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/' ^3 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(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 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 5if 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, 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, 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 Charlestertson, 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 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, 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, py 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 winede 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 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