inter-
vals, was 6993. Consequently, the diminution was 17.37.
Add to this, that during the experiment, there were momentary
diminutions amounting to 23 and even 31 pulsations, the latter
being nearly double that just mentioned.

According to the experiments above analyzed, the minimum
of the depression of the pulsations never corresponds, so to
speak, with the period of administration of the digitalis or digi-
taline, but rather to that of repose after the cessation of the
use of the medicine.

This curious result proves that the medicine continues its
action some time after the cessation of its exhibition, and, with-
out doubt, until no trace of it longer remains in the economy ;
whether its diminution is produced by any one of the numer-
ous emunctories, or whether by a reaction yet unknown, it is
transformed into some new compound completely deprived of
the property which pure digitaline possesses.

Article Second. Clinical Experiments Reported hy MM.
HomoUe s^nd Quevenne. "It concerns us now to examine,"
say these authors, " whether ulterior practice has confirmed
our first results. The facts collected by us, from observations
taken in several hospital services, furnish an affirmative reply
upon this subject.

"As to the intolerance oi^ digitaline, which is in our opinion
only a manifestation of its emetico-cathartic action, we have
encountered it but three times out of more than a hundred per-
sons to whotn we have administered this medicine; and in
these three cases, discontinunnce of the digitaline, or even
diminution of its dose, was sufficient to suspend very quickly
every unpleasant syptom.

'We think that those of our colleagues who have observed
more obstinate gastric symptoms, should attribute them to this

604 Bigitaline. [October,

circumstance, that they commenced with too high doses or
exceeded those approved by experience.

"As ibr ihe toxic action noticed by MM. Bouchardat and
Sandras, who having; injected digitaline into the veins of some
dogs, saw these animals perish in a short time, these facts,
which have become the basis of exaggerated fears, have been
badly interpreted. No account is taken of the mode of absorp-
tion, which so profoundly modifies the action of medicines, and
of the danger which this may of itself produce. How many
therapeutic agents, in fact, would medicine be compelled to
renounce if it were necessary to put them to the same test ?
We can say truly, that these toxic phenomena, independent of
theemetico-catharlic action, have never presented themselves
to our observation. We may add, that vomiting, when digita-
line is administered by the stomach in an exaggei'ated dose,
frees the economy from the excess of the ingested medicine,
and fulfilling, so to speak, the oflice of safety-valve, presents an
impediment to the development of true toxic symptoms."

As to the comparative efficacy of the preparations of digita-
lis hitherto used, and digitaline, MM. Honfiolle and Quevenne
leave to clinical experiment the burden of a final decision.
They think that their own observations and those published
hitherto, lead to the belief that the question wdl be resolved in
favor of digitaline.

After these preliminaries, MM. Homolle and Quevenne re-
port their own obsei-vations.

Having detailed eight cases, they add that, "in order not to
increase the size of their memoir, they have omitted several
observations of pleuritic eflfusions, and one of pericarditis, in
which digitaline appeared to them manifestly to increase the
resoption of the fluid ; that they have also neglected those ob-
servations which only go to establish the fact that digitaline,
like digitalis, diminishes the number of the pulsations of the
heart, the experiments quoted in their first memior leaving no
doubt upon this point."

The commission, strengthened by its own experience, had no
need, on its part, of more numerous observations, to be con-
vinced that to digitaline belongs, no less than to digitalis, the
admirable property of retarding the pulsations of the heart and
arteries. But it received with great eagerness fiicts proper to
demonstrate, in an irrefragable manner, that digitaline possesses
an action, a diuretic virtue, sufficiently energetic and constant
not to be called in question by any of the observers who have
long and conscientiously studied, at the bedside of patients, the
real effects of digitaline.

MM. Homolle and Quevenne sum up thus their [pharmaceu-
tic] parallel between digitaline and digitalis:

1851.]

Digitaline.

605

DIGITALINE.

An unalterable type, to which
digitaline may be invariably re-
ferred.

Constant energy of the medici-
nal agent.

Possible appreciation of the
quality of a given specimen of di-
gitaline by the measure of the in-
tensity of its bitterness, which
ought to be such as to require tv/o
quarts of water to destroy the bit-
terness of a centigramme of digi-
taline.

The extreme facility of its ad-
ministration to every person, with-
out exception.

DIGITALIS.

Imposibility of preserving un-
alterable a specimen which will
serve indefinitely as a point of
comparison.

Unavoidable uncertainty in re-
gard to quality, and consequently
the degree of activity of the plant
employed.

Al)sence of any positive charac-
ter, upon which we can depend,
to appreciate the difference of
quality between the different spe-
cimens of digitalis.

Difficulty of administration to
some persons, in consequence of
its taste and smell.

To decide the choice in favor of di^^italine, and cause the ba-
lance to incline definitely to its side, it is only necessary to cast
into the scale the weight of a long and exact clinical experience.
MM. Homolle and Quevenne have perfectly comprehended
this. "As to the difference of action which may exist," say
they, "between digitalis and digitaline, and the preference to be
accorded in this respect to the one or the other, it is for d'lni'
cal experience to determine. We may, for the present, refer
to the testimony of Professor Bouillaud, who has studied the
action of digitaline for several years, and does not hesitate to
say, relying upon a long experience, that it far excels every
other preparation of digitalis, in this, that it is less liable to
cause vertigo, dimness of vision, ringing of the ears, &c."

The following fundamental propositions sum up all the re-
searches of MM. Homolle and Quevenne, and to these the Re-
porters desire especially to call the attention of the Academy:

1. Digitaline (properly prepared) represents all the thera-
peutic properties of digitalis.

2. Digitaline exerts a regulating action upon the circulation,
and retards its movements. This action, which is essential and
nearly constant, requires only feeble doses, (ordinarily from two
to five milligrammes in twenty-four hours, in adults.)

3. If we exceed the dose of four or five milligrammes in
twenty-four hours, digitaline exerts, an emetico-cathartic action,
sometimes harsh and sudden, sometimes slow and gradual.

4. Digitaline produces a toxic action when it is absorbed in

606 Digitaline. [October,

large doses. This action has been produced by injecting into
the veins of a dog one centigramme of this substance. But,
when administered by the stomach, the toxic action does not
appear as dangerous as is generally supposed, the excess of the
medicine being expelled from the economy, for the mere rea-
son that it is not tolerated.

5. Compared with the powder of digitalis, which is consi-
dered as the best pharmaceutic prepartion of this plant, digi-
taline should have the preference, since it offers greater facility
of ingestion, a more certain action, and a more constant toler-
ance.

6. MM. Homolle and Quevenne add in a note, that digita-
line produces also two other order of phenomena; a diuretic
action and an excitation of the nervous centres, but that this
double action is far from being constant.

7. Finally, among the effects of digitaline we shall notice the
followins:, mentioned in the course of the work of MM. Ho-
molle and Quevenne :

I. Action upon the Eyes. In the course of the chemical
manipulations, some fragments of digitaline being projected
into the eye, the following was the result a slight painful sen-
sation in the organ, and after four or five hours, disturbance of
vision in such a manner that the flame of a taper appeared sur-
rounded by an areola, having the colors of the rainbow. This
effect was dissipated in the space of one day, without leaving
any trace of it. During its continuance the pupil was a little
dilated, appeared less contractile, and the crystalline lens ap-
peared to present a certain degree of opalinity.

The effect above indicated is produced also when a person
remains a length of time in an atmosphere charged with pul-
verulent emanations of digitaline.

II. Action upon the Skin denuded of its Epidermis. Ap-
plied upon the denuded skin, in the feeble dose of a milligramme,
and renewed at intervals of eight or ten hours, digitaline pro-
vokes a lively inflammation, with swelling, redness, and disa-
greeable numbness of the neighboring parts. This effect de-
prives us of the advantage of administering digitaline by the
endermic method, a method so valuable in certain cases.

Clinical Researches made hy the Reporter, [Bouillaud.]

For about four or five years that we have administered digi-
taline in our clinical service, perhaps not a single day has passed
in which we have not studied its action upon one or more sub-
jects, attacked either by simple neuroses of the heart, but chiefly
by more or less grave chronic-organic affections of this viscus
and of the aorta; we have also administered it in six or eight
well-marked cases of intermittent fever.

1851.] Bigitaline. 607

The total number of patients to whom we have given digital -
ine, amounts to, at least, one hundred and fifty or two hundred
of different age and sex.

With the exception of three, we have observed in all a more
or less considerable retardation of the pulsations of the heart
and arteries, an effect which could not be attributed to any
other cause than the administration of the medicine indicated.
We hasten to say that in the three patients, in two especially,
whose pulse was not sensibly retarded under the influence of
the administration of digitaline, sufficiently prolonged, there
existed a frequency of pulse kept up by a febrile phlegmasia.
In two of these three cases, this phlegmasia had its seat in the
envelopes of the heart (pericardium and endocardium), the
same thing which was encountered in one of the cases reported
by MM. Homolle and Quevenne.

It is true that three or four observations alone cannot resolve
a grave question of therapeutics. But those to which we have
referred authorize us to consider as very probable, at least, this
proposition : that the frequency of the pulse entertained by our
inflammatory /oyer, presents an obstacle to the effect of digita-
line, against which it almost completely fails.

In several cases in which the acceleration of the pulsations of
the heart (palpitations) was accompanied by irregularities and
intermissions, by disorder, ataxia, of the normal rhythme of
this great spring of the human machine, digitaline, like digitalis,
not merely quieted the palpitations but also regulated, some-
times completely, sometimes incompletely, and for a longer or
shorter period, the disorderly pulsations of the circulatory
centre, and, in a manner, restored this organ to reason, which
before to use a common expression was light-headed {hattait
lacampagne.)

Digitaline and digitalis are, then, at once a rctardator and a
regulator of the action of the circulatory centre. They con-
stitute, also, a debilitator of this same action. In fact, in all
cases in which tlie pulsations of the heart have been retarded
in a notable manner by digitaline, they have at the same time
lost their force or their intensity; (so also of the normal or
abnormal bruits of the heart.)

With a special dynamometer, or with the sphygmometer, the
different degrees of this diminution of force might be exactly
determined. Hitherto we have only appreciated this diminu-
tion with the hand, a sort of living and feeling dynamometer,
which, by long training, acquires, like other organs of the same
nature, an exquisite and so to speak a mathematical sensi-
bility. Inspection concurs with palpation in our appreciation
of the intensity of the i)ulsations of the heart. Finally, if the

608 Digitaline. [October,

stethoscope is applied over the region of the point of the heart,
this instrument is Hfted up, undergoes a kind of extension, which
is proportionate to the strength of the impulse of the circula-
tory centre.

We shall give, now, more precision to what we have hitherto
said upon the retardation of the pulse, by laying before the
Academy the numerical results furnished by fifteen patients,
taken indiscriminately.

The mean of the pulse, before the administration, was ninety-
six. The mean of the retardation in these fifteen cases was
forty-one, consequently about one-half the number (ninety-six)
which represents the mean before the administration of digita-
line.

In three cases, the number of pulsations to which the action
of the heart was reduced remained as high as eighty, one hun-
dred and two, one hundred and six. But these were patients
attacked by grave chronic-organic aflfections of the heart, in
whom the pulse beat from one hundred and forty to one hun-
dred and seventy per minute.

In comparison with these maximum numbers of retardation,
let us place those which represent the minimum. The latter
are twelve and fourteen in two patients, and sixteen in two
others; but, in one of these two last, the pulse beat only sixty
before the exhibition of the medicine ; and in the other, whose
pulse was eighty-two, the digitaline was administered only
during four days, (in all sixteen milligrammes.) In the two
others, the pulse was seventy-two in the first, and eighty-six in
the second, who took the digitaline for seven days only.

The mean of the number of granules administered to our 15
patients, was 58. They were taken in the dose, of 2, 3, 4, 5, 6,
7, per day. The mean of the number of days during which
they were administered, was from 13 to 14.

In one subject, we gave 70 milligrammes in 18 days ; in a
second 82 in 14 days ; in a third 98 in 20 days ; in a fourth
164 in 40 days. None of the patients suffered any remarkable
symptom. As soon as headache, vertigo, or distress at the
stomach supervened, we immediately suppressed the medicine.

In the 150 or 200 patients for whom we have prescribed
digitaline, we have taken the pains to have the medicine ad-
ministered in our presence at the time of our visit. In those
cases in which the dose was taken in two parts, that of the even-
ing was administered by the chief of the clinique himself, or by
the matron of the hall, to those patients who were to lake digi-
taline upon going to bed. One only, of whom we have spoken
above, has manifested grave cerebrnl symptoms, which how-
ever completely disappeared under the influence of the treat-
ment directed against them.

1851.] Physical Examination of the Abdomen. 609

One of the 15 patients who have made the subject of our
statistical resume belonged to the category of six or eight per-
sons attacked by well marked intermittent fever, whom we
have treated with digitaline in order to ascertain whether this
principle possesses the febrifufze virtue which we have ante-
riorly verified in the powder of digitalis administered internally
and externally (by the endemic method.) These six or eight
persons, treated thus in the presence of those who followed the
clinique, were cured very promptly and Without relapse.
Under this new point of view, digitaline may replace, then,
the preparations of digitalis formerly used.

In noticing these facts, having an authenticity which cannot
be contested, the reporter has no other object than to call the
attention of observers to a new and very curious property of
digitalis, and does not pretend to maintain that this plant can
be advantageously substituted for quinine, which he considers,
on the contrary, the first, and, so to speak, the prince of febri-
fuges. But ulterior researches will demonstrate, perhaps, that
digitalis is called to figure, with some distinction, among the
best succedanea of Peruvian bark.

Kow even admitting that digitalis, in spite of the oft-repeated
experiments of the reporter, does not possess a febrifuge power,
it is very certain that it possesses the property of retarding, mo-
derating and regulating the pulsations of the heart, and that it
does this not in a secondary consecutive manner, as diilerent
experimenters have pretended, but in a primitive and immedi-
ate manner. A proposition not less certain, according to the
researches consigned in the Memoir of MM. Homolle and
Quevenne, and according to those of the commission, is, tliat
digitaline is the principle to which digitalis owes the precious
and admirable pi'opeity which we have mentioned, as quinquina
owes to quinine the property, certainly not less precious and
less admirable, of curing intermittent fevers.

On the Physical Examination of the Ahdofnen. Bv Charles
J. B. Williams, M.D., F.R.S.

The physical examination of the abdomen by palpation^ is a
matter of importance, and demands a few directions and cau-
tions. The parts of the hands best qualified to feel are the
palmer surfaces of the fingers, the pulpy portions of the last
phalanx beincr endowed with the finest touch. But they should
be flatly applied, at least at first; as nothing is more likely to
start the abdominal muscles into rigid contjaclion than to puke
them abruptly with the ends of the fingers. For tiie same rea-

610 Physical Examination of the Abdomen, [October,

son the observer should not be too much above the patient ; and
if the bed on which the patient is placed is low, the practitioner
should sit or kneel beside it, in order to bring his arms and
hands more on a level with the abdomen. It is equally obvious
that the observer's hands should be comfortably warm, not
only for the sake of the patient, but also because the touch is
more sensitive in that condition. The posture of the patient
generally best suited for the examination is the supine, on a
mattrass or sofa, with the limbs lying straight, but without the
least straining or muscular effort. It is often recommended to
draw up the knees in order to relax the abdominal muscles ;
but this action is very apt to produce just the contrary effect,
and further interferes with the free accessibility of the lower
parts of the abdomen to the observer's hands. It is the great
object, that whilst the body and limbs are so equally and com-
pletely supported as to be in a state of perfect relaxation, the
whole abdomen shall freely admit of the application of the
hands to every part, and in every direction. This further sug-
gests, that in all cases requiring nicety in manipulation, the
abdomen should be laid bare, the clothing sufficiently put out
of the wa}', and that either the bed be narrow enough, or the
patient be moved to each edge of it, so that the observer may
be able, if necessary, to examine from both sides ; this is espe-
cially requisite in the deep palpation to be described further on.

The kind of tact by which the different properties of shape,
softness, and hardness, elasticity, weakness, &c., are distin-
guished, is so instinctive as scarcely to be capable of descrip-
tion ; but it may somewhat guide a novice to say, that we trace
the shape by applying the flat fingers and gently rubbing them
over and between the prominences and depressions. We test
the softness or hardness by pressing gently with the pulpy sur-
faces of the last phalanx on the successive parts over which the
hands are passed; that which readily yields being soft, while
the hard resists the pressure ; the elastic opposes it to a spring,
which, although yielding to strong pressure, sensibly pushes
away the fingers as their application is relaxed. Weight is felt
by lifting upwards a part, and observing what force is required
to do this, and with what force it presses down again on the fin-
gers as they are slightly withdrawn ; trying the weight of part
of the abdomen can be practised only in the lumbar and lateral
regions in the supine posture ; the anterior regions may be in a
measure lifted and weighed by the hands, when the patient lies
on his face, or sits leaning the body forwards; and this kind
of examination is often of much importance in the diagnosis of
ascites and solid visceral enlargements.

In the healthy state, the abdomen is in every region soft and

1851.] Physical Examination of the Abdomen. 611

moderately elastic ; it feels smooth and uniform to the hand
rubbed gently over it ; when pressed superficially or deeply, its
resistance is elastic and increasing with the pressure ; when
percussed on one side, no shock or fluctuation is felt on the
opposite side; the different parts when lifted, feel pretty equal
in point of weight. This uniformity of soft elasticity repre-
sents the intestinal canal in its normal state, containing a
moderate amount of gaseous, liquid, and semi-solid matter,
pretty uniformly distributed through it. As observed by in-
spection, slight prominences may often be felt, corresponding
with the stomach, the csscum, and occasionally below the um-
bilicus ; but these also feel soft and elastic as other parts, and
do not detract from the generally equable character of the
healthy abdomen.

Variations from this normal state of the abdomen may arise
from alterations in the walls; and it will be well to advert to
these before describing those caused by disease of the interior.
Excess of fat gives a fullness which will feel firm and elastic,
or soft and flabby, according to whether it is on the increase
or on the decrease ; but it may be known to be fat by its pecu-
liar lumpy feel on the surface, so that it may be pinched up by
the fingers and thumb ; and in this way the thickness of the
layer may be estimated. In the case of very fat paunches,
there are masses of fat also in the omentum and mesentery ;
these form the large-rounded prominence odhepot-belbj, which
renders the palpation of the abdominal viscera very difficult.
In order to reach them in such a case, it is necessary to press
firmly into the fat, and then to feel by moving the hand in a
circular, or backward and forward direction ; this may be best
accomplished in the iliac and hypogastric regions, where the
fat in the walls is not so thick as in the central regions of the
abdomen. Where a corpulent person has lost much flesh,
which is often the case in chronic disease, the loose tlabbiness
of the pendulous abdomen may embarrass the practitioner ; and
the more so, as the f^it which is left often has a granular or
knotty feel, which might be mistaken for formations within the
abdomen. These inequalities are to be distinguished by their
being superficial, and capable of being grasped between the
fingers and thumb ; and the examination of the deep parts is to
be effected by the hands steadily pressed inwards, pushing aside
these inequalities, and rollino: about or handling in divers ways
the viscera underneath. CEdematous walls are to be treated
in a similar manner, are distinguished by their inelastic, boggy
feel, and pitting on pressure.

Permanent tension of the abdominal muscles is a common
impediment to the palpation of abdomen ; it causes a feeling

N. S. VOL. VII. NO. X. 39

612 Physical ExaminatiGn of the Abdomen, [October,

of superficial hardness, especially in the direction of the recti
muscles. If there be any doubt as to its seat, it may be dissi-
pated by keeping the flat hand steadily and firmly applied with
increasing pressure for a few minutes, whilst the patient's at-
tention is taken off by conversation on another topic. The
muscles will then be found either to relax altogether, or so
much to vary their degree of tension, as plainly to reveal the
cause of the hardness. This test is equally successful, whether
the muscular tension be caused by nervous irritability, or by
actual pain or tenderness ; for even in the latter case, flat pres-
sure, gently and very gradually applied, may be managed so
as not to increase the pain.

Extreme flaccidity of the walls of the abdomen might be
supposed to remove all sources of fallacy in the manual axam-
ination of the abdomen ; and it is, in fact, an easy matter to feel
the place, shape, and consistence of almost every abdominal
viscus ; yet, under such circumstances, it is not very uncom-
mon to find the pulsation of the abdominal aorta mistaken for
an aneurism, and I have known the anterior convexity of the
lumbar spine mistaken for a tumour. These errors arise from
the observers not being aware how deep in the abdomen the
hand reaches, and would be readily corrected by placing the
other hand behind the back, and by thus feeling how small is
the distance between the tvv'O hands.

Palpable Sia-ns of Disease in the Abdomen. Feculent accu-
mulations occur chiefly in the large intestines and the lower
part of the ileuui ; but tiie remaining portions of the small in-
testines are commonly more or less distended with gas. Hence
the abdomen is generally enlarged ; and the fulness feels more
elastic around the umbilicus, and more resisting, yet not abso-
lutely hard, in the iliac and hypochrondriac regions. The
course of the large intestine may often be traced, the greatest
prominences being usually caused by the caecum and transverse
arch; and if the abdominal walls are not tense, it is quite pos-
sible, by the pressure of the fingers, to distinguish the feculent
masses by their substantial but inelastic feel, from the tympanitic
contents of other parts of the intestine. If the accumulation
be considerable, there is a very appreciable diflerence in the
weight of different parts of the abdomen, as tested in the mode
before described. If there be an excessive accumulation of air
in the intestines, this distends them so much that the feculent
masses cannot be felt, and the whole abdomen has a tight elas-
tic feel of rounded shape, but commonly showing more pro-
minence in some parts than in others.

In colic, and constipation with severe colicky pains, there
may in most instances be felt at parts, depression, correspond-

1851.] Physical Examination of the Abdomen. 613

ing with contracted portions of intestines, which are hard and
knotty, in comparison with the tympanitic elasticity of other
parts. The abdominal muscles are often spasmodically con-
tracted over these painful parts ; but they become eased and
relaxed under the steadily increased pressure of the flat hand.
In these cases the weight of parts of the abdomen, as tested by
lifting them when the patient is in the prone or leaning forward
posture, is less than usual, the contents being proportionally
lighter, and prevented from ponderating by the tight contrac-
tion with which they are bound.

The tympanitis of low fever and sinking states of paraplegia,
from destruction of the lower portions of the spinal cord, or
serious injury to its reflex function, is distinguished by the more
uniform and less tense elasticity of the abdominal enlargement.
The deficient tone of the intestines and abdominal muscles in
these cases causes a larger and easier distension ; and although
the quantity of air pent up may be much greater, the tightness
and resistance is less than in colic.

The presence of liquid in the ^peritoneal sac is capable of
alterinjz, in various ways, the palpable qualities of the abdomen.
The size and shape may be felt to be changed in the same man-
ner already described as obvious on inspection ; that is, the
size is more or less enlarged, with bulging projections in the
most dependent parts; the shape of the parts occupied with
fluid is smoother and more uniformly rounded than usual, and
in extensive accumulations the surface may feel polished. But
the resistance, as felt by pressure, is also distinctive; it is
peculiarly soft, inelastic, and heavy. These qualities are most
obvious where the abdominal walls are thin and flaccid ; and
under these conditions, there is no dificulty in detectin^j by the
feel only, even moderate quantities of fluid in the abdomen.
Ponrlerating to the most dependent parts, the fluid is to be felt
in the flanks in the supine posture ; at or near the umbilicus in
the prone posture; in the iliac region when the patient lies on
aside; and in the hypogastric region, when the patient sits
leaning forward. The soft and mobih?, yet weighty feel of
these dependent parts, is to be compared with the more elastic
and lighter resistance of other regions occupied by air-filled
intestines; and by making the patient change his posture,
allowing two or three minutas to give time for the subsidence
of the liquid, we may have tne further evidence that it is free
in the peritoneal sac, if we feel it still showing itself in the most
dependent parts. It does not often happen that there is enough
liquid in the intestines to give any thing like the same super-
ficially soft and heavy sensation under the fingers; and when
there is, it may be distinguished by its not thus gravitating from

614 Physical Examination of the Abdomen, [October,

one region to another, as well as by its giving less sensation of
superficial softness, and more of a gurgling or elastic feel, from
the presence of air.

In proportion as the quantity of fluid in the peritoneum be-
comes greater, the distension of the walls also increases and
hereby the softness of the abdomen is diminished, whilst the
weight is more palpable. The liquid still gravitates in greatest
volume to the lowest parts ; but it also spreads more or less
upwards in a layer between the viscera and walls of the abdo-
men ; and gives a smoothness of surface, and uniformity of the
peculiar weighty flucftiating resistance which characterizes
its presence. So long as the distension is moderate, the air-
filled intestines will usually float on the surface sufficiently
to be in contact with the uppermost portion of the abdomen;
and this will, of course, vary with the posture of the patient :
that part can generally be distinguished by a delicate touch,
which may be verified by the more obvious difference of per-
cussion.

But there is a palpable sign of the presence of liquid, often
manifest with a moderate degree of distension, more charac-
teristic than any sign, not excepting those of fluctuation and
percussion ; namely, the striking of the fingers against the liver,
or any other resisting body beyond the surface of liquid. It is
plain that this sign will be most evident where there is consi-
derable enlargement of the liver, spleen, or some other solid
body ; and as the liquid and solid become both more distin-
guishable on account of the contrast in the resistance which
they respectively offer to the fingers, the sign serves to detect
the presence of both. Thus, a slight enlargement of the liver,
reaching two or three inches below the margin of the ribs,
may not offer resistance enough to be distinctly palpable by
itself; but if there be a layer of serum interposed, and this be
abruptly displaced by the fingers, they will strike the solid body
with a distinct shock which will unequivocally prove the pre-
sence of both fluid and solid. It so happens that in a large
proportion of the cases in which there is fluid effused in the
peritoneal sac, there is also more or less enlargement of the
fiver, or some other large viscus ; hence this sign becomes more
generally useful. By its means the author has been enabled to
detect the presence of even thin deposits on the omentum and
intestines, and of deeper-seated mesenteric and ovarian tumours.
Solid feculent matter in the intestines may give a similar resis-
tance to the fingers under a layer of fluid ; and it is important
that this source of error should be avoided, by having the
bowels well cleared by aperients before the examination.

In manipulating for this sign of liquid and solid resistance,

1851.] Physical Examination of the Abdomen. 615

the fingers should be gently pressed more or less into the walls,
and then a deeper impulse is to be abruptly made with their
ends, so as to strike at any body which may offer resistance,
and which then meets the stroke. Over an enlarged liver or
spleen, this sign is best felt in the sitting or erect posture ; or if
the quantity of fluid be considerable, in the prone or leaning
forward position. Indurations of the omentum and intestines
are better detected when the patient lies on the back. In con-
siderable enlargements of the spleen or left kidney, the author
has found this sign in the left lumbar region ; but in other cases
the front of the abdomen is its usual seat.

On two occasions, through a modification of this sign, the
author has diagnosticated the presence of something adhesive
on the striking surfaces. One was a case of ovarian tumour
with ascites ; the other, chronic peritonitis with enlarged liver.
In both, the fingers readily felt the displacing fluid and the
striking against the solid underneath ; but on withdrawing the
pressure, the surfaces in contact could distinctly be felt to

adhere for an instant before following; the fin ere rs, beinof retain-

... . .

ed by something adhesive. This sticking sensation was plainly

felt by several students, to whom the author pointed it out at
the time, ascribing it to a coating of adhesive lymph. The
post-j7ioj-tem examinations did not occur till long after, but there
was in both cases a deposit of false membrane on the surfaces
which justified this inference. Probably this sign may prove
useful in aiding to detect the presence of the low forms of peri-
tonitis which frequently accompany abdominal tumours.

Fluctuation has long been recognised as a characteristic sign
of the presence of fluid in the abdomen. It is commonly felt
on applying the left hand on one side of the abdomen, and
striking abruptly on the opposite side with the right hand, so
as to direct the impulse towards the other hand. A wave is
moved by the impulse, and rapidly passing to the opposite side,
gives to the left hand the soft shock of fluid in motion. This
wave-stroke is transmitted from one side to the other only
when there is a continuous layer of fluid. If a fold of intestine
rises to the surface in the centre of the abdomen, it intercepts
the wave. Hence it often happens, where the quantity of
liquid is moderate, that the fluctuation is felt at the lower part
of the abdomen in the sitting or standing posture, and not when
the patient lies on his back. The distinctness and character
of the fluctuation vary according to circumstances that can be
pretty exactly defined. The most remarkable degree is that
produced when the abdomen contains much fluid, whilst the
walls are thin and their tension is increased by a good deal of
air in the intestines beneath the fluid. This adds to the elasti-

616 Physical Examination of the Abdomen. [October,

city of the walls ; and wherever struck, they instantaneously
transmit the shock with a kind of spring to every part of the
surface ; and so faithfully that if a quick tattoo be played with
the fingers on any part of the abdomen, each stroke can be felt
in every other ])art with the greatest nicety. This highly
vibratory fluctuation may therefore be considered a sign of
flatus in the intestines, together with liquid in the peritoneum.
Nor is this indication unimportant in its practical relations, for
it leads to the use of mercurial purgatives and carminatives ;
which, by dispersing the wind, not only relieve the tension of
the abdomen, but also bring the organs into a state more fa-
vourable for the absorption of the fluid.

When the distension of the abdomen depends on an excessive
quantity of fluid alone, the fluctuation is still very distinct, but
diflerenl in chaiacter from the last variety. It is less vibratory
and spring-like, strikes the feeling hand with a deader, heavier
shock, and recjnires a stronger stroke Irom the other hand to set
it in motion. Tiiis kind of fluctuation, together with the pecu-
liarly weighty feel of the abdonicn in every part, when lifted
with the hand, and the equally dull sound on percussion, is a
conclusive proof of the presence of a vast quantity of fluid,
such as can seldom be removed without the operation of tap-
pinir. In fact, the same weight and pressure which we feel
through the walls of ih.e abriomen, is also oppressing and ob-
structing: tlie organs of circulation, ahsorj'tion, and secretion,
to such a degree as to in.j>ede their functit)ns, and to render
them little amenable to purgatives and diuretics, which ordi-
narilv excite their action. Hence, with such a state of abdomen,
we find the urine and fa3ccs continue very scanty, and vitiated
in spite of all the remedies we em|>loy.

A moderate amount of liquid in the peritoneum requires more
care to develoj^e its Huctuaiion. It is most distincliy ielt in the
iliac reiiions wlien the patient is in the sitting or slanding pos-
ture, which not only accumulates the fluid in greater quantity
in these parts, but also thereby gives the requisite teiision to
the walls. If the liquid is in still smaller quantity, it may be
insufljcient to reach from one side of the abdomen to the other ;
and then it must be tried for in a more liniiited space, such as
the hyj)Ogastric or in the one iliac region in the sitting posture.
A delicate method of detecting small quantities of fluid by fluc-
tuation, is by keeping the patient ftu' some minutes lying on
one side, then after he has turned nearly but not quite on his
back, feeling for the fluctuation with the Angers lightly applied
to the iliac region of the undermost side, wdiilst the other hand
gently taps the flank or the hypogastric region ; or the position
of the feeling and striking hands may be reversed. By this

1851.] Physical Examination of the Abdomen, 617

expedient the fluid accumulates in contact with the walls, where
they are thin, and renders evident the gentlest fluctuation.

In feeling for such delicate and superlicial fluctuation it is
important that the fingers should be very lightly applied ; not
pressed into the walls ; otherwise the most sensitive parts of
the fingers will be out of the reach of the wave. The soft and
weighty feel of the liquid, as before described, may be taken in
confirmation of the sign of fluctuation. The sensation of un-
dulation itself, in fact, comprises more or less of the same im-
pression of something heavy, soft and in motion. It is impor-
tant not to mistake for fluctuation an undulatory movement
excited by percussion in the soft fat of the walls. This may
be distinguished by its more uniform difliision over the surface
of the abdomen ; by its not occurring more in dependent parts
than in others ; by its less liquid and weighty impulse against
the fingers ; and by its occurring chiefly in fat subjects, in
W'hom the flabby adipose texture can be pinched up between the
finger and thumb in such quantity as to prove that the walls
are too thick to transmit any very superficial feeling of fluctu-
ation from liquid in the abdomen. In fact these cases of flabby
fat abdomen are those in which small quantities of liquid are
less readily detected by fluctuation, than by the comparatively
greater weight and duller stroke-sound of the most dependent
parts.

The discovery of a small quantity of liquid is of great impor-
tance in some cases ; as for example, in distinguishing perito-
nitis from colic or neuralgic abdominal pain, and from tympa-
nitis, with which it is sometimes combined : and in detecting
the first commencement of ascites, when remedies are more
likely to be eflectual than in the advanced stages. We are
accustomed to watch for the signs of fluid eflusions as indica-
tions of analogous conditions in the pleura ; and by careful
attention to the tests of palpation and percussion, these signs
are not less available in the peritoneal cavity. It is true that
we have not the striking contrast of the hollow-sounding lung,
and the variations of voice and breath-sounds, to aid in their
detection ; but, on the other hand, we have the combined tests
of percussion and palpation, and above all, we have in changes
of posture of the patient the means of concentrating the liquid
in a dependent part, and of transferring it to another,"in a degree
unattainable with pleural cflusion.

An obscure fluctuation may sometimes be elicited in the
liquid contained in the portions of intestine, in the urinary
bladder, and even in the gall-bladder, and in cysts connected
with the ovarium, the liver, the kidney, and other viscera; and
if the quantity of fluid be considerable, it will manifest some-

618 Foreign Bodies in the Air-passages, [October,

what of its property of weight and soft resistance. But liquid
thus contained may be distinguished from that free in the peri-
toneum, by its more obscure and less superficial fluctuation,
and especially in its circumscribed position, which may not be
the most dependent, and which is not materially changed with
the position of the patient. It is quite possible to have com-
bined, and to distinguish the two kinds of fluctuation, the
peritoneal, superficial, or graviiative, and the viscetal, deep-
seated, or circumscribed. The detection of the superficial fluid
is even easier thni\ usual, for the sac or cyst underneath raises
the liquid, and makes it to spread more or less over its surface ;
W'hich renders the fluctuation more obvious, and affords the
additional criterion of the striking by displacement of the su-
perficial liquid, as before described. The deep fluctuation is
to be felt by first displacing the surface liquid by pressure, and
with the hands thus deeply applied, succussion is attempted,
and the contents of the cyst further felt. Change to the prone
or leaning forward posture will commonly help in this investi-
gation ; as the cyst is often heavier, and, displacing the super-
ficial fluid, comes in contact with the wall sufficiently to be
manipulated. When the peritoneal fluid is scanty, the sac is
more widely in contact with walls, and may not be separable
by any change of posture. Tn this case it may be of impor-
tance, in reference to an operation, to determine whether the
sac adheres to the peritoneal walls ; and in one such instance,
a case of ovarian cyst, the author was enabled to decide this
point by the following expedient. The funnel end of a stetho-
scope being applied to the abdomen wdiere the tumor was in
contact with the walls, suction was used at the other end so as
to make the walls adhere (by atmospheric pressure) to the
instrument; it then became a means of separating the walls
from the sac, the peritoneal fluid occupying the space; the
presence of which fluid was determined by palpation around
the part adhering to the stethoscope, and thus the non-existence
of adhesions was proved. This patient was subsequently
tapped ; and when the fluid again accumulated, the surfaces
could no longer be separated, adhesion having taken around
the puncture. [London Jour, of Med. Ranking s Abstract.

Researches upon Forei^^n Bodies in the Air-passages. By M.

LE DoCTEUR JOEEET DE LaMBALLE.

Under the above title, a series of interesting observations,
illustrated by cases, has just been published in the Union
Medicale, and from them the author draws the following prac-
tical conclusions ;

1851.] Foreign Bodies in the Air-passages. 619

1. That foreign bodies have a greater tendency to lodge in
the right than in the left lung, on account of the direction and
greater size of the v\^\\l bronchus.

2. That they penetrate into the air-passages during the
greatest possible divergence of the chordce vocales, while a
strong column of air is rushing into the trachea, as occurs
during a rapid succession of inspirations and expirations, for
example, in a fit of laughter.

3. That they pass through the superior opening of the larynx,
without raising the epiglottis, which is never depressed on the
opening, as has been stated.

4. That the epiglottis is always raised in virtue of its own
elasticity,

5. That the latter organ appears to act principally as a kind
of groove, in guiding certain liquids and solids, during the com-
plicated act of deglutition.

6. That foreign bodies rapidly traverse the air-passages in
obedience to the laws of gravity, and in consequence of the
impulseof the column of air.

7. That they are only momentarily arrested in a given point
in the air-tube ; that they may, in consequence, move about and
change their position, until they have induced an inflammatory
action, owing to which they become lodged in a certain part.

8. When their dimensions are unequal, they are arrested in
their oblique direction, at a division or subdivision of the bron-
chi, and they assume the direction of the tube when they fill a
normal opening.

9. That they more or less impede respiration and oxygena-
tion ; that they cause cough, often intermittent, sometimes
continued, and that they give rise to pain and a fixed sensation
which indicate their seat.

10. That their presence gives rise to a peculiar hruit,

11. That the bronchial secretion is always augmented by
their presence, being mucous and sometimes sanguineous.

12. That the respiration becomes puerile in the lung of the
other side.

13. That foreign bodies may give rise to a slow or rapid
asphyxia, to suppuration, emphysema, (fcc.

14. That foreign bodies which measure more than four lines
in all directions do not allow any hope of their expulsion by the
unaided eflorts of nature, since their dimensions exceed the
shortest diameter of the glottis.

15. That they have been spontaneously expelled from the
human trachea only when they were small.

10. That in dogs, on the contrary, in whom the glottis is in
the same plane as the upper opening of the larynx, the expul-

620 Foreign Bodies in the Air-passages. [October,

sion of foreign bodies is accomplished with facility, in conse-
quence of the dilatability of this opening, and of its dimensions,
which are considerable in all directions.

17. That, in the dead subject, foreign bodies clear the glottis
with difficulty ; even when blown upon with a bellows which
furnishes a considerable column of air.

18. That in the living subject, foreign bodies have not only
to overcome this passive resistance, but also the very active
opposing force of the constricting muscles of the glottis.

19. That we can, consequently, reckon on the expulsion of
only very small foreign bodies in man, and that when they have
a certain volume we can expect nothing from the efforts of
nature.

20. That the operation of tracheotomy becomes indispensa-
ble in nearly all cases of the introduction of foreign bodies into
the air-tubes, and that it is only exceptionally that it can be
dispensed with.

21. That the operation should be performed as soon as pos-
sible, in order to avoid inflammation, local bad consequences,
and immediate or chronic asphyxia.

22. That the opening of the air-passages is a delicate opera-
tion, which ought to be performed by successively dividing all
the tissues, and not by an incision including at once a great
part or the entire of the soft parts of the region; in this way
we avoid hemorrhage, the admission of air into the veins, injury
of the thyroid gland, &c.

23. That the air-tube ought to be opened as freely as possi-
ble, so that the foreign bodies may escape easily.

24. That we can be certain of the division of the trachea
only when the air escapes from it, producing a peculiar noise
easily. recognised by those accustomed to this kind of operation.
The author purposely lays particular stress on this phenomenon,
to which Dupuytren did not attach sufficient importance, since
according to the statement of MM. Marx and Brierre du Bois-
mont, that ahle surgeon had, in some instances, penetrated only
into the kind of hollow which is situated above the sternum,
althouf]jh he thouoht he had entered the air-tube.

25. That when the foreign body does not escape by the
opening at the moment of the operation, it is well, before pro-
ceeding further, to stimulate the sensibility of the trachea by
the introduction of a blunt instrument, so as to excite cough,
and cause effi:)rts at expulsion.

26. That the trachea ought to be opened more freely than
under other circumstances, when a body capable of swelling
with moisture has been for some time enclosed in it.

27. That reunion of the wound after the operation may be
obtained by the first or second intention.

1851.] Evidence of Puerperal Fever, <^c, 621

28. That when reunion by ihe second interftion is sought for,
it is accomplished by granulation, which requires a long time
to effect a complete cure.

29. That reunion by the first intention may be obtained by
simple compression or the interrupted suture. This latter
mode appears to the author much more favourable to imme-
diate reunion, as experiments on animals liave shown him its
possibility.

30. That immediate reunion may be obtained by the inter-
rupted sutui-e taking in only the dartoid lamina which sur-
rounds the trachea.

31. That adhesion may be obtained by another mode, which
consists in including partly or in whole the walla of the trachea,
letting the thread hang externally.

32. That the threads fall out between the fourth and the
thirteentfi day.

33. That the plastic secretion serves as a means of union
between the lips of the wound.

34. That cicatrization is accomplished only by means of an
intermediate product, and not by the direct adhesion of the lips
of the trachea.

35. That a suture which includes the entire thickness of the
walls of the trachea exposes this tube to an internal and exter-
nal inflammatory action, to tiie risk of deposits of organized
bands of lymph, and to encysted abscesses.

36. That a suture which includes only the investing struc-
tures and a part of the substance of the trachea, gives rise to a
plastic indammation, and is to be preferred to that which in-
cludes the cartilaginous panetes of the tube. ^'Unicii Medi-
caid. Dublin Quarterly Journal.

Evidence of Puerperal Fever depending upon the Contagious
Inoculation of Morbid Matter. By Dr. F. H. Arnetii, of
of Vienna. {Ed. Med. Chir. Society.)

There is, jierhaps, no subject in medicine that has excited
so much of the attention both of the medical profession and of
the public at large, as the er)ideiriic puerperal fever, sometimes
prevailing to a fearful degree in lying-in hospitals. So strong-
ly, indeed, jjas the apprehension of the public been excited, that
the entire closure of lying-in iiospitals has been repeatedly
urged, even by professional men and some of them have really
been shut up for a certain time.

Whilst I am fully convinced that the facts I shall have the
honor to communicate to the society, illustrative of one of the

622 Evidence of Puerperal Fever, ^c, [October,

most frequent causes of so dreadful a disease, and of a means
preventive of its spreading so fearfully, will prove interesting,
I have serious doubts as to my being competent to do justice
to the subject in a lanc^uage with v/hich I am but imperfectly
acquainted. This difficulty becomes still greater, as the out-
lines of what I have to say to-night are well known in this
country, through a very able paper of Dr. Routh's.

Having, however, been connected with the Vienna Lying-in
Hospital, and thus been enabled to watch the disease, and the
manner of its being spread and limited, I hold it a duty to give
the subsequent observations all possible publicity.

Before entering on the subject in question, I must apologize
for alluding somewhat to the history and the mangement of the
Vienna Lying-in Hospital.

The lying-in hospital w^as opened, together witfi the ''Gen-
eral Hospital," of which it forms a part, in 1784. Its wards
being always excessively crowded, the government, by which
it is supported, gave orders to build some new wards, and to
use them as a second obstetric clinic. Thus, in 1833, the first
midwifery clinic took possession of the new wards, leaving the
old buildings to the more recently estabhshed clinic. I think
it proper to observe, that these two clinics form only one large
building, their wards being in fact, so close together, that they
are merely separated by a wooden door.

The other arrangements are entirely similar in both estab-
lishments. The linen of both is "washed together. The two
clinics admit pregnant females on alternate days.

In 1839, however, from different reasons not connected with
our subject, it ^^as thought advisable that the new wards should
be exclusively devoted for the instruction of the male pupils ;
whilst, in the other establishment, the female pupils should be
trained. As, of late, a far greater mortality had prevailed in the
lying-in hospital than is generally to be met with in private
practice, councils of leading men of the profession were held
at different times, with a view to ascertain the cause of this
fearful amount of mortality.

These gentlemen were struck with the fact that the amount
of mortality was, wilhout any exception, far greater in the
wards where the medical students pursued their studies, than
in those where the midwives were taught. But this was the
case only since the year 1839; that is to say, from the time
that the medical students and the midwives occupied different
wards; the mortality having been nearly equal in former
years, when each clinic included among its pupils both medi-
cal students and midwives.

This will be exactly shown by the following table :

1851.] Evidence of Puerperal Fever, <^c. 623

Died in the whole lying-in hospiial. In the second clinic alone.

In 1834, 8U6 per cent. - - 8* per cent.
" 1835, 5-33 "... 498

" 1836, 7-61 *' - - - 7-8

1837, 828 " - - - 6-9

" 1838, 375 ^' - - - 4-94

Whereas, since the separation of the pupils took place, there
died in the

Clinic of the medical students. Clinic of midwives.

In 1839, 5-4 per cent. - - 4*5 percent.

" 1840, 9-5 " - - 2-6 '''

" 1841, 7-7 " - - 3-5

" 1842, 158 " - - 7-5

" 1843, 8-9 " - - 5-9

" 1844, 8-2 " - - 2 3

" 184.5, 6-8 *' - - 2-03 "

" 1846, 11-4 " - r 2 7

The commission generally adverted to the linen being wash-
ed without sufficient care, and to the unfavorable situation of
the wards, as explanatory of the great amount of mortality ;
but did not suggest any explanation of the great difference in
the relative number of cases ending fatally in the two clinics.
At length, in November, 1816, it was decided to diminish very
considerably the number of young medical men attending the
lectures of midwifery, as the opinion prevailed, that the too
frequent examinations of the patients, by great numbers of
students eager to make the best of their time while in the lying-
in hospital, had brought on epidemics of puerperal fever. And,
in fact, in the subsequent months of December, January, Feb-
ruary, and March, the mortality was much less; but reappear-
ed, unfortunately, in April, when, in this clinic, 37 died out of
somewhat more than 300 ; and in May, when 36 cases, out of
about the same number of confinements, ended fatally. This
failure proved, better than the best concocted theory, that the
real cause of the fact occupying our attention had not then been
discovered.

In March, 1847, Dr. Semmehveiss was nominated assistant
to the professor of midwifery, in whose wards this frightful
mortality had prevailed. From the first moment he was occu-
pied in finding out the cause of the epidemic which it became
his lot watch. As *'time," the best judge of opinions, had so
loudly spoken against the views that had hitherto prevailed,
it was certainly out of the question to inquire into them a
second time. His attention was very soon drawn to the man-
agement, both as to dietetics and medical treatment, in the

624 Evidence of Puerperal Fever, <^c. [October,

neighboring clinic, which had to boast of results comparatively
so favorable. But, to his amazement, he found that there
neither was the ventilation better carried on than in his own
wards, nor had any particular plan of treatment been resorted
to. At length, however, he was struck with what was very
likely the sole difference to be found in the management of the
two clinics, namely, the pupils of the one being mid wives, those
of the other medical students. The latter were, almost with-
out exception, in the daily practice of assisting at autopsies, of
which eight or ten took place in our large hospital almost every
day. The dissections were sometimes executed by the stu-
dents, or they handled at least the pathological preparations,
and examined them carefully. Moreover, the assistani used to
lecture on the obstetrical operations. These were performed
on dead bodies, and, of course, sometimes repeatedly. Now,
after such investigations and such practice, it w%is not rare to
see the students going immediately to the wards of the lying-in
hospital, and examining the pregnant and parturient women.

It is scarcely necessary to state, that the pupils of the other
clinic, being mid wives, did not take any share in the occupa-
tions just alluded to; nay, e\en the assistant of that clinic had
comparatively seldom to deal with post-mortem examinations,
as it was not a part of his duty to give instruction to the mid-
wives in pathology or operative midwifery.

Having convinced himself that the great prevalence of the
disease in his wards was caused by the inoculation of the fe-
male genitals, Dr. Senmielweiss began to entertain a hope of
being able to diminish this frightful mortality.

Every one who has been engaged in post-mortem examina-
tions must be aware of the very disagreeable smell, which it is
impossible to get rid of, even by the most careful washing. Of
course this smell which remains about the hands is more pene-
tratinnr and more lasting the more dissections have been made
at a time.

The existence of any smell can only be dependent on a sub-
stance detained on the epidermis, and is still sensible as long as
there remains the least atom of that substance. It is impossi-
ble not to recollect how actively the process of absorption,
generally speaking, is carried on in the pregnant female.

The opinion of Dr. Semmelweiss on this important matter
is as follows : Any jiuid matter hi a state of putrefaction*
communicated by linen, by a catheter, by a sponge, by small
particles of the placenta, even by the ambient atmosphere im-
pregnated with the foul substances may produce puerperal
fever.

* I think every morbid matter undergoes a degree of putrefaction, after it has
been discharged from the body for any length of time.

1851.] Evidence of Puerperal Fever, <^c. 625

If these ideas are admitted, it appears very likely that wash-
ing the hands with some powerfully cleansing fluid must destroy
the smell, and remove the morbific particles from the hand.

After having tried various substances, he was laterly in
he habit of prescribing for that purpose a solution of chloride
of lime as the cheapest.

In the course of the month of May, 1847, it was arranged
that no one should examine any woman in the clinic without
previously having washed his hands with solution of chloride of
lime, and having made use of a nail brush.

Even in June, it was impossible not to be sensible of the
influence of this precaution. Out of more than 300 women
that were confined in that month, only six died ; in July, three
out of about the same number ; in August, three ; in Septem-
ber, twelve; October, eleven ; November, eleven ; December
eight : whereas, in April, fifty-seven ; and in May thirty-six,
cases had ended fatally. In the year 1848, the mortality
amongst the puerperal women delivered by male pupils was 1
in 84 ; while, in the second clinic, amongst the women deliver-
ed by midwives, it was 1 in 7G.

Since the year 1827, the rate of mortality in the hospital had
never been so low. I need not say more than that from the
time when this precaution was introduced into the practice, up
to the time of my leaving Vienna in November last that is to
say, for more than three years the mortality in the two clinics
has always been nearly the same, which had never been the
case since 1839 that is to say, since the time when the male
and female pupils were exclusively confined to separate clinics.

A very similar observation was made at Kiel. Dr. Michae-
lis, professor of midwifery in the university of that town, wrote
a letter to Dr. Semmelweiss, bearing the date JMarch 18tli,
1848, in which he informed Dr. Semmelweiss that they had
been obliged, in 1847, (July 1,) to shut the lying-in hospital
because of the puerperal fever spreading fearfully. In Novem-
ber they opened the doors aj^^ain, but a very short time after-
wards the disease began again to make its appearance so that
they had already come to a determination to close the house for
a second time, when the news of Dr. Semmelweiss's opinions,
and the measures adopted in our lying-in hosj)ital, reached Kiel,
(December 21st,|iS47.) From that time, up to the 18th of
March, they had no case of puerperal fever, excepting one, that
was caused, as Dr. JMichaelis believes, by a dirty catheter.

I must call your attention to some more facts which, as it
appears, speak strongly in favor of the opinions of Dr. Sem-
melweiss.
In the course of those years when the post-mortem exam-

626 Evidence of Puerperal Fever, <^c. [October,

inations were less frequent with us in Vienna, owing to the
little importance attached to pathological anatomy, the puer-
peral fever was comparatively seldom met with; and this was
certainly not explicable by the wards being less crowded than
at present, as the one clinic of those former times contained
in comparison with its room nearly as many women as the
two clinics do now. You may recollect that I have stated
before that when first the second clinic was established, its
pupils included both midwives and medical students, and that
in these days the mortality in its wards was not less than in
the other clinic. It was only after the separation of pupils
already mentioned, that the reports of the second clinic became
much more favorable than those of the first clinic. They re-
mained constantly so; with one striking exception, however,
occupying the period between 15th October, 1841, and 15lh
October, 1843, when the mortality was much higher than usual,
the then assistant being very busy in anatomical pursuits.

According to the reports of the lying-in houses in the whole
empire of Austria, in none of those institutions where mid-
wives have been the only pupils has a puerperal epidemic
made its appearance ; but it reigned obstinately in Pavia,
where they used to dissect in one of the rooms of the lying-in
hospital the bodies of the children who died in the hospital.

There existed, within the last few years, two clinics in
Strasburg, as closely adjacent as those in Vienna, and divided
on the same plan in reference to the pupils. The professors of
Strasburgh told me that they had always less mortality in the
clinic to which the midwives were admitted, and that there
was no instance of any epidemic in those wards.

While in search of the true cause of the prevalence of puer-
peral fever, the impression on Dr. Semmelweiss was unfortu-
nately at first exclusively directed to the influence of postmor-
tem examinations, and the precautions that were already in
practice were not resorted to in the case of a pregnant woman
who was admitted into the lying-in hospital laboring under can-
cer of the uterus. As several days elapsed before her confine-
ment was over, and as the case was highly interesting, of
course every one wished to examine her. The consequence
of this was most deplorable. Fourteen mothers who had been
confined at the same time with this woman^nd who had been
examined by the same students, exhibited peurperal symptoms,
and three of them died, although puerperal fever had not been
prevailing immediately before, nor did any other case occur
except these fourteen.

I think there can scarcely be any doubt as to the mode in
which the matters of putrefactioa act on the system. All the

1851.] Emdence of Puerperal Fever, ^c, 627

symptoms that are so often observed in puerperal fever, and the
more so the greater the number of patients at a time is, show
clearly that it is phlebitis, ending in purulent infection, with
which the women are seized. The rigors, the shivering, that
prevail as the first symptoms, the dirty yellow discoloration of
the skin, the metastic deposits that are collected in the cellular
tissue and in the articulations, are ascribed by most of the very
eminent writers on the subject to the purulent infection ; and
every accoucheur is aware that those are also the symptoms of
the most hopeless cases of epidemic puerperal fever. But allow
me to observe that, as far at least as I am aware, purulent in-
fection is never met with except in cases v/here the purulent
matter comes in immediate contact with the blood, as is ob-
served in punctures inflicted in dissections, that present quite
similar symptoms, and end unfortunately too often in a similar
way.

If the discharges of the uterus and the vagina were the true
causes of puerperal fever in most cases, it would be decidedly
very difficult to say why they did not infect the women in both
clinics of the Vienna hospital with equal frequency.

Before concluding, I have only to express a hope that most
of the great variations of mortality may be avoided in future
by the greatest care after dissections, and by attention to clean-
liness, the air of the wards, the instruments, linen, &c.

It is, however, my firm conviction that any individual who
may not choose to submit to what we have stated to be neces-
sary after the contact with matters in putrefaction, may artifi-
cially produce the puerperal fever on many persons whom he
may successively examine, and who, in all probability, would
never have become ill but for this inhuman carelessness.

Allow me, in conclusion, to state, that I know of no case of
the puerperal fever having been communicated through the
clothes of a medical man to a patient. As far as I know, there
is no such case on record, neither in hospital nor in private
practice in Vienna, where it had been possible to trace a puer-
peral fever to such a source. As to erysipelas, which I am
aware is very often admitted in this country to produce puer-
peral fever, I feel myself bound to aver that erysipelas has by
no means been most frequently observed in the Vienna hospi-
tal when we had epidemics of puerperal fever, nor did we find
the children of the puerperal women seized with erysipelas.
Scarcely one of our pupils, and none of the nurses, were taken
with erysipelas during my stay in the Vienna hospital. [^Vesl-
em Lancet.

N. S. VOL. VII. NO. X. 40

628 Unconsolidated Fracture of the Thigh, <^c. [October,

Unconsolidated Fracture of the Thigh successfully treated by
Acupuncture. By M. Lenoir.

The rationale of the various plans of treatment which have
been adopted, in order to prevent the formation of false joints,
consists in the establishment of an inflammatory action in the
fibrous tissue situated between the bony fragments, and the
consequent secretion of a secondary callus. One of the me-
thods proposed has, in the hands of its inventor, M. Malgaigne,
been unattended with success : we mean acupuncture. But
the following case, communicated to the Societe de Chirurgie
by M. Lenoir, proves that this mode of treatment deserves some
notice, even although it has not afforded similar results to M.
Maisonneuve. Much of the success obtained by M. Lenoir
must, doubtless, be attributed to the many precautions observed
by '^.:'m.

Dupeche, a carpenter by trade, aged thirty-three years, in
falling from a height of fifty-two feet, fractured his right thigh.
He was immediately conveyed to La Pitie, and placed under
the care of M. A. Berard. After fifty-four days of treatment
the patient began to walk with the assistance of crutches, when
M. A. Berard, in order to remove a stiffness which existed in
the knee-joint, endeavoured by force to extend the motions of
this articulation ; in one of these manoeuvres the neck of the
femur gave way, and the signs of fracture re-appeared. The
broken bone was again reduced, and an immoveable apparatus
applied to keep the fractured ends in situ ; at the termination
of a month the apparatus was removed, but the fracture had
not consolidated, and the patient had himself conveyed home.

Six months afterwards M. Lenoir took him into hospital, for
the purpose of employing the treatment by acupuncture ; but
before trying this plan he used all the means likely to insure
success, and, amongst others, he had him placed on a mechani-
cal bed, so as to maintain complete freedom from motion, even
in attending to the calls of nature. As the fracture was oblique
and the upper fragment very sharply bevelled, and the frag-
ments, by overlapping, occasioned a shortening of about two
and a half inches, M. Lenoir had an apparatus for maintaining
extension constructed by a carpenter, a friend of the patient.
This apparatus consisted of a sort of long box, nearly in the
shape of the limb, and consequently wider above than below,
but longer than it ; it was about three inches deep, and was
composed of three pieces of light wood closely united to one
another ; of these three splints the external was eight inches
longer than the others, which terminated at the junction of the
thigh with the trunk ; this longer portion had at its upper end

1851.] Unconsolidated Fracture of the Thigh, <^c, 629

a mortise intended to facilitate the employment of counter-ex-
tension ; to the lower end of this groove a kind of toothed
wheel and axle was adapted, to which was applied a catch for
the purpose of fixing it. This apparatus, lined with carded
cotton, received the limb, the foot being covered with a gaiter
of licken furnished with a foot-strap; by means of this strap
rolled round the wheel extension was made, while counter-
extension was maintained by another strap well padded, passing
along the fold of the groin, having the ischium as its point d'ap-
put, and its ends fixed in the mortise in the outer splint of wood.
For several days nothing was done except to tighten the
straps according as they became relaxed. At last, on the 12th
August, seven months and some days after the accident, M.
Lenoir proceeded to insert the needles. At first he introduced
four, each being four inches long, and furnished with a head.
Their points were directed along the inner surface of the upper
fragment, from below upwards; an interval of but half an inch
being left between each needle. Contrary to his expectation,
and although he passed them in as far as the heads, he met no
obstacle to their introduction. This, doubtless, depended on the
existence of an interval between the two fragments, the exten-
sion effected by tb.e apparatus having reduced the fracture only
in the direction of the length of the limb, and not transversely.
The four needles remained in situ for six daj's ; at first they
excited redness of the skin, then a little pus appeared about
them, and rendered them moveable, and finally a slight swell-
ing and pain in the limb occurred. These symptoms indicat-
ing that inflammation had developed itself, M. Lenoir with-
drew the four needles ; and, after having cleaned them, he re-
introduced them higher up, following carefully the direction of
the upper fragment, and leaving between them the same inter-
vals as before. The same symptoms followed this second
operation; at the end of five days the needles had become
moveable, and w^ere taken away ; and the inflammatory action
now appearing to be suflicient to produce union, the introduc-
tioi of the needles was not repeated. The inflammatory swel-
ling of the limb w^as treated by poultices, antiphlogistic diet,
and cooling drinks; and when it was subdued, the two sur-
faces of the fragments were brought into closer proximity by
means of small splints placed around the thigh, and tightened
by two straps of leather, a practice previously employed by
Amesbury. The apparatus was inspected daily, and tightened
when necessary. At the end of twenty-three days, in order
to ascertain how far consolidation Lad advanced, the limb was
completely uncovered ; it was found to have neither got out
of shape nor undergone retraction ; but when the hand was

630 Scutellaria Laterifolia as a Nermne-i [October,

passed over the seat of the fracture, it still yielded ; splints
were immediately re-applied, the limb was replaced in its
groove, and extension continued. No fresh examination was
made until the expiration of thirty-five days from this time,
and then the callus was found to be sufficiently solid to justify
the removal of the entire apparatus. Carefully measured, the
limb was now found to be rather less than eight-tenths of an
inch shorter than that of the opposite side ; the knee-joint v/as
stiff, but the patella was still capable of some transverse motion ;
the thigh and the upper part of the leg were cedematous, but
otherwise there was no apparent deformity at the seat of the
fracture, and the callus was not very bulky. Lastly, the coxo-
femo;;il articulation was capable o{ motion, and the patient
was able to raise the limb by the unaided action of the muscles.
As an additional security, he was advised to keep his bed, and,
during a fortnight that he was confined to it, the cedematous
swelling of the limb was treated by fomentations of aromatic
wine, and by bandaging. At the end of that time he got up
and walked at first with the aid of crutches, and afterwards ot
a single stick ; finally he -left the hospital cured, and M. Lenoir
subsequently ascertained that on his return to his native dis-
trict (Auvergne) he had, during the entire of the following
autumn, driven a plough, and that he now experiences no diffi-
culty in the pursuit of field labour. [Bulletin General de
Therapeutique. Dublin Quar. Jour.

Scutellaria Laterifolia as a Nervine, By C. H. Cleave-
LAND, iVI. D., of Waterbury, Vermont.

One of the most valuable nervines that have been discovered
for our use, is to be found by the side of many of our strenm-
lets, and in low marshy places in nearly every part of this state,
and in sufficient quantities to supply the entire profession from
Maine to Texas, should they but be convinced that with us
grow plants possessing medicinal properties as useful and as
potent as are obtained from distant climes.

Such, I think, must be the belief of all who will make a trial
of the Scutellaria Laterifolia^ in the place of the English oi
German Valerian (Valeriana officinalis), that has been the main
article in use in this region in all nervous diseases since the day
when Assafoetida went out of fashion.

The Scullcap has not only a most remarkable power of con-
trolling the nervous excitability, as manifested in patients oi
an irritable temperament when fatigued, over-excited, or suf-
fering from slight physical derangement, but its most valuable
properties are displayed in those severe and painful cases

1851.] Scutellaria Laierifolia as a Nervine. 631

where we are led to use our most potent and active remedial
means. In Dellrium-trejnens, Tic-douloureux, Convulsions
from irritation of the ganglionic nerves or spinal cord, in Cho-
rea Sanctiviti, dental invitation among children, as well as in
the ordinary diseases of the nerves, where a soothing quieting
medicine is indicated, I have been led to prefer the Scutellaria
above all other nervines or antispasmodics, except in those
cases where an immediate effect is desirable. In such cases,
of course, we should resort to chloroform, ether, musk, castor,
and the other drugs of the same class.

Among my reasons for this preference, I would mention the
tonic property of the herb, which gives strength as well as
quiet ; its sudorific and its diuretic powers, both tending to
relieve the congestion that is usually present, which tends to
perpetuate the disease. It never leaves that excitable irritable
condition of the system when its soothing influence has worn
away, that follows some of the other nervines ; and it is so
readily administered that but little delay need occur, and no
evil results be anticipated.

I am led to call the attention of the profession to this plant
in the earnest and decided manner I have used, mainly because
of the high estimate I place upon it; but in part from the dis-
paraging remarks of the United States Dispensatory. I would
not wish to detract from the fair and just fame of the compilers
of that great work, or lessen tlie confidence that is so properly
placed in it, but I think I know more of this plant than those
authors could know, and write according to my own observa-
tions. Without doubt, the plant has been extolled too highly
by some, and also recommended in cases where it has failed of
answering the expectations of those w-ho relied upon it, but
not, I think, when used in such diseases as are indicated above.
To me it has never seemed inert and powerless, and having
had occasion to make j)ersonal use of it when the whole sys-
tem was suffering severely from being poisoned by decompos-
ing animal matter, I feel qualified to testify that "it does pro-
duce an obvious effect."

I have used it in the form of a saturated tincture^ a syrup,
and a cold and warm infusion ; and 1 prefer the infusions to
the other preparations when they can be conveniently prepar-
ed, the cold when it is desirable to obtain tlie tonic, and the
warm when the sudorific effect is demanded. Half an ounce
of the dried leaves to a tea-cup full of water will be very
strong, and it may be drank ad libitutn.

Of its curative power in cases of hydrophobia I can say
nothing, never having had an opportunity to give it a trial ;
but should such a case present itself, I should make a trial of
the plant in conjunction with other means. [/Y. Y. Register.

632 Miscellany. [October,

Effects of various Therapeutical Agents on the Animal Heat. By
MM, Aug. Dumeril, Demarquay and Lecoi^'te. The authors, in
their researches, propose to examine the effects on the animal heat
of various agents, introduced into the economy in successively in-
creased doses. The experiments were made in the laboratory of
M. Flourens, at the Jardin des Plantes. The animals experimented
on were full-grown dogs. As far as possible, they were kept fasting
from the evening before till the evening of the day on which the ex-
periment was made. The duration of the experiments or rather
the time during which it was thought requisite to keep the animals
under observation varied from six to twelve hours. The medicinal
su))stances were introduced in three ways, sometimes, and most
frequently, by the stomach ; sometimes by the veins ; and sometimes
by the cellular tissue. Before any experiment was made, it was as-
certained that the ligature of the oesophagus, intended to prevent
vomiting, did not produce any effect on the temperature of the animal
during a number of hours equal to the duration of the experiment
with the medicines.

The temperatures were taken with accurate centigrade thermome-
ters, capable of being substituted for each other in a case of accident.
Ail the temperatures were t^ken by the rectum, the thermcmclcr be-
ing introduced to the same depth, and being left in the gut, uniil it
remained at a fixed point for five or six minutes.

By taking these precautions, and by repeating in some instances
the experiments as often as ten or eleven times with the same sub-
stance, the authors have been able to assure themselves that the action
of any given remedy is always the same as regards the animal heat,
whether administered by the stomach, the veins, or the cellular tissue.
All the substances employed were prepared by M. Mialhe. They
used sometimes powder or extracts, sometimes alkaloids or salts. The
latter preparations were the only ones ever injected into the veins.
The substances were dissolved or suspended in water, oil, or mucil-
age ; the quantity of vehicle varying from one to four ounces, accor-
ding as it was to be introduced into the veins of the stomach.

The temperature of the atmosphere in which the animals were
placed was from 53 to 59 Fahr., and the temperature of the liquids
containing the drugs was from 6S to 95 Fahr.

The results now published are confined to those which bear upon
the animal heat. To give a systematic form to their series of exper-
iments, they have adopted Trosseau and Pidoux's classification ; they
have omitted those remedies of each class which are not sufficiently
energetic to produce some decided effect on the animal heat.

Excitants. This class of remedies has been examined carefully;
only the more pov/erful have been experimented with. These are
canthaiides, ergot, phosphorus, and strychnia. As a general result,
it may be stated, that all these agents have produced an elevation of
temperature varying from a few tenths of a degree to several degrees.

1851.] Miscellany. 633

Caniharides. This drug was experimented with four times, and
given in doses of 1^ grains to 3 grains and 6 grains. At the dose of
1^ grains the thermometer rose 2 1 (cenlig.) in a period of six
hours, during which the temperature was noted at intervals of two
hours. In three other experiments made in the same manner, and
with equal care, in which the doses were on two occasions 3 grains
and on one occasion 4 grains, there was again an augmentation of
temperature which with the 3 grains approached to 2, but with the
6 grains did not exceed 1. It will be seen in the course of the ex-
periments that cantharides is not the only substance which gives dif.
ferent, sometimes even opposite, results vvith varied doses.

Ergot. This substance, whose special actions on the uterus are
so well known, was given only once in the dose of a drachm ; and in
a period of five hours, during which the temperature was observed
several times, there was ascertained to be a rise of 0 . 8.

Sulphate of Quinine. It was introduced twice into the stomach in
doses of 15 and 30 grains. In these two experiments the final re-
sults were increase of temperature, which varied from 1 . 5 to 2 . 2.
But a remarkable phenomenon was, that, at the beginning of the ex-
periment, the temperature fell during the first two hours some tenths
of a degree.

Phosphorus. Six experiments were made. In doses of three tenths
of a grain, and of three fourths of a grain, there was a constant and
successive augmentation, 1 . 7 in the first, and of 2 . 2 in the second
whilst in the four last dogs to which the drug was given in doses of
1^ grains, 2\ grains, and 3 grains, there was a constant lowermg of
the temperature, though to an inconsiderable amount ; for it never
was to a greater extent than 0 . 2 except in the case of one animal,
which died in fifty minutes. Thus phosphorus in small doses raises
the animal temperature very manifestly, whilst in large doses it slight-
ly lowers it.

Sulphate of Strychnia. Four experiments were made with this
substance. Twice it was introduced into the stomach, and twice into
the veins. Only slight results were obtained ; but the temperature
was slightly elevated. The animals, however, always died rapidly
under the influence of this agent. [^Gazette des Hopitaux. Western
Lancet.

On the treatment of Small Pox. By Joseph G^osvexor Pasquix,
M.R.C.L.S., Birmingham. Having for many 5^ears watched the
unsuccessful treatment of small-pox, and also the fatal termination of
that disease, even when placed in the hands of the most skilful sur-
geons and physicians, I was therefore induced to give to it my most
devoted and undivided attention, supposing, as I did, that some valua-
blft addition might be made in the treatment thereof. After n.uture
deliberation thereon, it was my opinion that the pitting and consequent
disfiguration of the face after that disorder, was dependent upon the
confinement of the matter in the pocks for too great a length of time,
which thereby would cause a slough to form in the cellular tissue

634 Miscellany. [October,

lying between the cuticle and fascia of the face, which, being so thin,
is never more regenerated, thereby causing the cuticle to fall into
the space where the cellular tissue is then wanting, and thus follows
the pitting.

Secondly I was of opinion, that by puncturing each pock previously
to its coming to perfection, and then treating it with poultice, as a com-
mon abscess, I should not only avoid the pitting but also draw out of
the system that putrid matter which, had the pock been left to ripen,
would not only have caused the slough and pitting, but would have
been absorbed into the body, and produced most injurious results to
the system in general.

Thirdly. In numerous instances, I have seen patients die from the
eruption breaking out, not only on the tongue, fauces and pharynx,
but also on the most delicate part, the larynx. This I also thought
might be obviated by placing a few leeches over the external region
of the larynx, supposing it would, by diminishing the circulation in
that region, reduce the size of the pocks, and also give play to the
thyro-arytienoid muscle, and thereby prevent sutTocation.

Having formed these opinions, I telt determined to try them in the
next case of small-pox that came under my notice, which I have now
done, and beg leave to report to you the result of my experience :
I have had seven cases, four wherein the larynx was not at all affect-
ed, on which I tried the experiment of puncturing every pock on the
face, and afterwards applying repeated poultices. This treatment
succeded to my utmost satisfaction, the face being left as clear of
marks as it was previously to the attack of small-pox. I had three
more with affection of the larynx, the respiration being so diflicult that
I expected asphyxia would come on in a ^q\v hours. To these I ap-
plied leeches over the region of the larynx, and on the following morn-
ing, I found the respiration had become perfectly free and easy.

One of the three cases last reported, is that of D , a laborer.

This was the worst case of confluent small-pox I ever witnessed in
the whole course of my medical career. He was, in the early stage
of the disease, attacked with great diiHiculty in breathing; his tongue,
soft palate, pharynx, and larynx, as far as I could see, being covered
with pocks. I applied leeches at night, and on the following morning
his breathing was perfectly free and easy. His face was so com-
pletely covered with pocks, that I could not find one space over his
whole face, sufnci^t tolay on a grain of sand, which was uncovered
by any pock. In this case I punctured as many pocks as I could my-
self, and requested his mother and sister to puncture the remainder.
He is now up and doing well, and he has not a mark upon his face ;
but upon this case I will report to you hereafter. In this case the
feet were very painful previously to the appearance of the pocks. I
applied poultice. [London Lancet,

Frictions with Sulphuric Ether in Tetanus. We find a case of
Tetanus related in the Bui. Gen. de Therap., 15th June, 1851, taken
from an Italian Journal, in which frictions with sulph, ether produced

1851.] Miscellany, 635

very remarkable effects. The physician, M. Tibaldi, was called to
a man who had imprudently slept upon the moist ground, after getting
into a profuse perspiration from exercise. M. Tibaldi, finding his
bowels constipated, administered a purgative, and the next day he
was much better, but during the day he was taken with tetanic con-
vulsions. On the 17th, when M. Tibaldi saw the patient, tetanus
had developed itself. There was complete immobility of the whole
body, except the arms ; the eyes were fixed, but brilliant ; there were
spasmodic contractions of the muscles of the trunk and thighs, and
especially the muscles of the neck and back, with constriction in the
region of the diaphragm and throat. The pulse was 85, small and
hard, and there was an abundant perspiration. The patient was bled
twice during the day. The 18th, no better; was re-bled, and a dose
of tart, emetic administered. This rendered him more calm, and he
had several operations upon the bowels. The evening of the same
day, he was bled again and eight leeches were applied along the
sterno-cleido-mastoid muscle, and mercurial frictions made upon the
back. Considerable amelioration upon the 19th ; another bleeding
and a blister to the region of the diaphragm. In the evening the pa-
tient was bled again. Upon the 20th, the accidents returned : the
pulse was 100, high fever and violent tetanic contractions. Another
bleeding was practiced, a dose of tart, emetic was administered, and
leeches applied to the anus. In the evening he was again bled, but
did not improve much. Later in the evening the patient got worse,
and M. Tibaldi attempted to relieve the pains and induce muscular
relaxation, by frictions v.ith sulph. ether. A oleeding was practiced,
a half gramme of acetate morphine administered, and two frictions
made upon the lumbar regions, when the pains disappeared. The
frictions were continued for several days. On the 23d, the patient
could sit up in bed and hold his head erect. There was still a little
rigidity of the abdominal muscles. The patient continued to improve
daily ; during the mean time frictions were made. Upon the 4th
July, he was perfectly convalescent.

Frictions with Chloroform in a Case of Tetanus. The Bui. Gen.
de Therap., (July, 1851,) relates a case of Tetanus cured by fric-
tions with chloroform. It would seem that the beneficial efiecis of
chloroform are much more striking and more immediate than those of
sulphuric ether. A report of each is given in this number. A man
about 40 years of age was admitted in the hospital, under the care of
M. iMorisseau, affected with tetanus, the result of a wound upon the

636 Miscellany, [October,

anterior and lower part of the leg. M. Morisseau had immediate
recourse to chloroform : he ordered general frictions with four grammes
of this anesthetic, three times a day. In the evening the patient was
placed in an acidulated vapor bath. The next day he was better;
slept well during the night ; perspired freely and the convulsions were
less frequent. He was able to take a little liquid nourishment. 20
grammes of chloroform were ordered to be used in three frictions
during the day, and two acidulated vapor baths to be taken. This
treatment was continued during several days. The third day all the
serious symptoms had passed away, and in a few days more the patient
had quite recovered.

Scarlatina. Dr. Volz has recorded his experience of a severe
epidemic of scarlatina in Carlsrhue, from which he draws the follow-
ing deductions :

1. The extent and redness of the eruption are not in direct ratio to
the severity of the disease.

2. The proximate cause of the exanthem is a stasis in the cutane-
ous capillaries.

3. The exfoliating scales of epidermis do not transmit the conta-
gious principle of the disease.

4. The mucous membranes undergo the scarlatinous eruption
equally with the skin.

5. The lesions of the throat are of three varieties catarrhal, in-
flammatory, and gangrenous.

6. The inflammation of the parotid which accompanies scarlatina,
seldom terminates in suppuration ; that which follows the subsidence
of the exanthem, often suppurates.

7. In the consecutive anasarca the alterations in the kidney are
secondary, and depend on the change in the composition of the blood.

8. Death may occur in scarlatina from the following causes: con-
gestive apoplexy, suffocation, pyaemia, and anaemia. \_Med, News.

Treatment of Urticaria hy the Sulphate of Quinine. This is an

eruptive disease, usually distinguished by elevations of the cuticle in
the form o^ wheals ; it is sometimes exceedingly obstinate, resisting
all the means that may be brought to bear against it. We are induced
to notice this affection, because recently we have met with two or
three cases that yielded only to large doses of quinine.

It is often quite simple in its nature, yielding readily to tepid baths,
mild cathartics, and a restricted dirt; but again, it is accompanied
with much febrile disturbance, pain in the epigastrium, nausea, full-
ness in the head, and a burning sensation over the surface of the
body ; the face, hands and feet swell ; the eyes are almost closed ;
the tongue is loaded with a white coat, and the itching is intolerable
at times. Again, the eruption is accompanied with severe articular

1851.] Miscellany. 637

pains, all of which phenomena serve to complicate the exanthema,
aiid ruiment the difiiculties of the case. Dr. Wickham and M. Le-
grouse of the Hospital Beaujon report some cases of the worst forms
of Urticaria, which were promptly cured by full doses of quinine,
continued for two or three days.

Treated with quinine the articular pains, the painful tumefaction of
the face, feet and hands, the eruption itS' If, rapidly disappeared, to-
gether with the nausea, feln-iie excitement, and indeed all the distress-
ing symptoms. [iV. O. Med. Journ.

Treatment of Hemorrlioidal Tumors by Collodion. M. H. Gassier,
of Marseilles, reports a case in the Bui. Gin. de Therap., March,
1851, of hemorrhoidal tumors, treated with collodion, which we will
relate :

M. Gues, aged 48 5'ears, of a nervous constitution, was affected
for six years with hemorrhoids. All ordinary remedies were applied
to relieve the disease, but they were without effect. The patient
suffered intolerable pains for several hours after each stool, or indeed
until the hemorrhoidal tumors had re-entered into the rectum. The
cautery was proposed as an extreme resource, but the patient would
not consent to its use. As the usual applications in such cases had
been used in vain, collodion was proposed and applied before the tu-
mor was reduced. The collodion produced very intense pain, but
diminished \evy considerably in about twenty minutes. The follow-
ing night he slept well, which was the first good night that he had
passed in ten. From this time, the patient continued to do well, and
six months has passed away without any return of the disease.

M. Gassier asks whether it was the constricting power of the collo-
dion, or the anesthetic property of the ether, that produced the cure?

0?i a Neic Method of Treating certain cases of Epiphora. By
William Bowman, F. R. S. This paper describes a new mode of
treatment of those oases of epiphora which depend on a displacement
of the puncta lacrymalia out of the course of tiie tears, or on an ob-
struction of the canaliculi between the puncium and caruncle, the
inner extremity of the canals, together with the lacrymal sac and
nasal duct, remaining healthy. The author describes the exact na-
ture of these cases, and relates examples. The treatment which he
has devised consists in slitting up tlie canal from the punctum on the
conjunctival aspect, so as to carry backwards the orilice at which the
tears are received on to the mucous membrane near the caruncle ;
and he finds that the tears are in fact taken up by the remaining por-
tion of the canal, while the end towards the punctum is converted into
a groove. For the cases of obstruction from injury or other cause, he

638 Miscellany. [October,

suggests a modification of this operation, by which the canal between
the obstruction and the sac may be slit up for some way, so as to re-
ceive the tears at a new opening. The cases to which these new
operations are applicable, have been for the most part abandonedby
surgeons as incurable. [London Lancet.

Eclampsia ; various incisions of the neck of the Uterus ; delivery ;
recovery. Doctor de Beule, of Lokeren, has communicated to the
Medical Society of Ghent a very remarkable case, which has been
itself the subject of an excellent report by M. Frayes. It was a case
of violent eclampsia, occurring between the sixth and seven month
of pregnancy, in a woman with her first child, and who presented un-
doubted symptoms of labor. Indeed, from the commencement of the
disease she complained of heaviness in the lower belly, of continued
or bearing down pain in the region of the loins ; the neck t)f the uterus,
effaced and slightly opened, admitted the end of the finger. The first
attack of eclampsia was in the morning just as she awoke, having
had the evening before some premonitory symptoms. Notwithstand-
ing the active treatment which was adopted, the attacks became more
and more frequent, and m.ore and more intense, leaving the woman,
in consequence, in a comatose state more and more profound and pro-
longed. Towards the evening the death of the foetus was almost cer-
tain, and the condition of the patient was so critical, that M. de Beule
and the attending physicians, seeing her life in imminent danger,
considered it necessary to terminate the accouchement. M. de Beule,
by means of a straight bistoury furnished with a button, made, not
without some difficulty, four incisions in the neck of the uterus,
which was but little more dilated than at the commencement of the
disease. Two of these incisions were made at the sides ; the other
two in front and behind. The accouchement was the-n rapidly ter-
minated by the abstraction of a dead foetus, by means of the lever ;
and the convulsions ceased. The next day the woman was restored
to consciousness ; the consequences of the confinement were natural,
and the re-establishment of health was speedy.

The unbridling (debridement) of the neck of the uterus, sometimes
designated under the pretending and even inexact name of hysteroto-
my or vaginal csesarean operation, has already been practiced a great
number of times either for the extraction of uterine polypi, or in case
of occlusion, complete or incomplete, of the neck, or to make the ex-
traction of the foetus more easy in case of sudden or apparent death
of the mother, or in case of rigidity, organic alteration or spasmodic
contraction of the neck of the uterus, or, finally, to replace forced
accouchement under the diflferent circumstances which may require
it, among which figures eclampsia.

Confining ourselves to this latter, the cases in which it has been
combatted by the unbridling of the neek, are still not very numerous.
The first report of this kind is due toDubose, who addressed it to the
Royal Academy of Surgery. The operation was followed in five or
six minutes by the spontaneous delivery of a dead child ; but calm-

1S51.] Miscellany. 639

ness was immediately restored to the mother, and she had a favorable
confinement.

Contoniy was more fortunate in a case of this kind ; after the oper-
ation he delivered with the hand an infant apparently dead, but which
they succeeded in recalling to life.

M. P. Dubois performed the same operation, in 1840, at the Clinical
Hospital, on a woman affected with eclampsia. He afterwards appli-
ed the forceps, and delivered a living child. The woman, carried
back to her bed without consciousness, had, nevertheless, renewed
convulsive attacks, which were met by the application of thirty leech-
es to the mastoidal apophyses. About ten o'clock in the evening
consciousness returned, and the next day the woman was in a satisfac-
tory condition.

M. Godemir has published two private cases of his in which he was
enabled, thanks to this operation, to terminate the accouchement speed-
ily, in the midst of attacks of eclampsia, and to save the two mothers.
The children lived but a few hours.

Lastly, M. Hubert, Professor of Midwifery at the University of Lou-
vain, has performed the same operation under similar circumstances,
and with equally fortunate results to the mother.

Accouciieurs are still divided in opinion as to whether, in a case of
eclampsia, which resists the ordinary remedies, (bloody evacuations),
and this is the case most frequently, it is proper to resort to forced
delivery. Some, and they number among them high names in the
Profession, think, that the operation of forced delivery adds still more
to the nervous excitement, and only serves to increase the liability to
accidents. Others, and they are becoming more numerous every day,
contend that the delivery, forced or spontaneous, is the best means of
arresting the convulsions of the mother. Notwithstanding the exam-
ple of Dubose and Contoniy, the unbridling of- the neck was not re-
sorted to in order to produce forced delivery, and Mr. Velpeau, after
having delivered a woman, but with great suffering, by the introduc-
tion of the hand into the womb, regretted that he had not incised the
neck. This operation, he afterwards said, is neither very painful, nor
very dangerous in such a case ; and the result has since justified his
prediction.

The very remarkable case reported by Mr. de Beule, and those
which M. Fraeys has mentioned, are certainly a powerful encourage-
ment to resort in case of need to the unbridling of the neck and arti-
ficial delivery in puerperal convulsions, although delivery, natural or
provoked, does not always terminate the eclampsia, as the case report-
ed by M. Dubose suffices to prove. But, as an operation of this kind
is always a serious mutter, we will mention a remedy which has al-
ready succeeded twice in similar cases, that is: inhalations of chloro-
form. [Bulletin Med. So. Ghent. JY. O. Journ.

The injluence of the hours of the day on Mortality. The observa.
tions and calculations of Dr. Caspar lead to the conclusion that the
maximum of deaths occurs in the fore part of the day, and the mini-

640 Miscellany. [October,

mum between evening and midnight. The explanation of this, Dr.
Caspar seeks in the analogy between sleep and death : sleep being
the period in which great organic changes occur, is pro tanto, favora-
ble to the dissolution of the individual.

The diseases which are the causes of death exert a modifying influ-
ence on the hour at which death occurs. The origin and progress of
diseases, their exacerbations, and remissions, are frequently observed
to occur at certain times of the day. The influence of these on the
hours of death is shown by the following table of 5-391 deaths from
various diseases.

From midnight. From 6 A.M. From noon. From 6 P. M.
ACUTE DISEASES. to 6 A.M. to noou. to 6 P.M. to midnight.

Fevers

Inflammations - -
Exanthemata - -

CHRONIC DISEASES.

Phthisis ....

Atrophy - - -

Haemorrhages - -

Chronic Catarrh

Dropsies - - -

Neuroses - - -

Other chronic diseases, 76 102 69 85

64 75 66 66

160 164 182 160

44 45 43 59

186 240 215 186

347 381 282 255

163 186 161 121

41 47 34 24

90 119 93 64

267 267 191 179

rr , 1 > Acute - 268 284 291 285

Total f

Chronic -1140 1344 1065 914

The next table exhibits the variations from the general rule, in the
same class of diseases, on the side either of excess or deficiency, as
indicated by the signs -|-or .

From midnight From 6 A. M. From noon From 6 P. M.
ACUTE DISEASES. to 6 A. M. to noon. to 6 P. M. to midnight.

Fevers ...... 16 15 -\- 1 -1-30

Inflammations ... 12 45 -|-31 -1-26

Exanthemata . - - 22 55 18 -]-95

CHRONIC DISEASES.

Consumption - . - 27 1 -[-17 -j-U

Atrophy .... -1-5 -j-lS 15 8

Haemorrhages . - - -j- 6 -|- 4 -1-12 22

Chronic Catarrh - . -|-29 -1-31 10 50

Dropsies . - - . 6 -|-17 -]-ll 33

Neuroses .... -1-43 -j- 6 32 17

Other chronic diseases, 36 1 -j-lO -1-27

The following are briefly the conclusions of Dr. Caspar on th3 in-
fluences investigated by him :

1. As to births. More births occur from nine o'clock in the even-
ing to six o'clock in the morning than during the other hours of the
twenty-four. Labor-pains commence more frequently between mid-
night and three o'clock in the morning than at other times. Of those
births which terminated during the day, the majority were male child-
ren. Labor is longer if the pains begin in the day-time than if it
commence during the night. This influence is more striking with
still-born than with living children.

1851.] Miscellany. 641

2. As to deaiJis. The maximum general mortality occurs during
the earlier hours of the day, the minimum in the evening. Of special
causes of death the relative mortality with reference to the time of day
presents many variations. Inflammatory diseases present their max-
imum in the after-part of the day ; fevers and exanthemata in the
earlier hours of the night; haemorrhages in the fore part of the day
and in the after-noon ; and the neuroses generally in the hours after
midnight. [London Med. Gaz.^ April, 1851. Med, Examiner.

Feigned Insanity. The Gazette Medicale Lombarde reports the
case of a young herdsman, seventeen years of age, who, having vio-
lated a child seven years old, killed her on the spot by a blow on the
head. When arrested, he stated he had been urged to the commission
of the deed by the devil. On the day following his imprisonment, this
youth, who v.-as remarkable for his gaiety and intelligence, was found
in a state of almost complete imbecility, unable to make a single step
without trembling and crouching down, his head bent forward in-
clined to one side, his speech incoherent, and stammering, not giving
any collected answers to the questions put to him. He did not seem
at all conscious of the fate that awaited him. Two physicians, AJM.
Windier and Zinck, declared the insanity feigned, upon the ground
that they had never known such a form of the malady occurring sud-
denly at his age. The prisoner was subje(j^ed to the closest surveil-
lance, but he was in everything consistent with his disease. Recourse
was had to stratagem ; his couch was set on fire, water was unex-
pectedly poured upon him through the windows of his cell; but he
remained impassive beyond faint inarticulate cries.

The physicians nevertl.c.ess persisted in their opinion. When put
upon his trial, the prisoner answered no questions, seeming to doze,
and preserved throughout the same impassibleness. The jury found
him guilty of the crime, but admitted his insanity in extenuation ! He
was condemned for three years to the House of Detention. Returned
to his cell, the prisoner, finding that he had escaped capital punish-
ment, declared that he had been perfectly sane since his arrest, and
that he had simulated idiotcy at the suggestion of a fellow-prisoner.

There are few instances on record of feigned madness carried so
far, or persisted in for so long a time, under the circumstances.
[London Med. Gaz. Med, News.

The reciprocal duty of Physicians and of the Public towards each
other : An Address, delivered before the Medical Society of the
State of Georgia, at its second annual meeting, held at Atlanta, on
the 9th April, 18.31, by Richard D. Arnold, M. D., President of
the Medical Society of the State of Georgia, Member of the Amer-
ican Medical Association, &;c. Published by order of the Society,
Savannah: J. B. Cubbege. 1851. 8vo. pp. 30.

We take pleasure in calling the attention of the readers of the
Journal to the clear, forcible, yet practical remarks of the able Pre.

642 Miscellany,

sident of our State Society, on the reciprocal duties of the medical
profession and of the public. We are especially pleased with the
bold stand which he takes in favor of a liberal education, including a
knowledge of the Latin and Greek languages as the proper basis for a
medical education. We are satisfied that it is to the general deficien-
cy in this particular, much of the discredit into which our profession
has fallen, is justly due. What estimate must an enlightened public
place upon a professional man who is grossly ignorant of all those
branches of knowledge with which intelligent men every where are
conversant ?

The address urges upon physicians generally to receive no one as a
pupil " unless he be properly qualified by a good preliminary educa-
tion." This is a very proper rule, though we fear the instances are
not very frequent in which it is applied. Yet the precept cannot be
too frequently impressed upon those whose duty it is to guard the
portals of the profession.

The duties of the public to the medical profession are briefly ex-
amined, and the speaker seems to think " it is in vain to seek any
legislative aid to the ends proclaimed," though " he does not press
any extravagant claims upon the public.'' We entirely agree with
him in this opinion. We need expect no aid or protection from our
legislative bodies, though we are justly entitled to it, and without it
must sufier many evils. The difficulty we believe is incident to our
democratic institutions.

This address is worthy of a more extended notice, but neither
time nor space will permit more than these brief desultory remarks,
which we close by urging upon our friends who have not a copy of
the address, to procure it, and give it a careful perusal.

Health of Augusta. During the present season, our city has en-
joyed its usual good health. There have been a ^ew cases of small-
pox which was re-introduced among us in July, but the prompt efforts
of our city authorities to confine it (o the locality whence it appeared,
were entirely successful, and the disease has since been extinguished
by a thorough and general vaccination.

Editor of the Southern Medical and Surgical Journal. We are
pleased to announce the return of the Editor from his European tour,
and that he will at once resume his editorial duties.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES.NOVEMBER, 181. [No. 11.

PART FIRST.

r i g t n a I ommnnxcatio\x3,

ARTICLE XXXIV.

Typhoid Fever. By John S. Wilson, M. D., of Muscogee
County, Ga. (Continued from Sept. No.)

In the No. of this Journal referred to above, I had the honor
of submitting to the profession, in a brief and imperfect man-
ner, some remarks on the treatment of typhoid fever, conclu-
ding with the promise to extend them at some future time. I
now proceed to comply with that promise ; but before doing
so, I beg the indulgence of the reader while I adduce some
arguments and authorities, to sustain the third position assumed
in my article, which were omitted for want of space. The po-
sition referred to is this : *'3d. Typhoid fever is only a milder
form of typhus."

The identity or non-identity of typhoid and typhus fever
has, perhaps, given rise to more discussion than any subject
connected with them ; and when we remember that it is a
practical question when we remember that its settlement
would remove much of the confusion and difficulty which now
attend the study of these fevers, we should look favorably on
every effort at its elucidation, however humble it may be.
The evidence in favor of the position that typhoid fever is only
one of the forms of typhus fever, and not a distinct specific
disease, seems to me to be almost conclusive, notwithstanding
the high authority of those who advocate the opposite opinion.
I do not intend to weary the readers of the Journal, by long

N. S. VOL. VII. NO. XI. 41

644 Wilson, on Typhoid Fever. [November,

quotations from numerous writers ; I will only refer to some
of them, and briefly enumerate the arguments on the affirma-
tive side of this question. It appears, then, to use the words
of Dr. Bell, that "Both diseases have commonly an eruption,
and both may prevail without any ; both are attended with
frequent anatomical lesions ; the typhoid more generally with
one kind ; but both may run their course without any such
organic change. In both fevers the digestive and nervous
sj^stems are much deranged ; and in both there occur complica-
tions of bronchial and pulmonary disease and a morbid state of
the heart." *#*## There still remains one point of re-
puted contrast between the two, and that is, the contagiousness
of typhus," &c. ***#** "But here again there is a
nearer approximation than might first appear. Writers are
not at all agreed respecting the non-contagiousness of typhoid
fever. M. Louis now inclining to the belief of its being con-
tagious, and some of the warmest advocates of the contagious-
ness of typhus admit its occasionally spontaneous origin."
The next authority to which I shall refer is that of Dr. Joseph
M. Smith, Chairman of the Committee on Prac. Med. Am. M.
Assoc. His able report may be found in the Amer. Journal
of Med. Sciences, Oct., 1848, p. 512, and I bespeak for it a
careful perusal, by all who feel interested on this important
subject; and I believe with the author of this report, that all
should feel interested in it, and that it should " continue to at-
tract attention, until a unanimity in regard to it is attained
among the great body of enlio-htened physicians." After ex-
amining the symptoms of -each fever as given by different
authors, he concludes by saying: "Upon the whole it seems to
us, that the ingenious attempts which have been made to estab-
lish a specific distinction between typhus and typhoid fever, by
an analysis of the 5^m/?^o?725, have yielded no other profitable
result than a lucid exhibition of the modifications which genuine
typhus assumes under different circumstances of temperament,
habits and iT'ode of life, climate, &c. In no other light can we
reo-ard the able researches on the subject by Louis and numer-
ous other pathologists in Europe and America."

Dr. Smith next discusses the question, whether a distinction
can be founded on the anatomical character of the two dis-

1851.] VfWson, on Typhoid Fever. 645

eases; and I regret that I can only enumerate the writers and
observers quoted by him to show that lesion of the intestinal
mucous membrane is a frequent occurrence in typhus fever.
The authorities quoted by him, in Europe, are: Dr. Kennedy,
of Dublin ; Dr. M'Cormac, of Belfast ; Drs. Graves and Stokes,
of Dublin. AH these, be it remembered, founded their opinions
on their own observations, and from actual dissections. He
also quotes the distinguished names of Drs. Hewet, Tweedie,
Copland, Southwood Smith, and Marshall Hall, to the same
point. He also quotes Dr. Davidson of Glasgow ; and the oft-
quoted Dr. Lombard, who, on examining cases of typhus at
Dublin and Glasgow, recanted his continental pathology, and
declared that the British typhus and the French typhoid fever
were "not specifically distinct." The next physician referred
to is Dr. Staberoh, of Berlin, who, after studying the typhus
of England and Ireland for six months, declared that it "was
the same as the typhoid affection of the Continent." The same
report informs us that Dr. Stone, after treating and dissecting
numerous cases at Bellevue Hospital, declares his belief, "that
typhus and typhoid fever, so called, are identical." Prof. Clark
has arrived at the same conclusion. Dr. Sweet acknowledged
that his belief in the "non-identity of the diseases lessened daily."
"Dr. Griscom, one of the physicians of the New York Hospi-
tal, states, that often autopsies of patients dying of ship-fever
in that institution, in July, August, and September, 1847, six
presented follicular disease of the intestines." With an extract
from the concluding remarks of this report, I leave it ; but be-
fore doing so I would call attention to the fact, that all the phy-
sicians last mentioned, founded their opinions on observations
made among the emigrants sick of the ship (typhus) fever,
which prevailed so extensively among that class in 1847 and
1848.

The report concludes thus : " In view of the facts which
have been stated, it seems to the committee that no reasona-
ble doubt can remain that typhus and typhoid fever are identi-
cal. Were medical men united in this conclusion, might we
not hope, that with undivided attention and a union of effort,
more rapid advances would be made in determininfy the
causes of the morbid condition of the Peyerian glands and

646 Wilson, on Typhoid Fever. [November,

other organs which occur* in some cases of typhus and not in
others?"

The next and the best authority to which I shall refer, is
that of Dr. D. F. Condie. This accomplished physician and
writer, in a review of Dr. Bartlett's work on the fevers of the
United States, in which he maintains the non-identity of typhus
and typhoid fever, says: "In the present state of our know-
ledge on this subject, it is, we conceive, much safer to consider
the typhoid as one of the forms of typhus fever. Its distinct
and specific character has not, as yet, been satisfactorily es-
tablished."

I now return to the treatment. In my former article, I briefly
alluded to bleedings local and genQXdX cathartics and opium,
in the treatment of the fever under consideration: before no-
ticing other remedies, I will make a few additional remarks on
the two last mentioned opium and cathartics. I know that
the cathartic practice, in the beginning of this fever, is founded
on a plausible theory, and that it is recommended by the high-
est authority; for Dr. Watson says, in his Practice (p. 959),
" This I believe that the intestines should be cleared by an
active aperient in the outset ; and that laxatives should be
continued, if the bowels do not act every day without them."
As to the theory, I believe it to be false, and do not regard it ;
but I confess that I feel some diffidence in opposing the views
of so experienced and intelligent a physician as Dr. Watson;
yet I feel constrained to do so in this case, and to object to the
wse o{ active aperients and daily laxatives in typhoid fever.

I do not deny that an active cathartic, in the very beginning
of the fever, before it is fully developed, will occasionally suc-
ceed in arresting it ; for a fev/ instances of this kind have come
to my knowledge ; still I think, as a general rule, that the prac-
tice is unsafe and should be avoided. In some cases where
there was a decided tendency to coma, without much manifest
intestinal irritation, I have used cathartics a little more freely
than usual, but I can not say that I have ever seen any marked
benefit from them ; yet I should remark that my experience in
such cases has been limited ; for I have seldom ventured to
use them freely, even in the few cases above described, which

* It appears to me that the sense requires that this verb should be singular.

1851.] Wilson, on Typhoid Fever. 647

have been treated by me. The practice of giving daily laxa-
tives, I consider almost as objectionable as that of using active
cathartics: it may be admissible in some cases, and even ben-
eficial, but as a general rule, I think the practice objectionable.*
I would remark, while on this subject, that, according to my
theory, the coma and stupor in typhoid fever are more nervous
than vascular are produced more by exhaustion of the vis ner-
vosa, than by cerebral congestion or vascular fulness ; and this
is the reason, I think, why we derive so little benefit from bleed-
ing and purging, even where they seem to be indicated. By
reference to my previous article, it will be seen that I enjoin
much caution in the use o^ opiates, on account of the tendency
to coma; but, admitting the correctness of the above theory,
they might perhaps be used with more freedom than I have
been in the habit of doing : and apart from theory, I have heard
of cases in the practice of others, where they have had the
most happy effect, even in comatose cases ; still I think they
should be used cautiously, for fear of converting a nervous
coma or stupor, into a vascular congestion or inflammation. I
see by an extract contained in the Sept. No. of this Journal,
(p. 551) that Dr. A. G. Henry recommends the use of opium
m four or jive g{' dim doses, in typhoid fever. He says : "I
claim to have demonstrated beyond all reasonable doubt, by a
long and careful experience and observation, that while the
maximum doses of the schools are of doubtful utility, and often
prove injurious in fever, by increasing the dryness of the skin,
aggravating pain in the head, &c., &c., ^five grain dose will,
nineteen times in twenty, produce free perspiration and relieve
every unpleasant symptom. The notion that so generally pre-
vails among the profession, that opium cannot be used to ad-
vantage in fever while there is determination to the brain, is
certainly erroneous, if it is given in the doses which I recom-
mend, unless there is actual inflammation," &c. Now, not-
withstanding my cautions with regard to the use of this remedy,
I am inclined to favor the practice here recommended, if we
only had infallible diagnostic symptoms by which we could
distinguish the cases to which it is applicable ; for I believe if

Vide Dr. H. V. Woolen's excellent article on this subject, in this Journal
Jan. 1850, p. 22. Also Dr. Long's, before rel'erred to.

648 Wilson, on Typhoid Fever. [November,

we could do this, it would be better to give the opium in deci-
ded doses ; but as it is very difficult for us to determine the
cases in which large doses would be safe, I think they should
be used with much circumspection. (Vide Dr. Latham's opin-
ion, Watson's Practice, p. 961.)

I now proceed to notice some other remedies, in this fever,
and the next and perhaps the first in importance, is Calomel.
I think I may saj^ that there is no gjreat difference of opinion
in the profession, as to the use of calomel, as a purgative and
alterative ; but when we come to consider its constitutional or
sialagogue effects, we find physicians and writers much divided.
It is not my intention to introduce the authorities, pro and con,
on this point I shall, in discussing this, as well as other points
connected with the treatment, confine myself mostly to the
opinions which 1 have formed from my own experience and
observation ; for, apart from the latter, I consider my opinions
of but little consequence to any one. On the use of calomel
as a sialagogue, in typhoid (continued) fever, I will make only
one short quotation from Dr. Watson (op. cit. p. 960) He says,
in referring to a particular fever, (continued) which had pre-
vailed in London : *' A great number of the patients were
brought, sooner or later, under the specific operation of that
mineral (mercury) ; and in these patients (with one exception
only, where the mercury appeared to do neither good nor harm)
a decided improvement'^ was almost immediately apparent upon
the supervention of soreness of the mouth ; and all such pa-
tients ultimately recovered." Notwithstanding this strong
evidence in favor of the specific action of mercury, in contin-
ued fever, Dr. Watson says farther on : "In the form of fever
that is now epidemic, I do not think mercury is so proper.'
He concludes the subject with this remark: "I should give
mercury very cautiously, therefore, if at all, in this typhoid
variety of the fever." In my practice, I have seldom been
able to produce the specific action of mercury, (my experience
corresponding with Dr. Long's) but in the few cases in which
ptyalism, even in the slightest degree, supervened, there was
invariably a decided improvement.

I shall not attempt to say whether the constitutional action
The italics are Dr. Watson's,

1851.] Wilson, on Typhoid Fever. 649

of the mercury was an evidence of the mildness of the disease,
or the cauFe of the amelioration : I only state the fact, and de-
clare myself one of the advocates of the mercurial practice,
for reasons which I will now give.

I advocate the use of mercury then because I think it mode-
rates the fever, and if it does not shorten it, it renders it less
dangerous and more manageable. I advocate its use, again,
because it is universally admitted to be the best remedy we
have to unlock the emunctories of the whole economy and
restore their secretions ; which secretions are always suspended
in typhoid fever. These are my principal reasons for giving
mercury in this fever, and I am influenced more by the latter
than the former: I give mercury principally with a view to
its action on the secretions, glandular, follicular and cutaneous ;
if ptyalism supervene I am pleased to see it, because my expe-
rience has taught me that it is an omen of good that it is
either the evidence of a mild and manageable disease, or the
efficient cause of the amendment which invariably ensues. But
while I advocate the judicious use of mercury, I must condemn
the practice, too prevalent among some, of giving mercury in
all cases, under all circumstances, and in unreasonable quanti-
ties. I only adv^ocate its use as a general rule, and in small
doses ; for I believe that large doses are not only unnecessary
but positively injurious ; and I believe, again, that there are
cases in which it is not so appropriate, even in small doses :
for instance, where there is great prostration of the vital pow-
ers, with more nervous than vascular excitement. To con-
clude, then, on this part of the treatment: I generally give
calomel in 2 or 3 gr. doses, every 2 or 3 hours until slight
ptyalism supervenes, or until the restoration of the proper
secretions, and the abatement of all the unpleasant symptoms
indicate that the disease is subdued. I always endeavor in this
fever, as in all others, to avoid profuse salivation; I watch
closely for the effects of the mercury on the gums, and as
soon as they are manifest in the least degree, I suspend its
use. 1 always, before commencing the use of mercury, note
particularly the condition of the gums and teeth, for without
this precaution, they become so coated with sordes and the
secretions about the mouth so depraved, that we migiit be de-

650 Wilson, on Typhoid Fever, [November,

ceived were we to rely on the usual signs of salivation. I have
noticed if the gums are red at first, the first evidence of the
action of the mercury on them, is a change to a blueish ap-
pearance.*

Cold affusions. To the use of this remedy, when applied to
the whole body, I will devote but few words, as I have no ex-
perience with it in that way : I will only remark, then, that I
have the same objection to it that I have to emetics and active
cathartics, Viz., that we cannot expect to wash out the disease
by drenching the surface with cold water; and 1 object to the
remedy again, because, I consider it dangerous and too much on
the heroic order, for such a disease as typhoid fever. Of cold
affusions to the head, and cold sponging to the surface gener-
ally, when the skin is dry and the heat above par, I can speak
in terms of decided commendation, having often witnessed the
most happy effects from them. My experience has taught me
that cold affusions to the head, in the delirium of typhoid fever,
are more effectual than any other remedy, unless cups to the
temples, in the early stages of the fever be excepted. The
head should be shaved and the coldest water should be poured
on it, freely and continuously, until the delirium is subdued ;
and the remedy should be repeated again and again, on every
exacerbation of the delirium. A very good plan, after the
patient has been quieted by the cold affusion, is to have a funnel
partly filled with cotton, through which the water may pass
guttatim ; regulating the quantity so that it may evaporate and
not wet the clothing, bed, &:c. It is needless for me to say
that cold water, used after the manner above recommended, is
a potent remedy, and that its effects should be watched closely ;
and more especially when there is a strong tendency to coma.f

In the use of this remedy the effect produced on the pulse,
the temperature and the brain, will generally be a safe guide.
As to the use of cold sponging;, the feelings of the patient, when
he is sensible, will be an additional and important aid, directing

* On the use of mercury, external and internal, consult a very interesting ar-
ticle in the Sept. No. of this Journal, translated from the French, by Dr. James
Bryan, p. 546, et seq.

1 1 have known a case where coma was relieved, after cold water had failed,
by warm affusions to the head.

1S51.] Wilson, 071 Typhoid Fever. 651

ws with almost infallible certainty, when to persist and when
to discontinue.

Diaphoretics. Diaphoretics, naagnified by some into prin-
cipal remedies, in typhoid fever, with the intention of elimi-
nating a supposed morbid matter from the blood, I consider
only secondary and auxiliary remedies, in this fever, as in
all others. Still, while I place them in the secondary list,
I esteem them an excellent class of remedies, when they are
given in conjunction with others, and in accordance with the
general indications of treatment ; and I might add that they
are, perhaps, more entitled to be regarded as principal reme-
dies, in typhoid, than in any other fever. I will not attempt
even to enumerate all the numerous articles of this class which
have been recommended, for I think that a few well-selected
ones are sufficient to fulfil all the indications that may arise.
I will therefore confine my remarks to those to which I am
most partial those which I have almost exclusively used. My
list is short, consisting only of ipecac, pulv. Dov., spts. minde-
reri, camphor, carb. ammonia and the asclepias tuberosa.
The ipecac and spts. minder., I use in the earlier stages of the
fever the camphor and ammonia in the more advanced stages;
while the pulv. Dov. may be used at any time, with due cau-
tion, according to the circumstances of the case. The carb.
ammonia, may be merely neutralized by the acid forming a
simple neutral mixture, or if a stimulating diaphoretic be indi-
cated the ammonia can be added in excess.

The Asclepias, or butter-fly weed, I esteem highly as a dia-
phoretic, and I do not think its virtues are properly appreciated.
As it is not stimulating, it may be used in conjunction with
other remedies, in any stage of the fever. It acts finely when
given in warm infusion, combined with Dov. powders or either
of the remedies already mentioned.

Blisters^ external stimulants, ^-c. I can say with Dr.
Wooten,* that " there is no single agent of which I think more
highly than blisters" in typhoid fever. It is impossible to say
at what time they should be applied ; as this will vary in dif-
ferent cases it must be left to the judgment of the physician ;
Vide this Journal Jan. 1S50, p. 25.

652 Wilson, on Typhoid Fever. [November,

but 1 think that they might frequently be applied earlier than
they are generally, with much advantage to the patient, and
with but little risk. If the abdominal soreness or the diarrhoea
persist, after the free application of cups, I apply a large blister
to the abdomen, unless the febrile action still continue of a
pretty high grade.* I keep the blister open for a considerable
time, and then suffer it to heal. Should the abdominal soreness
still remain I use the cups again, and reapply the blister ; this
course, I continue as long as it is indicated by the symptoms
above mentioned, and I am pleased to say that I have never
seen any ill effect from it, but on the contrary the most decided
benefit. I know that blisters are no neutral remedies, and that
they will do harm when ill-timed; but I think that some com-
mit an error, in waiting until the necessity for them no longer
exists, or until the case becomes hopeless, before they resort to
them ; instead of using them earlier and keeping them open,
regarding them not as stimulants to re-excite the exhausted
powers, but rather as the most potent agents at our command
for the subduction of local disease. As to other external appli-
cations I have but little to say. Stimulants to the extremities,
frictions, &c., are generally used in the last stage of this fever,
when coma and other symptoms, too familiar to all, fore-sha-
dow approaching dissolution; /use them too, not omitting
blisters,! but I have never seen any advantage from them. I
only use them as a forlorn hope, and for the purpose of satisfy-
ing the friends, that all has been done that afforded the slight-
est prospect of relief Of course, it will be understood that I
now speak of those desperate symptoms, which immediately
precede death ; before these appear, stimulants to the extremi-
ties, or even to the whole surface, when the temperature is
below the natural standard, are no doubt beneficial ; and there
is one to which I am particularly partial, and that is the fre-
quent use of a hot foot bath to the water I frequently add
ashes or ley, and I think its virtues are thereby increased.
While on external applications, I will mention warm poultices,

*I have prevented any increased excitement b}'- giving a full dose of opium
at the time of applying the blister.

t The plan, recommended by some, of applying a blister to the whole scalp,
in such cases, I have never tried, though I think it might be useful ; still its ad-
vantages are very doubtful and it is liable to several objections.

8851.] Wilson, on Typhoid Fever. 653

&:c., to the abdomen. These are generally very grateful to
the patient and have a good effect in soothing the irritation of
the bowels. I generally use a simple poultice made of corn
meal, or mullein wrung out of hot water.

Stimulants and Tonics. My notice of these remedies shall
be very brief, because I have used them but little, and because
my design is, to confine myself principally to the results of my
own experience in the treatment of this fever. Stimulants
may sometimes, doubtless, be used to advantage, and in some
cases where there is great prostration, they are no doubt posi-
tively demanded ; but the cases which have fallen under my
observation have seldom required a resort to these remedies;
the persistence of abdominal or cerebral excitement, or both
together, contraindicating their use. I have sometimes used
them as a dernier resort, under the circumstances mentioned
in connexion with external stimulants, but never with the least
benefit. I think, when used at all, it should be done with great
caution, and if the usual evidences of their favorable action,
such as diminution in the frequency of the pulse, &:c., are not
soon manifest, they should be discontinued. The above re-
marks will apply mostly to the other class of remedies tonics :
they cannot be used until convalescence is fully established and
then they are of doubtful advantage. There is one important
article of this class which deserves farther notice, and that is
Quinine. I have tried the sulph. quinine, in all stages of typhoid
fever, and in doses ranging from 1 gr. to 20 grs., with as
strong prejudices in its favor as any one could possibly have,
yet I am sorry to say that all my expectations have been dis-
appointed, and that 1 have never seen the least benefit from it :
generally it seemed to be neutral, acting about like so much
chalk ; but sometimes its effects were manifestly injurious, I
never resort to it now as a febrifuge, unless there be a very
decided remission as a tonic, other and less costly articles will
answer as well.

Astringents and some other remedies. As I said in my pre-
vious article, I have seldom been annoyed by that troublesome
complication diarrhoea; I have always been able to control
this without the use of astringents, by giving small doses of

654 O'Keeffe, on Acute Laryngitis, <^c. [November,

calomel combined with opium or Dov. powders. Should this
not be sufficient, or should the opium be contraindicated, I
would prefer the acet. plumbi, the nit. silver or pure tannin, to
all other astringents. The balsam copaiva and turpentine
emulsions I have prescribed in some cases of diarrhoea and In-
testinal inflammation, and was pleased with their effects. I
have seen some cases in which the tenesmus was considerable ;
the intestinal disorder assuming a dysenteric character ; in this
class of cases, from their analogy to others, in which I have
witnessed the happiest effects from it, I would recommend an
enema of the nit. silver, 10 grs. to the oz. of water. In con-
clusion, I would repeat my former declaration, viz: that we
have no specific remedy, or established mode of treatment, but
that the treatment must be varied according to the peculiar
circumstances of each case, &c. The plan of treatment then,
which I have sketched, must be considered as that which my
experience and observation have taught me to regard as the
mosi generally applicable; while I have not entirely omitted
the contra-indicaiions that may arise, and the corresponding
modifications in the application of the remedies noticed. It
was my design in accordance with my promise, to "conclude
with a general summary of my experience" in the use of the
remedies noticed above, but I deem this unnecessary, as I have
alluded to this sufficiently in treating of each separate remedy.

ARTICLE XXXV.

CLEN'ICAL REPORTS, No. H.

On a case which presented difficulty in diagnosticating beiwjeen
Acute Laryngitis, and Foreign Body in the Larynx. By
D. C. O'Keeffe, M. D., of Penfield, Ga.

The notes on the following case are presented as they were
penned during its progress.

Feb. 6th, 1851. A child aged two years was suddenly seized
with dyspnoea about 4 o'clock, P. M., while out at play. A
record made three hours afterwards thus describes his condi-
tion : Appearance healthy, face flushed, countenance anxious,
indicative of great distress; respiration embarrassed, difficult,

1851.] O'KeefFe, on Acute Laryngitis, <^c. 655

sonorous and loud audible at a distance of three or four yards ;
abundant discharge of transparent glairy mucus from the throat,
the accumulation of which in the larynx causes emesis; some
thirst, deglutition somewhat difficnlt, and excites cough. As
often as the air-passages become burdened with mucus, emesis
ensues, and affords temporary respite from dyspnoea ; but the
difficulty again returns and is relieved in the same way. Has
distressing paroxysms of coughing, during which the danger of
suffocation seems impending, and generally terminate in a dis-
charge, more or less abundant, of frothy mucus. The consti-
tutional disturbance does not amount to more than would be
produced by the distressing commotions of emesis and cough-
ing ; nor is there any functional disorder save those connected
with respiration.

The history received from the child's parents shed but little
light on the cause of the difficulty. It is reported that the child
was out at play, came in the house screaming, foaming at the
mouth, and discharging an abundant secretion of frothy trans-
parent mucous. His mother, under the impression that he had
drank strong lye, gave him sweet milk in quantities sufficient
to cause vomiting. Of this conjecture she could adduce no
stronger evidence than his being where it was, other minor
corroborating circumstances were mentioned, but so flimsy as
to be unworthy of note.

Another opinion, resting exactly on like foundation, asserted
that a cotton-seed had got into his wind-pipe ; so that so far as
the previous history of the case goes, the effect of the conflict-
ing statements on my mind is neutral.

In this perplexity of opinion, I administered ipecac freely in
order to disgorge the stomach of its contents, and incidentally
disengage the foreign substance from the larynx, if that should
be the nature of the case ; for I must confess that the examina-
tion made of the fauces by candle-light, rendered still more
difficult by the struggles of my little patient, gave but little
certainty to my opinions. Emesis is exceedingly difficult to
excite, having taken a large quantity of a strong mixture of
ipecac, and but little matter yielded from the stomach, among
which are pieces of undigested chicken eaten since accident.
Vomiting affords temporary relief, but the mucous accumula-

656 O'Keeffe, on Acute Laryngitis^ SfC, [November,

tion in the air-passages soon returns, and the respiration be-
comes again embarrassed. Having ordered a dose of calomel
and Dov. powder, and directed the ipecac given if dyspnoea
returned, I left him for the night.

Friday morning, second day. Rested partially, and spent
the night under symptoms such as have been described; no
action from bowels, respiration less embarrassed, but still diffi-
cult ; some improvement in all the symptoms got up this
morning as usual and played with his toys for a short time.

The throat was now examined more thoroughly than here-
tofore. The mouth and tongue, as well as the tonsils and velum
are perfectly healthy ; there is a circumscribed slight redness
behind and above the tonsils, better entitled to the epithet
engorgement than inflammation ; heat of surface normal ; pulse
somewhat accelerated. The only deviation from health con-
sists in the function of respiration, which is still sonorous and
loud, so as to be audible at some distance. While pressing
upon the base of the tongue with a spoon-handle, a thick some-
what opaque mucous is seen bubling out of the glottis, quite dif-
ferent from the transparent discharge already referred to.

In view of the absence of inflammation in the fauces, and a
want of correspondence between the pectoral signs and consti-
tutional symptoms, I pronounced it a case of foreign body in
the air-passages, and advised consultation. Three physicians
saw the case with me, one of whom was of the same opinion
with myself, while the other two differed from the diagnosis
already expressed in favor of its being a case of acute laryngitis
brought on by contact of the caustic with the laryngeal mucous
membrane. Notwithstanding the difference of opinion in the
causation of the disease, there was unanimity in the treatment,
which consisted in giving olive oil until it should operate, with
occasional doses of ipecac.

Friday night. The dyspnoea having became distressing, I
was again sent for. The embarassed respiration returned late
in the afternoon with some fever ; the oil has operated once,
and but little effect from the ipecac the same want of sus-
ceptibility to the action of emetics persistent. Administered
ipecac to emesis, and had him put in the warm bath with some
benefit to the dyspnoea.

1851.] O'Keeffe, on Acute Laryngitis^ <^c, 657

Saturday morning, third day. Met in consultation with the
same gentlemen. The child spent a very restless night, but is
belter this morning; respiration less difficult; no fever, nor
difficulty in swallowing ; tonsils slightly enlarged, but redness
and congested appearance of fauces diminished ; discharges
large quantities of opaque viscid mucus from the rima glottidis
while the tongue is being pressed upon by a spoon-handle a
result which ensues as often as the examination is made. The
act of deglutition excites a slight cough.

The calm reflections of twenty-four hours resulted in no
change or modification of the opinions expressed at our last
meeting; there is still contrariety of opinion in our etiological
views it is still foreign body in the larynx on one side, and
laryngitis on the other. It was determined by all to give ipecac
ad emesim, which was done ; vomited tolerably freely incur
presence, ipecac to be repeated three times during the day, and
the warm bath used as many times ; gum arabic water as a
drink. Not unmindful of the aphorism of the Coan sage, " qua?
medicamenta non sanant, ea ferrum sanat," tracheotomy was
suggested as appropriate in the event of the danger of suffoca-
tion becoming imminent, but was deemed advisable to be
adopted as a last resort a procrastination frequently destruc-
tive of the ends in view.

Saturday night. The danger of suffocation becoming aug-
mented, I was summoned again to see him ; respiration embar-
rassed all day, but has undergone a change for the worse since
about 4 o'clock, other symptoms the same as I have described
them at the night visits. Not being in greater danger than I
had seen him, I administered nothing, but ordered ipecac given,
and the use of the warm bath, if the breathing should get any
worse. The child's parents, alarmed at the persistence of the
disease, and being cognizant to our postponement of tracheoto-
my until the condition of the patient should become perilous,
were importunate in urging its performance, and threatened to
dismiss from the consultation such as were known to be averse
to it, and have others called in their place.

Sunday morning, fourth day. Saw the case alone and found
it much better, after 12 o'clock at night, having discharged a
quantity of mucus, the breathing improved, and is now less

658 O'KeefFe, on Acute Laryngitis, <^c. [November,

embarrassed than it has been since the beginning of his illness.
Ordered castor oil given until it operates, and mucilaginous
drinks continued.

Monday mornings fifth day. Had no return of dyspnoea
since last visit ; rested v^ell ; has had three evacuations from
bowels ; respiration still improving the loud sonorousness of
inspiration is supplanted by the sub-crepitant rhcnchus. The
countenance is dull and anxious; pulse frequent 130 per m.;
heat of skin moderate. Ordered poultices to chest, and hive
syrup every two hours.

Evening visit. Find him much better; has vomited two or
three times; no fever ; no signs of thoracic disease now. Or-
dei'ed castor oil to-night, and hive syrup repeated less frequently.

Tuesday morning, sixth day. Find him still improving; no
fever ; respiration easy ; seems to be free from indisposition ;
is feeble and coughs a little when he drinks.

February VMk. Seven days since last visit ; his father in-
forms me he considers him well, and adds that he coughs a little
sometimes when he drinks water. He has continued free from
any trace of the disease up to date September 1st, 1851.

Remarks. The difficulty of diagnosis in the above case is
one of its chief points of interest; neither the inception, pro-
gress, termination or treatment modified, in the least degree,
the conclusions arrived at on the first consultation. The laryn-
gitis theory found favor principally in the circumstance that
all the morbid phenomena exhibited in the case are found to
exist in acute inflammation of the laryngeal mucous membrane*
which is doubtless true ; and it is equally true that acute inflam-
mation of the same membrane will, and always does, produce
important phenomena, which did not exist in the case under
notice. If the record only presents the out-lines of laryngeal
inflammation, but exhibits a/w/Z representation of another mor-
bid condition, is it not logically fair to decide in favor of that
whose picture is the more perfectly drawn ? In order to show
the difference between the symptoms detailed in the record,
and those of acute laryngitis, I will adduce the latter from the
August No. of the London Lancet.

The subject was a tall, thin, delicately formed Bengalese aged

1851.] Q-Keeffe, on Acute Laryngitis, (^c. 659

30. Symptoms: '* countenance anxious ; breathing impeded
and hurried ; voice husky and thick ; inabihty to protrude the
tongue, which was, as far as could be seen, dry and very much
coated; constant spitting; deglutition appeared impossible;
pressure over larynx and trachea caused intense pain, and the
whole of the trachea appeared swollen ; pulse 100 ; skin hot
and dry; bowels confined." At 12 o'clock, after some active
treatment had been instituted, the record says: *'Much the
same ; large quantities of mucus running from his mouth ;
deglutition still difficult; voice gone." Two days after:
"Dangerously ill; breathing hurried; sense of suffocation;
countenance expressive of great suffering; large quantities of
mucus clinging to, and dropping from mouth ; larynx tender ;
voice a mere whisper; any attempt to look into the mouth
caused great pain ; every attempt to swallow caused spasm and
the rejection of the fluid through the nose ; unable to lie down."

This case, under active and judicious management, recover-
ed, notwithstanding the alarming symptoms it presented. It
will be seen that many important features of the above descrip-
tion have no parallel in the record : e. g. : inability to protrude
the tongue: a dry and coated state of that organ ; constant
spittingof thick, tenacious mucus; difficult deglutition appa-
rently impossible ; larynx and trachea painful on pressure ; hot
and dry skin ; large quantities of mucus running from mouth ;
loss of voice; deglutition causing spasm and rejection of the
fluid through the nose ; inability to lie down. Now, how could
the case in question have been acute laryngitis when it lacked
so many of its essential elements? It is proper to state that
the oedematous variety of laryngitis is selected for comparison
because the case we have been considering, if laryngitis at all,
can be classed no where else, on account of the great distur-
bance in the respiratory function that existed throughout its
course. It would be difficult to pronounce a case laryngitis
that lacked so many of its important phenomena. There was
no greater constitutional disturbance than ought to result from
an imperfect aeration of the blood ; there was not that restless-
ness, nor starting from sleep that are found in acute laryngitis,
the patient could sleep sometimes from morning till evening.
The inspection of the fauces, and external pressure on the

N. s. VOL. vir. N'o. XI. 42

660 O'KeefFe, on Acute Laryngitis, <^c. [November,

larynx, ga\ e no indications of a local inflammation ; the appear-
ance of the tongue was normal. How could a disease, consi-
dered the most alarming and intractable, pass through all its
stages without exhibiting unmistakable signs of inflammatory
action? a disease so rapid in its progress as sometimes to
terminate fatally in eight hours, requiring treatment eminently
perturbating and energetic. Indeed the treatment pursued in
the case was a severe commentary on the diagnosis that favor-
ed laryngitis. If an acute inflammation of a vital organ was
thought to exist, and that inflammation was exceedingly rapid
in its progress and intractable in its nature, why was the child's
safety compromised by putting him on a course of inefTicient
palliatives? The absence of inflammation in the mouth and
fauces ought of itself apparently set the question of laryngitis
at rest ; for we would reasonably expect to find the mouth and
fauces the seat of disease after drinking boiling water, or a sub-
stance such as has been suspected in the present case, rather
than the larynx and trachea. But Dr. M. Hall assures us that
the " efTects of this accident (swallowing boiling water) are not,
as might be supposed, a priori, the symptoms of inflammation
of the oesophagus and stomach, but of inflammation of the
glottis and larynx, resembling those o( crovp."

It is only necessary to recapitulate from the record the evi-
dence in favor of its being a case of foreign body in the air-
passages, the nature of which is not known. 1st. There was
not more constitutional disturbance than ought to result from
an impure state of the blood from faulty aeration. 2d. There
was but little difficulty in swallowing as seen in the circum-
stance that pieces of chicken had been eaten since the acci-
dent ; deglutition excited a slight cough which constituted the
principal difficulty in swallowing. 3d. The paroxysmal char-
acter of the disease ; the remissions amounted almost to inter-
missions from suffering during the interval of the paroxysms,
there was oppressed breathing with rattling in the throat. It
will be seen that at morning visits there was always an ameli-
oration of symptoms, while the dyspnoea returned at night
approached and lasted a variable length of time. It maybe
asked what has become of the foreign body, and how account
for the subsidence of the distressing symptoms? About 12

1851.] O'Keeffe, on Acute Laryngitis, cj-c. 661

o'clock on Saturda}^ night (vide record) large quantities of
mucus had been discharged with marked relief to the dysp-
noea, which continued to improve from that time. The
foreign substance (cotton-seed or pebble) (!) was expelled then,
or is yet embedded somewhere in the substance of the respira-
tory apparatus.

There are numerous instances on record of foreign bodies
dislodging themselves from mucous canals after they have be-
come enveloped in mucus without any artificial interference.
This principle of nature ridding parts of the presence of foreign
substances is designated the stimulus of relief, and is considered
of such importance by some surgeons that they v/ould never
attempt opening the trachea while the foreign body is capable
of mobility. The second clause of my answer, viz: that if
the origo mali had not been expelled from the air-passages, it is
still embedded somewhere in the substance of the respiratory
apparatus, finds ample corroboration in the annals of medicine.

A Monk got a cherry- stone in his trachea, and was seized
with alarming symptoms of sufi^ocation forthwith. He soon
obtained relief and slept two or three hours; for a whole vear
he did not feel the least inconvenien 'e from it. At the end of
this lime he suffered from cough and fever, and evacuated a
stone as large as a nutmeg, composed of tartarous matter, to
which the cherry-stone had served as a nucleus. A copious
purulent expectoration followed the discharge of the foreign
body, and the patient died consumptive some time afterwards.

A case occurred to Desault, in which a cherry-stone was
lodged in one of the ventricles of the larynx ; the patient would
not consent to an operation, and died in two years of laryngeal
phthisis. (Vide Cooper's Surg. Diet.)

The following cases from Ranking's Abstract, July, 1849
though recorded as instances of foreign body in the oesophagus'
are, in the editor's opinion, in all probability, cases of foreign
body in the air-passages. A young man aged 10 years swal-
lowed an ear of grass, was immediately deprived of the power
of speech, and breathed with such difficuliy that he appeared
to be suffocated. Shivering and fever supervened, and all the
symptoms of a formidable disease of the lungs. Active reme-
dies were employed. On the seventh day of the disease, a

662 King's Surgical Cases. [November,

tumor the size of an egg appeared between the sixth and seventh
true ribs, causing acute pain. Suppuration followed, and the
abscess opened of itself on the thirteenth day, when after the
discharge of much fetid matter, the mother of the patient with-
drew a body which turned out to be the ear of grass. The
young man completely recovered. A child of six months, sw^al-
lowed an ear of grass with which he was amusing himself.
The accident was followed by a violent coughing, which, how-
ever, did not favor the descent of the body, because the awns
were so disposed that they should have made it re-ascend. In
the posterior part of the chest, considerable inflammation took
place, and terminated near the fifth rib in an abscess, in which
the ear of grass was found.

A girl of one year swallowed an ear of corn,* (wheat) which
was immediately followed by violent coughing. On the fif-
teenth day, the patient discharged fetid pus by vomiting; and
on the same day, appeared a tumor on the right side, near the
superior ribs. The surgeon felt fluctuation, opened the abscess
and withdrew the ear of corn, which presented itself first, and
then followed much matter. Air used to come through the
opening. The child recovered perfectly in five weeks.

In several Nos. of the London Lancet for this year, are re-
corded cases, showing how foreign substances, such as pins and
needles, may be retained in the tissues of the organs for an
indefinite length of lime without producing any injurious effects.
It is now seven months since the occurrence of the accident
in the case under notice, and we have no guarantee that the
child is out of danger; time, which "overthrows the illusions
of opinion, and establishes the decisions of nature," can alone
determine whether or not evil consequences may ensue.

ARTICLE XXXVI.

Surgical Cases. By Wm. Nephew King, M.D., of Roswell, Ga.

The following cases have presented themselves to us in a
region of country not very prolific in surgical practice. In the
treatment of most of them, we have been assisted by an accom-
plished friend, Dr. Chas. T. Quintard. As it is a matter of

In Great Britain and Ireland, the term corn is used in reference to wheal.

1851.] King's Surgical Cases. 663

some interest to collect the surgical statistics of the various
parts of our Slate, we offer them for publication, without far-
ther preface :

Case I. Fracture of the bones of the forearm, with exten-
sive laceration of the soft parts about the icrist. A. H., aged
10 years, in attempting to "strip a card" in the factory, had
his hand caught in the wheel, and his arm drawn in between
the two revolving cards, stopping the machinery. The band
was slipped and his arm removed. We saw him in twenty
minutes after, and found him in the following condition:
There was great laceration of the soft parts above and at the
wrist ; rupture and laceration of the radial and ulnar arteries ;
together with fracture of both bones of the forearm. The flexor
carpi radialis, palmaris longus, supinator radii longus, had been
with the integuments torn by the teeth of the cards, a number
of w^hich were found in the muscles of the palm of the hand.
The integuments had been torn down and the palmar aponeur-
osis completely destroyed. There was no very great hemor-
rhage ; ligatures were however applied to the arteries, the ends
of the bones placed in apposition, and cold water dressing pre-
scribed. Although the destruction of the soft parts had been
very great muscles, tendons, nerves and arteries being de-
stroyed the patient progressively advanced toward a cure.
He now has a very partial use of his fingers. There has been
no perceptible increase in the use of the hand since the acci-
dent, now upwards of eighteen months.

Case II. Lithotomy. B., aet. 7 years, had been troubled
with the usual symptoms of stone in the bladder, since his third
year. Two years ago he was sounded by a medical man, who
detected a calculus, his general health good. On the lOih
July last, assisted by niy friends, Drs. Henry F. Campbell, of
Augusta, and Dr. Quintard, we proceeded to perform the o[er-
ation for his relief. The patient having been placed under the
influence of chloroform, the bilateral o'^evdiUon was performed
with the lithotome: the stone was seized with a pair of small
forceps and readily extracted it measured in its longest diam-
eter, three and two-thirds inches, and in its shortest two inches.

664 King's Surgical Cases. [November,

and is composed of oxalate of lime. The patient did well and
in a few days was up and about.

Case TIL Compound comminuted fracture of the leg Am-
putation. G. L., eet. 17, of ansemic habits; in falling from a
peach tree, a distance of about 8 feet, fractured both bones of
the leg. The fibula was fractured transversely, about six
inches above the ankle joint ; the tibia was fractured also trans-
versely, about three inches above the joint, and forced through
the flesh. The accident happened two miles from his resi-
dence, and we saw him about six hours afterwards. The
anxiety of his parents induced us to attempt to save the leg,
and after chloroforming the patient, the bones were placed in
apposition and the leg dressed. But the next day it was evi-
dent it could not be saved, and the friends of the patient ac-
quiesced in an amputation. Assisted by my friend Dr. Quin-
tard, and Mr. B. King, the usual flap operation was performed,
just above the knee very little blood was lost and but one
ligature applied. The stump was dressed and brandy admin-
istered, at intervals, until the patient had recovered from
the shock of the operation. Three grains of quinine with a
four.th of morphine were given. The patient continued restless
for some time and gradually sunk into a troubled sleep. Dur-
ing the next day the patient was supported by brandy and
quinine. Finding his bowels constipated, a dose of oil was
administered, which did not act during the next twenty-four
hours; at the end of which time an injection was given and
repeated several times. He finally had a very good evacua-
tion .of the bowels, and there passed a quantity of scyballa3 and
water-mellon seed mixed in the foccal matter; after which he
seemed quite easy, and having taken a Dover's powder, fell
into a sleep. He did not pass a very comfortable night, in
the morning his pulse was weak and quick gave him brandy
and quinine. The stump looked very well on the inner side of
the fl:ip, and was healing by the first intention ; but the exter-
nal part looked pale and presented no appearance of union, on
the contrary seemed inclined to slough. He continued about
the same until the eighth day, when his pulse began to flag and
become weak in spite of the treatment which had been contin-

1S51.] King's SiiTgical Cases. GG5

ued up to this time. The stump became (Edematous and the
swelling passed up as high as Poupart's ligament by evening.
Xext morning it had continued above the hypogastric and Iliac
regions, involving a portion of the scrotum. A camphorated
liniment was now applied, bowels were opened and brandy
and quinine given every hour. Saw him at four in the after-
noon : found him sinking rapidly ; the swelling continued up
as high as the ensiform cartilage. He now complained of in-
tense heat and pain, particularly in the right iliac region.
Every thing was rejected by the stomach, even a tea-spoonful
of chicken water hiccough finally supervened and our patient
sank into the arms of death, retaining the full possession of his
faculties to the last.

It would no doubt have been proper to have amputated in
this case at once; but the prejudices of those with whom he
has to do, often come between the physician and what he con-
ceives his duty. It is a little remarkable that a fall of appa-
rently so trivial a character should have produced such terrible
injury. This may perhaps be particularly accounted for by
the peculiar condition of the patient's system. He was thin
and spare, having very little color, and scrofulous looking hair
there was but little vigor of body : about a year ago in walk-
ing through the Factory in which he worked he fell and frac-
tured his arm: this was also a transverse fracture. His bones
were extremely brittle and the external plate of the tibia
was inordinately thin. Although the circumstances were very
unpropitious for an immediate amputation, if we were to be
placed in similar circumstances, we should adopt it as the only
chance of saving the patient's life. We amputated above the
knee, as we found some bruises just below it.

Case IV. Injury of the leg and foot. A laborer at a saw-
mill got his foot entangled in the wheel whilst attemptinor to
remove a block that had been caught under the wheel of the
mill. He was standing in the "race-way," up to his arm-pits
in the water, at the time of the accident. By a turn of the
wheel, as soon as he had removed the obstacle, his foot and le^"
were drawn in by the current, eflectually stoppim^ the motion of
the xcheel. He was removed only after the shaft had been cut

OQQ King's Surgical Cases. [November,

and the wheel lifted out. We saw him some time after the ac-
cident, he was in the following condition: The anterior sur-
face of the foot and leg was very much torn and lacerated ;
some of the tendons were torn loose. The dorsal artery of the
foot was ruptured, producing considerable hemorrhage, but it
had been arrested by a compress and application of cold water.
The lower portion of the tibia was entirely exposed save the
periosteum about three inches up, the skin flaccid, and muscular
attachments entirely torn loose the ligaments at the ankle
were left intact, however, save the anular ligament. All of the
anterior surface of the foot and leg, and also the lateral por-
tion, were more or less torn and bruised. After removing the
bandage, &c., we found that there was little or no hemorrhage,
save venous. The coagulum having been formed sufficiently
strong: to close the mouths of the bleedins^ vessels we did not
ligate them. I clipped off such of the tendons and muscles as
were hanging loose. Upon examining the wound, the probe
struck against some foreign body, which proved to be frag-
ments of wood, a part of the bucket of the wheel, lodged behind
the ieiido achillis. They were extracted, followed, however,
by a considerable flow of blood. I continued the examination
until I had removed every fragment. I now ordered a large
elm poultice to be applied, enveloping the foot and leg in the
same, and administered a dose of sulph. morpii.

In the morning the wound was dressed, removed some other
fragments of wood, cut off bits of loose muscle, skin, &c., and
applied cold w^ater dressing. This was continued until the
third day, when sloughing of the bruised parts began. This
process was encouraged by poulticing. The sloughing being
confined entirely to the bruised portion, and the line of demar-
cation being perfectly distinct, we felt no uneasiness at its ex-
tending up the limb.

No interference was interposed we waited until nature had
done her work, and then removed the dead portions. The
patient, as soon as the sloughing process began, was put under
the use of w'ine and quinine. The wound now w^as dressed
with puiv. lignia and a small portion of quinine to act as a
stimulus to the healthy parts and as a purifying agent. Small
and firm granules were gradually developed, and the case pro-
gressed rapidly to a cure.

8851.] Typho-Mania, G67

Case V. Tumor of the Knee. P. 1. G., of plethoric habit ;
presented himself with a tumor on the inner side of the right
knee. It had been growing for two years, and when he came
under our notice it had attained the size of a goose e^g, pro-
ducing some pain and great inconvenience in locomotion.
The patient was chloroformed, the tumor removed and found
to be adi[)ose in its nature. Two small arteries were ligated
the wound dressed with sutures and straps and although it was
impossible to keep tlie patient confined or quiet, it healed very
rapidly.

PART II.

(EcUctic Department

Typho-Mania. By A. V. Williams, M. D., late Visiting
Physician to the New York City Lunatic Asylum, on Black-
well's Island, and President of the Medical Board of the Emi- '
grants' Hospital on Ward's Island.

To the Edilor of the American Journal of Insanity :

Dear Sir The following copy of a communication, written,
as I am assured, away from home at the bed-side of a patient,
in fulfilment at the last moment of a deferred promise, was re-
ceived by mail, while attending the late annual meeting of the
Association of Medical Superintendants of American Institu-
tions for the Insane ; and whether wholly verified by time and
further observation or not, the views it contains, though very
hastily expressed, wei-e deemed by the members of the Asso-
ciation present, to have an important bearing upon the inter-
esting form of disease to which they relate, and I send it to
you for publication, for the consideration of absent members
and others.

It may be mentioned here, as pertinent to Dr. Williams'
views, that Dr. Brigham, in his work on the brain, expresses
his belief, that that organ "is primarily affected" in idiopathic
fever, and that the primary disease is *' probably functional,"
and appears to consist in such a 'Moss or change of vitality or
natural energy of the brain, that it ceases to supply the other
parts of the system with tfieir due proportion of nervous fluid
or energy." Now if the "delirium and disease of the bowels"
in typhus and typhoid fevers are "consequences of a primary
affection of the brain," as Dr. B. thinks, is it not reasonable to
infer that, as one of the protean variations which almost every

G68 Ti/pho'Mania, [November,

disease will at different times assume, the delirium may show
itself as almost the first evidence of indisposition, and, becom-
ing more intense and protractino: itself longer than ordinary,
supersede the development of intestinal lesions and the usual
course and many of the usual phenomena of typhus?

^ ^ -^^ C.H.N.

Bloomingdale, New York, May 20th, 1851.

Ml/ dear Doctor : As you request, Twill write you some
account of that form of Insanity, which in our conversations
and in my reports, I have denominated Typho-manla, from the
striking typhoid character of the physical symptoms it exhibits
and the corresponding treatment required for its cure. 1 do
not, however, consider it a new form of disease. It was strong-
ly placed before me whilst acting as Visiting-Physician to the
New York City Asylum on Blackwell's Island. It prevailed
amongst Irish Emigrants newly arrived, who had been exposed
to the influence of Ship Fever, and suffered from the privations
of a long sea voyage.

Every one who has had charge of an Asylum, for any length
of time, will recollect to have had patients brought to him in a
state of raving, incoherent madness, when the physical suffer-
ings were so gi-eat as to strike the attention more forcibly even,
than the mental condition. The bodily disease or prostration
is so great that the question we ask ourselves is, will the patient
live? As far as my knowledge extends, this form of insanity
is not described in any of the systematic works on mental dis-
ease, but it is occasionally alluded to in Reports. Dr. Bell
has written an interesting paper upon it, and Dr. Ranney de-
scribed it in a paper on the Insanity of Foreign paupers, which
was read before the Association of Medical Superintendents
of Insane Asylums, at its annual meeting in 1850.

In the year 1848 a number of these cases were admitted into
the City Asylum on Blackwell's Island, and the large majority
of them were females recently landed. From a patient of this
class, typhus was introduced into that Institution, and the same
year the same thing happened at the Bloomingdale Asylum.
These circumstances, together with the appearance of the dis-
ease, tended to confirm me in the view that the exciting cause
of it was typhus poison. You suggested, as the reason why
Dr. Bell had seen more of this malady than the other members
of the Association, that he lived in a region where typhus pre-
vails. If the typhoid fevers of New-England are identical with
the typhus of Europe (our Ship Fever), which is held by high
authority to be the case, your conjecture may be correct.

Since my connection with the Emigrants' Hospital on
Ward's Island, I have seen this disease in its commencement.

1851.] Typho-Mania. 669

The patient would perhaps exhibit mer6 irritability and become
quarrelsome in the wards, when I have been asked to see him,
and have detected the real state of the case, and despatched
him to the Asylum, where the disease would run its course.
One remarkable feature of this disease is, that when patients
recover from it, they do so completely, and not by tfie gradual
return to reason, as in ordinary mania. When this has not
been the case, I have learned from some patients after a more
protracted recovery, that they have labored under mania be-
fore.

In the early stage of the disease there will be heat of skin,
quick pulse, furred tongue, foetid breath, the odor of typhus, red
eyes, generally constipated bowels, loss of appetite and great
thirst. The mental symptoms are those of some persons in a
slate of intoxication verging towards stupor. They talk wild-
ly and incoherently witli general hallucinations, without any
fixed delusions. If you arrest their attention, they will answer
correctly but impatiently, and hurry off in their wild frolicks,
hallo'oing, shouting, singing and tearing their clothes. If drink
is given, they gulp it down in the same hurry, and if they can
be prevailed upon to take food, swallow it without mastication,
bolting it like a famished dog. The mental excitement does
not subside with the heat of the skin and febrile disturbance,
but sometimes when the skin is cool and the pulse small and
feeble, they will rave most. In these cases, if depletion should
be resorted to, I doubt not the result would be fatal.

With regard to treatment I have only to observe, that it has
been in accordance with the views I entertain of its nature, and
has been that adapted to typhus fever, except as it might re-
quire modifications in particular circumstances. After the first
stage I have found great benefit from morphine; keeping the
patient under its influence, combined with tonics, until it run
itself out. Tartar-emetic ointment applied to the neck and be-
tween the shoulders, has also been of great service.

In the autopsies I have witnessed, the sinuses and veins of the
brain and its membranes have been loaded with dark blood ;
there has also been a congested state of the veins of the abdomi-
nal viscera. The brain itself has sometimes been soi'tened, and
there have also been effusions into the cavity of the cranium.

I do not recollect a case of typho-mania that ended in de-
mentia. Three years since, a lady, after returning from a visit
to her friends in '('onnecticut, was attacked with typhus fever,
and in the second week of the disease that peculiar form of
insanity set in, from which in a short time she completely re-
covered.

I think Dr. Bell remarks, that in some of his patients there

670 Startling Facts from the Census. [November,

was a suicidal propensity, and that by starvation. This I have
not observed, their aversion to food arising fronn the want of
appetite and absolute loathing. In the worst cases they could
be induced to swallow food, but in the rapid manner I have
before mentioned.

If opportunity offers, I will examine Peyer's glands, to see
whether they are affected in this disease. Dr. Hanney states
that he has never seen petechias, although I do not consider
the eruptions essential to constitute typhus. They are gener-
ally present, but frequently so few in number that they may
escape observation.

1 hope this hasty sketch may excite the members of your
Association to further investigation.

Yours truly, A. V. WILLIAMS.

Chas. H. Nichols, M. D.,

Physician to Bloomingdale Asylum, New York City.

Startling Facts from the Census,

Messrs. Editors In the interesting article on the increase
of our population, published in your paper of June 12th, you
remark in the words of The Commercial: "Either the free
colored population are voluntarily emigrating at a rate beyond
what is generally supposed, or there is something in their
social condition that is entirely inimical to their physical pros-
perity."

Many arguments might be adduced to prove that the latter,
and not the former alternative is the real fact. And as a re-
markable illustration of this truth, I send you a copy of a few
items from a statistical table which I compiled some years ago
from the U. S. Census of 1840, and published in a country
newspaper, without obtaining much notice, although it exhibits,
in a most striking light, the amazing prevalence of insanity and
idiocy among our free colored population over the whites and
the slaves.

It is a matter of regret, that the U. S. Census of 1840, groups
both these classes of unfortunates together, as if they were in-
volved in one and the same calamity. And it is also to be
regretted that there is no discrimination of the prevalence of
these maladies among the free blacks and the slaves. The
writer made an effort to have these imperfections obviated in
taking the late census in 1850; but he has reason to apprehend,
from what he has seen of the returns, that his feeble voice did
not engage the attention of the *' Commissioners" who were

1851.]

Startling Facts from the Census.

671

entrusted with the responsible duty of preparing the forms;
though they solicited suggestions from those who felt an inter-
est in the subject.

The census of our own Stale, taken in 1845, carefully dis-
tinguishes between idiots and lunatics; from which it appears,
that their ratio in the State of New York is about 4 to 5, or
more, nearly \Q to 21, on the whole population; but it makes
no distinction between the white and colored population in
regard to the existence of these maladies. It is obvious, how-
ever, from the following schedule, that there is an awful preva-
lence of idiocy and insanity among the iveQ blacks over the
whites, and especially over the slaves. Who would believe,
without the fact, in black and white, before his eyes, that euer?/
fourteenth colored person in the State of Maine is an idiot or
lunatic? And though there is a gradual improvement in their
condition, as we proceed west and south, yet it is evident that
the free States are the principal abodes of idiocy and lunacy
among the colored race.

STATISTICAL TABLE FROM THE U. S. CENSUS OF 1810.

States.

Maine

New-Hampshire.
Massachusetts. ..

Vermont

Connecticut

. Rhode Island. . ..

Ne W.York

New- Jersey

Pennsylvania ...

Delaware

Maryland

Virginia

North Carolina..
South Carolina. .

Georgia

Ohio

Kentucky

Louisiana

Total

Insane

White

and

populat'n

Idiots.
537

500.438

284,030

486

7-29,030

1,071

291.218

398

301,850

498

105.587

203

2,378.890

2,116

351,588

369

1,670,115

1,946

58,501

52

317,717

387

740,968

1,052

484,870

580

259,084

376

407,695

294

1.502,022

1,195

590,253

795

158.457

55

Proportion

1 in
I "
1 "
1 "
1 '
I "
1 "
I "
1 "
1 "
1 "
1 "
I "
1 "
1 "
I "
I "
1 "

950
584
602
731
606
520

1,108
952
861

1,126
821
704
835
689

1,387

1,257
742

2,873

Total

Insane

Color'd

and

popula.

Idiots.

],355

94

538

19

8,669

200

730

13

8,159

U

3,243

13

50,031

194

21,718

73

37,952

187

19,524

28

151,515

141

498,829

381

268,549

221

335.314

137

283.697

134

17,345

165

189,575

180

193.954

45

Proportion.

14

28

43

56

185

249

257

293

256

697

1,074

1,309

1,215

2,440

2,117

105

1,053

4,310

In the preceding list, I have aimed to give a view of this
subject on the territory occupied by the thirteen original
States. 1 have added Ohio and Kentucky merely to show that
the same contrast between the old free and slave States exist
in the new. Ohio and Kentucky, though contiguous to each
other, and of nearly equal age, exhibit the same amazing dif-
ference. In the former, there are just 10 colored persons who
are idiots or lunatics, where there is one in the latter.

In Louisiana, where a large majority of the population is
colored, and four-fifths of them slaves, there is but 1 of these

G72 Punctured Wound of the AbdomeUyi^c. [November,

poor unfortunates to 4,310 who are sane. In fact, the want
of sense or reason appears to be a rare visitation upon those
who are held in slavery. This is an ample theme for the specu-
lations of the physiologist and the moralist. ^N. Y. Observer,

Punctured Wound of Abdomen Wound of Liver : Recovery.
By Frederick G. Leroy, M.D., Resident Surgeon.

Wm. Craddock, act. 27, New York, seaman, admitted into
the New York Hospital, July 4th, 1851, (Dr. Post in attend-
ance,) with a penetrating wound of the abdomen, caused by
the premature discharge of a horse pistol, from which he was
endeavoring to withdraw the ramrod. The rod passed be-
tween his hands, and struck the abdomen a little to the right of
the median line, about an inch below the common cartilage of
the false ribs on that side. Upon introducing the finger, and
tracing the course of the wound, the liver could be distinctly
felt, and on passing its extremity over the surface of the organ,
a laceration of it was detected that corresponded with the ex-
ternal opening. From the nature of the injury, its precise
depth could not be ascertained. Patient had on at the time of
the accident, a common coloied shirt, with a red one beneath
it ; the fragment of red flannel was removed by the physician
who attended him previous to his admission into the hospital.
The portions of the colored garment were supposed to have
been carried in with the rod. Has vomited several times since
the accident ; at present complains of no pain, but has some
difficulty in respiration. There was a slight venous hemorrhage
from the wound. Pulse natural.

Treatment. Edges approximated by means of a suture.
Cold water dressing. I^. Tr. Opii. M. xxx. P.M. :^. Pil.
Opii. gr. 1. q. 2 h.

July 5th. Patient passed a comfortable night, after having
taken two of the above pills. Bowels being confined, ordered
an enema containing 01. Terebinth 5s; wound covered with
lint saturated in m. g. a., and emplas. vesicans over this as a
prophylactic. Strict diet.

July 7lh. There is slight tympanitis ; the bowels remaining
constipated, was directed to . Cal. grs. ii. q. 2 h. until they
were removed. Camph. cataplas. to abdomen. The calomel
vomiting him after the second powder, it was discontinued :
V^. Haust. EflJervesc.

July 12th. General condition favorable; no symptom of an
urgent character having presented since the last note. At
present there is no febrile action, has a natural stool, &c. The

1851.] Punctured Wound of the Abdomen, ^c. 673

slough is separatincj from the edges of the wound, which is
closing up with healthy granulations. To day, removed several
pieces of cotton, which upon examination proved to be the
missing portions of the colored shirt.

July 20th. Has had several paroxysms of pain over the re-
gion of the liver, and in the right shoulder, which he states to
iiave been of a tearing character, and most intense in the even-
ing. Respiration labored, and 27 per min. Pulse alternating
between 72 and 80, without any undue excitement. 3. Opiates
Camph. poultice to abdomen, and emplas. vesicans., over the
seatofj)ain; under the influence of which remedies, all the
unpleasant symptoms gradually subsided.

July 23d. Several chills have occurred in the last two days,
general condition very unfavorable, countenance har^gard, hot
surtace, labored inspiration, cough, with pain in the side. Pulse
92, frequent and hard, slight dulness on percussion. R. Tart.
Ant. et Potass, grs. i q 2 h. Emplas. vesicans. to side.

July 24th. After taking one dose of the antimonial solution,
patient became so much prostrated, as to require stimulants,
and upon reaction beingin a great measure established, ^. Pul.
Ipecac, frr. ss. m. g. a 3 ss. as a substitute for the above solu-
tion. Still complains of pain in the side, and difl[iculty on
inspiration. Auscultation reveals an indistinct crepitas. ^.
Emplas. vesicans. over the posterior surface of the lung.

July 30th. All the thoracic symptoms have subsided, with
the exception of a slight uneasiness in the rifrht side. Chills
continue ; has had as many as four in the twenty-four hours.
After some of tfiese attacks patient is very much prostrated,
and at times quite flighty. For these the sulphate of quinine
has been freely given, commencing with grs. x., and gradually
increasing up to the present time, when he takes grs. xxv. in
the day. The wound has entirely healed.

Aug. 4th. Has had no chills for four days past. Quinine
has been continued to the present date, when it is directed to
be gradually diniinished daily. The whole surface of the trunk
is covered with suppurating boils, that occasion considerable
constitutional irritation ; upon their sudsiding, patient's whole
system seemed to undergo a marked change for the better,
and he commenced gaining in flesh.

Aug. 16th. Since last date, an abscess has formed, and
pointed in the original wound, opened spontaneously and gave
exit to a greenish discharge, pus apparently tinged with bile ;
upon its ceasing, the wound again closed, and he was discharged
cured.

The present case possesses a peculiar interest, from the seri-
ous nature of the wound, and the entire absence of any report

674 Punctured Wound of the Abdomen, ^c, [November,

of cases strictly identical with it in the different Journals, and
surgical authorities that have been consulted. One of its
most prominent features was the greenish discharge from the
abscess, some of which was collected and placed in the hands
of a chemist for anal3^sis ; but no satisfactory return could be eli-
cited from him, although particularly requested to give it a care-
ful examination. That this discoloration was effected by bile,
is a fair conclusion, and one, I think, the history of the case justi-
fies. What office nature performed in its happy termination,
or how much should be attributed to the treatment employed,
is a question for conjecture. But, that opium exerted a benefi-
cial influence in this, is indicated by the pulse; and its efficacy
in wounds of a similar nature will be allowed, by all surgeons,
who have given it a trial. Cases of rupture of the liver occur,
though they are rare, and are generally the result of fracture of
the ribs, or some heavy weifjjht passing over the body. But
these lesions are not ascertained until revealed by an autopsy.
A case is reported in the Medico-Chirurg. Review, New Series,
vol. xxiv., p. 296, in which a cavalry officer was thrown from a
horse, and the animal trod upon his chest with his hind feet.
He survived the accident eight years, experiencing constant
pleuritic attacks. Before his decease he fell under the observa-
tion of the physician who had attended him after the accident,
who feeling an interest in the case, made an examination, and
found a rupture of the right lobe of the liver, throughout its
whole length and substance, from its anterior to its posterior
border. The cicatrix was large, broad, and of a cartilaginous
character ; occupying the fissure beneath this, were biliary con-
cretions. Two cases of wounds of the liver are recorded in
the case books of this Hospital, though no symptom presented,
by which they were recognized as such previous to death.
One, was that of a boatman, admitted w^ith a penetrating wound
ofthe abdomen, inflicted with a butcher's knife. Patient linge-
red twenty-two hours. Autopsy disclosed an incised wound
of the left lobe of the liver, three inches in length and one and
a quarter in depth. The second, was a cartman who had re-
ceived a gun shot wound of the abdomen, midway between
the umbilicus and ensiform cartilage. Survived the accident
twenty-four hours. On making an examination, the left lobe
was found to have been lacerated by the shot, and the coats of
the stomach perforated. [New York Medical Times.

1S51.] Spontaneous Combustion. G75

Spontaneous Combustion.

Tlie question of spontaneous combustion being involved in
a trial, recently, at the capital of the Grand Duchy of Hesse
Darmstadt, and scientific o})inions on the point conflicting with
each other, the Judge directed Profs. 8. Bischoff, and J. De
Liebig, to be summoned, in order, by their investigation and
testimony, to resolve doubts as to the probability of the occur-
rence of such an event.

A report of the case appeared in the Archives Gcncralcs da
Medicines, Paris, wliich has been translateci by a correspon-
dent of the Western Journal of Med. and Surgery. Tiie details
of the case are interesting, but we are obliged to omit them on
account of the space which they would occupy.

We give the oral re[oit of these distinguished Professors on
the subject of spontaneous combustion, aside from the particu-
lar facts in the trial referred to. It will be seen that they are
convinced of the impossibility of such an occurrence. \_EdLtor
Buffalo Med. Journal,

The first recorded case of spontaneous combustion, said Mr.
Bischoff, dates back about one hundred and fifty years (that of
Mihet a woman of Reims, in 1725.) By human Spontaneous
CoNibustion, we understand that a man has been more or less
burned, without our being able by external circumstances to
explain the burning. Then it is that we say, this man has burn-
ed not by aid of external combustibles, but within himself
(spontaneously;) an expression, which, implying an entire
tlieory, seems to be incorrect. How much better it would be
to say : we do not know how this person died, but, in saying
that he died from spontaneous combustion, we only substitute
an explanation quite as absurd. Thus the doctrine of sponta-
neous combustion, which has cre[t into the science, is the result
of ignorance, and not of scientific research or experimentation.
Upon what authorities does this pretended fact rest? The
forty-five or forty-eight cases which have been published, relate
to individuals burnt either where there was too little, or an
entire absence of, combustible material, to account for the com-
bustion. With the exception of two cases of complete and
four of partial consumption by fire, the victims of which survived,
no one })osscssing scientific knowledge, no witness of any sort,
has been present during the accident. The first case of coni-
]^lete spontaneous combustion, w\as witnessed and described
by a chamber-maid and an unknown person, and the second
by a stranger. In the four cases of partial combustion, it is
very evident that the first one was caused by burning sulphur,
which the burnt person spread upon his clothing in the endea-

N. S. VOL. VII. NO. XI. 43

G76 Spontaneous Combustion. [November,

vor to extinguish the flames with his hands : the second was
the case of a younsj girl of Hamburg, upon whose hands there
appeared a flame which was followed by vesicles ; but this fact
though reported by a distinguished physician, was not witnes-
sed by himself, or by any other person. Most probably then,
these vesicles were the result of some disease, or perhaps of a
burn intentionally made, for the purpose of attracting attention,
or gaining admission into the hospital. The third case, which
is very generally known, relates to a priest, named Bertoli,
and was reported in 178G, by an Italian surgeon. Any unpre-
judiced person, who reads the account of this case, must be con-
vinced that that individual was burnt by fire communicated to
his clothing from a lamp. The fourth is still less worthy of
confidence ; it relates to a blacksmith named Reynaleau : a
narration unconfimed by the slightest evidence, full of contradic-
tions, and windino- up with a characteristic trait, that holy water
only was able to extinguish the flames. Not one of these cases
has ever been reported immediately after its occurrence by any
one of recognized authority. Physicians have arrived in seve-
ral instances after the catastrophe ; and some of the cases have
been subjected to a judicial inquest, and have the appearance
of reality. But for an observer accustomed to criticism, and
to the requirements of rigid observation, the reports which we
possess are far from presenting the guaranties indispensable to
an enlightened investigation. Phenomena such as those of
spontaneous combustion, require a methodical observation,
which the cases mentioned do not possess the slightest trace of.
In none of them was there even an autopsy made, still less a seri-
ous, scientific investigation,or chemical analysis. In all the cases
of spontaneous combustion which have called forth judicial or
medical inquests, we constantly see an exhibition of levity, igno-
rance, prejudice, credulity, and very often of culpability. At
the epoch when most of these facts were reported, science itself
was not sufficiently far advanced to supply the lights necessary
for an analysis of what was observed. As to the numerous
cases that have been reported from hearsay, they are based
upon the authority of the school-master, the curate, or the vil-
lage mavor, but have never friven rise to an inquest of any kind.
A recent and very remarkable instance will demonstrate how,
graduallv, these accounts become introduced into the annals of
the science. M. Bischofl' here cited the case of pretended
spontaneous combustion, published by the Gazette des Tribu-
neaux, and reproduced in the Journal des Debats, for Fehmsiry
24th, 1850. The case was that of a man who, in a drinking
shop, where he had, according to custom, drank deeply, intro-
duced into his mouth in consequence of a bet, a lighted candle ;

1851.] Spontaneous Combustion. 677

he was suddenly set on fire from within, and his head and the
upper part of his chest were carbonized in half an hour in spite
of all the assistance rendered. The death and the effects of
the fire were reported to have been verified by two physicians.
From information acquired by 'SI. Liebig from different savans
of Paris, and especially from the prefect of police, it turns out
that the whole account was imaginative, and pure fiction, inven-
ted for the columns of the paper which had inserted it.

The question of spontaneouscombustion has been treated of,
adds M. BischofT, by Rudolphi and Treviranus, MM. Kopp
and Nasse. These savans have investigated and have expen-
ded a great deal of labor and of science for the purpose of ex-
plaining this phenomenon. But incredible as it may seem,
without first assuring themselves of the truth of reports as made,
they have admitted them as they were presented. Their ex-
planation only could be important, and this is wanting. We
do not deny these cases because we cannot explain them, but
because their existence must be based upon explanations which
tend to overthrow the laws, heretofore admitted as true and
exact, of physics, physiology, chemistry and pathology. I will
confine myself to the. mention of the fact, recognized by all,
that a bod}' containing twenty-five per cent, water, does not
take fire of itself, and does not continue to burn when started.
Suppose we collect all the solid parts of the body, the bones,
the skin, the tendons, the muscles, and put the water contained
in the body into a vase; kindle these solid parts and their en-
tire consumption will not afford sufficient heat to vaporize
the water. Alcoholic excess, however, we are told, brings
about a modification in the human body which renders possi-
ble its spontaneous combustion. It is true, all accounts of cases
of spontaneous combustion tell us that the subjects were ad-
dicted to the abuse of ardent spirits ; it is also true that alcohol
is inflammable ; and why not admit that the body soon becomes
impregnated with it, and that, especially when fire is commu-
nicated from the exterior, it can burn. Such reflections may
be made, but for the naturalist and physician they are valueless.
The knowledge which we possess upon the passage of substan-
ces from the stomach and intestines into the blood, teaches us
that alcohol reaches slowly, and in very small quantities, the
sanguineous system, and as the circulation goes on with great
rapidity, the alcohol is carried almost immediately into the lung's,
where blood comes in contact with the air. There the elements
of the alcohol become modified by its combination with the
oxygen of the air, forming carbonic acid and water which the
respiratory process eliminates from the system. Thus under
ordinary circiunstances we cannot even prove the presence of

G78 Spontaneous Combustion, [November,

alcohol in the blood, since it is decomposerl and thown off by
the lunffs. Here it mav be thou2;ht that alcohol taken al>und-
anlly will penetrate the blood in substance and in large quan-
tities, and spread itself throughout the whole system. Obser-
vations and experiments by distinguished men have been made
upon this subject, but they are contradictory ; some pretend to
have found alcohol in the blood, and even in the brain of persons
addicted to drink and who have died drunk. Percy discovered
traces of it in the brains of dogs into whose veins he had injec-
ted a considerable dose. But the observations of Percy are in
direct contradiction to those of Dr. De Pommer, of Zurich,
Avho found no traces of the spirit in the blood. MM. Bouchardat
and Sandras w^re unable to discover alcohol in any secretion
except in the pulmonary exhalation. So far then it remains
to be proved that the human body can imbibe alcohol like a
sponge ; moreover it is, a priori, impossible to admit that the
body being saturated with alcohol life could continue for a
single instant. The coagulation of the albumen, the arrest of
the circulation, and the destruction of the nervous system, are
the immediate results of the injection of any considerable quan-
tity of alcohol into the blood of an animal. For my own part
I am convinced that a dead body does not become combustible
from being saturated with alcohol. I have taken parts of a
dog into whose arteries I had injected alcohol at 92, and they
would not burn \Yhen exposed either to a flame or to the action
of carbon ; in the latter case only they roasted and carbonized,
but even that ceased so soon as withdrawn frojn the action of
the lire. M. Bischoffended by refuting and ridiculing the stories
of flames issuing from the mouths of drunken individuals.

M. Liebig, who, six years since, had given his opinion upon
spontaneous combustion, {Annates de ChiiJiie et de Fliysique,
1844, t. 1, page 331,) likewise opposed, for very extensive rea-
sons, the possibility of the facts reported on the subject. It will
be borne in mind, said he, that the jdea of spontaneous combus-
tion arose at a period when all opinions upon the subject were
erroneous. What takes place in combustion was only known
some seventy years ago, (Lavoisier.) What is necessary for the
combustion of a body, has been known only forty years, (Davy.)

Since the occurrence of the case of JMillet, of Rheims, to the
present time, some forty-five or forty-eight cases have occurred
which are alike in 1st. Always having taken ])lace diu'ing the
winter season ; 2d. The persons attacked have all been drunk-
ards, drunk at the time; 3d. They have most generally fiappen-
ed in countries where rooms are heated by open fire-places, and
furnaces of charcoal, in England, France, and Italy; in Russia
and Germany, where stoves are principally used, deaths from

8851.] Phosphate of Lime in Scrofula. G79

spontaneous combustion are very rare ; 4th. There have been
no eye-witnesses to the combustion ; 5th. No physician,
amongst all those who have attempted to explain these cases,
has seen one ; Gth. There is no infon^nation as to the quantity of
combustible matter consumerl ; 7th. Some time has always
ela]>sed from the commencement of the combustion until the
body has been found consumed. ^I. Liebig also argued with
great power upon the principal details reported as connected
with spontaneous combustion, and upon the ex})]anations given
of them. He also demonstrated clearly the error into wliich
the partizansofthe spontaneous combusiio)i theory have fallen.
The arguments which they employ beina- deduced, contrary to
all logical rules, in the cases in point ; death and the destruction
of the body, the cause of which is unknown, being assumed as
proof of the truth of the assumed cause. These are explained
by the fact of tlie possibility of spontaneous combustion, the
existence or possibility of which is proved by tlie same cases.
Tins discussion we are disposed to believe does not adniit of
refutation, and gives a fatal blow to the doctrine of spontaneous
combustion.

The trial, which occupied the greater part of the month of
March, 1850, concluded by the condemnation of J. Strauss, as
the murderer of the ('ountessof Goerlitz, to perpetual imprison-
ment. The journals have recently published that he lias made
a full acknowledgment of his crime. He admitted that going
into the chamber of the Countess upon some household duty,
and finding no one, he could not, upon seeing that the secretary
contained money and articles of value, resist the temptation to
steal. The Countess having discovered him in the act, he
seized and strangled her with some difficulty : then havin^^^
placed the body in an arm chair, near the secretary, he surround-
ed it with combustibles, to which he set fire for the j)urposeof
concealing his crime. \_Bulfalo Medical Journal.

Phosphate of Lime in Scrofula and other dej)ravcd states of
the System. By W. Stone, M. D., Prof of Surgery in the
University of Louisiana.

In the July number of the reprint of the London Lancet,
there is an article by Beneke, entitled the Physiology and Pa-
thology of the Oxalate and Phosphate of Lime, and their rela-
tion to the formation of cells. The conclusions of the author
are based upon careful chemical research and results fronj {he
use of the remedy. His researches show that in man. as well
as in vegetables and inferior animaLs, Phosphate of Lime as

680 Phosphate of Lime in Scrofula. [November,

well as albumen and fat is absolutely essential for the formation
of cells, and he considers that many of the pathological states
of the system depend upon a deficiency of this salt. The af-
fections in which it is advised are ulcerations dependent upon
a general dyscrasia, and not a mere local affection ; infantile
atrophy ; in those suffering from rickets and consequent diar-
rhea and tuberculous diseases, particularly of the lungs in the
early stages. I was favorably impressed with the article, and
being encouraged by the results of the Practice, I am induced
to relate a few cases by way of calling the attention of
the Profession to it, believing great improvement may be
made in the treatment of diseases dependent upon vice of
nutrition.

Case I. Slave Bob was admitted into my Infirmary early
in July, with a disease of his nose. Two large fungous growths,
one on each side of the nose, barely separated by a strip of
sound skin in the centre, of about one inch in diameter, extend-
ed nearly to the corners of the eyes. The cavities of the nose
were filled by a similar growth, and the disease was making its
appearance in the roof of the mouth. Kis general appearance
was bad. and not unlike that of a dirt eater. He complained
of pains in different parts of the body, but not much at the seat
of the disease, an I he had an indolent sweUing on one of his
feet which finally softened down, and on being opened, dischar-
ged a thin matter and broken down tissue, leaving an ill-condi-
tioned ulcer. I had to rely upon him for his history, which
must necessarily be imperfect. He said the disease commenced
four months previous in the nasal cavities and gradually made
its way through. An examination showed that the bones had
been absorbed the mass bled freely, and upon pressure a thick
cream-like pus appeared, and some of it resembled softened
tuberculous matter. Pulse feeble and frequent, and digestion
bad. I do not know what particular treatment he had been
under, but he appeared to be slightly under the influence of
mercury, and I put him upon the use of the hydroid of potass
cut off the fungus externally, and extracted a much as was
practicable from the nasal cavities with polypus forceps and used
a lotion of the sulphate of copper. No perceptible improve-
ment followed, and on the first of August I put him upon the
use of cod liver oil, but his digestion continued bad, had acid
eructations which he thought was worse when he took the oil.
The phosphate of lime was added eight grains three times a
day, and he soon began, for the first time to improve. His
color began to return the local disease began to assume a
better appearance. Local treatment was disregarded, and the
oil and phosphate of lime has been continued up to this time.

1851.] Phosphate of Lime in Scrofula. 681

His color is now of a shining healthy black. The fungus is even
with the surrounding skin. Cicatrisation is taking place, and
the fungus has disappeared from the nasal cavities, so that he
breathes quite freely through them. Those having confidence
in cod-liver oil, may attribute the favorable change to it alone,
but I would say that no favorable change took place until the
lime was given, although it had been given sufficiently, I think
for a fair trial. The oil may supply one deficiency, and the
lime another; but my object is not to theorise, but to draw
attention. Bleeding, leeching, cups and gum water, on the one
hand, and tonics, stimulants and opium on the other, are suffi-
ciently well undertood, but I believe that Chemistry is yet to
assist us and enable us to relieve many of those undefinable
maladies that depend upon vices of nutrition, either hereditary
or acquired, whilch cut off so many before the natural decay of
the system takes place.

Case JI. Miss . aged 24, had been in delicate health for

some time, without suffering from any particular disease. In
May last, a dry cough commenced, and loss of appetite followed,
etc. But to make it brief, as it is but a common case, I saw
her about the middle of June, and found the upper part of both
lungs filled with tubercles, in some places beginning to soften.
Her cough was almost incessant, expectoration slight, consiting
of viscid mucus, streaked with pus, and occasionally with blood ;
pulse a hundred and twenty, much emaciated, and her menses
had ceased. She had fever in the evening, and exhausting
night sweats. I ordered cod-liver oil, together with a soothing
cough mixture, for temporary relief, and to procure rest, which
she could not get without. This course afforded some relief,
but the appetite did not improve, and I could not say that any
marked improvement had taken place. About the first of July
I gave the phosphate of lime, in addition to the oil, and in a
short time there appeared 1o be some improvement in the appe-
tite ; the sweats begantoleave, and hercolorgradually to return.
The same course has been continued up to the present time,
and she says she feels better than she has for two years. Her
cough is in a great manner gone ; she has gained considerable
flesh, and has for the last two periods menstruated more natu-
rally than for two years previously. There could be no doubt
as to the precise nature of this case, and I am free to allow full
credit to the oil, but 1 am confident that the lime was equally
useful. The patient, who knows nothing of the medicine, spoke
of its good effects. If the theory upon which its beneficial
effects are based is correct, it ought to be an admirable assistant
to the oil. I do not pretend that this patient is eflectually cured,
but it must be admitted that the result of the treatment is highly

682 Operation for Hare-lip. [November,

It was a case of unmixed phthisis, that might
have been expected to terminate in the course of a few months.
Case III. A child of ivlr. W., aged about seven years, had
been laboring under a derangement of his bowels something
over a year, and had been treated by very excellent physicians,
with only temporary benefit. I saw him first in July, during
one of his bad spells, as it was termed. I will not be so tedious
as to give all the symptoms of the case, or the treatment that
had been pursued. Sufiice it to say that he was emaciated
very much, but there was no evidence of any serious organic
lesion, and no decided appearance of a scrofulous taint. Dys-
peptic diarrhea is a term as applicable as any one term to his
case, though at times he seemed to di;[rest tolerably well; but
there was no assimilation or appropriation of his food. lie
was at first put upon the use of hydriodate of*potash, in an in-
fusion of gentian, without any change, and finding tfiat he
sufiered from acidity, and added the phosphate of lime in doses
of six or eight grains, three times a day, which he is still using.
I saw him a few days since, and learned from the parents that
he had had no new attack, and that his bowels had been steadily
improving, and is gaining flesh and strength ra])idly. The
parents, who are highly intelligent, attribute most of the benefit
to the phosphate of lime. \_N. (). Medical Register.

A modification in the Operation for Hare-lip.

M. Coste, chief surgeon of the Hotel Dieu of Marseilles, has
been endeavoring to devise the means of obviating the ugly
notch which too often remains after the operation for hare-lip.
M. Coste states that the modification proposed and practised
bv M. Malgaigne is only applicable in double hare-lip, and that
in the simple deformity M. ~\Ialgaigne's method produces an
unsightly prominence.

The author in simple hare-lip, (which lies generally on the
left side,) has succeeded in avoiding the notch altogether, by
cutting a horizontal flap in the red part of the lip on one side,
and a kind of half mortise on the other. In paring the mar-
gins of the fissure, he takes ofl'more substance than is generally
done ; the flap and mortise are well secured by twisted suture,
and by one of the diminutive spring-forceps called "serre
fines ;" one transverse needle is placed a little higher u]), and
no application wdiatsoever made, so that the progress may be
more accurately watched. M. Coste has thus succeeded, upon
a little boy, twelve years of age, in completely avoiding th.e
above-mentioned notch. [London Lancet.

1851.] Migrations of a Pin and Needle. 683

Remarkable Migrations of a Pin and Needle through the Body
of a younis lady. By Napoleon B. Andehsox, M. D., of
Louisville, Ky.

On the 20lh of A])ril, 1849, Miss Catharine M , a^t. 19

years, in a fit of laughter, accidentally swallowed alai-ge brass
pin and a medium sized needle. A^o pain attended the passage
of these bodies into the stomach, nor was any felt until after
the expiration of about the third week, at which time a warm,
pricking sensation was lirst felt in the cardiac orifice of the
stomach, which position it maintained for the sjrace of three
months, when it gradually changed, and seated itself in the
lower lobe of the left lung. In this situation it remained for
some nine months, without any disturbance to the organ of
respiration in which it was felt, with the exception of occasion-
al cough and slight hemoptysis. During this period, the pain
gradually moved to the glenoid cavity of the scapula, and was
experienced at the insertion of the deltoid muscle, in which
situation considerable pain was the result of elevation or rota-
tion of the arm. From this point it moved to the arm pit,
when the arm had to be carried horizontally, and no elevation,
rotation, adduction, or abduction, could be performed without
excruciating pain ; the inner part of the arm turning very
black, from the infiltration, I suppose, of blood into. the sur-
rounding parts, l^ressure u|)on the parts, produced no mate-
rial change in coloration, nor was there any unusual amount of
sensation or numbness in any ]'art of the discolored portion,
with the exception of the region in which these foreign
bodies were situated. The arm remained in this condition,
with no material changes, until December, 1850, when the ]ain
and uneasiness moving from the arm-pit, towards the articula-
tion of the ulna and radius with the humerus, settled in the belly
of the bicejis tlexor muscle, forming there a dark spot the size
of a half dollar, and very sensitive to the touch. An emollient
poultice was applied for twenty-four hours, when fluctuation
indicated the use of the knife. A quantity of bloody i)us was
discharged, and the needle and i)in were extracted from tu^o
different aperlurcs, about half an inch apait. The ]in was
dark, but the needle was bright, and had undergone no material
change. Alteratives were used, and in ten days from the ex-
traction of the bodies, the lady liad perfect use of her arm, and
has continued to do so ever since.

During the period, from the swallowing of these substances
until their removal, the constitution was not disturbed in the
sliglitest degree, cxce})t the cough and hemoptysis spoken of;
and this continued only as long as those articles were passing

684 Water Dressings, [November,

through the lungs, after which the symptoms disappeared. The
lady underwent no treatment during their migration from the
mouth to the arm, with the exception of a purge when she first
swallowed the articles, and anodyne embrocations afterwards.
These pointed bodies appear to have travelled side by side
over the entire route from the mouth to the point at which
they were extracted, and must, in their course, have passed
through the stomach, diaphragm, lung, pleura, among muscles
and bloodvessels, before reaching the parts from which they
were extracted. The points of each article presented at the
incision made, and must, I suppose, have thus passed the entire
distance. [ Western Journ. cf Med. and Surg,

Water Dressings.

We condense from the Bui. Gen. de Therap. the following
notice of a Thesis read before the Parisian Faculty of Medi-
cine, upon the therapeutical effects of water, by M. Amussat, Jr.

The author first discusses the temperature at which water is
most conveniently employed as a surgical remedy. He thinks
that cold water should be rarely used, but in the majority of
cases it should be luke-warm. According to M. Amussat,
luke-warm water will be most advantageously used in simple
inflammations, erysipelas, burns, ulcers, gangrene, simple and
contused wounds, gun-shot wounds, &c. M. Amussat makes
three divisions of the modes of applying water, by dressing^
irrigation and immersion. There are, he says, three objects
to be attained in water dressings 1st, the pus should be allow-
ed to pass out freely; 2d, the moisture should be continuous;
3d, all evaporation should be prevented, in order that the part
may not be chilled. He fulfils these indications by means of
four pieces of cloth. The first piece is pierced with holes to
allow the pus to escape; the second is a common piece of
linen or cotton cloth moistened in warm water this is to ab-
sorb the pus ; the third piece is tinder prepared without salt-
petre or gun-powder ; the fourth piece may be made of any
impermeable tissue. If there is an abundant suppuration, the
dressing should be frequently changed. The dressing should
not be discontinued suddenly, but by degrees. M. Amussat
thinks this dressing far superior to poultices, but less powerful
than irrigation or immersion.

1851.] Magnesia as an antidote for Poisoning, SfC. C85

Magnesia as an antidote for Poisoning with Copper.

M. Roncher, in an article upon this subject, in the Gazette
Medicale de Strasbourg, draws the following conclusions, from
experiments he has made :

1st. That calcined magnesia will arrest entirely the symp-
toms of poisoning with copper, if it be administered sufficiently
soon after the copper has been taken.

2d. That the dose of magnesia necessary to neutralise the
salt of copper, is 8 grammes of magnesia to 1 of" sulph. copper.

3d. That as magnesia prevents the formation of the greenish,
soluble salt, it is quite probable that it will act as an antidote
to all the salts of copper. [Revue Medicale^ Aug. 1851.

Solution of Lac a Substitute for Collodion.
As a substitute for collodion, Dr. Mellez recommends a solu-
tion of powdered shell-lac in highly-rectified spirit. The
solution when cold, becomes gelatinous, and is used by joiners
for polishing furniture. Spread on tafTeta or linen and applied
to the skin, it shows all the properties of collodion. It is im-
penetrable to the air, water, fat, and the organic secretions ; it
does not irritate the skin, and can be employed instead of dex-
trin for fractu) es. Wounds heal remarkably quick when dress-
ed with this solution. Lend. Fharm. Journ.

Removal of Carbonic Acid from Cellars and other places
where it has accumulated.
Aubergier proposes to remove carbonic acid from cellars
and other places, where, from fermentation or other causes, it
has accumulated, by sprinkling about liquor ajinnonice; this
combines with carbonic acid to form carbonate of ammonia,
and fresh air rushes in to fill up the space produced bv the
condensation of the acid. [Ibid.

Iodine.
An account has been published by M. Chatin of a series of
experiments on animal and vegetable substances, with a view
to ascertain the amount of iodine that enters into their compo-
sition. All vegetables appear to contain more or less of this
element, and particularly water-cresses. Wine is much more
rich in iodine than water, milk richer in the element than wine,
and asses' milk more rich in this respect than that of cows.
Eggs contain a large portion of iodine. A hen's egg weighing
an ounce and a half, was found to contain as much iodine as a
quart of milk from the cow. [Ibid.

686 Miscellany. [November,

iHlsccllauB.

Reply to "Remarks" contained in the April numher of the Western
Journal of Medicine and Surgery, over the signature of "B."

Having just returned from Europe, after an absence of five nionths,
I find tliat my Report of "a case of Urinary Calculus, attended with
peculiar circumstances, and treated by Lithotrity," which appeared
in this Journal last April, has been made the subject of criticism in
the Western Journal of Medicine and Surgery (published at Louis-
ville, Kentucky,) and that tliese Strictures elicited a reply from an
esteemed friend, (in the July number of this Journal,) which has, in
its turn, been follov/ed by a rejoinder in the Western Journal, of Au-
gust. A sense of duty to myself as well as to science, demands of
me a sacrifice of feeling while I obtrude upon an enlightened profes-
sion the fallowing pages.

With a view to render my comments upon the " Remarks " of my
critic more intelligible, I will append them to each of his paragraphs
in the order in which these appear ;

" Remarks. Tliis certainly presents ' certain peculiar features,"
botli in anatomy and Surgery, and we are utterly at a loss to under-
stand some of tliem. Tlie fault may ])e ours, but there can be no
w'ron<T in stating the diiliculties.

" 1st. It is somewliat remarkable that a phymosis should have
created so great a resisting power in the prepuce as to dilate even the
ureters. Tliis strikes us as a very remarkable peculiarity. The
wonder is increased considerably when we find that notwith.standing
the ureters were thus dilated so as to i)ermit the passage of a stone of
novel dimensions, the urethra, which should have synchronised liber-
ally in tlie dilatation of the ureters, was so little inclined towards
anything of the kind, that it stopped the stone which had fallen through
the ureter ! The extravagant dilatation of the ureter is inexplicable;
but, assuming the claim as a fact, the dilatoriness of the urethra is
rather marvellous."

The reader will perceive that, according to this paragraph, I am
charged with having alledged that the phymosis " created so great a
resisting power in the prepuce as to dilate even the ureters," and that
"notwithstanding the zire/er^ were thus dilated so as to permit the
passage of a stone of novel dimensions, the urethra, which should
have synchronised liberally in the dilatation of the ureters, was so
little inclined towards any thing of the kind, tliat it stopped the stone
which had fallen through the ureter." Such is the meaning of the

1851.] MiscellariTj. 087

paragraph, bereft of the epithets, " remarkable," " wonder," " novel,"
" extravai^ant," "inexplicable," and " marvellous."

Now, if the reader will look over my Report, he will find no founda-*
tion whatever for such a charge. No where have I said or inferred
that the resisting power of the prepuce was so great as to dilate the
ureters and to permit the })assage of the stone. It is distinctly stated
in my first paragraph, that the patient was thirty years of age when I
operated upon him, and that he was but twenty w)ien circumcised by
Dr. Banks; thus leaving him entirely free from any phimosis or dif-
ficulty in urinating for a period of ten years before I saw him. Hav-
ing stated that the phimosis had been removed ten years before I saw
the patient, and more than nine years before the entrance of the stone
into the bladder, my Report caimot be so perverted as to make it appear
that I ever expressed or even entertained the views to which " B." ob-
jects. I again beg the reader to refer to my report.

It is true that I found a calculus in the bladder, and that I reported
the patient's narrative as " establishing conclusively " (in my opinion)
"that he did know the precise moment at which the stone came into
the bladder." The fact that the stone appears to have come down the
ureter, cannot be accounted fn* by " B." otherwise than by supposing
this duct to have been dilated by the resisting pov/er of the prepuce,
and he therefore endeavors to make it appear that such was my rep-
resentation of the case. It does not seem to have once occurred to
the critic that a calculus may be formed in the pelvis of the kidney,
pass into the ureter, and be gradually propelled forward by the urine,
thus dilating the ureter in its progress. Nor does he appear to have
ever heard of a case in which a calculus after thus passing down the
ureter, had been refused admittance into the urethra! He forgets
that whereas the ureters are comparatively passive in their resistance
to dilating agents, the urethra is essentially diflierent and also that
the column of urine emerging from the kidney would necessarily
press forward a body situated in the ureter until it entered the blad-
der, if possible ; but that the calculus might remain in this reservoir
without being necessarily forced into the urethra.

Again : according to " B." the " urethra should have synchronised
liberally in the dilatation of the ureters." This is a new doctrine,
for the originality of which the critic is unquestionably entitled to
credit. A case in which the urethra "would synchronise" with the
ureters in a dilatation consequent upon tlie descent of a renal calcu-
lus would indeed be "remarkable," " extraordinary," and "marvel-
lous." Whether or not the urethra should " synchronise liberally

688 Miscellany. [November,

in the dilatation of the ureters " occasioned by phimosis, is not the
question before us, since in this case as reported, no phimosis had
existed for more than nine years before the period at which the cal-
culus is alledged to have passed into the bladder.

*' 2d. The statement of the patient that he " heard something
drop," and therefore knew the exact moment of the entrance of the
calculus into the bladder, seems to have made a profound impression
upon Professor Dugas, for he unhesitatingly gave credence to the
statement. The patient may be excused for thinking that a calculus
could fall from the ureter into the bladder, but we have some difficul-
ties in our faith. The ureters enter the has fond of the bladder, very
obliquely, and a stone would have to fall up in falling from the ureter
into the bladder. And then when we remember the pathological
truths of Mr. Aldridge, which seem to show that the oxalate of lime is
not secreted in the kidneys, when we remember that there is no kind of
evidence that the ureters in this case were dilated even in the slightest
degree, and that the passage of a mulberry calculus through the ureter
would have made a man feel a multitude of other things besides the
falling of the calculus, we must remember that we have before us
what may be called the difficulties of faith."

I have no right to complain that "C" has not as much faith in
the statement of the patient as I have, who know him to be an honest
and intelligent gentleman. If all the circumstances detailed in the
second paragraph of my report are not deemed by " B." sufficient to
establish " conclusively the facts that he did know the precise moment
at which the stone came into the bladder," the fault is not mine. I
will not stop to correct an error of quotation, nor to return thanks for
" B.'s " sapient anatomical and philosophical suggestions. I am still,
however, credulous enough to believe that a calculus may emerge
from the ureter suddenly and with sufficient force to occasion just such
a sensation as "that of a buck-shot allowed to drop into a bag." I
do not know any form of expression by which my patient could have
imparted a more accurate idea of his sensation, and it is therefore I
gave his own language.

Will "B." "remember" that the patient was relieved of the phi-
mosis nine years before he experienced this sensation ; that " from
that time his health improved rapidly, but he continued subject to ac-
casional paroxysms of severe nephritic pains, which now became
confined to the left side;" and that this state of things continued until
the middle of April last (1850), when, although in good health, he felt
a calculus drop into the bladder ?" If, as intimated by"B.," the
calculus did not come from the kidney, why did the patient' never ex-

1851.] Miscellany, 689

perience any symptom of il in the bladder, until the day upon which
he felt the sensation in question ? Why were all the symptoms of
calculus in the bladder so well marked after the sensation ?

"B." experiences " what may be called the difficulties of faith,"
when he "remembers the pathological truths of Mr. Aldridge, which
seem to show that the oxalate of lime is not secreted in the kidneys,"
when he "remembers that there is no kind of evidence that the
ureters in this case were dilated even in the slightest degree " and,
finally, when he remembers "that the passage of a mulberry calcu-
lus through the ureter would have made a man feel a multitude of
other things besides the falling of the calculus." But " B." should
also "remember" that whatever the "truths of Mr. Aldridge may
seem to show," Prout, Bird and Brodie, to mention no others, recog-
nize the existence of calculi of oxalate of lime in the kidneys. Brodie
says that " a patient may void one of these calculi and never void
another, or he may void a second after the lapse of many years. In
one instance, however, in examining a body after death, I discovered
as many as five or six in one kidney.^'' (p. 225, from Chelius, v. 3,
p. 226.) One fact of this kind is worth more than a thousand conjec-
tures or theories. As to the "multitude of other //^^g5" that "B."
thinks the patient ought to have felt " besides the falling of the calcu-
lus," 1 would only remark that all surgeons of experience know that
the sufferings occasioned by the descent of stones from the kidneys or
by their escape from the ureters into the bladder vary infinitely and
that the passage of even rough ones is sometimes efiected without any
pain whatever.

" 3d. We feel some difficulty about the dimensions of the calculus.
We have seen between two and three hundred specimens of calculi,
and have heard from various other collections, and we have neither
seen nor heard of any calculus, except this one in Geoijia, that was just
one inch in length, and a half inch in thickness. These dimensions
are such a wide departure from that uniformity of proportion found in
calculi, that we think there must be some mistake in Professor Dugas's
measurements. There must be a want of accuracy. Did it not strike
the Professor that the (growth of his specimen was altogether too rapid
for a case of oxalate of lime calculus ? There seems to us a wonder-
ful celerity in every branch of this case."

In reply to the "difficulty " which " B." feels "about the dimen-
sionsof the calculus," I will merely suggest that it is not very surpris-
ing that he has not seen calculi of all the dimensions they may assume.
By a coincidence, which may appear to " B." somewhat singular,

690 Miscellany. [November,

Dr. H. F. Campbell, of this city, reported in July last, a case of Li-
thotomy in which the dimensions of the calculus, (which was of
oxalate of lime), approximate very closely to those indicated in my
case. " On measurment, it was ascertained to be of the following
dim.ensions : longest diameter, one inch and three-tenths : shortest
diameter, seven-tenths of an inch." (see South. Medical & Surgical
Journal, July, 1851.) Prof. Gross, of Louisville, the weight of
whose testimony will not be denied by " B.,*' in his recent and valu-
able work upon the Diseases of the Urinary Organs, thus expresses
himself:

" Most urinary calculi originate in the kidneys, from which they
descend into the bladder." (p. 341.) In relation to their form, he
says : " Vesical calculi are commonly of an oval form, but occasion-
ally they are round, spherical, or even cylindrical. Other varieties
of form are sometimes seen, as the conical, pyriform, cubic, triangu-
lar, pyramidal, gourd-like, polygonal, and the tetrahedral. Some-
times the concretion is thin and flat, like a coin, lenticular, semilunar,
or in the shape of a mushroom, a kidney, a mulberry, a bean or a
heart. Again, it may bo large and bul))ous at the extremities, and
narrow at the middle, like a dumb-boll. * * * In fact, there is no end
to the grotesque appearance of these foreign bodies.'' (p. 353.) And
yet, "B." objects to my case because "the dimensions are such
a wide departure from the ^^//brm^7^/ of proportion found in calculi."!
I leave it with the reader to determine whether it is more probable
that there was a "mistake" in my " measurements" than that "B."
has not seen stones of all the above forms and dimensions.

With regard to the time occupied in the growth of my "specimen,"
I have not expressed any opinion, nor do I know the source from
whence "B." has derived his belief that it was " altogether too rapid
for a case of oxalate of lime calculus." "There seems to us a won-
derful celerity in every branch of this case " of fault-finding.

"4th. The calculus in this case was ' oxalate of lime,' and the
stone was crushed with Heurteloup's ' hrise pierre,' at two sittings,
on two consecutive days, and the fragments were allowed to be pass-
ed off during the night. This is certainly the most remarkable
achievement yet effected by Heurteloup's instrument. It is enough
to excite the envy of Civiale, and put an end to the lateral operation.
If a calculus of oxalate of lime, one inch long, and a half inch thick,
can be utterly crushed in two sittings, in two successive days, so that
no vestige of it is left, what apology can there be for cutting instru-
ments for lithotomy? We have seen various efTorts with Heurte-
loup's instrument, and have been sometimes surprised with the result,

1851.] Miscellany. 691

but this success in breaking down, in two sittings, a stone of oxalate
of lime, of the size of the one recorded by Professor Dugas, certainly
takes the lead of all achievements we know of in lithotrity. We have
seen vesical stones of oxalate of lime removed by the lateral operation
after lithotrity had failed, and in which the most persistent efforts with
the drill for many sittings had failed to make any more impression
than if it had been used on a piece of Syenite. But if the improved
apparatus of Heurteloup can break up at two sittings, a mass of oxa-
late of lime, and remove it entirely in two days, lithotrity is making
rapid strides, and M. Roux is an accredited prophet, when he says ;
* lithotrity has assumed her function, and no surgeon hereafter will
attain sufficient experience to reach the highest degree of adroitness in
lithotomy.'

" We suppose these new claims of lithotrity will come before the
American Medical Association, and if they receive the endorsement
of that body, we may expect to see renewed evidences of the en^y felt
by European surgeons tor the rising reputation of American Surgery,
and we shall hear them again denouncing American surgeons for a
proneness to exaggeration. B."

The two last paragraphs of "B.'s" *' Remarks" fully illustrate
the spirit in which they were indited. Their unworthy imputations
and insinuations cannot provoke me to any special notice of them.
Regarding personalities in scientific controversies as decidedly in
bad taste, I have endeavored to avoid noticing any thing that might
savour of unfairness on the part of my critic.

When I published my case, I must confess that I did not anticipate
for it so much notoriety. I thought that it presented " certain peculiar
features " not unworthy of record, and endeavored with as much
brevity as possible to draw up a faithful report. The features I
deemed most interesting, are : 1st, the existence during twenty years
of a phimosis attended with an almost complete closure of the pre-
putial orifice, and which seriously implicated the general health of
the patient before he applied for surgical relief; 2d, the recurrence
of occasional attacks of nephritic pains during ten years after cir-
cumcision, which pains finally became confined to the left side ; 3d,
the accurate indication by the patient of the " precise moment at
which the stone came into the bladder ; 4th, the pawage of the stone
into the bladder just after micturition ; and lastly, the circumstance
that the stone entered the bladder three months after the last nephritic
attack. But it had not occurred to me that these peculiarities pre-
sented any thing incredible, nor even extraordinary. I merely re-
garded them as furnishing an interesting illustration of facts, which,
although already within the domain of science, are not of very frc-

N. s. VOL. vir. NO. xr. 44

\

692 Miscellany. [November,

quent occurrence. I have not had leisure to look over authorities on
the subject, but I do not recollect an instance in which the knowledge
of the precise moment at which the stone came into the bladder, is so
well established. Such may, however, be on record, and yet the addi-
tion of this case can do us no harm.

That the stone came into the bladder just after micturition is not
surprising ; but" it would be interesting to know whether such is
usually or only rarely the case. It may therefore be well to direct
attention to this point niore forcibly than has heretofore been done.
The fact that the distention of the bladder occasions a compres-
sion of the portion of the ureters engaged between its laminas, whereas
this compression ceases with the subsidence of distension, would lead
us a priori to infer that calculi rarely, if ever, enter the bladder when
filled with urine, and that they would be most apt to do so just after
micturition, when the flow of urine through the uncompressed orifice
of the ureter would exert most favorably its propelling influence upon
the stone. It is doubtless owing to this compression of the vesical
extremity of the ureters that calculi are so often arrested at this point
and that they sometimes remain fixed here. In the case before us, it
would seem probable that the calculus had remained at this point
about three months, the period which elapsed from the last nephritic
attack to the time at which the stone is indicated to have passed into
the bladder.

With regard to the operation by which the patient was relieved, I
did not, nor do I now see in it any thing miraculous, or in anywise
calculated to provoke the envy of our transatlantic brethren. It is
certainly flattering, however, to find that any one, even in our own
country, considers it a "remarkable achievement."

L. A. DUGAS.

P. S. The subjoined letter from Dr. Banks, has just been received,
and may perhaps satisfy "B." that the patient has been entirely re-
lieved of his calculus. L. A. D.

"Gainesville, Oct. 23, 1851.
^^Br. Dugas : Dear Sir, I have not been able to see Mr. Bell
since the receipt of your letter, as he lives about eighteen miles from
town. I saw him shortly after he returned from Augusta, and he
then complained of a slight soreness in the neck of the bladder. I
have seen him several times since then, and he has uniformly express-
ed himself as being entirely relieved from the disease. His general
health and appearance is much improved. I saw his brother on yes-
terday, and he confirms the above statement as to the entire restoration
of John L. Bell's health.

"Truly yours, Richard Banks, M. D."

1851.] Miscellany, C93

Physicians' Society for Medical Observation of Greene and ad-

joining Counties, We take pleasure in recording the organization of

a new auxiliary Medical Society, and doubt not that it will prove

highly beneficial, as well as agreeable to its members, if kept up

with proper spirit. We hope to derive from its influence valuable

contributions.

Greenesboro', GA.,Oct. 6th, 1851.

Pursuant to previous notice, the physicians of Greene and adjoining
counties, met in Greenesboro' on the 1st Monday in October, for the
purpose of organizing a ]\redical Society exclusively for mutual im-
provement, and as auxiliary to the Georgia State Medical Society.

Present : Drs. J. F. Foster, F. W. Cheney, R. S. Williams, A. H.
Randle, W. L. Alfriend, C. M. Park, R. S. Callaway, Samuel Hall,
Benj. Rea, Thos. P. Janes, H. H. King, J. E. Walker, D. C. O'KeefTe,
R. Olive, R. S. Massey, E. V. Culver.

On motion of Dr. O'KeefTe, Dr. Cheney was called to the Chair,
and Dr. Rea requested to act as Secretary.

After a few appropriate remarks by the Chair, explanatory of the
objects of the meeting, and urging the importance and utility of med-
ical organization on motion of Dr. O'KeefTe, a committee of five
was appointed by the Chair, for the purpose of drafting a Constitution
and By-Laws, consisting of Drs. Randle, Alfriend, Callaway, Rea
and O'KeefTe. The committee retired and after a short interval, sig-
nified through their chairman that they required further time for the
discharge of the duty assigned them.

Dr. Alfriend wished to see a uniform Fee-Bill adopted by the So-
ciety, and urged upon the meeting its importance and advantages.
Dr. O'KeefTe opposed the measure, on the ground of its general
adoption being impracticable, and as exerting an injurious influence
against the prosperity and perpetuity of the Society. Dr. Cheney
opposed it for the same reasons.

On motion of Dr. Randle, the vote of the meeting was taken re-
specting it, and decided that the Society recognize no fee-bill.

On motion, the meeting adjourned to meet again on the third Mon-
day in October. F. W. CHENEY, M. D., Chairman.

B. F. Rea, M. D., Secretary.

Greenesboro', Ga., Oct. 20th, 1851.
The physicians met, pursuant to adjournment, and organized by
calling Dr. Foster to the Chair, and Dr. JouxN E. Walker to act as
Secretary. '>

694 Miscellany. [November,

The minutes having been read and confirmed, Dr. O'KeefFe pro-
ceeded to read the Constitution, By-Laws and Rules of Order, drafted
by the committee appointed for that purpose at the previous meeting.
Each section having been considered and voted on separately, they
were finally adopted after considerable discussion.

On motion of Dr. O'Keeffe, the meeting resolved itself into the
^^ Physicians^ Society, for Medical Observation of Greene and adjoin-
ing Counties, Ga.,''' which is to be the name and style of the society.
On motion, the ofiicers of the meeting were requested to act as offi-
cers of the society until an election be had, which being held, the
following gentlemen were elected :

James F. Foster, M. D., Greenesboro', President ;
V/. L. Alffiend, M. D., White Plains, 1st Vice-President ;
F. W. Cheney, M. D., Penfield, 2d Vice-President ;
D. C. O'Keeffe, M. D., Penfield, Secretary.
J. E. Walker, M. D., Greenesboro', Treasurer.
On motion of Dr. H. H. King, the Society adjourned to hold its
first regular bi-monthly meeting on the first Monday in November next.
JAMES F. FOSTER, M. D., Chairman.
J. E. Waikee, M. D., Secretary.

Br. Isaac Hays' Circular.

Sir The Committee of publication respectfully submit to you, as
a member of the American Medical Association, the following state-
ment :

The whole amount received from the assessment for 1851 has been
about six hundred dollars, which, with the balance in the treasury at
the last report (four hundred dollars), makes one thousand dollars.

It is estimated that the cost of vol. IV. will be about seventeen hun-
dred dollars ; the expense of printing the Reports being one thousand
dollars, and of the prize essay, with the necessary illustrations, nearly
seven hundred dollars.

This last, which was awarded the prize of one hundred dollars,
and which the association ordered to be published in the Transactions,
is a paper of great merit, exhibits extensive research, and is illustra-
ted with numerous beautiful drawings, a number of them colored.
The publication of this essay will do credit to the Association, and
tend to elevate the scientific character of the American Medical Pro-
fession. But the committee are without the means for that purpose,
and they appeal to the Association to furnish them. A large number
of copies of the three volumes already published remain unsold, and,
if the members will complete their sets, and use their influence to ex-
tend the sale of these volumes, the required sum may be readily
raised.

1851.] Miscellany, 695

The committee call the attention of the Association to the terms
upon which the published volumes are now furnished to members, or
to societies which have been represented in the Association.
Either of the first three volumes separately (in paper covers) 81 50
A complete set in three volumes (paper covers) - - - - 4 00

do. do. do.' (cloth) 5 00

Single copies of vol. iv. (to permanent members) . - - 2 00
Three do. do. do. do 5 00

In all cases the amount must be remitted to the Treasurer of the
Association, Issac Hays, M. D., Philadelpliia.

Your earliest possible attention to the above is earnestly solicited,
to avoid great delay in the publication of the forthcoming Volume of
the Transactions. ISAAC HAYS, M. D.,

Ckairman of the Com, of Puh. Am, Med. Ass., and Treasurer,

Philadelphia, August 1, 1851.

American Medical Association. Prize Essays. At the meeting
of the American Medical Association held in Charleston, S. C, in
May last, the undersigned were appointed a Committee to receive and
examine such voluntarj' communications on subjects connected with
medical science, as individuals might see fit to make, and to award a
prize to any number of them not exceeding five, if they should be re-
garded as entitled to such a distinction.

To carry into effeet the intentions of the Association, notice is
hereby given, that all such communications must be sent, post-paid,
on or before the first day of April, 1852, to George Hayward, M. D.,
of Boston, Mass. Each communication must be accoiriOanied by a
sealed packet, containing the name of the author which v/ill not be
opened unless the accompanying communication be deemed worthy of
a prize. The authors of the unsuccessful papers may receive them
on application to the committee at any time after the first of June,
1852 ; and the successful ones, it is understood, will be printed in the
Transactions of the Association.

GEO. HAYWARD, Boston.

J. B. S. JACKSON,

D. H. STORER,

JACOB BIGELOW,

USHER PARSONS, Providence, R. I.
Boston, Aug. 20, 1851.

An Example of Ancient Superstition,
To the Editor of the Stethoscope:

Accomack C. H., Va., Aug. 13,1851.
Dear Sir. I send you for publication the following curious scrap
of antiquity, which I met with some months ago, while searching the
ancient records of this country. It has seemed to me to deserve a
place in a medical journal, as a very apt illustration of a medical su-
perstition, among the most remarkable of those with which tiie history
of our science abounds.

696 Miscellany. [November,

Those who have paid attention to the history of medico-legal sci-
ence are aware, that in former times and for a long period, it was a
belief universally entertained, that the wounds of a murdered man
would bleed afresh, hours and days after death, on the body being
touched by the murderer ; or that some other change, not less won-
derful, would occur in the condition of the corpse. This superstition
being received as an undoubted truth, it was very naturally turned to
account injudicial investigations, for the purpose of detecting the guilty
and acquitting the innocent. Dr. Dunglison, in his work on Physi-
ology, refers (in the chapter on Sympathy, &c.) to several instances
in which this kind of ordeal w^as resorted to ; and others may be found
in Beck's Medical Jurisprudence, in the chapter on Persons Found
Dead. Sir Walter Scott, who has made one of the leading incidents
of" St. Valentine's Day" turn on the practical application of this test,
in a case of murder where the other evidence was defective, denomi-
nates it the '"''hier -ordeal,''^ or the ^Hrialhy hier right ;" and speaks of
it as having been " often granted in the days of our Sovereign's an-
cestors, approved of by bulls and decretals, and administered by the
great Emperor Charlemagne in France, by King Arthur in Britain,
and by Gregory the Great, and the mighty Achaius, in this our land
of Scotland."

The confidence in the proof thus elicited seems to have been great,
inasmuch as it was regarded to be " the pleasure of Heaven, by some
hidden agency which we cannot comprehend, to leave open this mode
of discovering the wickedness of him who has defaced the image of
his Creator." This trial by "bier-right," in truth, originated in the
same notions of supernatural agency and direct divine interposition
which gave birth to the ordeals of fire, of water, and of battle. They
were all regarded in the light of appeals to Heaven for the discovery
of truth.

The facts of the case, of which the old records of our county court
furnish the history, are briefly these : On or about the 12th of January
1680, one " Mary, the daughter of Sarah, wife of Paul Carter," gave
birth to an illegitimate child, which was born alive, but died soon
after its birth. It was buried the next day by Paul Carter and his
wife in an old house, where it remained until the end of February,
when it was removed to the garden. The parties above named, who
were the only persons present at the birth and burial of the child, tes-
tified that they endeavored to preserve its life, that it received no vio-
lence, and that it was decently buried. But suspicions of foul play
having arisen, o^jury of twelve jnatrons was summoned, according to
the custom of those times, to investigate the case. They acted, it
seems, in the capacity of a coroner's jury, and their verdict, as copied
verhatim et literatim from the record, is as follows :

" Wee v^ subscrib*'^ being sworne to vew y^ body of a dead bas-
tard child confest by Mary y^ daughter of Sarah Carter to be borne
of her body w'^'^ said child we caused to be taken out of the ground in
the carden where it was very shallow put in then we caused Sarah

1S51.] Miscellany, G97

the wife of Paul Carter & mother of the said Mary to touch handle
and stroake y^ childe in \\^^ time we saw no alteration in the body of
y childe Afterwards we called for Paul Carter to touch y s<i child
& immediately whist he was streaking y^ childe the black and setled
places above the body of the childe grew fresh and red so that blud
was redy to come through y^ skin of the childe we also observed the
countenance of the said Paule Carter to alter into very much paleness,
the childe also appearing to us to be very much neglected in severall
respects as to y preservacon of such an Infant, & we doe conclude if
y child had violence it was by y throat w^^ was very black and
continued so through other places w^^ were black altered to red &
fresh coUered to w<^^ we subscribe our hands this first day of Alarch

[Here follow the signatures of Mary Hill, Margaret Jenkins, Ma-
tilda West, and nine other women, and that of " Wm. Custis, coro-
ner."]

In view of the preceding verdict, and the other evidence in the
case, the grand jury presented Paul Carter, who was supposed to be
the father of the child, for wilful murder, and he was committed to
appear for trial before the governor and council at the next general
court. As for Sarah, his v.ife, notwithstanding her having passed so
successfully through the ordeal of the touch, some very suspicious
circumstances in the other evidence led to a similar presentment
against her. The final result of the case, and the degree of import-
ance attached by the general court to the facts stated in the verdict of
the jury of matrons, I have no means of learning, as there is no refer-
ence to the trial in the records of this county.

Considering tlie length of time the child had been buried, and the
season of the year, the foregoing is one of the most singular examples
of this superstition that I have met with. Somewhat analogous to it
is the case quoted by Beck from Hargrave's State Trials, in wiiich
the body was disinterred thirty days after death and on being touched
by one of the accused, "the brow of the dead, which was before of a
livid and and carrion color," "turned to a lively and fresh color," &;c.
But much more marvellous phenomena were sworn to have been ob-
served in this case, viz: the sweating of the brow, the opening and
shutting of the eye, the repeated motion of the finger, and the dropping
of blood from it.

At the present day, it seems at first view inconceivable that super-
stition should ever have obtained such a complete mastery over the
popular mind, that persons apparently of good faith were ready on
Irequent occasions to bear testimony to such facts, and others as ready
to believe them. In our own case, above cited, we have the concur-
rent testimony of twelve persons under oath. Yet this strange super-
stition, like many others which have long been received and acted on
by the ignorant, has an unquestionable foundation in truth. The his-
tory of the cadaveric changes tvrought by putrefaction furnishes the
key to it. It is well known that the blood, though it generally coagu-
lates in the vessels soon aller death, is rendered fluid again by putre-

698 Miscellany. [November,

faction, in which condition it may be caused to flow from wounded
blood vessels, by any motion or change of position. It is also known
that the blood, thus rendered fluid, may escape from incisions sponta-
neously, in consequence of the developement of gas by putrefaction
in the heart and large blood vessels. Devergie, in his description of
the phenomena of this " gazeous putrefaction," {Med. Legale^ vol. i.,
p. 166.) remarks that thereby "the heart is emptied of blood, as well
as the large blood vessels. The decomposed blood is driven into all
the superficial veins and the general capillary system ; hence the
veins of the surface become distinct like bluish lines, visible externally
as if those vessels had been injected ; hence too, that reddish colora-
tion of all the white tissues, as the cellular tissue, the parietes of the
trachea and alimentary canal, of which the external aspect may
then simulate the appearance of inflammation." In this passage
Devergie gives a very satisfactory explanation of the phenomena ob-
served in ihe case of the child above mentioned, after its body had
been exposed to the air for a certain period.

It is very easy to conceive that in any particular case one or more
of these cadaveric phenomena might coincide with the presence or
the touch of an individual whom other circumstances might prove to
be the murderer; and in an age when the general tendency of the
popular mind was towards a superstitious belief in the marvelous, as
aflbrding evidence of divine interposition, it would require but few
such coincidences to establish a general law, and furnish sufficient
ground for constituting an ordeal for deciding upon the guilt or inno-
cence of persons accused of murder. Such is, no doubt, the true his-
tory of the origin of this "trial by bier-right."

Craving your pardon for the length to which I have allowed this
communication to run,

I am, very respectfully, &;c.,

L. S. JOYNES.

Hindu Remedy for Sterility. The following is copied, merely as a
matter of curiosity, from one of the medical works received from India
a short time since, and already alluded to in this Journal. Take
powder of bidari or anuloka, mixed with honey or ghee, and eat the
testes of a goat, roasted and prepared with salt, ghee and long pepper.
The preparations ofmaskulai, with sugar barley and wheat. Eat the
e'Ji;o's of crabs, crocodiles or turtles, properly prepared. Flour prepar-
ed with ghee and milk, rubbed on the feet with oil mixed with croco-
dile's eggs the flesh of rats, frogs, and the eggs of sparrows. The
patient, in the meanwhile, is to drink fresh milk with sugar, honey,
and swallow the powder of Swayangupta, with ekuruka. Bost. Jour,

Tea and its Adulterations. The " Analytical Sanitary Commis-
sion," in London, to which reference was made some months since in
this Journal, is still pursuing its analyses of various articles of food
and drink. The different kinds of tea and their adulterations have
occupied a prominent place in its investigations. A very brief sum-

1851.] Miscellany. 699

ming up of researches respecting this article is contained in the follow-
ing extract. Much curious information concerning the culture of the
tea plant is contained in the Commission's report in the Lancet, which
we may hereafter copy.

' The chief points ascertained with regard to black tea are

" 1st. That the principal black teas namely, the Congous and
Souchongs, arrive in this country, for the most part, in a genuine
state.

"2d. That certain descriptions of black tea, as Scented Orange
Pekoe and Caper, are invariably adulterated, the adulteration in gene-
ral consisting in the glazing of the leaves with plumbago or black lead ;
the Caper likewise being subject to admixture with other substances,
as paddy-husk, Lie tea, and leaves other than those of tea.

" 3d. That several varieties ^ a spurious Caper, or black gun-
powder, are prepared, which consist of tea-dust, and sometimes the
dust of other leaves, and sand, made up into little masses with gum,
and faced or glazed with plumbago, Prussian blue, and turmeric-pow-
der ; in some cases these imitations are sold separately, but most
frequently they are used to mix with and adulterate the better quali-
ties of Caper viz. those which are made of tea faced with lumbago
only.

" With respect to green tea the principal conclusions are

" 1st. That these teas, v%ith the exception of a few of British growth
and manufacture, from Assam, are invariably adulterated that is to
say, are glazed with coloring matters of different kinds.

" 2nd. That the coloiinjr matters used are in i^eneral Prussian
blue, turmeric-powder, and China clay, other ingredients being some-
times but not frequently employed.

*' 3rd. That of those coloring matters, Prussian blue, or ferro cyanide
of iron, possesses properties calculated to affect health injuriously.

" 4th. That in this country there is really no such thing as a green
tea that is, one which possesses the natural green hue considered to
characterize that kind of tea.

' 5th. That green teas, and more especially the Gunpowders, in
addition to being faced and glazed, are more subject to adulteration in
other ways tlian black teas, as by admixture with leaves not those of
tea, with paddy-husk, and particularly with Lie tea.

" That Lie tea is prepared so as to resemble green tea, and is exten-
sively used by the Chinese themselves to adulterate gunpowder tea ; it
is also sent over to this country in vast quantities, and is employed for
the same purpose by our own tea-dealers and grocers." [Ibid.

New Lebanon; iU Physic Gardens and their Products. The beauti-
ful valley of New Lebanon, situated about 80 miles east of the Hudson
river, in the State of New York, and noted for its attractive watering
place, the resort of many pleasure-seeking travellers in the summer
months, has long been celebrated for its gardens devoted to the culture
of medicinal plants, with a view to the supply of apothecaries, druggists,
and others in all parts of the United States. For a long time this

700 Miscellany. [November,

business was solely in the hands of the people called "Shakers," who
originated it as a regular pursuit, and who yet are largely concerned.
During the past summer, whilst on a visit to the valley of the Hudson,
we accepted an invitation from Mr. Henry A. Tilden, to visit his gar-
dens and laboratory situated in the township and village of New Leba-
non, where he and his brother conduct an extensive business in the
culture, drying and packing of plants, and the preparation of medicinal
extracts. The Messrs. Tilden informed us that they have about forty
acres cultivated under their immediate superintendence, somewhat in
the following arrangement : 9 acres in Taraxacum, 2 in Conium, 3 in
Hyoscyamus, 3 in Belladonna, 3 in Lettuce, 3 in Sage, 2 Summer Sa-
vory, 2 Stramonium, 2 Burdock, and Dock, 1 Marjoram, 2 Digitalis, 2
Parsley, Poppies and Horehound, 1 Aconite and Balm. The remainder
are occupied with Basil, Button Simke root. Blessed Thistle, Borage,
Coriander, Feverfew, Hollyhock, Hyssop, Larkspur, Lovage, Marsh-
mallow, Marygold, Mugwort, Mountain Mint, Southern Wood,Tansey,
&c. The narcotics, especially the Hyoscyamus and Belladonna, require
a rich soil, and they exhaust the land rapidly. These last attain a height
in many instances of five feet, but in general from three to four. They
are liable to be preyed upon more or less, at all seasons of their growth
by insects and worms peculiar to each, to such an extent in some in-
stances, as to destroy the crop. Conium maculatum grows spontane-
ously in all that region of country, having become naturalized. It is
seen along the roads, and in fields that have been abandoned for a
time, attaining often the height of six feet, and presenting a striking
object to the eye, by reason of its subdivided foliage. For this reason,
the Messrs. Tilden do not cultivate this plant very extensively, but
depend largely on that of spontaneous growth, which they gather from
the country many miles around, as far as the Vermont line, and in Mas-
sachusetts. It is probable that the Conium obtained in this way is really
more active, weight for weight, than the cultivated, being less succu-
lent. We noticed the Valeriana officinalis growing with great luxu-
riance, and as high as five feet, although its culture has not as yet been
much extended. Besides the varieties cultivated, large quantities of
indigenous plants are purchased from collectors in the West and South,
which are required in their business.

Their factory or laboratory is an extensive, oblong, three storied build-
ing, in the basement of which is a powerful steam engine which per-
forms the double duty of propelling the powdering apparatus, and of
driving a double acting air pump connected with their vacuum evapo-
rators.

The recent plants intended for extracts are brought to the mill from
the gai*dens, reduced to a coarse pulpy state by a pair of chasers, and
subjected to a powerful screw press to extract the juice. This is clari-
fied by coagulation, strained, and the pure juice introduced into the
large vacuum apparatus, holding several hundred gallons, where it is
concentrated rapidly to a syrupy consistence, at a temperature varying
110 130, almost entirely free from the deteriorating influence of
the atmosphere. In the construction of this apparatus, they have had

1851.] Miscellany. 701

a view to great extent of tubular steam-heating surface, so as to be able
to accomplish the very large amount of evaporation their business
demands. The finishing apparatus is analogous to the vacuum pan of
the sugar refiners. We witnessed the operation in progress with the
thermometer standing at 112 F. They make annually about 8000
pounds of extracts from green plants and roots, consisting chiefly of
Conium 2000 lbs, Dandelion 2000 lbs., Lettuce 1200 lbs., Stramoni-
um 500 lbs., Butternut 800 lbs.. Belladonna 500 lbs., Hyoscyamus
500 lbs., and so on. These extracts in the aggregate according to
Mr. Tilden's estimate are derived from about 300,000 lbs. of green
material, and require the evaporation of more than 20,000 gallons of
juice.

Besides these, a considerable amount of extracts are made from dry
materials, both foreign and indigenous as Gentian, Rhubarb, Chamo-
mile, Mayapple, Horehound, Cohosh, etc. They are also about en-
gaging largely in the manufacture of extract of Liquorice from loreign
root.

In the powdering department they run burr stones and chasers, and
use bolting and dusting apparatus. They powder large quantities of
material on contract, besides that for their special business, amounting
annually to from 50 to 60,000 pounds.

In the herb department, the quantity of material handled is very
large. The plants are brought from the gardens into a large room in
the factory building, where a number of girls are employed in picking
them over to remove other plants accidentally present, and separating
the decayed parts and the stems when desirable. They are then
placed on hurdles, and exposed in the drying room till properly desic-
cated. Two presses are kept in operation, by which 2000 pounds of
material are sometimes pressed in a week, and about 75,000 pounds
per annum, including near three hundred varieties of plants.

At the time of our visit, thirty men and five girls were engaged in
the several departments of their establishment.

When we consider the large amount of extracts of important drugs
prepared in vacuo, which are thus thrown into the market to replace
the former crude products, obtained by boiling down the juices, etc.,
in open vessels with a naked fire, according to the old method, we can-
not but believe that much good will accrue to the medical practitioner
in the increased power of these agents. The Messrs. Tilden have,
thus far, been directly beneficial to the medical interestsof the country.
But they have also been indirectly useful by inducing their neighbours,
the Shakers, from motives of competion, to adopt the vacuum pan, in
lieu of the open boiler, in the preparation of their extracts. We have
some few observations to make in reference to the medicine-producing
department of this remarkable people, who received us kindly during
a hurried visit whilst sojourning in their beautiful valley, but we are
compelled to defer them till our next issue. [Journ. Pliann,

Medical Coroners. Over and over again, the propriety of having
all coroners medical men, has been urged upon the appointing powers ;

702 Miscellany. [November,

but all the presumption is that they have too much business with the
living, to interfere Math old established errors that only concern the
dead. In England, the functions of a coroner are discharged with
ability, by persons of the best medical preparation for understanding
both the laws of the land and those governing organized beings. In
France, too, and over the continent generally, to put any other than a
physician into that office, would be considered absolutely absurd, and
an insult to the people. But how is it in our country, the boasted seat
of intelligence ? Hardly a coroner among us belongs to the medical
profession. In the first place, onlj'- one, in a town or city, is at all
necessary, and he should be centrally located. The city of London
has but a single coroner, Mr. Wakeley, the surgeon ; and Westmin-
ster another ; and yet they have a population of 2,400,000. In Paris,
every dead body found, is removed to the dead house, where the coro-
ner calls an inquest. In Boston, its 130,000 inhabitants have three
coroners appointed to them. A simplification of this unnecessarily
complicated system of rival coroners, where only one, a gentleman of
scientific attainments, is required, would be not only economical, but
satisfactory, as the truth, in regard to the causes of death under cir-
cumstances of suspicion, would be more certainly obtained. \_Boston
Med, and Sur. Jour.

Eating Pork. The New Hampshire Shakers have abandoned
pork, as food, and they are not without good reasons for doing so.
Moses understood the injurious effects of swine's flesh, which he learn-
ed of the Egyptians, and therefore interdicted it in his judicial char-
acter. The Egyptian priests, who were both philosophers and phy-
sicians, ages upon ages before the birth of the Jewish law-giver, had
gained an insight into the constitution of man, which, transmitted
through the Israelites, diluted and corrupted as it may be, still exerts
a powerful influence on all modern systems of legislation. Whatever
was unclean in the Mosaic catalogue of edibles, is still thought to be
unfit for human food, with the exception of swine. It is an anomaly
that the one article, more abhorred than all others in the Levitical
code, should become a favorite dish with us American Gentiles.
Scrofulous affections, if not generated, are thought to be aggravated
by pork ; and the measles has been charged to its use. The hog is
omnivorous, and more uncleanly than any other animal domesticated
for economical purposes a fact in itself sufficiently strong to deter
the Jews from using the meat. Let those who are possessed of the
information, show how much more we suffer from certain cutaneous
and glandular diseases than the people of countries where pork is not
used for food. We never saw a single swine in the whole of Egypt
or Syria. The old prejudice, or the ancient interdiction, appears to
influence the public sentiment in those countries. With these views,
we doubt not that the Shakers will be gainers in health, and perhaps
in longevity, by eschewing pork. Lard oil and stearine, in domestic
economy, are invaluable articles; and when the demand for them
requires all the swine raised, it will be a happy circumstance for the
people. [Hid.

1851.] Miscellany. ' 703

Mortalhij of Intemperance. At a meeting of the Statistical Society
of London, June 6th, a paper was read by F. G. P. Neison, Esq.,
from which we extract some data, in regard to the longevity of per-
sons who are habitually intemperate. The mortality of this class of
persons is shown to be frightfully high. In 6111*5 years of life, to
which his observations extended, 357 deaths had taken place ; but if
these lives had been subject to the same rate of mortality as the gen-
eral population of England and Wales, the number of deaths would
have been 110 only, or less than one-third. At the term of life from
21 to 30, the mortality was upwards of five times that of the general
community ; and in the succeeding 20 years it was above four times
greater. An intemperate person of 20 years of age has an equal
chance of living 15-6; one of 30 years of age, 13-8 ; and one of 40
years, 11-6 years; while a person of the general population of the
country would have an equal chance of living 44-2, 36-5, and 28-8
years respectively. The influence of the different kinds of drinks on
the duration of life was also shown; beer drinkers averaging 21-7
years, spirit drinkers 16*7 years, and those who drank both spirits and
beer indiscriminately, 16*1 years. The average duration of life after
the commencement of intemperate habits, among mechanics and labor-
ing men, was 18 years; traders and merchants, 17; professional
men and gentlemen, 15 ; and females, 14 years only, llbid.

Subsiiiutefor McMunn's Elixir of opium. The following is ex-
tracted from an article by E. Dupuy, New York, in the August number
ofthe Philadelphia Journal of Pharm.acy. Opium, 3x. ; water, q. s. ;
alcohol, 95 perct., I iv. The opium is to be made into a thin pulp
with water ; the mixture allowed to stand in a cool place 48 hours,
then transferred into an elongated glass funnel containing filtering
paper; a superstratum of water equivalent to the bulk of the whole
mass is added. When 12 ounces of liquid have been filtered, the
alcohol is added to the filtered solution. The proportion of opium is
the same as that in Tinct. Opii of the U. S. Pharmacopoeia. [Ihid,

Death of Sylvester Graham. Most of our readers in this part of the
country are familiar with the name of this individual, who some years
since made himself notorious in urging upon the community the sys-
tem of light and exclusively vegetable diet to which his name was
given. He has lately died at Northampton, in this State, at the age
of about 50. The Gazette, of that place, states that his health had
been gradually failing for the last year, and he had suffered much
from rheumatism in his hands and feet. " A post-mortem examina-
tion disclosed no disease in the system, which, in the opinion of the
medical examiners, was suflicient to produce his death ; and the im-
mediate cause of his decease is thought to -be the use, contrary to the
advice of his physician and friends, in the extreme exhaustion of the
system, ofCongress water and a tepid bath." [^Ibid.

704 Miscellany, [November,

BIBLIOGRAPHICAL NOTICES.

We are indebted to the publishers for the following works received
during our absence, and regret not having room to notice them more
at length at present. We hope, however, to be able to do some of
them more justice hereafter.

Elements of General and Pathological Anatomy, 'presenting a view of
the present state of knowledge in these tranches of science. By
David Craigie, M.D., F.R.S.E., &;c., &c. 2d edition, enlarged,
revised, and improved, pp. 1072. Philadelphia: Lindsay &; Blak-
iston. 1851.

The first edition of this work appeared in 1828, and established the
reputation of Dr. Craigie as a faithful observer. The present very
much enlarged edition shows that the author has kept pace with the
advances of science. By combining in the same work a study of the
tissues in both their normal and pathological conditions, much of the
monotony which would otherwise attend it is obviated, at the same
time that the acquisition of correct knowledge is facilitated. We
cannot too highly recommend it.

Special Anatomy and Histology. By Wm. E. Hornek, M. D., Prof,
of Anatomy, University of Pennsylvania, &;c., &c. 8th edition,
illustrated with anatomical figures, in 2 vols. Philadelphia : Blan-
chard & Lea. 1851.

Prof. Horner's Anatomy has been so long and so favorably known
to the profession, that it is barely necessary to state that the present is
a much improved edition, in order to secure for it the liberal patronage
it merits.

A Practical Treatise on the diseases and injuries of the Urinary blad-
der, the Prostate gland, and the Urethra. By S. D. Gross, M. D.,
Prof, of Surgery in the University of Louisville, dec, &c., with 106
illustrations, pp. 726. Philadelphia: Blanchard & Lea. 1851.

The learned author informs the reader that " the object of this
work is to present, in a systematic and connected form, a full and
comprehensive account of the diseases and injuries of the urinary
bladder, the prostate gland and the urethra." So far as we have been
able to look into the work, we have every reason to congratulate the
profession that it has been prepared by one so well qualified to
do justice to it. It is the only American monograph upon the sub-

1851.] Miscellany. 705

ject, and cannot fail to occupy a place in the library of all medical
readers.

TJrinary Deposits : their diagnosis, paiJioIogy, and tlierapeuiical indi-
cations. By GoLDiNG Bird, A. M., M. D., F. R. S., &c., ^c.
2d American edition, from the 3d revised and enlarged London
edition, pp.337. Philadelphia: Blanchard & Lea. 1851.

Dr. Golding Bird has been long known as one of the most success-
ful investigators of urinary deposits. In the work before us he gives
a faithful expose of the physiological origin and physical properties of
urine, and of the chemical pathology of the various elements of this
secretion, followed by remarks on the therapeutical employment of
remedies influencing the functions of the kidneys. This work is es-
sential to all practitioners, who feel it their duty to be well acquainted
with the resources of their art.

Lectures on the Eruptive Fevers ; as now in the course of delivery at
St. Thomas^ Hospital, in London. By George Gregory, M.D.,
&;c., &c. 1st American edition, with numerous additions and
amendments by the author, comprising his latest views. With notes
and an appendix, embodying the most recent opinions on exanthe-
matic pathology ; and also statistical tables, and colored plates. By
H. D. BuLKLEY, M. D., &c, of New York. pp. 379. New York :
S. S. &W. Wood. 1851.

The work of Dr. Gregory commends itself to the practitioner, not
only by the success it has met with in England, but also by the im-
portance of the subjects upon which it treats. Small-pox, measles,
scarlatina, erysipelas and vaccination, require so frequently our at-
tention, that we cannot be too well posted up in relation to them.
The additions by Dr. Bulkley are both valuable and interesting.

A practical Treatise on the diseases of the Lungs and Heart, inclu-
ding the principles of physical diagnosis. By W. H. Walsh, M.D.,
Prof, of the Principles and Practice of Medicine, &;c., in Univer-
sity College, London, &;c., &;c. pp. 512. Philadelphia: Blanchard
& Lea. 1851.

Diseases of the chest are becoming more common in the Southern
States as intermittent and remittent fevers diminish in frequency.
We therefore esteem this publication as quite opportune, independent-
ly of its well known intrinsic value. A thorough knowledge of tho
principles of physical diagnosis may be obtained here, and cannot bo
dispensed with in the present state of our science.

706 Miscellanij.

On diseases of Menstruation and ovarian ivjlammation, in connexion
with Sterility, ^pelvic tumours, and affections of the Womh. By E.
J. Tilt, M. b., &c., &c. pp. 286. New York : S. S. & W.
Wood. 1851.

We are much pleased to find Dr. Tilt's views reprinted in our
country. He has treated with much originality subjects of growing
interest, and his book cannot be read without great profit.

Letters to a candid inquirer on Animal Magnetism. By William
Gregory, M. D., F. R. S. E., Prof, of Chemistry in the University
of Edinburgh, pp. 384. Philadelphia : Blanchard dz; Lea. 1851.

No subject has met with more decided hostility on the part of phy-
sicians who have not studied it, than Animal Magnetism ; yet of all
classes of society, physicians are those whose vocation furnishes them
most frequently with facts beyond their ability to explain, and which
they nevertheless are compelled to admit. Scepticism in science is a
duty but so is unbiassed and candid inquiry. The Letters of Dr.
Gregory appear to be written in the proper spirit and should therefore
be read.

The Laws of Health, in relation to mind and hody : a series of Letters
from an old practitioner to a patient. By L. J. Beale, M.R.C.S.
pp.295. Philadelphia : Blanchard & Lea. 1851.

This very sensible production is Vv ell calculated to enlighten the
non-medical public, to whom it is addressed, upon a subject of ail
others the most interesting. If it were carefully read by thinking
men, it would tend very materially to correct a multitude of vulgar
errors and to lessen the success of charlatanism.

The Physician^ s Prescription Book; containing list of terms, phrases^
contractions and abbreviations used in prescriptions, with explanatory
notes, SfC, S^c. 1st American, from the 10th London edition, pp. .
Philadelphia : Lindsay & Blakiston. 1851.

This little book contains much useful matter to the student who is
not well acquainted with Latin, and who wishes to become familiar
with the phraseology of prescriptions. We believe, however, that
the use of our vernacular in writing prescriptions would diminish the
number of accidents which continually occur in putting them up. We
can see no good reason for mystifying by abbreviation and dog latin,
what ought to be made as plain as possible.

Errata. Page 516 (Sept.No.) Uth line from bottom ; instead of " Sijnochu"
read Sijnocha; and 2 lines lower down, instead of "synochus," read synocha.
Also, page 521, 3d line from bottom, instead of "creeping and jerkey," read
creeps or jerks.

SOUTHERN

MEDICAL AND SURGICAL

JOURNAL.

Vol. 7.] NEW SERIES. DECEMBER, 1S51. [No. 12.

PART FIRST.

rigtnal (!Iommttnicatiou0.

ARTICLE XXXVII.

Contribution to the History of Typhoid Fever, By H. R.
Casey, M. D., of Appling, Ga.

On the 20th day of April last I was called to see Ben, a
negro man, aged 26, whom I found to be in a low state of
fever: skin hot and dry; pulse 140; vomiting a dark greenish
slime, with diarrhoea constant and wasting ; tongue redish on
the tip and edges and cupped on the top ; eyes sunken, though
of a peculiar brilliancy; great tenderness of abdomen; tym-
panitis and gurgling on pressure over the right iliac fossa.
On enquiry into the previous history of the case, I learned that
the " boy had been sick for three weeks, having a paroxysm of
fever every day, but apparently of a light kind, rising about
noon of each day, and continuing on through the night ; that
in the forenoon he would be free of fever ; that he did not
complain of any pain, only of great weakness, and that from
the beginning of his attack." Not thinking there was much
the matter with the boy, his owner had not called in medical
aid, but had treated him himself, for a mild, though obstinate,
attack of intermittent fever. He had given him repeated doses
of calomel at night, andcastor oil in the morning, and quinine
during the intermission. Persisting in the treatment, and
thinking the disease would ultimately yield to the remedies
instituted, the case went on, overriding the mercurial and the
great anti-periodical, until twenty-one days had passed, at

N. S. VOL. VII. NO. XII. 45

708 Casey, on Typhoid Fever. [December,

which time his symptoms became suddenly alarming. I was
called in, and found him as above described. For the past
dozen years I have had my commission, and have been fulfil-
ling its requirements as occasion demanded; but in all my inter-
course with the sick I had never seen a case of typhoid fever,
nor had I ever met with a case identical in all its bearings
with the one before me. For four or five years of my prac-
tice, my field of operation was in the south-western part of the
State, in the counties of Baker and Lee, where bilious remit-
tent and intermittent fevers are to be seen in all their protean
forms, from the mildest quotidian to the algid or pernicious
variety ; the other years of my medical pilgrimage have been
in the more interior of the State ; but, as before observed, ty-
phoid fever had been to me a " thing unseen." Yet from what
I had read of this fever 1 immediately diagnosticated the case
before me as one of genuine typhoid fever, and my prognosis
was unfavorable, as I considered the boy in the last and fatal
stage. The diarrhoea and vomiting being the most urgent
symptoms, presenting the indications first to be met, I ordered
small doses of morphine in gum water ; blisters to the abdomen
and between the scapulae ; glysters of starch and laudanum
pro re nata.

21st. Found the patient in nowise improved by treatment :
the disease hurrying him on to the world of spirits. Fever had
not abated since last visit; delirium had supervened during the
night, and its ravings were still to be traced in his low mutter-
ings ; feet and hands cold ; abdomen enorm.ously distended
and hot, with great meteorism, tympanitis, and gargouillements.
Ordered brandy and carb. ammonia ; sinapisms to the ex-
tremities ; hot mustard pediluvia. With this treatment he
seemed to rally a little. Gave him to eat chicken broth with
rice: he took a little, closed his eyes in sleep and into that
sleep from which there is no awaking.

I was sent for the next day to open an abscess on a negro's
leg, and took occasion to step into the room to see the corpse,
and was surprised at its appearance. Twenty hours had
passed away since the departure of the spirit from the body,
and yet there it lay with the blood still boiling or bubbling up
from his mouth and nostrils, until a stream some 4 to 6 feet

1851.] Casey, on Typhoid Fever, 709

had stained the table on which he was laid out, coming, I sup-
pose, from the stomach, or possibly from the pulmonary vessels.
From his eyehds to his toes, his skin was stretched to its utter-
most. A few hours before his death, on examining the tem-
perature of the different surfaces, I had felt and seen the boy
all over, and the tegumentary tissue w^as soft and yielding, with
the exception of the abdominal covering. Now, such was the
extent of the distension that no indentation could be made. No
post-mortem w^as allowed.

On the 22d, was called to see case 2d. Sam, aged 16, who
was attacked the evening before with fever. Pain in the head.
Upon examining Sam, I was led to the belief that typhoid fever
had set in as an endemic on this plantation. The fever, in this
case, did not seem to be very high, though his pulse was full,
and presenting in a remarkable degree the double beat spoken
of by some writers ; tongue red on the tip and edges and furred
in the centre, the red palpillse appearing through the white
coating. Upon examining his bowels, I found them but slight-
ly distended, without gurgling. I instituted a general plan of
treatment, which was put into practice in this, and in all the
subsequent cases. I treated them on the expectant method ;
not expecting to cure the fever, but husbanding the energies of
the system, reserving special treatment for the complications
that might supervene in individual cases. My plan was to
commence with an emetic dose of ipecac, and often full emesis
was procured to continue it in nauseating doses for a day or
two ; opiates at night. Seneka tea to follow the ipecac ; Port
wine, with a nutritious and non-excrementitious diet.

23d. Called to Sam, and found him with more fever than at
last visit, and complaining of pain in his bowels ; some tender-
ness. Had fifteen or twenty leeches applied to his abdomen,
and warm poultices to succeed them. Gave him Port wine,
with 10 grs. Dover's at night. This case ran its course in
fourteen days, without any threatening. His fever would rise
every day from 12 to 4, and continue on through the night,
when there would be an intermission of some four to six hours.

Case 3d, was shown me while attending to the above. Eliza,
aged 19, was attacked with fever ; pain in the head ; great
thirst ; tongue similar in appearance to the last. Ordered, an

710 Casey, on Typhoid Fever. [December,

emetic of ipecac ; and after its operation, to continue the nau-
seant in small portions, alternated with spts. mindereri. I
shall not^ive (as I write from memory alone) the full particu-
lars of each day's observation. This proved to be a very long
and obstinate case, the fever not running its course under forty
days. There was in this, and in case 2d, an eruption on the
face, neck and chest. Her bowels, in the course of her attack,
took on diseased action ; tympanitic and gurgling, with thin,
watery evacuations. Leechings, fomentations. Port wnne, and
opium, corrected this state of things. She had a paroxysm of
fever every day for forty days. There was then a subsidence
of all febrile action for thirty six hours : then a return of fever,
which made its appearance daily for five days. After this, she
convalesced slowly.

Case 4th. Edmond, aged 15, was attacked with fever. Pain
in the head ; tongue red and furred. This case was the only
one whose bowels were constipated. His owner had given
him, before I saw him, a dose of calomel, and afterwards oil ;
but his bowels, up to the time I saw him, were still unmoved.
I ordered a glyster of salt and water, which had the effect.
This case was treated with ipecac, seneka tea, and anodynes
at night. The eruption was out as thick as possible. This case
was obstinate, the fever continuing for four weeks, having
every day one paroxysm.

Case 5th. Abraham, aged 19, became a victim to the fever,
which, however, was of a mild type, running its course in
seven days.

Case 6th. Betsey, aged 16, was attacked with fever. Pain
in the head; tongue redish and furred ; bowels loose and tym-
panitic. Gave her an emetic of ipecac, and kept it up in nau-
seating doses for a day or two. Found her on one of my visits
complaining of a sharp pain in her left side ; pulse quick,
though not full nor corded. Thinking there might be a pleu-
risy supervening, I cupped her over the affected side, and
applied a blister. Fearing a diarrhoea, I could not treat the
case as I would have done ordinary pleurisy. I gave her
small doses of ipecac, alternating with it the acetate of ammonia.
Upon the drawing of the blister the pain and cough measurably
gave way, and she seemed to be doing well on the morning of

1851.] Casey, on Typhoid Fever. 711

my next visit. About 3 o'clock that day diarrhoea set in heavily.
I was sent for in haste, but, from other engagements, did not
see the patient until night. I then found her entirely prostrated
from the wasting aqueous discharges, and her appearance indi-
cating her in articulo mortis. She was delirious, trying to get
out of bed ; pulse small and quick ; extremities cold. Had
sinapisms applied to hands and feet. The head symptoms I
looked upon as sympathetic, the coma and delirium not depen-
dent upon either inflammation or congestion, but rather upon
loss of nervous energy. I ordered opium in chalk mixture;
blister to the abdomen ; but of no avail she succumbed that
night.

Case 7th. Mehaley, aged 13, was attacked with fever. Pain
in the head ; furred tongue. Ipecac was given her, and sub-
sequently seneka tea. This was a mild case, the fever running
its course in five days. She continued to convalesce for five
or six days, when there was a relapse. She was again treated
as in the original attack, and after nine days of fever she again
convalesced.

Case 8th. Ann, aged 17, was attacked with fever. Pain in
the head ; tongue red and coated ; pulse quick and presenting
the double or vibratory beat. Gave her an emetic of ipecac,
and after the emesis nauseating doses of the same at intervals
of three to four hours. This case proved to be a very obstinate
one, and gave frequent threatenings of fatality, but ultimately
yielded, after five weeks. This woman was of a delicate fibre,
of nervo-lymphatic temperament; had been in bad health for
some years ; had had a severe attack of pneumonia last spring,
from which she had not entirely recovered. Being very deli-
cate, I thought she would not be able to stand the prostrating
effects of the fever. Her lungs being in a weakened condition,
I supposed that the disease, should it search for an organ upon
which to spend its violence, would naturally go to the weakest
one, and that pneumonia would be the complication and the
death of the patient. My fears were in part realized: about
the third day of the fever she complained of pain in the chest ;
had a cough, and expectorated the pneumonic sputa. She was
cupped on the spine and blistered ; croton oil over the chest,
and put upon small doses of ipecac in flax-seed tea. The great

712 Casey, on Typhoid Fever. [December,

contra-stimulant, the sheet-anchor of safety in pneumonia, I
was afraid to resort to, for reasons which are obvious. In
some four to five days, these symptoms, to my surprise, sub-
sided, and she seemed to be doing well, and hopes were enter-
tained of her recovery. But these hopes were not long allow-
ed to obtain. She began to complain of pain in her bowels,
and upon examination, I found them swollen and tender upon
pressure. Ordered leeches, warm poultices, chalk mixture,
with Port wine. Despite of these means diarrhoea set in with
large watery dejections : she was made to drink freely of per-
simmon and elm tea ; put her upon sugar of lead and opium,
and covered her abdomen with a blister. Was sent for in
haste to see her, and on my arrival found her passing from the
bowels large bloody evacuations, with large clots of blood. I
increased the quantities of sugar of lead and opium, and gave
her enemas of sub. nit. argent. (8 grs. to the ounce). To this
last I attribute the check of the diarrhoea. I am in the habit
of using it in all obstinate cases of both diarrhoea and dysentery,
and I think I can say \tith almost uniform success; but here,
in this case, I feared a disappointment of its curative powers.
But again it proved "a source of life unto life." Her bowels
were checked of both bloody and watery discharges in a few
hours, and in twenty-four hours thereafter she had a tolerably
healthy evacuation. The fever continued on, and in its course
a mild pleurisy supervened, which yielded to a blister and
warm teas. Her convalescence was slow, but steady.

Case 9th. George, aged 19, was attacked with pain in the
head; tongue presenting the same marked similarity that had
been and continued to be observed in all the cases, and which,
for the sake of brevity, I shall term typhoidal. His bowels
took on the anatomical lesion in the course of the fever, but
yielded to the lead and opium powders. In seven days his
fever left him, and he began to convalesce.

Cases 10 and 11. Daniel and Matilda, (twins,) aged 11, were
the next victims to the disease, but of a mild type, the fever
continuing for seven days. Case 12. Joe, aged 9. Case 13.
Hiram, aged 13. Case 14. Anderson, aged 12. Case 15. Bill,
ao-ed 7 were all attacked in the same wa\% and with but little
interruption. The fever ran its course in from five to nine
days.

1851.] Casey, on Typhoid Fever. 713

Case IG. Basil, twin brother to Ben, was attacked with
fever and pain in the head, and sickness of stomach ; tongue
typhoidal. Tliis case presented some differences from the be-
ginning so much so that there was some doubt about his
having the fever. He did not take his bed as did all the others,
and even went out to work ; visited his wife some mile or two
distant. He was, however, taken down in a few days thereaf-
ter with a violent diarrhoea. I was called in haste to see him :
found him cold ; delirious ; bowels tender and tympanitic.
Applied a blister to his abdomen; mustard to his extremities;
brandy, with laudanum ; but it was too late his fate was
sealed ; he died in a few hours. The mother of these twins,
like many of the African race, is tinctured with superstition,
and she had imbibed the notion that her boys Avere poisoned,
and it is thought that she physicked them for the poison, which
may have given inveteracy to their attacks.

Case 17. Martha, aged 26, w^as the next victim, but the fever
was of a mild variety, and left her in seven days.

Case 18. McLin, aged 22, had a severe attack of the fever:
his bowels became seriously diseased ; great nervous prostra-
tion ; pulse weak ; skin cold ; brain much affected ; and, upon
the whole, gave threatenings of speedy dissolution. But, by
the timely use of the remedies which had been used in the
other cases, similar to this, he was saved, and recovered in four-
teen days.

Case 19. Lewis, aged 22, was attacked with fever. Pain in
the head ; tongue typhoidal ; with loose bowels, and with a
dry, hacking cough. When his diarrhoea was controled, ipecac
and a blister between the scapulae removed the cough, and after
seven days of fever he convalesced.

Case 20. Amy, sister of the last, was attacked at the same
time, and in the same way. She was treated on the same plan ;
but in her case the fever was of a more obstinate type, and
complicated : pneumonia, diarrhoea, hysteria, subsultus tendi-
num, and bed-sores, were all present, and aggravated her case.
The fever continued for six weeks, and finally wore her out.
The closing stage was marked by a wild delirium, and in her
ravings her spirit escaped from its brittle and shattered tene-
ment.

714 Casey, on Typhoid Fever. [December,

Cases 21, to 27. Moses, 20; Jane, 12; Adeline, 16; Erne-
line, 13; Cynthia, 10; Dick, 7, and Cassy, 10 years of age
were all attacked with the fever, and pretty much in the same
way. The fever, in all these cases, was of a mild type, and
ran its course in about five days.

Case 28. Nelly, aged 10, was attacked with fever. Pain in
the head, tongue typhoidal. This proved to be an obstinate
case, and the only one of the children that was so. Her bowels
became diseased about the third day, and after their adjustment
there was a metastasis of the disease to the head, and acute
meningitis supervened. This ultimately yielded to leeches and
cold cloths to the shorn scalp ; but when her fever left her, she
seemed to be in articulo mortis ; pulseless and cold as marble.
She was kept on brandy toddy for two or three days, and ulti-
mately recovered.

Case 29. Jackson, aged 20, was attacked with pain in the
head ; fever ; tongue typhoidal ; bowels tender, and somewhat
tympanitic. Was treated on the same plan as was adopted in
the onset, and recovered after an illness of some two weeks.

Case 30. Adeline, aged 16, was the last case I had up to the
time when I write. This was not a case of typhoid fever, in
its incipiency ; but after the original disease (severe at first)
began to give way, it became clothed in the livery of the pre-
vailing epidemic. This was a case, in its origin, of acute gas-
tritis the inflammation, after a given time, descended down
into the ileum and the characteristic abdominal lesion became
manifest in the tympanitis ; gurgling and tenderness over the
iliac fossa. This was a very long, tedious and exceedingly
critical case ; but after continuing for some six weeks, she
seems now in a fair way to recover. After the gastritis was
subdued by appropriate remedies, and the typhoid symptoms
set in, she was treated as all the other like cases were. Diar-
rhoea and pneumonia complicated this case.

Remarks. The above is a hasty and imperfect summary of
thirty cases of Typhoid fever, occurring in the family of
Maj. T. E. Beall, of this county, and in reporting them for the
Journal, I do so with no intention of writing a treatise upon
the fever in question, nor of attempting to settle the different

1851.] Casey, on Typhoid Fever. 715

controversial points that have been and still are agitating the
medical world. With an experience so limited as mine in the
management of typhoid fever, it would be rather assuming in
me to attempt to teach, when I am only commencing to learn.
I am only presenting a given number of cases that came with-
in the perview of my own observation the treatment institu-
ted in those cases, and the success attending that treatment. I
will, however, call the attention of the profession to one pecu-
liarity in these cases, and that is the type of the fever. Typhoid
fever is, and has always been, classed among the continued
fevers, and I do not remember ever to have read or heard of it
prevaiHng in any other form. By reference to my cases, we
find it of a positively intermittent character, there being gener-
allya decided intermission of from two to six hours. From
its decidedly intermittent character, I was induced to try the
quinine ; but no impression was made by it. I shall say no-
thing of the locality where this fever prevailed, for I place but
little stress upon local causes in the generation of typhoid fever.
The hidden, unseen, intangible miasmata are not culpable for
this fever. I am rather disposed to ascribe its cause and pre-
valence to a peculiar condition of the atmosphere. Nor am
I one of those who hold that typhoid is but a modification
of bilious remittent fever. Prof. T. D. Mitchell contends
for their identity, and he thinks quinine should be as efTectually
resorted to in this as in other fevers. Now, if the Professor's
reasonings are aposteriori that is, if he considers them in the
same category, because quinine has a like influence his teach-
ings are liable to be attacked, and *'of a right should be," for I
think I hazard nothing in saying that no practitioner in these
days ever resorts to quinine with a view to break up this fever.
It has no more effect in arresting a paroxysm, or in severing the
chain of febrile action, than so much saw-dust: typhoid fever
has a defined course to run, and as well may we attempt to curb
the storm, while at sea, as to attempt to cut short or stay in
its progress this fever with quinine The skillful mariner will
rather attempt to guide his vessel safely into port, than to raise
his feeble hand to still the raging element. It is a fever which
makes a great demand upon the vis medicatrix naturcc, and the
philosophic physician will make his means chime in with this

716 Casey, on Typhoid Fever. [December,

conservative power. Act upon nature's dictates by giving to
our remedies such a direction as will aid, and not antagonize
her salutary process sustain the powers of the system until
such time as its natural tendency to restoration brings about
recovery. As far as my observation extends, the greatest dan-
ger to be apprehended is from the bowels the supervention
of diarrhoea and a good plan of treatment is to use such
means as will have a tendency to prevent such a state of things.
With this view, I put my patient (ah initio) upon Port wine,
three times a-day, and opium at night. I locked up the bowels
from the jump "an ounce of prevention is worth a pound of
cure" using enemas alone, when dejections were thought
advisable. I believe I am safe in saying that the mortality was
small, in my cases, considering their number. The statistics
of France show a mortality of one-third. I consider it a con-
tagious disease. This opinion is in direct conflict with the
generally received notion of this fever, both in this country
and in France. (^ I learn from Professor Dugas, who has just
returned from a summer tour through Europe, that the French
physicians are changing their opinions on this subject, and that
he thinks Typhoid fever is now held by a majority of them to
be contagious. Two of my cases were married women, hav-
ing husbands living on plantations some miles from the infected
locality. The husbands of these two women (being allowed
to visit their wives in their sickness) were both attacked with
typhoid fever. In 1847, typhoid fever made its appearance in
a certain family in this county. A lady, who was a visitant of
the family, paid a visit to her friends in South Carolina. At
this time, the family she was leaving were in the enjoyment of
perfect health. It happened that the family in South Carolina
wxre suffering with typhoid fever. She returned to her
friends in Columbia, and in a few day^ after was taken with
typhoid fever : it spread through the family, and several of
them died. Dr. Grisolle is an advocate of the contagiousness
of typhoid fever, but qoncurs with Louis, that it may arise
independently of contagion, and with Gendrin, that one attack
gives immunity from a second. This last, I believe, is the
prevailing opinion of the profession, both of this country and
Europe^ My last case formed something of an exception to

1851.] Cnsey, on Typhoid Fever* 717

this rule; yet, as that was not a case of typhoid fever, in its
origin, it cannot, in all probability, be brought up as an ex-
ception to the general rule.

There seems to be a greater prevalence of this fever this
year than at any prior time, owing, doubtless, to a very dry
and extremely sultry summer, succeeding a cold, damp spring.
Nor do 1 know how to reconcile this notion wnth the fact of its
greater prevalence in Northern latitudes. To sum it all in a
very few words, J think I can safely say, that as yet we know
but little, of a certainty of typhoid fever. The aaibiguity at-
tached to this knowledge is well expressed by Prof. Darrach,
in his "charge" to the graduates of the medical department
of Pennsylvania College. In speaking of *' medical discern-
ment," the Professor says " In typhus and typhoid fevers,
how difficult it is in their multiform and antagonizing thera-
peutics, to determine upon the when, and the when not the
where, and the where not the how much, and how little the
how often, and ho-d) not at all,^'' etc.

In presenting my cases, I have given the ages of each and
every one, as there seems to be a contrariety of opinion on this
point. Some writers contend that typhoid fever confines itself '
to individuals betw^eeii the ages of 10 and 30 others, again,
from 15 to 35; while there are a few who say it has no lati-
tudes to its ravages, attacking, indiscriminately, all ages and
both sexes. On the plantation where the endemic of which I
write prevailed, there were some fifty negroes, ranging from
the infant of a few months, to the grey-headed grandsire. Its
ravages were confined to patients between 7 and 26 years of
age. Mothers with suckling infants were attacked with the
fever, while the infants escaped. Now, I don't think I am
authorized in saying that typhoid fever is limited in its attack
to persons between 7 and 26, because none younger and none
older than those ages were attacked : another year and another
epidemic might compel me to change my opinion. We should
not lay down postulates hurriedly. Dr. E. Parks, (Medical
Times, vol. xxi. p. 557,) in speaking of the diagnosis of typhoid
fever, winds up by saying, " finally, in fixing the diagnosis of
typhoid fever in adults, it should never be forgotten that it is
most common under 40, and seldom seen above that age. In

718 CsLsey, on Typhoid Fever. [December,

old people there are many febrile conditions consequent on
latent and subacute inflammation, or some urinary derange-
ment, which may, at first sight, bear some resemblance to ty-
phoid fever; but the age of the patient will be an insuperable
argument against the existence of the disease. By reference
to my plan of treatment, it will be seen that I have entirely
excluded mercury in all its forms. From my knowledge of
the eflfects of this remedy from the slow, protracted course
of the disease, its defined course, the diarrhoeal proclivity I
feel authorized in entering my caveat against mercury in the
treatment of typhoid fever. M. Becquerel, jr., has presented to
the French Institute an important rp.emoir on the treatment of
Typhoid fever with the sulphuret of mercury, internally, and
mercurial ointment endermically. I am not prepared to say
how the essay was received by that honorable bod3^

If the miasmatic fevers of our country are to be displaced by
this peculiar fever, it is time that we should " be up and a do-
ing," seeking to obtain information where it tan be found. If
we are to have yearly visitations of this fever, it is highly pro-
bable that a familiarity with it at the bed-side of the sick will
add to our now limited stock of knowledge, and the time may
come when we can as confidently expect success to attend our
treatment in this fever, as we now do in the management of
malarious fevers. We have some surety in this, from the fact
that ours is a cumulative science that as years roll around,
the science of medicine advances she sees no climacteric
point : that though she may now be basking in eflulgency, she
yet sees in the far distance a ray of light, still more dazzling
inviting her onward. The science is progressive, and in the
future there are laid up for the medical philosopher gems now
hidden from sight. And this is what, in part, gives beauty to
the study of the healing art. The idea that we can live on
and learn that our knowledge now, is only a stepping stone to
farther advancement, which will as surely follow, as probation
is lengthened, fills the mind of the medical inquirer with ineffa-
ble delight.

1S51.] Cooper^s Statistics of Houston Co. 719

ARTICLE XXXVIII.

Vital Statistics of Houston County. By Geo. F. Cooper, M.D.,
of Perry, Ga.

Vital statistics are to medicine, what mathematics are to the
astronomer. Perhaps our calculations are not as precise, and
may not attain our object as infallibly as his, yet the same
principle is involved, and to us the results are as grand. The
most astute observers have long since acknowledged the "nu-
merical system," based upon proper and authentic data, to be
the most practicable and reliable means of establishing the
average of life and its duration, the salubrity or insalubrity of
different localities and other matters most intimately connected
with and important to the progress af civilization. Extensive
laborers in this field are unfortunately but few, the work
which attaches to it is not enviable, but the reputation which
it secures is worth possessing. The works of Berard, Casper,
Tommasini, Roberton and Quetelet, will long live as remin-
iscences of their industry. The philanthropic efforts of Lem-
uel Shattuck, Esq., of Boston, to improve the sanitary condi-
tion of his commonwealth, will be imperishable; and those of
Dr. Simonds, aided by others, of New Orleans, to stay the
frightful mortality annually dealt out upon her population, will
not go unrewarded. And could the information which pertains
to medical science, recorded in the late census, and which is
quite accessible, be spread out before the public, developments
would be made highly encouraging to our empire State. Dr.
Pendleton, of Hancock county, projected a work that I would
gladly see consummated in the respective counties of the State,
and from which I have derived no inconsiderable aid in the
preparation of this paper. Houston county lies between 32
15' and 32^ 40' north lat. and 6 30' and 7^ west long, from
Washington, between the Ocmulgee and Flint rivers, below
the line of primitive rocks which touch at Macon, the nearest
point, I believe. Tertiary formations constitute its geology.*
Pine lands compose the largest area of its surface there is a

* At no distant day I hope to be able to speak of its meteorology from more
complete data than I now possess. I hope, therefore, my omission of it now,
will be overlooked.

720

Cooper's Siatistics of Houston Co. [December,

section of mixed growth that is pine and oak, and a ridge
stretching almost, if not entirely, from north-east to south-west,
through the county, apparently more elevated and possessing
I doubt not some interesting geological features ; many places
abound in lime rock composed almost wholly of fossil shells,
many of which are entire, and by conchologists could easily
be assigned their respective places. This ridge is well known
as "the oaky woods" or "lime lands," and is much the most
productive, owing doubtless to the great quantity of calcareous
matter present. These rocks are not very hard, and when
burned yield largely of pure lime. Most of the pine lands con-
sist of a silicious soil, and are therefore not productive ; while
some, and particularly those that border upon the streams,
have a loamy soil and are indeed the most desirable cultivable
lands in the county.

The following table will exhibit at one view the entire pop-
ulation, as to race, sex, age, i&c.

Years.

WHITES.

BLACKS.

MULATTOES.

Males.

Females.

Males.

Females.

Males.

Females.

under

10

1162

930

1680

1716

83

55

over 10 *'

20

775

654

1116

1029

54

127

*' 20 "

30

562

620

1033

1048

38

23

* 30 ''

40

505

387

465

469

11

7

" 40 "

50

192

190

200

152

2

2

" 50 "

60

124

129

176

197

2

1

*' 60 "

70

83

75

91

82

0

0

" 70 "

80

44

48

22

36

0

1

" 80 "

90

7

5

14

14

0

0

100 & over

0

0

1

3

0

0

This gives us, whites, 6492 ; blacks, 9544 ; and mulattoes,
406 being seven less than appears upon the census.

The aggregate population as recorded is 16449. It will be
perceived that one unusual feature occurs in this table : among
the white females, that from the age of 30 to 40 inclusive,
there is the diminution which generally occurs from 40 to 50.
This is explicable only on one ground and my acquaintance
in the county is not sufficient to verify the suggestion, that is
the critical period takes place earlier among the white females
than among the negroes. I think this idea would hold good as

1851.] Coopev''s Statistics of Houston Co, 721

far as my observation goes, it being rarely the case that white
females are found bearing children over the age of 40. Be-
tween 40 and 50 they get the ascendency and maintain it.
After the age of 50, particularly after 70, a sudden decrease
occurs, wdiich can only be explained by the fact of the county
having been settled comparatively of recent date. There is
no doubt, that as the county grows older, the number of these
ages will be swelled so as to compare favorably with the older
settled sections of the State. It will also be noticed that a
large number of slaves are under the age of 30, which is pre-
sumed to arise from the fact that, a large portion of our slave
population is a purchased one. This does not appear among
the whites, and is therefore rendered more plausible. The
males are predominant in both of the pure races, while in the
hybrid the females are quite in the majority ; a fact noticed by
Dr. Pendleton, and which he intimates may have some bearing
upon an interesting physiological fact alluding, I imagine, to
their procreation. In regard to extreme longevity, the blacks
take precedence ; while from 60 to 80 the whites have much
the largest ratio. One white attains 60 in every 41, while the
blacks only 1 in 57, and mulattoes 1 in 136. Whites who at-
tain 70, nearly 1 in 70, and blacks only 1 in 168. There are
only 3 mulattoes in the county who have attained 60, and only
1 at 80.

We have among the whites, 12 octogenarians, (7 males and
5 females,) which gives us 1 in every 543. There are 28 black
octogenarians, (14 males and 14 females) giving them predom-
inance, being 1 in 354. Not a single centenarian is recorded
among the whites, and only 4 among the blacks 1 male and 3
females giving them 1 in 2481. We should not overlook the
recent settlement of the county in connexion with this part of
the table.

Whether or not this extreme age is attained alone by the
original Africans, I cannot say ; I believe, however, the idea
would be upheld by investigation.

The number of marriages among the whites was 43. The
number of births 166 giving an average of 386 births to
each marriage, or 3-7 per cent., which, as well as I remember,
will compare favorably with England and some other European

722

Cooper's Statistics of Houston Co. [December,

countries. The number of black births was 223 making the
aggregate of births 389. This will give us among the whites
1 birth to 39*3 persons, and 1 to 44*5 of the blacks ; and 1 to
every 42 or 2*36 per cent, of the whole. Notwithstanding the
circumstances of the blacks, in the main, are much more adverse
to gestation, and perhaps three abortions occur among them to
one among the whites, yet the difference in the per centage of
births is small : with proper management, I believe they would
transcend the whites almost two to one. It is often to be seen
upon large quarters, where there are thirty, forty, and even
fifty negresses, scarcely a birth, and at most, not over three or
four occur during the year. I think I know some planters
who really do not desire the negro women to bear children,
because they cannot perform the same amount of labor. If
men would reflect, they might see in the end they become
their own despoilers ; and those who attempt to frustrate na-
ture's great design, and do not encourage the increase of their
own property, should not possess it.

There were 201 deaths in the county for the year ending
the first day of June, 1850: of that number, 114 were males
and 88 females, 72 were whites, 125 blacks and 4 mulattoes
making a per centage among the whites of 1*10, or 1 in 90*6;
among the blacks, mulattoes included, 1-29, or 1 in 769. For
females, the ratio was 1 in 80, or 1*10 per cent.; for males, 1 in
73*5, or 1'35 per cent. For the whole population, it was 1 in
81*7, or 1*22 per cent. leaving us an increase of population
by births alone of 2*36 per cent.

The following table will exhibit the number and ages of those
who died :

undei

' 5

100

over 5

<(

10

12

" 10

((

15

13

'* 15

20
25

11
11

" 20

ove

r 60

under 65

8

'* 25

i(

30

4

it

65

70

3

*' 30

tt

35

4

i(

70

75

0

*' 35

ti

40

6

it

75

80

2

" 40

45

5

<(

80

85

3

" 45

((

50

7

((

85

90

1

" 50

<(

55

1

((

90

95

0

*' 55

((

60

9

u

95

((

100

1

1851.] Cooiiev's Statistics of Houston Co. 723

Thus it will be seen that half of our mortality occurs among
those under 5 years of age, and much the largest proportion
of them are blacks ; which may be easily explained, in conse-
quence of the same care not being taken of them and the same
comfort being provided. The farmer should look well to this
matter, as he is loser and would be profited in an amendment.
That our climate or locality is inimical to the child, I have yet
to learn ; but really mothers would not be induced from the
above table to make a nursery of Houston county. I am
much inclined to the opinion, that the major part of this mor-
tality may be justly attributed to that prevalent, deprecable
belief, that " old women know more about children, than doc-
tors." It' might be expected that the mortality of the blacks
would exceed that of the whites; for they are, perhaps, as sus-
ceptible to predisj)osing, and certainly more exposed to exciting
causes, and they are not unfrequently crowded together in illy
ventilated houses, which too often become foci of disease, and
as often in shanties which do not protect them from the cold
and vicissitudes of winter. I noticed in Dr. Pendleton's paper
the mortality among the whites was only 0*76, while among
the blacks it was r35, a disparity much above ours. The ex-
cess of our white mortality over his may be, perhaps, in part,
explained upon the ground, that in the older settled portions
comfort and ease are studied much more than here, where all is
absorbed in that insatiable desire to make cotton and buy ne-
groes.*

The following is the order of deaths in each month : Janu-
ary, 18 ; February, 29 ; March, 15 ; April, 17 ; May, 28 ; June,
8; July, 16; August, 12; September, 24; October, 15; No-
vember, 7; December 11. The following will show the order
as to seasons : Spring, 60 ; summer, 36 ; autumn, 46 ; and
winter, 58 ; clearly showing winter and spring to be, by con-
siderable odds, the most fatal seasons a fact which, for the last
few years, accords with the observation of all. These seasons,
once the most salubrious and enjoyed, are now looked to with
much apprehension and dread. The average age of whites, at
death, was 20 years; of the blacks, 16'6 ; and mulattoes, 10.

* Efforts were made to obtain information touching the mortality of the adja-
cent counties, but were unavailing.

N. s. VOL. vn. NO. XII. 46

724 Cooper's Statistics of Houston Co. [December,

The number of the latter class, compared with the others, be-
ing too small to afford relial)le data. The great mortality
amoni,' children will account for this limited average, as it will
be seen by reference to statistical tables, cither of Europe or
this country, that as low down as our county sounds to many
of our up-country brethren, our mortality is by no means dis-
couraging.

The diseases occurred as follows, having been alphabetically
arranged :

A])oplexy, .... 1 Fever, typhus, ... I

Bronchitis, . . . . G " inflammatory, . I

Brain, rlropsy of . . 1 *' child- bed, .... 5

*' congestion of . 1 Gravel, ..... 1

" ii^flammatioR of 1 Influenza, 3

Bowels, inflammation of 15 Li juries, 18

Croup, 4 Intemperance, ... 3

Cramp Colic, ... 2 Lungs, congestion of . 1

Cholera Iiifantum, . . 1 Old age, 4

Convulsions Infantile, 4 Pleurisy, ..... 2

Dentiticm, .... 6 Pneumonia, .... 27

Diabetes, 1 Pertiissis, 4

Dropsy, . . . . .15 Rheumatism, . . - 1

Dysentery, .... 3 Scrofula, I

Erysipelas, .... 1 Suicide, 1

Fever, 9 Phthisis Pulmonalis, . 3

" congestive, . . 5 Unknown, .... 35

*' bilious, ... 1 Worms, 6

'* typhoid, ... 3

We find 12 deaths to have occurred from attacks upon the
brain and nervous system, 6 from dentition, 27 upon organs of
digestion, 15 from dropsies, 1 from eruptive fever, 20 from
idiopathic fevers, 1 from disease of fibrous tissue, 1 from glan-
dular, IS from injuries, 2 from intemperance, 4 of old age, 50
organs of respiration, 1 suicide, 2 urinary organs, unknown 35,
and 5 peculiar to women. More than half which compose the
diseases of the organs of respiration are pneumonia, which has
caused our citizens to look with so much apprehension to the
winter season, 18 of which I think occurred in one militia dis-
trict. In this instance, latitude seems to have lost its influence
in the production of that class of diseases which it usually ex-
hibits. The unknown stand out in bold relief, and is certainly

1851.] Weatherby, on Dysentery. 725

no argument that all have physicians, for doctors usually nanne
disease, whether riglit or wrong. The ugliest feature is, that
our morlnary records aie blotted with 3 deaths froni intemper-
ance. Thai class of disease, zymf)dic, which coustilules the
standard by which we are enabled lo compare different locali-
ties, and their j-elative salubrity does not occupy such a promi-
nent stand in ou)- catalogue of diseases ps to frighten us, and I
pi'esume there are not many sections which have the advanlnge
of us. In 'the county, there was one deaf white, 3 deaf and
dumb, 1 blind, 1 insane, and 11 idiotic. Among the blacks,
there were 6 blind, and 9 idiotic. Making the total of 1 deaf,
3 deaf and dumb, 7 blind, 1 insane, and 20 idiotic. The blacks
suffered most from blindness, evidently from cx]-)osure. Among
the idiots, 5 belonged to one famil}^ and 2 to another, thereby
swelling our number by hereditar\' transmission, and not inci-
dental causes. Out of the whole number, 17 were males.

AI^TJCLE XXXfX.

A notice of Dysentery, as it prevailed in Gordon and Cass
Counties. By J. S. Weatherby, of Palmetto, Ga.

Having noticed in the Sept. No. of the Journal, a communi-
cation from Dr. Campbell, of Augusta, on Dysenteric fever,
and observed that he failed to obtain reports from localities
where it prevailed, I have drawn up a sketch of an endemic,
that I with others, attended last summer, in the counties of
Gordon and Cass. This will of course be brief, as I have to
depend entirely upon memory.

The locality in which it first commenced and evinced more
malignancy, was in Gordon county, on and between the creeks
Salaquoy, Pine-log and Cedar. The whole of this region of
country was some years since very subject to bilious fevers,
but for the last two or three vears had been remarkablv healthv,
with the exception of sporadic caes of typhoid fever. The
spring and summer were remarkable for their heat and drought.
The endemic commenced about the 1st of June, and might be
truly called an awful scourge, sweeping over the counti-y with
a baneful and noxious influence. Scarcely a family in the re-

TS6 Weatherby on Dysentery. [December,

gion of its prevalence escaped a visitation from this unwel-
come guest; and many, particularly the very young and very
old, succumbed to it.

Symptoms. It was generally ushered in by slight pain and
tormina, in the lower portion of the abdomen, with frequent
desire to defecate. The discharges during the first day con-
sisted of feces mixed with a little mucus. These symptoms
gradually grew worse, the pain more intense ; and on the se-
cond or third day a slight chilhness was followed by fever,
which would generally be continuous. The abdomen at this
time usually became tender, and evacuations attended by the
most excrutiating pain, would occur at intervals of from fifteen
to thirty minutes. The evacuations consisted of bloody mucus,
and sometimes pus, resembling very much the contents of a
large boil that had been bruised. The tongue was generally
coated with a thick whitish or brown fur, and was frequently
cold at the tip. The head was very rarely affected. The pulse
was generally full, and from 80 to 100 per minute. The skin
generally remained harsh and dry until the latter stage, when
in fatal cases it became suffused with cold, clammy perspira-
tions. The duration of the disease was from ten to fourteen
days, though in some cases it proved fatal in less than ten days,
and in other cases recovery did not commence before the
twentieth day. I can say very little of the pathology of the
disease, as I made no post-mortems ; yet I think the onus fell
upon the large intestines, and that the inflammation frequently
extended to the whole alimentary canal.

The cause of the disease must have been atmospheric, as it
made its appearance in many places and at nearly the same
time ; the people, however, contended strongly for its conta-
giousness. When called to a })atient in the first stage of the
disease, if the pulse was full and strong, with febrile excite-
ment, the lancet was used freely and always with benefit ; after
which the bowels were freely acted upon, either with calomel
and ipecac, blue-mass, or castor oil and ipecac. Sulphate of
morphia was given to allay pain. After the bowels had been
acted on, Dover's powder was given every two or three hours ;
warm fomentations to abdomen ; injections of slippery-elm
tea, starch and laudanum, &;c., &c. In what might be called

1851.] Johnson's Case of Lithotomy, 72f

the 2(1 stage, if the pulse did not warrant bloodletting, I gave
calomel and Pulvis Doveri, night and morning, followed by
castor oil and ipecac. After the bowels were acted on by the
oil, pulvis Doveri was given in oft and repeated doses. I also
gave nitrate of silver injections in this stage. In the last stage,
if the disease progressed thus far, medicine did little good.
Stimulants and nitrate of silver injections were the principal
remedies. With this treatment, out of fifty or sixty cases, I
lost five or six.

ARTICLE XL.

A Case of Double Lithotomy. By Wm. J. Johnson, M. D.,
of Fort Gaines, Ga.

We make the following extracts from a letter received from
Dr. Johnson, dated Nov. Isl, 1851. The patient, Mr. Givins,
was 18 years of age, and had been afTected with symptoms of
stone from early lite. Dr. J. first saw him in August last, and
advised an operation as soon as possible. It was, how'ever,
only on the 8th October that he repaired to the Doctor for
relief. [Ed.

At 10 o'clock the next day, (9th Oct.,) I repaired to Frank-
lin, where I was met by my brother, Dr. Wm. G. Johnson, and
Drs. Hilburn and McKewen, surgeon-dentists, who kindly
administered the chloroform, while, with the assistance of my
brother, I undertook the operation and truly a formidable
operation it proved to be. Having secured the patient upon a
table, in the usual manner, I proceeded to perform the lateral
operation. . The operation progressed finely and satisfactorily
until I encountered the stone, when, from its large dimensions,
I found it impossible to extract it through the perineum. I
then made a great many ineffectual attempts to crush it with
the forceps, but all my efforts proved abortive, and I was com-
pelled, after a consultation with my brother, as a dernier resort,
to perform the high operation. The calculus was removed,
the wounds dressed in the usual manner, the patient put
to bed, and a dose of pulv. doveri et morphine administered.

728 Johnson's Case of Litliotomy, [December,

His situation for the first twenty- four hours was as comfortable
as could have beeii expected, under the circumstances. He
had scanty urinary discharges through the tul)e left in the open-
ing. He slept comfortal)ly, and declared himself more free
from pain than at any previous time for the last two months.
During the operation tl\e hemorrhage was slight, the patient
not having lost exceeding a half a pint of blood. The coats of
the bladder were much thickened and indurated, showing that
the long presence of the stone in the cavity of the bladder had
occasioned a structural change in its parietes, &c. After the
first twenty-four houi's, synrploms of peritonitis supervened,
accompanied witii ileus. He had cold surface and extremities,
constant vomiting every few nn'nutes, indomitable thirst, tym-
panitis, iSsc, obstinate constipation, &c., &c. Notwithstand-
ing these unfavorable appearances the patient lived some
eighty-two or three hours. The body of the calculus, I suspect,
is composed principally of phosphates; the outer crust, or
covering, is exceeding fragile, and the color is a greyish while
mixed with red. The calculus was weighed by Col. McAlister,
a mei'chant of Franklin, and found to weigh within a fraction
of six ounces. Could I have succeeded in securing all the frag-
ments, I am certain the weiglil would have been at least six
ounces. The following are the dimensions of the stone, taken
by a workman in this place, by rule : Length, 3 inches ; lon-
gitudinal circumference, 7 inches; width, 2 inches; lateral
circunifcrence, 5^- inches.

I have no recollection of having seen any case reported where
60 large a calculus has been removed in this State.

1851.] On the Phosphate of Lime ^ ^c. 729

PART II.

(Eclectic cpartmcnt

On the Physiology and Pathology of the Phosphate and
Oxalate cf Lime, and their relation to the formation of cells.
By William Beneke, M. P., Resident Physician at the Ger-
man Hospital, Dalston. (Continued from p. 473 of this
Journal.)

PART IL

Having alhidcd to the principal facts which afforded a proof
of the relation of the phosphate of hnie to the formation of cells,
in my lirst communication, there is one point which I have now
to insist I' pon.

It, namely, being a fact, that we are enabled to increase the
formation of cells in diseases whicfi evidently show a want of
formation of cells, by the adniinistralion of jihosphate of lime,
we must suppose that there exists a want of the latter in indivi-
duals who are afflicted with those diseases ; and so arises the
questi(>n whether it Ije true, thai in diseases which I have
shown to be most beneficially influenced by the administration
of phosphate of lime, that the phosphate is present in the system
in a smaller quantity that it onghl to be in the normal state ?

With respect to this questicm, we have first to couTplain of the
impossibility of directly determining the quantity of phosphate
of lime which is j)resent in the body. E^-ery one who has direc-
ted his attention to the quality of the bones in dificront skele-
tons will be acquainted with the great difierences of their con-
sistence ; however, we are unable to determine or even to
estimate these difierences during life. One might suppose,
perhaps, that the above question could be solved by acciu'ate
analysis of the blood ; this supposition, howevei", is also entirely-
wrong. The blood which is drawn froni the veins or arteries
does not show the ])roportion of the materials brought into the
systerji as food ; it does not only contain those materials which
are necessary for the formation of new snbstiuice, but it also
contains many parts which result from the wear and tear of
tissnes and organs, so as to form a compound mixture of nutri-
tious and excrementitious sul)stnnces. We ought, therefore, to
be as careful as possible in making iq) our results from those
analyses. We are very well aware of the increase of fibrin in
the blood in cases of acute rheumatism, pneumonia, and other
inflammatory diseases, but we have not yet anivedata certain
determination, whether this increase of fibrin is owing to an
increased quantity of albuminous substances taken as food, or

730 On the Phosphate of Lime, ^c. [December,

to an increased resorption of the fluid which penetrates the cel-
lular tissue of the various organs, and the single constituents of
which partly originate from chemical changes of the tissues
themselves. And still greater is our uncertainty in judging of
the origin of the phosphate of lime which is found in the blood.
It is not difficult at all to determine the quantity of phosphate
of lime contained in a certain quantity of blood ; but what con-
clusions can be drawn from such an analysis ? On the one hand
the phosphates are brought into the system with the food taken,
on the other they originate from the wear and tear of the bones
and the muscular tissue ; one part of them is concerned in the
formation of new substance, another part is thrown out of the
system by the kidneys and the bowels. Supposing now the
wear and tear of bones to be abnormally increased, an abnormal
quantity of phosphates will consequently re-enter into the com-
position of the blood, and by analysing the latter we shall find
an increased quantity of phosphates in it. The general waste
of bones is therefore leading to an increase of the phosphates
in the blood, and nothing really would be more erroneous, than
to suppose the general quantity of phosphates in the system to
be increased, whenever we find their quantity increased in the
blood. We cannot therefore avail ourselves of the analysis of
blood in order to solve the above question ; but there is ano-
ther way which will enable us to do so, and this way is afford-
ed by continued analysis of the urine and the faeces. Thereby
we shall know what quantity of phosphates is thrown out of the
system, and by comparing this quantity with the average quan-
tity of phosphates taken with the food, we shall be very well
enabled to judge of a general increase or decrease of the earthy
phosphates in the system. However, as it is very likely that the
greatest part of the phosphates contained in the excretions of the
bowels originate directly from the ingesta, and as it is certain,
on the contrary, that the greatest part of the earthy phosphates
contained in the urine originate from the wear and tear of the
tissues and bones of the system, I have in the first place only
directed my attention to the latter, and I have found the analy-
sis of the urine to give a satisfactory answer to the question
proposed. It is clear that if in the normal state from six to
eight grains of phosphate of lime are eliminated from the econo-
my in twenty-four hours, and elimination of from thirty to forty
grains must indicate a general loss of bony substance ; and
from the quantities of phosphate of lime found in the urine, we
may approximatively determine whether such a loss takes place
or not. I do not myself consider the analysis of the urine alone
sufficient for a complete solution of the above question ; such
a solution absolutely requires also analyses of the faeces and

1851.] On the Phosphate of Lime, ^c, 731

ingesta ; however it will be seen that, to begin with, those ana-
lyses of the urine are sufficient, and that they indicate the way
which we have to apply to in our future inquiries. Thus, then,
instead of the above question, the question that arises is, whe-
ther in those diseases which I have shown to be most benefi-
cially influenced by the administration of phosphate of lime,
the earthy phosphates are eliminated from the system by the
urine in a larger quantity than in the normal state ? whether
different quantities of ])hosphates are excreted in different dis-
eases generally ? and what quantities these are ?

I am happy to state that I have succeeded in answering this
question satisfactorilly ; and it really afforded me great pleasure
to see the results of the analysis of the urine agreeing in the
most remarkable manner with my former observations. I have
found that in all chronic diseases which are distinguished by
wasting, emaciation, ulcerations of the skin and of the bowels,
&LC., (such as scrofula, especially rickets, &c.,) a much larger
quantity of phosphates is removed from the economy by the
urine, than ought to be in the normal state ; and even such
quantities as one never would have imagined, without entering
into these examinations.

Previously, however, I have to say a few words on the mode
of examining the urine which I adopted. As in otfier examina-
tions of this kind, I here also only endeavoured to obtain ap-
proximate results, which I believe to be sufficient for general
deductions. It seems to me quite indifferent, indeed, whether
we know that a man's urine which is passed during twenty
four hours, contains ten grains or whether it contains eleven
grains of phosphates; if our mode of analysis is sufficient to
show whether a given quantity of urine contains ten, fifteen,
twenty, thirty, fifty, or more grains of phosphates, I think this
mode affords a way by which we may arrive at positive results.
First, I believe it ought to be our only object to obtain such
general and positive facts, upon which we can base our physio-
logical and pathological views ; and having become accjuaintcd
with these positive general facts, we may enter upon their
more accurate examination, though in many cases we shall
hardly gain anything else thereby, than a quantity of numbers,
more positive and accurate than could be obtained in the other
way; we shall gain other numbers, but no other views. In
this way I then proceeded with res{)ect to the phosphates of the
urine ; and the following was the mode of examination which
I employed.

It is wx'll known that the phosphates of lime, as well as of
magnesia, are held in solution in the urine by its acidity, and
directly precipitate when the urine becomes alkalescent by the

732 On the Phosphate of Lime, cj^c. [December,

addition of alkalies, or animoniacal by putrescence. This pre-
cijjitation of the j^hospliates ))ecomcs much more complete
when the urine is heated pr boiled, a)jd ly the addition of a
solution of soda to boih'ng urine \vc may ])recipitatc the whole
quantity of phos[thalcs piesent. Snpposiiiii- now we put a small
quantity of urine (about two (b-nchius) into a test-tube, boil it,
and add a few (b'ops of a solution of pure cavbouate of soda, so
as to make the urine alkalescent, and dircctl}' \vc shall perceive
whether a small or a large quantity oi" phosphates is present.
By always making use of the same solution of soda (I used a so-
lution of one ounce of dry carboi^ate of sof'a in twelre ounces
of distilled water,) and of the same sort of test-tubes, we shall
farther observe, that by the preci|Htation of the phosphates, cer-
tain and distinct degrees of tui-bidity are produced in this u-ay
in diiferent sorts of urine, and even these degrees are so v/ell
marked, and so easily distinguished one fi'om aviother, that I
have considered this w:iy sufjicient in order tojiidire of the
quantity of pljos[hates presoitin any ui'ine. ] therefore marked
these various degrees of turbidity by numl)ers, and so exhibited
for myself seven various t}])es, on which I fouicded my observa-
tions. B}' No. 0, I marked a sort of urine whicii did not show
the least turhidity by the addition of soda whcji boiled ; by No.
^ a sort which became opalescent by the same means ; by No.
1, a sort of urine which became opalescent in a higher deui'ee,
but so as still to admit of the recognition oi' objects behind the
test-tube, as, for instance, the bais of the window, &c. ; by No
1|- a sort which exhibited an opalescence of such a deifree that
it was impossible to see through it, or to lecognise any object
behind it; by No. 2, a sort which became quite tuibid by the
addition of soda, when boiled; by No. 2^, a sort frrm which,
after a few seconds, ])roceeded a precipitation of phosjihates,
when treated in the same way ; ])y No. 3, a sort which directly
yielded a precipitation 1)3^ the addition of soda; and lastly, by
No. 4, a sort of urine froj)i which the greatest possible amount
of phosphates was ])recipitated. These numbers, and these
significations of them, soon became so familiiir to me, that by
several most accurate analyses, which I instituted in order to
have a test of accuracy, I almost always ol)tained equal results
so as to convince me that this mode of analysis Avas to be relied
upon.

Of course there occurred descriptions of urine which could
not with propriety be marked by any of the numbers alluded
to ; well then, I marked them by |, 1^, If, &c.

In order to know the positive quantity of phosphates which
was contained in the difflsrent sorts of urine, 1 made most accu-
rate analyses of each of them, and these analyses the more in-

1851.] On the Phosphate of Lime, <^c, 733

creased my confidence, as iho)' showed quite sinnilar results to
the numliersijro})oseil.

When nieetinu^ with alkah'ne or animoniacal urine, of course,
after hfivinir well slii'rcd it np, so that the sediment, if there he
any, should he equally distributed thmnL^hont the whole, I first
tried the degree of alkalescence, and according to this degree
I adfleil a few drojis of soda-solnliou or none ; and when meet-
ing with ajhuminous urine,! hrst precipitated the alhumen or
boiled the urine, after the addition of the solution of soda, in
which case the alhitmeu dnes not cnnirulate. The eye may
often ))rove fftllacions ; however I conld never deviate far Uum
the truth, and the error committed conld neve)' surmount the
quantity of phosphates which I marked hy i, or at the most i.

In accurately rlctormining the quantity ofjihosphates jjrcsent
in any of the numhered types, I used the following method:
Four ounces of lu-inc are njado ami^ioniiical hy the addition of
a few di'ops to annuonia ; the preci})italion thereby produced
is redissolvcd by acetic acid, and then a sufficcnt quantity of a
solution of oxalate of potnsh is added ; a precipitation of oxalate
of lin)e takes place, and this having subsided, after about twenty-
four hours the urine is filtered. Thereby a residue of oxalate
of linie and a filtered fljiid is obtained. The oxalate of lime is
then burned with the filter, and carbonate of lime results. Now,
on gentl) lifting the lid of the crucible, a few drops (3 to 5) of
concenti-ated sulphuric acid are added; the acid is evaporated
at about 200, and then the sul[ihate of liriie is strongly hnrned.
The resulting weight of sulphate of linie multiplied by 0*7647
gives the accurate amount ot phosphate of lime, the weight of
the filter-ash having been previously derlucted. To the filtered
urine is then adrlcd a few (lro[)s of annuonia, and a precipitate
results, which consists ofajihosphate ofanimonia and maunesia,
(triple ])hosphate.) After a low hours this precipitation is
collected on a filter, anr] the residue, burnt with the fikei* and
"weigheH, indicates the exnct quantity of pyroi)hosphate of mag-
nesia, the weight of the filter-ash having been here also previ-
ously sid)tracted. By summing up the quantity of phosphate
of lime and of phosphate of maunesia, we shall obtain then the
exact quantity of earth}' phosphates which is contained in four
ounces of mine, from which may be easily calculated the
quantity contained in one ounce, or in 1000 pni'ts of urne. (This
method of analysis has been investigated by Dr. Ileintz, at
Berlin, and kindly communicated to me by Dr. Boeckcr.)

The following now arc the results of the analyses which I
have pcrformcfj in this way, on which we may depend the
more as most of them have been twice repealed. First, the
urine, which I marked by 0, always contains a very small quan-

734 On the Phosphate of Lime, <^c. [December,

tity of phosphates ; this quantity, however, cannot be detected
in the above-described way, but it never seems to exceed the
quantity of 0*2000 grains in one ounce of urine. There are
many steps between no phosphates at all and of 02000 grains ;
they require a more accurate study in order to show the pre-
ternatural decrease of the quantity of earthy phosphates in the
urine. But as we shall consider here only the hypernormal
increase of the quantity of phosphates which are excreted in
the urine in diseases, I am compelled to waive tfiis discussion
at present. I have only to state, that in every case we may
consider a urine marked by 0 as containing 0*2000 grains of
earthy phosphates, or less ; never more than this in one ounce.
With respect to the other descriptions of urine, I should really
far exceed the limits of this paper by adducing the results of the
single analyses ; they can be seen in a pamphlet which I have
lately published in German}^ entitled, ''Zur Physiologie und
Pathologic des Phosphorsauren und Oxalsauren Kalkes." Goet-
tingen, 1850. Here I only beg to state the general results as
follows :

A urine marked by \ contained nearly 0*250 0-300 grains
of earthy phosphates in one ounce; a urine marked by 1,0*400
0-450 grains ; a urine marked by H, 0*550 0*600 grains ; a
urine marked by 2, 0-700 0.750 grains ; a urine marked by
3, roOO ] -050 grains; and lastl)', a urine marked by 3 4,-
rOOO 1.3000 and more grains of earthy phosphates. By re-
ferring to these numbers we may easily approximatively cal-
culate the quantity of earthy phosphates voided in twenty-four
hours, and I am sure we shall never be far from the truth.

After these explanations I have to speak of the different
quantities of phosphates which I met with in the urine in dif-
ferent diseases. My observations of course do not extend to
all diseases ; it would scarcely be possible to give such accounts
in a large number of years, notwithstanding I observed a suffi-
cient number of cases with respect to this point for the deduc-
tion of some general results.

First, I have to remark generally, that scarcely any disease
occurs, in the course of which we should not sometimes find an
increased quantity of phosphates ; that at any rate there exists
no disease which does not admit of some hypernormal excretion
of phosphates at someone of its periods ; on the other hand we
meet at different periods of disease with quite different quanti-
ties of phosphates, as, for instance, it often happens that in the
first stages of diseases we do not find an increased quantity of
phosphates at all, and that at a later period a large quantity is
excreted. With respect to this point, and in order to obtain
results which can be depended upon, it is therefoie indispensa-

1851.] On the Phosphate of Lime, <^, 735

bly necessary to examine the amount of phosphates almost every
day ; we shall never arrive at correct views if we do not attend
to this rule.

Secondly, it must be stated as a general result, that the quanti-
ty of phos}>hates excreted does not depend as well upon the
nature of the disease itself, as upon the individual afflicted ; and
if in one case of rheumatism we find, for instance, a large a-
mount of phosphates in the urine, we do not detect any increase
at all, perhaps, in another case. This point really is a very
important one : it afibrds the best proof of the general fact, that
we are always wrong in speaking- of certain diseases as of in-
dividuals, or as of well defined and marked never-varying alte-
rations of the physiological state of the body, and that we shall
never succeed in obtainino* positive results, if we do not direct
the most accurate attention to the previous history and the for-
mer state of the individual who has become afflicted with any
disease in other words, if we do not individualize disease.

It may be concluded from these short remarks, that it is very
difficult to give an account of the excretion of phosphates,
generally apjilicable and absolutely right in almost every case.
However, we meet with some pathological states which, gene-
rally speaking, very rarely show an increase of the excretion
of phosphates; with other affections which always show an in-
creased quantity of phosphates in the urine and even a most
anomalous quantity; and with others which are generally dis-
tinguished by a slighter, but continued loss of phosphates. To
these states and affections I shall now draw attention, and I
scarcely know how to give a better ex})lanation of them, than
by referring to the numbers above alluded to.

I have met then with urine containing only such a quantity
of phosphates as I have marked by 0 or |

1st. In persons who, always showing a good state of health,
a normal complexion and colour, and a strong constitution, have
accidentally become afflicted with disease or injury, as, for in-
stance, with syphilis, wounds, contusions, 6lc. As I really
considered these persons as nearly healthy, at least for so long
a time as the affection remained a local one, I am inclined to
view the quantity of O'lOOO 0*2000 grains of earthy phos-
phates in one ounce of urine as nearly the normal quantity. It
must, however, be remembered, that it is always extremely dif-
ficult to speak of normal states of health, a precise distinction
between health and disease being incompatible with our present
amount of knowledge, if conceivable at all.

2nd. In the first stages of acute diseases, as, for instance, of
acute rheumatism, pneumonia, pleuritis, peritonitis, &c. When
these diseases happened in persons who did not exhibit any

730 On the Phosphate of Lime, <^c. [December,

other siirns of diseaserl constitution, and had never been ill be-
fore, I did not, either during the whole course of the disease nor
upon recover}-, find an increased quantit}' of phosphates in the
urine. But it was seldom I met with such persons. When,
on the other hand, persons were afflicted with acute diseases
who neYQY enjoyed good health before, or sulfered from dyscia-
sia of the blood, I almost always met with an abnormal quanti-
ty of phosphates in the urine after the acute stage having ceased;
there appeared now all the symptoms of the original dyscrasia,
and cither the leconvalescence was a very slow one, or emacia-
tion, general weakness, &c., was still increasing; instearl of
acute tuberculosis, the symptoms of chronic afTectioii of the
lungs appeared ; instead of acute rheumatism, chronic rheu-
malism remained. From these very remarkable differences I
concluded with certainty, that it was not the disease itself
which caused a decrease of the excretion of phosphates, but
that this rlecrease was exclusively dependent upon the acute-
ness of s3'mptonis, ihat is to say. the feverish aclioii a circum-
stance which 1 shall refer to in the following parts of this paper.
It must also be mentioned, thnt in some cases of acute disease
I met with a quantity of phosphates, as mnrked by | or l,even
during the first periods; in these cases, howevei', the quantity
of phosphates was very considerable after the acute symptoms
having ceased.

3rd. In the first stages of typhus fever. Here I always met
with a decrease oflheijunntity of earl hy phosphates in the urine
a result which, after a great many analyses, seems to be a cha-
racteristic one. With respect to the later jieriods of typhus,
however, the same refers to them as 1 have stated on acute
diseases generally.

4th. In some cases ofBright's disease, as well as in some
persons who suffered from stenosis of the orifices of the heart,
or from insudieiency of their valvules. But some cases also oc-
curred where an absolute increaseof phosphates was met with;
however, in these cases complications or affections of other
organs could be observed ; and I am inclined to suppose that the
d3'scrasia of the blood, which leads to the well known degenera-
tion of the kidneys, as well as the dyscrasia which results from
the above-mentioned diseases of the heart, does not cause by
itself any increase of the earthy phosphates in the urine.

5th. In the first stages of carcinoma, (but only in these ;) an
observation the more interesting, that Rokitansky alludes to the
preternatural development of the bones, or the proportion of
phosphate of lime in persons afflicted with cancer. I myself
found, in a post-mortem examination of an individual who died
from carcinoma of the lungs, all the cartilages of the ribs ossi-

1851.] On the Phosphate of Lime, <^c. 737

fied ; whicli was never the case in persons who during life
passed for a long time increased quantities of phosphates, and
had hecn afflicted, for instance, with tuberculosis.

I have to arid ^rencrally, that in all cases where I observed no
increase of the phosj)hates in the urine during the ichole course
of a (hsease, I likewise never oljserved emaciation ; that is, want
of formation of cells: these persons altogether were of strong
constitntiou and showed arcmarkalile development of the mus-
cles. In these i>ersons blistered surfaces healed far more speed-
ily than was the case in persons Avho passed a hypernormal
quantity of phosphates, the average time )eing three or four
days. Of course in acute diseases emaciatitm -was observed,
though no abnormal loss of ];hosphates could be detected ; the
same was the case with Bright's disease. In these :'.fref:tions,
however, many cii-cnmstances concur, which suificicntly ac-
count for the waste of tissues circumstances which do not re-
quire any further explanation.

With respect to the quantities of phosphates which I marked
by i, 1, li, and even 2, I found tliem to lie present in very
different and nearly all sorts of diseases, varying on different
days in one case, and always remaining of nearly the same a-
mount in others. These cases proved in a most remarkable
manner that it is not the disease itself which causes the excre-
tion of phosphates, but that there niust necessarily exist some
otiicr cause in the econon)}^ to account for the excretion allud-
ed to. I observed the n^entioned quantity of i^hosphatcs, that
is to sa3% from about 0'350 to 0*700 grains in one ounce of urine,
in chronic rhenmatisiii of the joints or muscles, in the chronic
staire of tuberculosis, in the ulcerative stage of carcinoma, in
different sorts of chronic diseases of the skin, such as eczema,
impetigo, ecthyma, anrl l>oils, slight eases of scrofula, syjihilis,
emphysema of the lungs, and especially in cases of chronic
dyspcjisia, haemorrhoids, &c. It is impossible to give any spe-
cial account of the quantities observed, unless I give a special
explanation of every case, an explanation which woidd too far
exceed the extent of these papers ; moreover I shall speak about
the cause of the excretion of phosphates in the following part
of this communication, and we shall become acquainted there-
by with those circumstances on which the excretion of the
different quantities, in different diseases depends ; but I have
to state, that the general complexion of patients in these cases
rarely surpassed what we call the middle de^rree and often
even did not surpass an emaciated, feeble state of health ; these
patients do not get fat or muscular, in spite of large quantities
of wholesome food ; on the contrary, the more they take, the
less they gain strength and power ; indeed, as long as the excre-

738 On the Phosphate of Limey <^c. [December,

tion of phosphates is abnormally increased, the formation of
cells is impaired.

Thirdly, I have to speak of diseases in which I met with the
largest quantities of phosphates, such as marked 2, 2^, 3, and 4.
These quantities have been found :

1st. In scrcfula and rickets. Especially in children afflicted
with scrofula and ulcers, or other diseases of the skin, as impe-
tigo, boils, &c., vvith diarrhoea and atrophy, I found large quan-
tities of phosphates passed by the urine ; in one case of inflam-
mation in the knecjoint, in a young man who was afflicted with
scrofula, the quantity of earthy phosphates passed amounted to
nearly a drachm every day.

2nd. In tuberculosis, especially in those stages where the
very acute state and deposition of tubercles in any organ has
ceased, a slight fever, however, and the dyscrasia of the blood
continues. I did not observe any increased quantity of phos-
phates during the first attacks of acute tuberculosis, exhibiting
the well known symptoms of typhus : but as soon as the localiza-
tion had taken })lace and an exudation in the lungs was pro-
duced, the general symptoms decreasing in acuteness, the phos-
phates appeared in the urine in an increased proportion, and
soon amounted to OS, 0*9, or even 1 grain in one ounce of urine.
This being the case, I was rather puzzled at not finding any
increase of phosphates during the very last days of some per-
sons dying of tuherculosis. But also this point I shall account
for in the following part of this paper.

3rd. In such cases of acute rheumatism which occur in anae-
mic individuals, and are well known to be accompained by a
remarkable loss of flesh, or by a want of formation of cells. I
have mentioned alread}^ that in the acute stages of these cases,
I met with no increased proportion of phos})hates at all ; but
as soon as the acute stage was over, the phosphates appeared,
and then rapidly increased to nearly the same amount as I obser-
ved it in tuherculosis.

4th. In the last stages of carcinomatous and some other
affections, yielding large quantities of pus or ichorous secretions,
such as psoas abscess, suppuration of the cellular tissue, &c.
In these very cases, the general emaciation of the patients was
very remarkable, although readily accounted for, if we take in-
to consideration, that for the formation of cells three substances
are required namely, albumen, fat, and phosphate of lime, and
that two of these were evidently excreted from the economy
in an immense quantity ; on the one hand, by the suppuration ;
by the urine on the other. However I also met with some rare
cases in which a remarkable emaciation took place, in conse-
quence of abundant suppurations, without a remarkable increa-

1851.] Oti the Phosphate of Lime, ^c. 739

crease of the phosphates having been observed. But these cases
could scarcely afford any objection to my other results, the
suppuration being so large as sufficiently to account for the
emaciation itself. It is self-evident, that in all cases where
emaciation takes place, we must not only look at the quantity
of phosphates eliminated from the economy, but likewise at the
quantity of albuminous and fatty substances which have been
taken as food during the course of the affection, which are pre-
sent at its commencement, and which are eliminated in the form
of pus, serous exudations, urea, &:c.

With respect to the other cases referred to, it must also be
generally stated, that in almost every case the emaciation was
a very rapid one during the excretion of large quantities of
phosphates, and sores of blisters applied to these individuals
scarcely healed at all, or at least not till after a long time. We
may provide persons who are afflicted with these diseases with
the largest quantities of albumen and fat, but we never shall pro-
duce thereby a remarkable increase of tissues or complexion
that is to say, of formation of cells, if we do not diminish at once
the excretion of the phosphates by the urine. The disease will
not cease as long as their excretion continues, but if a decrease
of the phosphates in the urine takes place in an early stage of
the affection, ve may be induced thereby to believe that the con-
dition is really an improving one. On the other hand, it should
be remarked that the nature of the diseases alluded to is a very
different one ; that therefore, the hypernormal excretion of phos-
phates is also here independent of the disease itself, and that
there must exist some other cause of it, the investigation of
which will be the subject of the following part of this paper.

These are the chief points which I have to refer to, with res-
pect to the different quantities of phosphates excreted from the
economy in different diseases. The general conclusions are,
that a hypernormal excretion of earthy phosphates by the urine
is independent of the nature of the disease ; that wherever we
observe such an excretion, we find a corresponding deficiency
of formation of cells, emaciation, and loss of strength ; but that,
finally, this deficiency of formation of cells is not always exclu-
sively caused by a hypernormal loss of phosphates ; that, on the
contrary, it is often only the result of fever, of supjnn-ation, of
want of nourishment, or of any other loss of materials neces-
sary for the re^^eneration of tissues and orjjans.

There is one point more, which I have to direct the attention
to. It having been well known for a long time and more ac-
curately established by the inquiries of Dr. Bence Jones, that
the quality and quantity of the urine are very dilierent at dif-
ferent times of the day, I also examined the quantities of phos-

N. S. VOL. vii. \o. xu. 47

740 On the Phosphate of Lime, <^c. [December,

phates voided at different periods in twenty-four hours. It is
not here the place to explain, that by repeating the very in-
teresting examinations of the urine, published b}. Dr. Bence
Jones, in the Philosophical Transdctions, Part II. 1849, p.
235, I did not obtain quite the same results as this able physi-
cian respecting the decrease and increase of the acidity of the
urine ; I only have to remark with respect to the phosphates,
that this quantity also is very varying at different periods of
the twenty-four hours. But, from a great many analyses of
this kind, I could not detect any certain regularity in the ex-
cretion of the phosphates ; it may only be stated that generally
in persons who are known to pass hypernormal quantities of
earthy phosphates during twenty-four hours, in one sort of urine,
out of three or four sorts passed after dinner, we find the lar-
gest quantities of phosphates ; and that likewise generally one
specimen of urine, out of three specimens passed in the morn-
ing, contains a large quantity of them ; the other ones showing
either a decrease from, or an increase to, the highest amounts,
or no hypernormal excretion at all. This being a fact, we
shall never be able to judge of the quantity of earthy phos-
phates present in one ounce of urine of any person, unless we
examine the whole quantity which is passed during twenty-four
hours. A quantity of urine, passed at a certain time of the
day and examined with reference to the phosphates, will always
lead to wrong conclusions respecting the whole quantity of
phosphates excreted during twenty-four hours. I have care-
fully attended to this circumstance in my observations, so as
to make them trustworthy in this respect ; it should never be
neglected by others entering upon similar investigations.

To sum up now the results of the first and second part of
these communications, I have shown in the first that, supposing
a sufficient quantity of albumen and fat to be present, the pro-
duce of cells evidently increases by the administration of phos-
phate of lime; that, on the other hand, by this administration
we may promote the cure of diseases which show a deficiency
of formation of cells ; and that especially in scrofulous affections
the administration of phosphate of lime has often proved most
beneficial. On the other hand, in the second part, I have estab-
lished the fact, that in nearly all chronic diseases, where we
observe a loss of flesh, emaciation, and general weakness, a
hypernormal quantity of phosphates is always excreted from
the economy by ,the urine, and more especially in those cases
where the administration of phosphate of lime proved most
beneficial. Perhaps it might be supposed that these quantities
had been increased by the phosphate of lime taken as a remedy ;
but this is by no means the case ; on the contrary, my observa-

1851.] On the Phosphate of Lime , ^'C. 741

tions prove that, even during the administration of phosphate
of lime, the' quantity of earthy phosphates in the urine often
decreases, supposing a proper treatment in other respects to
be employed. Well, then, the harmony of the results of the
above two parts is so striking, that we scarcely can admit of
any doubt in their truth, and the physiological as well as the
pathological importance of the points alluded to is so apparent
that it does not require any further explanation. We know
that the phosphate of lime is indispensably necessary for the
production of cells ; we know that in a great many diseases
the phosphates are excreted from the economy in very abun-
dant quantities by the urine; and we know even that in these
diseases the formation of cells is deficient. Shall we have any
doubt that by substituting the quantity of phosphates excreted
by the urine, or by removing the cause of their excretion it-
self, we must afford a great benefit to persons who are afflicted
with the diseases alluded to?

There remains one difficult point, which I have to refer to.
In the way which I relied upon in determining the quantities of
phosphates in the urine, I precipitated the phosphate of magne-
sia, as well as the phosphate of lime. This having been shown
microscopically and chemically, the question arose, whether the
results which I spoke of with respect to the phosphate of lime
would not require an amendment? It is true the proportions
between phosphate of lime and phosphate of magnesia are very
different in different urines ; however, I rarely observed the
quantity of magnesia to exceed the quantity of lime; on the
contrary, it was more often found less. I therefore concede,
without any hesitation, that the exact quantity of phosphate of
lime could not be ascei'tained in the manner which I adopted ;
but generally we shall not bcT far from the truth in supposing
half the quantity of earthy phosphates present to consist of
phosphate of lime, this being ixenerally below and very rarely
beyond the real quantity. I must repeat with respect to this
point the above-given remark, that I have only looked for ap-
proximative results, and that I believe them sufficient for the
conclusions which 1 have drawn. All these relations demand
a very accurate revision ; nor can I refrain observing that the
proportions between phosphate of lime and phosphate of magne-
sia, in different diseased persons aie highly interesting, so nuich
so as to recommend their most accurate study and exact analy-
sis. In expressing this opinion, I refer, for instance, to a commu-
nication in the Annales de Chimie et de Physique^ Juin, 1849,
t. xxvi, 3e serie, entitled, " Recherches sur les Causes du Goitre
et du Cretin isme, par ?vl. T. Grange ;" but I am compelled to
waive the discussion for the present, it being rich enough in
itself to form the subject of a special treatise. [London Lancet.,

742 Destruction of the Lower Jaw, <^c. [December,

Case of Destruction of the Lower Jaw and of a portion of the
Face^ under Homasopathic treatment. Novel Operation.
By Prof. F. H. Hamilton, M. D.

Martin Neuman, 7 years old, was attacked on the 10th of
August, 1849, with a mild dysentery. The family were Ger-
man and sent for a German Hom(Eopathist, who gave him at
once small pills which " looked and tasted like sugar !" also a
powder and a solution.

Within seven days from the time the medicines were com-
menced, salivation began, and small ulcers appeared upon the
inside of the mouth, upon the gums, &c. Three days after,
the ulceration had extended so rapidly that the lower lip was
nearly separated, and in a day or two more it fell off entirely.
Three months later the greater portion of the lower jaw came
away in one piece, being two and a half inches long and includ-
ing the whole diameter of the bone with its corresponding teeth.
The bone and teeth are now in my possession.

It is a coincidence somewhat remarkable, that the sister,
Amelia, several years older, was ill in the same way and at the
same time (it was during the prevalence of the cholera in this
city), and took medicines from the same man, viz: solutions,
&c., and within one week she was severely salivated also, and
her mouth became ulcerated, but no destruction of bone or of
the soft parts ensued.

In January, 1850, the lad was brought to me by hi 5? father.
The lower jaw was then reproduced through the whole extent
of that which had been destroyed, but the teeth were of course
not replaced : nor was there a vestige of a lower, lip, and even
the bone was thinly and imperfectly covered with integument.
His condition was distressing in the extreme, since he could
masticate only with great difficulty, and his saliva was constant-
ly pouring upon his chin, excoriating his face and neck, and
saturating his clothes.

First operation for the restoration of the lip. .Tan. 14, 1850,
in the presence of the class at the Medical College, I abraded
the upper edge of the skin corresponding to the lower lip,
to the extent of a quarter of an inch each way from the cen-
tre ; from either extremity of this horizontal incision I cut
perpendicularly about one inch, and then starting from the
lower end of these incisions, I carried the knife outward and
downward to the left, and outward and downward to the right,
one inch and a half. The two lateral pieces thus marked out,
were now dissected from the jaw and slid upward and drawn
together with sutures above the central piece ; the lower edge
of the lateral pieces thus united were stitched also to the upper
and abraded edge of the central piece.

1851.] Destruction of the Lower Jaw, <^c. 743

The object in leaving a central piece* attached to the jaw,
and uniting the lateral pieces above it, was to prevent the later-
al pieces, which were to constitute the new lip, from drawing
down again by the contraction of the wound below. The
plan was original, I believe, and proved successful. The new
lip, however, became, in process of time, through stretching
and shrinking, insufficient, and I made a second operation
to increase the depth of the lower lip. and prevent more effec-
tually the saliva from dribbling from the mouth.

Second operation, Aug. 28, 1850, at my office, in the presence
of Drs. Samuel Carey, Camp, and others. My mode of pro-
cedure was entirely new% and as I believe, has established an
important principle in this class of operations. The operation
was as follows : A single incision was made just under the
chin, extending along the lower edge of the inferior maxilla
about three inches from side to side. All the integument com-
prised between this horizontal incision and the upper edge of
the lower lip, was now raised from the bone, and the entire
mass slid upward until its lower edge was made to correspond
with a line just below the upper border of the jaw. Here this
edge was made fast to the jjeriosteum, by several interrupted
sutures. The gaping wound below was left to close by granu-
lation. The result has been that adhesion occurred between
the lower edge of the flap, thus secured, and the periosteum,
and no disposition was afterwards shown in the flap to draw
downward as the wound cicatrized ; but on the contrar}^ the
skin from below, that is, from under the chin and the neck, was
somewhat drawn upward, and thus between the formation of
new skin and contraction from the skin below, the wound closed.

The new principle established is that hy attaching the skin
directly to the periosteum its displacement hy cicatrization,
and contraction, is prevented. Everyone who has operated
for the restoration of the lower lip will see the advantages
which this plan offers. There is nothing to which the upper,
free border of the new lip can be attached, and there is conse-
quently nothing but the mere transverse tension of the lip, to
prevent its descending as cicatrization progresses below. This
tendency I sought to avoid in the first operation by leaving a
central piecQ untouched and adherent to the bone, and then
bringing the new lip above it. But this procedure requires a
sacrifice of a portion of the transverse diameter of the lip, and
is often wholly inadmissible ; and always objectionable, if the
same end can be attained by another mode. This new mode,
as we have demonstrated, prevents the sliding downward, with-
out sacrificing any portion of the lip. These remarks are ap-
plicable especially to cases of complete loss of the lip. Where

744 Eclampsia Nutans, or Salaam Convulsions, [December,

only a portion is lost, variolas other methods of supplying the
deficiency may be practiced ; as by stretching the lip, or sliding
i'rom the cheeks, or even by an operation of " torsion" from the
cheeks.

This idea originated in having observed elsewhere the capa-
city of periosteum to form skin. I have several times proved,
contrary to tlie often repeated doctrine, that skin may form
denoDo, independent of old skin : as where there has been an
extensive destruction of the integuments over a bone where
the parts have been torn away or have sloughed quite to the
periosteum, and consequently no old skin could have been left
from which the new could form except at the edges ; yet in the
very centre of this broad ulcer new skin has sprung up like an
oasis, and gradually spread outward in all directions. But this
has always been where the periosteum was actually exposed,
W'hich first becoming white and spongy, has soon shown itself
to be the nucleus of a new skin in fact it has become itself
converted into skin, remaining ever afterwards depressed, im-
movable and adherent to the bone at that point.

The result of the case of the lad Neuman, is that he has a
lower lip, sufficient to cover the gums and a part of the bodies
of a set of artificial teeth which our ingenious dentist. Dr. Har-
vey, has made ibr him. The lip is narrow, for we have not
yet been able to prevent tiie contraction and rolling in of the
upper edge as it heals,, but it would certainly have been much
narrower, or entirely lost if the adhesion to the periosteum had
not been etlected.

I w'ill not omit to say that by the constant efl^ort to use the
lower lip, or perhaps simply by the lapse of time, the lip has
very perceptibly lengthened in its vertical diameter during the
last six months. [Bufalo Med. Jour,

Case of Eclampsia Nutans, or ^^ Salaam Convulsions.*' By
E. C. BiDWELL, M. D., Keene, 0.

Ix March, 1849, Mr. Newnham published an article on this
interesting disease, containing the detailsof four cases all that
were then known to be on record. The next year, Dr. Will-
shire reported another case. These two essays comprise, so
far as my knowledge extends, the bibliography of the disease.
Of these five cases, the last only had a favorable termination,
the other four issuing in idiocy or death.

Soon after meeting with Mr. Newnham's essay, a case of the
disease came under my own observation ; and though diflfering
but little from the cases therein reported, I have thought it

1851.] Eclampsia Nutans^ or Salaam Convulsions. 745

worthy of record, since every case of a malady which has
occupied so small a space in medical literature, and, at the
same time, of such grave importance, possesses an interest and
value which cannot attach to mere repetitions on more familiar
subjects.

At the age of three months, the subject of the present report
suddenly lost the power of motion. She was afflicted at the
time with very obstinate costiveness; further particulars not
recollected. She was treated with cathartics, &c., and was
promptly relieved. About the same time, some of her relatives
began to suspect her of deficient intellect ; but with the above
mentioned exception, she seemed to enjoy uniform good health ;
and the parents profess to have noticed nothing wrong with
her till she was almost six months old. At that time she was
observed, on waking in the morning, and three or four times
during the day, to bow or drop her head forwards convulsive-
ly. This movement was repeated several times in the course
of one or two minutes, and the series repeated three or four
times every day. These paroxysms were accompanied by
suffusion of the eyes, most marked in the night. There was
no expression of pain, and theie was, apparently, a momen-
tary loss of consciousness. There was not, at this period, any
unusual heat of the head ; no flush of the face at any time,
which was generally quite pale. The feet were habitually cold ;
the bowels always costive, and the appetite always good.

With the exception of several slight remissions, of a few
weeks perhaps, the peculiar convulsions increased progressive-
ly in frequency and intensity. When she was one year old,
the paroxysms recurred very frequently, almost always soon
after waking from sleep, and at other times also, with thirty or
forty convulsions in rapid succession in each, and accompanied
with a cry as if from pain. By this time it had become evident
that her mental development was very much retarded, if not
wholly arrested. She had the appearance of a dull child of
seven or eight months ; but her general health seemed unaf-
fected, and she was able to walk at thirteen months.

Subsequently, her growth was slow, and the intellect evi-
dently retrograded. Gradually, the morbid movement increa-
sed in extent; from the slight nod first described, it became a
true oriental "salaam," in which the head was drawn sud-
denly quite down to the floor, with such violence that the fore-
head and lips were continually bruised and lacerated from the
injuries received. At this jieriod, there was but one convul-
sion at a lime, lasting but an instant, and attracting no atten-
tion from the little suflTerer herself, except when attended by
severe injury. This was repeated many times during the day.

746 Eclampsia Nutans. [December,

Still later, epileptiform fits were superadded, less frequent, but
individually of longer duration. Towards the end of her se-
cond year, she was hopelessly epileptic and idiotic. At twenty-
six months, she died, after a short illness, with febrile symptoms,
and a great aggravation of those peculiar to her case.

For the last few montiis all treatment was discontinued,
previous to which time she had passed through the hands of
several different practitioners, regular and empirical ; had been
blistered behind the ears, and on the neck ; pustulated with
tartar emetic ; bathed with warm, and showered with cold
water, separately and consecutively ; had taken tonics, cathar-
tics, vermifuges, alteratives, specifics, and what else I am un-
able to say, all with no sensible effect, unless, possibly, that,
while suffering palpably from the drug disease, the morbid mo-
tions were less conspicuous. Perhaps none of the temporary
amendments or remissions, already noted, could be fairly at-
tributed to any system of medication to which she was subjec-
ted. The parents think, that one remedy, and one only, had
a decided effect on the disease : the decoction of yellow dock,
Avith a small quantity of bichloride of mercury, was taken for
a considerable period, during which the habitual costiveness
was entirely obviated, and for the same period the characteris-
tic symptoms were ameliorated. The costiveness and the con-
vulsions returned together immediately on its discontinuance.

The principal points of the disease, as exhibited in this case
and in most of those previously reported, may be recapitulated
thus ; the diagnostic nodding or bowing of the head ; its oc-
currence soon after sleep, though it also occurred at other
times ; the subsequent accession of another form of convulsive
movement, intercurrent with the original ; the permanent in-
jury to the intellect ; and finall}', its irremediable character,
and fiital result. In one important particular only did it differ
from the most of those there was no paralysis.

I have been thus minute, at the risk of being tedious, in re-
porting this case, upon principle, believing that clinical reports
are valuable very nearly in proportion to their completeness.
Doubtless, the reader will consider the space better occupied
with these details than with any speculations or hypotheses of
mine, which are therefore omitted. INew York Journ. of Med.

On Eclampsia Nutans. By Dr. Faber.

Dr. Faber relates two cases of this curious affection. The
first occurred in a girl, a3t. 3, who though pale and weakly had
not suffered from any decided disease, until three months be-
fore, when she complained of headache and sleepiness, began

1851.] Eclampsia, SfC, 747

to squint somewhat, and sometinaes to nod her head towards
the left side. This noddins: action was at first continued oniv
for a few minutes three times a day, during which the head was
making constant salutation-movements. After a wliile the at-
tacks increased in frequency, and were fearful!}^ violent. The
child was much disposed to sleep ; and became, on waking, con-
vulsed in the extremities, this passing on to com))lete e[)i!epsy.
She was backward in mental development, and had an idiotic
expression of countenance. The second occurred in a boy,
aet. 6, who showed good capabilities for instruction up to the
commencement of his sixth year, when he fell into the water.
He remained in bed several days after in a drowsy state, and
never again so lively and quick. After a while he was obser-
ved to nod his head for two or three minutes, and this several
times in the course of the day, the motions being sometimes so
rapid that eighty could be counted in a minute. They com-
menced at first slowly, like real salutations, but gradually in-
creased in quickness, when the child would fall back in a pas-
sion. During the time they continued, his face was distorted,
and great fatigue was induced. He was aware when the at-
tacks were coming on, and his consciousness continued during
their prevalence. He was pale and feeble, and had acquired a
peculiar, stupid look.

The reporter inquires whether this is a partial chorea or a
peculiar form of spasm, and whether it is dependent upon mor-
bid conditions of the brain or spinal marrow. The most care-
ful examination of his two cases did not enable him to decide.
No pain or tenderness about the head or spine were discovera-
ble, and nothing abnormal in the general condition. Various
applications and medicinal substances were resorted to with
but very little success iron seeming the most useful among
them. Brit, and For, Rev., from Schmidt's Jahrh. vol. Ixvii,
p. 213.

Eclampsia, and its relations to Albuminuria in Lying-in

Women.

M. Depaul read a note on a case of eclampsia, and submit-
ted observations, of which the following were the conclusions:

1. Convulsions of an epileptic character, are rarely seen in
the first four months of pregnancy. The case related is there-
fore interesting, as having occurred at the end of three months,
in a person who previously had not been subject to epilepsy or
any other nervous affection.

2. It is erroneous to stale that the prognosis of eclampsia is
more favorable in proportion as gestation is less advanced, or

748 On the Nature of Viruses. [December,

according as labor, if it have commenced, is distant from its
termination.

3. This opinion is founded upon an inference not drawn from
facts, viz., that the paramount indication of treatment is deple-
tion of the uterus.

4. The dangers which threaten, the foetus consist in the
modifications which the maternal blood undergoes, and in the
disturbance of the uterine circulation; the death of the foetus
not unfrequently occurs in the course of a convulsive paroxysm.
The foetus resists the causes of destruction more certainly in
the earlier than in later months when it is nearer to its perfect
state.

5. The best treatment of these cases is full general depletion.

6. Neither paleness of the countenance, smallness of the
pulse, nor the presence of albumen in the urine, are contra-in-
dications of depletion.

7. Albuminuria is more frequently met v^ith in pregnancy
than in any other physiological state.

8. Without denying the possibility of nephritis in a preg-
nant woman, the presence of albumen in the urine must gene-
rally be regarded merely as a functional derangement. This
is confirmed by the results of autopsies.

9. This aibun)inuria cannot be regarded as the cause of the
convulsion, since the latter has often preceded the former.

IMedical Gazette.

[The following article, translated for this Journal from the
Kevue Medicale (of Paris), offers a new field for observation
and reflection. It bears the impress of a philosophic mind, and
well deserves the attention of the profession. It is high time
to abandon the vagaries which have so long obtained in rela-
tion to the causes of disease and to direct our attention to
something more tangible and comprehensible. The works of
M. Raspail, in France, and Dr. J. K. Mitchell, in our country,
have done much already to direct attention to the subject.]

On the Nature of Vh^uses.

Dr. Hameau's work upon the Nature of Viruses and the laws
which govern their action in the economy, was made the sub-
ject of a Report by M. Londe to the Academy of Medicine of
Paris, from which we draw the following details :

According to M. Hameau, poisons, miasmata and venoms,
affect the economy instantaneously when in sufficient quan-

1851.] On the Nature of Viruses, 749

tity, but iheir effect continually decreases in intensity during
its continuance ; they are themselves decomposed at the same
time that they exert a decomposing influence ; they, in short,
obey the laws of chemical affinities; whereas viruses act as
living beings, or as insects. The following are M. H.'s corol-
laries :

1st. Any heterogeneous substance that may introduce itself
into a living body, remain inactive in it for a certain length of
time, multiply in it, and then leave it to act in the same man-
ner upon another body, would seem to possess a vital principle.

2d. Its mode of action resembles closely that of insects
which introduce themselves into plants and animals. The
smali-pox, for example, appears to develop itself in the same
manner as fecundated germs of insects, for, like these, it re-
quires a foreign nidus in which it may derive nourishment, be
incubated and developed.

3d. Even when it causes death it is unlike poisons, venoms
and miasmata, for these, in acting, lose their own force, are
decomposed, and can exert no influence until they have subdu-
ed the vital powers, whereas it, on the contrary, acquires ac-
tivity, multiplies, and is unharmed by the vital forces.

4lh. This matter especially resembles the itch acarus which
multiplies its generations in our tissues. The itch might be
taken as the type of all affections of virulent origin.

5th. It is indelibly characterized by contagion, incubation
and reproduction. The cause of any disease which combines
these three features is a virus. These features vary in each :
the period of incubation is different ; they do not all multiply
with equal rapidity, nor are they ail equally contagious.

Gth. Some viruses are persisting, and others temporary or
migratory. The former never leave the system of their own
accord, as syphilis, the itch, pellagra, 6z,c. ; the latter leave the
system after a certain length of time, as the small-pox, scarlati-
na, measles, &c. The persisting, after having been driven
from the body, may return indefinitely ; but the temporary do
not return after leaving.

7th. There is an antipathy between certain viruses, at least
for a certain time, so that a body whilst under the influence of
the one is exempt i'rom the invasion of the other, which must
be owing to an opposition in their nature, and also to certain
excrementitious particles left by the affecting virus. There is
also a repulsion between the temporary viruses and the bodies
they have left, inasmuch as they do not return to them, which
must also be owing to their having left in the bodies something
disagreeable to them. The cause of this repulsion is similar to
that which makes all animals loathe their excrements.

750 On the Use of Bile. [December,

8ih. Each climate appears to have viruses proper to it, al-
though these may be transported at a great distance from their
origin. Yellow lever appears to have originated in Africa ;
syphilis, in America; variola and cholera, in India; the itch,
malicinant pustule, and perhaps typhus, in Europe.

i)th. There are viruses proper to various species of animals,
such as farcy and glanders in horses; -the rot in sheep. Those
that affect man do not affect brutes, and vice-versa; yet there
are some exceptions to this. I have, says the author, strong
reasons to believe that we have derived pellagra from the
sheep, and I have seen an awful instance of the glanders com-
municated to man.

10th. Every cause of sickness that may travel or chancre
climate is a virus. It could not run over great distances if it
did not reproduce itself; therefore, of all causes of disease, none
but the virulent have the power of.reproduction. It cannot be
a miasm, because all miasmata being made up of dead and
deconiposing substances, must also themselves be soon decom-
posed under the influence of the physical and chemical laws,
whereas a virus is not subject to these laws.

11th. All viruses might be divided into two classes, the visi-
ble and the invisible or aerial. The author terms visible virus
all liquids produced by a disease, which, it matters not how,
may produce the same disease, by manifesting the three char-
acteristics above mentioned, (contagion, incubation, and repro-
duction.) The liquids furnished by the itch, variola, vaccine
and syphilis, are visible viruses. The invisible are those ethe-
rial substances which manifest themselves to our senses only
by the diseases they induce, but which reveal to the judicious
observer the three characteristics of the virus.

Blondlot on the Use of Bile.

The Revue Medicale (August, 1851) contains a synopsis of
a memoir presented to the Academie de Medicine, by M.
Blondlot, upon the use of bile, which we think worthy of no-
tice. The author endeavors to determine whether bile is
essential to digestion or whether it is a mere excretion which
serves no purpose in the function of digestion. He thinks that
he established in 1846, in a thesis upon the functions of the
liver, that the bile is an excretion, which passes out of ihe
economy through the intestines, and has no chemical action
upon the food with which it comes in contact. After many
unsuccessful attempts M. Blondlot succeeded in forming a fistula
in two dogs, which allowed the bile to pass out through it. In

1851.] False Aneurism of the Brachial Artery. 751

these dogs the ductus choledochus was obliterated so that the
bile could not enter the intestines. One of the animals was
killed a month after the fistula had been established, durinp;
which time digestion had been regularly performed, although
the ductus choledochus was obliterated. The second animal
was preserved in order to follow up the experiments. This
bitch survived five years, with good appetite, hunted with
vivacity, and annually produced a litter of puppies. The flow
of the bile was observed to be intermittent, it was slight when
the animal was fasting, but abundant during digestion.

The autopsy showed all the orirans of the chest and abdo-
men healthy, except the liver. This organ was hard, and its
surface strewed with yellowish points : in short, it presented
the appearance of a cirrhosed liver. Solid adhesions united the
bladder to the walls of the abdomen. The gall bladder retained
its dimensions and form, though its walls were a little thicken-
ed. The cystic duct was dilated, and at the point of junction
of this with the hepatic duct the origin of the ductus choledo-
chus could be seen, this being obliterated. '

The author concludes, from these experiments, that the bile
is not at all essential to digestion, but is entirely an excrementi-
tious fluid. If it is of any importance it is secondary, and may
perhaps, with the mucus, form an emulsion with* the fatty
matters and protect the intestines against the acidity of the
chyme, which it in a measure neutralizes.

Note. What kind of food did the dog eat? Did the kid-
neys sympathize?

False Aneurism of the Brachial Artery Cured by Galvano-
Puncture. By M. Amussat.

M. Amussat has related the following case before the
Academy of Medicine of Paris: A butcher, aged 35, wound-
ed the internal and lower part of the arm with a penknife ;
the artery was injured, compression used and seventeen days
afterwards the man was sent to M. Amussat with a pulsating
tumor, the size of a hen's Q^g, on the spot where the wound
had been inflicted.

Mr. Amussat, relying on the accounts published by M. Pe-
trequin of Lyons, tried galvano-puncture in the following man-
ner: Two fine platinum needles, covered with gum lac over
that portion which was to be in contact with the skin, were
introduced into the tumor, and the poles of a trough of thirty
compartments brought into contact with the needles for the
space of five minutes. The couples were gradually increased
to twelve, and after five more minutes (giving altogether ten)

752 Hydrastis Canadensis in Gonorrhoea. [December,

the needles were withdrawn, because the patient was in great
pain. Lead wash was then applied to the tumor; no unplea-
sant symptoms occurred, and three days afterwards the aneu-
rism presented pulsations over an areathe size ofafive-shillincr
piece. Four needles were now introduced ; this sitting lasted
sixteen minutes, and the couples were increased to sixteen.
The same dressings were used as before, and in four days the
tumor was found smaller, harder, presented no pulsations, and
had assumed a brownish color. The swelling diminished in
size from day to day, the pulsations never returned, and the
cure may be looked upon as quite complete, as M. Amussat
presented the patient to the Academy in July, 1851, whilst the
operation had been performed on the 13th of October, 1847.
After almost three years the value of such a case has very
naturally remarkably increased. \_Lancet.

Hydrastis Canadensis in Govorrhoca. Bv D. M. McCann,

of Ohio.

As it has for its object the diffusion of knowledge advantage-
ous to the Medical Profession, permit me to call the attention
of the profession through the columns of your excellent Medi-
cal Journal, to the use of Hydrastis canadensis, (yellow root,
orange root,) in gonorrhoea.

I am not aware that any of my brethren have ever used it
in this affection, before myself My experience, however, in
the administration of it, though not extensive, is yet sfficient to
warrant me in soliciting a trial of it by those having more
opportunity of testing its curative powers than 1 have. I have
used it in several cases in various stage's of the disorder, and
in every case with the most satisfactory results ; more espe-
cially with males than females. I was led to its use by noti-
cing its well-known sanative properties over inflammations of
mucous and epithelial structures, such as aphtha? of the mouth,
&c. The ardor urinte, and discharge of mucus, has been en-
tirely suspended in every case in from twenty-four to seventy-
two hours. In some cases I used the balsam copaiba, in others
injections of infusion of the hydrastis alone, but with about the
same results, a perfect and permanent eradication of the disor-
der.

I have varied the strength to suit the case in its different
stages, but as a general rule I have used about one drachm of
the dried root to the pint of infusion injecting a syringe full
three or four times a day.

I hope that some of the profession will give this article a fair
trial. [^Ohio Med, and Surg, Jour.

1851.] Cure for Tape Worm. 753

[The following cure for Tape Worm was communicated to
the Boston Medical and Suigical Journal by a gentleman
whose respectability is known to the Editor of that Journal :]

Cure for Tape Worm. Procure sufficient seed of the pump-
kin (those grown in the West Indies are the best) to make two
ounces after removing the outside shell of the seed ; put them
into a mortar and add half a pint of water ; pound them well
up, and make a liquid orgeat of them, which strain through a
cloth. Drink this mixture in the morning on a fasting stom-
ach. If it does not operate in the course of an hour and a half,
take one ounce of castor oil. Drink all the time as much fresh
cold water as the stomach can bear or contain ; that is, drench
yourself with water. After taking the orgeat, if the stomach
is well rubbed with ether, and an injection of about 60 drops of
it is taken, you will find it an assistant to the orgeat, but this
may not be necessary. Should the first application of the
remedy not answer, repeat it the next morninfr, and there is
no doubt your complaint will be removed. The worm will
leave the patient all at once, and probably entire. This can
be ascertained by finding the small end or head of it, which ta-
pers ofl^ almost to a point.

[Since the publication of the above, the Boston Journal has
been furnished with a case in which the remedy was complete-
ly and promptly successful.]

On the Histological Nervous Elements in Adhesions. By
Dr. ViRscHow.

The author observes that he had undertaken the examination
of adhesions with the especial object of ascertaining whether
nervous fibres were to be discovered in those structures. He
had searched in vain a long time, but had at last twice succeed-
ed in detecting them, by the addition of a solution of soda to
the preparation. The first was in an adhesion that had been
formed between the surface of the lung and the side of the
thorax : here he had discovered two thick nerve-tubes running
a parallel but perfectly distinct course, and following the direc-
tion of the elastic fibres. They presented a double contour:
their contents were here and there aggregated, so as to impart
a varicose aspect ; their anastomoses were not perceptible ; it
was not possible to mistake them. The second occasion was
in examining a fiat adhesion from between the liver and diaph-
ragm. The nerve-tubes had the same appearance as the above:

754 New View of the Supply of Blood, SfC. [December,

they did not traverse the entire adhesion, but terminated by
pointed ends at certain distances. A short distance before it
divided it sent off a branch, which proceeded for about half a
line and then terminated by a pointed extremity. In this case
the nerve was clearly traced from the diaphragm. In both
these cases numerous other adhesions were examined, without
discovering any trace of nerve. [Medical Gazette^ from Ver-
handlungen der Physicalisch-Medicinischen Gesellschaft in
Wurzburg, 1850. New York Journ. cf Med.

New View of the Supply of Blood to the Muscular Fibres of the

Heart.

Dr. Spurgin in the Harveian oration, delivered by him this
year, propounded anew view of the supply of blood to the
muscular fibre of the heart. He argued that that supply could
not be derived from the coronary arteries, as is universally
taught ; but that it flowed through certain foramina in the
cavities of the heart itself, to which all the coronary vessels
stood in the relation of veins. In confirmation of this view he
pointed out a peculiarity in the structure of the coronary arte-
ries, and referred to medical history, which afforded an instance
of a total obliteration of the passage through those arteries,
without causing a cessation of life. [^Med. News and Library.

Gastrotomy successfully performed for Extra- Uterine Preg-
nancy. By Drs. Bradley and Rogers.

The patient was a negro woman, aged 28 years, the mother
of seven children. In June, 1849, six weeks after conception,
she began tocomplainof colic, attended with constipation. On
the 10th of February, 1850, she supposed herself in labor. On
examination, the os uteri was natural and the breasts were
flabby. There had been no movement of the child felt since
the middle of November, at which time there was milk in the
breasts. A tumor filling the whole right lumbar region, extend-
ing above the hypochondriac, and below to the iliac region,
and somewhat to the left of the umbilicus. There was also
present considerable febrile disturbance. She was certain that
she had felt the motions of the child, from the fourth or fifth to
the seventh or eighth month, when she supposed it died. The
diagnosis being extra-uterine pregnancy, the removal of the
child was recommended.

On the 7th of February, 1851, the patient having been pre-
viously prepared, chloroform W'as administered. An incision

1851.] Impregnation prior to Menstruation, 755

was made extending for two inches above the umbih'cus to the
pubes. The fetus was found in the right fallopian tube, fully
formed and about the size of a seventh-month child. But little
decomposition had taken place. It was firmly attached to the
peritoneum, anteriorly and posteriorly, and latterly to the uterus.
In separating the attachment, the epidermis of the child was
removed at the adherent portions. After removal, the parts
were carefully cleansed, and four sutures, with sufficient ad-
hesive plaster, were used, and an opiate was ordered. Her
recovery was rapid, so much so that, four weeks after the ope-
ration, it was complete. [lY. O. Med. ^ Surg. Jour.

A case of Impregnation prior to Menstruation. By Henry
Ritchie, M. D., of Chicago, 111.

Mrs. , aged 21 years, a Swede, stout, apparently healthy,

and well developed, came to us (with an interpreter, as
she spoke our language imperfectly) about four weeks ago,
stating that she had been married sixteen months, had never
menstruated in her life, was anxious as well as her husband for
progeny, had been under one physician in the city, but that
his medicines did her no good. She said her situation made
her melancholy, because she was not like other women, w^as
afraid her husband would not love her. She frequently had
pains in her loins and down her thighs, but not periodically.
We saw her husband several days after, and told him what we
thought was the matter; and that she must subject herself to
an examination, which was cheerfully assented to by both.
Found the mammary glands well developed, the person full,
the abdomen well rounded and plump; pervaginam, the cer-
vix uteri could be felt much longer apparently than natural, the
end of it projecting but slightly into the vagina, with neither
anterior or posterior lip. The os being a mere slit in a flat
surface rather concave than convex, resembling a thin section
of a cylinder three quarters of an inch in diameter, the neck
from this point gradually tapering back, was lost to the sense
of touch without being able to trace the body of the uterus,
though in a subsequent examination it could be felt per rectum.
Venereal orgasm in tact. Diagnosed retained menstrual se-
cretion from ?ome abnormal condition of uterus. Concluded
it would be perfectly justifiable to explore the uterus. Com-
menced with a small gum catheter and stilletto, did not succeed
in introducing it into the os after repeated efforts ; as we had
no speculum along with us, suspended further efforts until the
ibllowing day, when we introduced a speculum, found the os

N. B. VOL. VII. NO. XII. 48

756 Impregnation prior to Menstruation. [December,

and the vicinity quite vascular with ecchymosed spots about
it, no doubt the result of manipulation in endeavoring to in-
troduce the instrument the previous day. We now succeeded
in introducing a small bougie, transfixed. with a stillett about
three quarters of an inch, which was followed by a large one,
but neither with the force we thought justifiable, would the
instrument penetrate further. We then concluded that the ob-
struction was also at the os internum, or that the cavity of the
uterus was occluded. Requested her at the beginning of the
following week to come to our office, for the benefit of a con-
sultation with my partner Dr. D. Upon her response to my
request, my partner examined her, coinciding with my views
of the case. We concluded that it would be perfectly justifia-
ble to use cutting instrument to get into the cavity of the uterus,
conjecturing that probably, there was fibrous membrane that
precluded the ingress of the instrument and egress of the
menstrual fluid. We prepared a sharp pointed instrument of
sufficient length, and introduced it about the same distance as
we had previously done the catheter. On the application of
force, the instrument appeared to be entering something very
resisting and tough in its structure ; when the instrument was
unhanded and struck, it would vibrate. Some objections now
presented themselves to a perseverence in forcing the instru-
ment onwards. What ! if there was arrest of development of
the uterus, and we should now be in contact with the fundus
of the organ, the next effi^rt might send the implement through
the walls of the uterus into the cavity of the abdomen; this
was not a pleasant reflection. In this dilemma we dismissed
her for another week, to give us time to decide what further
we could do. Upon her return we used a trocar and elonga-
ted the passage so that a catheter would now pass about an
inch and a quarter, but there still remained something that
resisted the trocar. We still hesitated about increasing the
amount of force to drive the instrument deeper. Under this
state of uncertainty we concluded to have our opinions fortified
by advice, before venturing further, and called in Dr. E. to
see the case. From the history and examination, he conclud-
ed it was a case of retained menses, and coincided with us that
interference to open a passage was justifiable. We proceeded
no further at that time, but appointed the next week for her re-
turn. One day to her anticipated return, we were sent for.
Upon arrival was presented with something that she had passed
in the night. At first sight, without reflection, we thought it
was the uterus, which had been separated by sphacelus in con-
sequence of the violence done it. We immediately made a
per vaginum examination, and our fears were appeased, for the

1851.] Diseases of the Heart. 757

organ was in statu quo. *\Ve then concluded that it was a
polypus, that had been detached by our interference, it never
occurred to us that it was an ovum, even when the old woman
in attendance, suggested in broken English, that probably it
was one little baby. Sure enough the old lady was right, for
on our return with it to the office, its section disclosed a foetus
about six weeks old.

We saw the patient again this morning with her husband,
and both asseverate that never until we manipulated, had any
sign of blood come from the part. She also positively reiter-
ates that she never previous to marriage or since, has seen a
spot of blood from the part. We have no doubt of the truth of
their statements, as there can be no motive for deceiving.

\_Westeim Lancet.

A Statistical Report upon Disease of the Heart, derived from a
consideration of all the Cases admitted into St. George''s
Hospital during the last two years and a half. By Dr. Bar-
clay. (" Proceedings" of the Royal Med. Chirurg. Societv
June 24, 1851.).

Rheumatism is first considered as one of its causes. Divided
into two nearly equal classes those really inflammatory or
acute, and those less so, or sub-acute the former class is found
to contain sixty-seven cases with cardiac lesion, sixty-four with-
out, and twenty-one doubtful. Endocardial murmur is found
not to be certain evidence of disease, even in the most acute
cases Females are slightly more liable to acute rheumatism
than males, but less liable to a recurrence of the disease.
Females are more decidedly liable in a larger proportion to
cardiac complication, and this is especially proved by the exist-
ence of friction-sound in the proportion of three females to
two males. Cardiac complication exists eighteen or twenty
per cent, more frequently in subsequent attacks than in primary
ones. It is in the proportion of three to two of all the cases
up to the age of twenty-five, and falls very rapidly after that
age. The cases of sub-acute and chronic rheumatism furnish
no examples of recent inflammation of the heart, but a consi-
derable number of cases of old disease. So far as could be
ascertained, these were almost all traceable to previous acute
attacks, and were only about one-third of the cases which had
previously suflTered from acute rheumatism. The postmortem
appearances of recent inflammation are found associated with
acute rheumatism, with disease of the kidney, with inflamma-
tion of the peritoneum and pleura, and with old disease of the

758 Diseases of the Heart. [December,

heart, especially when hypertrophy existed, and with turbulent
action during life. The cases of old disease of the heart are
divided into sixty-one rheumatic, seventy non-rheumatic, and
sixty-nine doubtful. They show a very considerable prepon-
derance of males, especially among fatal cases. Up to the age
of twenty, almost the whole, and even as far as thirty, more
than half the cases are associated with acute rheumatism. In
the next twenty years, the non-rheumatic almost doubled the
rheumatic cases, and after fifty, there are scarcely any deri-
vable from rheumatism at all. The duration of rheumatic cases,
dating from the first attack of acute rheumatism to death, is
generally much longer for females than for males, varying in
the latter from four to six years ; in the former, from twelve to
sixteen years. Four out of seven fatal cases of acute rheuma-
tism, and twelve out of eighteen of older standing, are associa-
ted with pericarditis, which is always severe and extensive;
but universal adhesion is neither the constant nor even the
common result of rheumatic pericarditis, and it exists in cases
where the previous existence of rheumatism is altogether deni-
ed. In valvular disease, there are eighteen rheumatic cases,
twenty-three non-rheumatic, and twelve doubtful. The recent
cases are all examples of inflammation of the nnitral valve.
When old and recent disease exist together, and when old
disease is seen in difl^erent stages, the mitral valve generally
appears to have been first attacked, and the aortic secondarily ;
and hence the preponderance of double valvular lesion in rheu-
matic cases seems to be due to renewed inflammations at dis-
tinct periods. Inflammatory thickening occurs also in several
cases in which there had been no rheumatism. Disease of the
kidney is associated with two cases of simple recent fibrinous
deposit on the valves, and three of recent pericarditis, in which
no other cause was known to have been in operation. It seems
questionable how far this can be taken as a cause of great
thickening of the valves, or of an adherent pericardium. Dis-
ease of each set of valves seems to produce, in nearly equal
proportions, hypertrophy and dilatation, but aortic regurgita-
tion, especially the latter; atheroma of the aorta, more com-
monly hypertrophy ; adhesion of the pericardium, chiefly dila-
tation. Disease of the kidney is associated with an immense
majority of the cases of hypertrophy, and similarly of all the
cases of disease of the kidney ; more than a third presented on
post-mortem examination more or less of hypertrophy of the
heart. A table is appended, in which the post-mortem appea-
rances are arranged, of all the cases in which clinical history
threw any light on the disease of the heart found after death.
Lancet.

1851.] Miscellany. 759

ill i 0 c U a n J.

To the Reader. As the present number will complete the seventh
Volume of the new series of this Journal, it is proper that we tender
our thanks to those who have by their subscription, contributed to its
support, as well as to those whose valuable communications have
given interest to its pages. We have every reason to feel flattered,
whether we turn to the respectable list of our readers or refer to that
of our able correspondents. The Index appended to this volume,
will show no less than forty original papers, besides a large accumu-
lation of matter derived from foreign and domestic periodicals, and
making upwards of 300 different articles in the miscellaneous and
eclectic departments. We believe that this volume will be found to
present a pretty faithful expose of the advances of our Profession
during the current year, and as much of the " medical news" of the
day as would comport with the dignity of a scientific Journal.

The objects of this publication are the diffusion of knowledge, the
establishment of a medium of communication between Southern prac-
titioners and those of other sections, and consequently the elevation
of Southern medical literature. We may therefore earnestly solicit
a continuance of patronage, both pecuniary and scientific. Let each
of our subscribers endeavor to obtain one more name and let all
who have any thing of interest to communicate, use our pages. We
exchange with all the medical periodicals of our country and with the
most valuable issues of the European press ; so that whatever appears
in this Journal will be as widely diffused as if contained in any other
work.

We renew our pledge to spare no efforts to make the Journal ac-
ceptable to all parties, and have every reason to hope that we will be
aided liberally by our professional brethren of the South.

[The unguarded sale of arsenic is so frequently attended with mis-
chievous consequences, that we copy the subjoined law of England
in the hope that the subject may be brought before our Legislature.
Jt would, perhaps, be well for the State Medical Society to suggest the
propriety of some such enactment in Georgia.]

An Act to Regulate the Sale of Arsenic, 5th June, 1851. Whereas,
the unrestricted sale of Arsenic facilitates the commission of crime:
Be it enacted, by the Queen's most Excellent Majesty, by and
with the Advice and Consent of the Lords Spiritual and Temporal,
and Commons, in this present Parliament assembled, and by the au-
thority of the same, as follows :

760 Miscellany. [December,

1. Every person who shall sell any Arsenic shall forthwith, and
before the delivery of such Arsenic to the purchaser, enter or cause
to be entered in a fair and regular manner, in a book or books to be
kept by such person for that purpose, in the form set forth in the
Schedule to this .let, or to the like effect, a statement of such sale,
with the quantity of Arsenic so sold, and the purpose for which such
Arsenic is required or stated to be required, and the day of the month
and the year of the sale, and the name, place of abode, and condition
or occupation of the purchaser, into all which circumstances the per-
son selling such Arsenic is hereby required and authorized lo inquire
of the purchaser before the delivery to such purchaser of the Arsenic
sold, and such entries shall in every case be signed by the person
making the same, and shall also be signed by the purchaser, unless
such purchaser profess to be unable to write, (in which case the person
making the entry hereby required, shall add to the particulars to be
entered in relation to such sale, the words, "cannot write,") and,
where a witness is hereby required to the sale, shall also be signed
by such witness, together with his place of abode.

2. No person shall sell any Arsenic to any person who is unknown
,to the person selling such Arsenic, unless the sale be made in the pre-
sence of a witness who is known to the person selling the Arsenic, and
to whom the purchaser is known, and who signs his name, together
with his place of abode, to such entries, before the delivery of the
Arsenic to the purchaser, and no person shall sell Arsenic to any per-
son other than a person of full age.

3. No person shall sell any Arsenic unless the same be, before the
sale thereof, mixed with soot or indigo, in the proportion of one ounce
of soot or half an ounce of indigo at the least to one pound of the Ar-
senic, and so in proportion for any gi eater or less quantity : Provided,
always, that where such Arsenic is stated by the purchaser to be re-
quired, not for use in agriculture, but for some other purpose for which
such admixture would, according to the representation of the pur-
chaser, render it unfit, such Arsenic may be sold without such admix-
ture, in a quantity not less than ten pounds at any one time.

4. If any person shall sell any Arsenic, save as authorized by this
Act, or on any sale of Arsenic shall deliver the same without having
made and signed the entries hereby required on such sale, or without
having obtained such signature or signatures to such entries as re-
quired by this Act, or if any person purchasing any Arsenic shall give
false information to the person selling the same in relation to the par-
ticulars which said last-mentioned person is hereby authorized to
inquire into such purchaser, or if any person shall sign his name as
aforesaid as a witness to a sale of Arsenic to a person unknown to the
person so signing as witness, every person so ofiending, shall, for eve-
ry such offence, upon a summary conviction for the same, before two
justices of the peace m England or Ireland, or before two justices of
the peace or the sheriff in IScotland, be liable to a penalty not exceed-
ing twenty pounds.

5. Provided, That this Act shall not extend to the sale of Arsenic

1851.]

Miscellany.

761

when the same forms part of the ingredients of any medicine required
to be made up or compounded according to the prescription of a legal-
ly qualified medical practitioner, or a member of the medical profes-
sion, or to the sale of Arsenic by wholesale to retail dealers, upon
orders in wu'iting in the ordinary course of wholesale dealing.

6. In the construction of this Act, the word " Arsenic" shall
include Arsenious Acid and the Arsenites, Arsenic Acid and the
Arseniates, and all other colorless poisonous preparations of Arsenic.

THE SCHEDULE.

Day of Sale

1 Septem-
ber, 1651.

Name and Surname! Purchaser's Place
of Purchaser. I of Abode.

Johu Thomas.

Heudou I Elm
I i Farm,

Condition or
Occupation.

Farm
Laborer.

Quantity of
Arsenic sold.

5 pounds.

Purpose
for which

required.

To steep
Wheat.

{Purchaser's Signature.) Witness.

John Thomas. James Stone.

Or if purchaser cannot write,
Seller to put here the words,
'cannot write.' [London Pharm. Journ., July, 1851.

{Seller's Signature.)
George Wood.
Grove Farm, Hendon.

The State Medical Board. In a pamphlet I published a short time
since, containing the " The Laws of the State of Georgia in Relation
to the Practice of Medicine,'' there is an error on page 7, which I
wish to correct through the Medical Journal. The list of members
constituting the State Medical Board, is, in my pamphlet incomplete.
I have, through the kindness of Dr. Thos. F. Green, of Milledgeville,
been furnished by the Dean with the following list of the Medical
Board as at present organized :

L. D. Ford, > .

T D rt } AuiTusta,

I. P. Garvm, ) =* '

R. M. Moore, Athens,

J. Branham, Eatonton,

B. F. Keene, Hillsboro',

E. A. Broddus, Monticello,

H. T. Shaw, Covington,

R. Banks, Gainesville,

G. D. Phillips, Clarksville,

J. Persons, Columbus,

W. J. Johnson, Fort Gaines,
H. K. Burroughs, Savannah,
M. A. Franklin,

J. M. Green,
T. Fort,

B. A. White,

C. J. Paine,
T. F. Green,
G. D. Case,
S. G. White,

Macon,

Milledgeville.

J

In the above list are one or two names which have been added
since the last meeting of the Legislature.

Although the error is not a very important one, per se, I shall, nev.
ertheless, be obliged if you will insert this in the Journal.

Yours, most truly,

C. T. QUINTARD.
Cor. Sec'y Med. Soc. State of Georgia.
Eoswell, 20th Oct., 1851.

762 Miscellany. [December,

Ichiliyosis Cornea. Dr. Austin L. Sands, of Cold Spring, N. Y.,
reports in the N. Y. Journal of Medicine, the case of a female 50
years of age, from whose occipital region he removed a horny excres-
cence which had been growing 16 years, and which measured 6|
inches in length and 3 inches in circumference at its base.

" She took no notice of it for some time, but, becoming so large as
to interfere with the proper adjustment of her cap, and obliging her to
raise her head from the pillow at night whenever she wished to turn
over in bed, while it also incommoded her from reposing upon her
back, she was necessitated to apply to her family physician (a homoe-
path) for relief, who promised her that in the space of a short lime he
would be enabled to remove the difficulty by the use of sundry small
white pills which he proceeded to furnish her with ; while at the same
time he assured her that he had treated successfully, to a cure, several
similar cases within the past year in his own practice. For five years
she continued to use the homoeopath's pills, but still the horn remain-
ed still the horn continued to grow. In view of this condition of
affairs her faith began to falter, but for some time it was supported
with the assurance of her physician " that he had not as yet got hold
of the right pills." Reassured by this assertion, which was repeated
from time to time, she kept on until the spring of the present year,
^vhen she consulted me, and finally submitted to its removal by the
knife."

Cost of the Doctorate in Paris. The Union Medicale makes the
following estimate of the cost of the Degree of Doctor of Medicine
in Paris : The collegiate education requires 7 years, and to obtain
the two baccalaureate degrees, 2 years more are necessary; then the
medical studies, properly speaking, will average 6 years ; making a
total of 15 years. The 7 years at college cost 1000 francs per an-
num, making 7000 francs ; the 2 baccalaureates, 320 francs ; the 6
years at medical college, 1200 francs a year, or total 7200 francs.
Private courses of study, 1000 francs ; matriculations, examinations,
and diploma fee, 1100 francs ; instruments and books, 2000 francs.
Making a grand total of 18,620 francs, or about $3,724.

Danger of Gutta Percha Bougies. The N. Y. Medical Times
contains a notice of three cases in which Gutta Percha bougies have
been broken in the bladder or urethra. Two of the cases occurred
in New York and the other in England. Bougies made of this ma-
terial should at once be discarded from use.

Deaths from Chloroform. The Medical Gazette of Strasbourg fur-
nishes the particulars of a case in which a lady suddenly died during

1851.] Miscellany. 763

the extraction of a tooth under the influence of chloroform. Another
death occurred last July, in London, during an operation for the re-
moval of the testis under the influence of this agent.

BIBLIOGRAPHICAL NOTICES.

Operative Surgery, based on Normal and Pathological Anatomy,
By J. F. Malgaigne, Professor, (kc, Paris. Translated from the
French, by Frederick Briilan, A.B. M.D., M.R.C.S L. Illustra-
ted by wood engravings from designs by Dr. Westmacott. pp. 565.
Philadelphia: Blanchard & Lea. 1851.

We are gratified to find this valuable work made accessible to
American readers. It has been remarkably well received in France,
and is there regarded as a standard production. The translator has
not avoided gallicisms as much as he might have done, but this does
not materially impair the value of the work.

Minor Surgery; or Hints on the every day duties of the Surgeon*
By Henry H. Smith, M. D., Assistant Lecturer on Clinical Sur-
gery in the University of Pennsylvania, &c., &;c. 3d edition, with
numerous additions. Illustrated by 247 engravings, pp. 456.
Philadelphia : E. Barrington and G. D. Haswell. 1850.

This is another exceedingly useful manual, emanating from an
American. The modesty of its title page should not detract from its
intrinsic merit. It is as copious and complete a work of the kind as
we know of.

Medical Lexicon a Dictionary of Medical Science; containing a
concise explanation of the various subjects and terms of physiology,
pathology, hygiene, therapeutics, pharmacology, obstetrics, medical
jurisprudence, SfC, with the French and other synonymes ; notices
of climate, and of celebrated mineral waters ; formulae for various
officinal, empirical and dietetic preparations, SfC. By Robley Dun-
GLisoN, M. D., Prof, of the Institutes of Medicine, &c., in Jefferson
Medical College, Philadelphia. 8th edition, revised and greatly
enlarged, pp. 927. Philadelphia : Blanchard &; Lea. 1851.

The fact that this Dictionary has now reached its 8th edition, shows
how highly it is esteemed by the profession, and renders unnecessary
to its farther success any special commendation from us.

New Remedies ; with formula for their administration. By Robley
DuNGLisoN, M. D., Prof of the Institutes of Medicine, &c., in the
JeflTerson Medical College of Philadelphia. 6th edition, with ex-
tensive additions. Philadelphia: Blanchard & Lea. 1851.

To the present edition of the above work, Prof. Dunglison has ad-
ded much valuable information hitherto scattered through the numer-

764 Miscellany.

ous medical periodicals, and consequently of difficult access to the
mass of practitioners. This is one of the most useful of the author's
works, and will doubtless be eagerly sought after by those who wish
to be posted up in therapeutical applications.

First Principles of Medicine. By Archibald Billing, M.D., A.M.,
F.R.S., &c., &;c. 2d American, from the revised and improved
5th London edition. Philadelphia: Lea &; Blanchard. 1851.

Billing's Principles of Medicine have been so long and so favorably
known as not to need any eulogy from us to secure a continuance of
patronage. Suffice it to say that in the present edition the author has
spared no pains to make the work even more worthy than it was be-
fore of ihe praise bestowed upon it.

New Medical Journals. The New York Medical Register is de-
funct and "the New York Medical Times" has appeared just in
time to take its place. This is edited by J. G. Adams, M. D., and is
issued in monthly numbers of 32 pages, at 82 per annum. The
New Orleans Monthly Medical Register, of 12 pages to the number
at 81 per aunum, has also been received. We cordially wish them
both a successful career.

We acknowledge the reception of the first volume of the " Transac-
tions of the Medical Society of the StaLe of Pennsylvania," and also
of the 4th number of the "Quarterly Summary of the Transactions
of the College of Physicians of Philadelphia, both of which contain
valuable documents to which we hope soon to be able to refer.

We have received the announcement of the intention of Dr. Frank
A. Ramsay, of Knoxville, Tenn., to establish in that city a " Primary
Medical Scool," as recommended by the American Medical Associa-
tion. The Doctor has our best wishes for his success.

Medical Colleges in New York. The highest number counted in
any of the lecture-rooms, including all the persons present during
any part of the lecture, was as follows, viz :

In the College of Physicians and Surgeons, 197

In the University of New York, - - 179

In the New York Medical College, - - 69

The catalogues of each of the schools will doubtless show an in-
crease when published. But the aggregate will be diminished from
the last year, chiefly from the falling ofl' of Southern students, very
few of whom have yet reached New York. [N. Y. Med. Gazette,
Nov. 15.

INDEX TO VOL. VII.

Abdomen and liver, punctured

wound of 672

Abdomen, physical examination of 609

Abortion, quacker}' in 186

Aconite in lichen and prurigo.. . 179
Acupuncture in unconsolidated

fractures 623

Addresstoihe reader, by the editor, 61

Adhesions, histology of 753

Adhesive subsiauce, new 179

Ages of Animals 574

Air-passages, foreign bodies in. .. 618
Alabama State Medical Associa-
tion 306

Amaurosis, by H. F. Campbell,

M.D 73

Amaurosis, nephritic 123

Amaurosis successfully treated ... 69
American Medical Association,. 64

(( it tt jgo

" " 256

u c (I 271

" " " 447

Amputations 272, 273, 274, 275

Anatomical dissections in N. Y.. 320

Ancient superstition 695

Anesthetics used externally 179

Anesthetics in Richmond, "Va 312

Anesthesia by spirits of turpentine, 275

Anesthetic agents, local 368

Aneurisms 369, 751

Animal heat, effects of various

agents on 632

Ankle, sprains of 115

Anus, fissure of, by J. Harriss,

M.D 131

Aorta, compression of, for uterine

hemorrhage 573

Appeal in behalf of women 126

Appetite and digestion, extraordin-
ary ; 560

Apoplexy, pathological appearan-
ces in 553

Arnold, Dr., address 641

Ascites in children 446

Arsenic, act to regulate the sale of 759
Asphyxia from drowning and

hanging, treatment of 572

Asthma, diagnosis of 489

Asthma, tartar emetic in 113

Atrophy, progressive muscular. . . 244
Augusta, health of 642

Beale, on the laws of health, &c.. 706

Beck, J. B. Prof 194

Bernard on the functions of the
liver 229

Bile, use of 750

Bilious fever, diagnosis of 460

Billing's Principles of Medicine.. 764

Bismuth in diarrhoea 565

Blackwell, M. D., Miss 127

Bladder, operation on, by Prof. Par-
ker 63

Blood, influence of salt diet on . . . 120
Blood, cor.dition of carbonic acid

in the 121

Blue suppuration 436

Bowels, green and melaenal dis-
charges Ironi 360

Bowman's Medical Chemistry. . . 65
Brandon, Dr., case of monstrosity,

by 591

Brodie, Sir Benjamin 62

Burns 273, 274, 275

Caesarian operation, successful . . . 574
Calculous diseases, effects of cro-

ton water on 66

Campbell, H. F. on dengue fever . , 20

" case of amaurosis 73

'' on the striped and unstriped

muscular fibre 139

" on seminal weakness 204

" on injuries ot the cranium. . 279
" congenital^deficiency of both

patellae..' 305

" surgical cases 387

" lithotomy 459

Campbell, Robert, on intestinal

worms 333

" case of senile gangrene 457
" death from ovarian tumor in

a child 594

Cantharidine, ethereal solution of 124

" ointment 124

Caoutchouc urinal 179

Carbonic acid in the blood 121

Carbonic acid in cellars 685

Carcinoma, encephaloid 272'

Caseine in the blood 484

Caseine in the blood of nurses 114

Casey, H.R., on typhoid fever.. . 707
Cataract, operation upon bears for 130
Cauliflower excrescence of uterus, 295
Cauterizing the ear in sciatica... 44

Cervical vertebra, dislocation 178

Census, startling facts from the. . . 670

Chancre, phagedenic 415

Chemistry, Prof, of, in Harvard

University 130

Chemistry, by Fawns 65

Chemistry for students 180

Chest, di.seases of the 536

Chloasma HI

766

INDEX.

Chloroform for poisoningby str)-ch-

nine 447

Chloroform in tetanus G35

Chloroform with ergot in parturi-
tion 156

Chloroform & ether, by Dr. Flagg, 253
Chloroform, intemperate use ot. . 3l3
Chloroform in infantile convul-
sions 317

Chloroform in hysteria 394

Chloroform in 9000 cases 506

Chloroform in spontaneous tetanus, 105

Chloroform, deaths from 762

Childbirth, effects of ether in 60

Children, diseases of 66

Chloride of mercury, poisoningby 58

Cholera in Cincinnati G6

Cholera, microscopical examina-
tion in 112

Chorea 119

Circular, by Dr. Hays 694

" Prize essays 695

" by Prof. Gross 514

Citrate of calcine in sick headache, 103

Clements, J. A., death of 194

Cod-liver oil in phthisis 122

Coffee and cafeine, notice of 101

Collodion in small-pox 244

" in symblepharon .', 247

" for in-growing toe-nail 304

*' substitute for 6H5

" in hemorrhoids 637

Colon, secreting function of 224

Colored students in a Medical Col-
lege 125, 192

Combustion, spontaneous 675

Concussion of the brain 277

Consumption, ravages of 256

Contributors, notice to 62

Convulsions, veratrum viride in . . 13
" puerperal, by P. W. Harper, 79
Cooking and preserving meat, re-
marks on 576

Cooper's treatise on fractures and

dislocations 450

Cooper, G. F. vital statistics 719

Copper, antidote for 685

Coughs, camphor in nervous 108

Coupdesoleil 495

Cox, A. L., Prof 194

Craigie's general and pathological

anatomy 704

Cranium, injuries of 524

' injuries of, by H. F. Camp-
bell, M.D 279

Davie, on the ganglionic system.. 210
' " " 256,285,344

Deafness, glycerine in 399

Death of students in New York.. . 130

Dengue, by H. F. Campbell, M.D. 20

DiarrhcEa, creosote in 501

*' sub-nitrate of bismuth in ... . 565

Diet drink, recipe for 254

Digestion, pancreatic juice in 352

" extraordinary 560

Digilaline 597

Disgusting remedies 575

Dislocation of the elbow joint 3

" of the lower jaw 176

" of the cervical vertebra 178

Doctorate, cost of in Paris 762

Donation to McLean Asylum.... 130
Dropsv, external applications in.. 297

Drowning, asphyxia from 572

Dugas, L. A. on dislocation of the

radius and ulna 3

" urinary calculus, treated by
lithoirity 207

" surgical cases treated by 271

" reply to "Remarks" in West-
ern Journ. of Medicine 686

Dunglis(in's Medical Lexicon 763

" new Remedies 763

Dysentery, unusual forms of 567

" in Gordon county 725

Ear, adhesion of the 372

Eating pork 702

Eau de Cologne 511

Eclampsia nutans 744, 746

Eclampsia 638, 747

Editor's Address to the reader 61

Editor, return of the 642

Editor, to the reader 759

b^lectro-raagnetism in poisoningby

opium 427

Electro-physiological researches.. 234
Epigastric pains, diagnostic value

of 303

Epiphora, new treatment of 637

Epistaxis, instrument for arresting 575

Errata 706

Ergot and chloroform in parturi-
tion 156, 190

Eruptive disease in an infant 69

Erysipelas, muriated tincture of

iron in 498

Ether and chloroform, by Dr. Flagg 253

Ether, sulphuric, in tetanus 634

Eve, P. F. case of stricture of the

oesophagus 284

Extracting teeth, student's guide in 253

Extraction of needles 321

Eye, tannin in diseases of the 446

Fall from a height of fifty feet 277

Females and males, production of 60

Fevers, dengue, in Augusta, Ga , . 20

" intermittent, common salt in 123

" typhoid, 298,323, 515, 546, 643, 707

" and dysentery 567

" veratrum viride in 13

Fire arms, curious effects 511

Fistula, vesico-vaginal 432

Fistula in ano, in a child , . 434

INDEX.

767

Fissure of the anus 131

Foetus in ulero, effectsof raother.. 307

Fractures 117, 387, 628, 663, 664

Frick, renal affections, 65

Gang! ion ic system, physiolo^ry and

patholoj<y of 210, 256, 285

Gangrena senilis 457

Gar, family poisoned by eating.. 366

Gasiralgia 370

" diagnosis of 302

Gaslrotoray 754

Gerhard on diseases of the chest . . 64

Glossitis, case of 77

Goitre, cause of 183

Gonorrhoea, hydrastis canadensis

in 752

Graham, death of Sylvester 703

Gregory on eruptive fevers 705

" on animal magnetism. . . 706
Greene county, physicians society 693

Gross on the urinary organs 704

Gutta percha bougies, danger of. . 762

Hall, Marshall, on the spinal svs-

tem 31,62,81, 143

Hair and Nails, growth of 122

Handkerchief, swallowing a 322

Hare-lip, operation tor 682

Harriss, J. on fissure of the an us . . I3l
" physiology of the pneumo-

' gastric, &c 451,587

Harper, P. W. on puerperal con-
vulsions 79

Headache, sick, cured by full inspi-
rations 104

" treated by citrate of cafeine, 103
Heart, new view of its supply of

blood 754

Heart, statistics of diseases of the. . 757

" wound of 307

Hemorrhage, spts. turpentine in . . 99

" from the face, periodic 123

Hooping-cough, cochineal in 124

Horner's anatomy and histology, 704
Human skeleton, proportions of.. 574

Humboldt, Baron 66

Hydranhrosis, iodine injections in 52
Hydrocele, new method of treating 185

Hysteria 447

" with chlonic spasms 394

" new form of 118

Ichlh5'osis cornea 762

Impermeable applications in vis-
ceral inflammations 445

Importance of Latin and Greek to

the physician 254

Impregnation prior to menstrua-
tion 755

Infants, pruritus of vulva of. .109, 435

Infants, quintuple birth of 443

Inferior maxillary, destruction of 742

Ingrowing toe-nail 251, 304

Injury of the leg and foot 665

Insanity, feigned 641

Insane hospitals for the 512

Insanity caused by tape- worm .... 322

imtestinal worms, influence of . . . . 333

Intemperate use of chloroform 313

Inverted toe-nail 304

Iodine 685

" ethereal solution of 500

" tincf. of, in ext poisoning... 578

" presence of, in sarsaparilla.. 510

Iron, bromide of 247

Itch ointment 370

Jenner, Dr 118

Jeter, H. M. cesarian section .... 136

Johnson, W. J. lithotomy 727

Keloid or fibrous tumor of the skin, 67

King, W. N. surgical cases 662

Kile-tail plug 60

Knox, on the races of men 65

Laryngitis, and foreign body in

the larynx 654

Lichen and prurigo, aconite in . . . 179
Lime, phosphate and oxalate of, in

disease 473, 679

Lipoma over the occiput 278

Liston, pension to Mrs 322

Liihotritv, case of 207

Lithotomy 393, 459, 663, 727

Liver, functions of 229

" punctured wound of 672

London Lancet, reprint of 128

Long, J. A. on typhoid fever 323

Lupus, Cazenave on 550

Males and females, 'production of 60

Malgaigne's Operative Surgery.. 763

Mamma, fibrous tumor of 279

Medical Board of Georgia 762

Medical Journals, new 764

Medical college, another 193

Medical college in Iowa 66

Medical college of Georgia 257

Medical college of Georgia, gradu-
ates of, in 1851 257

Medical college at Evansville .... 130

Medical coroners 701

Medical literature. Southern 311

Medical men going to Europe 318

Medical periodicals, new 194, 764

Medical professors in Spain 386

Medical society, Georgia 194

Medical society of the State oi Ga. 257

Medical statistics at Paris 447

Medical colleges in New York . . . 764

Medicine, alleged uncertainty in 321

Medicine, more wonders in 575

Medicine in Turkey 64

Memphis institute 128

768

INDEX.

Microscopic anatomy 66

Microscopic examination in Cho-
lera 112

Migrations of a pia and needle in

the body 683

Mortality in Boston 25#

Mortality in Lowel 256

Mortalitv, influence of the hours

of the day on 639

Mortality of intemperance 703

Monstrositv, case of 591

Muscular fibre, striped & unstriped 139

Muscular atrophy, progressive.. , 244

Nashville Journ. of Medicine and
Surgery 450

New Lebanon, its physic gardens
and the products 699

Nitrate of sil ver, by J. S. Wilson . . 340

Norwood, W. C. on veratrum vi-
ride in fevers 13, 62

Northwestern Medical and Surgi-
cal Journal 318

Observations, &c. on the nature of

various diseases 424

Ohio Med. and Surg. Journal 318

O'Keeffe. D. C. case of uterine tu-
mor 527

" difficulty in diagnosticating
between acute laryngitis &
foreign body in the larynx, 654
Opium, substitute for McMunn's

elixir of 703

" ill effects of relieved, &c 118

Ophthalmia, treatment of 107, 420

Orchitis, treated by laudanum 252

(Esophagus, stricture of 284

Osteo-sarcoma of inf. maxillary . , 526
Ovarian tumor in a child 594

Palpitation,symptomatological va-
lue of 301

Pancreatic juice in digestion 352

Patellae, congenital deficiency of

both 305

Paralysis of the face 69

Pendleton ,E.M. hysteria with chlo-

nic spasms 394

Physicians prescription book 706

Physicians in Erie county. Pa 255

Phosphate of lime in disease 729

Phthisis and asthma, tart. emet. in 113

Phthisis, cod-liver oil in 122

Placenta, action of ergot in produ-
cing retention of 317

Placenta, stethoscopic sounds at-
tending its detachment 113

Pneumogastric nerve, &c. physi-
ology of 451 , 587

Poisoning by chloride of mercury 58

" with opium 427

" by strychnine 447

Poisoning, treatment of, external . , 578

Prurigo, aconite in 179

Pruritus of the vulva in children 435

Priapism, treatment of 370

Puerperal fever depending upon
inoculation 621

Gtuackery in abortion 186

Gluintard , C. T. case of glossitis . . 77

" surgical cases 524

" on veratrum viride 579

Ramsay, primary medical school,

by Dr. F. A 764

Ramsay, H. A. on scarlet fever.. 268
Refracture of the leg to improve

detective surgery 117

Renal affections 65

Reply to "Remarks" in the West-
ern J ournal 437, 687

Revaccination in Prussian army. 241

Rheumatism, subcut, punctures in 113

" treated by lemon juice. . 174, 236

" terminating in suppuration. 238

Robert, W. H. contributions by. . 67

Rossignol, H. report of surg. cases 271

Rubeola treated by inunction..... 59

" inoculation in 318

Scarlatina 268, 636

" remarks on treatment of 399
Scalp, new method of uniting

wounds of the 124

Sciatica, cauterization in 44

130
Scutellaria laterifoliaasa nervine, 630
Seminal weakness, treatment of.. 204

Sight, remedy for short 129

Skey's operative surgery 449

South. M. & S. Journ., history of. 314

Southern Medical Reports 578

Small-pox in New York 192

" " deaths by 194

" treatment of 633

" congen ital 506

" occurring a third time

after vaccination 445

Smith's Minor Surgery 763

Smith, Dr. J. M 194

Speculum vagina J 29

Spinal system, synopsis of ..31, 81, 143
Spinal cord, prepartions of the ... 55
Spinal accessory, physiology of 451,587
Spine, a functional affection of the 409

Spirometer, the 170

Spleen, rupture of the 56

Sterility, remedy for 130

" Hindu remedy for 698

Strychnine poisoning by 447

Stevens, Dr. A. H 130

St. Louis Probe 192

Summer, W. J. on the vis medica-
trix Datura? 195

INDEX.

'69

Syphilis, new treatment of 48

Surgical cases 271

Swallowing a handkerchiel 322

Tape worm, cure for 753

" " insanity caused by.. 322

Tapping extraordinary 318

Tampon ^)0

Tea and its adulterations G98

Tetanus, treatment of traumatic. . 165
" curedby division of nerve 293

Tilt on menstruation, &c .... 706

Transactions Med. Soc. of Penn . 764
Transactions College Physicians

of Philadelphia 764

Transfusion, successful case of. . . 509
Ty phomania 667

Urethra, stricture of 93

Urinal caoutchouc 179

Urinary calculus, case of 207

Urinary deposits, Bird on 705

Urine, on the so-called chylous . . . 430
Urticaria treated by sulphate of

quinine 636

Uterus, diseases of 1 80

" cauliflower excrescence of 295

Uterine tumor 527

Uterine hemorrhage, compression
of aorta for 573

Vaccination andrevaccination 242,502

Vagina, occlusion of 316, 390

Vaginal speculum 129

Varicose veins 252

Varicocele, treatment of 110

Veratrum viride in fevers, convul-
sions. &c 13, 579

Vesico-vaginal fistula 432

Viruses, nature of 748

Vis medicatrix naturae 195

Walsh on the lungs and heart 705

Water dressings 684

Weatherby, J. S, on dysentery.. 725

Wilson, J. S. on nitrate of silver. 340

" " on typhoid fever 515, 643

Word, R. C. trea'lm't of scarlatina 396

W^orms, Influence of 333

Wrist, injury of 3S9

Yale and Castleton colleges 194

Yellow and bilious fevers, diagno-
sis of 460

Date Due

1

iftpK ts ag^

MAY 4 1!

174

Library Bureau Cat. No. 1137

Sniithern --^

'.^dicgj gnd Surgical

Jm^T-nFl

6-1850

)39a H

So'atliorna Medicrl and ^ur^ical Joiirnf.