Southern Medical and Surgical Journal, 1852

SOUTHEHN

MEDICAL AID SURGICAL JOURNAL.

EDITED BY

L. A. DUGAS, M. D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGU.

Medical College of Georgia.
" Je prcnds le Hen oitje le trouve."

VOL. VIIL 1852. NEW SERIES.

AUGUSTA, GA.

JAMES McCATFERTY, PRINTER AND PUBLISHER,

1852.

SOUTHERN

MDICAL AND SURGICAL
JOURNAL.

Vol. 8.] NEW SERIES. JANUARY, 1852. [No. 1.

PART FIRST.

rtgtnal Communications.

ARTICLE I.

The Pathology of Phlegmasia Dolens. By H. V. M. Miller,
M. D., Professor of Physiology and Pathological Anatomy
in the Medical College of Georgia.

Milk leg, White leg, Swelled leg, Puerperal tumid leg,
Anasarca serosa (Cullen), Bucknemia sparganosa (Goode),
Phlegmasia lactea, (Edema lacteum, Phlegmasia dolens, Crural
phlebitis. These various names, by which this disease has at
different times been called, indicate to some extent the changes
of opinion which have taken place in relation to its pathology.

It has been observed, and imperfectly described, by older wri-
ters, more distinctly by Mauriceau, and its history still more
accurately sketched by Puzos in the year 1759. These all
concur in the opinion that it is caused by a deposit of milk in
the affected part ; and to prevent the metastasis upon which
it was supposed to depend, many practitioners kept the child
constantly to the breast, in order to determine the secretion of
milk in its appropriate organ. Puzos, however, occasionally
resorted to much more energetic treatment, from which it ap-
pears that he regarded the disease, at least in its subsequent
progress, as highly inflammatory; but, notwithstanding the
energy of his treatment, he bewails the loss of some of his pa-
tients in terms which would do no discredit to the renowned

N. S. VOL. VIII. NO. I. 1

6 ^littor, ^ the Pathology of Phlegmasia Dolens. [J anuary,

Sangrado himself. " J'ai eu le malheur de perdre plus d'une
malade malgre toutes les saignees que j'avois pu faire : non que
les saignees eussent ete contraires ; mais elles avoient ete insuf-
fisantes pour ces cas las, parceque le mal etoit plus puissant
que le remede et qu'il n'y en avoit pas d'autre."

This view of its pathology is still perpetuated in the popular
belief of this and of nnost of the countries of Europe, but has
long since been discarded by the profession: first of all, per-
haps, by Dr. Hunter, who, although he published nothing on
the subject, and advanced no new theory of the disease, con-
stantly in his lectures denied the correctness of the old.

In 1794, Mr. White suggested the opinion that the disease
depended upon obstruction or some other morbid condition of
the lymphatic vessels and glands of the affected part. This
hypothesis, or the modifications of it, proposed by Mr. Tyre
and by Dr. Ferriar, one of whom thought the lymphatics were
ruptured, and the other that they were acutely inflamed, be-
came generally prevalent.

In the year 1800, Dr. Hull attempted to show that many of
the circumstances attending the disease could not be accounted
for upon the supposition that the lymphatics were alone affe^^t-
ed. He contended that there existed a general inflammatory
condition of the limb, involving all of its textures, but having
its primary seat in the muscles, cellular membrane and cutis.
In accordance with th^se views, he gave to the disease the
name by which it is still most generally designated Phlegma-
sia dolens.

The general adoption of the name proposed by Dr. Hull is
not to be regarded as a measure of the favor with which his
pathological opinions were received : to these there were many
objectors. It was not, however, until 1823, that appearances
observed in post-mortem examinations were appealed to for
the purpose of elucidating this topic. During that year, M.
Bouillaud, and Dr. Davis, of London, published accounts of
dissections of the bodies of persons, dead of this disease, which,
if they did not enable them satisfactorily to explain all the
phenomena which it presents, constituted something solid and
tangible upon which to base subsequent pathological enquiries,
and demonstrated the superior value of even a few facts, in
such investigations, over the most ingenious speculations.

1852.] Miller, on the Pathology of Phlegmasia Dolens.

In none of these cases, nor in any which have since been
pubhshed, did the lymphatic vessels or glands appear lo have
been primarily affected, and in most of them, in no other way
than by slight tumefaction, such as frequently attends oedema
of the extremities from other causes. In a few, they seem to
have participated tosomeextent in the inflammatory condition
of the neighboring parts, and in but one were they found in a
state of suppuration.

In recent cases, the veins of the affected limb were uniform-
ly found to be more or less firmly and completely plugged up
with a coagulum of blood, which adhered to the sides of the
vessels, the inner coat of which was of a deep red color, pro-
duced, it was supposed, either by contact with the coagulum,
or by inflammatory action. In cases of longer standing, the
vessel was found obliterated by the organization of the coagu-
lum, or of the coagulable lymph which had been effused from
its walls. These appearances were co-extensive with the
disease, involving the vessels of one or both extremities, or
extending some distance up the vena-cava, and implicating its
communicating branches to w'hatever height the plugging and
obliteration might have gone.

In accordance with the pathology which these observations
were supposed to establish, the disease was called Crural
phlebitis, and its proximate cause asserted to be "a violent?
destructive inflammation of the iliac veins and their contribu-
tary branches, including, in some cases, the inferior portion of
the vena-cava." Pressure upon the veins of the pelvis by the
gravid uterus, during gestation. Dr. Davis thought, predisposed
to the disease, and upon the sudden removal of it by the con-
summation of parturition the phlebitis was developed.

The facts, detailed in these publications, have never been
controverted ; but the explanation of them has been deemed so
unsatisfactory by many persons as to create a doubt whether
the cases described "by Bouillaud and Davis w^ere to be consid-
ered as examples of genuine phlegmasia dolens, or to be viewed
as essentially different diseases, analagous in their nature to
those formidable attacks of phlebitis which are sometimes con-
sequent upon venesection, or succeed to accidental injuries.
Even Mr. Lawrence, who made the post-mortem examination

8 Miller, on the Pathology of Phlegmasia Dolens. [January,

in the first of the cases which threw any light upon the nature
of the disease, became subsequently fully satisfied that phlegma-
sia dolens did not arise from inflammation of the iliac and
femoral veins.

That inflammation in those veins had existed in the cases
submitted to examination was undeniable ; but in what way it
was established, or how connected with parturition, or with the
condition of the uterus, subsequent to delivery, had not been
very clearly made out. If, as was said, it was produced by
pressure upon the veins of the pelvis, why was it not developed
during gestation ; if, by the removal of the pressure, why was
its appearance delayed, always for some, and often for many
days after delivery ?

Dr. Robert Lee has subsequently attempted, by numerous
dissections, to demonstrate that the inflammation acknowledged
to exist in the large veins, is in all cases propagated from the
vessels of the uterus in which he thinks it originates. His
publications furnish abundant testimony of the accuracy and
faithfulness of previous observers, and of the fact that the cases
submitted to examination were ordinary examples of phlegma-
sia dolens. They also prove, that in many instances the veins
of the uterus are in the same condition as those of the lower
extremity, but he has utterly failed to show why that condition
should originate in the veins of either, or in what manner it
may bei extended from the one to the other. Other observers,
indeed, and among them Dr. Locock, her Majesty's accoucheur,
deny the universality of the diseased condition of the uterine
veins, as contended for by Dr. Lee. But supposing this con-
dition always to exist, will it account for all the phenomena
which phlegmasia dolens presents, or are we, with Dr. Churchill,
to conclude that some further information is necessary before
we can fully comprehend its true theory? and with Hasse,
that the subject demands further investigation?

It is a fact, confirmed by universal observation, that the
veins do not readily take on inflammatory action. They may
be bruised, cut, torn, stretched, and injured in a variety of
ways, without the exhibition of greater liability to inflamma-
tion than other tissues of the body ; and when in common with
the contiguous structures they have assumed this condition,

1852.] Miller, on the Pathology of Phlegmasia Dolens. 9

how seldom is it that the formidable and rapidly fatal symp-
toms, characteristic of what is called phlebitis, are presented.
It cannot be denied, that in every instance in which any organ
of the body is inflamed, the veins participate in that condition,
and yet there is no propagation of the inflammation in either
direction along their walls. There is nothing, in fact, in. their
structure which would favor such propagation, or lead us to
suppose it possible, independently of the extension of the
inflammation in the surrounding tissues. Their nutrition is
independent of the blood which is contained within them, and
is ministered to, solely by the vasa vasorum which are derived
from the arteries, distributed to and serving for the nutrition
of neighboring parts. Inflammatory action, which depends
upon a perverted action of the nutrient vessels, cannot there-
fore exist in the veins alone, without being extended to or from
the adjacent tissues, not along the course of the vessel, and cer-
tainly not with the rapidity observed in cases of phlegmasia
dolens, for such is not the course of the nutrient vessels, and
such is not their mode of vascular connexion. If, however,
in defiance of well established physiological laws, we were to
concede the possibility of the extension of inflammatory action
along the coats of the veins, from any point where it might be
established, as for example, in the vessels of the uterus, in what
manner would we account for the peculiar direction which it
takes, and for the effects which it produces. Upon this suppo-
sition, it would follow the route of the circulation until it arrived
at the veins from one of the lower extremities, and then the
reverse direction, until it had implicaled all the vessels in com-
munication with them, when it would capriciously extend its
influence some distance along the vena cava and seize upon the
veins of the other lower extremity, and terminate by obliter-
ating the cavities of them all, and by the establishing of puru-
lent deposits at one or several points in their course.
. It will not remove the absurdity of the hypothesis to suppose,
with Dr. Davis, that the puerperal condition establishes a pre-
disposition to inflammation sufficient to account for every
physiological absurdity, for the disease has been observed in
females who were not in this condition, but affected with can-
cer of the uterus, simple ulceration, or other diseases of this or

10 Miller, on the Pathology of Phlegmasia Dolens. [January,

other of the pelvic viscera which result in suppurative action ;
and also in persons of the male sex, suffering from hemorrhoi-
dal, vesica], or renal inflammations.

In vievi^ of these difficulties, it is not surprising that, while
due credit is awarded to the gentlemen who have with praise-
worthy zeal investigated this subject, and perfect credence is
given to their descriptions of post-mortem appearances, many
persons have hesitated in the adoption of all their deductions,
and of the names by which they choose to designate the disease,
as indicative of its true pathology, and have preferred, with
Dr. Churchill, to retain the older appellation while awaiting
the further information necessary to the perfect theory of the
disease.

It is not improbable, that the desired information has been
delayed by the preconceptions of pathologists and their too
close adhesion to the exclusive solidism which has supplanted
the humoral pathology of older writers. The changes of struc-
ture in solid parts are readily appreciated by the senses, and
are better calculated to arrest the attention and to furnish facts
of indisputable authenticity, by which a solution of the various
symptoms of a disease may be obtained, than the more myste-
rious and uncertain alterations to which the fluids of the body
are subjected. It is diflicult also to trace these alterations,
from their origin to their ultimate results, with the precision
and accuracy which are demanded by the rigid analytic philo-
sophy of the present time; and hence in the investigations of
the origin and nature of diseases the solid parts of the body
have received a very disproportionate share of attention.

The extension of pathological knowledge has more recently
in theory at least, led to the rejection ofthe exclusive claimsof
either fluidism or solidism, and to the concession that the animal
structure is composed of parts, every one of which, may not
only partake of disease, but under certain circumstances be-
come the cause of it ; and has induced enquirers to engage in
the tedious and difficult task of tracing the different changes
which the blood undergoes in its circulation, and the effects of
agents upon it, whether these are the retained material of nor-
mal, or the product of morbid secretions, or foreign substances
introduced from without.

1852.] Miller, on the Pathology of Phlegmasia Dolens. 1 1

Much is to be anticipated from the further prosecution of
these investigations, and already it is probable that they justify
us in advancing one step in the pathology of the disease at the
head of this article, and if the deductions are not erroneous,
will lead to a fuller understanding of phlebitis in all its forms.

The conclusions to which they would lead are, that phlegm-
asia dolens or phlebitis is caused by the introduction of diseased
matter, usually pus, into the blood that inflammation of a vein
is not an essential part of the primary affection, which precedes
constitutional symptoms, even when morbid mattei^ has found
its way into the circulation through a vein^ and that when the
veins are inflamed, it is an effect, and not the cause of the recep-
tion of diseased or foreign matter into them.

John Hunter showed that admixture of pus with blood caused
its coagulation. If but a little of it be mixed with recently
drawn blood, the latter will coagulate round the globules of pus
and form a mass which will adhere to the first surface with
which it comes in contact, and it is not until the coagulum
thus formed, is broken up or dissolved, that its elements can
circulate with the blood.

Mr. Henry Lee, of London, has recently shown that this
change is produced in blood out of the body in two minutes,
while fifteen minutes are required for the coagulation of un-
mixed or healthy blood.

The following experiment performed by him, proves that
pus will cause the coagulation of blood more rapidly within the
vessels than out of the body:

" The right jugular vein (of an ass) having been opened, two
fluid ounces of pure healthy pus were injected and propelled
in the course of the circulation, by pressure upon the vein ex-
ternally, the vein became tense during the operation, and sensi-
bly resisted the attempts that were made to propel its contents
toward the heart, even forcible pressure was not sufficient to
overcome the resistance offered to the return of the blood, symp-
toms of constitutional irritation followed, the vein was felt
thickened as far as the sternum, and the animal was destroyed
about nine days afterwards.

Post mortem appearances. ***** Qn the right side an
abscess had formed in the course of the vein, and for two inches

12 IMiller, on the Patliology of Phlegmasia Dolens. [January,

the whole of the parts were imbedded in a confused mass of
pus and lymph, in which it was impossible to distinguish the
structure of the vein. Both above and below this for several
inches, the vein was filled with coagula, which effectually
obliterated it. These coagula extended for several inches in the
course of the circulation ; but beyond, in both directions, the
vessel was pisrvious."

In a number of other experiments, *'so sudden was the ef-
fect, that the n)ixture of blood and pus coagulated before it
could traverse the jugular vein, as indicated by the induration
and cord-like feeling of the vessel."

The immediate effect then of the introduction of pus into
the veins is the coagulation of the blood within them, and the
degree to which it may take place, will depend upon the extent
of the injury and the degree of healthiness of the blood, and
may vary from a small coagulum, such as re-unites the edges
of a punctured vein to the prolonged plug which precedes its
obliteration.

The object of the coagulum so formed appears to be to isolate
the purulent matter, and thus prevent its introduction into the
general circulation ; and it is only when this intention is frustra-
ted, by the large amount of pus, the mechanical disturbance of
the process or the loss of the coagulability of the blood, that the
grave and often fatal constitutional symptoms are manifested.

The blood coagulated within the vessels is in the same condi-
tion as if it were effused into a serous cavity, and becomes
organised in the same manner, or as coagulable lymph would do
in the same position, the only difference between them being
the presence of the red particles in the former ; and there is no
sufficient reason to suppose that they would cause fibrin, which
contains them to comport itself differently from that which is
free from them.

The coagulum adhering to the sides of the vessel becomes
a bond of union between them, a pellicle of lymph forms around
it which increases in thickness, and finally becomes vascular
and so firmly united to the sides of the vein, as to be insepera-
ble from them. Inflammation is not necessary to the comple-
tion of this process ; it is an example internally, of *' union by
the first intention," which is so frequently observed, and al-

1852.] Miller, on the Pathology of Phlegmasia Dolens. 13

ways desired in external injuries, and doubtless in many instan-
ces accomplishes the sequestration of the vessel or the insulation
of the pus without the accompaniment of symptoms of constitu-
tional irritation, or other changes in the surrounding structures
than would result from the obliteration of a vein from the appli-
cation of a ligature. But if the amount of pus be considerable,
or the adhesive process be from any cause interfered with, ad-
ditional phenomena are presented, characteristic of the farther
progress of the disease. The pus, though cut off from the gene-
ral circulation, may fail to be absorbed, and like other foreign
matter, be discharged externally by the ulcerative process. In-
flammation of the vein and of its communicating branches may
be thus excited at one or many points, by the presence of th*e
pus within it, or by the congested state of the capillary vessels,
consequent upon its obliteration. This is precisely what is ob-
served in disease, and what is produced by experiment.

*' On the 23d of November, 1848, about an ounce of perfectly
pure pus (previously warmed.) was injected into the right
jugular vein of an aged ass ; the vein immediately became cord-
ed, and the blood appeared to have coagulated in the vessel.
26th, the wound in the neck began to suppurate, and an abscess
subsequently formed in the course of the vein about midway
between the opening and the sternum." Several abscesses
had also formed in the neighborhood of the external opening.
(H. Lee.)

Cruveilhier produced similar effects by injecting ink into the
veins of animals, the tannic acid of which w^ould here seem to
coagulate the blood as quickly as pus would do ; thirty-six hours
after, the large veins were distended with adherent coagula of
blood, a number of bloody patches or congested spots were found
in the muscles and cellular tissue of the limb, which, if the ani-
mal were allowed to live, subsequently suppurated.

These experiments certainly explain several of the circum-
stances occasionally attendant upon phlegmasia dolens. They
account for the obliteration of the vessel which is known to
precede inflammation of it, for the conjestion of its communi-
cating capillaries, for the exemption of those which have some
collateral anastamosing branches, for the tumefaction of the
limb, for the subseqent establishment of inflammation and for the

14 Miller, on the Pathology of Phlegmasia Dolens. [January,

occurrence of suppuration at one or several points of the affec-
ted vein.

If any mechanical or other cause disturb the reparative pro-
cess, the coagulum beginning to be formed, or an additional
amount of purulent matter may be propelled in the course of
the vein, and the same process be recommenced at another
point, or if the occlusion of the vessel be not complete, the pas-
sage of successive portions of pus would seal up the cavity for a
still greater distance in the direction of the heart, and thus, if
the pus had its origin in the uterus, might successively impli-
cate as has been w^itnessed, the vena cava and all the vessels
emptying into it as high as the hepatic vein.
It generally happens, when the provisions to prevent the
passage of this poison into the veins which are known to exist
at the seat of suppuration, have been inoperative, that it will
be arrested by the immediate effect which it produces on the
blood. It is perhaps only when there exists some morbid con-
dition of the circulating fluid induced by previous disease, the
purperal condition, hemorrhage, or some vice, of constitution,
that pus is permitted in any dangerous quantity to go the round
of the circulation, and even then there exists a farther provision
for its arrest and ejection from the body, not as has been sup-
posed by the mechanical arrest of its larger globules in the capil-
lary vessels, but by the repetition in them (with diminished
force, but more favorable conditions of adhesion,) of the same
phenomena that attend its first introduction. Under these
circumstances, when the mass of the blood has become infected,
are developed, the well known symptoms of constitutional irrita-
tion during which different organs of the body may be simulta-
neously attacked and various isolated spots in them will become
rapidly disorganised, while the surrounding textures remain un-
altered either in structure or color. The final effort to stay
the progress of the poison is made in the capillaries and hence
they are the seat of pathological appearances which vary ac-
cording to the condition of the blood at the time. If it still
retain coagulating force, though much impaired, one or more of
the capillary vessels will become obstructed and the ordinary
changes follow, local inflammation will be developed by the
irritation of the poison and pus will be formed at the seat of the

1852.] Miller, on the Pathology cf Phlegmasia Dolens. 15

congestion, and not translated thither from the original injury.
In fact, in persons of enfeebled habits and where the blood is
in a depraved condition at the outset of the disease, these dis-
tant abscesses are observed sometimes to occur without any
apparent evidence of a previous attempt to circun)scribe the
poison, and even so early as scarcely to allow the supposition
that pus could have been fully formed at the original point
affected. But it is not difficult to comprehend how coagulation
and arrest of circulation may be produced in the slow moving
minute columns of blood in the capillary vessels, by causes in-
sufficient to aflect larger streams or even those in the normal
and healthy state of the circulating fluid.

It is scarcely necessary, if the limits of this article allowed it,
to exhibit proof of suppurative action in some organ having
always preceded attacks of phlegmasia dolens. This has been
abundantly furnished by persons who have sought to establish
its necessary connexion with inflammation of the veins. In no
instance has it occurred in persons, not in the puerperal condi-
tion, where purulent matter was not found in some organ from
whose veins its transmission into the larger vessels would ac-
count for the phenomena, as in the left leg, after amputation of
the right, after ulceration of the kidney, uterus, any of the pel-
vic viscera, or of hemorrhoidal, tumors, &c. In every case of
parturition, the resemblance of the vascular condition of that
portion of the uterus to which the placenta was attached, to a
recent wound, or amputation, has been long the subject of
remark, and will account for the production of purulent mat-
ter in cases which terminate favorably, without the accom-
paniment of metritis ; and in most of the instances of a fatal
character pus has been actually found in the veins, insula-
ted by coagula in the same manner as in experiments on
animals.

It is not intended to extend this notice to cases of phlebitis
occurring in other parts of the body, but it is evident that if the
conclusions expressed are not erroneous, they are referable to
the same cause, as they unquestionably present similar phe-
nomena. They occur most generally under circumstances
which favor the ready introduction of pus into the veins, as
when some of the larger veins have been wounded, and the

16 Miller, on the Pathology of Phlegmasia Dolens. [January,

process of union has been disturbed ; when some portion of
bone has been involved in the original lesion, as in amputations
or injuries of the head, in which the closure of the vessel is
prevented by its firm attachment to unyielding surrounding
structures. But in no part of the body is the same facility
afforded for the occurrence of this accident as in the uterus.
The intimate union existing between its muscular fibres and
veins, renders the contraction and dilatation of the latter de-
pendent upon the permanent contraction of the former, and
consequently upon every relaxation of the uterine fibres, the
coagula which close the large venous trunks are liable to be
displaced, and no obstacle would be offered to the access of
purulent or other offensive matter into them. And to this
facility of entrance is perhaps to be attributed the fact that, in
phlegmasia dolens, the coagulation and obliteration of cavity do
not always begin in the uterine veins, which are sometimes
found pervious and healthy, while the ordinary effects of the
disease are manifested in the larger vessels.

These instances are much more readily accounted for upon
this supposition than by attributing them to inflammation ori-
ginating in the uterus and propagated along the walls of the
veins. The healthy condition of the vessels in the supposed
seat of the original lesion, forbids the idea of any such propaga-
tion, and leaves but the plain inference that the cause of the
appearance is to be sought in the character of their contents.

Fortunately, the contraction of the muscular fibres of the
uterus and the tortuous condition of its veins render the coagu-
la so firm as usually to prevent the introduction of pus, from
the surface of the uterus or when it may be formed in its sub-
stance by inflammation of the organ, and it is only in excep-
tional cases that phlegmasia dolens makes its appearance. Any
cause which will relax this contraction or by other means dis-
turb the coagula, will favor its production: hence hemorrhage,
which would not be likely to excite inflammation, is not an un-
frequent precursor of it, and in almost every instance it makes
its appearance some days after delivery, when by the ordinary
process of reparation the coagula are being separated from the
mouths of the vessels by absorption or by the spontaneous
contraction of their fibrine.

1852.] Norwood, on Veralrum Viride, 17

The study of the post-mortem appearances in cases of
phlegmasia dolens and of so called phlebitis in other parts of
the body, by whomsoever published, (but which cannot be here
reproduced) will strongly tend to confirm the pathological
views imperfectly sketched in the preceding pages, and if es-
tablished they should so far modify the treatment as to avoid
the danger of breaking up the adhesions and interfering with
the process by which nature seeks to repair the injury, while
combating an inflammatory condition which, when it exists,
is but the effect of a pre-existing cause, and is never to be re-
garded as the origin or essence of the disease.

ARTICLE II.

Additional Remarks upon the value of Veratrum Viride, By
W. C. Norwood, M. D., of Cokesbury, S. C.

We have been endeavoring for some time to awaken and
interest the profession in the powers and properties of Veratrum
Viride. We now venture again, and the third time, to call
aloud ! We have been cautiously, and, as we believe, judi-
ciously, using the above article, alone and in various combina-
tion, for the space of eight years, which ought to allow us to
speak with some confidence, and should be a reasonable war-
rant for what we may assert in the sequel. After various trials
and combinations, we unhesitatingly assert that we verily be-
lieve we have adopted that form of combination which is the
best. We gave to the public, in two former numbers of this
Journal, (see June No. for 1850 and January No. for 1851,) a
portion of our experience, with a statement of what were the
powers and properties of the article ; and we give this in farther
addition. Its powers are perhaps more strikingly. manifested
in the speed and certainty with which it relieves and cures
pneumonitis typhoides. Its culminating curative powers stand
out in all probability more strikingly in this than in any
other disease. We fearlessly assert, that it is as much of a
specific in pneumonitis as quinine is in the treatment of inter-
mittent fever, and that it will cut short and break up at the first
outset of the attack as many cases due allowance being made

18 Norwood, on Veratrum Viride. [January,

for the violence of the attack and the importance of the organs
affected as quinine will, of intermittent. We challenge the
world to produce its equal, either singh^ or in any combina-
tion of remedies. Again : it is the sheet-anchor in typhus and
in typhoid fevers. It is the only remedy that has ever been
found to arrest the above fever or fevers, and to rob them of
the terror and dismay they are known so universally to pro-
duce. It not only cures cases beyond the reach of any known
remedies, in the last stage of the disease, but it breaks up many
cases at the outset, and cuts short others that are fully formed,
and in full and perfect progress. Farther: we have found
nothing that arrests convulsions in children, accompanied wuth
high febrile symptoms, from one year old and upwaids, with
any thing approximating such certainty and speed. In hooping
cough, it stands unrivalled and alone, as a remedy that may be
relied on when accompanied with high febrile excitement.
Di\ J. A. Stewart, in writing to us in relation to its powers,
states thus: "I know of no remedy worth mentioning, save
yours. Having seen cases of pertussis every day for ten
months, and used your remedy every few days, I cannot recom-
mend it to that notice it deserves without being considered as
an enthusiast in its use." We hasten on to notice, farther, that
it is a powerful and reliable agent in the treatment of typhoid
dysentery : that w^ith it we can readily manage that fearful,
malignant and mortal disease.

The next class of diseases we shall notice, and briefly il-
lustrate its powers in by a couple of cases, is the certainly and
speed we mean undoubted certainty with which it cures or
relieves the pain and febrile excitement occasioned in mumps,
by a metastasis to the testicle.

Case 1st, Mr. A. Found him with the testicle much swelled
and intensely painful ; great pain in the head ; skin hot and dry;
pulse 110; tongue thickly coated. Commenced with eight
drops every three hours, the dose to be increased one drop
every portion till nausea or vomiting occurred. The third
portion excited free emesis. The pulse was reduced to 65
pulsations per minute, the skin became cool and moist, and
there was perfect relief of the pain and all unpleasant febrile
symptoms were subdued and removed, and by continuing the

1852.] Norwood, on Veratrum Viride. 19

remedy in small portions, so as not to sicken, there was no re-
turn of either pain or febrile symptoms. The symptoms of
Mr. S., in the second case, were similar to the first, being free
from pain, in the head excepted. He was treated in the same
manner precisely. The third or fourth portion vomited freely,
on the occurrence of which the pulse was reduced to 60 beats
per minute, which before commencing was upwards of 110,
with an entire removal of all pain and febrile excitement.

In traumatic lesions we have tested its powers sufficiently to
warrant us in asserting that it will control and regulate any
arterial excitement produced thereby. We fully tested that
fact in the New York emigrant's hospital. Who can calculate
its value and importance, by the ease and certainty with which
it controls and subdues high arterial excitement after capital
operations ? How many cases run down and perish from high
sanguineous excitement alone, without any other appreciable
cause, after well executed operations ? We feel confident that
in the above we can afford the surgeon a remedy that will
quiet his fears and remove his apprehensions in such cases,
and that he can control at will inflammation, arterial and gen-
eral sanguineous excitement, that so often supervene and defeat
the successful result of the most skilfully executed operations
in surgery.

We feel fully assured, that we can confidently offer to the
world the desideratum so long sought and wished for, namely,
an agent that will certainly and undoubtedly control and sub-
due morbid arterial excitement, the great frequency of the
contractions of the heart and arteries, so especially belonging
to all acute diseases, and the removal of which has been as
difficult as its presence was universal in all severely acute dis-
eases. Dr. Bass, writing us on the subject, observes, " It seems
to act directly upon the heart and arteries, as manifested by a
diminution of the force and frequency of the pulse ; it relieves
irritation, congestion and inflammation establishes the equili-
brium of the circulation excites free diaphoresis and expec-
toration, which well adapts it for the treatment of pneumonitis,
pneumonia typhodes and asthma in which diseases I have
used it effectually, or in other words, with unparalleled success."
Dr. J. Branch, in writing us on the same, states, " I will simply

20 Norwoodj'oTi Veratrum Viride, [January,

say, I regard it as one of the most important articles of the
materia medica. You never made a more just and appropriate
remark, than you did when you said,, it would say to "the
pulse thus fast shalt thou beat and no faster." I have used it
in many cases of the severest sort of typhoid fever, with the
happiest effect ; it will cool the surface, reduce the frequency
of the pulse, while at the same time it does not diminish its vol-
ume or strength. Indeed, I have sometimes thought that the
volume and strength of the pulse was increased, in atonic cases,
under the use of this article. The following will serve as an
illustration of its use and effects: When called to a case of
typhoid fever with a hot surface, frequent pulse, great rest-
lessness, in a word, with all the symptoms of such a case if
the patient be an adult, I commence with giving him 8 drops
of the article every two hours, and increase the dose a drop or
two at every succeeding dose, until slight nausea is produced,
never fearing but that when this effect is produced I shall have
a cool surface, an infrequent pulse, and an absence of all febrile
excitement. I then continue more or less of the article, until
the case is broken up." Dr. J. A. Stewart, in a letter on the
same subject, writes thus : " I do not believe any remedy or
combination of remedies possesses the same powers in pneu-
monia or pleuritis as yours it not only lessens the frequency
of the pulse, but exerts a curative influence on the disease, and
with regard to its lessening the frequency of the pulse, I unhes-
itatingly say, without fear of successful controversy, that it will
control the pulse in any and every case where it is morbidly ex-
cited. I regard your "remedy" as peculiarly adapted to the
treatment of pneumonitis, pleuritis, pneumonia typhodes, per-
tussis, typhus fever with increased action of the heart and ar-
teries. Mr. Rodgers, in whose family you practice, was at-
tacked with typhoid pneumonia about the time you left home,
and Drs. Agnew and Traynham attended him, and when all
hope of his recovery was lost, his family recollected that some
of them had been rescued from an untimely grave by your
remedy urged the physicians to give the *' drops.',' Neither
of the physicians having the medicine, they determined to send
to me for it; and, with only 5ij of the tincture, both of the
physicians assured me they had saved Mr. Rodgers, and would

1852.] Havnss's Case of Phimosis. 21

not take less than five dollars for the remnant of the two
drachms."

We have every confidence that it will cure scarlet fever,
also that it will be a valuable remedy in puerperal fever. We
are waiting an opportunity to test its powers in the treatment
of yellow fever. If we should succeed in curing yellow fever
or materially lessening its fearful mortality, who will not hail it
the master discovery of the age ?

Above we have given a brief outline in addition to what we
have heretofore published. We intend shortly to give a full de-
tail of the powers of the article and our entire experience.
We challenge the world to discredit the above. We pledge
ourselves, and stand ready to demonstrate the powers and effects
claimed. We have staked our reputation for veracity and
medical skill on the above, and we are perfectly willing to
abide the verdict of a liberal and enlightened profession and
an intelligent community. Truth is omnipotent. The above
was not got up in a day, or a corner, but is the result of years
of laborious investigation, and of time and money spent to prove
and test the certainty and correctness of our experience, and
the conclusions reached, the world can either receive it or re-
ject it.

[The preparation of Veratrum Viride used by Dr. N. is the
Saturated tincture of the root. Edt.]

ARTICLE III.

Report of a Case of Phimosis, with Remarks. By Juriah

Harriss, M. D., of Augusta, Ga.

Phimosis differs very much in character and form, accord-
ing to the circumstances under which it occurs. It may be
temporary or permanent, and the latter kind, w^hich alone re-
quires an operation, may be congenital or accidental.

Permanent accidental phimosis may be the consequences of
chancres, vegetations, indurations of the prepuce, herpes, and
adhesions of the prepuce to the glans penis. All of these
causes induce phimosis, and frequently to such an extent as to
render an operation necessary. When the deformity is con-

N. S. VOL. VIII. NO. I. 2

22 Harriss's Case of Phimosis, [January,

genital, it of course requires an operation. Ricord observes,
that when the adhesions between the prepuce and glans penis
are intimate and of long standing, they should not be dissected
up, but only a portion of the prepuce should be removed, suffi-
cient to allow free micturition. The old operation of slitting
the prepuce above or below the glans, is very objectionable.
It was first proposed and performed by Celsus ; after prevail-
ing a considerable time, it fell into disuse, but was revived and
extolled by M. Cloquet. Since this, it has been the process
preferred by the profession generally.

A very serious objection to this operation is, that it substi-
tutes one deformity for another. It removes the phimosis, it
is true, but there remain two flaps, which destroy the symme-
try of the organ and constitute an impediment to coition.
The operation of simple circumcision is decidedly preferable
to the old plan of Celsus. The wound heals as rapidly, and
leaves a much prettier result. Ricord's operation, which is in
effect but a circumcision, is more neat and much to be preferred
to either of the above modes. I will give his manner of oper-
ating, by detailing a case.

A boy, about eight years of age, being presented for exami-
nation, I discovered a very long prepuce, with a small tumor
upon its lower margin. The tumor was situated just beneath
the skin, in the subcutaneous cellular tissue. It felt very much
like an adipose tumor. Its position and size lessened very
much the perputial orifice and rendered micturition somewhat
difficult. I deemed it advisable to circumcise the child, as by
so doinsc I w^ould relieve him at the same time of the tumor
and phimosis ; moreover, the wound would not be any larger
than that required for the extirpation of the tumor, and this
might result in a permanent phimosis which would itself event-
ually necessitate another operation.

Ricord divides his operation into four stages: 1st. An ink
mark is made two lines in front of the base of the glans ; this mark
is of course oblique and serves as a guide to the forceps. 2d. A
long needle, with its point covered with a ba!l of wax, to pre-
vent pricking too soon, is then passed between 'the prepuce
and glans and made to transfix the upper portion of the prepuce
a line or two in front of the mark, at the base of the glans

1852.] Harriss's Case of Phimosis. 23

penis. 3d. The phimosis forceps are then applied to the pre-
puce in front of the mark and behind the point of the needle.
4th. The needle is next seized and pulled upon to extend the
prepuce. 5th. The bistoury is, lastly, passed between the nee-
dle and forceps, and the protruding prepuce is excised. The
operator should be careful to cut against the forceps, which
have a smooth edge which serves as a guide and secures a
regular surface.

After the section, and before the forceps are removed, a
sufficient number of sutures are to be passed through the
groove in the jaws of the instrument, and thus entirely through
the two sides of the prepuce. The forceps are then removed
and the sutures severed in the middle and tied upon either side.

I performed the operation according to the plan of Ricord, ex-
cept that I did not apply the sutures, but made use of the ser-
refines, or small wire forceps of Vidal de Cassis. These forceps
close of themselves and are very useful in slight wounds.
They retain the parts together, and may be removed at any
time without pain.

Upon dissection of the tumor, after the operation, I found
that it was not adipose in structure, but was an encysted tu-
mor. It was composed of a sack containing a soft substance,
resembling rich cream. This matter I placed under the micro-
scope, and found an abundance of rhomboidal crystals of chol-
esterine. These crystals were disseminated through the mass,
and were in some points agglomerated together and overlapped
each other. There were also an abundance of fatty granules
or cellules (grumeauxgraisseux.) There were but few element-
ary granulations, which is rather unusual in such tumors.

The cyst was composed of fine cellular tissue and a number
of small cells, some with and some without nuclei. The cyst
appeared to the naked eye delicate, pearly and semitranspar-
ent. The French style this kind of tumor a cholesteotome.
Cold water dressing was applied to prevent hemorrhage and
too great inflammation.

I performed the same operation upon an adult, sometime
since ; but owing to a strong syphilitic taint, the wound has not
healed properly, and the patient is consequently not yet well.
I may give a report of this case at some future time, with ad-
ditional remarks upon phimosis.

24 Cod-liver Oil, [January,

PART II.
cUrtt apartment

Cod-liver oil ; Supeinoritij to any other single remedy in
phthisis; Illustrative instances of its value ; Different kinds
compared; Collateral remedies sometimes useful, often un-
necessary ; Effect of its introduction into the system hy fric-
tion ; Mode of action ; Important practical generalizations
derivable from a knowledge of its mode of action ; The aj)-
preciation and use of facts. By Theophilus Thompson, M.D.,
F.R.S., Physician to the Hospital for Consumption, &c.

The great object, gentlemen, of all our researches is to at-
tain to the successful treatment of disease. With this convic-
tion I propose to devote the present lecture to the considera-
tion of the effects of a remedy which you will have observed
is very largely employed at this hospital, even to the extent of
more than 600 gallons annually.

The records of the hospital give you an opportunity of com-
paring the effect of treatment conducted on general principles,
irrespective of the use of this remedy, with treatment in which
the administration of this medicine has occupied an important
place ; and the more carefully you institute the comparison the
more will you be convinced of the value of this substance in
the treatment of phthisis, when appropriately administered, and
combined with the use of such other measures as any special
circumstances in the individual patient may require.

But you will like to see examples of its use. I first intro-
duced M. A. F., a female aged thirty-two. The expansion of
the two sides of her chest at the upper part is not perfectly
equal, although a practised eye may be required to detect the
difference ; in the left sub-clavicular region inspiration is in-
terrupted ; in the right subclavicular region the expiratory
murmur is prolonged. The disease is at a very early stage,
and cod-liver oil has been given in the hope of improving her
strength, and thus warding off further disease. Her progress
is encouraging ; the pulse, in the last six weeks, having gone
down from 116 to 80, and her weight increased five pounds,

The next patient, A. S., is a tailor, who has suffered much
from confinement in close workshops. The principal physical
signs at the time of his admission were, dulness on percussion
and extensive moist crepitation over the upper half of the left
chest. Softening of tubercular deposit was obviously proceed-
ing rapidly, and this is the period in phthisis when the influence
of remedies is usually least satisfactory. The patient looks
very delicate. The pulse has remained about 100 for the last
seven weeks, notwithstanding the administration of the cod-

1852.] Cod-liver Oil 25

liver oil, and his general aspect is unpromising ; still some good
effect has been produced, and there is an addition of five pounds
to his weight.

The next patient, L. D., a young woman aged twenty-one,
came into the hospital on the 31st of October, with moist
crepitation at the apex of the right lung, and gurgling in res-
piration and cough on the left ; phthisis existing in the second
stage on one side, and the third on the other. The pulse, as
in ihe'previous patient, remains as yet unaltered, but there is
an improvement of strength, a subsidence of night perspira-
tions, a regular state of bowels, which were previously relaxed
and, in the three months of her use of the oil, an increase of
weight to the extent of six pounds. The local signs also indi-
cate amendment. The expectoration is much diminished, and
a dry, blowing respiration has taken the place of gurgling.

E. M., the patient now before you, under the judicious care
of my colleague, Dr. Cursham, has acquired so ruddy a com-
plexion that you would not suppose her an invalid. There is,
however, cavernous respiration at the apex of one lung ; still,
the cough is subdued ; the expectoration, once profuse, has
ceased, and she has gained no less than fifteen pounds weight
in about twelve weeks. It is right to mention that she has
had spermaceti mixture and compound hemlock-pill for her
cough; and of late, in addition to cod-liver oil, the following
mixture: Twenty-four grains of ammonio-citrate of iron ; two
drachms of spirit of nutmeg ; six ounces of infusion of calumba ;
an ounce twice a day.

Here is another patient, S. G., aged twenty-five, who is
fattening, and the catamenia, long interrupted, have returned
a circumstance of great significance and promise. You find a
little cavernulous rhonchus, only, where there was formerly
extensive gurgling ; and a marked flattening in the subclavi-
cular region indicates the process of contraction of a cavity.
Her weight, which was seven stone thirteen pounds on her
admission, in July, has steadily increased, and now, at the end
of February, it is nine stone, two pounds, and the concurrent
symptoms of vomiting, palpitation, and oedema, with which
this patient was for a time harassed, have entirely disappeared.
In addition to cod oil she had syrup of iodide of iron, and coun-
ter-irritation has occasionally been established by the applica-
tion of a linimeni made according to the following prescription :
Take of iodine, and of iodide of potassium, each an ounce; of
rectified spirit, two ounces: mix.

I must have the satisfaction of introducing one more patient,
whose case is highly gratifying. This young woman, M. B.,
is, I am informed, the only remaining member of a large family

26 Cod'Hver Oil [January,

all of whom have died of phthisis. She was admitted five
months since, with dull percussion al the right apex; at the
left, gurgling in respiration, and cough. Her case was examin-
ed and recorded by two other medical gentlemen before I
explored her chest, and my account corresponded with theirs
as to the existence of cavity in the left side. To-day two of
my colleagues have examined her, and agree with me in the
opinion that no sign of cavity can now be detected in that
situation. Let me describe the progress of her improvefnent :
The extent of the gurgling gradually lessened, then dry cavern-
ous respiration was the principal sign ; this was superseded
by blowing, and then bronchial breathing, and at present I
detect nothing wrong except a little flattening of contour,
sight dulness on percussion, and wavy inspiration. The cata-
menia have returned ; the pulse has sunk from 112 to 80 Her
weight five months since was seven stone twelve pounds and
a quarter ; we will try it again : it is now nine stone five
pounds and a quarter.

You may wish to form an opinion regarding the compara-
tive efficacy of the different kinds of cod-liver oil. In my early
trials of the remedy, six years since, forty or fifty cases were
treated with the coarse kind, resembling what is used in pre-
paring leather, and the average benefit derived did not mate-
rially differ from that effected by the purest varieties subse-
quetly employed. At a later period I had the curiosity to try
these different kinds, combined with liquor potassae, and pepper-
mint oil, giving alternately the coarse and the purified cod oil,
and recording the report of the patients ; and it is a curious
fact that the majority actually gave the preference to the mix-
tures in which the coarser oil was introduced. Objections
have been made to this combination as complicating the treat-
ment with the addition of a medicine by some persons supposed
to be inappropriate ; but my experience is favourable to the
use of liquor potassae, especially in the early stage of phthisis,
and theoretical arguments might be advanced in its favour.
In scrofulous affections, if Dr. Hughes Bennet be correct in his
hypothesis, there is probably undue acidity of stomach, un-
favourable to the solution of albuminous materials. The alkali
of the salivary and pancreatic fluids, being neutralized, fails to
convert the carbon into oil. The lungs not having enough
carbon to excrete, local congestions arise ; the blood is over-
charged with albumen, and the albuminous exudation being
deficient in fat, elementary molecules are not formed so as to
constitute nuclei capable of development into cells, and tuber-
cular corpuscles are the natural result.

Cod-liver oil probably tends to obviate the series of derange-

1852.] Cod-liver Oil 27

ments just described, by combining with the albuminous ele-
ment of chyme, so as to form the healthy chyle-granules which
feed the blood, and, for the reason above named, is probably
better introduced in scrofulous subjects when combined with
an alkali. It is a curious fact, that when, about seventy-five
years since, cod-liver oil was largely used at the Manchester
Infirmary, chiefly in the treatment of rheumatism, the medi-
cine was ordinarily given combined with alkali ; Dr. Percival's
favourite prescription being twelve minims of soap lixivium,
an ounce of cod-liver oil, and half an ounce of peppermint
water. The practice of administering a little lemon-juice after-
wards would not necessarily interfere with the action of
the alkali, and is worthy of incidental notice in connection with
the recent valuable suggestions of Dr. G. O. Rees in the treat-
ment of rheumatism with the acid of lemons. Occasionally,
although not frequently, the stomach rebels against the oil,
however purified, and in whatever combination ; and I have
been accustomed in consequence, under such circumstances,
to introduce the oil endermically.

Three years since I was requested to see a gentleman from
the country, confined to his bed, emaciated, hectic, and ap-
parently failing rapidly, with a cavity at the apex of the right
lung. There was considerable diarrhoea; and thinking the
internal use of cod-oil unseasonable, I ordered an ounce, com-
bined with oil of lavender, to be rubbed into the chest night and
morning. This gentleman gradually rallied, and returned to
the country, where he advanced much in strength and weight,
and rode about on horseback. I examined him last year, and
judging from the physical signs, found the size of the cavity
materially reduced.

J. S., a patient under my care for the last two years, with
softened tubercle in the left lung, notwithstanding the adoption
of a tonic regimen, and the internal administration of cod oil,
got gradually worse, and in the four months preceding August,
1850, her weight was reduced from 105 to 97 pounds. I then
prescribed, as a liniment, three ounces of cod oil ; an ounce of
sal volatile; half a drachm of oil of lavender; five grains of
opium : half to be rubbed in night and morning. In a fortnight
improvement commenced, and in two months her weight had
risen to 104 pounds.

M. A. W., a patient lately in the hospital with cavernous
respiration at the summits of both lungs, and who had weekly
lost on an average a pound in weight for twelve weeks, rallied,
gained a little weight during the first month of using the same
liniment, and left the hospital somewhat improved. But I will
not multiply examples. It is enough to say that satisfactory

28 Cod-liver Oil. [January,

results have been sufficiently frequent to authorize the mea-
sure, sometimes as an auxiliary to the internal use of the oil,
but more especially as a substitute when the stomach revolts
at its internal adtninistration.

I am indebted to Dr. Glover, of Newcastle, for a reference
to some observations of Dr. Klencke, of Braunschwig, confir-
matory of the results just described. In a memoir on the
Therapeutical History of Cod Oil, Dr. Klencke says, " I
shaved some young dogs, and rubbed them with cod-liver oil
twice daily for three weeks. At the end of this period they
were in as good conditon as doo-s to whom oil had been inter-
nally administered ; their bile w^as found as rich in fat, and
their chyle equally charged with corpuscles without nuclei."
Klencke adds that similar changes were observed in the bile
and chyle of a cat bathed twice a day for some time in the
same remedy, and that some oil was discovered in the urine of
the animal, proving its free absorption by the skin.

You will naturally ask me whether there are any disadvan-
tages incident to the use of so valuable a remedy ? and you
may repeat questions I have occasionally heard : Does it often
produce diarrhoea ? Does it tend to increase haemoptysis ? As
respects the latter question, it might be sufficient to mention
that the average frequency of the occurrence of haemoptysis,
as recorded by Louis and other observers, was fully as great
in phthisical cases before cod-liver oil was introduced as it
has proved in those cases statistically reported at this hospital
in which this remedy has been perseveringly used. When
haemoptysis is active, as characterized by phenomena described
in my second lecture, it is, indeed, easy to iuoagine that a reme-
dy which increases the fulness of the pulse might aggravate
the spittins: of blood ; under such circumstances the fish-oil
should be discontinued, and the removal of blood by cupping
may be desirable. When, however, as is frequently the case,
the haemorrhage is passive, means which tend to enrich the
blood are calculated to lessen the haemorrhagic tendency, and
its occurrence is by no means an adequate reason for the sus-
pension of the oil.

As respects diarrhoea, a malady which the remedy under
consideration has been supposed occasionally to aggravate, my
own impression is that no such influence is evinced unless a
state of erethism of the mucous membrane is present, in which
case measures should be used to obviate such condition prior
to the administration of the oil. Many of the patients take the
oil unmixed, or, when such combinations are appropriate, float-
ed on nitro-muriatic acid mixture, or on lemon-juice. The
addition of creasote occasionally makes the stomach more tole-
rant of the remedy.

1852.] Cod-liver Oil 29

An ounce and a half of cod-liver oil, four drops of creasote,
two drachms of compound Iragacanlh powder, and four ounces
and ahalf of aniseed water, form a suitable mixture, of which
an ounce may be taken thrice daily.

Those who take the oil unmixed, may cover the taste by
eating dried orange peel, or by introducing a little dinner-salt
into the mouth before and after the oil.

You will observe from the cases tabulated in the preceding
page, all of which you have had an opportunity of seeing,
and the conclusion is in harmony with more extended observa-
tions, that if the use of cod oil has any influence on the con-
dition of the bowels, that influence is rather astringent than
laxative.

1 believe the fact to be that this medicine has no direct in-
fluence on the intestinal action, but that by improving the
general health it tends indirectly to restore a natural condition
of the bowels, whilst it expands the pulse, lessens the expecto-
ration, moderates the night perspirations, and in many instan-
ces supersedes the necessity for the use of any other remedy.

You will say the evidence adduced of the powers of cod oil
is strong, but that the remedy was formerly highly estimated
and yet fell into disuse, and you may inquire whether it may
not exhibit the fluctuations of fashion, and again sink into ob-
livion. The best w-ay to secure for any remedy its proper
place in therapeutics, is to determine its mode of action ; and
with this view I have from time to time endeavoured to obtain
an analysis of the blood of patients who were in the course of
improvement under its use : as an example, let me show you
the analysis of the blood of a phthisical man in the Le Blanc
ward, who had gained fourteen pounds weight in three months
and had essentially improved under the cod-oil treatment.

Dr. Snow did me the favour to make the analysis. I place
by the side, for comparison, the analysis of the blood of a heal-
thy male, as given by Becquerel and Rodier :

Of a Phthisical man after three months
Analj'sis cf Blood of a Healthy ]V^ale. Treatment with Cod oil.

Water 779 0 770-6

Blood-globuies 141-1 143 5

Fibrine 22 4-0

Albumen G9-4 ) ..^ ^ o, ^

Extractive and salts.... 685 '^"^ ^'^

Fatty matters 1-6 0-4

The interest of these analyses is increased by their harmony
with the observation of Simon, who recorded an increase of
blood corpuscles and diminution of fibrine under the use of cod
oil : and their importance becoines more obious when they are
viewed in reference to the facts stated by Andral andGavarret

30 Cod-liver Oil. [January,

who, having analysed the blood in twenty-one cases of phthisis
found their nnaximum of fibrine, 5'9, their mininnum 2-1, and
that the amount of corpuscles approxinnated to the normal
standard in only two instances, in which it was represented by
122'1 and 120*4. Frequently, indeed, the amount was below
100, and the decrease of corpuscles was almost always accom-
panied with a corresponding increase of fibrine. (Simon's " Ani-
mal Chemistry," vol. i., p. 281, Sydenham Soc. edit.)

You see that, in the patient just referred to, the proportion
of blood corpuscles pretty closely corresponds with that cha-
racteristic of health, and Mr. llodgers reports a similar result
from the examination of the blood of some other patients to
whom we have given the oil. As far as I am aware, howev-
er, chemical observations lead to the conclusion, that in phthi-
sis deficient proportion of blood-corpuscles is the usual pecu-
liarity. Struck with this circumstance, I took pains to collect,
chiefly from Simon,, analyses of the blood in different diseases,
and I have placed before you averages of the proportion of
blood-corpuscles and albumen in certain diseases, with a view
to compare them with phthisis.

Average Proportion of some Constituents of Blood,

In health

Albumen.
76

Corpuscles.
1.30

Pneumonia

80

122

Phthisis

100

78

Rheumatism

100

74

Diabetes

105

80

Chlorosis

72

56

Bright's disease

103

50

Carcinoma

45

55

Ervsipelas

100

You will observe that there are two diseases which present
a peculiar similarity to phthisis, in their proportions of albumen
and of corpuscles. These are rheumatism and diabetes. Now
it is a remarkable fact, that rheumatism is the malady for the
treatment of which cod-liver oil was first introduced into this
country, and for which it has been so largely and successfully
employed elsewhere. The variety of rheumatism in which it
was most effectual is that in which the imporverished condition
of blood is most likely to occur.

Dr. Percival, half a century since, (see Works Literary,
Moral, and Medical, by Dr. Thomas Percival, vol. 4, p. 354,)
observes, "Men and women advanced in years, whose fibres
maybe supposed to have acquired a degree of rigidity, find
surprising effects from it (cod-oil.) Some who have been crip-
ples for many years, and not able to move from their seats,
have after a few weeks' use of it been able to go with the as-

1852.]

Cod-liver Oil.

dl

sistance of a stick, and, by a longer continuance, have enjoyed
the pleasing satisfaction of being restored to the natural use of
their limbs, which for a long time before liad been a burden to
them. Two cases occurred lately in which the oil bad an ex-
traordinary effect, even on young persons, whose ages did
not exceed ten years. Guaiacum, calomel, blisters, &c., were
tried on both these patients, but with so little benefit that opiates
were given merely to procure temporary relief Their lower
limbs seemed to be a burden to them, and they had such an
appearance of distortion, that no hopes of relief could be well
entertained. In compliance with the particular request of
their parents, the cod-oil was given. The one obtained a per-
fect cure, the other nearly so ; the latter having a little distor-
tion in his back, is prevented the use of his legs. So general
(adds Dr. Percival) has been the use of the oil with us, that we
dispense fifty or sixty gallons annually ; and the good efl^ects
of it are so well known amongst the poorer sort, that it is parti-
cularly requested by them for almost every lameness. Except
bark, opium, and mercury, I believe no medicine in the materia
medica is likely to be of more service, and I should wish for a
more general use of it in order to prove that the above account
of its good eflfects is no exaggeration."

I am strongly impressed with the value of the remedy in
diabetes. It is true that this disease involves an additional
element, which it is not easy to suppose amenable to such a
remedy as fish-oils, but the benefit derived in many respects is
often remarkable.

In the month of April, 1848, a patient came under my care
who had been affected with diabetes for some months, and had
taken creasote and other medicines with little advantage. At
the time I first saw her the quantity of urine passed in twenty-
four hours, amounted to ten pints.

The following table will show^ the progress under the cod-liv-
er oil treatment ;

Dates.

Urine.

Remedies.

auantity.

Specific

Gravity.

1848.

April 1

Cod-oil, two drachms three times a day.

Ten pints.

" 13

Ditto.

Six pints.

" 20

Ditto.

Four pints.

1040

" 27

Cod-oil, four times daily.

Six pints.

1042

May 4

" five times daily

Three pints.

1042

" 11

Ditto.

Three pints.

1037

" 18i Ditto.

Two pints and quarter

1-020

Subsequently this patient passed unavoidably into other care
and owing to a misunderstanding, did not resume the cod-liver

32 Cod-liver Oil. [January

oil, which had been, from temporary causes, intermitted. She
took a variety of remedies, including sulphur, hydrochloric acid
opium and alkalies. Drachm doses of carbonate of soda for a
time acted favourably, but on the whole she retrograded. Her
weight, which in Juue, 1848, was 107 pounds, (had fallen, by
December, 1849, to 88 pounds. Her appearance was haggard
and there was threatening^ of pulmonary disease. The cod-oil
was resumed, and even then with temporary advantage, but
she ultimately relapsed and sank.

The theory which I have now proposed in explanation of one
mode of action of the oil is in harmony with the fact that its
good effects are specially produced in women and children, for
in them the relative proportion of corpuscles is stated by chem-
ists to be small.

I may state that the remedy has afforded me most satisfac-
tory results in neuralgia and sciatica, when associated with
anaemia. Whenever arterial or venous murmurs indicate such
a condition, a rapid improvement may be expected to follow
the administration of the oil, even without the assistance of fer-
ruginous medicines. In some disturbed manifestations of the
nervous system w'hich may appear more moral than physical,
the presence of a weak, small pulse, has sometimes led me to
give the oil, and with signal success. Do not think that I dwell
on this subject from any love of fanciful hypothesis. When the
light issuing from a certain number of facts seem to converge
towards aparticular point of explanation, it is useful to try the
applicability of that explanation to analogous facts, and thus to
entertain, I do not say to adopt a theory a sort of tentative
theory, or '^prudens qucestio.'" If the theory prove universally
applicable, we obtain a law: if the explanation be found incor-
rect, it is yet seldom fruitless : indeed the proof of its inadequacy
serves to narrow the field of inquiry, and to increase the proba-
bility that the next step may be in the right direction towards
the attainment of truth. Time is sometimes lost in the laborious
accumulation of miscellaneous facts. Numerism is productive
only by the amount oi'' lumen siccum,'^ intellectual intuition,
applied in the selection and appreciation of facts. There is an
aristocracy in facts as well as races, and the mind should be
taught to discern their prerogative dignity. "The naturalist
who cannot or will not see that one fact is often worth a thou-
sand, as including them all in itself, and that it first makes all
the others facts who has not the head to comprehend, the soul
to reverence, a central experiment or observation, (what the
Greeks would perhaps have called a prolophaenomenon,) will
never receive an auspicious answer from the oracle of Nature."

To apply these observations to our immediate subject, let

1852.] Fatal Effects of Tartar Emetic in Pneumonia. 33

me remark that changes produced on the blood by diseases or
remedies may fairly be placed amongst the cardmal facts. It
can scarcely be doubted, that if a professor accomplished in
chemistry were officially connected with every hospital, such
facts might be so collected as to render the discoveries of this
important science available, in a remarkable degree, for the ad-
vancement of practical medicine.

Should further observation confirm what has been suggested
in this lecture regarding the influence of fish oils on the compo-
sition of the circulating fluid, we shall discover more than the
reason of their usefulness in phthisis ; we shall show that they
have no exclusive adaptation to that disease, but that they may
be given with equal promise in various diseases associated with
analogous conditions of the blood ; and thus we may come to
establish a therapeutical law so widely applicable as to simplify
our principles, extend our resources, and consolidate our sys-
tem of practical medicine. Such a generalization would com-
mend itself to my mind by its freedom from complication
and obscurity ; for I am sure you will agree with me as to the
evidence afforded in the noblest triumphs of philosophy, that
although shallowness and obscurity are continually associated,
yet that the ocean of truth is clear as well as deep, and that in
proportion as we approach the truth, we shall attain to sim-
plicity. \^London Lancet.

On a rarely observed, hut very fatal Effect of Gastro-intestinal
Revellents ; especially of the Tartrate of Antimony and
Potassa, and particularly in the treatment of Pneumonia.
By Wm. M. Boling, M. D., of Montgomery, Alabama.

There are but few articles of the Materia Medica which
exercise so certain a control over any serious morbid state or
action, as the tartrate of antimony and potassa does, over in-
flammation of the pulmonary parenchyma. Its efficiency, I
may say, is universally admitted. Unfortunately, however, its
value as a remedy in pneumonia, or any other disease indeed in
which its protracted use may be required, is diminished by the
circumstance of its occasioning in many instances, violent dis-
ease of some of the abdominal viscera, which often leads to a
fatal result. It is in pneumonia, however, according to my own
observation, that the efl:ect referred to is most frequently pro-
duced by it, and developed in the most violent and rapid man-
ner ; probably, it is but reasonable to suppose, because in this
disease its protracted administration is more frequently practi-
ced than in any other. As generally administered, it is not im-

34 Fatal Effects of Tartar Emetic in Pneumonia. [January,

probable, that the remedy, even in cases in which the ultimate
result may be favourable, produces by its contact, more or less
irritation of the gastro-intestinal mucous membrane, which
gradually subsides, after its suspension, during convalescence.
Its visible effect upon the skin, when used locally, might lead to
such an inference, and indeed appearances somewhat analogous
to this are sometimes observable, not only after death, in the
gastro-intestinal mucous membrane, but during life, in the mouth
and fauces, as a result seemingly of its use. In fact it is to a
revellent effect, resulting from this local irritant action, that its
efficacy in pneumonia and other diseases, is attributed by the
advocates of the physiological doctrine. It is not, however,
this local action, merely as spoken of and described by the gene-
rality of writers, to which it is my object to call attention at
present, but more particularly to an array of symptoms of a
much more violent and sudden character, connected seemingly
with a metastasis of morbid action, from the thoracic (when
administered in the diseases of this cavity), to the abdominal
viscera ; the result, it may be, of an exaggerated influence of
the character mentioned. Whatever the correct explanation,
however, as to the mode in which the effect is produced, the
condition itself is one of extreme danger.

There is reason to believe, however, that though in the
treatment of pneumonia, the state in question is more frequen-
tly induced by the use of tartar emetic, than by anything else,
a similar condition is occasionally brought about by other agents
administered to such an extent as to produce a high degree of
irritation of the gastro-intestinal mucous membrane ; and I
believe that it is with more certainty developed, under a com-
bination in the treatment, of calomel with the antimonial, than
by the latter alone.

Supposing the remedy to have been continued several days,
the phenomena referred to, are developed much in the following
manner. The patient may seemingly be doing well under the
continued use of the remedy ; the dulness on-percussion, and
the frequency of the pulse diminishing ; the skin perhaps be-
coming moist, and the respiration improving. Suddenly in
some cases, in others somewhat gradually, the patient becomes
restless, the thirst is augmented, the discharges from the bowels
are more numerous and thin, the abdomen becomes tympanitic
and perhaps tender, the tolerance is lost, and though he may
not have done so for several days, he vomits or makes frequent
efforts to do so ; the tongue becomes dry and pointed ; there is
jactitation present, anxiety of countenance, delirium and perhaps
stupor a short time before death. Occasionally jaundice super-
venes, and in a few cases the matter vomited bears a close re-

1852.] Fatal Effects of Tartar Emetic in Pneumonia. 35

semblance to that ejected in yellow fever. During the progress
of the change, the pulse becomes more frequent, hard, concentra-
ted, small and thready.

The rapidity with which the symptoms mentioned are devel-
oped varies a good deal in different cases. I have known in-
stances in which death has taken place in about six hours from
the time of the first evident unfavourable change ; in every
respect, up to that time, the progress of the case being apparent-
ly favourable, and the graver symptoms subdued. Oftener the
case is protracted to ten or twelve hours, and sometimes to a
longer period.

Simultaneously with the changes above spoken of, or, as it
were, preceding them rather, a more or less rapid disappearance
of the signs and symptoms of the primary disease takes place.
From a state of almost complete solidification of an entire lung,
with dulness on percussion, and bronchial respiration ; in the
course of four or five hours, I have found the pulmonary tissue
permeable, and the chest resonant and yielding a healthy res-
piratory murmur ; a corresponding improvement in the cough,
thoracic pain, difficulty of breathing, &c., proceeding at an
equal rate. The rapidity with w^hich this change in the condi-
tion of the lung takes place is proportionate to the violence and
rapidity of the newly developed abdominal disease.

In any case of pneumonia under the antimonial treatment,
although the patient may seemingly have been doing well, the
supervention of the slightest tympanitis, with augmented thirst
and a tendency to diarrhoea, may be regarded with suspicion, as
the probable precursors of a very grave condition ; and I am
now led to regard my patient's doom as almost settled, when, in
addition to these symptoms, there is a rapid instead of a gradu-
al removal of the dulness on percussion, unattended with the
crepitant rale of resolution. Where a case is closely watched
the latter will be found to precede somewhat the former symp-
toms of the progressing change ; and I have more than once
surprised, not only the relatives of patients, but professional
gentlemen in attendance with me, by announcing a coming
change for the worse, basing my opinion on the physical sign
just stated, where everything otherwise seemed favourable ; the
patient comfortable, and apparently, perhaps, convalescent.

This termination of pneumonia, under the administration of
antimonials, especially when given in what would be conside-
red anything like adequate doses by the advocates of the doc-
trines of Rasori, I am led to believe cannot be of very rare
occurrence in the south ; for I think that I have seen almost as
many patients die of the superinduced or substituted affection
as of the primary. And yet the largest quantity for the twenty-

3G Fatal Effects of Tartar Emetic in Pneumonia, [January,

four hours, in which I have been in the habit of prescribing the
tartrate of antimony and potassa, falls far short of what would
be considered a medium dose for the same time, by the genera-
lity of physicians of the contrastimulant school. Under the
supposition, however, that it not unfrequently occurs, it is some-
what strange that we find so little in the works of authors who
have written on pneumonia, especially as treated with antimony
according to the contrastimulant doctrine, in which anything
like a distinct reference is made to it, much less an accurate
account of the condition. Neither in the French nor Italian
writers of the contrastimulant shool accessible to me have I
been able to find any account of it, though in many we find
allusion to the mere local irritant action of the agent in ques-
tion upon the gastro-intestinal mucous membrane. This is
more especially, however, the case among the advocates of the
physiological doctrine, by whom the curative influence of the
remedy in question, in pneumonia, is ascribed to a revellent
operation. The condition spoken of by the followers of Rasori
as a loss of the tolerance, resembles it in many respects, and I
have sometimes suspected that in their descriptions they may
have had in view a state identical with that to which I now
have reference. If so, however, their delineation is incomplete
in several important particulars ; and I would especially men-
tion the sudden subsidence of the original disease, with the
occurrence of the new train of alarming symptoms. Moreover
no one, I imagine, who has ever observed a well-marked case
of the state to which I have reference, even under the influence
of a favourite doctrine, could see in it merely a general depres-
sion of the vital powers somewhat below the standard of health ;
and, in short, could suppose that the phenomena manifested
were not the consequences of actual local lesion of the viscera
of the abdomen.

I have been disappointed in not finding an account of it in
such of the writings as I have met with, of the Italian followers
of Rasori ; because, not only from the immense doses in which
they are in the habit of administering the antimonial prepara-
tions, but from the similarity of their climate, and diseases gene-
rally to our own, in their hands especially, I had been led to
suppose it must frequently occur. Owing to the fact, that in
the north, the susceptibility of the gastro-intestinal mucous
membrane to irritant impressions is less than in the south, it
probably occurs less frequently there than with us. One rather
mild, but unqestionable case, I find recorded in the American
Journal of Medical Sciences for April, 1848, by J. F. Peebles,
M. D. of Petersburgh, Virginia, in a paper calling attention to
certain unfavourable effects of tartar emetic. Two other cases

1852.] Fatal Effects of Tartar Emetic in Pneumonia, 37

are given by B. R. Jones, M. D. of Montgomery Alabama, in
the New Orleans Medical and Surg icalJournaliov September,
1850 ; in which he particularly refers to it as a result of the
operation of antimony.

My own attention, several years ago, w^as forcibly drawn to
this unfavourable action of the tartrate of antimony and potassa
in pneumonia especially, and it was alluded to in a paper on
the treatment of the inflammatory affections of malarious dis-
tricts, which I, published in the American Journal of Medical
Sciences for July, 1844. Two cases are there given, among
others of a diflferent character ; and, in regard to one of them,
the following remarke is made. " In this case, an occvuTence
took place, which is by no means unusual with us here, in the
treatment of acute thoracic diseases, particularly when tartar
emetic or calomel is used to any considerable extent, and more
especially when they are used in combination ; viz., the super-
vention of gastro-enteritis about the time, or soon after a con-
siderable amendment has taken place in the original disease."

But, though I have been able to find nothing, or but little,
that can be regarded as having allusion to the accident in ques-
tion, where most I expected to find accounts of it, viz., among
authors of the school of Rasori, in speaking of the use of tartar
emetic in pneumonia, a graphic description of a similar state
produced by the continued administration of calomel may be
found in the work of Golis on hydrocephalus. " Many times,"
he says, " I saw, under these large and long-continued doses of
calomel, the hydrocephalic symptoms suddenly disappear, and
inflammation of the intestines arise, which terminated in death.
Still oftener, I have observed this unfavourable accident, from
an incautious use of calomel in croup ; viz., where all the fright-
ful symptoms of this tracheal inflammation, which threatened
suffocation, would vanish suddenly/, and enteritis develop itself,
which passed rapidly into gangrene and destroyed the patient."
(Davis, on Acute Hydrocephalus.)

Although it is probable, that it is through a local irritant ac-
tion of the antimonial upon the gastro-intestinal mucous mem-
brane, that the effect in question is brought about ; the manner
and circumstances of its development lead not unreasonably to
the inference, that a real metastasis takes place ; that in addi-
tion to that irritation, which the remedy, probably, in almost
every instance produces, where it is lon^ used ; that, for instan-
ce, which it would produce in a healthy subject ; there is a
superadded morbid action, transferred upon the abdominal vis-
cera, in lieu of the pneumonia, which has suddenly disappeared.
It will be remembered, that, generally, it is not till after a par-
tial subsidence of the pneumonic symptoms, that evidences of

N. S. VOL. VIII. NO. I. 8

38 Fatal Effects of Tartar Emetic in Pneumonia, [January,

the gastro-intestinal irritation are manifested. It partakes,
then, more of the character of metastasis than revulsion, though
an irritant action may have determined it.

Why the morbid action, from which the patient was, probab-
ly, to all appearance in no great danger, in the lungs, should
prove so frequently fatal when transferred to the abdominal
viscera, is a question which naturally suggests itself. Perhaps
it may be the suddenness of the invasion. Perhaps the transla-
ted morbid action, operating in conjunction with a morbid state,
which had already been developed in a high degree in the gas-
tro-intestinal mucous membrane by the remedy, but which, up
to the moment of the metastasis, had remained latent, in conse-
quence of the preponderance of the pneumonic inflammation.
Perhaps, a greater depression of the vital powers results from
an equal degree of morbid action in the gastro-intestinal mucous
membrane, than in the pulmonary parenchyma.

Notwithstanding this occasional unfavourable influence of
the tartrate of antimony and potassa, I have felt reluctant to
dispense with its use entirely in the treatment of pneumonia, in
which, otherwise, its efficacy is so great ; and, for some time, it
has been an object with me to devise some plan of administra-
tion, by which, while its favourable operation might be secured,
the former eflect might be entirely, or in a gi'eat measure
avoided.

Without entering into any detail or discussion of the various
and somewhat contradictory views entertained by different
physicians, or sects of physicians, as to the modus operandi of
the tartrate of antimony and potassa, I think it may at present
be safely assumed that, while its sedative or contrastimulant
influence is exerted, after its absoi*ption and commixture with
the circulating mass, the unfavourable effects resulting from its
adminstration, to which reference is here made, are consequen-
ces of its direct local action upon the gastro-intestinal mucous
membrane. To be sure, according to experiments of Magendie
it would appear that its emetic operation is secondary to its
absorption, and the result of a special affinity for, or action upon
the stomach, w^hile in its transit through the vascular circle ;
but it would seem a visionary refinement in toxicology, to refer
the effects of which I have been speaking to an inffuence thus
exerted, aware, as we already are, of its irritant action upon
the mucous and dermoid tissues, when locally applied.

It is not at all improbable, however, that in some rare cases,
the revulsive operation of the remedy on the gastro-intestinal
mucous membrane may prove favourable, according to the
views of Broussais ; but, knowing as we do, that other gastro-
intestinal revellents exercise no such special control over the

1852.] Fatal Effects of Tartar Emetic in Pneumonia. 39

phlegmasise of the thoracic viscera, as the agent in question, as
a general rule, his explanation of its modus operandi will, I am
inclined to believe, be deemed incorrect. On the contrarv,
when the local effect on the gastro-intestinal mucous membrane
is developed in any considerable degree, recovery, even when
it follows, is retarded rather than advanced by the circum-
stance; not only by the additional febrile disturbance, but by the
diminished absorption which results in consequence ; and that
when it occurs in a high degree, it occasions in pneumonia the
train of alarming, and so often fatal phenomena.

Assuming then that the sedative effect of the remedy through
W'hich its curative influnce in pneumonia is brought about, is
produced by that which is absorbed ; and the deleterious effects
under consideration, by that which, remaining unabsorbed, or
which is not for a considerable time absorbed remains long
applied in contact with the gastro-intestinal mucous membrane
by what indeed may very properly be deemed a redundancy of
the article that over and above what can be readily acted on
by the absorbents, it is manifest that to secure the former and
avoid the latter, no more of it should be prescribed than it is pro-
bable will be promptly taken up by these vessels, and its admin-
istration regulated in such a manner as best to secure this end.

With this object in view% I at first commenced to diminsh
the dose, although in no case had I ever given it in anything
like the quantity recommended by many physicians of the con-
trastimulant school ; nor did I find the efficacy of the remedy
less when I had fallen back upon about the quantity advised
by many before the rise of the contrastimulant doctrine : say
three, four, or at most six grains in the tw^enty-four hours, than
when I gave it in doses twice or thrice as large ; but its mis-
chievous effects were infinitely less. It does not necessarily
follow because in many cases the larger doses of the ultra con-
trastimulists are tolerated for the time, and generally without
any manifest ulterior mischievous effects, that they are really
required.

Besides this reduction of the dose, say for the twenty-four
hours, to the smallest possible quantity capable of producing a
sedative influence, I have also adopted the plan of giving it in
small portions, frequently repeated, so that not more will be
swallowed at a time than may be promptly, at once indeed,
acted on by the absorbents, rather than in larger portions at
longer intervals, by which the mucous membrane w^ould be of
necessity subjected to a longer contact with a part of each
portion swallowed. The method has seemed to me a bad one,
of giving the quantity intended for the twenty-four hours at
lengthened, though equally divided intervals throughout this

40 Fatal Effects of Tartar Emetic in Pneumonia, [January,

period ; but still wors e the plan followed by Laennec, in some
cases, of giving the entire quantity intended for the twenty-
four hours, in but three or four portions, at short intervals, and
then omitting it for the remainder of the day. By this method
the local or revellent influence of the remedy is induced in the
highest possible degree, while the sedative influence is obtained
in a degree, perhaps, proportionably lessened. Generalh^, I
give from three to six grains, according to the extent of the
inflammation and the grade of febrile excitement present, in
the twenty-fours, dissolved in six ounces of water. Of this
solution, I give, during the day, a teaspoonful every half hour ;
but, if the patient is disposed to sleep, that his rest may not be
too much disturbed, twice the quantity every hour during the
night. I have not found, as we are led to believe would be the
case by some of the followers of Rasori, that the tolerance of
these smaller doses is less readily established than of the larger.
In some cases, where the attack is violent, in connection with
blood-letting and other appropriate measures, with the view of
bringing the system as speedily as possible to some extent under
the influence of the agent, I venture to give at first one or two
doses, say of a third or half a grain each, of it. To favour its
rapid absorption, by all means the remedy should be administered
in perfect solution, in water alone ; and the plan of administer-
ing it in combination with mucilage, as of acacia, flaxseed, elm,
&c., is eminently calculated to lead to the result it is intended
to obviate. Instead of sheathing the gastro-intestinal mucous
membrane, or at least of protecting it in this way against the
local irritant action of the remedy, such substances favour the
latter effect, by retaining the salt for a long time in contact
with the mucous surface, in consequence of the obstruction to
its ready imbibition, which they present. That absorption
should take place, it is manifest that contact is necessary ; con-
sequently, nothing can be gained by placing either the absorb-
ing surface, or the remedy to be absorbed in such a condition
as to protract the process. Neither do I think the plan is a
good one, of giving such fluids in the intervals ; though from
the universality of the practice, popular prejudice is so strongly
set in its favour, that the physician who prohibits them entirely
is in danger, in case of a fatal result, of censure from the pa-
tients' friends, for the omission. The pilular is also a very ob-
jectionable form of administration ; being calculated to lead to
a slow absorption, and a protracted contact of the remedy, with
a limited portion of the gastro-intestinal mucous membrane ;
favouring thus a concentrated local action, and the develop-
ment rather of its topical irritant, than of its general constitu-
tional influence. The form of administration in complete sola-

1852.] Fatal Effects of Tartar Emetic in Pneumonia. 41

tion, in as large a quantity of water as it is probable will be
entirely absorbed in the intervals between the doses, I regard
as important.

Although I have had reason to be gratified with the method
above recommended of administering the remedy in question
in pneumonia, it is more than I am willing to assert, that its
noxious operation can be thus, in all cases, entirely obviated.

More recently, with the same object in view, in some cases
I have adopted the plan of administering the tartrate of anti-
mony and potassa, in the form of enema, under the impression
that its local irritant action upon the rectum, would be unim-
portant, in comparison wdth that on the stomach and duode-
num ; hoping the while, that in adequate doses its general seda-
tive operation might be as well secured. In the use of the
remedy, after this method in pneumonia, I generally give about
three grains every third hour, with fifteen or twenty drops of
the tincture of opium in an ounce or two of warm water ; and
its controlling influence, where the enemata have been well
retained, has not appeared to me appreciably less, over the
febrile excitement and local morbid action, than when I have
administered it by the mouth.

Although the results of my practice from this method of treat-
ment have been highly favourable, one case stands on record
in my case book, in which it was principally adopted, calcula-
ted to cast a doubt upon its invariable innocuousness. Deter-
mining in the commencement of the attack to treat the case
principally with the antimonial enemata, I ventured as I
thought I might do with safety, having this intention in view,
and as the attack was a veiy violent one upon a more free
administration of the remedy by the mouth, during the first
eighteen hours, than is my common practice ; and it is not
improbable that it was to this, in conjunction with the action
of mercurials administered occasionally by the mouth during
the progress of the case, that the metastasis was in reality at-
tributable. Still I could not entirely divest myself of doubt on
the subject ; but even admitting in this instance an unfavoura-
ble operation from the enema treatment, I still rest satisfied of
its comparative safety, in contrast with the usual method of ad-
ministering the remedy by the mouth.

In the case in question, up to the evening of the fifth day,
the patient was apparently doing well ; the febrile excitement
regularly moderating, and the organic disease gradually subsi-
ding. At this time a very slight tendency to tympanitis was
discoverable, and a more rapid removal of the thoracic dullness
on percussion had taken place, than between anv two of my
previous visits. The patient expressed himself better, however

^ Ovarian Irritation, [January,

and the general symptoms were apparently favourable. It was
consequently with no slight surprise on the part of the patient's
friends, as well as of a professional friend who, on this occasion,
visited the patient with me, that my intimations were received
of a probable speedy fatal termination. The signs and symp-
toms of pneumonia rapidly disappeared; the tympanitis increas-
ed ; diarrhoea, thirst, restlessness, jactitation, delirium followed
by incomplete stupor of short duration, came on, and in ten
hours from the time of the first symptom of the approaching"
change, he was dead. [Amer. Journ. of the Med. Sciences.

On Ovarian Invitation. By Fleetwood Churchill, M. D. T.
C. D. & E., and M. R. I. A. Read before the College of
Physicians of Ireland.

The following description relates to an affection which, al-
though very common, is but very little noticed in books. This
has probably arisen from its having been placed among the
symptoms of other diseases, although it is quite distinguishable
from them.

It resembles most closely the disease described by Dr. Tilt
under the name of subacute ovaritis ; but the cases that I
have seen have led me to differ from that very intelligent
writer, and to conclude that the affection to which I refer is
not inflammatory. I have, therefore, preferred the term Ova-
rian Irritation.

I have met with it in women of all ages between the com-
mencement and cessation of menstruation, so that I do not
think age has much influence in the production of the disease ;
but I am quite certain that it is most frequent in women of a
delicate, nervous temperament, though by no means confined
to them.

The chief characteristic symptom is an uneasiness, amount-
ing in the greater number of cases to pain, and in some cases
to very severe pain, to one or both iliac or inguinal regions,
but most frequently in the left, which Professor Simpson
seems to think is owing to the propinquity of the left ovary to
the rectum, and the exposure to any irritation thence arising.
This pain may be a constant dull aching, or it may be acute
and occuring in paroxysms ; it is greatly aggravated by stand-
ing, and generally by walking: indeed, in the severer cases, I
have known the patient quite unable to walk.

There is generally some complaint of fulness about the iliac
region, but upon careful examination I have rarely been able
to satisfy myself that this was more than a sensation : I cer-
tainly never felt anything like a distinct tumor. There is,

1852,] Ovarian Irritation, . 43

however, always considerable tenderness, which in some cases
is extreme to the slightest touch. When the irritation is great
it may be extended to the bladder, giving rise to a desire to
evacuate its contents frequently, and causing great pain in
doing so. Hysterical paroxysms are by no means unfrequent.
Jn two of the most violent cases of hysteria that I have seen
for some time, there was extreme tenderness of the region of
the left ovary and pressure there aggravated the hysterical
j^aroxysm.

If we make a vaginal or rectal examination, we shall most
frequently discover nothing unusual, neither heat nor tender-
ness nor swelling ; in a few cases, however, I have found that
moving the uterus laterally caused uneasiness in the side af-
fected. When speaking of a rectal examination in subacute
ovaritis, D. Tilt remarks, that the ovaries are more or less
painful on pressure, and that they are from twice to four times
their original size. This I have not found in the affection now
under consideration, and it constitutes one reason for my
doubting that it is the same disease, as that described by Dr.
Tilt.

These are the principal local and direct symptoms I have
observed ; they vary much in degree, and are in some cases
so intense as to resemble an attack of acute ovaritis. 'J'hey
differ also more or less according to the circumstances in which
the attack occurs ; and in order to elucidate this point, I shall
briefly enumerate the circumstances.

1. In patients who suffer occasionally from amenorrhoea, it
is not uncommon to find ovarian irritation at these periods,
and not altogether confined to them. Whether the ovarian
irritation be the cause of the suppression of the catamenia, or
merely a symptom, is a question not easily decided. In many
cases I think it is probably the primary affection, but in some
others it appears to be the reuslt of the amenorrhoea. The
suffering is often considerable, and may be prolonged until the
next catamenial evacuation ; if that be full and free, the pain
and tenderness generally disappear.

2. Upon the sudden suppression of menstruation, it is not
unusual for the ovaries to be almost instantly affected, either
by the form of disease I have described, or by an acute inflam-
matory attack, which is more rare.

3. In dysmenorrhcea there is more or less ovarian irritation.
If we examine the patient minutely as to the seat of the pain
during the period, we shall find that it is principally in the re-
gion of one or both ovaries, and often accompanied by tender-
ness on pressure. In the majority of these cases I am inclined
to think that the ovaries are secondarily affected.

44 - Ovarian Irritation. [January,

4. In menorrhagia, the ovaries may apparently preserve
their integrity for a long time ; but if the attacks be frequent,
I have generally found that these organs, one or both, become
affected, and that the irritation frequently continues long after
the discharge has ceased.

5. I have repeatedly seen this ovarian irritation accompany
congestion and erosion of the cervix uteri, but it most frequent-
ly comes on after the latter disease has persisted for some time
or after it is nearly or quite cured. The ovarian irritation,
however, in these cases, very soon subsides.

6. I have already mentioned its occurrence in hysteria,
both when the latter is evidently dependent upon catamenial
disturbance, and when the periodical discharge is quite cor-
rect.

7. In some few cases I have recognised ovarian irritation in
cases where the uterine and ovarian monthly functions were
apparently accurately performed, but the patients were of a
hit^hly nervous temperament, in delicate health, and without
offspiing.

These various classes include, I think, all or nearly all the
examples of the diseases which have come under my observa-
tion. In many cases it requires care to separate the ovarian
symptoms from those caused by the concurrent disease, but in
other instances this distinction is quite obvious. When un-
complicated, the disorder rarely gives rise to any general or
constitutional symptoms. Many of the subjects of it are del-
icate and weak, and of course this attack keeps them so ; but
ordinarily, the pulse is not quickened by it, and there is neith-
er heat of skin nor thirst. The appetite is seldom good, but
it is not worse than usual, and the bowels are generally ir-
regular. I have examined the urinary secretion, and have
repeatedly found it scanty, acid, and occasionally mixed with
mucus.

As to the pathology of this affection, there are several points
of considerable interest.. I think we can entertain no doubt
that the ovaries, one or both, are the seat of the irritation ; the
peculiar and fixed locality of the pain, and its frequent con-
nexion with the ovarian function of menstruation, all confirm
this view. But- the next question is more difficult to decide
positively, viz : Is the disorder an inflammatory affection of
the ovaries, either acute or subacute ? The disease described
by Dr. Tilt certainly presents characteristics of inflammation,
which I have never observed in the present disorder. The
absence of tumefaction generally, and of a distinct tumor
always, the negative results of an examination joerrao-x/^a/Tj and
per rectum^ the intermitting and paroxysmal character of the

1852.] Ovarian Irritation. 45

attack, the absence of all the ordinary results of inflammation
(as abscess, accumulation of fluid, &c.), even in the several
cases, and the success of a certain line of treatment, are all, to
my mind, very strong arguments for the non-inflammatory
nature of the disease. In most of these particulars, it differs
from the subacute ovaritis of Dr. Tilt. 1 have certainly seen
some cases in which the point seemed doubtful, and it is proba-
ble that the one form of disease may, under certain circum-
stances, merge in the other ; but I cannot resist the conviction,
that the affection I have described is essentially neuralgic and
not inflammatory.

Again, it may be asked, is this ovarian irritation the cause
of the menstrual disorder or its effect, or merely a concomitant
symptom ? No one acquainted with the present state of ova-
rian physiology could deny that the integrity of the menstrual
function must be largely influenced by the condition of the
ovaries. If this ovarian irritation always preceded the cata-
menial period, I should be inclined to attribute to it the subse-
quent distress ; and in many cases it appeared to me that I
could so trace it as the chief cause. But, in some cases, the
ovarian irritation distinctly Ibllowed the menstrual disturbance
or came on towards the termination of the monthly period ;
and lastly, in other cases, the irritation existed with no cata-
menial derangement at all. Without doubting, therefore that
ovarian irritation may disturb the menstrual functions in vari-
ous ways, I cannot agree with those who think it invariably
does so, nor yet with those who are inclined to attribute all
menstrual disorders to deviations from the normal condition of
the ovaries.

I need not occupy time by enumerating many causes for its
production ; all those which act either upon the uterus or ovary
and disturb their functions, may be considered as causes of ova-
rian irritation, and among these the most frequent, probably, is
cold.

I believe that, in many cases, excess in sensual intercourse
has given rise to it ; and I am also inclined to think, that in a
few cases I have known it originate from the entire depriva-
tion of that stimulus. For some valuable remarks upon this
subject I shall refer my readers to Dr. Tilt's excellent work, a
review of which appeared in a late number of this journal ; all
that he says upon this point is, I think, equally applicable to
ovaritis and ovarian irritation.

The circumstances under which the attack occurs, I mean
its relation to the menstrual functions, the symptoms, and the
peculiar locality of the pain, render the diagnosis tolerably
easy in most cases. It may, certainly, be mistaken for intes-

46 Ovarian Irritation. [Januar}%

tinal irritation ; but, in general, there are no other symptoms
than the pain to justify such an opinion. The bowels, even if
irregular, are free from irritability.

It will, however, require a little more trouble to render it
certain that there is not acute ovaritis, which the tenderness
might lead us to suspect. But this tenderness is generally
much greater than that resulting from inflammation ; it is a
kind of a nervous tenderness which shrinks from the weight of
a finger as much as from severe pressure. Moreover, in
acute ovaritis, the organ is always swollen and enlarged, and
it can generally be felt distinctly to be so by an internal ex-
amination.

In phlegmonous inflammation of uterine appendages, or
pelvic abscess, as it has been termed, the hard and painful
tumefiiction is quite plain at the brim of the pelvis, and, there-
fore, it cannot easily, be confounded with the present disor-
der.

I shall not enter at any length into details of the treatment
of this disease, inasmuch as I have only my own experience
to which I can refer. The choice of remedies will be govern-
ed, to a certain extent, by the health, strength, and state of
constitution of our patient. With strong, healthy women, I
have tried leeches to the ovarian region, with some benefit, but
not complete success, nor in all cases ; from six to twelve may
be applied at once, and repeated, if necessary, after an interval.
Poultices after leeching are of use ; and indeed, when no leech-
es have been applied, I have seen much comfort and relief
derived from repeated poulticing. With delicate women,
and they are frequently the subjects of this disease, bleeding
in any form has appeared to me rather injurious than benefi-
cial.

I have tried the repeated application of small blisters with
better results than leeching. The irritation of the surface cer-
tainly relieves the pain in many cases, and, if continued, may
finally cure it ; but, I must confess, I have seen it fail repeat-
edly.

Anodyne liniments and anodyne plasters occasionally seem
to afford relief, but they are often of little or no use ; I tried
anodyne enemata several times with partial success.

In two or three cases I used the tincture of aconite, applied
liberally to the iliac region, but I confess the result disappoint-
ed the expectations I had formed.

Having failed in affording relief in two or three obstinate
cases, I determined to try the effect of opium applied to the
upper part of the vaginal surface. I accordingly ordered some
balls or pessaries to be made, somewhat in the mode of Dr.

1852.] Congenital Ovarian Tumor 47

Simpson's medicated pessaries, each ball to contain two grains
of opium, half a drachm of white wax, and a drachm and a half
of lard. The whole, when mixed together, formed a ball about
the size of a large marble, and I placed it at the upper end of
the vagina by means of the speculum, leaving the patient in bed
for the rest of the day. The success was quite beyond my
expectation; the relief was very speedy, and in most instances
complete. Even when the pain did return after a few days, a
second application removed it. The tenderness disappeared
with the pain, and no unpleasant consequences have resulted in
any instance.

I have now tried this remedy in a considerable number of cases,
and with almost invariable success. I have rarely found it
necessary to bleed or blister since I first adopted this plan ; and
I recommend it, with considerable confidence, to the profession.
I may add, that I have tried these pessaries in cases of dysmen-
orrhcea, applying one the day before the catemenia were ex-
pected, with decided benefit.

It is hardly necessary to say that, in this disease, the bowels
should be regulated, and gentl}^ freed by medicine when neces-
sary. If the appetite is bad, vegetable bitters may be given,
and I have generally found it useful to combine some alkali with
them. {^Dublin Quarterly Journal of Medical Science,

History of a case of Congenital Ovarian Tumor with Cysts,
Fatty Matter, Hair, and Bone, in wfiich Ovariotomy was pro-
posed. By Robert Lee, M. D., F.R.S.

I was requested by Mr. Gaskell, in November, 1842, to see
^liss F , about twelve years of age, who had not long be-
fore suffered from an attack of mumps, followed b\' pain and
enlargement of the abdomen. The whole abdomen, and espe-
cially the hypogastrium, was large, hard, and irregular. It was
supposed by the mother of the patient that sufficient attention
had not been paid to the regular evacuation of the bowels
while at school, from which she had recently returned. The
catamenia had not appeared, and there were none of the symp-
toms of puberty present. Active cathartics were given, but
the enlargement and hardness of the abdomen continued after
the bowels had been thoroughly evacuated. I saw the patient
with Mr. Gaskell thrice at short intervals, and formed the opin-
ion that some obscure organic disease, not glandular, existed.

Dr. Merriman was then consulted, and I am indebted to his
kindness for the following account of the case from the 22nd
December, 1842, till the month of May, 1843 :

48 Congenital Ovarian Tumor, [January,

"On first seeing this young lady, I was sensible of a fluctua-
tion low in the cavity of the abdomen, and a feeling of tightness
within the pelvis, which led me to believe that the pelvic viscera
were involved in the disease, and 1 ordered diuretics as prin-
cipal remedies. Miss F was from time to time brought

to my house ; and on the last day of her paying me a visit, the
opinion 1 gave of the case was so unfavorable as to induce her
parents to wish that Dr. Paris's opinion should be taken. Dr.
Paris met me, and a plan of treatment was adopted and acted
upon for about a week. Meantime her parents had been urged
to consult the late Mr. A. White, who saw her with me Janua-
ry 23rd, 1843, and on this occasion a tumor, evidently ovarian,
was distinctly to be seen emerging out of the pelvis. She was
now put upon a course of hydriodate of potash, which, together
with change of air and more advanced season, appeared to
improve her general health. Throughout the month of March
her health remained much the same, but the tumor did not di-
minish, and in April Mr. Aston Key was called in. He con-
tinued to give the hydriodate of potash, and had the parts fo-
mented, without much benefit. She was brought to me in the
month of May, and, I believe, went to the sea-side.*'

About the end of October, 1843, nearly a year having elapsed

from the time I first saw Miss F with Mr. Gaskell, her

parents again consulted me respecting her, and as the abdomen
was then greatly distended with fluid, I recommended that she
should be tapped, and that Mr. Aston Key, under whose care
she had been for some months, should be requested to perform
the operation. This was done on the 2nd of November, and a
quantity of dark-coloured, gelatinous fluid, evidently the pro-
duct of an ovarian sac, was drawn off*. As no case of ovarian
dropsy at the age of thirteen had ever before come under my
observation, and before the appearance of the catamenia, I had
been led to conclude that the fluid was contained in the sac
of the peritonaeum, and that the cape was not one of encysted
dropsy. After the fluid. had been drawn ofl*, the lower part of
the abdomen was still hard and irregular, and a solid mass
about the size of a hen's egg, was distinctly felt the day after
the tapping in the epigastric region.

From the 3rd of November, 1843, to the 7th of February,

1845, I was never consulted by the parents of Miss F , nor

obtained any information respecting the state of her health.
On the morning of the 7th of February she was brought to my
house by her father and mother. The abdomen was again
largely distended with fluid. I was informed by them that
tliey had been induced to consult Dr. F. Bird, and that he had
given it as his opinion that their daughter's case was in all res-

1852.] Congenital Ovarian Tumor. 49

pects most favorable for the operation of ovariotomy. They
further stated that Dr. Locock had been consulted the day
before, and that he considered the case highly favorable for the
operation, and uro^ed its immediate performance. It had, in
fact, been determined, before they came to me, that the opera-
tion should be performed, and they seemed confident that their
daughter would speedily be restored to perfect health. Appa-
rently their pui-pose in calling upon me, was not so much to
obtain my sanction to the proceeding as indirectly to reproach
me for not having long before recommended or performed an
operation which they believed to be so efficacious and devoid
ofdanger. Instead of offering any observations on the proprie-
ty of the operation, I took down Vol. xxvii. of the Medico-
Chirurgical Transactions, and turning to Mr. B. Philips'
Table of "Operations for the Extraction of Ovarian Tumors,"
begged them to run their eyes along the column of results. In
this they saw the word "death" repeated twenty-eight times,
thrice three times running, and once four times without any
intervening case of "cure'' or "recovery." Nothing further
was said respecting the operation on that day.

On the 16th of July, 1845,1 was requested to meet in consul-
tation, Dr. S. and W. Merriman, Dr. H. Roe and Dr. F. Bird,
to consider the propriety of ihe operation of ovariotomy in this
case. I pointed out the necessity of having the patient again
tapped, and the condition of the ovarian cyst and tumor, fmd
of all the pelvic and abdominal viscera, carefully determined
before any operation was attempted. After some opposition,
I succeeded in obtaining the acquiescence of all to this propo-
sal. During the tapping, the canula being obstructed, the fluid
ceased to flow, and on inquiry into the cause of this, it was dis-
covered to have arisen from a quantity of fatty matter and long
hair. It was at once obvious that the dark-coloured viscid
fluid was not escaping from an ordinary ovarian cyst, but from
a cyst containing, along with the fluid, long hairs and fatty sub-
stance, and probably a jaw-bone and teeth, as in numerous re-
corded cases of congenital malformation of theovaria. After
the fluid, fat and long hairs had been drawn off, a large irregular
mass remained in the hypogastrium, and the small tumor in the
epigastric region was still to be felt. At this consultation "it
was the opinion agreed to, that the operation was not immedi-
ately necessary, and might with propriety be deferred three or
four months." Dr. W. Merriman made \his memorandum the
same day.

To the best of my recollection I never saw the patient acrain,
and, until about the end of August, 1846, could not learn what
had become of her. I was then accidently informed that Miss

50 Congenital Ovarian Tumor, [January,

had died at Ramsgate, but after much trouble I have not

succeeded in ascertaining precisely when this took place. The
body was, however, brought to London, and a post-mortem
examination made by Dr. H. Roe, Dr. F. Bird, and Mr. B.
Holt. Mr. Holt did not preserve any notes of the morbid ap-
pearances, and does not know the date.

On the Gth of September, 1846, Dr. F. Bird very kindly gave
me the following description of these, which I took down in
writing in his presence, and the same day copied into my jour-
nal of cases, from which it is extracted.

"Abdomen greatly enlarged. On opening the integuments,
adhesions equal to a space of six inches, the centre where the
puncture had been made, from which the adhesions radiated.
No other adhesions elsewhere. Slight attachments above to
the omentum. A great ovarian sac came into view, con-
nected with the right ovary, involving the whole of it, the pedi-
cle formed by the broad ligament and Fallopian tube, which
was eight inches long ; the chief vessel was the spermatic ; the
anterior half of the tumour presented a spherical outline, but,
posteriorly, nodulated throughout ; the sac an inch thick ante-
riorly, whereas, behind it was extremely thin, like tissue paper ;
within this a soft vascular mass, which had ulcerated, and this
had poured out a great quantity of blood ; the sac having given
way, haemorrhage had also taken place into the peritonaeum.
On laying open the sac, it was multilocular, but one large cyst,
with a number of small ones; patches of inflammation on the
lining membrane. One large and hard mass existed on the
left side, where we felt the hardness traced up on the left side,
eight inches long, four wide, and two in thickness ; consisted of
numerous small condensed cells, having a centre of bone, with
hairs not yet examined."

I obtained permission to examine this mass, by making an
incision into it. The structure was that usually termed by pa-
thologists malignant disease of the ovary. The tumor had
interspersed throughout its substance numerous long hairs and
pieces of bone.*

A case in some respects analogous to the preceding occurred
several years ago in the United States of America, in which the
operation of ovariotomy was performed, and was followed by a
fatal result. I am not aware that any other case resembling
this has yet been recorded. {^London Lancet

Had a full examimation of all the parts of the tumor been made, it is pro-
bable that teeth would likewise have been discovered.

1852.] Use of Fat in the Animal System.

On the use of Fat in the Animal System. By Prof. Draper.

There is deposited in certain parts of all animals a substance
insoluble in water, fusible at a low temperature, combustible,
and, though of variable constitution, known under the general
designation of fat.

I shall direct your attention to the nature and functions of
this substance. It discharges an important duty in the economy.

Fats are secreted from the blood, in which they pre-exist,
by the adipose cells, which sometimes occur sparingly scatter-
ed through the areolar tissues, or, when clustered, constitute
the adipose. The primary form of these cells are spheroidal,
though, as is often the case both in plants and animals, this
form is departed from through the influence of pressure, and
polygonal forms are assumed. Between the cells of adipose
tissue a net- work of blood-vessels ramifies, for the double pur-
pose of furnishing to the cells the fat they are to secrete, and
likewise water; advantage beino: taken of the proverbial inso-
lubility of all oily material in this liquid, and so long as the
walls of the cells are kept moist, the contents cannot escape by
transudation.

The adipose tissues occupy an intermediate position between
the tissues that are constant and those that are variable. They
do not necessarily exhibit that extreme proneness to change
so characteristic of the muscular or nervous. With some in-
significant exceptions, which will be discussed hereafter, no oily
substance ever escapes from the system until it has undergone
change. These bodies being insoluble, in water, cannot be
removed in the urine.

It is not alone in animals, but also in plants, that w^e find fat.
In the leaves of various grasses, in seeds, and fruits, it can be
detected, by resorting to proper chemical processes. In those
articles that are used as food by the herbivora, it constitutes a
very appreciable part. One hundred pounds of Indian corn
contain about nine pounds of a thick oil, and one hundred
pounds of dry hay contain about two pounds of fat.

What is the purpose for which nature resorts to this sub-
stance 1 I may answer that question by asking another. Why
do men resort to it ? Why do they go in ships, and brave the
winter of the Polar Seas, encountering the perils of the whale
fishery ? Why, in some parts of the country, are animals
raised, as much for their fat as their flesh ? What is the ob-
ject of all those inventions which transmute the lard of the hog
into a pure and cleanly body, approaching in quality sperma-
ceti or the wax of the bee? It is for the purpose of availing
ourselves of the combustion of this tribe of bodies, which ex-

3^ Use of Fat in the Animal System. [January,

perience has shown are the best of all sources of heat. Fat is
burnt in lamps and candles, because it is the most compendious
source from which a high temperature can be obtained. Na-
ture resorts to the comtJustion of this substance in the interior
of the system, for the same reason that we do in domestic
economy.

The constitution of the common fats is that they contain
carbon, hydrogen, oxygen ; the two former in great excess.
During their oxydation a very large amount of heat is set free,
because the heat-giving powers of hydrogen are brought into
operation. When a fat burns, if there be an abundant access
of air, the carbon turns into carbonic acid, and the hydrogen
into water ; but if the supply of air be limited, and this is a
remark which should be borne in mind from is constant-phy-
siological application, the hydrogen burns away first and leaves
the carbon. In our experiments, we often witness this ; it
gives origin to the dense black soot or smoke that arises from
smoky lamps. When the combustion of an oil or fat in the
system is complete, the products arising, carbonic acid and
the vapor of water, are so constituted that they can escape
through the lungs; and advantage is taken of this incident to
effect the grand process of the introduction of atmospheric air.
These bodies thus ministering to the functions of respiration,
we speak of them as elementss of respiratory food.

Two opinions have been entertained respecting the origin to
the fat thus def)osited in the tissues of animals. 1st. That it
is manufactured in the system by certain vital or chemical me-
tamorphoses from the food, in which it is not found to any
great extent. 2d. That it is simply extracted from the food,
in which it occurs naturally, being fabricated, in the first in-
stance, by plants.

There are many facts which seem to show that fatty bodies
can be formed from other organized substances. Several years
ago it was discovered, on opening one of the burying grounds
in Paris the Cemetery of the Innocents for the purpose of
removing the dead bodies that had accumulated there, that all
those which were below a certain depth had become converted
into a fatty substance, now known under the name of adipocire.
The muscles, the hair, the brain of these bodies appeared to
have been entirely changed, giving origin to this substance,
which has received its name from a resemblance it possesses to
wax and fat.

But, as respects the case of the cemetery of the Innocents,
and the production of adipocire generally, Chevreul has estab-
lished its nature by showing that adipocire contains the same
constituents as human fat, partially saponfied by ammonia. A

1852.] Use of Fat in the Animal System, 53

mass of flesh, placed in a current of water, will, under certain
circumstances, change into adipocire, but not more truly fatty
matter can be obtained in this way, than could have been ex-
tracted directly fom the flesh by the action of sulphuric ether.
So we conclude that, whenever the change takes place, it is
not a production or generation of fat, but the muscular and
other tissues decaying away, the fat is simply set U'qq^ and
becomes saponified by the ammonia, arising during the putre-
faction.

In a former lecture it was stated, that both waxes and fats
occur in the leaves of plants. These substances possess such
a relation to one another that all the oily bodies may arise in
succession from wax by a series of partial oxydations. Under
the influence of the sunlight, the leaves efl^ect the decomposi-
tion of carbonic acid, causing its oxygen to be evolved and its
carbon to be fixed in their tissues. There can be little doubt
that one of the starch family of bodies is the first to make its
appearance. The formula of those bodies shows that, by par-
tial oxydation, they can be converted into fat, a result that we
witness every summer. The sap which has a sweet taste in
the stem, loses its sweetness in proportion as oily matters form
in the fruit.

From plants, animals derive the oleaginous substances they
fix in their tissues. The vegetable world obtains them from
the carbonic acid and water of the air, the animal returns
them back to the atmosphere as carbonic acid and water again.
And, indeed, in this manner, all the carbonaceous atoms of
which our bodies are composed, vibrate as it were backward and
forward from the inorganic to the organic world. Now they
reside in the air, and are tossed about by winds and currents
now they are organized as vegetable forms, and, after serv-
ing awhile for the sustenance of animals, are cast back by pro-
cesses of oxydation into the atmosphere, to run their race
again.

The genera] mode of accumulating fat is by collection from
the food, both in the case of carnivorous and also herbivorous
animals, the food in which it occurs most commonly to a sufii-
cient extent. But the animal system can, when forced thereto,
transmute both starch and sugar into the condition of oil, in
the process of duodenal digestion.

I have so often incidentally referred to the physiological uses
of this important body, its destruction by oxydation in the inte-
rior of the system, for the purpose of sustaining animal heat,
so often pointed out the great superiority it possesses over other
bodies in this respect, by reason of the large amount of hydro-
gen it contains, that it is scarcely necessary to dwell on those

K. S. VOL. Vlir. NO. I. 4

54 Use of Fat in the Animal System. [January,

points in detail. In fevers, where there is an abstinence from
food, we see how quickly the fat disappears, a general emacia-
tion setting in, and frona those deposits where it has been so
carefully stored this combustible body is removed.

For the accumulation of fat, whether it be incidental, as in
the human species, or purposed, as in the preparation of cattle
for the market, there are obviously two conditions. The ac-
cumulation will depend 1st. On the quality of fat presented in
the food. 2d. On the slowness of its consumption in the sys-
tem. Now, there are several circumstances which bear on
this latter condition, and which here require to be pointed
out.

1st. Whatever checks the respiratory process, or the intro-
duction of oxygen into the system, will aid in the deposit of
fat. Quick respiration implies quick oxydation ; for the air
introduced must have its affinities satisfied. To promote the
accumulation of fat, an animal must be so situated that its res-
piration shall be slow.

2d. The higher the surrounding temperature the less is the
loss of heat from the body by radiation and contact of the air,
and the system is not. required to develope so much heat, and
consequently the destruction of fat is less. A high external
temperature tends, therefore, to the accumulation of this body.
3d. Rest, or quiet. All movements taking place in the mus-
cular tissues tend to the accleration of the respiratory act. A
man runs, and he quickly begins to pant. Large quantities of
air are introduced, and the destruction of fat is ti)e consequence.
For this reason, of all the conditions under which an animal can
be placed, sleep is by far the most favorable for the accumula-
tion of fat. The respiration is tranquil and slow, there is a
great freedom from muscular exertion, and usually the tempera-
ture is higher than when we are exposed in the pursuits of
active life to the open air.

These things have been long understood by persons interes-
ted in the fattening of animals before their significance w^as
detected by physiological chemistry. In certain places, where
an inordinate obesity is given to animals for special purposes,
each of these conditions is carefully observed. When geese
are fattened for the sake of their livers, a delicacy much sought
after by epicures, the process is to cram the bird with as much
Indian corn, or other oily food, as possible, to tie its wings and
feet, to ensure quiet, to place it in the chimney corner, or other
warm situation, where the temperature is pretty high. Under
these extraordinary conditions the bird sleeps profoundly,
breathes slowly, introduces little air, destroys little fat. But
the absorbents are busily engaged in taking it up, and an amaz-
ing accumulation is effected at last.

1852.] Use of Fat in the Animal System. 65

We sometimes see at agricultural exhibitions, Logs in a state
of prodigious fatness. The form of the animal is altogether
gone, if its feet touch the ground they are of no use as organs
of locomotion, the snout barely projects beyond the rotundity of
the face, the tip of the tail looks as it" it were at the bottom of
a pit. This forced condition of things has been produced by
resorting to the precepts just laid down. The animal has
been kept in a daik, warm place, crammed with oily tbod, in
quiet, and asleep. Every thing is done to lower the respira-
tory process, and abate the destruction of fat.

When we come to discuss the functions of the liver, we shall
find that the secretion of that gland, the bile, stands in a certain
relation to the respiratory function, bile, the predominating
constituents of which, carbon, hydrogen, sulphur, are all com-
bustible bodies. In cases where there is an interference with
the respiratorv functions, as in phthisis, and where less oxynen
than usual is introduced into the system, these combustible
bodies cannot be got rid of in the usual way, by converting
them into carbonic acid, water, &c., and a reflected action is
thrown upon the liver, which, unable to discharge its duty,
often becomes engorged with fat. In this respect the condition
is not unlike that artificially produced in the goose, as above
mentioned.

I am persuaded, also, that these things are intimately con-
nected with those embarrassments of the action of the liver,
and hepatic diseases generally, which are so constantly en-
countered in liot climates, and in the warmer portions of our
own country, in the hot seasons of the year. The high tem-
perature of the surrounding air, often at a point near that of
the animal system, prevents any great loss of heat, either by
radiation or by contact ; the dew point, too, is commonly very
high, and loss of heat by evaporation goes down to a minimum.
In this semi-febrile condition, a man instinctively abstains from
everything that can raise his temperature, he avoids violent
or perhaps even moderate exercise, he sleeps in the heat of the
day, and as far as he can diminishes the activity of the respira-
tory functions, and the quantity of air introduced. But as the
consequence of this, the lungs are unable to discharge their
appointed duty, an embarrassment is thrown on the liver, the
carbon and hydrogen since they can be no longer burnt, fall
under the action of that gland, which is overtaxed with the un-
natural task.

It is for this reason that men in warm climates instinctively
abhor all oily and fatty food, and choose fruits and watery diet.
In these the amount of combustible materials is small the use
of thehi, therefore, leads to the evolution of little heat, and the

96 Use of Fat in the Animal System, [January,

disturbance I am dwelling on is to an extent avoided. How
different with the man who lives in the cold north regions ; an
orange or pine-apple is but a poor tempation to a Laplander
or Esquimaux. He wants tallow and train oil. The cold air
that surrounds him keeps his temperature dow^n, so that he
has hard work to keep it up. He wraps his greasy person in
furs of warmest kind and consoles himself with the belief that
in another and happier world the righteous shall feed on the
blubber of whales.

What, then, gentlemen, is the result at which we arrive
from a full consideration of the subject ? We conclude that
man and all other animals under ordinary circumstances find
in their food all the fat they require; that these have been
made in plants by the all-pervading influence of the sun ; but,
under special circumstances, we are constrained to admit,
that if fat does not occur in the food to an extent sufficient for
the wants of the system, the system by resorting to processes
of sub-division, which we can artificially imitate, can manu-
facture it : that introduced by the lacteals, but not by the veins,
the fats are either destroyed by gradual oxydation for the
production of heat, one fat after another appearing in succes-
sion, as these partial oxydations go on, and carbonic acid and
water being developed at last, or the excess is stored up in
the adipose tissues for the future wants of the system, or, in the
female, it passes into the secretion of the mammary gland, and
is a constituent of milk. But whether it is thus stored up or
thus secreted, its final duty is the same, it is to be burnt for the
sake of the caloric it can evolve, and thus translated into car-
bonic acid and water is restored to the atmospheric air, ready
under the influence of the sunshine to be metamorphosed by
plants back again into fi\t.

From these general views we now descend to particulars,
and I shall proceed to offer you rigorous proof that both in her-
bivorous and carnivorous animals the fat deposited is not made
in the stomach, but collected from the food. We shall then ex-
amine the system followed on the great scale by those who
are interested in the fattening of cattle for the market, and also
the production of milk, one of the main constituents of which
is butter, this will furnish us with striking illustrations of the
principles under consideration. Next, we shall see how all
oily bodies when once introduced into the system begin to
undergo change, and evolve caloric, and how, in order to regu-
late and control this, a special mechanism is resorted to, in
which the cutaneous and respiratory surfaces and the malpi-
ghian bodies of the kidney discharge an important duty.

[N. Y. M&d, Gaxette.

1852.] Sciatica treated with Sulphate of Morphine, 57

A Case of Sciatica treated successfully hy Inoculation with
Sulphate of Morphine, By Charles Brackett, M. D., of
Rochester, Ind.

The following, if you think proper, you may publish. It is
concerning a case of Sciatica, (I like the shorter, and full as
expressive term, in lieu of the Neuralgia Femero-Poplitae,) of
long standing, which I treated by inoculating the skin over the
course of the nerve with Sul. Morphine, made into a thin paste
with Croton Oil.

This was a case of some years duration, and had been treated
in this country and New York without an appearance of bene-
fit.

The patient Wm. R., aged about fifty years, of a spare habit
but large and muscular frame, and active disposition, had suf-
fered for the past ten or fifteen years with occasional rheumatic
attacks, affecting generally his upper, though often his lower
extremities and back. The pain, and weakness in his back,
and in the course of the sciatic nerve for the past two years,
had been persistent, so that he needed the aid of a cane when
walking; for the past few months he had been confined to his
bed, suffering such pain as only the victim of neuralgia has a
knowledge of. I have tried most of the medicines which I
thought could give him relief, both in the form of internal and
external medication; at length I concluded to try this plan
of inoculation, although I had not a remote idea of deriving
permanent benefit from it, yet I could not bear the idea to give
him up to the perpetual use of morphine, from which alone ia
large doses he found relief.

I began about the origin of the nerve, and inoculated the
paste above mentioned about every four inches, down to his
heel, wiiich was as far as he felt any pain. That night he rested
better than he had for a long time previously, the pain being
entirely removed along the track of the inoculations; towards
morning the pain attacked the Anterior Tibial Nerve, where
previously it had never existed, and where it became as acute
as it ever had been on the posterior part of his leg. I followed
this pain up with my scarifications, putting in as much of the
paste as I dared do in from four to six punctures made with a
point of a thumb lancet at each place of inoculation. At this
time I made my points of inoculation about three inches apart
from the knee to the middle of the dorsal surface of the foot, so
far as the pain existed ; it ceased, and at my next visit it had
appeared in the Plantar Nerves. I scarified and inoculated the
sole of his foot, and from that time till his death he never suf-
fered from any pain about that leg.

58 Quinine in Cholera Infantum. [January,

This patient, a robust Virginian, suffered more I think than
any one I ever saw. Judging from his appearance, I thought
it must be lru\y perfect agony he suffered.

He Hved about a year after the cure of his Neuralgia, when
he died from comphcated disease of the Spleen and Liver,
chronic in its character. A?, ^postmortem was not allowed, I
cannot give the exact condition of the viscera.

Though there is nothing remarkable about this case as res-
pects the originality of its treatment, which I do not claim for
it, yet the ra|)id and almost magical effects of the inocculation,
together with the total and permanent disappearance of the
neuralgic disease, I think probably ought to place it among the
first remedies to be used in this disease, the treatment of which
(through necessity from an absence of a knowledge of its ex-
isting causes) so often assumes an empirical tendency. At
any rate it is to be considered a valuable adjuvant to other
treatment. [North-western Medical and Surgical Journal.

Quinine in Cholera Infantum. By G. W. Booth, M. D., of
Hardin county, Tenn.

I have for some time intended to call the attention of my pro-
fessional brethren to the quinine mode of treating cholera infan-
tum. I have practised in Mississippi and Tennessee for several
years regions where that disease annually makes its visita-
tions. I have had an opportunity of seeing much of^ it, and
treating a great number of cases. I believe its remote cause
to be identical with that of our common autumnal fevers.

It prevails at the same period of the year, and in the same
locations, and I have found it amenable to the same treatment,
aided by the usual remedies for the local complications. There
are in all the cases that have fallen under my notice distinct
remissions, if not intermissions. During this subsidence of the
symptoms, I give quinine liberally, and, in fact, in many cases I
give it, regardless of fever, throughout the disease. I can confi-
dently recommend this mode of treatment as pre-eminently suc-
cessful, after testing it for many years. I have seen many cases
recover under the use of the sulphate, that I should have des-
paired of without its aid. I write this simply to get you to
call the attention of the profession to the use of quinine in this
disease. I have never written an article for the medical press ;
and this is not intended for the public eye.* 1 do not expect
that any, or at least many, will adopt my mode of treatment

[*\Ve insert it nevertheless, in the hope that Dr. B. and others of what are called
country practitioaers will be encouraged to write for the medical preis. Ed.]

1852.] Variations of the Sulphates and Phosphates. 59

difTeringfr.om what is usual, on the recommendation of an ob-
scure practitioner one entirely unknown to fame. As this is
the season for the prevalence of cholera infantum in your city,
I request you to jzive it a full and fair trial ; and if you find it suc-
cessful, then send it abrond under the prestige of your Gazette.
I use the quinine in every stage of the disease, in what would by
many be considered large doses. Occasionally 1 defer its use
for a short time, to relieve some of the most urgent symptoms
such as excessive gastric irritability, and cerebral affections.

\_New York Medical Gazette,

Abstract of a Paper on the Variations of the Sulphates and
Phosphates excreted in Acute Chorea^ Delirium Tremens,
and Injiamination of the Brain. By H. B. Jones, M.D.

Having determined the variations of the sulphates in the
states of health when difierent diets, amount of exercise, and
medicines were taken, the variations of the sulphates in disease
were examined. At the same time the total amount of alka-
line and earthly phosphates was determined,, partly in order to
see whether the amount of sulphates and phosphates bore any
relation to one another, and partly tn test the conclusions which
were drawn in the author's previous paper on the variations of
phosphates in disease. The cases were thus classified:

1st. Acute and chronic diseases, in which the muscular
structures were chiefly aflfected, as chorea.

2d. Functional diseases of the brain, as delirium tremens.

3d. Acute inflammatory diseases of the nervous structures,
as inflammation of the brain.

4th. Chronic diseases of the nervous structures.

5th. Acute diseases, in which neither the nervous nor the
muscular structures were chiefly affected.

6th. Chronic diseases, in w^hich neither the muscular nor the
nervous structures were chiefly aflfected.

The three last classes gave only negative results.

In illustration of the first class, three cases of most intense
chorea are detailed; the urine was examined frequentlv, from
the third to the eleventh day. The phosphates were found to
be diminished. The sulphates were found to be in very great
excess. The urine was found to be so loaded with urea, that
nitrate of urea, chrystalized out before the urine was concen-
trated. The specific gravity of the urine was as high as 1036
in one case, 1035 in another, and in the third, 1031. "

In illustration of the second class, three cases of delirium tre-
mens are given. The urine was examined from the fifth to the

60 Intermittent Fever, [January,

fourteenth day of the disease. The phosphates were not found
to be so remarkably as in the cases reported in the previous
paper. The sulphates were found to be exceedingly increased.
The amount of urea was so great that nitric acid caused an
instantaneous crystallization. The specific gravity also v^'as
in one case, 1041 ; in another, 1037; and in the third, 1027.
In other words, there was the most remarkable correspondence
between the state of the urine in acute chorea and in delirium
tremens.

In illustration of the third class, four cases of acute inflam-
mation of the brain are given. The urine was examined from
the fourth to the twenty-sixth day. Though the inflammation
in these cases was not so intense, as in those which were re-
corded in the author's previous paper referred to, yet they
confirm the statement that in inflammation of the brain, the
phosphates in the urine are increased ; they also lead to the
conclusion that the sulphates are at the same time increased
in the same degree.

In conclusion, the author states the phenomenon common to
acute chorea and to intense delirium tremens is increased and
unceasing muscular action. The muscles are highly complex
organic compounds, in which sulphur exists in an unoxidized
state, and the muscular action of oxygen, which, among other
results, gives rise to the formation of sulphuric acid and urea,
the amount of oxidation being proportioned to the intensity of
the muscular action. The result produced is an increape of
the sulphates and of the urea of the urine, just as in health they
would be increased if continued strong exercise were taken.
The increased amount of urea does not constitute a disease re-
sembling diabetes, but it is only an evidence of the changes
which are taking place within. The increase of sulphates and
phosphates in inflammation of the brain, is also an evidence of
increased oxidation of the nervous structures. These simulta-
neous variations depend on the fact that the amount of sulphur
in the brain is nearly the same as the amount of phosphorus.
Thus at onetime we have evidence of increased oxidation of
the elements of the nervous structures ; and we may thus ar-
rive at the conclusion, that at one time the function of the nerves,
and at another that of the muscles, is inordinately increased.

[^London Lancet,

Intermittent Fever, affecting only one half of the Body.

Dr. M. L. Knapp has given in the September number of the
New York Journal of Medicine, the history of a case of fracture
of the tenth dorsai vertebra, with other injury to the spine, which

1852.] Constitutional Origin of Erysipelas. 61

resulted in complete paralysis of sensation and motion of the
lower half of the body. While in the state of paraplegia he
was attacked with intermittent fever and strange to relate, only
the part of the body above the fracture suffered the lower half
that was paralysed retaining its ordinary temperature.

Dr. Knapp goes on to say: "The peculiar condition of the
patient, however, under a paroxysm of fever is full of interest,
and arrests the attention in a remarkable manner, filling the
mind with a kind of awe. One half of the body of the man had
a perfectly developed ague, and the other half had none ! Who
ever heard of or saw the like before ? Who ever will look upon
the like again ? Does it establish tlie nervous pathology of fever ?
The distinctive symptoms that go to make up an intermittent
fever, were strongly marked, and observed their regular suc-
cession in all pans of the system above the injury where the
cerepro-spinal influence was maintained ; but the parts below
were completely exempt from all febrile phenomena neither
cold, nor heat, nor pallor, nor rubor, nor sudor !

If this case does not prove the nervous pathology of fever, it
proves at least that parts cut off from direct and healthy con-
nection with the spinal axis are exempt from the phenomena
of fever ; and the inference is that these nervous phenomena are
consequent on the primary impressions made on the cerebro-
spinal system by the malarious poison circulating in the blood.
The altered and vitiated secretions of the stomach, liver, etc.,
for which oceans of mercurial cathartics have been given in
malarious fevers, aimed at the primary cause of the disease, are
but secondary phenomena. [Charleston Med. Journal.

On the Constitutional Origin of Erysipelas, and its Treatment,

Dr. A. J. Walsh has furnished the Dublin Quarterly Jour-
nal, (Aug. 1850) some remarks on this subject, with cases, which
are worthy of consideration. The following is a summary of
his remarks :

1st. That erysipelas is a constitutional disease, depending
solely on a morbid state of the blood; and that the eruption
and fever are the means that nature takes to get rid of this
poison.

2d. That, for all practical purposes it is only necessary to
divide the disease into idiopathic and traumatic.

3d. That tartar emetic seems to act specifically in erysipe-
las, by assisting nature in her efforts to throw off the disease.

4th. The best method of administering this medicine is by
dissolving one grain in a quart of any bland fluid ; the solution
to be taken in the twentv-four hours.

62

On Anasarca in Disease of the Heart. [ Januar}^

5th. That as soon as the tartar emetic has acted sufficiently,
sulphate of quina, or some other tonic is to be administered. '

6th. That, if the patient is debilitated, we must administer
tonics at the same time that we give the tartar emetic.

7th. That under this treatment the erysipelatous inflamma-
tion may spread, but not with the same*^ violence, nor to the
same extent, as if the disease were left to itself

8th. That we shall often require to give aperient medicine
during the course of the case, as it is absolutely necessary to
keep the bowels free.

9th. That local applications are unnecessarv, and often inju-
rious.

10th. That incisions are not necessary, except in the third,
or suppurative stage: and if the antimonml treatment be early
resorted to, it very rarely occurs that suppuration takes place.

[^Amer. Jour. Med. Science.

On Anasarca in Disease of the Heart. By M. Chomel.

The progress of iiifiltraiion is ordinarily slow and progres-
sive in affections of the heart ; but, nevertheless, nothing is
more common than to meet with individuals among the work-
ing-classes, who, while presenting the appearace of health, and
without having manifested any sign of disease, are seized with
anasarca, the physical and material signs of cardiac alteration
not being present, or only, at all events, to a ver\ slight degree.
This is because there are causes prevailing in this class of
society such as excess of labour, fatigue, watchings, misery,
drinking which, in a measure, precipitate the course of the
disease. These causes come in addition to the natural influen-
ence of the disease ; and the anasarca appears at a period when
without these it would not have manifested itself So, when
these causes are removed, and the patient is kept at rest, and
sheltered from the unfortunate conditions that have given rise
to so serious a complication, the oedema diminishes daily, and
the patient soon leaves the hospital believing himself cured.
Few^ exposures to excesses, fatigue, or misery, reproduce the
anasarca, which may be again dispersed, and that for several
times ; but after a certain number of sucii attacks, it in the end
becomes permanent.

Frequently the appearance of an acute anasarca throws a
ray of light on obscure and embarrassing cases, indicating in
the great majority of cases an acute disease of the heart.
Doubtful endocarditis and pericarditis are often thus revealed
to the observer by general oedema. M. Chomel thus considers
that in the case of anasarca coming on, when we can discover

1852.] Pleuritic Effusions. 63

neither change in the blood nor albumen in the urine, we are
authorized in admitting the existence of disease of the heart,
or laro-e vessels, even when all material si^ns of this aifection
are completely absent. [^Brit. and For. Med. Chir. Rev.,{\-oix\
V Union Medicale. *

Cases in which there was unusual Difficulty in the Diagnosis
of Pleuritic Effusions. Bv T. A. Barker, M. D. (Proceed-
ings of Royal Med. Chirurg. Society, May 27, 1851.)

The first case related by the author was one in which there
was extensive emphysema of the lei't lung, which had encroa-
ched greatly on the right side of tfie chest, pusfiing the heait
and mediastinum beyond the mesial line. The right lung,
which was closely adherent to the costal pleura, was reduced
to about a fourth of its usual size, was exsanguine, and contai-
ned no air, resembling a lung compressed by effusion in the
pleura. In consequence of these changes, no respiration could
be heard in the right lung during life : the right side of the
chest was universally dull on percussion, and the patient could
only lie on the right side or sit erect. Along with these symp-
toms were others closely resembling those which usually at-
tend hydrothorax; and the dyspnoea and symptoms of approach-
ing apnoea being very urgent, the author thought himself
justified in having a very fine trocar introduced into the chest,
in order to ascertain positively whether there w^as fluid. No
inconvenience resulted from the operation, and the symptoms
were soon afterwards explained by the discovery, on post-
mortem examination, of the very unusual state of parts above
described.

The next case was one in which, without any of the general
symptoms of pleuritic effusion, it was discovered, by ausculta-
tion, &c., that there was no respiration going on in the posteri-
or third of the left lung. In four days the person died. The
lungs were healthy ; but there was extensive effusion, confined
to the back part of the chest by a very narrow line of adhesion
extending from the upper and back part of the chest to the
diaphragm, halfway between the ribs and the sternum. The
author referred to three other cases which he had seen, in
which the pleuritic effusion had' been limited by adhesions in
the same position and precisely similar ; only one of these had
been seen by him during life, and in that the symptoms closely
resembled those in the case last related. Two other cases
Were shortly alluded to, in which there was emphysema to a
considerable extent ; but respiratory sounds could be heard in
every part of the affected sides, in conseauence of the lung

64 Miscellany, [January,

being kept partially in contact with the ribs by mucous adhe-
sions, forming several separate cavities in which the purulent
matter was contained. ILond. Med. Gaz.

ill i 0 c 1 1 a n g.

A new Method of preventing Fats and Fixed Oils from iecoming
Rancid. By Charles VV. Wright, M. D , of Cincinnati. In
company with one of the early settlers of this part of the United States,
the conversation turned upon the history and habits of the Indians
formerly living in this valley, and among other things he mentioned
the curious manner in which they preserved bear's fat from becoming
rancid, of which the following is a brief account : In the early part of
winter the fat is removed from the body of the animal and subjected
to the trying-out process, as it is termed ; that is, it is subjected to a
degree of heat sufficient to coagulate and separate the azotized matter
which subsides to the bottom of the vessel, and the oil is drained off.
After this operation is completed, it is melted again with the bark of
the slippery elm tree, {ulnius fulva) finely divided, which may be used
either in the fresh or dry state. The proportion is about one drachm
of the bark to the pound of fat. When these substances are heated
together for a few minutes, the bark shrinks and gradually subsides,
after which the fat is strained off and put aside for use.

The bark communicates an odor to the fat that is hardly to be dis-
tinguished from that of the kernel of the hickory nut.

Thinking this might be turned to account in the preservation of the
fatty matters, I subjected many of them to experiment, and in every
instance the result was alike successful. One specimen of butter,
(an article which is well known becomes rancid sooner than any
other kind of fat,) prepared in this way more than a year ago, is as
sweet and as free from disagreeable odor, as the day it was made,
having been exposed all this time to the atmosphere and changes of
temperature.

Hog's lard may be preserved in the same manner.

This fact will be of much importance in the preparation of cerates
and ointments which can be thus protected from rancidity.

In the lubrication of delicate machinery an acquaintance with this
fact may be of benefit by preventing the injury that results from the
use of rancid oil. [ Western Lancet.

Free Medical Education. The class at the University of Michi-
gan, numbers 151 bona fide under graduates. If the physicians
who are availing themselves of the tree lectures were included in
the catalogue, as is the fashion elsewhere, the aggregate would exceed
200. The course of instruction in this school is thorough, and the
standard of qualification for the doctorate elevated, so as to chal-
lenge comparison with the best colleges in the country. At present
there are 5 Professors, shortly to be increased to 7. Such provision

1852.] Miscellany. 65

for ^vee medical teaching, must prove a blessing to the state, which
has so liberally endowed their University and set the example of a free
Medical College.

It jnust not however, be supposed, that free medical education is
exclusively to be had in Michigan, else injustice would be done to
other schools, every where in the country. To go no farther back
than last year, we know two Collefjes, which in the afj2rre<]:ate on
their catalogues, numbered 641 students, viz. 411 * and 230, f re-
spectively, and yet the highest number of tickets paid for, numbered
140 in the former, and 151 in the latter. By this it is apparent, that
free medical educatmi was extended to 271 in the one, and 79 in the
other, being an aggregate of 350 free sludenfs in these two colleges!
The difference lies in the fact, that in Michigan this liberality is ex-
tended by the State, while in New-York, the credit is'due to the Pro-
fessors in these schools, and to the very natural ambition of excelling
each other in the numbers of their students. Many gentlemen who
can afford it, would doubtless rather lecture to large classes for noth-
ing and find themselves, than to be paid for teaching small classes.
The title and position is sought, rather than the emoluments of pro-
fessorships; and if such men are capable and faithful to their trust,
they are worthy of double honor, and to them should be awarded the
merit of making medical education free, at their own expense. They
may not thank us for depriving them of the prestige they derive from
the hypothetical receipts of their chairs ; but it may serve to reconcile
restless aspirants for high places to learn that they do not pay at all,
in the proportion which they seem to do, from the statistics of college
catalogues, which are signa fallacissima. Let such learn fo be con-
tent with the emoluments derived from diligent practice, and seek to
make their private station a post of honor, for such it will be, when they
shall inspire public confidence in their integrity, skill and success.
Such practitioners secure both dignity and emolument beyond the
modicum of either, which they can hope to reach as public teach-
ers. [NeicYork Med. Gaz.

Professor Gorini. This gentleman, who is professor of natural
history at the University of Lodi, made, before a circle of private
friends, two nights ago, a very remarkable experiment illustrative of
his theory as to the formation of mountains. He melts some substan-
ces, known only to him>'elf, in a vessel, and allows the liquid to cool.
A-t first it presents an even surface, but a portion continues to ooze up
from beneath, and gradually elevations are formed, until at length
ranges and chains of hills are formed, exactly corresponding in shape
with those which are found on the earth. Even to the stratification
the resemblance is complete, and M. Gorini can produce on a small
scale the phenomena of volcanoes and earthquakes. He contends,
therefore, that the inequalities on the face of the globe are the result

* University of New York 1

t College of Physicians and Surgeons, New York 7

68 Miscellany. [January,

of certain materials, first reduced by the application of heat to a liquid
state, and then allowed gradually to consolidate. In another and
more practically useful field of research the learned professor has de-
veloped some very important facts. He has succeeded to a most sur-
prising extent in preserving animal matter from decay without re-
sorting to any knov/n process for that purpose. Specimens are shown
by him of portions of the human body, which, without any alteration
in their natural appearance, have been exposed to the action of the
atmosphere for six and seven years ; and he states that at a trifling
cost he can keep meat for any length of time in such a way that it
can be eaten quite fresh. The importance of such a discovery, if on
a practical investiiiation it is found to answer, will be more readily
understood when it is remembered that the flocks of sheep in Australia
are boiled down' into tallow, their flesh being otherwise almost value-
less, and that in South America vast herbs of cattle are annually
slaughtered for the sake of their hides alone. Times.

Kate Dresser, 36 years old, of Schuylhill Co., Pennsylvania, has had
more children than most women. The first child was born in 1829,
and the last in February, 1851. She had twins five times, and in
February, 1848, had four children at one birth ! making twenty-one
children in twenty-one years, and six children in the space o^ eighteen
months! The four children at a birth were apparently healthy and
well formed. One lived about four weeks, another eleven months, the
third a little over a year, and the fourth, a fine boy, is still living.
There are now twelve of the whole number living, seven boys and
five girls ! [Bssion Med. and Surg Jour.

Distribution of Prizes to Idiots. The French periodicals contain
the details of a singular exhibition at the Salpetriere Hospital of Paris.
This is the great asylum foraged and incurable females, and contains
a great number of idiotic and epileptic inmates, who are incited to
cleanliness, industry and good behaviour, by the distribution of prizes
to the most meritorious in these particulars. The scene is represent-
ed as having been exceedingly interesting.

Quarantine Laws. A convention of some of the most distinguish-
ed physicians of Europe, has been for some time sitting in Paris for
the purpose of maturely considering the quarantine regulations in
force, and of recommending to their respective Governments such
modifications as they may deem proper under the more enlightened
views of the age. The result of their labors will be very interesting
to all commercial communities.

Scrofulous Ophthalmia and Granular Lids. These intractable af-
fections have been treated with great success by Dr. Isaac Hays, of

1852.] Miscellany. 67

Philadelphia, with cod-liver oil. The testimony of a practitioner of
such well established reputation cannot fail to secure to this plan of
treatment a fair trial.

Suicide icith Chloroform. We perceive that Dr. Reyer, chief phy-
sician of the Imperial Hospital at Vienna, has recently committed
suicide by fastening a bladder filled with chloroform to his mouth and
nostrils by means of adhesive plaster.

Death of distinguished men. It is our painful duty to record the
deaths of several of the most distinguished members of the profession
in this country. Within the last two months we have lost Professor
Granville Sharp Pattison, of the University of New York, one of the
ablest lecturers on anatomy we have ever heard; Dr. John Kearny
Rogers, long known as one of the best surgeons of New York; Dr.
James R. Manley, one of the most aged and respectable physicians of
the same city ; Dr. E. DeKay, a distinguished naturalist; and Dr.
Nicholas Hard, the able professor of anatomy in the Medical Col-
lege of Iowa.

We are indebted to the authors for quite a number of pamphlets,
which we regret not having room to notice more at length. Among
them are :

A Lecture on Sanitary Reform, by Lewis Rogers, M.D., Professor
in the University of Louisville. It is an able and strong appeal upon
the subject, and will be again noticed by us.

Two Lectures, by Professor Jackson, of Philadelphia the one
showing that " Medicine is a Science and not a mere Art" and the
other upon the " Vital Forces." Both are full of interest, and in the
distinguished author's most captivating style. The latter is especially
valuable as bearing upon practical principles of great importance.

An Appeal to the Legislature of Alabama, for the establishment of
a State Hospital for Lunatics and Idiots; prepared by order of the
" Alabama State Medical Association." This paper is from the pen
of Dr. Lopez, of Mobile, and is one of the most interesting of the kind
we have seen. It is to be hoped that the philanthropic efTorts of the
association may be favorably acted upon by the Alabama legislature.
The Transactions of the first annual meeting of the Kentucky State
Medical Society, held iu the city of Frankfort. Being its first meeting,
nothing more was done than the appointment of committees and the
adoption of a constitution.

68 Miscellany.

Proceedings of the organization of the Physicians' Society for Medi-
cal observation of Greene and adjoining counties, Georgia. We wish
this society every success, and hope it may lead to the formation of
others like it.

An Address on the Hygienic and Medicinal uses of Alcoholic
Stimulants ; by F. M. Robertson, M. D. being No. 10 of a series of
addresses delivered before the Charleston Total Abstinence Society.
An excellent address, full of valuable truths to the physician as well
as to society at large.

Report of the Committee appointed on Mrs. Willard^s theory of
Respiration, hy the New York State Teachers^ Association. Mrs.
Emma Willard, so well known as a teacher of young ladies, is ambi-
tious to enlarge the field of her inculcations, and to enlighten physiolo-
gists and pathologists in relation to respiration, circulation, and the
treatment of diseases. The reporters " beg leave to state that they
believe the theory to be irwe." " This theory affirms that the motive
power, which causes the circulation of the blood, is created by an ex-
pansion of the volume of the blood in the lungs, produced by the com-
bustion of the carbon of the venous blood, caused by the oxygen of the
air introduced by breathing." Since the publication of her Treatise
on tlie Motive Powers, &c., Mrs. W. has issued another work, entitled
" Respiration, and its Effects ; more especially in relation to Asiatic
Cholera and other sinking diseases." Truth is valuable, from what-
ever source it be derived, and if our fair country-woman can aid us
in its discovery, let us not be slow to award her all merited praise.

Dr. R. D. Arnold, the worthy President of the State Medical Socie-
ty, has been recently elected Mayor of Savannah.

There are now three or four Female Medical Colleges in the Uni-
ted States. It is not stated whether the Graduates are to adopt the
Bloomer costume or not.

Colleges of Dental Surgery are being multiplied. We see another
recently established in Syracuse, N. Y. We believe that no institu-
tion of this kind exists in Europe a singular fact.

Kossuth and Sir James Clark. Sir James Clark has waited on the
distinguished Hungarian refugee, and kindly proffered his profession-
al services. We do not know whether the offer was accepted. [Lon-
don Lancet.

[We hope that this contemptible way of seeking notoriety will not
be adopted by any respectable practitioner in our country.]

SOUTPIERN

MEDICAL AND SURGICAL
.lOURML.

Vol. 8.] NEW SERIES. FEBRUARY, 185L [No. 2.

PART FIRST.
r t g i n a I (E o m ni it n i c a 1 1 o it 0 .

ARTICLE IV.

Fractures of the Clavicle. By L. A. Dugas, M. D., Professor
of Surgery in the Medical College of Georgia.

The relative frequency of fractures of the Clavicle and of
other portions of the human skeleton, may be deduced from a
series of two thousand three hundred and twenty-five cases,
collected by M. Malgaigne, from the records of the Hotel-Dieu,
of Paris, as having been treated in that institution in the course
of eleven years. Among these there were

623 fractures of the Fibula, with or without the tibia.

' " Tibia, with or wnthout the fibula.

' " Humerus, including^ those of its neck.

' " Femur, do. do. do.

' " Radius, with or without the ulna.

' " Ribs.

' " Clavicle.

' '* Ulna, with or without the radius.

From the above statement we may work out the following
table of proportions :

Fracture of the Fibula, - 1 in 3J

do. '* " Tibia, - - - 1 " 44

do. " " Humerus, - - - 1 " 7}

K. B. VOL. VIII. KG. ir. 5

544

do.

310

do.

303

do.

267

do.

262

do.

225

do.

145

do.

70 T)ug3.s, on Fractu7'es of the Clavicle. [February^

Fracture

of the Femur,

1 in7|

do.

" " Radius, rfot quite

1 " 9

do.

" " Ribs, -

1 *' 9

do.

" " Clavicle",

1 " lOi

do.

'* " Ulna,

1 " 16

The inmates of the Hotel-Dieu being adults, these data da
not apply to children in whom fractures of the clavicle are
probably more common. It appears that males, children as
well as adults, suffer this injury more frequently than females ;,
a fact which does not depend so much upon any peculiarity of
conformation as upon the circumstance that boys and young
men are, by their habits and occupations, more exposed to ac-
cidents and violence than girls and young womeu. These
fractures are said to be comparatively rare in the aged of both
sexes. Among the 225 cases above enumerated, there were
31 in persons beyond sixty years of age. But it should be
remembered that the number of inhabitants thus advanced in
life in any community, is small when compared with that of
younger adults.

The liability of the clavicle to fracture may be explained by
reference to its form, its exposed position, its connections and
its office. Its curvatures and the inequality of its diameters add
to its fragility, from whatever direction the force applied may
proceed, for whilst a straight shaft would more effectually re-
sist the many shocks to which it is exposed by falls, or blows
upon the shoulder, a more uniform diameter would lessen the
danger of fracture from forces applied between the extremities
or toils body. Moret>ver, it is unprotected by muscular cov-
erings, superficially situated, and peculiarly exposed to blows
sustained in conflict. Again : being the only medium of bony
connection between the trunk and the upper limb, which is
instinctively called upon to avert the injurious effects of falls,
it has very often to sustain the weight of the body in addition
to the impetus derived from the accident. Finally, it may be
broken by muscular efforts, as in lifting or throwing heavy ob-
jects, pushing bodies forward, &:c.

Fractures of the clavicle, like those of other bones, may be
complete or incomplete, simple or compound. Any point of
the clavicle may be the seat of fracture, and this may be either

1852.] Dugas, on Fractures of the Clavicle. 71

oblique, transverse, or comminuted. When occasioned by
forces applied, directly or indirectly, to the shoulder, they are
usually found to be oblique, and to exist about the middle of
the bone. The transverse fractures are less common, and the
comminuted still more rare. These result generally from
direct blows received in front, and are therefore not so uni-
formly confined to any particular portion. They are also
more often complicated with contusions, laceration, displace-
ment, and injury to the adjacent parts than the former of
oblique fractures.

Fractures of the clavicle may be most advantageously stu-
died by dividing them into those which implicate the body or
shaft of the bone, and those which occur at the acromial and
sternal extremities.

Fractures of the body of the bone constitute the great majori^
ty of cases, and may be occasioned by direct blows, by falls
upon the shoulder, arms or hands, or by violent muscular efforts.
They may be transverse, oblique, or comminuted, including
fragments of various dimensions between the two extremities,
and sometimes constituting really a double fracture. They are
occasionally found to be incomplete, the bone appearing to be
merely bent at an angle more or less obtuse. In these cases
there is only a portion of the diameter of the bone broken, and
consequently only a partial Jaceration of the periosteum.
Crepitation cannot therefore be induced without completing
the fracture, as is sometimes done in endeavoring to straighten
the shaft.

If a complete fracture hQ transverse, with jagged or serrated
edges interlocked, there may be neither displacement nor crepi-
tus perceptible, unless the fragments be draw^n asunder and rub-
bed against each other. This variety is therefore sometimes
confounded with the incomplete fracture. In a clean transverse
fracture of the shaft, the acromial fragment will be dragged
down by the shoulder, and may slide beneath, before, or behind
the other, according to the position of the shoulder. Such a
displacement will be much more readily detected than that
attending an oblique fracture, for the obvious reason that the
obliquity of the fracture will lessen the diameter of the ends
which overlap each other. In either case, the shoulder i

72 Dugas, 071 Fractures of the Clavicle. [FebTuary,

drawn forward by the muscles, and there is observed upon the
anterior aspect of the bone, a depression at the seat of fracture,
which will disappear measurably by pressing back the shoulder.
The obliquity of fractures of the clavicle varies very much,
and has been known to be two inches in length. Its direction
is usually from the acromial to the sternal portion, and from
the front to the rear. There are exceptions, however, in which
this direction is reversed.

The degree of displacement consequent upon complete frac-
tures of the shaft of the clavicle varies necessarily according to
the direction of the solution of continuity. There is usually less
apparent displacement in oblique than in non-serrated transverse
and comminuted fractures. Yet, if the direction of the obliquity
be such as to offer no resistance to the dragging down of the
acromial fragment by the weight of the shoulder, the displace-
ment may be equal to that in transverse fractures. It is
evident that if the direction of the obliquity be from above
downward, and from the sternal to the acromial portion, the
acromial fragment will still rest upon the sternal, and thus pre-
vent any downward displacement. The displacement of either
of the fragments may then be found upwards, downwards,
forwards, or backwards, although the distal fragment is that
most frequently found displaced downwards and backwards.

Fractures of the shaft are those in which we might reasona-
bly apprehend injury to the adjacent blood-vessels and nerves.
Yet this is of very rare occurrence. These fractures are usu-
ally detected without much difficulty. The pendulous limb,,
depressed shoulder, and the inability to use the arm or to carry
the hand to the opposite shoulder or to the head, without more
or less pain about the clavicle, added to the history of the vio-
lence sustained, will be sufficient to direct attention to this
bone. If the fracture be incomplete, the bone will seem to be
bent, and the angle will be detected by passing the finger along-
the surface of the bone, but no crepitus will be observed unless
the fracture be completed as already suggested. If the frac-
ture be complete, the displacement evident to the eye and felt
by the finger, the crepitus produced by moving the shoulder in
various directions, the local tenderness upon pressure, &c., will
leave no doubt as to the nature of the injury.

1852.] Dugas, 071 Fractures of the Clavicle. 73

By fractures of tke acromial extremity we understand those
existing between the articulation and the sternal edge of the
coraco-clavicular ligaments These result most frequently
from blows upon the top of the shoulder, but may, like those
of the shaft, be occasioned by falls upon the shoulder or out-
stretched arms. They are much more rare than those of the
shaft, though more common than those of the sternal extremi-
ty. They are usually transverse or at a right angle with the
axis of the bone, but may present various degrees of obliquity.
Although formerly thought never to be attended with displace-
ment, it is now well established that this sometimes occurs ta
a very considerable degree. When no displacement exists, it
is probable that the fragments are maintained in situ by the
coraco-clavicular ligaments, or by the periosteum, or by both,
in consequence of their having escaped laceration. The liabili-
ty to displacement is increased by the obliquity of the fracture.
Being, however, generally attended with very little pain,
and often with neither manifest displacement nor crepitus,
fractures of this portion of the clavicle may escape detection.
The surgeon cannot, therefore, be too guarded in his diagnosis,
although even under such circumstances a careful examination,
especially if there is not much tumefaction, will usually reveal
a slight groove and feeble crepitus.

Fractures of the sternal extremity are so rare that very few
cases are to be found on record ; hence the discrepancies in
reference to the existence of any displacement of the frag-
ments some authorities insisting that none occurs, whereas
Malgaigne refers to two cases in which the external fragment
was drawn downwards and forwards. In children, the ster-
nal epiphysis may be separated so as to simulate a partial dislo-
cation, and to render the diagnosis much more obscure than it
is, even in those cases in which the fracture exists between the
costo-clavicular and stenio-clavicular ligaments without dis-
placement.

The treatment of fractures of the clavicle has taxed the inoe-
nuity of surgeons as much, if not more, than that of any other
class, so that a mere enumeration of the various plans proposed
would far exceed the limits of this paper. They may all,
however, be classed under three divisions viz : those consist-

74 Dugas, on Fractures of the Clavicle. [February

ingof a cushion or pad in ihe axilla, and a roller bandage passed
around the chest in various directions, of which Desauk's may
be considered the type ; those consisting of loops passed around
the shoulders for the purpose of drawing them backwards; and
those consisting of a sling bandage.

In cases unattended with displacement, it is evident that
nothing more is required than the maintainance of the limb
and shoulder in a state of immobility, so as to prevent subse-
quent displacement and to favor adhesion. A simple sling*
with^a bandage throvv-n around the thorax and elbow so as to
keep this firmly applied to the side, will therefore be all
sufficient. BiU when there is a displacement of one or both
fragments, this must not only be reduced, but the apparatus
used must be such as will effectually secure the reduction until
a callus be formed say from three to six weeks.

The indications to be fulfilled are, in most cases, to carry
and to fix the shoulder upwards, backwards, and outwards. In
some instances it becomes also necessary to exercise a certain
degree of compression upon the sternal fragment. These indi-
cations were studiously met by Desault, in the very complex
bandage which bears his name. Although still recommended
by high authority, it appears to me exceedingly objectionable.
In the first place, the cushion placed in the axilla for the pur-
pose of forcing the shoulder outwardly when the elbow is
drawn against theside, must necessarily exercise a degree of
compression upon the blood-vessels and nerves, which few, if
any, patients can endure ; yet, unless the pressure be sufficient
to throw out the shoulder the object of the cushion is not se-
cured. Indeed, I must confess that I have never been able to
succeed in having it borne by any one to whom I have applied
it with a view to this end. Again : the numerous circles of the
roller bandage around the chest, offer an impediment to respi-
ration which is often intolerable. Finally, the iiicility with
which the whole apparatus becomes displaced, however skilful-
ly applied and carefully pinned and stitched, requiring frequent
readjustment, is, of itself, an objection of sufficient importance
to lead us to its total rejection.

A radical objection to the padded loops by which the shoul-
ders &re drawn back, is that by this plan we attain only one of

1S52 ] Dugas, on Fractures of the Claude. 75

the indications pointed out as usually to be fulfilled. The
shoulder is neither carried upwards nor outwards. Besides this,
they rarely fail to produce chaffing to a greater or less extent.

The sling bandage is that to which I hav-e given a decided
preference for the last fifteen or twenty years. It is unneces-
sary to describe the numerous modifications of this simple
bandage, proposed by surgeons of ail countries, and I will there-
fore proceed at once to describe tbe one I habitually use, with-
out, for a moment, pretending to originality, lest, ]>erhaps, some
book-worm migiit discover that precisely the same h-ad been
proposed by others.

The displacement having been carefully reduced by move-
ments of the shoulder in various directions, according to the
particular case, and by direct action upon the iVagments them-
selves, let an aid maintain the reduction by placing the ends of
the fingers of the affected limb upon the top of the opposite
shoulder, by bringing the elbow against the side, and by press-
ing up the e^bow so as to carry the shoulder upwards, outwards
and backwards, as will be done under those circumstances.
The next step will be to secure the limb in this position.
For this purpose, I procure a square yard of cotton fabric,
(unbleached shirting, for example, as this is softer than the
bleached, which is usually starched,) and cut it diagonally, so
as to obtain a triangular bit, to the acute angles of which should
be sewed slips three inches wide and three or four vards Ions:.

Apply the middle of the base or long side of the triangle be-
neath the elbow, leaving a margin of about four inches behind,
and carrying the obtuse angle towards the fingers. One of the
acute angles, with its strip, will novv^ be carried between the
arm and chest, up to the fractured clavicle, around the back of
the neck, over the sound shoulder, in front, and beneath the
axilla, and, finally, around the chest, including the arm just
above the elbow. The other end and strip will be carried in
front of the fore-arm, up to the sound shoulder, behind ond be-
neath the axilla, and around the chest and arm, so as to meet its
fellow, and to be tied to it firmly. The margin left projecting
behind the elbow should then be elevated, doubled, and so se-
cured with stitches as to prevent the elbow from sliding out of
the sling in that direction. The portion of the triangle situa-

7G Eve's Case of Adherent Fcctuses. [February,

ted along the fore-arm should be also folded around it, and thus
secured. Lastly, the strips encircling the chest and arm should
be stitched, to prevent their upward or downvv'ard displace-
ment. If it be necessary to press down the sternal fragment,
this can be effectually done by interposing a little pad between
the bone and the bandage which passes over it.

The advantages of this bandage are to be found in its perfect
adaptation to the necessities of the case, in its great simplicity,
in the facility with which it may be made secure, and in the
very slight inconvenience to which it subjects the patient.
Children, as well as adults, bear it without a murmur; and if
it becomes necessary, for purposes of cleanliness, to remove
it, any intelligent mother or nurse may re-apply it, if the physi-
cian be not accessible. Whilst it cannot be denied that, under
any plan of treatment, there will occasionally remain some
inievennessor deformity at the seat of fracture, I must say that
1 have very rarely seen any thing of the kind in cases treated
on this plan, notwithstanding the fact that I have not unfre-
quently, after applying the bandage once in presence of the
mother, left the subsequent management entirely to herself.

ARTICLE V.

A Case of Adherent FcEtuses. By Joseph A. Eve, M. D.,
Professor of Obstetrics, &c., &c., in the Medical College
of Geor2:ia.

o

A remarkable case of adherent foetuses occurred in my prac-
tice on the 19th of October, some account of which may not
be altogether devoid of interest to the readers of the Southern
Medical and Sui-gical .Journal, especially to those who may be
fond of natural cuiiosities, or feel disposed to study Nature in
her sportive freaks.

Mrs. S., a German lady, 21 years of age, was taken in labor,
October lUth, 1851, about 4 a. m. When I was called to her,
she had been in labor about eleven hours. The head of a child
had been expelled three or four hours before I saw her; her
pains were violent but ineffectual. I succeeded, with the great-
est difTiculty, in bringing dov/n one arm and shoulder, and then
the other; after which the delivery being still retarded, I ap-

1852.] Eve's Case of Adherent Foetuses. 77

prehended an enlargement of the abdomen or some other spe-
cies of deformity. Directing the patient to bear down with
all her strength, and in concert with the uterine contractions,
making such traction as I deemed safe and proper, I succeed-
ed in delivering her of two female foetuses, united by their
breasts and abdomen as low down as the umbilicus ; the
amount of force employed in their delivery was by no means
excessive. The midwife in attendance stated that the head
expelled before my arrival was at first alive that the lips
moved when a finger was inserted into the mouth. I have no
doubt from the appearance of the foetuses, that both were alive
when labor commenced. The death of the first might have
been determined by the long continued violent labor, or by
tractions made on the head, or, it may have been consequent
upon the death of the second, which must have occurred while
the head of the former was descending, as the head of the lat-
ter was unavoidably thrown back, and the cervical vertebrae
dislocated ; the death of one must necessarily have involved
the death of the other, as there was but one heart common
to both.

The difficulty in the delivery is attributable to their mode
of union, and not to their bulk, as they were premature by a
fortnight at least, and both together only weighed \0\ pounds,
whereas it is not very uncommon for children weighing
eleven or twelve pounds, to be born after comparatively easy
labors. The foetus that presented first is somewhat larger than
the other. The smaller resembles the mother, the larger the
father. They are united breast to breast from the neck to the
umbilicus. The umbilical cords unite as they pass out, and
form one cord, diverging again within an inch of the placenta.
There was but one placenta, with nothing peculiar in its ap-
pearance.

Mrs. S., was in a very comfortable state, a slight headache ex-
cepted, for an hour and a half after the delivery, when she was
seized with convulsions, which continued to recur at irregular
intervals, averaging about forty-five minutes until she had
eleven. By copious blood letting, chloroform, and morphine,
with some measures of minor importance, the convulsions were
moderated, and finally, arrested, after which her convalescense

TS Eve's Case of Adherent FcBtuses. [February,

was as favorable as could liave been reasonably anticipated.
The patient iiad applied a bandage firmly around her neck to
compress a goitre, fearing that it might become enlarged by
her violt^nt efforts during labor ; this of course, was removed
as soon as it was discovered : whether this had any agency in
determining the attack of convulsions will be considered, differ-
ently, according to the theory entertained of the causation of
convulsions: in my opinion its influence was by no means incon-
siderable, although it must be admitted that much may be fairly
attributed to the violence and lonof continuance of the labor.

That these foetuses were dead-born was certainly a blessing
to themselves, and to their parents, a kind and merciful dispen-
sation of Providence, as life would have been a heritage of
misery and mortification.

They were so extensively and strongly adherent that it is
difficult to understand how their safe delivery could be effected,
without a coincidence of the most favorable conditions, and
advantageous circumstances. Had their connection been by
the abdomen, admitting of greater mobility, as in a case quo-
ted by Burns, or by a distinct band, as in the Siamese Twins,
had they been more premature, or smaller, the feet or knees
presenting, the maternal pelvis very capacious, with the soft
parts thoroughly relaxed, they might have been expelled alive,
without the interference of art, or the delivery might have been
assisted and rendered safer, by gently drawing upon the feet of
one, thereby to cause the head of that one to descend a little in
-advance of the other, and prevent their simultaneous descent
into the pelvis, which would most probably cause destructive
compression.

Since the commencement of the present course of lectures in
the Medical College of Georgia, an examination was made by
Dr. H. F. Campbell in the presence of Professors Means aud
Miller, Br. R. C. Campbell, and myself The united cord on
section, exhibited three arteries and two veins, it was examin-
ed with a microscope. Each fcetus has a distinct stomach and
intestinal canal and set of lungs. There was only one heart and
one liver, common to both ; there are two sterna, one on either
side, united at their upper extremities, each appertaining as
much to one foetus as to the other, constituting the principal

1852.] Eve's Case of Adherent Fcetuses. 79'

media of junction between them ; the sterna, accordingly,
instead of being in the median line in front, having an anterior
and a posterior face, are so placed, one on each side, that they
face each other from right to left.

Before this examination, from a superficial view, they ap-
peared to be distinct fcetuses united by their sterna. The ex-
amination could not be extended farther w^ithout mutilating
and destroying the appearance of this truly interesting and
wonderful lusus naturae, which has been preserved with great
care in the College Museum ; indeed as it was kindly and gene-
rously given to us by the parents for that purpose, we did not
feel at liberty to pursue the anatomical investigation farther
than might be compatible with the perfect preservation of its
original form.

There is in the same Museum, another very similar instance
of monstrosity which occured some years ago in the practice
of Dr. R. D. Moore, of Athens, and which he kindly presented
to the Medical College, through our friend Dr. Wm. E. Dear-
ing of this city.

I requested Dr. Dearing to write to Dr. Moore for an account
of this monstrosity, that both might be included in the same
communication, but I regret that ii has not yet been received.

In Dr. Moore's case of adherent fcetuses, the attachment is
not so extensive ; the adhesion is chiefly by the abdomen, being
separate from two to two and half inches below their necks.
They are black, both females; they appear to have arrived at
full term. They were taken from the jar in which they are
preserved, but they had been so eviscerated during the delive-
ry, or upon subsequent examination, that we could determine
nothing satisfactorily respecting their internal organization.
We hope Dr. Moore will still furnish for this Journal a particu-
lar description from notes taken at the time.

Instances of multiple adherent fcetuses, are, we believe ex-
tremely un frequent in their occurrence.

Dr. Churchill, who is doubtless as well acquainted with the
history and statistics of Obstetrics as any author living, or dead,
has the following paragraph in the last edition of his "System
of Midwifery," edited by Dr. Condie of Philadelphia:

80 Yavqs Case of Adherent Fcetuses. [February,

" Double monsters are very rare, and may create great diffi-
culty in the delivery, although there are cases on record of the
children having been born alive. Dr. Burns quotes several
such: 'In the seventh volume of the Nouv. Journ. p. 164,' he
says, 'is a case where two children were born at the full
time, united by the inferior part of the belly, from the centre
of which came the cord. The vertebral columns almost touched
at the lower part. The two children, who were of different
sexes, lived, we are told, twelve days, but nothing: is said of
the labour. In the Bulletins for 1818, p. 2, two children, who
were joined by the back at the sacrum, are stated to have been
born, and lived till the ninth day. The first child presented
the head, but the midwife could not well tell how the second
got out. There is another case, at page 32, of a woman who,
after many days of labour, bore a monster double in its upper
parts. The spinal column was united from the sacrum to the
top of the dorsal vertebrae, then the cervical vertebrae divided
to form two necks. The midwife finding the head to present
along with the cord and a hand, tried to turn, but could dis-
cover nothingr but superior extremities. She, therefore, let
her alone. The head was afterwards expelled, but neither na-
ture nor art could deliver the body. M. Ratel finding the head
and tvvo arms already almost separated from the body, cut
these parts ofi^, then introducing his hand, he found another
head, turned the child, and brought away the whole mass.'

" There is a skeleton in the Royal College of Surgeons of
Ireland, of a double monster, the children being joined by the
lower part of the sacrum, and I believe they were also born
alive. The Siamese Twins is another instance of the kind."

One of the most remarkable and curious laws, appertaining
to the developement of monsters, is that of symmetry. How-
ever strangely and variously two or more foetuses may be uni-
ted, intermixed, amalgamated, fused or welded together, similar
parts are always found united. We never observe an arm at-
tached to a leg, or a leg to a hand, a side to a back, or a back
of one to an abdomen of another, but similar always to similar
parts, and symmetrically and evenly, appearing to verify the
correctness of Serres' doctrine of evolution.

The most remarkable peculiarities of the internal organiza-
tion of this monstrosity, consist firstly, in the unity of the heart,
and consequently intercommunion of the circulation, the aorta
soon after its origin divides into two branches, one distributed
to each Ibetus. Secondly, in the singleness of the liver, there

1852.] Milner's Case of Chorea. 81

being one common to both. Thirdly, in having one thoracic
cavity common to both, the latteral boundaries of which are
constituted by the sterna, being situated latterally one on either
side, instead of anteriorly. From the fact that thereare only one
heart and one liver common to both, while each has a distinct
stomach and intestinal canal, may we not infer that the princi-
pal office of the liver is accessory to the heart, whether it be
regarded as a diverticulum or a depurator of the blood.

ARTICLE VI.

A Case of Chorea treated hy Chloroform. By W>i. A. MiLr-
NER, M. D., of Union Parish, Louisiana.

I believe it is generally admitted that but little more is
known of the nature of this disease, than that it is afunctional
derangement of the nervous system. It is therefore not my
design to advance pathological views upon a subject so imper-
fectly understood by abler and more experienced practitioners,
but merely to give the treatment of a single case, which will,
perhaps, not be uninteresting.

I am aware, too, that the prognosis of uncomplicated chorea
is generally favorable, there being instances of spontaneous
recoveries; nevertheless, it is a very ugly, and I may say
formidable, disease, and one which excites the greatest interest
and solicitude on the part of friends and parents.

June 5. My attention was called to the daughter of Mr. L.,
aged 9 years. She was able to run about, but there was irre-
gular motion of the hands, and some slight twitching of the
muscles of lips and face; she was yet able to feed herself
complained of some headache. She was taken from school
two months previous to my seeing her, from complaining of
headache and general, but slight, indisposition. Prescription
Active purge of rhei. colocynth and calomel every third night.
Being rather anaemic, put her on Valet's ferruginous pill, three
times per day.

June 8. Bowels are well acted upon ; but the case has grown
rapidly worse. It seems that every voluntary muscle in the
whole system is in motion ; deglutition is performed with great

82 Milner's Case of Chorea, [February,

difficulty requires two persons to hold her up. Average sleep
in twenty-four 1 to 2 hours, in very short naps. Prescript
tion \ gr. sulph. morph., repeat every hour until sleep is
induced; applied blister, 2^ by 6 inches, over dorsal region;
sulph. zinc, 1 gr., three times per day.

June 10. My patient has eaten nothingof consequence for two
days; stomach very irritable; the zinc was rejected repeat-
ed, and rejected, for two days; morphine seems to aggravate,
even in 1 gr. doses, instead of quieting and inducing sleep.
Blister drew well, and is considerably irritated from the inces-
sant motion, which makes me regret having put it on. Pre-
scription Oil and turpentine to move the bowels; stop the zinc,
and gave comp. tinct. gentian 5j., and H j. infusion snake root,
three times per day, with 1 gr. ext. hyoscy. at night, and re-
peat once, in an hour, if required.

June 11. Patient rested better last night, stomach is quiet-
ed, and desires to eat. Continued same treatment.

June 12. Patient passed a restless night; has some erysipe-
latous spots on hands and feet, which I attribute to hyoscy.,
having taken 2 grs. last night. The stomach is quiet ; eats
soup or gruel with difficulty; takes nothing solid. The mus-
cular disturbance is still very great ; no appreciable amend-
ment.

I now proposed to Mr. L. to use chloroform, since the ano-
dynes had ceased to have the desired effect, of inducing sleep,
&:c., but it was strongly opposed by the family, from the abom-
inable prejudice existing against what I consider a God-sent
blessing.

I refused to treat the case farther, without consultation, upon
which Dr. Calderwood, of Monroe, was sent for. He arrived
in the evening of the 13th. We immediately used chloroform,
and kept the patient under its influence for an hour. She slept
quietly for about an hour after the anesthesia subsided, but
aroused up into the same incessant motion. We again put her
under its influence, and used it every time she waked during
the night.

June 14. Patient seems more quiet while awake this morn-
ing. Prescription Use chloroform at 9 o'clock, A. M., and
.at 4, P. M., with 1 gr. hyoscy. ext. at night, and chloroform

1852.] MWner's' Case of Chorea. 83

every time she wakes during the night. Connmenced snlph. zinc
in } gr. doses, three times per day, gradually increasing the
dose.

June 17. Patient has improved rapidly; can sit alone in a
chair; slept all last night without chloroform. Continue same
treatment.

June 20. Patient can walk alone, feed herself, and speak
tolerable distinctly ; has knitted a little. She is now taking as
much as 1 gr. zinc, three times per day ; has slept without
chloroform at night, since the 17th. Continue same treatment.
Chloroform once per day. Bowels keep regular without phys-
ic, since using hyoscy., and left off morphine.

June 30. Patient has continued to improve; the muscular
disturbance is very slight, with short but distinct intermissions ;:
her color is quite sallow ; tongue clean, but red : circulation
rapid, with good appetite. Have increased zinc to 2 grs., stom-
ach will not tolerate more. Prescription Discontinue hyoscy.,
and continue chloroform once per day, and zinc as before. .

July 5. Patient is quite clear of all symptoms of chorea, but
is in a very anaemic condition. Prescription Discontinue
other treatment, except the occasional use of chloroform, when
wakeful at night, and put her upon an iron tonic, which has
had its desired and usual effect in such cases.

Dec. 1. Up to this time my patient has had almost uninter-
rupted good health.

The speedy and successful treatment of the above case, is
attributable, in my humble opinion, almost, if not entirely, to
chloroform, having used zinc, silver, copper, ammonia, and
the thousand and one remedies, in other cases, before the dis-
covery of chloroform, with bad success.

84 Ofi Cancers. [February,

PART II.
dcittiit iDepartmcnt

On Cancers. Read before the Medical Society of St. Louis^
July 27t/t 1851. By Charles A. Pope, M. D./Frofessor of
Surgery in the Medical Department of the St. Louis Uni-
versity.

Mr. President : In whatever light we may regard them,
tumors constitute a most important and interesting part of
surgery. Whether in their mode of origin, their growth, their
local and constitutional effects, their classification, diagnosis
or treatment, they are of exceeding interest. Their diagnosis
often presents the greatest difficulty, and this is of itself impor-
tant, for they are not all to be treated alike ; as is the diagno-
sis, so is the operation. The method by exclusion, as applied
to the discrimination of tumors, has, in not a few instances, led
to results in diagnosis, unparalleled in the annals of surgery. I
allude, among others, to the case of the foetal tumor, removed
from the scrotum by Velpeau. But of all tumors, the malig-
nant merit most attention. The very name of cancer carries
with it ideas of suffering and of death. The subject then is
one of the deepest interest ; and having met with the thesis of
M. Broca, of Paris, wherein are so clearly and succinctly sta-
ted the views of M. Lebert, I have thought it worth while to
lay them before the Society in our own tongue. It is, perhaps,
proper to state that they have not yet met with that general
adoption to which they are entitled, and which a wider knowl-
edge of them will ensure. So far as my own limited experience
and observation go, they fully coincide with the doctrines of
Lebert, and I have, for several years taught in accordance with
them.

M. Broca has ably defended the microscrope, if, indeed, it
needed defence. The defects often attributed to the instru-
ment, are oftener due to those who use it. Muller has said that
"microscopical and chemical analysis can never become a means
of surgical diagnosis; it were ridiculous to desire it or to sup-
pose it practicable." As to the desirableness of such a result,
but few, perhaps, will concur with the distinguished physiolo-
gist. But although of little or no benefit in the diagnosis of
tumors, yet if after removal it show to us whether the growth
be benign or malignant, prognosis will be benefitted, and satis-
faction result both to the surgeon and the patient. Where
else, indeed, are we to look for certainty in this respect. All
other tests have heretofore failed. Mere physical characters,

1852.] On Cancers. 85

although described by the most minute and skilful anatomists
are yet insufficient. Their chemical constitution varies it is
true, but not to an extent desired by the systematic writer or
practical surgeon. Fat and gelantine are the proximate prin-
ciples usually found in the benign, as albumen constitutes the
chief bulk of malignant tumors. This, however, is not enough.
Up to the time of Lebert's researches even the microscope had
proved ineffectual. Before his efforts, nothing more than the
elements which characterize the simplest tissues, had been found
in growths avowedly malignant. Thanks, however, to the la-
bors of this distinguished micrograph ; the question has at length
been solved. Although Muller led the way, yet Lebert found
the key. The specific cancer cell has been seen and recog-
nised. Though varying like men's faces, they still bear a suf-
ficient resemblance to be referred to the same generic type.

Proficiency in the use of the microscope is not, as many sup-
pose, of easy attainment. Time and study are requisite; and
for this very reason we would urge its repeated employment
in order to derive that invaluable aid to be afforded by this won-
derful instrument

The observations of M. Broca upon 52 cases of true cancer,
are all in favor of his propositions. They embrace a period of
six years. Many of the patients were subjected to several
operations. He has followed them all, and but one of the whole
number was living at the beginning of 1850. He had been
operated on eight times by M. Blandin, and within a few
weeks after the last operation the disease re-appeared with
every probability of a fatal result.

The author is still pursuing his observations, and his re-
searches cannot fail to prove of great value to the profession.

I aui glad that this subject has attracted the attention of the
American Medical Association, as among the reports to be
made at its next meeting is one on the "Results of Surgical
Operations in Malignant Diseases." The name of Prof. Gross
to whose able hands this report has been confided, affords
every assurance that it will redound to the reputation of its au-
thor as well as the good of medicine.

A few propositions on the so called Cancerous Tumors.
[ " Anatomia verum medicinae lumen." Morgagni.]

I. It is impossible to give a definition of what is generally
understood by the term cancer. This is not a single affection,
but a group presenting merely some marks in common.

II. Pathological anatomy, as it existed prior to the employ-
ment of the microscope, has thrown no light on the nature of
the different tumors denominated cancerous. The differences

N. S. VOL. VIII. NO. II. 6

86 On Cancers. [February,

which the most skillful observers had recognized in their struc-
ture by no means corresponded with their clinical study.

The microscope has substituted science for hypothesis and
opened the way for exact and fruitful observation. Every ob-
servation, past or present, which has not been subjected to the
microscope, should be considered as irrelevant.

III. The juice extracted by scraping or pressure, from the
different so called cancerous tumors, always presents an innu-
merable quantity of nucleated cells, in different stages of de-
velopement. Muller, wiio discovered them, has pointed out
their various forms ; but having seen tumors only, and no pa-
tients, he has continued to confound affections which at the
present day are distinct, M. Isaac Mayor has well described
the elements of epidermic tumors, although he did not venture
to separate them from the class of cancers. Lastly, M. Lebert
has studied them both anatomically and clinically, and it is he,
who has the honor of having first divided the so called cancer-
ous tumors into three distinct species, each characterized by a
special histological element.

IV. These elements are :

1. The cancerous element properly so called, without ana-
logue in the economy.

2. The fihro-plastic element, for a long time supposed to be
without analogue in the economy, but recently found by M.
Robin, in the uterine mucous membrane.

3. The epidermic, or better, the epithelial element, identical
with the normal elements of the epidermis and epithelium.

V. Hence three kinds of tumors :

1. Cancerous tumors properly so called, the only ones which
should henceforth be designated by the name of cancer.

2. Fihro-plastic tumors.

3. Epidermic, or better, epithelial tumors. I prefer the lat-
ter denomination, because the epidermis is but a species of the
genus epithelium, and especially, because the dried layers of
the epidermis, in accumulating the one upon the other, may
give rise to inert tumors (corns, warts) very different from
those I am now considering.

VI. The pure fibro-plastic tumors may exist wherever there
is cellular tissue ; they seem to be the result of certain chronic
inflammations. Although disposed to increase, and even to
ulcerate, they may sometimes get well without an operation;
they almost always do get well when completely excised.
They should be stricken from the class of malignant tumors.

VII. It being possible for the fibro-plastic element to be de-
veloped wherever the cellular tissue is the seat of any chronic
affection, it is consequently often met with in epithelial or can-

1852.] On Cancers, 87

cerous tumors ; but it is only adventitious, and does not modi-
fy either their nature or progress.

VIII. There are no mixed tumors, composed partly of the
epithelial, and partly of the cancerous element.

IX. Epithelial tumors can only originate on surfaces cover-
ed by epithelium. They are often attributable to mechanical
causes ; they increase, generally, more slowly than the real
cancerous tumors ; they ulcerate sooner or later, then grow-
more rapidly, invade adjoining tissues, and may even penetrate
bone ; but the ulcers to v^'hich they give rise, do not become
the seat of hemorrhage ; the engorgement of corresponding
lymphatic ganglia, takes place very rarely ; no general infec-
tion is produced, and death occurs only from the exhaustion
which is inseparably connected with protracted suppuration.
In a word, these tumors are essentially local ; they never re-
turn, when completely removed. When they re-appear after
ablation, it is always in situ, because they w^re not entirely
extirpated ; they do not return, but merely continue.

Almost all the affections called cancers of the skin, particu-
larly, the noli me tangere, and the pretended chimney sweep's
cancer, nearly all the tumors of the lip, many of those of the
tongue, the soft palate, the penis, vulva, vagina, the neck of
the uterus, for a long time considered as cancers, are nothing
more than epithelial tumors. I have once met with this affec-
tion at the pylorus ; M. Lebert has found it in the parietal
arachnoid of man, and M. Robin in the internal membrane of
the iliac veins of the horse.

X. A tumor which does not actually contain cancer cells,
has no more chance of becoming cancerous, than any part so-
ever of the body of the individual who bears it. The theory
of the degeneration and transformation of tumors is an hypothe-
sis without foundation. It is refuted inasmuch as nothing con-
firms it. Thus far, nothing proves that a tumor may pass
from the benign to the malignant state.

XL Glandular hypertrophies, already contra distinguished
from cancer by Sir A. Cooper, have again been confounded
with them by inattentive observers. Cancer cells have been
mistaken for the epithelial cells which line the glandular cul-de-
sacs. M. Lebert has also overthrown this error. The dis-
tinction between cancer properly so called and glandular hy-
pertrophy is always possible for those who are acquainted wilh
the intimate structure of glands.

XII. Hypertrophied glandular tumors may seem tore-appear
after extirpation, because a still healthy portion left by the ope-
ration, may in its turn become hypertrophied ; but however
numerous the returns, the disease remains always local, and is
sooner or later cured by a final operation.

88 On Cancers, [February,

XIII. We have no right to say that a tumor is cancerous
merely because there is re-appearance. We should call can-
cerous those tumors only, in which the microscope has shown
the existence of the cancerous element.

XIV. The cancerous element is composed of free nuclei,
and of cells with nuclei similar to the free nuclei. The unifor-
mity and regularity of the nuclei contrast with the varieties of
form and size presented by the cells. Sometitnes the number of
free nuclei is greater than the cells and sometimes the contrary.
The cells may be wanting, but the free nuclei are never absent.
I have observed that in returning cancers, the cells were very
small and not numerous ; on several occasions I have not found
them at all.

XV. Genuine cancer may be produced wherever there are
vessels. These tumors are developed without a known cause ;
the influence of hereditary disposition even is far from being
demonstrated. They grow generalK more rapidly than epithe-
lial tumors ; cause always sooner or later in the corresponding
lymfjhatic ganglia engorgements which assume the character
of cancer ; produce, always subsequently to the ganglionic in-
volvement, a general infection of the system, known as the can-
cerous cachexia. Lastly, at a subsequent period, they often
give rise to a great many secondary cancers, called metastatic.
These may occur anywhere, but they bear a marked pre-
dilection for the glands and ganglions. This is a freqent occur-
rence ; I have observed it nine times. It would probably al-
wavs occur, if the patients lived sufficiently long.

XVI. It is only after having maturely reflected, after hav-
ing collected numerous observations and followed patients for
a long time, that I venture to make the following proposition :

When, after an operation, the microscope has shown the re-
moved tumor to be really cancerous, the tumor always returns
after a greater or less length of time, either in or around the
cicatrix, in the corresponding lymphatic ganglia, or more rare-
ly in some other part of the economy.

XVII. Turnors which have returned, progress both locally
and generally more rapidly than the original tumors ; if re-
moved, repullulation is more prompt than at first.

Reproduction takes place usually in the six months following
the operation, but sometimes much later. I have never seen
it postponed longer than two years.

Most of the preceding ideas are now entertained by men
who are engaged in general anatomy and clinical study: they
are all developed in the work of M. Lebert. He it is, I re-
peat, who has effected the revolution of which I have shown

1852.] Oji Cancers. 89

Tiyself the partisan. Having had the good fortune to be time-
y'nolified of the structure of tumours called cancerous, 1 have
Deen enabled to study a great number during my residence
(internat) in the hospitals. I have followed, for a long while,
the patients who bore them, and profitably observed the dis-
ease and its various terminations. It is thus that I have come
Lo the hopeless conclusion, that real cancer never forgives. A
few unimportant details aside, this proposition is among those
above formulated, the only one which belongs to me ; but it
has appeared sufficiently grave to be here cited. In order to
sustain it, it were well to begin by an exposition as rapid as
possible, of microscopical discoveries.

These discoveries are in opposition to classic theories ; they
make a clean sweep of what has until now been said by the
most celebrated surgeons ; and nevertheless, after having veri-
fied, it seems to me proper to adopt them, without bemg ac-
cused of presumption, and want of respect for one's masters.
Indeed, I am happy to acknowledge that neither talent, perse-
verance, nor philosophical ideas were wanting to our predeces-
sors, the chasm which they have left, and the errors which
they have committed, are solely due to the insufficiency of their
means of investigation.

It is, in fact, only within a few years, that the microscope
has opened an entirely new era in the science of organization.
This wonderful instrument, long abolished from severer studies,
and given up to the cabinets of the curious has now become
one of the most solid bases of anatomy. It has revealed to us
the mysteries of embryonic formations, and the admirable struc-
ture of the tissues, arrived at their complete developement ;
it alone could serve us in the still m.ore difficult study of the
innumerable alterations to which these tissues are liable.

In reading the preface of the first book of Morgagni, we are
struck w^ith the analogy, which exists between his" times and
our own ; then, pathological anatomy still in its infancy, ran
counter to the humoral theories and empirical doctrines. In
presence of an impending revolution, with which medicine w^as
threatened, a violent reaction arose against the youthful sci-
ence, which attacked two equally redoubtable forces : tradition
and routine. The struggle was long and angry, but truth must
always triumph : victory was in favor of pathological anatomy.

So at the present time, the study of the ultimate elements,
which compose diseased tissues, .has sudenly enlarged the boun-
daries of pathological physiology. The microscrope has al-
ready upset more than one theory, and ruiiied niore than one
hypothesis, but it has also provoked an obstinate resistance.

The microscope has therefore escaped neither calumny, nor

90 Ou Cancers. [February,

injustice ; it has been said that it was a faithless instrument, a
source of illusion and of error ; that in its confused images, one
might, at will, find the most varied forms. A few contradictory
results met with in authors, have been opposed to each other,
and disdainfully rejecting every new idea, the would be obser-
ver has thrown it aside.

The microscope so unjustly discarded, has, in fact, the right
to defend itself Once for all, we should put an end to these
trifling accusations, ' which everybody repeats without having
sufficiently thought on them.

The microscope, it is said, gives false images. This unfor-
tunate objection recoils heavily on those who make it. Let
them follow a course on physics ; they will learn of the pas-
sage of luminous rays through superimposed lenses. It is clear
that the microscope exhibits what exists, and nothing more
nor less.

The microscope, it is also said, is a frequent source of illu-
sion. In proportion as the magnifying power is increased, so
are the images more obscure, and their outlines more indis-
tinct. Optical illusions are favored by this species of twilight,
as they occur in reality, towards dark, in the landscape of dis-
tant objects. One may, .at pleasure, figure these ill defined
shadows which his imagination seeks.

This objection has some foundation, but what does it prove ?
That real observers should never employ powers capable of
rendering images indistinct for want of light. In the present
state of the opticians's art, every power which exceeds 1200
diameters (800 diameters according to the new calculations of
M. Robin) is a source of confusion. Below this limit, images
are sufficiently distinct, and in a given preparation every one
should find the same elements.

But whence the innumerable contradictions of which every
one speaks ?

First of all the contradictions are more apparent than real ;
they bear rather upon the interpretation than on the form of
histological elements ; moreover they are, in fact, rare, and ex-
ist only in a few accessory details. Is there even a mediocre
observer, who at the present day denies the existence of the
globules of the blood, of lymph, of pus, of spermatic animalculi,
or of the osseous corpuscles ? Certainly not. It has been
asked only, whether the spermatozoa are or are not animals,
whether the lymph globules are changed or not, into blood glo-
bules, whether the osseous corpuscles are or not, in communi-
cation with the large vascular canaliculi, by the intermedium
of the small calcareous canaculi. But I ask, is there a point in
simple anatomy, ou which there has been no discussion ?

1852.] On Cancers. 91

Without mentioning the disputes between Vesalius and the
Galenists; without recalling the canal of the spinal marrow,
the articular glands, the hepatico-cystic ducts, the canal of
Cochwitz, and so many other anatomical mystifications : with-
out opposing Sabatier, who gives to the urethra a foot in length,
and M. Malgaigne, who allows it only six inches ; shall we find
any two anatomists who agree upon the aponeuroses of the
groin and perineum ? Should we require of microscopic re-
searches a greater precision than in anatomy, visible to the naked
eye ? Is it not more than evident that the miscroscope is
quite as innocent of the errors of microscopists, as the scalpel
is of those of anatomists ? It is a reflection not generally made
particularly when we find ourselves mistaken, because we like
better to blame an instrument, than blame ourselves.

But the cause of the microscope is able to triumph even
whilst making concessions. I am willing to grant that there
are in micrography a number of inexact and contested facts.
But what does this prove ? Merely that there are good and
bad observers ; that we are too hasty in publishing the result
of our researches, and especially that we think ourselves skilled
in the use of the microscope, at a period when we should be
content to learn and verify what others have said. When we
have looked two or three times through a microscope, w^e see
images as distinctly as after prolonged study : we describe and
even figure them, and then say : here is what I have seen ; my
eyes are as good as those of another ; if any one sees different-
ly from me, it is the microscope that deceives. But this is not so.

The world of the infinitely minute, is a world by itself; most
colors have disappeared, perspective is a novelty ; objects seen
by transmitted light, seem reduced to but two dimensions, and
all elements comprised in their thickness, seem situated on the
same place. What habit, what education is required, to bend
the sight to these wholly new observations ? The infant, al-
though possessed of touch to rectify his errors extends his arms
to grasp the moon. Ideas of perspective are only gradually ac-
quired. Such is the case in the first attempts of the student of the
microscope. And then, how many precautions are neccessary
not to admit into the preparation any foreign element. A fila-
ment of any kind, a grain of sand, a bubble of air, have often
deceived the tyro.

In the simplest tissues may be found globules of blood, fat
and fibres of cellular tissue. It is then a study requiring time
under the direction of a master. We should proceed from the
simple to the complex, and never venture to give an opinion
about a morbid tissue, before we are thoroughly acquainted
with normal histology. Ordinarily the reverse is the case.

92 Diseases of the Stomach. [February,

We make our first essays on diseased tissues, before having
even read a treatise on general anatomy. Is it any wonder
then that so many reject the micoscrope, disappointed by an
unsuccessful beginning ; that as many others, more culpable
still, refusing to become students again, heap error on error,
contradiction on contradiction.

By a happy initiative, at which the friends of progress should
rejoice, the Faculty have felt that the histological should be
early begun, and carried on simultaneously with other medical
studies. The establishment of a microscopical laboratory
promises splendid results for the future. [St. Louis Medical
and Surgical Journal.

On the Diagnosis of Diseases of the Stomach. By Henry
Kennedy, A. B., M. R. I. A., Fellow of the King and Queen's
College of Physicians in Ireland.

There are few medical men who have been engaged in prac-
tice, for even a limited period, but must have been struck with
the fact, that the most serious and threatening symptoms of
stomach disease may exist, and be even persistent for a con-
siderable time, and yet in the end the case may turn out to be
one of functional disease merely, and the patient get quite well.
And, on the other hand, a patient may labour under the most
formidable organic disease of this organ, and yet scarcely pre-
sent a single symtom indicative of its presence. These two pro-
positions it is essentially necessary to keep ever in mind ; and
it may be doubted whether they are yet sufficiently recognised.
Before proceeding farther I shall illustrate them by the follow-
ing cases, briefly narrated :

Case I. Some time back Mr. Cusack exhibited to the Pa-
thological Society a specimen of disease of the stomach of an
extraordinary extent. Literally three-fourths of the organ
were converted into malio-nant disease. All the coats were
involved, and the mucous membrane presented one sheet of
fungoid disease. But what was extraordinary was, that the
individual from whom it was taken had been able to take his
food, and made no complaint until within a very few days be-
fore his death.

Case II. A medical gentleman, about fifty-five years of
age, had long been w^hat might be described as delicate. He
had been in the army, and on his way home from Jamaica, was
obliged to use, for some weeks, bread of a very inferior quality.
This disagreed w'ith him even more than common, and before
he landed he was suffering daily from dyspepsia of a severe
character. Oa reaching home the symptoms did not abate,

1852.] Diseases of the Stomach. 93

and shortly afterwards he was invalided. From that period
until his death, which took place some months later, he was
never free from suffering, referred to the stomach. He was
seen by several eminent gentlemen ; the symptoms he chiefly
laboured under were constant pain, nausea, loss of appetite,
and occasional attacks of pyrosis. On one occasion he threw
up a considerable quantity of blood ; but at the time there
were some doubts as to its source. He had some cough, which,
with expectoration, increased towards the end ; and he finally
sank, reduced to the very last degree of marasmus, and never
having lost the symptoms referred to above. I assisted Dr.
Kirkpatrick to make a jjost mortem examination. On first
view the stomach appeared perfectly healthy, and it was only
after a very minute inspection that w^e were able to detect two
small ulcers, each about the size of a split pea, existing close to
each other, in the great extremity of the organ. The coats,
too, of the stomach appeared thinned, having probably partaken
of the general marasmus. In the luno;s was found some tuber-
cular matter, in large masses, but not occupying any particu-
lar site.

Case III. Mr. , a professional gentleman, began to suf-
fer from pain in his stomach, chiefly after his meals, and more
frequently after his breakfast than at any other time of the day.
He was at this period twenty-six years of age, of tall stature,
and had been, though subject to occasional headaches, previ-
ously healthy. He had always, however, been inclined to con-
stipated bowels. The attacks., in the first instance, w^ere slight,
and were more of the character of painful digestion than any-
thing else ; for at a certain period after each meal he felt more
or less uneasiness. By degrees, however, they became more
severe ; and as they did, their character somewhat changed.
They were now% in a very marked de2;ree, periodic ; that is,
the patient would be six weeks, or even longer, free from any
suffering, and then an attack w^ould occur very suddenly. On
many occasions he w^ent out on his ordinary business in the
morning, and would return in an hour or two sufl^ering from
the attack. He always referred its comjmencement to a point
opposite the pylorus, from which the pain would spread, but
not to any great extent.

I am quite unable to describe these attacks.* They were
perfect whirlwinds while they lasted, which they usually did
from four to six hours; and the patient's sufferings seemed to
be agony itself. He frequently expressed himself as if he should

* Any one who will call to mind the story of the " Martyr Philosopher,"
given Avith such grapic effect in the " Diary "of a Physician," "will have a good
idea of the patient's sufferings.

94 Diseases of the Stomach. [February,

die inconsequence of them. While the fit was at its height
vomiting took place, but never of any large quantity of fluid;
and as it passed off, the stomach began to secrete air, which it
would then do in enormous quantities, and was always consid-
ered by the patient himself as a good sign. It is only neces-
sary to say further of this case that he has been completeh^ free
from these fearful attacks for a period of upwards of four years.

Though other cases might easily have been given, these ap-
pear to me quite suliicient to show what difficulties surround the
question of diagnosis in diseaees or affections of the stomach.
The well-known fact, too, might be adduced here in further
proof of this position : that the disease known as chronic ulcer
of this organ has fiequently led to a fatal result from perfora-
tion, without any complaint having been previously made by
the patient ; and their usual condition would seem to bear out
this view, for many of these cases present all the signs of the
most robust health.* But if we come to inquire why such
difficulties exist, the reason appears to me to be in great part
explained by the fact, that both the functional and organic af-
fections of this organ give rise to the same series of symptoms ;
and this will be made evident, if vv^e try to place the signs of
organic disease in one column, and those of functional deraiige-
ment in another ; for we shall then find that both lists will
contain very nearly, if not exactly, the same series of symp-
toms. Pain, nausea, vomiting, flatulence, sense of distention,
pyrosis, throwing up more fluid than what has been taken,
hematemesis of different kinds, and other symptoms, are each and
all common to either state. Hence, I repeat it, the difficulties
which so frequently arise in arriving at an accurate diagnosis, f
But it will be asked here, are there no signs which may be
considered as absolutely indicative of organic disease? And
this leads me to notice more particularly two symptoms, on
which many have placed an entire reliance. I mean the symp-
tom known by the name of the black vomit; and secondly, the
presence of a tumor of the stomach itself.

As to the first of these, it appears to me too much stress has
been laid on it as diagnostic of organic disease, and, for this
simple reason, that it occurs in cases where we have positive
evidence there is none. For, w^hat is this black vomit? No-
thing, I believe, but an exudation of blood, altered somewhaf
by the secretions of the mucous membrane of the stomach ;
and this, I presume, few will assert, can only take place where

* An interesting paper by Dr. Lees, on Perforation of the Stomach, will be

found in the tenth volume of the New Series of this Journal.

t A similar line of observation has, I find, been pursued in the " Bibliothe-
que du Medecin-Praticien," edited by Fabre. 1851. Vol. ii. p. 490.

1852.] Diseases of the Stomach, 95

there is ulceration or fungoid disease. Henfiorrhage from the
stomach we know can occur where there is no morbid change
whatever in the mucous membrance, as in some cases of en-
larged liver. I have seen instances of this nature, where the
first blood thrown up was of a bright red colour ; but as the
attack passed off, it got gradually darker, and finally put on all
the characters of black vomit.* Yet, in these cases, the mu-
cous membrane was found healthy, though congested. But
further, many acute diseases exhibit this symptom in a very
marked degree, and a most serious symptom it ever is. I have
seen it in bad cases of scarlatina, of fever, small-pox, and of
puerperal fever ; also in a case of rupturedf uterus ; and on
examination of such cases I have found no organic change in
the mucous membrane. The yellow fever, too, of warm cli-
mates very generally presents this symptom. Hence, the con-
clusion appears to me a fair one : that this particular symptom
may occur in the m.ore ordinary affections of the stomach,
where nothing but functional derangement exists; and before
these remarks are concluded, I hope to prove it.

The second s5"mptom I have alluded to, the existence of a
tumor, is one of more moment, and it must be allowed that in
the great majority of instances it will lead us to a correct diag-
nosis; yet even thissysmptom, palpable though it be, may deceive
us ; and I would call particular attention to this fact, for, after
having made some research on the matter, I cannot discover
that it has been hitherto noticed. The point I would observe
upon is this, that a tumour may exist in the stomach, which in
the progress of time, may entirely disappear; or, at least, get
into a state in which it may not be palpable on external exam-
ination. I believe two distinct circumstances may give rise to
such a state of things. Before noticing these, however, I would
just observe on the much greater facilities which some subjects
present for the detection of tumours than others ; and it is a
point always to be kept in mind. There are, I presume, few
who have not met instances where all the symptoms would
lead one to look for the presence of a tumor which did in reality
exist, but which no external examination could detect. As far
as I have seen, this difficulty has been in great measure due to
the natural depth of the chest, rather than to any other single
cause, such as the thickness of the abdominal parietes, or the site
of the tumor. So that it may be safely stated, that the absence

* Somethiug very like this may also be seen in cases of hemorrhage from
the lungs,

t The occurrence of the black vomit in this case would appear to be impor-
tant to notice, for it points out a state of the system which cannot be considered
healthy, and which may predispose the uterus to an alteration of structure that
may lead to its rupture.

96 Diseases of the Stomach. [February,

of all external sign of a tumour would not justify us in assert-
ing that none existed.

But, further, there is a state of some of these tumours which
I am not sure has been hitherto noticed, I mean their mobility,
not from external handling, but by the act of respiration. In
a case which I saw, through the kindness of my friend. Surgeon
Neville, of Brunswick-street, it was most remarkable. At
every inspiration the tumour moved fully one inch and a half,
and, what is of more importance, this sign was the means of
settling a question which had previously been raised, namely,
as to whether the tumour was an aneurism or not, for it had a
very strong pulsation.* Whether the mobility was, in this
particular instance, more than ordinary I cannot say, but it is
worthy of remark that the patient was of unusual stature, for,
though he was a tailor, he was six feet four inches in height.
This mobility, then, even granting that it is not always present,
appears to me a symptom which ought to be looked for in this
class of cases.f

It has been already stated that a tumour which has been
palpable to the touch may disappear, and this may, I believe,
occur in either of two ways. In the first the tumour, so far
from enlarging as the disease advances, lessens. This we know
to be common in cases of malignant disease, as in cancer of the
breast when ulceration is going on, and the same may occur
when a similar disease exists in the stomach. This has hap-
pened twice under my own observation, and in one instance it
was so marked, that a doubt was thrown on the accuracy of a
previous diagnosis. An examination, however, after death,
solved the difficulty, by disclosing a large ulcerated surface,
with some traces of tumour still remaining. Thus, then, I be-
lieve, and it is comparatively well known, our diagnosis may in
one way be rendered obscure. Before describing the second I
shall give some details of the following case :

Case IV. Miss , about 30 years of age, unmarried,

suffered from a sharp attack of English cholera, in August,
1849. She was of the sanguineous temperament, but of a list-
less habit of body. The menstrual function w^as quite healthy.
From the attack of cholera she does not appear to have com-
pletely recovered, for shortly afterwards, within a month, she

* The post rnortem examination of this case disclosed a tumour of a malig-
nant character, which formed a complete circle on the mucous membrane of
the stomach, close to the pylorus. It was exhibited at the Surgical Society.

t Through the kindness of Dr. Lees I have very lately seen a case of abscess
of the liver, in which the tumour presented to the right of the epigastrium, and
was very distinctly moved downwards by the act of inspiration, a point of some
importance to determine, as it showed that at the time no adhesions had taken
place. This subject seems worthy of further investigation.

1852.] Diseases of the Stomach, 97

began to throw up a small portion of each day's dinner. This
gradually increased, until, in the course of four months, every
thing taken in the way of food came up, though, curiously
enough, medicine did not. With this state of stomach the pa-
tient complained of a fixed pain, which she referred exactly to
the pylorus, and where, when she was examined in bed, a dis-
tinct tumour could be felt. It was circumscribed, and painful
on pressure, and was recognised by Sir H. Marsh, who, at this
period, saw the patient with me. What she threw up at first
was merely her food unchanged. In the course of a month,
however, a large quantity of clear fluid, mixed with saliva,
came up. This fluid she described as being salt, bitter, and
burning by turns. Such was what might be called the persist-
ent state of this patient until the latter end of January, and be-
ginning of February,IS50 ; that is, about six months from the
time she began to throw up her food. At this period, attacks
of a much more serious character were superadded. These
attacks were wonderfully periodic, taking place regularly each
second day, between five and eight o'clock in the evening.
They were preceded by shivering, paleness, and great anxiety
of countenance ; at the same time that the pulse, which com-
monly beat between SO and 90, rose to 130, and even 140. In
this state the sense of burning, from which she was never free,
became very much aggravated, and she described it as extend-
ing from the stomach to the throat ; which latter part was con-
stantly excoriated from the nature of the fluids vomited. With
these severer attacks she now also bes^an to throw up a quan-
tity of stuff having the characters of black voniit. It was of a
dark brown colour, and was always attended with a much
larger quantity of fluid than what the patient had taken. On
several occasions now, too, what came up was tinged with
blood.* It will be easily understood that from the violence of
these attacks and their constant recurrence, the general health
must have suffered severely ; and such was the fact. Loss of
flesh went on with great rapidity. She became reduced to a
skeleton, being quite unable to leave her bed, and symptoms
again and again threatened that her sufferings would be aggra-
vated by stripping. During the period she was so reduced,

* The microscope was not used in this case, there being nothing in what was
rejected to lead us to suspect that anything of either an animal or a vegetable
organization existed in it. There can be no doubt, however, that the instru-
ment can afford most valuable assistance in some cases; as proof of which I
would refer to a late number of the Medical Times, where a case of great in-
terest is given very fully by Dr. Jenner of London; and also to Dr. Todd's
papers in the London Medical Gazette. Cases also, illustrating its application,
have been brought before the Dublin Pathological Society by Drs. M'Dowel
and Lyons ; but they have not been yet published.

98 Diseases of the Stomach. [February,

Dr. M'Donnell, whose valuable assistance I then had, felt with
me the tumour repeatedly.

It is unnecessary to pursue the history of this case further;
it occupied many months more; suffice it to say that the pa-
tient has perfectly recovered, mid that now no tumour can be
Jelt. It must be allowed, however, that at one period of the
case the prognosis was gloomy in the extreme.

This case I have given at some length, as it appears to me
to be one of considerable interest. The patient certainly pre-
sented a series of symptoms from which few have recovered.
She had all those which are thought to mark the presence of
organic disease, including the black vomiting, the throwing, up
of much more fluid than she had taken, and the presence of a
tumour. Of the exact nature of the case I do not profess to
offer anything like a positive opinion. In the first instance it
would appear to have been an example of the affection so well
described by Sir H. Marsh ; while at a later period there were
strong grounds for supposing that actual disease had taken
place, possibly some form of ulceration. This, however, is only
conjecture, though it is borne out by the extreme emaciation
which the patient at one period presented. This symptom is,
I believe, amongst the most constant of those attendant on or-
ganic disease; and yet it does not always exist, as some of the
cases of chronic ulcer fully confirm.

But how are we to account for the tumor and its subsequent
disappearance ? It will be recollected that it was felt by Sir
H. Marsh, and repeatedly by Dr. M'Donnell and myself. My
conviction is, that at no period of the case did any morbid
growth exist but that what was felt due to an irregular action
of a portion of the muscular coat of the stomach itself

Any one in the habit of opening bodies must have been often
struck with the varieties which the stomach in its general as-
pect presents. In one subject it will be very large, and appa-
rently dilated ; in another it is found contracted to a remarka-
ble degree, and its coats, to all appearance, thickened ; while
in a third it presents an example of the hour-glass contraction,
described so long since by Sir Everard Home. The other
hollow viscera, too, we know, take on at times this irregular
action of the muscular coat, as may be seen in parts of the in-
testines, and still more strikingly, perhaps, in the uterus. In
subjects favourable for examination, I have myself felt portions
of the intestines, knotted, as it were, so as to afford distinct evi-
dence of irregular action going on ; and which has all disap-
peared with the cause which gave rise to it.

So I take it to have been in the case just given. The irrita-
tion, which there can be no doubt of existed in the mucous

1852.] Chronic Inflammation, ^c. 99

membrane of the stomach, caused aspasctic state of contraction
of apart of the muscular coat, and this, in its turn, caused a
thickening, a temporary tumor so to speak, which it was possi-
ble to feel through the thin abdominal walls. As the irritation
lessened, however, this spastic state gradually subsided; and
hence we have an explanation of the disappearance of the tu-
mour, and the recovery of the patient. To suppose that there
existed in the stomach a tumor caused by organic disease which
subsequently disappeared, would be a straining of experience
farther than any case on record would justify.

Much might be said on the treatment of these cases, for it
would appear to be anything but yet settled. For the present,
however, I must confine myself to one rem.ark. At the period,
in the case last given, when there were good grounds for sup-
posing that some ulceration existed, I carried into effect an idea
which had been long in my mind, viz : that in such cases w'e
might give medicines for the express purpose of healing the ul-
cerations, in fact of acting locally on them, as if w^e had an
ulcer on the surface of the body to deal with. With this view
creasote was given, to the amount of three drops,-three times a
day ; and, as I believe, WMth advantage. Nor do I see any rea-
son why other medicines as w^ell might not be administered
with this intention, and in cases where it would appear to be
too common to consider them as being beyond the resources of
our art, as, for instance, the disease known as the chronic ulcer
of the stomach. In this disease there is no evidence of anything
of a malignant character, and, of course, nothing (amounting,
I mean, to an impossibility) to prevent its healing. We know
there is proof on record of such an occurrence having taken
place ; and consequently our efforts should be directed, not
merely to pallitate, but to cure, difficult though its attainment
may be. But where is there not difficulty in medicine ? With
this object in view, then, I venture to make this suggestion.
[Dublin Quai^terhj Jour, of Med. Science.

On Chronic Inflammation, and other Morbid states, of the
Corpus Cavernosum. By Hexry James Johnson, Esq.,
formerly Lecturer on Anatomy and Physiology, and lately
senior Assistant Surgeon to St George's Hospital.

I venture to lay the following cases and observations before
the profession, in order to direct attention to a subject which
has not hitherto engaged it. I trust that this imperfect notice
of what, I should imagine, is a rare affection, may lead to com-
munications of greater value from others.

100 Chronic Inflammation, 4'C. [February,

In a work of mine, which the Lancet recently did nne the
honour to review, will be found a brief account of "Chronic
Inflammation of the Corpus Cavernosum." That account com-
prised in a solitary case all I had then witnessed. By one of
the coincidences which make railway accidents come in a
crowd, and cumulate in a week those unfrequent operations at
a hospital, which the calculation of chances ^/ioii/fZ spread over
months, I have seen in the short time which has elapsed since
the publication of that work, three distinct instances of the dis-
order. I shall therefore take the liberty of laying the entire
group before your readers, to exhibit at one view their points
of similarity and of difference.

Case I. "A barrister of something more than middle age,
had led from early years a dissolute life, and had experienced
more attacks of gonorrhoea than he could enumerate or I re-
member. He managed the majority of these himself, and his
principles of treatment were simple. He took capivi till he
got well, however long he might be in doing so; and as he did
not care to restrict himself in living, he came at last to think
that gonorrhoea was almost his normal state, and that it little
mattered whether he had it or not. But Nemesis, though lame,
still catches her victim, and this gentleman found that the 'gods'
do really

"Make scourges of our pleasant vices."

" Some six months before he consulted me, which was in the
summer of 1845, he began to experience lancinating pains in
the body of the penis, just anterior to the scrotum ; the organ
was tender on erection, and it gradually assumed a sort of spi-
ral twist, which was neither comfortable nor prepossessing.

" When I saw him, this sort of torsion was considerable, and
gave an irresistibly ludicrous appearance to the part, which
looked somewhat like the appendix vermiformis, or a pig's cur-
ly tail. On examination it was obvious that the cause resided
in the corpus cavernosum, the fibrous wall of which was irre-
gularly indurated, while thickening and consolidation invaded
the erectile tissue within. The character of the affection more
nearly resembled that of the palmar fascia in watermen, than
anything with which I can compare it. Erection had become
as insupportable as imperfect, and the suffering was positively
great.

"I prescribed leeches, blisters, mercurials, tartar-emetic and
iodine ointments, fomentations, poultices, cold lotions, even ice,
with calomel and opium, salines, iodide of potassium, and sar-
saparilla, the liquor potassas all the remedies, in short, which
would naturally occur to me in the management of such a case.

1852.] Chronic InJIammation, ^-c. 101

Their good effects were limited to the removal (and that ex-
tremely tardy) of the tenderness and pain. Beyond that they
had no influence. The induration remained, the contraction
rather increased, and erection, if no longer attended with actu-
al suffering, was a source of profound discomfort. In the early
part of 1846, he consulted, I believe, several other hospital
surgeons, and one (he w^as no anatomist) recommended divis-
ion of the cavernous body. It could do no good, as it was not
attempted. I have not seen the patient since 1847, and I un-
derstand that he remains in nearly the same state as when he
quitted me.^'

Case 2. A respectable tradesman, fifty-one years of age, of
pale complexion, and of nervous temperament, married, but
separated from his wife, had from youth been addicted to
venereal indulgences. On three or four occasions he had suf-
fered, in early life, from gonorrhea, and he once had syphilis,
eight or ten years ago.

Five or six months prior to my seeing him, he felt, in the
act of connection, an acute pain in the penis. It Avas a week
or more before it totally subsided. Gradually, however, he
became aware that, in erection, the organ was curved upwards,
and that the spot where he had experienced pain was the seat
of distinct uneasiness. These symptoms increasing, he applied
to me in May of the present year.

On examination of the penis, I discovered, on its dorsum, im-
mediately anterior to the pubes, a hard nodule, about the size
of a small horse-bean, but not so perfectly defined. It could
only be distinctly felt on pinching up the corpus cavernosum,
between the finger and the thumb, and I found, or fancied that
the induration was rather in its fibrous envelope than in its
substance. It was slightly tender when compressed.

The corpus spongiosum was of its usual form and density,
and the course and stream of urine were not the least impeded.

I was disposed to imagine that the case w^as one of chronic
inflammation, occasioned by the rupture, in coition, of some of
the fibres of the cavernous sheath. The possibility of such an
accident may be readily admitted, when w^e reflect on the fre-
quency of partial rupture of the tendo-Achillis, and aponeurotic
fibres of the gastrocnemius.* But I confess that I was not
without a suspicion that there might be incipient scirrhus.

*It is generally, I think, supposed that rupture of the tendo-Achillis is a not
uncommon occurrence. The injury that is looked upon as such is anything
but rare ; but I have never myself seen the whole tendou tom, AVhen we con-
sider its extreme strength, it is most unlikely that it should be so. What really
happens in the great majority of instances is this: either some of the outlaying
fibres of the tendon, or some of those of the aponeurotic lamina which dil-
fuses itself over the gastrocnemius, or some of the muscular fibres of the latter,

X. s. VOL. vin. xo. ri. 7

102 Chronic Inflammation, <^c. [February,

The patient being then averse to local depletion or blistering,
I prescribed the mercurial ointment, with belladonna, which
was to be constantly applied.

On the 10th of June he called on me again. The induration
was rather less, but the lump was more diffused, and had ex-
tended somewhat to the left. He now assented to more active
measures, and I gave him Plummer's pill, with opium, at
night, and the liquor potassEe, with the iodide of potassium and
sarsaparilla, twice daily. At the same time I directed him to
blister the penis resolutely.

He had done so thrice when he paid me a visit on the 14th of
July. There was little change for the better, in fact, although
the hardness had diminished, the superfices of the morbid de-
posit had increased. There was also a greater degree of ten-
derness, which he attributed, probably with justice, to the blis-
ters. I requested him to rub in, night and morning, an oint-
ment composed of the iodide of potassium, belladonna and cam-
phor, and not to discontinue the general treatment, which agreed
with him particularly well.

On the 1 8th of August, I saw him for the last time. The
induration was still on the decline, and the margin of the swel-
ling w'as less defined ; but it was more diffused. It was obvi-
ously limited to the wall of the cavernous body, which crum-
bled when pinched, like a piece of parchment. The tenderness
had again subsided, and there was little uneasiness in erection,
or, indeed, in coitii, which, contrary to my express injunctions,
he now confessed he had indulged in. The penis, however, on
those occasions w^as twnsted to the left side, an alteration due to
the extenison of the thickening in that direction.

I advised his taking the mercurial pill every second instead of
every night, and in other respects I left the treatment as it
was. I have ah'eady stated that he has not subsequently call-
ed upon me.

Case 3. A gentleman residing in one of the Channel Islands,
between forty and fifty years of age, of florid complexion, and
of healthy constitution, consulted me last June, under the fol-
lowing circumstances :

give wav in a sudden effort, Perrot,. the celebrated ballet-dancer, ^^as saM ro
have met with this accident. He was forced to retire altog'ether for a year or
two: and, when he returned for a while to the sta:e, he was eompeHed to con-
fine himself to pantomime. Now, it so happened that I was called to Perrot, and
ihe tendo-Achillis was 7?^)^ ruptured,- aiew of its fibres had snapped, and that was
all. I may take this opportunity of making one other observation. Almost
all the cases of this description which have occurred to me were in persons of
a gouty habit. The fact is not unattended with interest, and I should be glad
tolearn if mv experience is confirmed by that of othej.s. If it be so, I conceive
that the physiological explanation is not difficult, and that some practical con-
clusions might be drawn from it.

1852.] Chronic Injlammaiion, ^-c. 103

Though long married, he had " intrigued freely," tillwithin the
last few months, when he found that, in erection, the penis was
curved upwards, and that to a painful extent. The uneasiness,
in the act, was seated in front of tfie pubes, where a spot was
tender upon pressure. He applied to a medical friend in the
island, w^ho told him that he often saw cases of that sort, and
prescribed severe counter-irritation. This was of some service
to hin-^, but, coming to London to witness the Exhibition, he had
been recommended to me.

On examining the penis, I found, half an inch anterior to the
pubes, a perfectly defined and regular induration, situated in
ihe median line, upon its dorsum. It was scarcely so large as
a small horse-bean, flat, imperceptible to the naked eye, and
distinguishable only on pinching up the corpus cavernosum
between the finger and the thumb. It was evidently seated in
the wall of the cavernous body, and did not extend into its inte-
rior. It was tender on firm pressure, and the seat of discomfort
in erection, when the curvature of the penis was so pronounced
as to have compelled him to abandon all connubial intercourse.

I prescribed, during his stay in London, when sight-seeing
rendered counter-irritation inadmissible, the application of the
iodide of potassium in the form of ointment, and its internal
use in combination with sarsaparilla and with the liquor potassse.
I also recommended him, on his return home, to pursue an ac-
tive course of blisters. I have not heard of him since.

Case 4. A country gentleman, between fifty and sixty years
of age, florid, stout, and healthy-looking, had always been ad-
dicte(#to the gratification of his passions. In early life he had
attacks of gonorrhoea, but none for many years. Some eigh-
teen months, or thereabouts, before his visit to me, he had felt,
in connexion, a sudden though not a violent pain in the penis,
immediatly contiguous to the pubes. For some time aftewards,
he experienced in erection a sense of inconvenience, which
gradually passed away. Eight or nine months ago, he began
to observe that the organ, when distended, became curved to-
wards the abdomen, and that sexual intercourse grew difficult
on that account. He applied to an eminent physician in his
neighborhood, whoassui-ed him that it was. a matter of no im-
portance, and that he had had the same thing himself! What
he prescribed (it was not counter-irritation) was unproductive
of benefit, and, matters growing worse instead of better, he
came to town for advice. He went to an eminent hospital-sur-
geon, who introduced a bougie, and seemed to regard the case
as one of stricture. As the patient found no impediment to the
free passage of his urine, this opinion was unsatisfactory, the
more so as the instrument rather increased the irritation. On
the 23rd of Julv he consulted me".

104 Chronic Inflammation, ^-c. [February,

I found on the dorsum of the penis, near the pubes, inclining-
rather to the right side, but spreading over the centre, a flattish,
ovoid, defined, but not absolutely regular induration, three lines
and a half in its long diameter, and two and a half in its short,
the former being from side to side, the latter from before back-
wards. Its characters were best appreciated by pinching up
the corpus cavernosum, in the parietal lamina of which it was
seated, immediately beneath the skin. This was unadherent
and unaffected ; but the hardness (I imagined) extended slightly
into the substance of the cavernous body. There was trifling
tenderness on pressure, still more in erection, and, in that condi-
tion, the incurvation of the organ towards the pubes rendered
sexual intercourse extremely irksome, if not actually impossible^

I prescribed the same remedies as in the previous cases, and
I have not seen nor heard of the patient since.

The following appear to me the most obvious infereTices
which the facts warrant us in drawing.

1. A regret that the facts themselves are sa imperfect. With
the exception of the first, a sufficient length of time has not
elapsed to decide the, issue, or admit of a positive conclusion.
I should be equally condemned by logic and experience, if, tin-
der such circumstances, I dared to dogmatize. But I write
with the hope of obtaining information, not with the pretence
of giving it. That is my apology.

2. One feature is common to all the cases ; the subjects werer
immoderately given to venery. Whoever abuses the func-
tions of an organ, accepts a blank bill upon the future. It may
run for a longer or a shorter date, but it must come due. That
the sheath of the cavernous body should sufl^er from excesses
of this description is easy enough of comprehension; submit-
ted to sudden and violent distention, the web of which it is
composed may very readily be damaged. The chronic in-
flammation of the palmar fascia, which occurs in watermen
and smiths, is a strictly analogous instance, the organic tissue
being the same, and the cause of mischief not dissimilar. The
respective ages of all the patients w^ere very nearly alike.
Each had attained, and one had passed, the middle period of
life, when the vita). and elastic powers of the organs are decli-
ning, and the fibrous membranes exhibit a pronenessto disease,

8. In the second and the fourth case, a sudden pain was ex-
perienced in connexion, where the induration subsequently
formed. It is natural to imagine that this was due to a lacera-
tion of some fibres. The correspondence of the phenomena
with those exhibited in partial rupture of the tendo-Achillis
requires no further demonstration.

4. In the first case only, was there any ground for attribu-

1852.] Chronic Inflammation, ^-c. 105

ting the aflfection to gonorrhoea. I should, a priori, anticipate
that. The uretha is tunnelled in the spongy body, with wliich
the cavernous is in little more than contact. Gonorrhoeal in-
flammation, when so intense or so erratic as to travel beyond
the mucous membrane, would naturally invade the contiguous
structure, the erectile tissue of the corpus spongiosum. Such
we find to be the ftict. Acute and chronic inflammation of it^
is a common consequence of gonorrhoea.

In the case where the exception to this general rule occurred,
the circumstances were themselves exceptional. Debauchery
was carried to its extremest limit, and the indulgence of the
passions was crowned hy the abuses of the most empirical treat-
ment ; and perhaps it will not escape observation, that, as
the causes were in a great measure peculiar, the result was
also different. I the place of a small circumscribed deposit
in the fibrous envelope of the cavernous body, a more extensive
and more serious alteration implicated its interior.

5. I conceive that thi is a rare affection, partly because I
have seen it rarely, but principally because I know of no de-
scription of it. 1 imagine, too, that the profession is, in general,
imperfectly acquainted with it. For, in my fii'st case, an hos-
pital surgeon proposed to divide the wall of the cavernous body ;
in the third, the medical attendant protested that he witnessed
the disorder frequently ; and in the fourth, a physician pooh-
pooh'd the thing, because he had had it himself: while a London
surgeon looked on it as stricture, and treated it with the bougie.

G. To whoever saw, and to some, perhaps, who may read
these cases, a suspicion of schirrhus might occur. A candid
review of all the circumstances tends, I think, to dispel it ; but
it would require more time than has elapsed, and indeed more
confidence than I possess, to decide, ex cathedra, against the
jJossibiJily of malignant action.

7. The principles of treatment are unhappily more simple
than their application is successful. The removal of inflam-
matory action would be sought, of course, in local depletion
and active counter-irritation, while absorption of the lymph
would be promoted by the application of iodine or mercurv, and
by their internal use. Tlie success which may reasonably be
expected from such measures w^ould not appear to be extraor-
dinary, although I may observe that the nature of the tissue,
as well as the functions of the organ, must naturally discourage
the idea of speedy benefit. Few complaints, I imagine, de-
mand more persistence on the surgeon's part, or more steady
resolution on the patient's.

In a future and not remote contribution, I shall advert to
some other morbid stales of the cavernous body, more or less
allied to the preceding. {^London Lancet.

lOG Cerebral Disease. [Febraary,

On the premonitory signs of severe Cei^ehral Disease and
their importance. By Dr. Devay.

[We have considerably curtailed this valuable essay, but
hav^e endeavored to omit nothing of real utility. The author
introduces the subject by remarking on the extreme difficulty
in arriving at an accurate diagnosis in cerebral affections, the
symptoms being induced by lesions of various kinds the same
difficulty exists in the interpretation of tiie premonitory symp-
toms, which are, nevertheless, excellently demonstrated in the
following observations :]

I. Premonitory signs, furnished by the intellectual and moral
faculties, Almost all authors of repute have mentioned, with-
out always attaching much importance to them, the disturbances
of intellect which precede attacks of severe cerebral disease.
Insanity has its period of incubation, its premonitory symptoms;
and frequently it is found that the first act of insanity, which
caused alarm, has been preceded by several symptoms which
had escaped observation, and sometimes the first phenomenon
of the disease has been taken for its cause. The insane often
combat their false ideas, before the disorder of their reason, and
the internal contest w^hich precedes the explosion of their mad-
ness, are perceived. The most general precursor of every se-
vere affection of the brain is a state o{ cerebral lassitude, pre-
senting much analogy to that state of intellectual torpor which
follows severe or pestilential fevers. There is observed in the
habitual gesture of the patients, in their attitudes and movements
a total absence of what may be called the consciousness of ac-
tion. The brain seems to have lost its 6a/a?zcmo- power over
the ensemble of the functions of the life of relation. These pa-
tients are often in a constant state of slight habitual vertigo,
whicli they call weakness of the head, and which is frequently
accompanied by debility in the limbs.

The memory is frequently impaired in the precursory period
of cerebral affections. Thus, patients have forgotten the names
of their friends, or of the most common things. In conversation
they have diifficulty in finding proper words to express their
meaning, and are obliged to make us of circumlocutions. i\Iore
rarely, t!ie memory becomes more powerful ; it seems to take
a new^ flight, and reproduces, to the great astonishment of the
patient and his attendants, events which had seemed to be en-
tirely forgotten. The curious and inexplicable fact of reminis-
cence corresponds to the exaltation of the special sensibility of
certain senses. It is sometimes observed after a slight attack
of apoplexy.

Next to the impairment of the memory, and also of the atten-

1852,] Cerebral Disease. 107

tion, which is fixed with difficulty, or not at all, on objects pre-
sented to the notice of the individual, the' most striking change
is in volition, which is diminished. The man who has hitlierto
been most firm, who has shown most tenacity in his views, who
has pursued the plan of his life with great determination, be-
comes, in a measui-e, like the toy of a child ; those who are
about him, even his inferiors, can command him. Human de-
])ravity has often taken advantage of this moral decadence for
culpable ends ; and the man who has hitherto most rigorously
and carefully managed his affairs, is all at once spoiled of his
goods, either by extorted donations, or by burdensome expen-
ses. The public see in these cases hizarreries of character ;
the physiolojrist and the physician see in them the first expres-
sion of a pathological condition. This weakening of the will,
which, according to our observations, is chiefly connected with
those cerebral lesions which lead to lunacy, or to paralysis of
the insane, necessitates an alteration of the judgment. . . .
This will is the result of the other faculties ; and it is not be-
cause it is wanting in the idiot, or lunatic, that they are irres-
ponsible ; but rather because they are ignorant of the rules
which should direct it.

There is but a slight transition from this \.o perversion of the
7noral faculties one of the most mysterious points in psycho-
\og\\ '

The abrupt changes which may occur in a man's tastes, in
his inclination, in his manner of living, in a word, in his social
aspect, are worthy of attention. Modifications of this nature,
when they do appear in a slow and progressive manner, do not
arise from the action of moral influences, and can only arise
from a change in the nervous system. Thus it has long been
remarked, that unusual gaiety in a habitually grave indWidual
may denote the approach of an attack of apoplexy. It is the
same with those who suddenly seek for noise and bustle, after
having loved retirement and quietness for a great part of their
life. We have known a man, aged 57, who^ having up to that
led a grave and even austere life, gave himself up to the pursuit
of amusements unsuited to his age, and was a few months after
seized with sudden and complete apoplexy {apopleziefoudroy-
ante.) A complete change in the turn of the ideas, when it is
not the result of advanced age, when it manifests itself in a
short period of time, and when it cannot be traced to the action
of moral influences is very suspicious. We have known a voung
physician who exhibited this phenomenon in a very marked
manner, and who a short time after, was seized with 'paralysis
of the insane. When we knew him three years before, he was
very free in his assertions, and inclined to*^ exaggerate ; but he

108 Cerebral Disease. [February,

had become discreet, and wary in his speech. His former con-
dition, and the medium in which he had hved, showed sufficient-
ly that this change could not be the eifect o^ progressive amend-
ment; we considered that there was some disease, and our
opinion was ultimately confirmed.

It is conceivable, that the same psychological perturbation
w^hich changes the moral sentiments may likewise impair the
sentiment of self-preservation ; and hence that suicidal melan-
choly may mark the commencement of a severe affection of
the brain. The disease is, moreover, very often conjoined
with a lesion of the intellectual and affective faculties.

II. Premonitory Signs furnished by the Sensorial Func-
tions. Most of these are furnished by the sense of vision. We
will merely mention dimness, the appearance of objects as if
coloured red, photophobia, &c., which may indicate threaten-
ing meningitis, as well as cerebral hypei'semia ; these symp-
toms bear an especial relation to acute diseases of the encepha-
lon. These signs may exist several years before the explosion
of the disease. Before attacks of apoplexy, impairment of vis-
ion sometimes exist in a high degree without being known to the
patients,especia]ly when, as is most commonly the case, it is not
sufficient to prevent them from seeing those who are about them.
The mistake is the more easy, as this symptom may be limited
to one eye ; the other compensating for the weakness of its
fellow. Amblyopia is a frequent symptom ; sometimes there
is a complete blindness, as in the case of the Baron Hornestein,
cited by Wepfer {Anatomia Apoplecticorum) who became
blind three weeks before a fatal attack of apo[)lexy.

A valuable sign, belonging in some degree to what may be
called the expression of the eyes, consists in a want of parallel-
ism in these organs ; it is not squinting, nor is it the look of
hallucination. It seems pretty well defined by the following
expression : The eyes are not in the axis of the reason. There
may be certain defects in this relation pointed out between a
material object and a moral fact ; but those persons who are
accustomed to scrutinize the human look, and to see reflected
in it the different passions will easily understand me.

The phenomenon of exaltation of special sensiljility, as a
precursory sign of a severe encephalic lesion, is sometimes met
with. It is in this case, as in other circumstances in which it
is observed, one of the most mysterious problem.s for the phy-
siologist. It is well known that hearing often becomes exces-
sively acute before attacks of apoplexy. The patients, incom-
moded by the least noise, become irascible ; they perceive
distant sounds which are unheard by those who are with thenj.
The fineness of hearing must be distinguished froni the percep-

1852.] Cerebral Disease. 109

tion of strange and imaginary sounds, which is nothing but a
sensorial hallucination.

The sense oi hearing may present the same modifications as
that of vision. Some persons are tormented with drumminc];
in the ear, with- continued or intermittent tinkling. Some be-
lieve that they hear the most strange noises. These hallucina-
tions are by no means the constant precursors of an encephalic
attack; they may be connected with simple perversions of the
sensorial function.

Premonitory Signs furnished hy the Organs of Motion and
Sensation. The alterations of the muscular functions present
great variet}', from the simple hesitation which we have al-
ready noticed, to paralysis which is complete, but which, on
account of its nature and its seat we shall denominate irregular
paralysis. It is not uncomn)on to observe a state of general lan-
guor which makes the patients seek for rest for xhefar niente.
Van Swieten has remarked, in treating of apoplexy: Frimo
oritur languor et amor quietis et otii. At other times those
who are about to be attacked with cerebral disease are much
agitated, and expend a great amount of activity in their move-
ments. Dr. Tessier has lately attended a lady, aged 60, who
from the critical age, has been subject to attacks every month,
at the period when she used to menstruate. She loses consci-
ousness ; and after having recovered her senses, is paralysed on
one side of the body, with great embarrassment of speech.
These symptoms continue some days, and gradually leave her
to return at the fixed period. But some days before the new
attack, this lady, though usually quiet and peaceable, exhibits
much agitation ; she cannot remain in her place, and those who
are about her always know what this sign means. In this
case we recognize an example o^ periodic nervous apopUxy.

Impairment of muscular motion is exhibited in various de-
grees. It is especially remarked in the lower limbs, which
seem to bend under the weight of the body, and render the gait
rather unsteady. The debility is the more striking if the per-
son be young, and has no apparent cause for it. Portal was
able to prognosticate an attack of apoplexy in a gentleman ap-
parently in perfect health, from observing a slight fixedness in
the left eye, and a slight weakness in the leg of the same side.
The dignitus semi-mortuus, noticed by Dr. Marshall Hall, is
one of those instances of irregular paralysis, of which it is so
important to determine the true signification. Some time ago,
we saw the followinsj case: A man, aged 54, one day called
on us. In conversation, he jokingly noticed a sort of deadness
which he felt in the little finger of the left hand, while the rest
of the hand was able to perform its ordinary functions. We

110 Cerehral Disease. [February,

advised him to put himself under treatment : he neglected this
advice, and some days after was seized with cerebral conges-
lion, which left his faculties remarkably weakened. The dizi-
ius semi-mortuus has sliortly since been noticed in a valuable
communication from Dr. Gillet de Grandmont.

Irregular paralyses, which seem to arise from exhaustion of
the sources of the sensitive and motive powers, may appear
under circumstances in which they do not constitute a symp-
tom of such great importai^iCe. Such are those which some-
times follow hysterical convulsions, lead-colic, venereal abuses,
<&:c. Hei'e, these phenomena are connected with transient mo-
difications of innervation. The suddenness of the attacks, their
frequent isolation from other symptoms, their seat in parts dis-
tant from each other, while those lying between preserve the
integritv of tlieir movements, constitute the exceptional charac-
ters of those palsies which are connected with a latent alteration
in the nervous centres. We must not lose sight of the difficul-
ty of deglutition which some patients experience some time
before being attacked ; as well as the seirii-paralysis of the vo-
cal cords and tongue, giving lise to stammering or aphonia.
The paralysis of the uppej* eyelids, which become oedematous,
is also a sion of great value

General sensibility may be abolished, simply diminished or
exaggerated. The first two forms alnjost always follow mus-
cular paralysis ; but they may exist alone. Sensibility may be
exaggerated in two forms. The patients may present hyper-
sesthesia, or exquisite sensibility of the whole cutaneous surface ;
so that the least touch troubles them. This is an increased
anormal sensibility an exaggeration of the sense of touch, cor-
responding; the exaltation of the sensorial faculties which we
have already studied. Sensibility may also be exalted in the
form of pain ; and this merits our most careful attention. Vio-
lent pains, precursory of a severe cerebral lesion, have often
been mistaken for neuralgia. The same is the case in treating
cephalagia, supposed to be dependent on dyspepsia: and this
error is more readily fallen into, as the stomach is often disor-
dered. The diagnosis in these cases is sometimes difficult ;
but the duration and violence of the pain will lead to the sus-
picion, that there is something more than ordinary headache ;
and that, although the functions of the stomach are troubled at
the same time, the headache is often too intense to be accounted
for by the state of that organ. The patient cannot in general
endure a warm room, nor the noise !Tiade by persons about
him, nor even the fatigue of agreable conversation, without
suftering an aggravation of his headache. The paroxysms are
sometimes accompanied with vomiting, and sometimes with

I

1852.] Cerebral Disease, 111

violent beating in the head. If with these symptoms we remark
paleness of lace, and weakness of pulse, and if active measures
have been employed without benefit, we are led to suspect the
presence of organic lesion.* Painful cramps are not unfre-
quent. Portal has seen patients who suflered severely fron:^
cramps in the legs before an attack of apoplexy.

Cutaneous sensibility presents other singular modes of per-
version. A case is related of a man who, several months be-
fore being attacked with apoplexy, experienced from time to
time an absolute loss of sensibility on five or six isolated points
of the skin of the thorax, each of about the size of a five-franc
piece. Here the skin mi^ht be pinched without causing any
pain ; beyond, the sensibility was perfect. The partial aboli-
tions of sensation were not constant. On some days there was
not the least diminution of sensibility ; then suddenly, and simul-
taneously, it was annihilated in the isolated portions. Such
unusual modifications of functions directly dependent on the
brain, ought to furnish us with arguments in favor of the possi-
bility of moral and instinctive perversions, and of their depen-
dence, not on the corruption of the moral faculty itself, but on
a latent pathological condition of the organ. Hence arises the
doctrine of irresponsibility.

It is in the life of relation that indicatory, signs are especially
to be looked for. At the initial period of severe cerebral dis-
ease, organic life reveals tew or no disturbances. The symp-
toms which may exist under this head only acquire value in
connexion with those which are derived from the life of rela-
tion. The brain must be much afiected to produce changes in
the nutritive function. Exce))ting sleep, which is one of the
confines of animal and organic life, there is not in the latter
any essential functional disturbance. In the initial period, most
patients have lost the power of sleep ; or, if this function be
performed, it is rather a fatiguing drowsiness than refreshing
sleep. The digestive functions present no other special disor-
der than obstinate constipation, which is often difficult to be
overcome by drastics. The eyelids sometimes becomes oede-
matous; and, in some subjects, attacks are preceded by small
efiusions of blood, even in the tissue of the conjunctiva. The
secretions are but little altered. The urine is sometimes high-
ly albuminous ; but this is a subject for fuither researches.

[RanJdng's Abstract,

* Abercrombie. Diseases of the Brain, p. 453.

1 12 Symphyses of the Pelvis and its Treatment, [February,

Pathological Relaxation of the Symphyses of the Pelvis, and
its treatment. By M. Ferdinand Martin. (Translated for
this Journal.)

After parturition, there sonnetimes exists a relaxation of the
various symphyses of the pelvis ; this is ordinarily produced by
the patient leaving her bed too soon. As it is accompanied by
various and grave sympathetic phenomena, as also by other
co-existent lesions, it is not surprising that it is frequently, even
I)}" the most experienced physicians, sometimes mistaken for a
uterine engorgement, and sometimes for a retroversion of the
organ.

In women effected with relaxation of the symphysis pubis,
the erect posture is particularly difficult, sometimes even im-
possible. The patients then feel an acute pain in the sacral
region, with a numbness in the whole extent of the abdominal
members. Generally, after making ten or a dozen steps, they
are obliged to sit down. It frequently happens that the motion
at the symphysis pubis, caused by walking, produces a tension
of the tissues surrounding the urethra, and provokes a pressing
and painful desire to ui'inate.

The diagnosis is rendered more cei'tain by the following ex-
amination : If the physician holding the iliac ci-ests makes the
patient walk a few steps, he perceives that the os innominatum
upon which a small portion of the weight of the body rests,
rises very sensibly, whilst the other bone sinks notably. Fur-
ther, if by the aid of both hands it be attempted to produce
movements in an inverse direction to the iliac bones, it is plain-
ly perceived that there is a great want of the normal solidity
of the symphysis.

Finally, if it is ascertained that the impediment to standing or
walking began during the latter stages of pregnancy, there can
be no doubt but that it is a permanent relaxation of the sym-
])hysis pubis, and the efficacy of appropriate treatment renders
the diafrnosis certain.

M. Martin has always observed that the retention of the iliac
bones against the sacrum restored to the patient, in a very short
time, almost the entire freedom of motion. The apparatus
which he always used with success, consists of a large belt of
steel, padded on the inside, embracing the entire pelvis, passing
over the external iliac fossa in the space between the great
trocanter and the crest of the ilium. The belt should be tight-
ly drawn. With this apparatus, a lady who could not go up
twenty steps without stopping two or three times, was enabled,
after wearing it two days, to walk about a large garden alone.
This, however, is not ahvavs the case. One of M. Martin's

1852.] Lt gaiter e on Animals. 113

patients could walk with the aid of the belt, but as soon as she
would lay it aside progression become very fatiguing. M,
Martin was of opinian that another pregnancy would produce
a pernnanent cure, providing the patient wore the belt during
the time and kept her bed for at least two months after confine-
ment, without leavinsr off the apparatus. This plan succeeded,.
and two years after M. Martin saw his patient, when the long-
est walk could be taken with ease.

It is proper to state that, the disease here described is not
always so grave as in the cases cited by M. Martin. He chose
the worst, to show in a clearer light the character of the in-
firmity to which he has called the attention of his colleagues^
\_Journ. des Con., Medic o-Chirurg.

Experiments with the Ligature on Animals.

Doctor Hester :

Dear Sir At yoor requests, I give you a succinct descrip-
tion of experiments made by me on living animals. Thefol-.
lowing is a faithful and correct account of said experiments,,
with their bearings on the actual state of Physiology and Pa-
thology, etc.

Some years ago (I was then a student in the Charity Hos-
pital of New Orleans) I noticed repeatedly, that patients dying
in the verv last stage of Phthisis Pulmonalis, offered at post
mortem examination, strong thick cords crossing the cavernous
hollows made by the progress of the disease. Upon close ex-
amination, I found that these cords were the pulmonary arteries
obliterated in that part of the lungs. Such a pathological fact
suggested the idea of applying this natural process of oblitera-
tion of the arteries in the cure of aneurisms. During mv stay
in Mexico, I have been able to make experiments on living^
animals, and such experiments have confirmed the views I
entertained on the subject.

On three living sheep, I took up one after the other the fol-
lowing arteries : The two carotids, and the two femoral.

After the first week, I noticed in all three an accelerated
process of cicatrization, without any apparent suppuration, al-
though the wounds had not been united by sutures, or any other
means. At that time (Sth day) I dissected in one the part
where the ligature had been applied. Here I must say, that
instead of using the ordinary silk ligatures employed in the
operation of aneurism, and instead of tying the arteries (as is
usually done in the operation of aneurism) tight enough to cut
their inner coats, 1 used the common tape, and pushed it loose-
ly round the arterv, as is done in the case of a seton.

114 Ligatures on Animals. [February,

After a minute dissection, I noticed there was no perceptible
pulsation at the distal side of the artery. I withdrew the liga-
ture quite easily, as it did not press strongly on the artery. 1
could not perceive as yet any circulation in the above men-
tioned portion of the artery. I then cut the artery across, and
observed thnt it was completely blocked up by a thick coagu-
lated blood (the clot observed after tying an artery in the usual
way.) Withdrawing the clot, a jet of genuine arterial blood
came out.

The week after, (16th day) I dissected the neck and leg of
the second sheep, and found that the wound was completely
cicatrized. There was, as in the first case, no perceptible cir-
culation in the artery below the seat of the ligature. With-
dravvincT the ligatures, there was no pulsation ; cutting the arte-
ry, no blood came out ; the clot was firmer, and adhered to the
walls of the artery. I detached the clot with a little more
difliculty than in the first sheep, and arterial blood came out.

In the third sheep, (on the 22d day) the clot was more strong-
ly attached to the walls of the artery, and more firm, than in
the two first instances.

In none ofthe.se three sheep could I notice any suppuration.

Thinking that some infiammati(m and suppuration would
hasten the obliteration of the arteries, and render it more per-
fect, I performed successively the very same operation on two
more sheep, three dogs and one calf Instead of using simply
the tape line, as I had done in the first cases, I applied to it
some strong precipitate ointment, and took a great deal of care
in bringing daily a fresh portion of the tape line in contact
with the artery, and the parts surrounding it; It was with
difliculty that I produced inflammation and a little suppuration
in the sheep, but readily produced it in two dogs and in the calf.

After the 17th day, the obliteration of the arteries was per-
fect in all the sheep, the dogs, and in the calf

Now, what is the bearing of these experiments in the opera-
tion for aneurism especially in the large arteries? Evident-
ly, if performed on the human being, as I performed it on the
living animals, there is not the slightest risk of secondary
haemorrhage ; which, consequently, adds considerably to the
chances of success, considering that in man inflammation and
suppuration is more easily produced than in animals ; such in-
flammation would, at the same time, be propagated to the dif-
ferent coats of the arteries, and, consequently, promote much
quicker the obliteration of the arteries.

Yours, respectfully, J. Piernas, M. D.

San Luis Potosi, Mexico, 1851.

[New Orleans Med. and Surg. Journ,

1852.] Scutellaria Lateriflora, 115

On Scutellaria Lateriflora.

To the Editor of the American Journal of Pharmacy.

Respected Friend, The article in the last N"o. of the .Tonr-
nnl, page 370, by C. H. Cleavcland, M. D., on Scutellaria later-
iflora, calls to mind some of my experience, coinciding with his,
which I offer in hopes it may prove a benefit to some of the af-
flicted ; and because a remedy which is not much known, or
has but little reputation, requires testimony in its favor to call
it into notice.

About twenty-five years ago my wife had quite a severe at-
tack of tic doloureux on one side of her face, and as the scullcap
had been a good deal spoken of as a remedy for hydrophobia,
I determined to try it in this case, supposing its influence to be
exerted on the nervous system. By the use of two or three
pints of infusion, made with an ounce of the herb to a pint of
boiling water and taken in doses of a wine-glass full three or four
times a day, the disease appeared to be entirely relieved : in the
course of a week or ten days, however, it returned, when the
scullcap infusion was again resorted to, and continued several
weeks, after which there was no return of the disease on that
side. A few years after this period my patient was attacked on
the other side of her face, but the diligent use of the Scutellaria,
as before, soon relieved her, and she has, ever since, remained
free from that painful disease.

I have advised this remedy in other cases of tic doloureux,
and it has had equal success in some, while in others it has failed.
I have a'so given it in cases of tremor, from the abuse of alco-
holic drink, with happy effect, and in one case of great depres-
sion of spirits produced by dyspepsia. As to the after effect of
this nervine, my observation corresponds with that of Dr.
Cleaveland. Respectfully,

Wm, Stabler.

Alexandria, Virgina., 10th mo. I8th, 1851.

Fracture of the Acromion.

All physicians are aware of the difficulty of making a prompt
and correct diagnosis of many injuries of the shoulder, and of
the unmanageable character of fractures of the acromion, and
of fractures and dislocations of the clavicle. In previous num-
bers of the Transylvania Journal, I have spoken of the plan
adopted by Prof. B. W. Dudley in the management of fractures
and dislocations of the clavicle. I now propose to explain his
views in relation to other injuries of the upper extremity, and!
shall dwell more particularly on those, concerning which there
is an acknowledged imperfection in surgerv.

110 Fracture nf ths Acromion. [February,

Fracture of the acromion process \s more common than a
similar injury of any other portion of the scapula. It is caused
by a blow on the point of the shoulder, and may be recognized
by the flattening of the deltoid outline, and by observing that the
broken fragment of bone returns to its position when the arm
is extended at right angles with the body. By pressure, exer-
cised alons^ the spine of the scapula towards the acromial ex-
tremity with the arm extended, a crepitus may generally be
produced. When the arm hangs by the side, more or less pain
is produced by the dragging of the central fibres of the deltoid
muscle upon the fractured process. Extension of the arm, by
relaxing the deltoid and permitting the broken fragment to re-
treat into the proper position, affords relief, and restores the
natural relations of the acromion. The treatment would seem
to suggest itself, after a knowledge of these facts in the history
of the injury. The complete relaxation of the deltoid muscle is
the only means of securing the coaptation of the fractured pro-
cess, and it is perfectly evident, that the dressings recommended
by surgical authors do not tend to produce such relaxation.
Dessault's bandage is worse than useless ; Sir Astley Cooper
admits that his jnethod will not procure ossific union, and John
Bell is strano;elv in error when he directed the arm to be bound
to the body and pressed upwards so as to render the shoulder
more prominent. The effect of this treatment may be readily
inferred fi'om the fact that the shoulder is thereby rendered
more prominent. The pressure of the head of the os-humeri
upon the central portions of the deltoid muscle can have no other
effect than to draw the fractured acromion farther out of its
place, and thus defeats the prime object of treatment.

If the fracture results in ligamentous union, a long time is re-
quired for the restoration of the perfect functions of the arm.
In one case that I had an opportunity of observing, the patient
could, with considerable difficulty, raise his arm at right angles
with the body after the expiration of 12 months ; and it was
not until long after that period that the perfect and ready use of
the member, in those movements requiring the extending power
of the deltoid muscle, was recovered.

If that gentleman had submitted to a confinement of three
weeks duration, upon his couch, with the arm extended so as
to relax the only muscle that tends to displace the broken bone,
he would have arisen with a perfect limb.

It is necessary to secure the arm in the extended position in
order to maintain the advantage while the patient sleeps. To
depress the limb at any time prior to tolerably firm provision-
al union, is a backward movement to the starting point. By
this simple resource, a fractured acromion may be perfectly

1852.] Hints on Cancerous Affections. 117

cured, and with no sacrifice on the part of the patient, except a
confinement of 15 or 20 days. At the expiration of two weeks,
if the extended position has been carefully maintained up to that
lime, tlie provisional calkis will be strong enough to admit of
the cautious depression of the limb ; but it would be unsafe to
use the limb before the expiration of the fourth week subse-
quent to the fracture. This treatment is founded upon the me-
chanical impossibility of adapting any contrivance which will
keep the fractured bone in position exclusive of the extension
of the arm and upon the demonstrable proposition that by re-
moving the traction exercised upon the acromion by the central
fibres of the deltoid muscle, the broken fragment will be drawn
back into proper position by the trapezius muscle and the cora-
co-acromial ligament.

Fracture of the coracoid process, requires no other treatment
than the application of an ordinary sling, which will sustain the
arm drawn forwards into an easy position in front of the chest.
This position relaxes the coraco-brachialis, biceps, and pectora-
lis minor muscles, and permits the fractured process to retreat
into its proper position.

It is remarkable that Mr. Skey bareh^ mentions fracture of
the acromion in his Operative Surgery, and says not a word in
relation to the treatment. The subject of Fractures and Dislo-
cations does not enter, at all, into JNIalgaigne's treaties on Oper-
ative Surgery. These are sad defects. There is no subject of
more interest to practitioners generally, and in relation to which
plain and simple directions would be of more service. Frac-
tures and dislocations are presented in the every day practice
of physicians while capital operations are rare.

[Transylvania Medical Journal.

Hints on Cancerous Affections. By Professor W. Stone.

*In the October number of the ''Register," I called the atten-
tion of the profession to the use of the phosphate of lime and
nitrogenous diet in depraved states of the system in scrofulous
diatheses. Now, as it is believed that true cancer never occur-
red in decidedly scrofulous subjects, it is fair to infer that an op-
posite course of diet is more appropriate ; and it is very proba-
ble that by directing our attention to the subject, we may be
able to fix upon some agent that will aid in arresting the pro-
gress of this dreaded disease. Experience has shown that the
least nitrogenous diet is best in this disease. In the memoirs
of the celebrated Nathan Smith, written some twenty years ago
by his son Nathan R. Smith, of Baltimore, are found the views

N. S. VOL. VIII. NO. II. 8

118 Hints on Cancerous Affections. [February,

of this remarkable man, which were based purely upon obser-
vation, without a chemical idea to theorise upon. His diet for
this disease was vegetable ; and of this he thought green corn
the best. A case is related of a lady on whom he operated for
a very large cancerous breast, involving the glands of the axilla.
It was in the season for green corn, and the patient was put
upon this article of diet. Sufficient was gathered when in the
milk, and dried, to last until the season returned, and this made
soft by boiling, and used with little or no seasoning. He states
that whenever she attempted to return to her usual diet, she ex-
perienced shooting pains in the part, but finally, after two years,
she gradually changed her diet. The notice of this case was
given seven years after the operation, and there was no appear-
ance of a return of the disease. Corn in this State contains, I
believe, more phosphorus than any other vegetable, but whether
this renders it more suitable to this disease. I am not prepared
to say. Professor Bigelow, of Boston, relates a case in which
diet kept a cancerous affection dormant, at least, for many years,
or rather he states that it was gradually getting well. This was
the case of the late distinguished surgeon Amos Tw^itchell, of
Keene, N. H., with whom I was well acquainted. I dined with
him in 1848 ; he furnished a good dinner for his guests, but
dined himself on milk and berries. Vegetables of the blandest
kind constituted his main food, but I do not think he confined
himself to any one article. The disease was seated in the in-
ner canthus of one of his e\es, was removed many years ago
with the knife, but the cicatrix soon took on the same
degeneration, and he relied upon diet ; and although it might
appear to a gourmand a very meagre diet, he was able to under-
go more fatigue at the age of 64 than many young men. I
mention these cases not as being remarkable in themselves, but
because they illustrate the effects of diet, and at the same time
cover the view^sof two medical men, remai'kable for their powers
of observation.

Asa remedy to be given in aid of diet, I think arsenic, with
our present knowledge, is the best. There was an able article
in the London Lancet, I think in the fall of 1849, on the use of
arsenic in lupus and canceroid diseases, which was interesting
because it showed how it should be given to be useful. The
preparation used was Fowler's solution, in doses of from two to
five dropSy and continued for a long time. The writer also
cdled attention to the fact that instead of increasing the dose
after long use, it should be diminished. I have always conten-
ded that alteratives, to be useful, should be given in such doses
as will not disturb the natural functions. The solution is advi-
sed in such doses as will permit its use for an indefinite length of

1852.] Dislocation of the Femur, 119

time, without producing any manifest specific effects. I have
great confidence that this, toiiether with diet, will exercise a
very salutary influence over this dreaded disease.

\_New Orleans Med. Register.

Dislocation of the Femur downwards, reduced after two months.
By Professor W. Stone.

Mr. B., a very athletic man, was received into my Infirmary
August 21st. He stated, that on the 22d of June, in Western
Texas, while taking shelter from a storm, the house was blown
upon him causing him serious injury, which confined him over
a month, when he was able to move, by the aid of crutches, and
finally made his way to my Infirmary. The thigh was greatly
abducted, slightly flexed, and lengthened to an unusual degree';
npparently four or five inches, and it gave great pain to move
it to any extent. The reduction was effected by making exten-
sion and counter extension, in the usual way, to dislodge the
head of the bone. The patient was placed upon his back, and
the extension made in the direction in which the limb was found.
AVhen it was deemed that sufficient extension had been made,
lateral force was applied to the upper part of the thigh, by means
of a sheet, of which I took one end, and two strong men
the other. The body was carried laterally, the knee being
fixed by the extending band, until the limb was on a line with
the body, or perhaps a little adducted, when I put my foot
against the crest of the ilium and gave one strong pull, nearly
to my full strength, when it yielded with a sound as if lacerating
a firm tissue. The limb could be adducted and moved in any
direction, but as soon as the effect of chloroform subsided, there
commenced more pain on the inside of the thigh, and in the course
of the obturator nerve than in the joint, which lasted several
days. After the patient was put in bed, the limb appeared, in
some positions of the body, to be an inch or more longer than
the other ; indeed about as much lengthened as is usual in dislo-
cation into the thyroid hole. As soon, however, as the pain
and soreness subsided, so as to allow the limb to be straightened,
a careful measurement, from fixed points, showed that it was
the same length as the other ; the apparent lengthening being
produced by the obliquity of the pelvis, caused by walking upon
crutches and leaning to the sound side, to maintain the centre
of gravity. The limb was slow in recovering strength, but the
patient at the present time, walks about the city with the aid
of a cane. [Ibid.

320 Bismuth in Typhoid Fever, [February,

Suhnitj-ate of Bismuth in large doses in Typhoid Fever. By
M. Aran.

M Moneret had previously noticed the good effects of sub-
nitrate of bismuth in choleriform diarrhoea, and in the diarrhoea
of children. M. Aran had administered it in a case of obsti-
nate diarrhoea following typhoid fever ; its success was rapid,
and in twelve days the patient was convalescent when the sub-
nitrate w-as administered, and that the completion of the cure
was delayed only by this diarrhoea, which continued with much
obstinacy. The case, therefore w^as one of that diarrhoea which
almost always accompanies typhoid fever towards its termina-
tion, and which is most frequently connected with lesion of
Peyser's plates, and with an irritated state of the intestinal
mucous membrane ; for at this period, the utility ofalvine eva-
cuations is indisputable, purgatives having the property, if not
of abridging its duration, at any rate of preventing ov render-
ing less intense the complications of other organs. But because
this diarrhoea, while it continues within certain limits, does not
present any special indication, at least of active interference, in
the earlier stages of the typhoid fever, it does not follow that it
should be disregarded when it lasts beyond its ordinary term,
during recent, or not yet complete convalescence. Sometimes
indeed, after a few davs fever, appetite returns, fever diminish-
es, the tongue becomes moist, the meteorism disappears, the
stomach is indolent, and yet the stools continue liquid and fre-
quent, and the patients cannot bear the slightest nourishment.
In this state amylaceous lavements containing a few drops of
laudanum are ordinarily employd, but often without success.
The physician is thus puzzled to raise the strength of the patient ;
}f he allows food, he has to fear enteritis ; if he leaves his pa-
tient to absolute diet, his strength, instead of increasing, dimin-
ishes daily ; he should then have recourse to subnitrate of bis-
muth as a powerful auxiliary. [Bulletin General de Therapeu-
fique. Stethoscope.

Diuretics in Diseases of Children during Dentition, By G.
W. Garland, M. D.

There never was an age when the human mind seemed to
nm riot in,|is w^ell as out of our profession, amidst the maze of
metaphysics and speculation, so completely as the present. No
sooner is a suggestion made, than the idea is thrown into the
laboratory of science, and undergoes an immediate test. And
of all the subjects upon which the minds of Pathologists have
been let loose, towards the perfecting of none have their energies

1852.] Diuretics in Children during DentitioTu 121

been more praiseworthily employed, than in acquiring accurate
knowledge of the character or properties of the renal secretion
in disease, and in pointing out the revulsive action of diuresis
in various conditions of the system.

Observation has taught us tliat the effect of irritation, both
general and local, is to diminish intestinal and urinary secretion;
that we have immediately following this, a febrile state, which
if allowed to continue may quickly produce alarming symptoms
and in youngsubjects cerebral disturbance is among the earliest.
One of its most prolific sources is the irritation produced by
dentition. We may safely affirm, however, that there is but
little danger from dentition so long as the kidneys act freely,
however distressing the symptoms may be. The same remark
will hold true in most cerebral affections of children, produced
from sympathy.

When there is scanty secretion of urine, the circulation and
all the energies seem clogged and oppressed. And who has
not witnessed the almost instantaneous relief following a free
discharge of urine ? The mind, as well as body, becomes more
li^ht and vivacious.

We learn then, by our own feelings, to anticipate the results
which must attend the stimulation of the kidneys in many dis-
eases.

Physicians do well, therefore, to pay particular attention to
the condition of the kidneys in all febrile and irritative diseases,
especially in infancy and childhood. The too common practice
of combining alteratives and cathartics does well where the case
is not immediately urgent ; but a diuresis which will often
prove critical, and always be followed by the ver}- best results,
may be promoted almost at once by a purgative, composed of
senna and salts, followed by frequently repeated doses of nitrate
of potassa, which I conceive to be the most simple as well as
the most efficient means that can be resorted to.

In health and disease the kidneys are carrying on an active
eliminatory process, and the skiltul physician will avail himself
of it in treatin,!! all diseases, particularly those numerous and va-
ried febrile affections of children, during the two or three first
years of their lives.

Every practitioner of experience who may chance to read
this imperfect article, will have his thoughts turned back upon
some little patient which caused the depest solicitude, while suf-
fering from a tardy dentition. They will remember that while
the little sufferer lay in a half comatose state, tui-ning its head
from side to side, tiiey learned with infinite anxiety that the pa-
tient had not passed urine for the last twelve or twenty-four
hours. A few hours more, and a crisis has come. The alter-

122 Puncture of ths Stomach. [February,

ative treatment tells by frequent, dark discharges, that the patient
is under its influence. The kidneys feel its power, and respond
by copious discharges of urine, when the little sufferer is, though
but a few hours before, on the verge of a fatal coma, free from
danger.

The object of this communication is to tell the profession,
that in my opinion, this moment of intense concern and point of
imminent danger may be avoided by early and repeated stimula-
tion of the kidneys with nitrate of potassa combined, where the
state of the bowels will admit, with Rochelle salts. I would
not be understood to recoftimendthe preclusion of all other treat-
ment. Mucilages and sedatives are important, and, indeed,
must never be dispensed with ; but potassa is the hobby upon
which 1 hope some member of the profession will mount, who
has a less tardy pen than mine, and give me through your valu-
able journal, the results of his experience. [iV. H. Journal of
Msdicine,

A Case of Puncture of the Stomach, with Protrusion for six
hours. Reported by Charles William Ashby, M. D., of
Culpepper C. H., Va.

A negro boy, 6 years old, the property of Mr. R. B., fell upon
a pair of sheep shears, which he had in his hand, whilst running
down a hill. The instrument penetrated the stomach obliquely
from above, just grazing the left side of the sternum and edges
of the ribs, making a flap-like orifice in the integuments.

I was called in consultation by my friend. Dr. P. C. Slaugh-
ter, and found nearly the whole stomach protruded, and dis-
charging its contents through an aperture about three-quarters
of an inch in length.

Aware of the controversy which has long existed among
able surgeons, on either side, as to the propriety of stitching
the stomach or bowels, the everted edges and gaping appear-
ance of the wound in the stomach made it necessary, I thought,
that a stitch should be taken. To avoid irritation, as much as
possible, with the finest needle and silk I \entured to take a
single stitch through the middle of the wound.

Before I saw the case, Dr. S. had made some efforts to re-
store the organ to its natural position, but it did not occur to
me at the time that I should have any serious difficulty in re-
placing it, at least after enlarging the orifice a little. But such
was the unruly nature of the boy his violent screaming and
resistance, the nausea and vomiting which constantly attended
the handling of the stomach that notwithstanding I enlarged
the orifice several times to a considerable extent, our best

1852.] Puncture of the Stomach, 123

efforts not only failed to restore the organ, but it seemed to
protrude the more.

At this juncture, fearing the irritation resultincj from further
efforts, I suggested the use of chlorotbrm, notwitfistandincr the
necessary delay of having to send several miles for it. Whilst
under its influence, I found it necessary again to enlarge the
aperture slightly, and then had no farther difficulty, although
the boy vomited as freely as before from handling the organ.

The wound of the integument was rather ragged in its ap-
pearance, and of course a little bruised by our efforts.

The wound of the stomach was brought directly opposite
the tegumentary wound, and gently retained within its verge.
A single stitch, patent lint, with cold water and a bandage,
completed the dressing.

The patient was placed on his side, absolute rest was enjoin-
ed, and soon afterwards a large dose of opium was administered.

From the time of the accident until the completion of the
dressing six hours intervened, and yet the boy retained his
strength most remarkably.

Under the influence of the opium our patient rested well the
first nicrht.

2d day. This morning the pulse is a little excited, and face
flushed vs. to make a decided impression ; and this was re-
peated twice during the day, and opium after each bleeding
absolute diet enjoined but the boy desires no food.

3d. The wound had a healthy appearance, but tenderness of
the abdomen and tympanitis greatly increased our fears as to
the result. The pulse feeble and quick ; the bowels not moved
since the accident.

Turpentine enema and a succession of blisters were ordered,
and after the bowels were moved the opium was resumed.

4th. Our patient evidently improved, tympanitis and tender-
ness diminished, pulse more quiet, countenance and general
aspect of things more encouraging takes a little hot water tea
this morning, for the first time gum water and opium contin-
ued.

5th. The wound not healed by the first intention has a dark
spot immediately over the wound of the stomach, and is dis-
charging a very offensive sanious matter. A soft poultice, and
the same prescription continued.

6th. The ligature came out this morning. The same pre-
scription continued. From this date the boy gradually recov-
ered, without any particular change in the treatment.

Re?narks. 1st It has occurred to me, that possibly it would
have been better for me to have restored the stomach, at least
partially, before the stitch was taken, as I ran the risk of break-

124 Ohservatione on Pustule Maligne, [February,

ing out the ligature by the subsequent efforts at reduction ; and
I am sure that the accumulation of gas, though some escaped
with an audible sound several times, did not increase the diffi-
culty.

2d. This case was admirably adapted to the use of chloro-
form, and illustrates most happily its incalculable value, when
used with discrimination.

3d. As your journal is eminently practical in its character,
for the benefit of the younger members of the profession, it may
not be amiss to allude briefly to what I conceive to be a most
important principle in our profession, viz : that an ivjlamed or
diseased organ must have rest. In this case, the stomach, in-
stinctively sensible of its wounded and disabled condition, re-
fused most emphatically, for four days, to re("eive any nourish-
ment not even gum water and but very little.of anything for
about ten days, notwithstanding the entreaties of master and
friends, contrary to our orders.

An inflamed eye instinctively excludes the light from itself,
so that the physician who interrogates nature intelligently, at
once gets the idea of confining his patient to a dark room, and
thus putting the organ entirely to rest. When the lungrs are
inflamed the patient breathes as much as possible by the abdom-
inal muscles, and lymph is thrown out, gluing the organ to the
side, doubtless to prevent motion and friction as much as possi-
ble. The same thing is true of inflamed bowels ; and because
some constipation, the result ofthis principle, exists, I have known
great error and I may say even death to result from goard-
ingand stimulating the organ with drastic purgatives.

This principle of rest is susceptible of very extensive appli-
cation in practice; and any inflammation can be cured, I believe,
to which it can be applied.

The immortal Physic, always true to the laws of nature, re-
cognized this principle in the treatment of coxalgia and other
diseases of the joints. In conformity to this important law of
the animal economy, in the above case, we gave opium Ireely,
to prevent nervous and vascular reaction ; and by thus adding in
keeping the wounded organ in a profound state of repose, it con-
tributed, it is believed, no little to the favorable result.

^Stethoscope.

Observations on Pustule Maligne. By C. Trenerhy, M. R. C.
S. E., L. A. C, Assistant physician to the Civil Hospital,
Gibraltar.

It appears that Christoba Martinez, aged sixty, a Portuguese
by birth, presented himself as an out patient of this hospital on

1852.] Observations on Pustule Maligne.. 12i

the 21st of October, 1850, suflering from the pustule maligne ;
he stated that he had been navigating on board a vessel laden
with wool and salted bullocks' hides Ironi Larache.

On the 14thot'the following month, Manuel Fernandez, aged
sixty, a relative of the above, was admitted with a similar disease;
he said he was a fisherman, and had not been near any wool or
hides.

Francisco Lapena, aged forty-eight, a Spaniard, and Fran-
cisco Docarmen, aged sixty-ei^ht, a Portuguese, both mariners
on board a Portuguese vessel laden with hides and gum, were
similarly affected.

Jose Pedro, aged fifteen, a Portuguese, had not been ne ar any
vessel, wool, or hides for fifteen days, but notwithstanding be-
came affected with the disease, as did also Juan Bayestero. who
had not been near the source of contagion for five days.

Juan Catania, aged thirteen, said he was standing on the
wharf one Sunday afternoon, when he experienced a slight
itching of the right upper eyelid, and the following morning the
characteristic pustule showed itself

On the 2nd of March, 1851, Lorenzo Pau, aged twenty-two,
became aflected, after beins: en2:a2:ed in weis^hins; salted hides
on board a vessle that came from Tunis.

The disease was characterized in the above j)atients expe-
riencing a slight itching in some part of the face, followed by a
small pimple having a dark depressed centre, surrounded by sev-
eral almost imperceptible phlyctinea, from which oozed an ich-
orous fliuid ; the glands of the neck on the affected side, but more
especially the parotid, became enlarged and indurated ; the
head, face, neck, and upper part of the thorax were afterwards
frightfully swollen and disfigured, the tumefaction having a pe-
culiarly tense and elastic feel ; the respiration was laborious, and
attended with a singular croaking sound whilst the voice was
of a disagreeable guttural nature.

Two of the cases terminated fatally a few hours after admis-
sion ; the one with symptoms of suffocation, and the other of
apoplexy ; the rest had a very protracted recovery, but more
particularly the first case, whose life was compromised on dif-
ferent occasions by extensive suppuration and sloughs having
formed on the left side of the face and neck, attended with fre-
quent alarming attacks of haemorrhage, so much so, that on one
occasion my assistants was suddenly called for by Drs. Merry
and Cortes, (who had the chief care of the patient at his own re-
sidence,) and it became a question whether the carotid artery
should not be ligatured ; the poor fellow was spared the opera-
tion,'and recovered after nearly four months suffering.

The treatment consisted in an immediate and free application

126 Chloroform in Micturitiou, [February,

of the actual cautery to the affected spot, and afterwards the
diacetate-of-lead lotion, which were sure to arrest the disorder
if applied within twenty-four hours from its appearance; the
bowels were cleared out by an aperient ; and other symptoms,
such as fever, suppuration, and sloughing, were treated on gen-
eral principles.

The disease is generally considered contagious, and to de-
pend upon carbuncles, or some peculiar virus existing in the
hides at the time the animal is slaughtered, which remains per-
manent, and whatever preparation the hides or wool under-
go, it cannot be destroyed ; therefore whether sitting on a hair-
bottomed chair, lying on a woolen or hair mattrass, carrying a
hair trunk, or wearing a woollen garment made with the affected
material, disposes us to the dreadful malady ; an opinion that is
certainly not borne out by my experience ; for it must have
been observed how few became affected out of the numerous in-
dividuals that were necessarily engaged in those vessels having
the hides and wool ; besides, the immunity experienced by the
medical men and relatives in attendance on those affected, car-
ries some weight in favor of its non-contagious nature ; but as
additional proofs, I may mention that Drs. Merry, Cortes, and
myself, have unavoidably had our fingers frequently covered
with the blood and matter issuing from the sloughs that formed ;
further, I have inoculated some kittens with matter taken fresh
from some of the above subjects without the slighest ill effects
ensuing.

I am, therefore, inclined to suspect that insects are generated
at same particular period, or under some peculiar condition of
the animal, and lodge in the hide or wool, from whence they
are apt to escape and seek a nidus in the skin of any other ani-
mal, which in its turn becomes affected after a short time with
the poison secreted sui generis of this insect. \_Londo?i Lancet.

Chlorofonn in jjainful Micturtion.

We condense from the Journal des Con. Medico-Chir. the
following case, by Wm. Guisard :

My son, three years of age, affected with painful phymosis,
would not atteujpt micturition nor defication, through a dread of
the excessive pain which these acts produced. On the 8th July
last, the patient whilst under the influenceof chloroform, taken
preparatory to the operation for phymosis, passed water and
feces remarkably freely. Twenty-four hours after, the patient
not having urinated, chlorform was again administered, and
was again tbllowed by the same result as at first. At this jime
the child was not entirely insensible, for he knew when the
water was passing, and said it gave him no pain.

1852.] Miscellany, 127

ill i s c cl I a n 2.

Mobile, (Alabama,) Nov. 1st, 1851.

Sir : At the last annual meeting of the " American Medical As-
sociation," I was appointed Chairman of a Committee, to report at
its next session, on the ^^ Endemic Prevalence of Tetanus.^' The
subject is a novel one, its solution ditiicult of attainment and not easily-
controlled by any individual effort.

Permit me therefore to solicit your assistance, to the extent of your
information, either from pergonal experience or inquiry, embracing
the immediate circuit under your professional supervision. My ob-
ject is not to tax you with long or elaborate replies, but simply, where
admissible, to furnish affirmative or negative answers.

Your attention to the following queries, and answers seriatim, for-
warded by mail to my address, on or before the 15th day of January,
1852, will not only serve the special object of the Association, but
particularly oblige. Very Respectfully,

Your Ob't. Serv't., A. Lopez.

1st. Are there any physical causes, in or about your locality, pro-
ductive of Endemic Disease, and if so, what form does such disease
assume ?

2nd. Have changes by clearing of lands, change of culture, or any
other circumstances, been the cause of such Endemic ?

3rd. Has Tetanus been of frequent occurrence, and if so, does it
hold an analagous or independent origin ?

4th. Does it follow the laws which govern other climatic Endem-
ics, in sufficient number, and simultaneous prevalence to warrant the
belief of its identical origin ?

5th. What form of Tetanus have you most commonly met with?

6th. The proportion of Traumatic to Idiopathic ?

7ih. Have meteorological variations governed the production and
character of the disease ?

8th. The average number of deaths from Tetanus ?

9th. Have adults or children been most liable to its attack ?

10th. What sex ?

11th. Proportion of whites to negroes ?

12th. Duration of disease previous to fatality ?

13th. Interval between cause and developements ?

14th. Does Trismus Nascentium ever observe an Epidemic or En-
demic character?

15th. Do you consider it Traumatic or Idiopathic ?

16th. Are negro or white children most liable to it ?

17th. Your belief as to its origin ?

18th. Proportion of deaths to cures?

19th. Have you found any form of treatment more successful than
another, in either Tetanus or Trismus Nascentium ?

128 , Miscellany. [February,

AMERICAN MEDICAL ASSOCIATION.

Committee on the Radical Cure of Reducible Hernia.
To the Members of the Medical Profession throughout the United States :

The undersigned are a Committee of the American Medical Asso-
ciation to report on ' the radical cure of reducihle hernia.''^ They
are desirous of obtaining from their professional brethren any infor-
rnationthat is calculated to throw light on this important and interest-
ing subject.

They therefore take the liberty of proposing the following questions.
An answer to any or all of them, or any liicts connected with the
branch of Surgery on which tliey are directed to report, would be
gratefully received.

1st. Have you been in the practice of treating reducible hernia
with a view to its radical cure ?

2nd. Have you ever performed any surgical operation for this pur-
pose ?

3rd. If so, please to describe the operation and the mode of per-
forming it.

4th. What proportion of cases, of all in which you have operated,
has been cured 1

5th. Have any alarming or fatal effects, in any instance, been
caused by the operation 1

6th. If so, please to describe them.

As the Report must be made at the Annual Meeting of the Asso-
ciation, to be held in Richmond, Va., in May next, it is desirable that
the answers to the above questions sliould be forwarded to any one of
the committee on or before March 1st, 1852.

Geo. Hayward, J

J. Mason Warren, > Commilte.

S. Parkman, }

Boston, November 26, 1851.

State Society.

The annual meeting of the " Medical Society of the State of Geor-
gia,'' will commence in Augusta on the second Wednesday in April.
As we anticipate a session of unusual interest, it is hoped the mem-
bers of the Association will come up from all parts of the State in
their full strength. The presence of the Faculty, generally, is
specially invited, and will be warmly welcomed.

C. B. Nottingham, Rec'g. Sec'y.
Macon, 12th, January, 1852.

Female Medical College of Pennsylvania. It appears that this
interesting institution has recently held its first commencement : " An
efficient orchester was in attendance and discoursed excellent music.
The exercises v/cre commenced with prayer by the Rev. Dr. Brainerd,

1852.] Miscellanij. 129

after which Prof. T. S. Langshore, delivered an interesting address
to the Graduates. The degree of " Doctor of Medicine" was then
conferred by Wm. J. iMuller, President of the College, upon eight
ladies, who had terminated their regular course of instruction, in
these words : " Ladies, after a careful and thorough examination, on
the part of our Board, you have been found fully qualified to become
practitioners in the healing art of ?.Iedicine and Surgery. In the
name and on behalf of the corporators of the Female Medical College
of Pennsylvania, I present you a Diploma, signed by the President
and Faculty, conferring upon you the degree of Doctor of Medicine,
with all the honors, rights and privileges appertaining thereunto.'^
The thesis were upon "Wounds," "Neuralgia," "Electricity,"
" Anemia," " Diagnosis," " True Physician," " Chlorosis," and
"Influence of the nervous system on the functions of Respiration and
Nutrition."

Kinesipaihy. A new system of medical practice has been intro-
duced into Europe, and it may naturally be expected that it will be
imported, and sooner or later practised among us. It would not be
strange were it to supersede and take the place of homoeopathy, to
which it is assimilated in other points besides a common lack of sci-
ence or reason. It certainly is superior on the score of economy
for though the doses to be taken in the former are infinitesimal and
therefore portable and cheap, in the latter no doses at all are required^
and all the mysterious movements and " shakings" are to be accom-
plished on the sick body itself! The originator of this improved sys-
tem seems to have been a Swedish fencing master by the name of
Ling, who is represented, in the Edinburgh Monthly Journal, to have
been an universal genius. He was successively a graduate in theolo-
gy, a volunteer in the Danish navy, a fencing master (in spite of gout
in his arm,) a lecturer on old Norse poetry, history and mythology, a
professor of fencing and gymnastics, a student of anatomy, physiology
and other sciences, a writer of poetry, and, withal, "a man of high
moral tone, pious, sincere and honest," and died in 1839 with tiie
honors of knighthood upon him. His qualifications are therefore un-
questionable ! All that Ling himself appears to have really accom-
plished, and probably all that he claimed at first, was set forth in a
work published by him, and may be considered as merely an improve-
ment in the practice of gymnastics and calisthenics. Upon this has
been engrafted the system of quackery alluded to above. M. Roth,
M. D., of London, who comes before us clothed with Ling's mantle,
has sent out an octavo of 300 pages, devoted to the treatment of dis-
ease by "movements," alias Kinesipathy. His interpretation of the
term is as follows :

" By the word ' movement,' in a medical and hygienic sense, is to
be understood every change of position and difference of form, deter-

130 Miscellany. [February,

mined by time and amount, in the whole body, or in any part of it,
and which may be produced by tlie organism itself, or by any animate
or inanimate mechanical agent."

In accordance with this definition, there are a great variety of
movements quite as many as there are dilutions and potencies in the
homoeopathic system and each and all possess great power over the
human body, as is rendered plain by another quotation :

"Whatever exists in our body, either as a part of it or as a foreign
substance, must at a certain moment have a definite shape ; therefore
every change of the space in one part necessarily produces a corres-
ponding one in the surrounding tissues a change that is thence pro-
pagated to the most remote parts o^ tlie body, and which depends,
with respect to its form, upon the amount of the alteration produced
by the first movement."

Lest any one should still be in the dark, however, respecting what
kinesipathy really is, we copy the full definition of one of the move-
ments and its effects. It is called the

" Chopping Movement. Chopping consists in alternative short
blows, produced by the external sides of both the operator's hands.
Choppings are principally used on the posterior surface of the trunk,
chest, and also on the limbs. If it is desirable that the succession
produced by this movement shall be less and softer, then the chopping
is done with the external edges of the two little fingers, v/hile the other
lingers are spread apart, but not kept spasm.odically fast, so that they
act also by striking upon the little finger.

" Chopping may be confined to one part only, or may be exercised
on a larger surface, by constantly moving the position of the hands.
The chopping is called a ' longitudinal' one, if the hands are moved
in the longitudinal direction of the trunk or of the limb ; and a 'trans-
versed' one, if the blows are executed across the limbs.

^^ Effect. Choppings produce generally a venous absorption in
the capillary texture, not only of the external skin and the tendinous
expansions, but also, if more strongly used, in the muscles and bones ;
in imperfectly paralyzed muscles they excite the innervation both of
the motory and sensitive fibres. If directed on the lower extremities,
on the soles, they act very well in heemorrhoidal complaints, head-
ache, &c. On the chest or along the spine, there are efficacious
specific movements in certain complaints of the chest, partly by their
direct influence on the muscles of the chest, partly by the tremulous,
passive vibration communicated to the lungs."

Then there is the ''shaking movement," the "rising-up move-
ment," the " letting-down movement," " transversal chopping," " vi-
bration," &c. &c., which we have not room to describe. These
" movements" are all claimed as a remedy in acute as well as chronic
diseases. In gonorrhoea, even, cases are brought forward to show
their great efficacy. Can quackery and imposture "further go ?"
It does really seem as though we might hope that "things will come
right at last," when such a multitude of absurdities and inconsisten-
cies are countenanced and supported by those who break away fron>.

1852.] Miscellany, ISl

or who never have entered, the ranks of legitimate and scientific prac-
tice. [Med. and Surgical Journal.

Discovery of the Male Acarus Scahiei. One of M. Cazenave's
pupils, M. Lanquetin, has just found the male acarus scabiei upon
the hand of a patient affected with the itch. It seems that this acarus
had long been sought for in vain, and some works on skin diseases do
not even mention its existence. As this parasite is very small, being
less than half the size of the female, it had hitherto escaped detection.

[V Union Medicale. Med. News.

Suhsfituiion of lodaied Oil for Cod-liver Oil. M. Champouillon
gave to the Acad. Med. of Paris the following results of his experi-
ments :

102 phthisical patients were treated with cod-liver oil. Of these,
51 were in the first stage, of which 21 were cured; 37 were in tlie
second stage, of which 9 were cured, 3 died; 14 were in the third
stage, of which 6 were cured, 4 died.

75 other phthisical cases were treated with iodated oil. In none of
these did any amelioration take place ; in many the disease was ag-
gravated. [Ibid.

Medical College of Constantinople. This school consists of two
departments. The first comprises the study of the Turkish, Arabic
and French languages. Geography, History, Cosmography and Ma-
thematics. The second that of Medicine proper. Prof, of Botany,
Zoology and Surgical clinic, M. Caratheodori ; Chemistry and Phar-
macy, M. CoUeja; Physics, M. Basilides ; Anatomy, M. Warthbich-
ler; Physiology, M. Gaspard ; Materia Medica and Therapeutics,
M. Archigenes ; General Pathology and Hygiene, M. Mavrogeni ;
Minor Surgery, M. Steysan-Bey; Principles and Practice of Medi-
cine, M. Fauval; Medical Clinic, M. Rigler ; MedicalJurisprudence,
M. Servican ; Midwifery for the male department, M. Zohrab ; Ditto
for female do. Mehmed Effendi.

The number of students in the school is 444. In the course of the
year, 11,000 persons were vaccinated there, 640 patients were treated
in the clinics, and more than 160 operations were performed, about
11,000 patients presented themselves at the gratuitous consultations.

[Journal des Con. Medico-Chir.

Preparatory Medical ScJiools. We perceive that our Charleston
neighbors have organized two of these institutions upon quite a re-
spectable footing, and that they are to go into operation in the ensuing
spring. One of them is styled the " Charleston Preparatory Medical
School," and the other " The Charleston Summer Medical Institute."
We wish them both success.

132 Miscellany.

A System of Operative Surgery : hased upon the Practice of Surgeons
in the United States : and comprising a hihliograpliical index and
historical record of inaiiy of their operations, during a period of 200
years. By Henry H. Smith, M. D., Surgeon to the St. Joseph's
Hospital; Assistant Lecturer on Demonstrative Surgery in the
University of Pennsylvania ; Lecturer on the Principles and Prac-
tice of Surgery in the Philadelphia Medical Institute, &c. Illus-
trated by numerous steel plates. Philadelphia: Lippincott, Gram-
bo & Co. 1852.

The publication of the above title page alone would be sufficient to
create in the mind of every American practitioner a desire to procure
the work. Its intrinsic merits will secure it a place in the library of
all who feel interested in Surgery. It was some time ago announced
that a translation of the beautiful work of Bernard and Huette upon
Operative Surgery was in preparation, but iDr. Smith has anticipated
its issue by a very faithful reproduction of all the valuable peculiari-
ties of the French work and by the addition of a very considerable
am.ount of Am.erican matter, well calculated to make it, to us at least,
the most desirable work upon the subject in our language. We were
indeed much in need of a work to w^hich we might look for the
achievements of American surgery impartially and systematically set
forth ; and we have every reason to think, judging from the specimen
before us. that Dr. Smith will accomplish this object creditably.
Errors of omission will doubtless be found in the Bibliographical
Index, which may bo corrected in a subsequent edition, or in the
forthcoming volumes. The very bungling manner in which Ameri-
can views and doings were thrown into tlie poor translation of
Velpeau's great work on Surgery, could not and did not satisfy the
profession in this country.

Dr. Smith having already published an excellent work upon Minor
Surgery, the present publication will comprehend 1st. General du-
ties and Elementary operations ; 2d. Operations on the Head and
Fa-ce ; 3d. Operations on the Neck and Trunk; 4th. Operations on
the Genito-Urinary organs ; and 5th. Operations on the Extremities.
The volume before us contains the two first parts, and the remainder
will be issued as early as practicable. This, with Dr. Smith's for-
mer work, will constitute a whole which cannot fail to place the
profession in our country under deep obligations to the distinguished
author.

We are indebted to Publishers for several valuable works, which
will be noticed in our next.

SOUTHERN

MDICAL km SURGICAL
JOUKFAl.

Vol. 8.] NEW SERIES. MARCH, 1852. [No. I.

PART FIRST,
riginal dommuttications.

ARTICLE VII.

Epidemic Dysentery, as it prevailed in a portion of Floyd
County, Ga.y in the Autumn of 1851. By Wm. C. Bran-
don, M. D., of Hermitage, Ga.

In view of the fact, that ours is a progressive science, and
that its whole history is made up of an accumulation of isolated
facts and brief records, I am induced to ask a small space in
the " Journal," that I may register upon its pages a short ac-
count of an epidemic as it occurred during the past autumn.
I do not propose to offer any thing new, either in pathology or
therapeutics. But as the present is greatly dependent upon
the past, for the present state of medical science, for the his-
torical accounts of epidemics, the opinions entertained as to
their pathology, the remedies employed in them, &c., so the
future may look back to the present period in the world's his-
tory with as much interest, for faithful and authentic records
in medicine, as we now do to the past. This article of itself,
lam aware, may be of little worth, but when taken in connex-
ion with other accounts of this, or even different diseases, it
may not be altogether without its value; and more especially,
when we remember the fact that scarcely any disease appear-
ing epidemically at different periods, possesses exactly the
same features at each occurrence of the epidemic. At one

N. S. VOL. VIII. NO. III. 9

134 Brandon, on Epidemic Dysentery. [March,

time it ma} be very malignant and intractable, and upon a fu-
ture occurrence be mild and readily amenable, to treatment.
During the past year, two original articles on Dysentery have
appeared in this Journal one from the pen of Dr. H. F. Camp-
bell, of Augusta, Ga., in the September number, another in the
December number, from Dr. Weatherby, of Palmetto. I pre-
sume the disease (or rather the epidemic) treated of by those
gentlemen, to be the same as that of which I propose to speak,
bearing, perhaps, some modifications. The disease is said to have
prevailed to a greater or less extent in several of the Southern
States during the past summer and autumn. But as I can not
say with positive certainty, that such is the fact, I shall confine
my remarks to a personal knowledge of the extent of the dis-
ease ; for my design is to record fact only.

The disease made its appearance in this and the adjacent
counties, both in this State and Alabama, in the early summer
months. It did not show itself at or near the same time in aU
places. Frequently it would prevail in a particular place or
neighborhood for two months or more ; while another point
not five miles distant, would be wholly exempt, but in its turn
become extensively infected, while the disease would be disap-
pearing, or entirely arrested where it previously existed. It fell
to my lot to see but very few cases during the first four months
of its prevalence. The cases I did see presented nothing of par-
ticular interest, above that of ordinary sporadic dysentery, in
this section of the country ; and had not the disease shown itself
to a considerable extent in other and various parts of the coun-
try, 1 should have considered them nothing more than sporadic
cases. It was not until October, that the disease made its ap-
pearance to any great extent within the bounds of my prac-
tice. Although the disease had been migrating (so to speak)
from place to place for four months, and frequently under a
very formidable character, yet about this time (October) the
type of the disease was somewhat changed, and unlike most
epidemics, it became more malignant just previous to its disap-
pearance. The disease now assumed a strictly typhoid type :
this was a peculiarity which attended every case which came
under my observation, whether the attack was mild or more
formidable. So similar to occasional cases of typhoid fever

1852.] Brandon, on Epidemic Dysentery. 135

were these symptoms, that it was, I learn, even by some physi-
cians, pronounced typhoid fever ; an error (if I may be allov^^ed
thus to express myself,) which might easily have been avoided,
by a little attention as to what portion of the alimentary canal
was bearing the onus of the disease.

In the greater nungber of cases, the attack came on with-
out premonitory symptoms of any duration. The first warn-
ing the patients generally had, was severe griping pain, and
sudden call to stool ; the result of which was, the discharge of
a small portion of blood, or blood and mucus, and occasionally
of mucus alone. The frequency of dejections, or calls thereto,
depended generally upon the character of the attack. In the
worst cases, they were as often as every ten or fifteen minutes,
for the space of an hour or two ; then succeeded -by an hour,
perhaps, of rest to the patient, with entire freedom from pain,
to be follow^ed again by severe tormina and imperious tenesmus.
The color of the blood discharged was variable; sometimes it
was dark or venous, generally, however, it was of a bright
arterial hue. In the more formidable cases the discharges
presented a spumy appearance. I believe that no case recovered
where this symptom was very persistent. There was one
symptom which almost invariably attended every case ; that
was, the entire absence of fecal matter in the evacuations, even
where the patient was attacked having the stomach and bowels
in an ordinary state of repletion. And in many cases, it was
with difficulty that a feculent dejection could be procured by
cathartics, such as were thought advisable to be employed in the
disease. In this respect, the disease differed from that form
which prevailed in the summer, as reported by the gentle-
men above referred to, at least in some instances. One of
them speaks of serous or diarrhoeal discharges, the other of
feculent passages. In no single instance did I observe serous
evacuations in any stage of the disease, and very seldom fecal
matter until a change for the better. In one case, which proved
fatal, for thirty-six hours prior to death the discharges were
mixed with, and sometimes appeared to consist entirely of pus,
giving out an exceedingly offensive odour.

Nausea, retching, and vomiting were present in the majority
of instances. In the milder attacks, nausea was absent in a de

136 Brandon, on Epidemic Dysentery, [March,

gree. The matter ejected consisted generally of the liquid
Avhich had been taken into the stomach, sometimes of a little
tenacious mucus. In connexion with the excruciating pain,
almost invariably referable to some portion of the colon, there
was tenderness under pressure at some point along the bowels.
This, however, was by no means an in^pariable symptom ; for
even in some very severe cases it was wanting to some extent.
Very little tenderness was felt, in the eorly period of the dis-
ease in any case. The pain and tenderness under pressure
was occasionally felt along the whole tract of the colon: and
in fact, in some severe attacks the whole bowels with the sto-
mach gave the same response ; especially in cases attended by
retching and vomiting. Tympanitis was not present in every
case, but more frequent in young, than adult subjects. The
febrile symptoms were of a low grade. The pulse ranged
from a hundred to a hundred and forty, depending upon the
character of the attack. It was always feeble, sometimes so
feeble and thready as scarcely to be counted, even in adults of
ordinary constitution. The skin was dry and usually cool, ex-
cept over the bowels, where frequently there was pungent heat
of the surface ; ordinarily the extremities were cold and could
be restored to normal temperature with difficulty.

The tongue at the onset of the disease was moist, and pre-
sented a dark appearance, as if deeply stained. This dusky ap-
pearance soon seemed to extend (if possible) below the epithe-
lium itself. Unless the attack was a mild one, the tongue
gradually became dry and of a heavy dark brown color, in
some of the worst cases even black, along the back part. This
organ was frequently cracked, or dotted with small superficial
ulcers. I

In the greater number of my patients the appetite was but
little impaired, except during the period when they were la-
bouring under nausea. The tliirst usually was very considera-
ble, ordinarily the urine was scanty and high coloured. In
some instances, in children, it presented a chylous or milky ap-
pearance. The body of the patient as well as the discharges
from the bow^els exhaled a strikingly cadaverous and sickening
odour. The breath possessed the same character.

One striking feature in the disease was, the almost entire

1852.] Brandon, on Epidemic Dysentery. 137

unimpairment of the mind. Even in the most formidable cases I
observed very little mental depression, or low delerium, symp-
toms so common in diseases of adynamic character.

In but very few of the cases which I was called to attend,
did it fall to me to make the first prescription. Some had
been under the care of other physicians, but the greater num-
ber had been subjected to some domestic treatment, such as
castor-oil, epsom salts, some of those death-dealing patent pills,
'* spirits and white sugar burnt with lightwood splinters with
a little mutton tallow in it, and some black root tea ;" often too,
to the great detriment of the patient. In view of the feeble
state of the pulse and coolness of the surface, I saw no case
in which I deemed the lancet admissible. Cups were used in
some instances along the course of the colon, but without the
least discoverable advantage.

If I had reason to believe the bowels were loaded with fecal
matter, my first object was to relieve them of this. My usual
prescription was, an oz. of castor-oil with from 1 to 2 drs. oil
of turpentine, for an adult ; diminished in proportion to the age
of younger subjects. Often this dose had to be repeated, some-
times twice, before a fecal dejection could be procured.

The turpentine was left out in some instances, and my opin-
ion is, with disadvantage to the patient. I used no saline ca-
thartics, for in every instance where they had been used prior
to my visit to the patient, I believe they had acted injuriously,
especially where the stomach and small bowels were implica-
ted to any great extent. The injurious effect may have resulted
from the large quantity it was requisite to employ in order to
get an operation ; probably if they had been used in a diminished
quantity and at proper intervals the effect might have been
beneficial. After treating a few cases and seeing the tardi-
ness with which cathartics acted, I was induced to commence at
the outset with mercurials ; even where it was necessary to use
cathartics. In connexion with the oil and turpentine, I admin-
istered 12 grs. calomel or 15 grs. blue mass, in divided doses;
within 24 hours. Even that amount of the mercurial seemed to
add but little force to the cathartic, it sometimes requiring two
doses of the oil and turpentine with the mercurial conjoined, to
produce one or two fecal discharges, and these were often small.

138 Brandon, on Epidemic Dysentery. [March,

The mercurial was not given with a view toils cathartic effect,
but as an alterative. It may at first view seem to the reader,
rather heterodox that a mercurial should be used in what we
term alterative doses, and for the purpose of obtaining its con-
stitutional effects, while at the same time, cathartics are admin-
istered. But after seeing the slowness with which purgatives
acted, I thought it possible that the mercury might make some
impression upon the system before it would be carried off by
them, and at least, it would but act favorably as an adjuvent to
them. Where the stomach and small bowels gave evidence of
considerable irritation the purgatives were withheld ; however,
in the greater number of cases, the patients had used them suf-
ficiently before I was called. After having used the cathar-
tics, and finding that they had been used sufficiently, my next
object was to re-establish the- deficient, or rather, suppressed
secretions, for it appeared that few, if any were in a natural
state. To accomphish this I used from 2 to 4 grs. of calomel
every four hours, or blue pill 5 grs. every six hours, combining
opium to the amount of 2 to 4 grs. or its equivalent in mor-
phine or laudanum, owing to the degree of pain, every twenty-
four hours. The only perceptible effect of the opiates was the
anodyne. And to me, it was a singular fact that but very
few of my patients showed any signs of narcotism or stupor
from these doses. Where they were kept up for several days
and then diminished, no headache follow^ed, as is frequently the
case. And in speaking of the symptoms of the disease, I should
have mentioned that headache was scarcely ever present. In
some of the cases, where the mercurial did not make its im-
pression early, which it seldom did, I combined ipecacuanha
from i to :^ gr. with each dose of the mercurial. The nausea
I believe, was not increased by the ipecac, even in cases where
this symptom was already present. This combination, that is,
the calomel and ipecac, appeared to exert a greater curative
influence than any other prescription I employed. Where the
calls to stool were very frequent, the acetate of lead w^as com-
bined occasionally with other remedies. In some cases I em-
ployed emolient anodyne, and astringent enemata. Occasion-
ally they showed decidedly beneficial effects, while in other
cases no alteration was made in the condition of the patient

1852.] Brandon, on Epidemic Dysentery. 139

from their use. For several days after I commenced treating
this disease, it was my practice to employ blistering over the
most tender points and frequently over a considerable portion
of the abdomen. In view of the character of the disease, it
seemed to me a decidedly appropriate treatment ; but to my dis-
appointment, (I am of the opinion,) they exerted little or no influ-
ence over a large majority of the cases in which they were used.
From this opinion, I was induced to dispense with them, unless
in cases where the stomach was irritable. In comparing the
results of cases where blisters were, and were not used, other
things being equal, the difference w^as not considerable. Not-
withstanding such are the conclusions which my observation
has induced, if a similar disease was again to come under my
care, I should resort to vesication with the expectation oi
benefit, until facts proved the reverse.

Warm fomentations and gently stimulating rubefacients,
I found to be of service. If their therapeutic effect was not
great, they w^ere decidedly soothing and agreeable to the pa-
tient. Where vesicatories were used serum collected in them,
but slowly and scantily, and they soon became dry and crusty,
unless some stimulating ungent was pretty freely applied. I
generally applied the mercurial ointment with the object of af-
fecting the system.

The tepid bath was freely used in the cases of young sub-
jects ; the mustard foot-bath with adults. Where the vital
powers were considerably depressed, and this w^as generally
the case, I administered wine at intervals in small quantities.
I should have given quinine, believing thedisese to be of mala-
rious origin, but from the fact that the worst cases which came
under my care had been treated with quinine, with other reme-
dies, as I was informed by the friends of the patients.

This was the general plan of treatment I pursued, modifying
it according to the age, constitution, condition, &c., of the
patient. As every practitioner is aware, though a general
plan of treatment may be pursued, it must frequently be altered
somewhat, according to circumstances. I lost no single case
where I succeeded in making any visible mercurial impression.
To do this, it was generally exceedingly difficult and in some
cases failed altogether. Some patients recovered without evi-

140 Brandon, on Epidemic Dysentery. [March,

dences of ptyalism. I think my most successful treatment was,
the mercurial and ipecac combined. And should it ever be my
lot to meet with such a disease again, I should place my chief
reliance upon these remedies, in connexion with wine and opi-
um. Some of the milder cases were treated almost entirely
v/ith opium.

The result of my course of treatment was any thing but
flattering. The proportion of cases Avhich proved fatal was
about 25 per cent. And shocking as this may appear, it was
greater success than was obtained by some who treated the
same disease. The mortality in all the cases which I knew any
thing of those treated by myself, those under the care of other
physicians, and those not treated at all, except by domestic
prescriptions, was about 37 per cent. The condition of many
of the patients was unfavorable to proper treatment, being de-
prived of the comforts of life, and of proper nurses. The worst
cases which fell into my care had been under treatment by
others, and two-fifths of those I lost, were of this number. I do
not make this remark as intimating that they had been impro-
perly treated, for they doubtless had not, so far as the physi-
cians were concerned.

During my short experience in the practice of medicine I
have met with no disease possessing half the malignancy of the
one under consideration. No age or sex was exempt. The
child of tw^o years and the matron of eighty-four were alike
the subjects of the disease. The majority of the patients were
below the age of puberty.

Dr. Campbell, in his article before referred to, remarks it as
a singular fact, that negroes were not attacked by the disease, as
it occurred to him. My observation was the same at a dis-
tance of two hundred miles from where Dr. C.'s cases were
located, and at a different season of the year. While the dis-
ease was prevaiUng, I heard of one case in the person af a negro
child, in the neighborhood of my practice. It was fortunate
that some class of persons was exempt where the disease pre-
vailed so malignantly. In some instances, from the very begin-
ning of the attack, it seemed that death had marked his victim,
and the disease progressed to a dissolution of the patient in
despite of any remedial measures which could be adopted.

1852.] Brandon, on Epidemic Dysentery. 141

Fortunately this form of the disease was of short duration. It
prevailed so malignantly but for the space of about six weeks,
when the heavy rains and frosts, between the 15th and 25th of
November, seemed suddenly to" arrest the disease entirely. The
rains and severe frosts may not have had any influence upon
the disease, but I attributed its arrest to them. They may,
however, have been coincident occurrences. The section
where the disease thus prevailed was situated on a large creek,
(the Armuchee,) and its tributaries a region formerly con-
sidered malarious, and until within the last two or three years
the location of autumnal fevers to a considerable extent. Doubt-
less the disease was of malarious origin. But it will require
one more skilled in etiology than I am, to say why this malaria,
or epidemic constitution of the atmosphere, as Sydenham terms
it, did not produce remittent or intermittent fever, instead of a
malignant typhoid dysentery. Was there some change in the
constituents of this malaria, or could there have been a different
state of susceptibility in the system of the subject, that de-
termined the character of the disease ? Was it the same
idiosyncracy in the negro, which so often seems to exempt him
from autumnal fevers, that preserved him in this disease ?

I might have extended these remark to double the length ; in
fact, I might have given the history of all, or a certain number
of cases in detail. But I deemed it more prudent to give
a general account of the disease, treatment, &:c., rather than
pursue a different plan, probably to the exclusion of more inter-
esting and important matter from the pages of the Journal.
And lest such should be the case, I have endeavored to be as
concise as possible.

*

ARTICLE VIII.

Extracts from the Records of the Physicians^ Society for
Medical Observation, of Greene and adjoining Counties,
Georgia. By D. C. O'Keeffe, M. D., Secretary.

January 12th, 1852. Thrush in Children. Dr. B. F. Rea
read a paper whose object was to lay before the Society
some views of the pathology and treatment of a malady which
presents itself, perhaps, as frequently to the practitioner as any

142 O'Keeffe Reports of the Society for [March,

other, yet is regarded by many as a disease of no great
importance in a practical point of view, and even too lightly
noticed in works on infantile disease.

** Thrush is readily recognized by the small curd-like deposit
upon the epithelium of the lips and upper surface of the tongue,
in children at the breast. It is at first of a milk-white or pearly
hue, but occasionally assumes a yellowish color, sometimes
covering the upper and under surfaces of the tongue, inside of
the cheeks, gums and pharynx; and some authors among
whom are Armstrong^ Marley, Gardien assert that it extends
quite through the stomach and intestinal canal to the anus.
Having frequently met with thrush^ and being interested in
diseases of this class, I have, for some years, studied it atten-
tively, and do not believe it is ever attached to the mucous
membrane of the stomach and intestinal canal, although small
portions of the aphthous (?) deposit may, and doubtless do, often
escape into the stomach and bowels. The deposit is always
found more firmly attached to the epithelium of the lips, tongue,
&c. ; and as the latter organ is so abundantly supplied with
papillae, which, with the epithelium, seem to afford the best soil
for its growth, we here find it more firmly attached than any
where else. Again : we know that the epithelium which cov-
ers the mucous membrane of the lips, tongue, cavity of the
mouth, pharynx and oesophagus, extends only to the cardiac
orifice of the stomach the mucous membrane of which, as
w^ell as that of the intestinal canal, being covered with a coat-
ing or varnish of mucous matter, not adapted to the attachment
and growth of the aphthous vegetations. Some of the best
authorities consider it a diphtheritic inflammation, and de-
scribe it under the heads of pultaceousand pseudo-membranous
inflammation. From this I dissent. Thrush dannot be a
diphtheritic inflammation, for diphtheritis (from the Greek, diph-
thera) means a form of inflammation in which a false membrane
is formed, and characterized by an exudation of fibrinous or
albuminous matter, in the form of a pellicle upon the surface of
the membrane, underneath the epithelium. Now we can have
no diphtheritis without inflammation, and the exudation is
underneath the epithelium ; whereas, we may have Thrush
without inflammation, and the deposit is upon, not under^ the

1852.] Medical Observation. 143

epithelium. Moreover, if thrush were an exudation, caused by
inflammation, we would certainly sometimes see it become
organized, which I have never seen ; nor have I seen the un-
usual redness and increased heat of the mouth which are stated
by some authors to precede attacks'of the disease.

I do not consider inflammation even necessary to the causa-
tion of thrush; and although the deposit may often be upon an
inflamed mucous membrane, yet I look upon it as a mere coin-
cidence, and not as cause and efl^ect. I believe, however, that
if the deposit be allowed to remain undisturbed, it may excite
inflammation in the epithelium, and by contiguous sympathy
the mucous membrane underneath may become inflamed. The
term aphthae, which is sometimes applied to thrush, is incorrect ;
for the very word itself leads to the idea that there is inflam-
mation which is true of aphthous afl^ections, but not of thrush.
Both may exist simultaneously, as I have myself seen ; but
they are far from being one and the same disease one being
a vesicular afl^ection, the other a genuine parasitic deposit ;
and this constitutes the true pathology (if you will allow the
expression) of Thrush.

The disease under consideration may sometimes occur with-
*out any general disorder of the constitution ; but more frequent-
ly we find general symptoms present themselves.

The diarrhoea which is often present, and which indicates
disorder of the digestive organs, bears generally a direct rela-
tion to the extent and severity of the disease. There is usually
an abundant formation of acid, as indicated by the green evacu-
ations, which are so acrid in aggravated forms of the malady as
to produce redness of the anus and nates ; and hence some
suppose that the disease has extended through the alimentary
canal. Sometimes there is vomiting of greenish acid matter.

Prof. Wood says : "Children prematurely born, or brought
up by the hand, or nursed by unhealthy women, are more liable
to be affected than others. In fact, whatever tends to impair
the health and vigour of the infant, to induce acidity of the
stomach, or other gastric and intestinal *sorder, disposes to its
occurrence. Yet it often occurs under apparently the most
favorable circumstances, and in healthy, w^ell fed children."
I shall proceed, as briefly as possible, to give the outlines of

144 O'Keeffe Reports of the Society for [March,

treatment I have found most successful, without, however, en-
tering into particulars. As the disease is purely local, yet as
the constitution sometimes, though secondarily, suffers, we
must, when indicated, use a constitutional as well as a local
treatment. I look upon topical applications as forming the most
important part of the cure in most cases ; and indeed in the
milder forms, nothing more is needed. Borax, with sugar or
honey ; and alum combined with some vegetable astringent, I
have found to answer only in mild cases, and doing little if any
good, even when persevered in, in the severer forms of the
malady. In such cases, my course is to apply some alkaline
lotion pretty freely for a few days, and about the best is a solu-
tion of carb. potash (oi. to i. f. water) ; after this I use a
solution of nitrate of silver, in the proportion of six, eight, and
sometimes even more, grains to the ounce of water.

This is generally about all the local treatment that is re-
quired. A solution of bichlord. mercury, as recommended by
the German physician, Eisenmann, may be very useful, but I
have not used it. When there is diarrhoea, hydrg. c. creta, or
the chalk alone, will be found very beneficial. If the diarrhoea
is attended with flatulence and acid eructations, and greenish
curdy stools, rhubarb combined with sup. carb. soda, in the'
proportion of 4 or 6 grs. of the former to 6 or 8 grs. of the latter,
and given in some carminative infusion, pro re nata, (a pre-
scription peculiar to myself in such cases,) answers better than
any thing I have used. After this, astringents must be resorted
to, and I have found the mineral astringents best. Of these, a
solution of nitrate of iron is to be preferred. I have used this
for several years. It is much more astringent and efRcient
than a solution of chloride of iron, and not in the least caustic,
and when given in doses of 8-10, or even more, drops, three
times a day, or oftener if necessary, it diminishes the irritability
of the weakened and relaxed mucous membrane of the stomach
and bowels.

We must not, however, lose sight of alkalies, both topically
and internally, whenever the indications call for their use. I
always avoid any compound into which sugar enters, either as
a local application, or as an internal remedy ; for the sugar is
converted into acid, which favors the increase of the malady.

1852.] Medical Observation, 145

We may often premise our treatment with an emetic, which
sometimes has a very beneficial effect."

The opinions expressed by Dr. Rea, in the foregoing essay,
were at variance w^ith the views of some of the members of the
Society ; but, on account of the intense cold, it was received
without any discussion.

Strangulated Hernia. Dr. J. E. Walker reported a case
of Strangulated Hernia which occurred in the person of a

young man, J. L , aged about twenty-two. *'He was a

laborer in one of our manufactories, of spare but muscular
form and temperate habits. First saw him at 3 o'clock, P. M.,
of the 14th December ult., and found him in the most intense
agony of pain, which he referred to the region of the umbilicus*
Upon investigation, I elicited the following:

He has been the subject of a small oblique Inguinal Hernia
of the right side, from a boy, but as he had suffered little incon-
venience from it, he had never before made it known even to
the members of his own family. He states that the tumor hag
never entirely disappeared since he first noticed it, which, as
will he seen, is one of its chief points of interest. On the
morning of the day above stated, his bowels became relaxed,
and after straining at stool, he discovered that the hernia had
descended much lower than usual, and that the tumor was
much larger, which, however, did not create pain until after a
second evacuation. He now felt as if a cord were being drawn
lightly between the testicle and navel, giving rise to excru-
ciating pain, and causing an entire inability to return the hernia.
On examining the tumor, which was small, I found it so tender
that the patient could not bear the slightest pressure the
greatest pain being at the seat of stricture. So great was the
suffering, that the gentlest manipulations produced violent mus-
cular agitation, amounting almost to convulsions. He had
vomited freely before I saw^ him, and continued retching se-
verely, and occasionally ejecting a thick yellowish matter, with
some bile, but no fecal matter that I could discover the whole
surface was cold and of a purplish hue.

In this state of things I determined to apply fomentations to
the tumor, with cloths wrung out of water as hot as could be

146 O'KeefFe Reports of the Society for [March,

borne, and also bloodletting was attempted but failed, in con-
sequence of the coldness of the surface and smallness of the
veins. After having used the warm applications for thirty
minutes, I made an unsuccessful attempt to replace the hernia.
I ordered the fomentations continued while I went to my office
for medicine; and after my return, finding the patient a little
more quiet, with a warmer surface, I attempted again to bleed
him, but succeeded in extracting only a few ounces of blood.

I now determined to try the effects of Tart. Emetic, of which
I gave him one-fourth of a grain at short intervals. The se-
cond dose having produced slight vomiting, and knowing the
danger of my case being made worse by the straining of eme-
sis, I guarded the tumor with the palm of my hand, to prevent
a further descent until the vomiting should cease, at which
moment I used the Taxis, and was much gratified to find that
I could reduce the tumor to less than half its original size, but it
could not be entirely returned. The pain was now mitigated,
but not relieved. Farther interference being deemed improper
for the present, I administered half a grain of Morphine and left
him, w^ith a promise to return at 7 o'clock. Dr. H. H. King,
to whom I am under many obligations for his valuable sugges-
tions and assistance, saw the case with me at the hour appointed.
We found the patient about as I had left him, except that he
was more composed and had less arterial excitement. He had
just vomited, but without affecting the tumor. At the sugges-
tion of Dr. King, he was placed in the warm hip-bath, and
while in it, another attempt was made to bleed him. Although
the V. S. was not as successful as we desired, the patient, partly
from loss of blood and partly from the influence of the bath,
w^as fast approaching syncope ; while in that state he wds
placed in bed with the hips elevated, and Dr. King was re-
quested to try the " Taxis," which he did for some minutes,
with great pain to the patient and little effect on the tumor. I
made another attempt with no better success.

The patient insisted that it was now as far reduced as it had
been for years ; was free from pain, except when the tumor
was handled, and that in that condition, he suffered no incon-
venience whatever. Accordingly, we agreed to give him half
a grain of morphine and leave him for the night. On the morn-

I

1852.] Medical Observation. 147

ing of the 19th I saw my patient, and to my gratification found
the tumor had entirely disappeared, without his consciousness.
He had fallen asleep soon after we left him on the night pre-
vious, had rested well all night, and awoke in the morning to
the pleasant reality of finding his hernia gone and himself free
from pain. He was directed to keep his bed for a few days,
and to have a suitable instrument for retaining his bowels in
their natural cavity. I saw him in the afternoon of the same
day, and found him with some fever and tongue furred. Di-
rected him to take half an ounce of castor oil, which acted
kindly ; next day he walked about the house, and in a very
short time was attending to his ordinary business."

Case of Uterine Polypus, by Dr. H. H. King. On the 19th
day of Feb., 1851, I was called to see a negro woman who had
been suffering for six months or more with a "misery," as she
termed it, in the lower part of the abdomen. I supposed the
pain was seated in the uterus, from the fact that she had not
been "regular" for some months, and as she told me she
thought it was about time for the catamenia to appear. I pre-
scribed a cathartic and warm hip-bath, which relieved her for
a short time, although her catamenia did not appear. In the
early part of the spring I saw her again, when she told me she
thought she was laboring under prolapsus uteri. I made a digi-
tal examination, and instead of a prolapsus, I found a tumor
about the size of a hen's Qgg, which I partly succeeded in re-
moving'with caustics, not having a suitable instrument to oper-
ate with. On the 8th of July I saw her a^ain. She told me,
when I arrived, that she had suffered all the pains of childbirth,
and, to use her own expression, " her body had come from her."
Being dissatisfied with the digital examination I had made, I
found, on occular inspection, that a polypous tumor, weighing
three pounds, had been extruded. Before removing it, I re-
quested my friend, Dr. Walker, to see the case with me. After
examining the tumor and satisfying ourselves of its nature and
the manner of removing it, we proceeded to take it away,
which we did by ligating the pedicle as high up as we could,
and cutting it through with the knife. I endeavored to pro-
cure an instrument for the removal of the attachment, but

148 O'Keeffe^Reports of the Society for March,

failed in doing so. After several weeks, the ligature and a por-
tion of the pedicle came away, and her general health improved
very much. I do not look upon the case as cured, on account
of the great disposition of such tumors to form again, and from
not having a suitable instrument to remove the attachment.
This tumor has been deposited in the Museum of the Medical
College of Georgia.

Dr. Rea wished to know the nature of the polypus in ques-
tion, and on being informed that it was of a fibrous character,
urged an objection to Dr. King's opinion that fibrous polypi
are prone to return ; he (Dr. R.) thought such tumors seldom
returned.

Dr. O'KeefTe said that fibrous polypi of the uterus, as a gen-
eral rule, do not reproduce themselves, unless they assume a
malignant character, as they sometimes do ; but that fibrous
polypi, in other parts of the body, may grow again.

Pneumonia treated with Veratrum Viride. Dr. R. S. Cal-
loway referred to three cases of pneumonia, well marked and
violent at their commencement, which he had brought to a fa-
vorable termination by the use of the American Hellebore.
They were treated for four or five days with the usual reme-
dies : V. s. cal. diaphoretics, expectorants and blisters, without
any mitigation of their symptoms ; indeed every thing seemed
to portend unfavorably when he commenced the use of the ve-
ratrum viride, and in a day or two, the condition of the patients
ceased to be dangerous, and their convalescence wa5 rapid.
Dr. C. uses a saturated tincture of his own make, in the dose
of 12 gtt. every two hours until a decided effect on the system
is manifested by nausea and a diminution in the frequency of
the pulse; he then suspends its use for ten or twelve hours,
after which, he repeats it as before, and so on as long as the
symptoms require it. In connection with the veratrum viride,
Dr. C. uses an anodyne expectorant occasionally, and aperi-
ents to keep the bowels in a laxative condition.

Dr. Rea gave his experience with the American Hellebore
as favorable to the good effects already attributed to it ; and
added that, in his opinion, its sedative properties were owing
to the nausea it induced, in the same way that ipecac, and tart,
antimony are sedative.

1852.] Medical Observation. 149

Dr. 0*Keeffe added his testimony in favor of the report just
made by Dr. Callaway, respecting the very beneficial effects
of the veratrum viride in reducing the heart's action, and as-
serted that he had rather be deprived of all other sedative
agents than the one under consideration. He did not believe
that its great controling power over the circulation was entire-
ly owing to its nauseating effects : he thought the remedy had
a direct sedative influence over the heart and arteries through
the medium of the nervous system, for he had seen the hellebore
reduce the frequency of the pulse without any nausea or vom-
iting.

Dr. Jas. F. Foster made allusions to some interesting cases of
midwifery which had come under his observation. One was
a woman who had had nine children, intermitted child-bearing
for nine years, during which she suffered from leucorrhoea sev-
eral times took "some medicine," and conceived again after
nine years intermission. Another case was a woman he had
attended and delivered of a full grown child without her having
any knowledge of her pregnancy. She had borne no children
for a few years, lived on good terms with her husband, in res-
pectable society, and had no reason whatever to falsify.

Urethral injiammation in the female. Dr. D. C. O'Keeffe
read a i-eport of a case of urethral inflammation in the female,
supposed to be caused by the continued use of the catheter for
two or three weeks. The subject was a woman of feeble con-
stitution and lymphatic temperament. Six months previous
to my seeing her, she was delivered of a full grow^n child after a
somewhat tedious labor. After delivery the bladder was evacu-
ated for two or three weeks in succession by the catheter, owing
to a temporary paralysis of that organ. From this time dates
the commencement of the state I shall presently describe.
Her recovery from child-bed was slow and satisfactory, with
the exception that she suffered very much from ardor urinae
and after urinating discharged some blood guttatim. For
this she took various diuretic preparations with but little, if
any, benefit to her sufferings. During this time she was under
the care of the gentleman who attended her in confinement,
and came under my care in the above condition.

K. B. VOL. VIH. NO. III. 10

150 O'Keeffe Reports of the Society for March,

Prescribed the tripple syrup of buchu, uva ursi, and pareira
brava, lunar caustic injections into the urethra, and leeches to
vulva and perineum. Of these but tbe first was used, owing
to the patient's own objections, and the ext. belladonna was re-
commended as a substitute, which latter proved of no bene-
fit. While under the use of the above diuretic syrup, she was
entirely relieved from ardor urinae and hematuria, but on dis-
continuing it, the ardor would return and continue a few days
and be followed by the hematuria. She continued this remedy
for four months without any suffering while taking it, but on
its discontinuance, the same result would ensue that did at first.

Seeing no prospect of permanent benefit from the syrup, she
at length consented to use the lunar caustic, to which she ob-
jected solely through fear of its severity. A solution of lunar
caustic I gr. to 1 oz. was injected into the urethra, but three
times with a glass syringe, and no return of the disease has
been experienced since. The pain in urinating, was quite se-
vere after the use of the caustic, but it soon subsided and re-
turned no more. She used none of the syrup after the first
application of the caustic.

Remarks. In this case we see exemplified the error of not
yielding immediate and implicit obedience to the physician's
prescription ; for to her own reluctance to use the caustic may
be fairly attributed her long and needless suffering. The pre-
sent and beneficial effects of local applications of nit. silver to
affections of the mucous membranes are also illustrated in the
case before us, as well as the inutility of treating such affec?-
tions with constitutional remedies. And from it, I would also
draw the practical inference, that the promiscuous treatment of
gonorrhoea in the female, by means of vaginal injections, is in-
correct and in^definite, inasmuch as the vagina, the urethra or
the cavity of the uterine neck may be each respectively the
seat of the gonorrhoeal inflammation ; hence the use of the
speculum is indispensable to a coirect diagnosis, and conse-
quently to a correct mode of treatment.

The cause of the urethral inflammation in the case just re-
ported was attributed by the patient and friends to the long
continued use of the catheter, and I think, in xill probability.

1852.] Medical Observation. 151

with good reason, as the patient and husband were altogether
above suspicion in a moral point of view. There was an error
ofomission, perhaps, in her management in childbed (as stated by
herself and husband,) which consisted in suffering the bladder
to become so distended before resorting to catheterism that it
became entirely paralysed temporarily, thereby prolonging the
necessity for the use of the catheter. So that the whole diffi-
culty might have been prevented had her attending physician
obviated by the intervention of art, the supervention of the
condition that rendered necessary the long continued use of the
catheter.

In bringing these remarks to a close, I would wish to call
the attention of the Society to the abnormal effects of cod liver
oil on this patient, which she took, the year following the date
of the above notes, for general debility. She lost in weight,
but gained in density of the muscular system.

ARTICLE IX.

Medical Statistics of the last Georgia Census. By John S.
Wilson, M. D., of Muscogee county, Georgia.

There are some facts revealed by the last Census in Geor-
gia, of such a striking character, that they cannot fail to engage
the attention of the medical profession; and I have therefore
compiled the following table (which has cost me much labor)
for the benefit of the readers of the Journal. The facts alluded
to above, and which will be disclosed by the table, are these
viz: 1st. That the Middle Counties of Georgia are less salu-
brious than the Southern ones, contrary to the common opinion.
2nd. That Georgia, taken as a whole, stands unrivalled in
salubrity, giving less than twelve deaths in one thousand
persons. 3rd. The table will present some striking facts in
connexion with the health of different counties, which are suffi-
ciently remarkable to engage the attention of all who wish to
find a healthy location. I have divided the State into three
parts Northern, Southern and Middle giving the total popu-
lation of each county, and the number of deaths during the
year 1850, together with the proportion of deaths in each
Division, &:c. as follows :

152

Wilson's Medical Statistics,

[March,

Northern Counties.

Population.

Deaths.

Northern Counties.

Pojndation.

Deaths.

Cass,

13,300

105

Brought up.

120,619

860

Chalooga,

6,815

79

Gwinnett,

11,257

110

Cherokee,

12,800

81

Habersham,

8,895

17

Cobb,

13,743

24

Hall,

8,713

69

Dade,

3,682

30

Jackson,

9,768

91

De Kalb,

14,328

118

Lunnpkin,

8,954

46

Elbert,

12,959

143

Madison,

5,603

68

Floyd,

8,205

49

Murray,

14,433

67

Foi-sytb,

8,850

39

Paulding,

7,039

66

Franklin,

11,513

96

Rabun,

2,448

12

Gilmer,

8,440

54

Union,

7,234

64

Gordon,

5,984

42

Walker,

13,109

139

Carried up, 120,619 860

218,072 1609

A fraction over 7 deaths in 1000 persons. Least mortality
in Cobb, which gives the remarkably small mortality of If or
near that in 1000 persons.

Middle Counties.
Baldwin,
Bibb,
Burke,
Butts,
Canrjpbell,
Carroll,
Clark,
Columbia,
Coweta,
Crawford,
Fayette,
Greene,
Hancock,
Harris,
Heard,
Henry,
Jasper,
Jones,
Jefferson,

Population.

8,148

12,699

16,100

6,488

7,232

9,357

11,119

11,961

13,635

8,984

8,709

13,068

11,578

14,721

6,923

14,726

11,486

10,224

9,131

Deaths.

11
177
326

55

62

70
149

86
218
118

99
242
128
149

41
157
180

85
131

2550

Middle Counties,
Brought up,
Lincoln,
Meriwether,
Monroe,
Morgan,
Newton,
Oglethorpe,
Pike,
Putnam,
Richmond,
Talbot,
Taliaferro,
Troup,
Twiggs,
Upson,
Walton,
Warren,
Washington,
Wilkes,

208,299

5,998

16,476

16,985

10,744

13,296

12.259

14,305

10,794

16,246

16,534

5,146

16,879

8,179

9,424

10,821

12,425

11,766

12,107

Deaths.
2550

94
210
210
216

95
175
150
160
291
208

88
148
107

74
135
138
159
193

426,673 5401

Carried up, 208,299

Nearly 12| deaths in 1000 persons. Healthiest county,
Heard next, Carroll, Jones, Fayette and Newton. Greatest
mortality in Burke.

1852.] Booth's Case of Puerperal Convulsions. 153

Soutliern Counties.

Population.

Deaths.

Southern Counties.

Population.

Deaths.

Appling,

2,949

27

Brought up,

127,066

1649

Baker,

8,120

126

Lowndes,

8,351

64

Bryan,

3,424

63

Macon,

7,052

00

Bullock,

4,300

28

Marion,

10,280

72

Camden,

6,319

61

Mcintosh,

6,028

111

Chatham,

23,900

385

Montgomery,

2,154

22

Decatur,

8,262

92

Muscogee,

18,578

187

Dooly,

8,361

110

Pulaski,

6,627

87

Early,

7,246

55

Randolph,

12,868

130

Effingham,

3,864

68

Scriven,

6,847

32

Emanuel,

4,577

25

Stewart,

16,027

156

Glynn,

4,933

106

Sumpter,

10,322

140

Houston,

16,450

201

Tattnall,

3,227

10

Irwin,

3,334

15

Telfair,

3,026

9

Laurens,

6,442

54

Thomas,

10,103

125

Lee,

6,659

117

Ware,

3,888

18

Liberty,

7,926

116

Wayne,

1,499

10

Wilkinson,

8,214

87

Carried up,

127,068

1649

262,154

2909

About 11| deaths to 1000 persons. Healthiest county, Ma-
con, no death three next, Telfair, Tattnall and Scriven.

Whole population, 905,999. Number of deaths, 9,920 not
quite 11 deaths to 1000 persons.

ARTICLE X.

Cold Water in Puerperal Convulsions.
M. D., of Carrollville, Mississippi.

Bv G. W. Booth,

In the year 1848, I was called early one morning to see Mrs.
E. W., wife of P. W. On my arrival, I was informed that she
had been in labour for several hours. She was about 18 years
of age, short stature, and of ruddy appearance. This was her
first pregnancy, and I was informed by the old midwife who
was in attendance that the labour appeared to progress favora-
bly till a short time before I was called in. The patient's
friends had discovered some convulsive twitchings about her
face which alarmed ihem, and I was consequently summoned.

The waters had been discharged sometime before I saw her.
On examination, I found the head at the inferior strait present-
ing naturally, and the soft parts in a favorable condition. The

154 BootWs Case of Puerpe7'al Convulsions. [March,

pains appeared to be effective. Soon after I had made an ex-
amination, the muscular tvvitchings about the face deepened
into the most terrific general convulsions I have ever witness-
ed. She was delivered in a few minutes after the accession of
the convulsions, of a fine healthy girl, of average size. I was
in hopes, after this event, that some mitigation, at least, would
take place in the symptoms. In this, however, I v^as disap-
pointed, as the convulsions continued to recur as before. She
remained perfectly unconscious, from the first severe paroxysm,
throughout the course of the disease. I put into vigorous play
all the usual remedies for this formidable disease, but without
influencing it materially. I continued this treatment till late
in the evening. I now ilespaired of the patient's life, and an-
nounced the fact to her husband and friends. As a dernier
resort, I determined to try the efiect of cold water, applied by
pouring it freely over the whole system. To carry this treat-
ment into effect, I had her taken from the bed and laid on the
floor, with a quilt under her and a sheet thrown over her body.
I then, from a large pitcher, poured water, fresh from a well,
over her, from head to feet, for several minutes. After the
application of the water, I had dry clothes put on the patient,
and she was replaced in bed. In the course of half an hour
after this she awoke from the stupor, which had existed since
morning, perfectly rational, and had no return of convulsions
after the water had been used. She now had no recollection
of anything that had taken place since the first convulsion, and
appeared to be surprised to learn that her child was born.

There was inability to pass of her urine, and I drew off a
large quantity with a catheter the state of her bladder having
been unattended to in the earlier part of her labour. I used
the instrument but once, as she was able afterwards to evacu-
ate the bladder without its aid. She had a fine "getting-up,"
and was as well in a few days as is common after the most
favorable labours.

Mrs. W. has borne two children since, without any untoward
circumstance attending either labours.

1852.] New Tlieory of Respiration and Circulation. 155

PART II.
(Eclectic Department

Some Remarks on the recent Discovery, that the Chief motive
Power of the Blood is in the Lungs and not in the Heart,
and its application to useful Purposes. By Samuel A.
Cartwright, M. D., of New Orleans, late of Natchez.

I have elsewhere detailed the experiments proving, by ocu-
lar demonstration, in the vivisection of alligators, made in
this city, that the chief motive power of the blood is in the
lungs, and not in the heart. Animation was restored by arti-
ficial respiration, after the animal experimented on had been
perfectly dead to all appearances for about an hour. Organic as
well as animal life had been destroyed by tying the trachea.
It is a remarkable fact that tying the trachea is the only means
by which that amimal can be expeditiously killed. They will
live for days after decapitation, or immersed in water, but
speedily die when the trachea is tied. After life had been, to
all appearances, completely extinguished, the heart, lungs and
abdominal viscera were exposed to view by a careful dissec-
tion. The inflating process was then commenced. The blood,
at length, was seen to move from the vessels of the lungs to
tiie quiescent heart thus proving that the primum mobile and
chief motive power of the blood are in the lungs and not in the
heart. Dr. Dowler, who performed the vivisection, supposed
that atmospheric air imparted to the globules of the blood a
self-locomotory. According, however, to the theory of Mrs.
Willard, of Troy, to test which some of the experiments were
made, it is the caloric evolved in the transformation of venous
into arterial blood that gives the motion. Be this as it may,
the important discovery that the primum mobile of the blood
and its chief motive power are in the lungs, rests not on theory,
but on ocular demonstration, repeated again and again. Mr.
Crawford, long ago, attempted to explain the phenomena of
animal heat by supposing that the caloric, generated in the
lungs by respiration, was conveyed through the arterial sys-
tem in a latent state to all parts of the body, and was there giv-
en out in the form of sensible heat. The foundation of this
theory was the greater capacity of arterial than venous blood,
for caloric. His premises were denied by Davy and the most
of his CO temporaries but subsequent observations have
proved them to be correct in the main. Mrs. Willard's theory
of the motive powers of the blood rests upon the same basis as
that of Mr. Crawford's doctrine of calorification the difl^erent
capacity of arterial and venous blood for caloric. The theory

156 New Theory of Respiration and Circulation. [March,

itself is not the subject under consideration, but only in its main
proposition, that the chief motive power of the blood is in the
lungs, and not in the heart. Whatever be thought of the theory
itself, it has the high merit of having announced a most impor-
tant truth, which is proved by ocular demonstration, and will
stand as an important discovery, whether the reasoning that
led to it be correct or not.

I propose to make some remarks on the application of this
important American discovery to useful and practical purpo-
ses. Lord Bacon truly says : " For of all the signSFof philoso-
phies none are more certain and noble than those taken from
their fruits. For fruits and the discoveries of works are as the
vouchers and securities of the truth of philosophies." "As it
is in religion that faith be manifested by works, philosophy
should be judged by its fruits, and held as vain if it prove
barren." {Nov. Org., Sect. iv. 73.) The discovery that the
chief motive power of the blood is in the lungs, and not in the
heart as Harvey supposed, I propose to show will not prove
barren, but rich in useful fruits " the vouchers and securities
for its truth." Lest, however, some errors which have crept
into physiology, may prevent any portion of those physcians,
who are not too old or full of prejudice to receive a new idea
conflicting with their former opinions, from seeing and believing
in the discovery, it may not be amiss to surround it with some
of the highest authorities in medicine, each holding a light so
closely to it, as to convince the sceptical that it rests on the rock
of the latest revealed truths in science, and not, as they might
gratuitously suppose, on idle speculations behind the times.

Among the authorities, Sir Benjamin Brodie stands foremost
and closest, he having, many years ago, come very near stum-
bling on the discovery. He killed a cat, i. e. paralyzed the
action of the heart and lungs, with the poison called woorara,
and then by dint of artificial respiration, kept up for two hours
and a half, brought the animal to life. He saw so far into the
mystery of the motive power of the blood, as to ascertain that
the heart's action depended upon the action of the lungs; and
hence the experiment with the cat was to see whether lile might
not be preserved by artificial respiration until the efl^ect of the
poison on the nervous system had time to wear away. Sir
Benjamin's idea was good, and true as far as it went, but it
did not reach the main truth of the discovery first announced in
Troy, and subsequently demonstrated in New Orleans. Al-
though he brought the cat to life, he had no suspicion that the
chief motive power of the blood was in the lungs, and that the
heart performed a subordinate part in giving it momentum.
His experiment, however, went far enough to prove, that Bichat

1852."| New Theory of Respiration and Circulation. ]57

and some other physiologists, in supposing that the blood con-
tinued, for a time, to circulate through the lungs by the action
of the heart after respiration ceased, only becoming unaerated
after the lungs ceased to act, fell into a great error, which for
many years misled investigation from the true path of inquiry.

Dr. Kay, however, deserves much credit for correcting the
error, which he has done by proving, that as soon as respi-
ration stops, the blood begins to stagnate in the pulmonary
capillaries, because it ceases to be transformed from venous
to arterial. In the language of the new philosophy, because
its motive power is taken away by the cessation of the process
of arterialization, therefore it stagnates. Dr. Kay ascertained
the fact, but he could not divine the cause. His researches do
not go far enough to detract from the merits of the discovery,
but they furnish sufficient light to show that it rests upon sci-
entific truth.

Baron Cuvier, the highest authority in natural philosophy,
brings the light of that science in support of the new doctrine,
that the chief motive power of the blood is in the respiratory
organs. His great work, called " Animal Kingdom," revised
by Latreille, article Reptilia, says " The blood derives its heat
and the fibre its susceptibility of nervous irritation from res-
piration." Not only that, but his other great work " Le-
cons d'Anatomie comparee," abounds with proof of the intimate
relation of muscular motion and nervous influences, with res-
piration as their source and spring. Speaking of animals, he
says, " Chacune de ses classes jouit de la faculte de se mouvoir
precisement dans le degre qui correspond a la quantite de la
respiration." (Vol. /. p. 52.) The blood could not derive
heat from respiration without deriving more or less power of
motion ; because caloric is not inoperative. Those who ob-
ject to the truths of natural philosophy as authority in medi-
cine, forget that the former is the root of the latter. Hence
objections, drawn from medical theories, should have no weight
when brought against the truths of the mother science.

Harvey discovered the course of the circulation of the blood,
but he did not discover the chief power that moved it. His
discovery was incomplete, as it erroneously placed it in the
heart instead of the lungs. In consequence of this radical error,
the science of medicine has not been as much enriched by the
discovery of the circulation as was anticipated, as it only served
to lead the blind into a dazzling and uncertain light whereas
the discovery that the chief motive power of the blood is loca-
ted in the lungs, and not in the heart as was erroneously sup-
posed, has opened a rich field for improvement in physiology,
pathology, and in the more successful methods of treatment in

158 New Theory of Respiration and Circulation. [March,

disease. Before Dr. Bassi, charged, by the scientific congress
lately held at Genoa, to explain the reason why silk worms fed
on indigo leaves have a blue color imparted to the membranes
between the parietes of the air-tubes, can give a satisfactory
explanation of that phenomenon ; and before Prof. Bryan, of
Philadelphia, can interpret the experiments he is now making
on papilios, they will have to look into the anatomy and physi-
ology of those insects, brought into the light furnished by the dis-
covery locating the motive power of the blood in the lungs.
The dorsal vessel, called the heart, according to Cuvier, has no
muscularity, although these insects have upwards of four thou-
sand muscles. M. Lyonet counted in the caterpillar, called
the cassus ligneperda, 4041 distinct muscles. The heart has
but one artery, and that artery no branches. The muscles
have no blood-vessels distributed to them, nor is there any cel-
lular membrane between the layers of their fasciculi, being
parallel and without attachment except at their origin and in-
sertion resembling hairs tied at their two ends. There are
no veins, but more nerves than in the human body, viz : 47 pair
in the papilios. Every part of the insect is pervaded by tra-
cheal branches penetrating to the extremeties of every appen-
dage of the body ; yet in the interstices between the tracheal
vessels the nutritive juices, which tie experimenters found
colored in those worms fed on indigo leaves, are carried by
some unknown agency to all parts of the body no doubt by
the same spring or locomotive power which in man is the pri-
mum mobile of the blood.

But it is not so much in explaining mysteries in entomology
that the discovery is valuable, but in leading the way to impor-
tant improvements in therapeutics and other practical and
useful sciences. Thus before roses can be planted on the pallid
cheek, it is important to know in what way healthy red blood
can be soonest made, warmed, depurated and kept in motion.
Before the "young idea can be taught to shoot" witk vigor,
it is all-important that a current of red healthy blood be distri-
buted to the brain the organ of thought. The same impor-
tant agent, red healthy blood, is absolutely necessary to give
tone, vigor and symmetry to the body, and to prevent it from
falling an untimely prey to consumption and other ills. But it
is not so generally known, that red healthy blood is just as
necessary for the full developement and integrity of the mor-
al faculties as the intellectual ; and under this aspect, the dis-
covery of its motive powers has strong claims to the attention
of theologians. Church history bears witness, that ''the stony
ground''' where the seed of christian truth takes no deep root,
is the very ground trod by a people whose blood is vitiated by

1852.] New Theory of Respiration and Circulation. 159

idleness, filth, impure air and unwholesome diet. Instance, the
indolent Hindoos and other inhabitants ofpopulous Asia, breath-
ing the impure air of crowded hovels without sufficient food or
clothing. Instance, the idle eaters of ant eggs and caterpillars,
overspreading Africa, and the denizens of the cellars of London.
Education, therefore, in its broadest sense, physical, moral, re-
ligious and intellectual, is essentially and indissolubly connected
with red healthy blood. Hence, when Mrs. Willard indicated
one of the chief ways, by which red healthy blood could be
made at will, and that every child could be taught to make it
for itself, she was not, as it was supposed, out of her province,
as the head of a renowned institution of learning,*but standing
on the broad platform of her profession, and directing the build-
ing of a permanent basis for it to rest upon throughout all time.
In forming that basis, she naturally looked into the science of
physiology for certain materials in regard to the motive powers
of the blood ; and not finding them there, after going as far as
Harvey went, she brought that science back to natural philoso-
phy, the parent from which it sprung, w^hich receiving new
strength and increase therefrom, readily conducted her to the
hiding place of the materials she was seeking a golden fleece,
more valuable than that of fable. If some medical men gain-
sayed her for overturning things on the altar of Harve>, it w'as
because they had not reflected that the empire of science, so
long encroached on by empiricism, calls for enlargement, and
that America, like Rome, needs a Minerva. Surely the alms-
house, the hospital and the sick room, is too small an empire
for the numerous votaries of the comprehensive science of
medicine a science, like the Crystal Palace, embracing almost
everything worthy to behold in its study, but narrowed down in
its practical exercise to a few common-place duties, associating
it in the public mind with nothing but nauseous drugs, making it
the tenor of the people, and in too many instances driving
them from its advantages until the fear of death is upon them.
So much knowledge, with a field too small to call a tithe of it
into requisition, requii^es the extension of the practical sphere
of its operations, and that sphere will need enlargement until it
embraces in its practical boundaries, not only therapeutics,
hygiene, &c., but the art, long sought after by the ancients, of
making the old younger, children healthy, men vigorous, and
w^omen pretty. This art has always been imperfect ; its basis
or starting point a knowledge of the motive powers of the
blood and the ways and means of making red healthy blood at
will having been unknown. While the erroneous hypothesis
of Harvey prevailed, that the heart, whose action is not under
the will, was the primum mobile and chief motive power of the

160 New Theory of Respiration and Circulation. [March,

circulating fluids, instead of the lungs, which are under the will,
there was no known way, except through the slow and uncer-
tain process of diet, change of climate, exercise, or a course of
medicine, by which the vitiated, cold, impoverished circulating
fluids could be reached, depurated, or rendered red, warm and
healthy. Body, mind and morals had to suffer all the effects of
deteriorated humors as a necessary evil the direct road to
purify the blood through the respiratory organs being unknown,
from incorrect theories of the power that moved it and the loca-
tion of that power.

The true doctrine on this subject was no sooner promulga-
ted, than I r^Huced it to practice, and have made it tell well as
a valuable adjuvant in the treatment of many diseases, particu-
larly those of a chronic kind, and the cold, phlegmatic ailments
so common among females in hot climates. Some complaints,
especially acute inflammations, require repose of the respirato-
ry organs, absolute rest and a spare diet ; while the great mass
of chronic and congestive disorders are greatly benefited by
their activity. Thus in pleurisy, the curative process of nature
prevents full respiration by piercing the side with pain when-
ever the ribs are expanded ; because the motive power of the
blood being in the lungs, full breathing would aggravate a com-
plaint consisting in too much heat and momentum. On the
other hand, the cold, congestive and torpid affections require
increased activity of the lungs to heat, redden, and vivify the
circulating fluids. Full breathing in the open air and sun light
is beneficial to children of infirm constitutions, and applicable
to most of the diseases and infirmities peculiar to females, great-
ly assisting other necessary remedies, as malaxation, friction,
inunction, bathing, &c., to improve the complexion, to prevent
the hair from falling out, and the teeth from decay.

There has been a fearful increase of consumption and female
complaints, and a large field opened for dentists, since the old-
fashioned spinning wheel, called the big wheel, has been laid
aside. In ancient times the women ground at the mill that is,
turned a horizontal stone with an upright staff* for a handle, re-
quiring them to stand up and to use both hands. Two women
grinding at the mill, standing opposite to each other, was one
of the best species of exercise to expand the lungs and to depu-
rate the blood, without giving coarseness to the muscular system
and no doubt greatly contributed to the health, grace and classic
beauty for which the ancient women were so renowned. The
discovery of the motive power of the blood, and the location of
that power, will be a good antidote against the folies ofBloom-
erism, enticing: women to assume indiscriminately the avoca-
tions of men. Most of these avocations would make them coarse,

1S52.] Reproduction of LaclaLion. IGl

rough and masculine in appearance, like the weather-beaten fe-
male peasantry of Europe. The discovery is valuable as a key
to find those species of exercise, which do not give coarseness,
deformity and masculineness to the general muscular system
and its tegumentary covering, but softness, symmetry, agility
and grace, united with health, as the wheel and the mill-stone
formerly gave. A substitute for the last-mentioned exercises
is yet a desideratum. Mrs. VVillard's substitute of early rising
and running backward and forward before an open window,
moving the arms and expanding the chest, is a very good one,
but is defective in not being associated with some visible object
of utility, and consequently somewhat difficult in being gener-
ally practised to a sufficient extent. The inventor of some
species of play or kind of work, requiring similar movements,
would be entitled to the thanks of the community. It could be
improved by being performed in the morning sunshine, as sun-
light is particularly beneficial to youth in strengthening their
constitutions.

It was a rule in Egypt to bestow divinity and consecration
upon the inventor of any useful remedy or thing ; and as instinct
oftener than reason led to discoveries, the Egyptian deities
were mostly in the form of reptiles and other animals of the
brute creation. But if America, like Egypt, Greece and Rome,
is to have mythological divinities, I am sure that none will ob-
ject to their coming in the form and likeness of woman. Hence
I have no apology to make to the profession, of which I am a
humble member, for giving in my adhesion to an important prac-
tical truth in science, first announced by an American lady,
long famous for her erudition and intelligence, and for the num-
ber of our country's fair daughters who have been refined and
polished by her hands. [^Boston Med. Journal.

Report of three Cases in which Lactation was reproduced by
the application of the Child to the Breast. By Ariel Bal-
Lou, M. D. (Read to the Rhode Island Medical Society.)

Case I. In the autumn of 1836, Mrs. J. G., aged between
thirty and forty years, of sanguine temperament, robust con-
stitution, and the mother of several children, was confined.
The presentation was natural, and no unusual circumstances
attended her delivery. Subsequently she suffered from an
attack of phlegmasia dolens in both of the lower extremities,
attended with high febrile action, and, as is usual in such cases,
extreme suflfering. The secretion of milk ceasing early in the
disease, the child v/as removed to a wet nurse, with whom it

162 Reprochclion of Lactation. [March,

remained three or four months, during which time there was
no return of milk. In the spring of 1837, the family being
about to move a short distance from the village, where they
could enjoy a better air and a more unrestricted exercise, the
mother was anxious to take her infant with her, but did not like
to deprive it of the advantages of the breast during the then
coming warm season. I advised the mother to take her child
and apply it to the breasts in the same manner she would do if
she had a flow of milk, assuring her it was my confident opin-
ion that in two or three weeks she would have milk, and a
sufficient quantity, at least her usual supply.

She did so, and in about two weeks the secretion of milk was
reproduced. She continued to nurse her child for more than a
year, producing her accustomed quantity of milk.

Case II. Mrs. N. D., aged about twenty-five years, was
confined in December, 1841. Nothing worthy of note trans-
pired during her confinement and recovery. In April following
her child weaned itself, in consequence of a sore mouth. Her
milk soon entirely disappeared. In July following I was called
to see her child, which was sufl^ering from an attack of cholera
infantum. Having lost several children about that time from
this disease, I expressed my regret that the child was deprived
of the benefits of the breast, adding, that in my opinion its chan-
ces of recovery were diminished in consequence.

The mother was informed of the course I had advised in
other cases where it was desirable to reproduce the secretion,
and of the results. On my visit the succeeding day, she inform-
ed me that she had applied the child to the breast, and that it
nursed and seemed pleased and more quiet ; but she was not
aware that any milk was obtained or that she had any for it. I
advised her to persevere in the application of the child to the
breasts, which she did, and the child recovered, and in the
course of a week or ten days obtained a full supply of nutri-
ment from the breasts.

The mother continued to nurse for months with as full and
perfect a secretion of milk as though no interruption in the se-
cretion had occurred.

The following case I report as having an important practi-
cal bearing on the treatment and disposal of a class of cases
which occur in our community at the present day, to cure which
or otherwise dispose of satisfactorily to the physician, is often
found difficult.

Case III. Mrs. O. H. H., aged about twenty-one years, of
feeble constitution and nervo-lymphatic temperament, was con-
fined in July, 1847. Previous to her accouchment she was
troubled with chronic aphtha, red canker, or with that condition

1852.] Retro-Pharyngeal Abscess. 163

of the system which is well known as "sore mouth attendant
on pregnancy and lactation." Nothing unusual occurred at
the time of deli very. No considerable loss of blood was sustain-
ed. As in similar cases, there was a remission of diarrhoea
and sore mouth for a few days after accouchment, giving rise to
a hope that, being relieved from the condition of pregnancy, she
would recover the powers of digestion and the assimilation of
nutriment, so as to enable the system to sustain the calls upon it
consequent to lactation. But in the course of ten or twelve
days after accouchment the sore mouth and diarrhoea returned
with increased violence, producinggreat debility. The secre-
tion of milk was copious. Her pulse 120 ; the tongue flabby ;
there were frequent copious dejections of j^ellowish water, the
face and extremities bloated, &c. Fearing the worst results
for my patient, I advised the im.mediate removal of the child
from the breasts of the mother to those of a wet nurse, at the
same time informing the parents that on the recovery of the
mother she could at pleasure reapply the child to the breasts
and have a full supply of milk, and be enabled to perform all the
duties and functions of a mother for an indefinite period of time.
The child was given in charge of a wet nurse, the milk gradually
disappeared, and the patient recovered under the use of tonic
remedies and a generous diet. Between two and three months
after this the mother called on me, having the appearance of
restored health, and inquired if she might now take her child
home with a hope of realizing my former assurances that she
would be able to reproduce her milk. I assured her there was
no doubt in relation to such a result, and her ability for the future
to nurse her child. She took the child, applied it to the breasts,
and in the course of two weeks had a good supply of milk.

I met her some nine months after, when she informed me
she was happy in the enjoyment of good health, and, to use
her words, she " had as good a breast of milk as if she had never
dried it up." [American Jour, of Med. Sci.

Retro-Pharyngeal Abscess, its Medical History and Treatment,
^'C, By Charles M. Allen, M. D., Resident Surgeon of
the New York Hospital.

[A reprint from the New York Journal of Medicine, of an
article with the above title, deserves condensation for our
readers.]

Position of Abscess. Between the posterior wall of the
pharynx and the cervical vertebrae.

Acute Abscess, Predisposing Causes. Same as predispose
to the formation of abscess in other parts of the body ; may be

164 Reti'o- Pharyngeal Abscess. [March,

the result of hereditary scrofulous taint, of the poison of syphilis,
of long-continued habits of intemperance, of difficult dentition
in children, of scarlatina, variola, &c. &c.

Exciting Causes. Exposure to cold, followed by inflamma-
tion of the pharynx itself, which, terminating in suppuration, de-
posits the pus betwee n the pharyngeal fascia, and the muscles
lying upon it ; or inflammation of the lymphatic glands behind
the pharynx, where these glands are found to exist, or by a for-
eign body, as a fish bone, passing through the posterior wall of
the pharynx and forming the nucleus of abscess, or by retroces-
sion of erysipelas, stricture of oesophagus, rheumatism, &c.

Chronic Abscess. Predisposing causes of the same charac-
ter as in the acute form of the disease.

Exciting Causes. Caries or tubercular disease of the cer-
vical vertebrae, progressing nearly in the same manner as psoas
abscess.

Symptoms of Acute Form, Local uneasiness, stiffness in the
back of the neck, chilliness, succeeded by febrile excitement;
though fever is not an invariable attendant, the chiliness being
continuous. In young children convulsions are sometimes
present, often cedematous swelling of the anterior and lateral
portions of the neck ; as the disease advances soreness of throat
is increased, and a sensation of a foreign body arrested at the
base of the tongue is experienced ; respiration difficult, voice
nasal, cool perspiration about the head, pulse always quick and
very frequent, though sometimes full and forcible. In children
the dyspnoea often produces convulsions, which speedily termi-
nate in death.

Attempts to swallow or to lie down increase the dyspnoea,
and the somnolency or coma when present. The tongue is
spasmodically thrust out when the patient is requested to show
it, and returned with considerable difficulty, though it is often
protruded from the mouth without the ability to return it.

The internal surface of the mouth and throat is congested
with swelling of the tonsils and epiglottis, and an ovoid tumor
may be felt by the finger pushing against the posterior wall of
the pharynx, and in some instances, separating the alee of the
thyroid cartilage of the larynx. If death results, it is caused by
asphyxia, or by spontaneous opening of the tumor, its contents
deluging the air-passages.

Symptoms of the Chronic Abscess, are usually symptomatic
of some constitutional disease, mostly traceable to hereditary
taint. Pain in the back of the neck increased by moving the
head, and often most severe in the after part of the day. As the
disease advances, these symptoms become more marked, resul-
ting in complete closure of the jaws. In such cases, the cavity

k

1852.] On some of the Causes of Pericarditis. 165

of the abscess is liable to follow a more extended route, termina-
ting sometimes in the mediastinal space, or again between the
deep lateral fascia of the neck.

After (sometimes a long period of time) the dyspnoea, dyspha-
gia, &c., appear as in the acute variety, but often attended
with a low typhoid form of fever, which terminates in death
unless promptly and skillfully treated.

For want of space we pass over the diagnosis, prognosis, and
pathology of the disease, as presented by Dr. Allin, and pro-
ceed to state the treatment, which is divided into surgical and
medical.

Surgical Treatment. Make a free opening into the cavity
of the abscess, as follows : support the head of the patient firm-
ly, pass the forefinger of the left hand into the mouth, raise the
velum palati, and press ihe point of the finger against the tumor ;
then open with a common scalpel or bistoury, the blade being
covered with sticking-plaster, to within half an inch of its ex-
tremity. The incision should be free, at first, to avoid the ne-
cessity of repeating the operation.

Medical Treatment. Apply emollient and soothing poultices,
fomentations, &c., to the neck ; after the discharge has ceased
the local application of an astringent gargle, as follows :
^. Bi-boratis sodas 5ij ;
Tinct. myrrh ae f d j ;
Syr. simplicis f 5ss ;
Aqua purae f ivjss ;

Misce.

The condition of the general system may need tonics, and
even stimulants, but it is not usual to administer, where the ap-
petite is good, and the patient's strength may be sustained by
a generous system of nourishment.

The pamphlet contains, in addition to what has already been
stated, a statistical table of fifty-eight cases.

[New Jersey Med. Reporter.

On some of the Causes of Pericarditis. By Dr. John Taylor.

In this communication, which appeared in the *'Medico-Chi-
rurgical Transactions," vol. xxviii. p. 453, the main object of
the author is to determine what are the principal causes of per-
icarditis, and to ascertain their frequency, both absolutely and
relatively to each other.

He does not profess to investigate all the causes of pericar-
ditis. He has first inquired what were the causes actually ob-
served in all the examples of the disease which have fallen un-

N. S. VOL. Vlir. NO. III. 11

1G6 On some of the Causes of Pericarditis. [March,

der his notice ; in the next place, he has investigated more in
detail, their frequency, both absolutely and relatively to each
other, as well as some other of the circumstances connected
with each of the causes so observed ; lastly, he has examined,
incidentally, the influence of the same causes in producing in-
flammation of other internal organs, both in connection with,
and independently of, pericarditis.

The cases of acute and severe pericarditis examined are 35
in number. Of these nineteen occurred in the progress of acute
rheumatism ; ten in connection with Bright's disease of the
kidneys ; three others may have had Bright's disease, but if not,
the cause is unknown ; one occurred with malformation of the
heart and consequent cyanosis : two were produced by the ex-
tension of inflammation from a neighboring texture, in one
from the liver and diaphragm, and in one from the left pleura.

These severe cases of pericarditis may again be conveniently
subdivided into two smaller groups.

1. Those occurring in persons previously in good health, or
in the course of an acute disease ; and 2nd. Those occurring in
}ersons in bad health or in the progress of some chronic disease.
A remarkable and important difference will be found in these
two divisions, in relation to the causes of the disease. Of 29
cases examined, with a view to this difference, sixteen belong
to the first, and thirteen to the second, of the two divisions just
described. Of the cases in the first class all were complicated
with acute rheumatism, and none of them, so far as is known,
with Bright's disease. Of the cases in the second class, only
one was complicated with acute rheumatism ; whereas fully two
thirds were known to be associated with Bright's disease, and
all of them may have been.

The two great causes of pericarditis, therefore, appear to
have been acute rheumatism, and Bright's disease of the kid-
neys. The author next enters into some considerations inten-
ded to show that these two diseases owe their power of inducing
pericarditis to the same ultimate cause, viz : an alteration in
the composition of the blood ; but he does not attempt to deter-
mine, whether the alteration in the blood be essentially the same
in relation to the production of pericarditis, in the two diseases
referred to. If it be assumed that the pericarditis, which was
associated with cyanosis, likewise depended upon the state of
the blood in that disease, it will then appear that only two gen-
eric causes of the inflammation of the heart were observed in
thirty-five cases under consideration, viz : a morbid condition
of the blood, and extension of inflammation from a neighboring
texture.

The author next examines the cases of adhesion of the peri-

1852.] On some of the Causes of Pericarditis. 167

cardium, and of white spots upon it, with references to the
causes of the inflammation producing them ; and he arrives at
the conclusion, that in every case in which any information is
given upon the subject, there had previously been either acute
rheumatism, or pleurisy, or there was found actually existing,
either Bright's disease, or some other disease of the kidneys.

The two chief causes of acute pericarditis which were thus
observed, viz : acute rheumatism, and Bright's disease of the
kidneys, are next examined with more detail.

1. Of Acute Rheumatism as a cause of Inflammation in the
Heart. The frequency of acute rheumatism, as an observed
cause of pericarditis, has been already stated; it was observed
in two-thirds of all the rases of the latter disease.

Of seventy-five cases of acute rheumatism, treated by the au-
thor in University College Hospital, thirty-seven, about one-
half, had, morbus cordis of some kind or degree ; the rest had
probably none.

Among these seventy-five cases of rheumatism, there occur-
red six of acute pericarditis of considerable severity, besides
two very slight cases. The proportion of the former, therefore
was one in twelve and a half cases. In the same seventy-five
cases of rheumatism, there were thirty two cases of valvular
disease of the heart, either old or recent, besides two known to
be recent. There was, therefore, one case of valvular disease in
about every two cases of rheumatism.

The author next compares these results with those of various
writers upon the same subject, and from this comparison he
concludes

1. That acute inflammation of the heart has occurred less
frequently, as a complication of acute rheumatism, in his expe-
rience, than it has been believed to occur in the experience of
those writers whose opinions seem to have been most generally
adopted by the profession.

2. That the frequency of inflammation of the heart, even in
his cases, has been such as abundantly to show the great influ-
ence of acute rheumatism in its production.

An attempt is next made to ascertain the real amount, and
the causes of the difference between the observations of the
author and those of the writers referred to. The result, as it
respects most of these writers, may be briefly stated to be,

1st. Of Pericarditis. In those instances in which such data
have been given as enable us to compare similar cases, the re-
sults are very nearly the same. In various instances, however,
no comparison can be fairly made, either from the want of fi-
gures, from the mixing together of cases of endocarditis, and of
pericarditis, or from a great diflference in the age of the subjects.

168 On some of the Causes of Pericarditis. [March,

With respect to Endocarditis, the discrepancy is much grea-
ter than in the case of pericarditis, and one of the chief causes of
the difference appears to the author to be, that most writers
have given the proportion of cases of valvular disease in acute
rheumatism in such a manner as implies (when it is not directly
stated) that they were all cases of acute disease omitting,
therefore, to distinguish the proportion of them which were of
older date.

The proportionof cases of valvular disease of all dates obser-
ved by the author is nearly the same as that observed by thej
chief writers referred to ; but he attempts to show,

1st. That the greater number of these are examples of ok
valvular disease.

2nd. That, at all events, in most cases it is very difficult t(
distinguish when the disease is recent and when old ; and, 3rd:
That, as far as he has been able to ascertain, acute endocarditis
is less frequent than acute pericarditis in rheumatism.

The frequency of morbis cordis in chronic rheumatism
next inquired into, and compared with that in acute rheumatisr
and from this inquiry it appears, 1st. That the total numbei
of cases of morbis cordis, old and recent, is nearly the same ii
the two kinds of rheumatism. 2nd. That acute inflammation''
of the pericardium and of the endocardium is much more com-
mon in cases of acute than of chronic rheumatism.

The frequency of other internal inflammations in the course
of acute rheumatism is next examined, and compared with that
of inflammation of the heart, and the result is that the last men-
tioned inflammation exceeds every other in the frequency of its
occurrence.

The next subject of examination is the circumstances which
favor the occurrence of inflammation of the heart in the progress
of acute rheumatism.

1st. Metastasis. Metastasis of the rheumatism did not oc-
cur in any one of the cases observed; hence it is inferred that
this is not the ordinary nor even a frequent mode in which rheu-
matism produces cardiac inflammation. It does not, however,
follow from these facts that metastasis never takes place, and
it is attempted to be shown that its occasional occurrence is
both consistent with theory and established by observation.

In this part of the paper the author refers 1. To some cases
of rheumatism in which the inflammation of the heart appeared
before that of the joints. 2. To some cases of what has been
termed "rheumatic fever without arthritis," z. e., cases presen-
ting all the symptoms of acute rheumatism except the affection
of the articulations. 3. To one of his own cases in which he
thinks it probable that there have been acute rheumatism, and

1852.] On some of the Causes of Pericarditis. 169

in which there was pericarditis, but no affection of the joints
throughout.

2nd. Form of the Rheumatism. Adopting the divisions of
rheumatism given in the treatise of Dr. Macleod, we find that
all the cases of rheumatic pericarditis occurred in connection
with the fibrous as distinguished from the capsular form of rheu-
matism. In estimating the influence of this circumstance, how-
ever, it is neceasary to remember that the fibrous variety of
rheumatism is much more common than the capsular.

3rd. Intensity of the Rheumatism. From the cases exami-
ned, it appears to result that the violence and fatality of rheu-
matic pericarditis, are generally greater in the cases in which
the accompanying rheumatism is very acute than in those in
which it is sub-acute. Whether pericarditis be more frequent
in the more severe than in the less severe form of rheumatism,
the author's cases do not enable him with confidence to deter-
mine. As far as they go, however, they are opposed to such a
view, for three-fourths of the examples of rheumatic pericardi-
tis occurred in subacute rheumatism.

4th. Stage of the Rheumatism. In more than half the cases
of rheumatic pericarditis, the affection of the heart appeared on
or before the fourth day of the disease. With one exception,
the pericarditis did not appear sooner in those cases in which
it was very severe than in those in which it was much less se-
vere.

5th. Infiuence of Repeated Attacks of Rheumatism. In the
cases examined, pericarditis was found to be both more fre-
quent and more severe in the first than in subsequent attacks of
rheumatism.

6th. Previous diseases of the Heart. Ten out of fifteen pa-
tients had no previous disease of the heart, and among these
were found all the most severe cases of pericarditis.

7th. Age. Of fifteen patients, nine, or about two-thirds, were
only twenty years of age or under; five were between twenty
and twenty-six ; and one was about fcrty.

8th. Sex. Of fifteen patients, nine were males and six were
females. It is necessary, however, to remember that rheuma-
tism is more common among men than women.

9th. Influence of Venesection. Twelve of the patients had
not been bled before the pericarditis appeared; the remaining
three were bled, one eleven days, one five days, and one three
days, before the pericarditis supervened.

Mode in which Rheumatism produces Pericarditis. Upon
this question the author adopts the following hypothesis as con-
\ sistent with all the facts he is acquainted with':

Tiie cause of acute rheumatism is probably the presence of

170 Ou some of the Causes of Pericarditis. [March,

some morbid matter in the blood, which has an especial affinity
for the fibrous and fibro-serous tissues of the body, and which,
by fixing itself in one or more of these, induces various local
inflammations. The similarity of the structures impliciated, is
probably the reason why rheumatic pericarditis or endocardi-
tis often occurs at the same time w'ith or succeeds to rheumatic
inflammation in the joints, just as rheumatic inflamation in one
joint occurs with or succeeds to that in another ; and the heart
is more frequently (?) and more severely affected in severe ca-
ses of acute rheumatism, for the same reason that more joints
are affected and more severely affected, and also that more fever
is present in such cases ; which reason may not improbably be
a greater abundance of the materies morbi in the blood.

II. Of Bright' s Disease of the Kidneys as a Cause of Inflam-
mation in the Heart. We have already seen that of thirt3'-five
cases of pericarditis, Bright's disease* was the only assignable
cause of the inflammation in thirteen, or more than one-third.
It remains to institute the corresponding and complementary
inquiry, into the frequency of pericarditis and endocarditis in
Bright's disease.

1. In the bodies of fifty patients, who had either died of
Bright's disease or who were ascertained to have this dTsease
in an advanced stage, acute pericarditis was found in 5, or in
1 out of 10. and acute endocarditis in 4, or in 1 out of 12.

2. On the other hand, in 142 bodies, in which the kidneys
were not affected with any appreciable disease, acute pericardi-
tis w^as found in 4, or in 1 out of 35, and acute endocarditis in
2, or in 1 out of 71.

Pericarditis and endocarditis, therefore, being four times more
frequent in fatal cases of Bright's disease, than in fatal cases
without renal disease, it seems clearly to follow that the influ-
ence of Bright's disease in producing these inflammations is
unquestionable and great.

III. The frequency of other internal inflammations in fatal
cases of renal disease, is next examined and compared with
their frequency in fatal cases without rCnal disease. From this
comparison it appears,

1. That the proportionate number of acute internal inflam-
mations, exclusive of those of the heart, is twice as great in the
series of cases with renal disease, as in that without such disease;
the numbers being respectively ninety-six and forty-two per
cent.

2. That the proportion of patients, likewise, among whom
these inflammations were distributed, is greater in the former
than in the latter series of cases ; the numbers being respective-
ly sixty and thirty-six per cent.

I

1852.1 On some of the Causes of Pericarditis, ITl

Hence we may safely infer, that Bright's disease has a great
tendency to produce other internal inflammations besides those
of the heart.

IV^. A further examination of the same facts shows, that
the relative frequency of various internal inflammations, is dif-
ferent in fatal cases of Bright's disease and of other diseases,
taken indiscriminately.

The following are the various inflammations inquired into,
arranged in the order of their frequency, as they were calcula-
ted to be due to renal disease, or to the causes operating in other
fatal diseases.

1. Injlammations due to renal disease. Cerebritis, pneu-
monia pleuritis, pericarditis, endocarditis, meningitis, peritoni-
tis. 2. Inflainmaiions independent of renal disease. Pleuritis,
pneumonia, peritonitis, meningitis, cerebritis, pericarditis, endo-
carditis.

V. From a compai-ison of the numbers given in this paper,
we may calculate the tendency to produce various internal in-
flammations of the causes operating in fata! cases of Bright's dis-
ease as compared with those present in cases without renal
disease. If we use the term Bright's disease, to represent all
the causes operating in fatal cases of Bright's disease, and then
compare these with the causes in operation in fatal cases with-
out any renal disease, we shall find that Bright's disease pro-
duces: 1. Endocarditis, almost 5 times as often as all other
causes put together; 2. Cerebritis, fully 3|- times as often ; 3.
Pericarditis, fully 2\ times as often ; 4. Pneumonia, jusi 5 times
as often ; 5. Pleuritis, just | times as often ; 6. Meningitis, 3
times less frequently ; 7. Peritonitis, 100 times less frequently.
Tlie author next inquires into the comparative efiicacy of acute
rheumatism and of Bright's disease, in producing pericarditis
and other internal inflammations.

In comparing these two affections, we meet with some diffi-
culty, arising from the fact that one of them is an acute disease
and is seldom fatal, whereas the other is chronic and generally
fatal. It appears to the author that the best mode of avoiding
this difficulty is, to compare fatal cases of Bright's disease with
ordinary cases of acute rheumatism. If the object were to
ascertain the proportion of cases, in which traces of previously
existing inflammation were found, ihis method would be objec-
tionable, because the one disease having run a much longer
course than the other, it would have had much more time to
produce any inflammation which it had the power to produce ;
but, if cases of actually existing inflammation alone be counted,
then the objection does not exist, and the result should not be
far from the truth.

172 Synovial Articular Inflammation, [March,

Of seventy-five cases of acute rheumatism, eight, or one in
nine and a half, were compHcated with pericarditis acuta. Of
fifty fatal cases of Bright's disease, five were compHcated with
pericarditis acuta or one in ten.

Hence, Bright's disease in the advanced stage, and acute
rheumatism, appear to have caused acute pericarditis in an
equal proportion of cases.

An examination of twenty cases of old adhesion of the peri-
cardium, however, shows, what the considerations stated above
might have led us to anticipate, that old adhesions of the peri-
cardium have been produced twice as often by Bright's disease,
as by previous attacks of acute rheumatism.

From considerations which could not readily be made intel-
ligible in this abstract, the inference is next drawn, that acute
rheumatism has a greater tendency to produce pericarditis
than has Bright's disease in its earlier stages, and consequently
that the tendency of Bright's disease to induce pericarditis, and
probably also other internal inflammations, increases in propor-
tion as the affection of the kidney is more advanced.

The conclusion thus arrived at is quite in accordance with
the modus operandi of Bright's disease in producing local in-
flammations, which has been assumed in an earlier part of the
paper; for, if this efl^ect of renal disease depend upon a morbid
condition of the blood, arising from the excessive accumulation
of urea, we should expect the effect to increase in proportion as
the structure and the functions of the kidneys, and the conse-
quent composition of the blood, deviate more from the healthy
condition.

In conclusion, some remarks are made upon the probable oc-
currence of pericarditis in other blood diseases, besides those
observed by the author.

Likewise some observations on the importance of the consti-
tutional or predisposing causes of inflammation, as distinguished
from the exciting causes. \_Abridgment from Braithwaites
Retrospect.

Cases of Synovial Articular hiflammation of the Knee, treated
successfully 10 ith Urate of Ammonia.^ By W. E. Horner,
M. D., Prof, of Anatomy in the University of Pennsylvania,
Senior Surgeon of the St.* Joseph's Hospital, etc.

The liniment of ammonia is so well known in the treatment
of chronic articular affections, that its character may be consi-

* This paper was originally read before the Academ}- of" Natural Sciences, on
Tuesday December 9tb, 1651, though now published by pieferencein a Medical
Journal.

1852.] Synovial Articular Injlammation. 173

dered as settled ; but my attention has been only lately called
to the still higher powers of urate of ammonia, an article which
though sufficiently offensive to the olflictories, has a strong com-
pensating quality in the efficiency of its action. My first obser-
vation in regard to it was the result of having accidentally been
called to a poor woman who was in a state of unremitted and
excruciating suffering, day and night, but especially during
the latter period, /rom a chronic inflammation of the knee joint,
attended w^ith considerable swelling and tenderness, and some
degree of redness. I made to it the ordinary applications of
cold fomentations, and evaporating lotions, enjoined rest, attend-
ed to her diet and the state of her bowels, and gave opiates
at night in the shape of Dover's pow^der. After ten or twelve
days of attendance, in which no progress was made to a cure,
I was much gratified on a visit to find that the pain had ceased
suddenly, and that the preceding night had been spent in great
ease. The strong expression of satisfaction on my part, led to
a communication from her, with many apologies for herself,
that, finding the disease so little abated, she had been tempted
to try the remedy of a simple friend, who had been remarkably
improved by it in a similar attack. This remedy was a poultice
made of human urine, thickened with potter's clay, and put on
as warm as one could bear it; and to be repeated when it got dry.
She declared to me, that this rather indelicate application had
relieved her of all pain in a few hours. The fact of relief was
incontestible ; the question was in regard to the remedial agency
of the article employed, and I therefore determined to make
some experiments on the value of ammonia in combination
with fine ai'gillacious earth.

Having a similar case shortly afterwards, in the St. Joseph's
Hospital, I tried in it a solution of muriate of ammonia formed
into a poultice. i\o very distinct or satisfactory result followed,
and it was discontinued. Having the idea still in my mind,
and wishing to be satisfied about it, but reluctant to employ the
article resorted to by the poor woman, I determined to find my
urate of ammonia in some other form of an easy kind, and for
that reason adopted the guano, which has so large a proportion
of phosphate of lime, urea and of urate of ammonia in it. A

female patient, aged 34 years, Mrs. C , from Tamaqua

in this State, who had for more than a year labored under in-
flammation of the right knee, was put under my charge at the
St. Joseph's Hospital, Oct. 8th, 1851. She had been well at-
tended to by Dr. Schemer, who had conducted her through the
most acute period of her complaint. The joint had suppurated,
and she came to town with a small fistulous orifice on the inner
side of the knee, through wiiich a probe could be easily passed

174 Synomal Articular Injiammation. [March,

between the tibia and os femoris. From this there came daily
a spoonful or more of matter, when a plug was withdrawn from
the orifice. She still suffered great pain at night, the part was
tender, and was in continual uneasiness, and she had some slight
fever in the afternoon. Here was exactly the case to try the
efficacy of urate of ammonia, as naturally formed in animals.
I accordingly obtained some guano, and had it made into a hot
poultice with clay. The joint was kept envel^iped in the poul-
tice with frequent changes, for nearly the remainder of the
month, at the end of which time a very marked improvement
had taken place in the amount of pain, and also in the degree
of swelling; and the purulent discharge had almost ceased.

The application produced a very copious vesication of the
knee, and it had to he weakened to reduce the caustic qualities.
Having conducted this treatment as far as seemed necessary,
the skin was permitted to heal. Some little pain recurring
afterwards, she was blistered for it ; that getting well, the em-
plastrum calefaciens was applied, and the leg was also kept
supported by an extending band on the ankle, and a counter-
extending one on the thigh, their action being sustained by a
splint on the outside of the limb. At the end of six weeks,
November 25th, she has left the hospital without pain or uneasi-
ness in the knee. The joint is in a state of false anchylosis,
and straight. I have covered the knee with emplastrum adhe-
sivum, and secured it in that position vvith strong paste board
splints, moulded to the knee ; and have recommended her to
keep it so for two or three months, until all danger of seconda-
ry suppuration be removed. Probably at the end of this time
the judicious use of frictions and of Stromeyer's screw splint,
may impart some flexion to the limb.

The Hospital record sheet shows the following details of
dates, which may be inserted in this place:

Oct. 9. Poultice of guano, {itrate of ammonia) and potter's
clay, equal parts.

Oct. 10. iPoultice has blistered. It was discontinued, and
simple cerate applied.

Oc^. 11. Patient has less pain ; sorenessof knee reduced, and
not so much swelling. A poultice with one-third of the urate
of ammonia, and two-thirds potter's clay.

Oct. 13. Vesication.

Oct. 14. Quantity of urate reduced to one-fourth of poul-
tice. Treatment continued pretty much in this state to near
the end of the month. Vesication by Emplast. Cantharid. about
this, but omitted on record.

Oct. 28. She was permitted to eat as she pleased.

Nov. 5. Emplastrum calefaciens.

1852.] Synovial Articular Inflammation. 175

Nov. 12. Discontinue emplastrum calefaciens, and re-apply
the urate of ammonia as on 14lh October.

While this case was in progress, another occured in a boy
who had the knee joint opened by a cut of half an inch or so in
length. Synovial inflammation followed, with the ordinary
symptoms. Its usual acute-period was passed through, under
the depletory antiphlogistic treatment, and with evaporating
lotions to the part. The disposition to fall into the chronic
state, attended with tumefaction was relieved by five days use
of the same argillacious, uro-ammoniacal poultice.

The Ward sheet exhibits the following entries in regard to
this case : Patient, Timothy Roach, aged nineteen years, admit-
ted September 23d, a day or two after accident. Knee painful
and stiff, somewhat swollen. Rest and fomentations of warm
water directed on that day. Also loss often ounces of blood
from arm.

Sept. 24. Local bleeding by scarified cupping. Fomenta-
lations continued.

Oct. 4. Warm fomentations to this date; in the mean time
an evident articular effusion has occurred into the synovial
membrane of the knee. A blister plaster 4 inches by 4, was
then applied.

Oct. G. Blister plaster 2X3 inches.

Oct. 7. The patient so much relieved from pain as to be per-
mitted to leave his bed and promenade with a crutch.

Oct. U. Some aching and temefaction indicated a persistence
of afticular irritation. The poultice of urate of ammonia
(guano) one-fourth, potter's clay three-fourths, was then applied
hot, with frequent renewals to the 14th of October, at which
time all the symptoms were relieved. The patient was dis-
charged cured on the 15th.

The above cases are reported much in outline. I shall con-
tinue, as opportunity ofl?ers, to test the value of the above reme-
dy, and also compare its results with other remedies. It
appears to me to have some special qualities, which are of a
highly beneficial kind in the affections alluded to. It is so active
a revulsive when applied strong, that I have no doubt of their
being many cases of serous inflammation in which it may be
usefully resorted to. I would here suggest a trial in puerperal
peritonitis and in pleurisy. I see no objection except the
odour.

The poultice of guano and clay dries very quickly, so that
it is better to shield it with oiled silk or India rubber cloth.
The clay I look upon as simply a vehicle, but it may also have
some physiological action from its physical properties in regard
to moisture.

176 Affections of the Ear. March,

The analysis of the best guano, by the chemist, presents the
following constituents, which are mentioned here for facihty of
reference. The proportions will vary according to their at-
mospheric exposure and to the degree of adulteration in trade.
As it is an expensive article for agricultural purposes, it has
become common to reduce its chemical relations by the addi-
tion of common earthy substances :

Uric acid, thirty per cent.

Uric acid with ammonia.

Carbonate of ammonia.

Muriate, oxalate, and phosphate of ammonia.

Free ammonia.

Phosphate of soda.

Phosphate of lime.

Sulphate of potash and soda, and oxalate of lime.

It is the large quantity of ammonia in it which makes it so
active a stimulant to vegetable growth, and so disagreeable to
the smell. It, however, is not so intolerable medically, as assa-
fetida, an article which we have but litte hesitation in prescri-
bing. \_Medical Examiner.

On the Pathology of some Affections of the Ear which induce
Cerebral Disease, By Mr. Toynbee.

Mr. Toynbee has presented a memoir to the Royal Medico-
Chirurgical Society, in which he has endeavored to specify the
diseases of the ear which are liable to extend to the brJln, as
well as to show that each division of the internal aural appara-
tus has its particular division of the encephalon to which it
communicates disease. He states, for instance, that 1 . Affec-
tions of the external meatus and mastoid cells produce disease
in the lateral sinus and cerebellum. 2. Affections of the tym-
panic cavity produce disease in the cerebrum'. 3. Affections
of the vestibule and cochlea produce disease in the medulla
oblongata. In speaking of the external meatus, its intimate re-
lations with the lateral sinus and cerebellum are pointed out;
the affection most frequently producing disease in these parts
is shown to be catarrhal inflammation of its dermoid layer, one
of the numerous diseases which have hitherto been classed
together under the term otorrhoea. This affection of the ex-
ternal m.eatus is fully described ; and it is shown that it is
found to endure during many years, without the presence of
pain, or any other symptom calculated to apprise the surgeon
of tiie presence of a formidable disease, while the bone may be
becoming slowly carious, and portions of the dura mater and
cerebellum disorganized. In the second division of the paper,

1852.] Affections of the Ear. Ill

the tympanic cavity is described to be the part of the ear from
which disease is most frequently propagated to the brain. This
circumstance is accounted for, firstly, by the great liability of
the mucous membrane of the tympanum to undergo pathologi-
cal changes ; and, secondly, by the existence of very intimate
relations between this membrane and the dura mater. The
affection of the tympanum which most frequently produces dis-
ease in the cerebrum is chronic catarrhal inflammation of the
mucous membrane, an aflection thus far only known as an
otorrhoea. The four changes in the dura mater and cerebrum
produced by the affections of the tympanum are

1. Inflammation of the dura mater, and its separation from
the surface of the petrous bone by serum.

2. Ulceration of the dura mater, and its complete detach-
ment from the petrous bone.

3. An abscess in the substance of the cerebrum.

4. Undefined suppuration of the substance of the cerebrum.
From a careful examination of cases, it appears that chronic

catarrhal inflammation of the mucous membrane of the tym-
panum may exist as many as twenty or more years, without
the production of any disease beyond it, or at least, without the
existence of symptoms by means of which the presence of such
disease can be diagnosed ; nevertheless, in the great majority
of cases vital structures become sensibly affected in a much
shorter period. In a third section of the paper the author de-
votes some space to the consideration of the labyrinth, and it
is shown that purulent matter in the vestibule or cochlea some-
times causes disease of the auditory nerve, which is transmitted
to the medulla oblongata, producing suppurative inflammation
of the meninges, and death, without the presence of any caries
of the bone. In the course of this paper the author shows the
necessity of abolishing the use of the term otorrhoea, and of
using in its place the names of the several diseases, eight in
number, of which a discharge from the ear is one of the symp-
toms. In conclusion, the facts which he is desirous of impress-
ing upon the minds of medical men are, that the bone, dura
mater, and substance of the brain may be slowly undergoing
disorganization, without the presence of any other symptoms
calculated to reveal to the medical man the existence of formi-
dable disease than the presence of a discharge from the exter-
nal auditory meatus ; and that, consequently, no person suffer-
ing from catarrhal inflammation of the dermoid layer of the
meatus, the membrana tympani, or of the mucous membrane of
the tympanum, can be assured that disease is not being pro-
lono^ed to the temporal bone, the brain, and its membranes ;
and that any ordinary exciting cause, as an attack of fever or

178 Anti-Syphilitic Agents to replace Mercury, [March,

influenza, a blow on the head, &c., may not induce the appear-
ance of acute symptoms, which, as a general rule, are speedily
fatal. \_Medical Times.

Anti-Syphilitic Agents, to replace Mercury.

In the Comptes Rendus des Sceances de PAcad, des Sciences
for the 3d of November, 1851, we find a note on this subject by
M. Edouard Robin, followed by experimental researches, by
Dr. Vicente.

M. Robin, reflecting on the fact that the mercurials, used in
the cure of Syphilis, did not probably exert any peculiar action
on the system, but removed the disease by entering the circu-
lation and destroying the venereal virus, was led to the belief,
that other substances, besides those which had been employed
hitherto, might be found, which would exert the same power
over the poison.

All the anti-syphilitic remedies at present known, belong,
according to M. Robin, to the class of anti-septic substances ;
and pertaining: to the same class, two compounds appeared to
iiim eminently worthy of trial in this disease these are the
bi-chromate of potash and the sesqui-chloride of iron.

Accordingly he invited a very experienced practitioner, M.
Vicente, to study experimentally the action of the bi-chromate
of potash, and the results at which he arrived were very favora-
ble. We insert the resume of the observations of M. Vicente :

" 1. The bi-chromate of potash is undoubtedly an anti-syphi-
litic agent, and acts with more energy and rapidity than the
mercurial preparations.

"2. In the three cases in which I ha^e administered this
new therapeutical agent, the patients have experienced no
inconvenience, except perhaps some nausea at the commence-
ment, particularly when they neglected to drink water after
the pill, in order to prevent the slight local irritation ; but with
this precaution, and the addition of opium, as a corrective, the
stomach soon tolerated the bi-chromate of potash, which, being
completely soluble in water, may be administered in a draught
or pill ; taken after a meal the pills have never caused either
nausea or vomiting.

"3. The bi-chromate of potash being soluble, its absorption
into the system is complete and almost instantaneous ; hence
the rapidity of its therapeutical action, even in doses of a quar-
ter of a grain.

'* 4. The bi-chromate of potash does not appear to be anti-
plastic in its action like mercury ; it did not cause salivation,
diarrhoea, or any particular phenomena.

1852.] Case of Tetanus. 179

"5. Consequently, if these fiicts be confirmed by subsequent
experiment, this agent will advantageously replace the mercu-
rial preparations." [Transylvania Med. Journ. P.

Report of a fatal Case of Tetanus following the ligature of
Hcemorrhoids. By James Bolton, M. D. (Read before the
Medical Society of Virginia, at its October meeting.)

M. C, colored female ret. 35 married ; has suffered in-
tensely from piles since the birth of her first child fifteen years
since.

Oct. G. A mass of about the size of a hen's egg protrudes
from the anus, and separates the nates.

Operation. The patient was fully anaesthetized. The mass
was so vascular that merely sponging with cold water caused
the loss of about half a pint of blood in a few minutes.

It was divided by sulci into three tumors. A needle was
passed through the base of each, carrying a double ligature,
Avhich was tied on both sides of the tumor.

Iq forty-eight hours nearly the vvho'e had slouched off.
Chlorine wash was applied to correct the fcetorand to promote
healthy action.

On the fourth day a moderate dose of sulphur and bitartrate
of potash was ordered to remove constipation caused by opium
used to allay the pain which was produced by the ligatures.

About three or four times the quantity ordered was given,
and produced violent hypercatharsis. This was not checked
until it had lasted several days, owing to neijlect of directions.

On the 11th day the patient felt remarkably well until night,
when she suffered from cramps of the hams.

On the 12th day there were symptoms of decided tetanus.
Ordered morphiae sulph. gw ss. ; quinine di-sulph. gr. x. every
second hour. Chloroform to be used as often as necessary to
subdue spasm. Directions not attended to until night.

Observing some fostor from the anus, applied injection of
strong solution of nitrate of silver.

13th day. Spasms continue when free from the influence of
chloroform. Some tendency to sink. Inability to swallow.
Directed mercurial inunction extensively. After relaxing the
patient completely by chloroform, passed a stomach tube and
injected morphiae sulph. gr. i. ; quinine sulphate 3i. and bran-
dy oss. Only one spasm occurred after this, but the patient
continued to sink, and died without a struggle in about four
liours. A post-mortem examination was not permitted.

Rem.\rk3. Up to the time that hypercatharsis was produced,

180 Strychnine and Turpentine in Cholera. [March,

the patient was doing very well. Pain had ceased and the ap-
petite and spirits were good. From that time pain returned,
accompanied by physical and mental depression. It is there-
fore highly probable that the irritation of the part, together
with general exhaustion, which no doubt caused the tetanus,
was really due to the improper administration of medicine to
the patient, already in a critical condition from the operation.

[Stethoscope.

Strychnine and Turpentine in the treatment of Cholera By J.
Howes, M. D., Resident Physician of the Commercial Hos-
pital, Cincinnati.

From the last of April to the middle of June, there w^ere ten
cases of cholera in the Commercial Hospital, nine of which died
under the treatment usually adopted in such cases. These cases
were mostly far advanced, as indeed, are nearly all those brought
to the Hospital.

The success following this treatment was so small, that I con-
cluded none could be much less, and therefore considered every
case of cholera a legitimate subject for experiment ; and as it
devolved on me, in the absence of the attending physician, to
prescribe for all patients who came into the wards over which
I, as resident physician, had charge, I tried the effect of several
different remedies uDon persons attacked with cholera, and final-
ly settled upon the following :

^. Strychnia, gr. ss.

Spts. Turpentine 3ii.
Mucilage, I viii. M.

Dose, table-spoonful, to be given every half hour, until the
discharges have ceased, and perfect reaction is secured.

This treatment, with the consent of the attending physician,
has been made use of in the last twenty-five cases of cholera
which we have had in the hospital. Of these cases, ten were '|
in a state of perfect collapse ; twelve had a perceptible pulse,
but otherwise manifesting all the phenomena of collapse ; and
three had a warm dry skin, and a pulse of nearly natural full-
ness, with vomiting, purging, and cramps, the discharges pre-
senting the appearance of rice water.

Of these twenty-five cases, three did not react at all, four died
of consecutive fever, and eighteen recovered.

In some of the worst cases, we repeated the dose every fifteen
minutes instead of half hour. One of the most desperate took
three and a half pints of the mixture, in forty-eight hours, and

1852.] Treatment of Ancsmia. 181

recovered. None of them manifested any of the poisonous ef-
fects of strychnia.* We made as much use of external applica-
tions in our first cases, as in the last. Frictions of all kinds we
always found to exhaust very much those patients who were in,
or approaching very nearly, collapse. In a fevv cases we have
made use of sinapisms or blisters. [Western Lancet.

Extract of Beefs' Blood in the treatment of Ancemia. By Dr.
VoN Mauthner, of Vienna. Translated from the French
by H. A. Johnson, A. B., Interne to Illinois Gen. Hospital.

Dr. Von Mauthner, Director of the Hospital, St. Amne, of
Vienna, has employed for some time the extract of Beef's
Blood in the protracted Anaemias of children. According to
this distinguished practitioner a large number of diseases are
caused by an Anaemic state, rather than is generally believed,
by irritation, and ought, therefore to be treated by other than
antiphlogistic means. Unfortunately, science has furnished,
as yet but few remedies, capable of combatting successfully
Asthenic diseases, having their point of departure in the con-
stitution of the blood.

M. Von M. has employed with success the Ammonio Chlo-
ride of Iron in the treatment of children, presenting periodi-
cal symptoms of congestion, without any appreciable organic
cause, and in debility attending intermittants, but he has be-
come convinced that there are Anaemic conditions in which
the patients do not bear the use of any of the preparations of
Iron, and it is in such states that the Extract renders the most
efficient service.

The extract is prepared in the following manner : Blood,
fresh from the animal is thrown in a filter, and the residue
evaporated to complete dryness. It is administered in the
form of powder, or dissolved in water, in quantities of from
grs. 10 to 3 i. per day. Under the continued use of this means
the patients improve very much in appearance and gain rap-
idly in strength. This result ought to astonish no one when
it is considered that the extract supplies just those substances
which are wanting in the blood of these little sufferers, viz :
the heematine and the fibrine.

According to Dr. Von Mauthner, this preperation is especi-
ally adapted to the following Anaemic morbid conditions :
1st. Anaemia succeeding chronic diarrhoea of children of a cer-

Since ihe above was writteD, we have had a patient to whom was adminis-
tered one and a half pints of the above mixture, in sixteen hours, which produ-
ced quite severe tetanic spasms, which were relieved in a few moments by chloro-
form, and the patient is convalescing.

N. s. VOL. viir. NO. III. 12

182 Reunion of Wounds of the Spinal Cord. [March,

tain age. It is on the contrary of but very little use in very
young subjects and in such as have just been taken from the
breast. 2d. Ancsmia after Typhus. The author who is per-
fectly convinced of the advantages which it offers in this case,
assures us that it may be administered without any danger
of fatiguing the digestive organs. 3d. Anaemia which follows
severe pneumonia, when the lungs are not as yet restored to
their normal state, and the patient is troubled w^ith cough and
fever ; but it is to be remarked that the remedy is not equally
})eneficial in tuberculosis. 4th. Ansemia succeeding wasting
suppuration, and scrofulous ulcere. 5th. Anssmia after serous
accumulations produced by scarlatina. In this corwiition of
the system it seems to surpass all other remedies in use, since,
contrary to the effect which has been observed of other tonics,
it produces no irritation of the kidneys, a result often leading to
haematuria and albumenuria and constituting a new disease.

This remedy, so simple in its use,.and costing only the labor
of preparing it, merits, as it seems to u>s, the attention of prac-
titioners, especially for the poorer classes, among whom Anae-
mic effections are unfortunately so common. Annales, Med. de
la Flandre Odd. [North-western Med. and Sur. Jour,

On the Reunion of Wounds of the Spinal Cord, with Restoration
of its lost Functions. By M. Brown-Sequard.

During the last three years, M. Brown-Sequard has made a
eonsiderable number of experiments, with the view of determin-
ing the degree of reparative power which exists in the Spinal
Cord ; the results of which are very remarkable. The follow-
ing is one of the most striking: The spinal cord of a pigeon
was entirely divided between the 5th and 6th dorsal vertebrse ;
and the operation was followed by complete paralysis of the
posterior part of the body, as regarded sensibility and volun-
tary movement. At the end of three months, voluntary
movements began to show themselves,, in the midst of reflex
actions; and sensibility also reappeared. These powers grad-
ually augmented ; and six months after the operation, the bird
could stand for some minutes, but fell if it attempted to walk. In
the course of the seventh month it began to walk, but unsteadily,
helping itself by its wings. By the end of the eighth month, it
could walk, slowly without support ; but if it attempted to walk
fast, it fell over, unless it supported itself by its wings. Twelve
months after the operation, it could run ; and when the account
of the case was drawn up, fifteen months after the section had
been made, its progression seemed in all respects normal, save
that a certain degree of stiffness remained in its gait.

I

1852.] On Kiestein. 183

In several Guinea-pigs, in which the section had only been
made through one-half of the spinal cord, an incomplete return
of voluntary power was observed within seven or eight months
after the operation. In the case of one Guinea-pig, which had
been subjected to this operation a year before, and in which
sensibility appeared to have been completely restored, and vol-
untary movement less completely, a careful examination was
made of the injured part. It was found that the section had
traversed both the posterior columns, as well as the anterior and
lateral columns, and a portion of the grey substance on the right
side ; all of which parts exhibited a sort of contraction, the con-
tinuity of the divided parts being re-established by a whitish
cicatrix. On examining the substance of this cicatrix, it was
found to be in great part made up of fibres of areolar tissue, the
direction of which was transverse or oblique ; but these were
crossed by great numbers of nerve-fibres running in a longitu-
dinal direction, which exhibited a double contour, and were
uninterruptedly continous through the whole extent of the cica-
trix. Amongst these were scattered someganglionic corpuscles.
A like reproduction of nerve-fibres in the cicatrix of the spinal
cord, has been substantiated by ^I. Brown-Sequard in two other
cases. [Gazette Medicate. Brit, and For. Med. Chir. Rev.

On Kiestein. By Dr. Veit.

In consequence of the discrepancy of opinion which prevails
among observers as to the value to be attached to the appear-
ance of the urine termed Kiestein, as diagnostic of pregnancy,
Dr. Veit has, during a year andalialf, been conducting a series
of experiments at the "Halle Lying-in Institution. He has ex-
amined for this purpose the urine of 10 men, of 4 non-pregnant
females, and of 48 women in various stages of pregnancy. He
comes to the same conclusion as Hofle (Chemie und Micliros-
hop am Kramkenhette) and, recently, Lehmann, viz., that the
so-called pellicle of Kiestein is no peculiar matter at all, and is
not of the slightest value as a sign of pregnancy. In urine of
both non-pregnant and pregnant women, pellicles are formed
containing vibriones, and frequently the triple phosphate; the
chief difference between the respective urines being, that in
that of pregnant women, alkaline, and in that of non-pregnant
women, acid, reaction more frequently manifests itself. "This
may, in some measure, depend upon the greater concentration
ot the urine in pregnancy, and the larger proportion of mucus
mixed as a consequence of the changes induced in the condi-
tion of the mucous membrane of the bladder by the passive
hyperaemia of that organ during pregnancy. Persons partak-

184 Induction of Premature Labour. March,

ing of a more nitrogenous diet than did the poor pregnant wo-
men whose urine \vas examined, might furnish different results
in this respect. \_Zeitsch. fur Gehurt. Brit. Amer. Journal,

On the Induction of Premature Labour,

At a late meeting of the Edinburgh Obstetrical Society, Dr.
Moir made a statement of the mode of inducing premature
labour, which was introduced by the late Dr. Hamilton. The
plan consisted in gently dilating the os uteri with the finger or
a catheter, and separating the membranes fr(5m the cervix
without rupturing them. When labour came on it proceeded
as in the natural way, and the probability of the life of the child
being saved was much increased by avoiding a premature rup-
ture of the membranes. When this proceeding failed to induce
labour, Dr. Moir was in the habit of passing a catheter along
the posterior surface of the uterus, between it and the mem-
branes, and by means of the stillet, puncturing the latter high
up. By these means he had succeeded in every case but one.

Dr. Simpson is in the habit of inducing premature labour by
dilating the os with sponge tents ; and he considers this a more
certain as well as a more safe mode than any other. Like Dr.
Hamilton's plan, it had the advantage of not rupturing the mem-
branes. It had also, in Dr. Simpson's opinion, other advan-
tages. He has tried Dr. Kiwisch's plan of injecting a continuous
stream of tepid water against the os uteri in one case with suc-
cess. [Edinburg Monthly Journal.

On the Effect of Pressure above the Pubis in Uterine Hcemor-
rhage. By Edward Williams, M. D., Resident Physician
to the South-Eastern Lying-in Hospital, Dublin.

I was lately called to a case of uterine haemorrhage, occur-
ring after labour, and after the expulsion of the placenta. When
I arrived I found the patient bandaged tightly ; vinegar appli-
cations, also, had been used externally to the genitals ; the pulse
in both wrists was scarcely perceptible, and she appeared a
good deal prostrated. The flooding had been arrested by the
above means, at least partially. I applied pressure with the
hand above the pubis, and instantly, not more than thirty se-
conds or a minute, it produced a magical effect on the pulse,
which became bounding and strong, as if the heart had been
stimulated to increased action. Theorise as you may, I leave
this to learned physiologists ; I merely state the practical re-
sults viz., increased action of the arterial system and arrest
of the flooding.

It may be said, all this is nothing new ; all this is stated in books

1852."] Detection of Mercury, ^c. 185

on midwifery. I am aware of this, and claim nothing original ;
but I believe that practical observations may strengthen and
confirm the views of theorists and authors, and thus continued
observation of many may do service to the talented few.

[London Lancet.

On the Detection of Mercury in the Body of a Person Dying of
Mercurial Cachexy. By M. Gorup-Besanez.

That quicksilver is one of the metals capable of absorption
into the economy is a well-known fact, detected as it has been
by various chemists, not only in the blood, but in the secretions
of various organs, and especially the saliva, and in the structure
of the organs themselves. But as to the mode of its distribution
the duration of its presence in the various organs, and whether
it is found in all or certain tissues only, are points yet to be in-
vestigated. Dr. Gorup-Besanez relates the result of a recent
investigation of the body of a woman, who was long (tweniy
five years) laboriously engaged in silvering looking-glasses, but
who, from the convulsive tremors that were induced, had been
obliized to desist from her occupation lor a year prior to death.

The somewhat colapsed brain did not entirely fill the skull,
and the dura mater was of a reddish-blue from venous conges-
tion. The consistency of the brain w^as firmer than usual. The
lungs were hepatized, loaded with dark-coloured blood, and non-
crepitant.

The chemical results obtained by following the processes of
Fresenius and Babo were as follows. The lungs and heart
gave no traces of mercury ; a very small quantity was detec-
ted in the liver, and none in the bile. A doubtful precipitate
was thrown down upon the gold plate by the brain, while the
spinal column presented no traces. That any remains at all
should be found after a year is remarkable, and is confirmatory
of other facts, proving how long certain metals, e._^. antimonv,
may be retained in the economy. That the liver w^as the onfy
organ in which it could then be detected, confirms the doctrine
that metalic poisonous substances are longest found in that or-
gan. [Buchner's Report. Brit, and For. Med. Chir. Review.

On the distribution of the Blood-vessels in the Mucous Mem-
brane of the Stomach. By Henry Frey.

The distribution of the blood-vessels in the gastric mucous
membrane has an interesting relation to its double function ; for
the vessels of the surface, which are those most concerned in
absorption, are veins, and have a large diameter; whilst those

186 Meadoio Sweet in Di'opsy. [March,

of the deeper portions of the membrane, which are subservient
to secretion, are arteries, which form very delicate net-works
around tlie gastric follicles. [Henle and Pfeufers Zeitschrift.
Ibid.

Meadow Sweet in Dropsy. By M. Tessier.

From experiments made by M. T., in certain cases of drop-
sy, he believes that spiraea ulmariaor meadow-sweet possesses
diuretic properties ; that it is also slightly astringent and tonic ;
that it is agreeable to the taste, and produces no disturbance of
the stomach or of the nervous system; and that all parts of
the plant seemed to potsess the same properties. After all
known diuretics had been used in vain in a case of ascites,
connected with intestinal irritation, M. T. ordered a quart of
the decoction of the meadow-sweet to be taken daily. From
the third day, the patient passed much more urine than before.
At the end of 16 days, the medicine was suspended, and the
urine became at once scanty ; it was resumed, and continued
six weeks ; and the dropsy was removed without occasioning
any debility. In a young woman affected with heart disease,
it produced abundant diuresis, without lowering the circulation
like digitalis. IBuIL de Tkerap. Northern Lancet.

Sulphuric Acid in Diarrhoea.
The British medical periodicals contain additional testimony
in favor of the diluted sulphuric acid in diarrhoea and affections
approximating to cholera. The success obtained by some is
represented as very striking. All concur, how^ever, in repu-
diating this remedy in cases presenting dysenteric characters.
It is most useful in passive diarrhoea or those forms of the dis-
ease in which there is not much excitement. The doses re-
commended vary according to circumstances, but are usually
quite large. One formula suggested consists of \ oz. of the
dil. sulph. acid (of the dispensatories) in 1\ oz. water of which
1 oz. may be given every two hours, or oftener, if rejected by
the stomach. For children, it may be made palatable by
sweetening.

Prurigo of the Genital and Anal Regions.

Various remedies are from time to time recommended in the
journals for this disagreeable and obstinate affection. The

1852.] Ammonia in Lepra and Psoriasis. 187

London Lancet, for December 15th, gives an application of
M. Tournie's, as having been used with much success. *' The
affected spot is to be rubbed twice a day with calomel oint-
ment, (one to two drachms of calomel to ounce of axunge,) and,
after each application, dredged with a powder, consisting of
four parts of starch to one of powdered camphor." We have
used a great variety of applications, for the relief of this un-
manageable atfection, and have derived most advantage from a
cerate made of calomel { 5 i,) in Goulard's cerate ( i.) \_Medi-
cal Examiner.

Sesquicarbonate of Ammonia in Lepra and Psoriasis,

M. Cazenave, so well known as a very successful dermatolo-
gist, has just published experiments tending to show that ses-
quicarbonate of ammonia may advantageously be used as a
succedaneum of arsenical preparations, in lepra and psoriasis.
The salt is mixed in the following proportions : Half a drachm
of sesquicarbonate of ammonia; diaphoretic syrup, seven
ounces ; take from one to three table-spoonfuls per diem. The
physiological effects are very slight, but in the space of about
a week the scales begin to fall off; those which succeed are
thinner, the patches which give them support gradually fall in,
the redness fades after a longer or shorter time, and a lasting
cure generally ensues. If Diarrhoea, lassitude, cephalalgia,
quick pulse, and rapid alterations of heat and cold, were to
occur, as was the case with two or three patients, the remedy
should be suspended. [^London Lancet.

New mode of Disguising the Taste of Cod- Liver Oil.

Dr. Routh exhibited to the Medical Society of London, a
specimen of "Sardine flavoured oil," prepared by digesting a
number of sardine fishes, as sent over from Italy, in some cod-
liver oil. After a month or so, the oil acquired the tase and
smell of the sardines, and was very pleasant to take ; spread
over a piece of hot toast, it formed really quite a luxury. The
bottle was handed round, and seemed to give general satisfac-
tion. [^Medical Ti?nes.

Umbilical Superf (Elation.

M. Danyau read (Nov. 18th) to the Academy of Medicine
of Paris, a report on a case by Dr. Sulikowski, of a girl born
in 1833, who had at birth a remarkably large abdomen, which
increased in size till the age of ten years. During this period
her health was greatly impaired, and she suffered much from

188 Miscellany. [March,

abdominal pains and other symptoms. In 1843, a rupture took
place at the umbilicus, and from twelve to fourteen pounds of
serous liquid escaped ; the tumor was notably diminished ;
through the opening left in the parietes a substance could be
perceived, fleshy, resisting, red, and studded with teeth and
hair. Several years afterwards the tumour was successfully
removed by operation, and was found to contain a deformed
male foetus. \^Medical News.

On the Abortive Treatment of Gonorrhoea by Chloroform,
By M.'Vexot.

M. Venot, of Bordeaux, states, as the result of a twelve-
month's experience, that injections of chloroform, though of
little avail in confirmed gonorrhoea, are possessed of a complete
abortive efficacy, if employed during the first week. [Bull, de
Tnerap. Brit, and For. Med. Chir. Rev.

ill i s 1 1 a n g.

Religious Monomania ; Self -mutilation. (Under the care of Mr.
Lloyd.) We desire to call our readers' attention to a patient admit-
ted a few days ago, under the care of Mr. Lloyd. The ease is one
of a very painful character, and falls as much under the cognizance
of the psycologist as the surgeon : the former will therein find a new
example of religious monomania with destructive tendencies, and the
latter an instance of self-mutilation, somewhat startling in a purely
surgical point of view.

It appears that the patient is a well-conducted servant girl, twenty-
three years of age ; she has light hair and complexion, and has been
in service for the last nine months with a widow lady at Islington,
where she never showed any signs of mental aberration. Her father
was a bricklayer, who died from a severe cold caught in a well ; her
mother and sister are alive ; and it would seem that no distinct signs
of insanity have been known to exist in the family. The patient her-
self states very clearly that she was very happy in her situation, that
she went to church every Sunday, and that she was in the enjoyment
of good health. The catamenia have always been regular, and no
uneasiness in respect of menstruation was ever experienced.

On the morning of the 7th of November, the mistress had left the
kitchen but a short time when her attention was attracted to a very
strong ammoniacal smell about the house. She inquired from the ser-
vant whom she had just left below stairs, whether some linen was
burninsT, and receiving no answer, she proceeded into the kitchen,
where she found the girl before the fire with her left arm thrust into
it. The mistress, who was naturally very much alarmed, soon be-

1852.] Miscellany, 189

came aware that the hand had been completely severed from the arm^
and was lying on the fire ; and when anxiously inquiring for the
cause of this frighiul scene, the girl exclaimed that she had cut off
her hand with the carving knife, and that God had told her to do so.
When remonstrated with touching this sad mutilation, she seized a
steel skewer, and attempted to destroy her own eyes by thrusting its
point into them.

A surgeon, who had hurriedly been sent for, was soon upon the
spot ; and whilst he was endeavouring to take from the fire the severed
hand which was lying upon it, the unfortunate creature rushed for-
ward, and thrust her right and only remaining hand into the fire. By
this last and desperate act she inflicted a severe burn upon the fore-
arm and hand. She was finally conveyed to the hospital, a sad victim
to a sudden and unexpected monomaniac attack.

On examination, it was found that the left hand had been severed
from the arm as cleanly as a saw could have done it, the only
difference from an ordinary amputation being, that no soft parts had
been left for covering the lower ends of the radius and ulna, which
latter were quite exposed, with small fragments of cartilage still half
attached, the whole being somewhat obscured by charring. It M'ould
appear that the bleeding was inconsiderable, and as no actual haemorr-
hage had to be stopped, it may be surmised that the actual charring
to which the stump was exposed soon after the mutilation may have
acted as the actual cautery. The left forearm was somewhat swollen,
and on the right side the hand and forearm were found to be severely
burnt, the action of the Bre having penetrated to the cellular tissue.
The poor girl was keeping her eyes closed, and when the lids were
separated it was found that the skewer had principally wounded the
conjunctive and sclerotic, between the lower eyelid, the external can-
thus, and the globe ; there was much infiltration between the tunics,
but the iris was untouched in either eye.

The patient seems to be strictly y/iono-maniac, as she gives very
apposite and satisfactory answers respecting her age, state of health,
family, and various other circumstances. When questioned, how-
ever, as to the unfortunate mutiliation she has inflicted upon herself,
she invariably answers that God told her to do it. When closely
pressed as to how she knew that she ought to commit such an act she
appears wrapped in her monomania, and merely answers, " God
knows."

On the second day there was some purulent discharge from the
eyes ; the stump, which had been simply dressed, and the right arm,
which had been wrapped up in cotton wool, were rather painful ; the
bowels had been twice moved and the patient had been tranquil, com-
posed, and even inclined to sleep. When interrogated she does not
seem displeased at being disturbed, and gives short and clear answers
to the questions put to her; she does not cry out or mutter, but now
and then moves the upper extremities slowly in different directions
and finally raises them above her head. 'J'he breathing is slow and
regular, the carotids beat somewhat faintly and heavily, and when a

190 Miscellany. [March,

certain pressure is made upon one of these vessels, the patient utters
no complaint, nor do any cerebral phenomena become apparent.

Although the poor girl has been very quiet since admission, she is
M'atched with great vigilance, as she might suddenly be seized with a
fresh monomaniacal and destructive fit. Mr. Lloyd ordered some
calomel ; and purposes, when the patient has been watched for a few
days, to endeavor to render the stump a serviceable one. We shall
watch the progress of this case with painful interest, and acquaint our
readers with its subsequent features. [^London Lancet.

The Microscope as a jneans of Diagnosis. One occasionally hears
the question asked " Have you any faith in the microscope ?" and
asked, too, in such a spirit as to convey the answer in the question.
This expression of doubt as to the value of this inestimable instrument,
has in a great measure arisen from confounding the statement of the
facts observed with the conclusions drawn from them by the observer.
A microscope, such as can now be had for a very reasonable sum,
cannot err. It may not be able to reveal all that is essential to minute
structure, but it cannot add anything of itself to that which is placed
beneath it for examination. The microscope is to the eyes of ordinary
observers what a pair of spectacles is to the eyes of the short-sighted.
Both individuals are enabled to see that which is invisible to the unas-
sisted vision. It is when the observer begins to interpret, that error
commences, and it is to him, and not to his instrument, that the ques-
tion as to faith applies. Well, then, does it become those who seek
to make use of the microscope and who can now-a-days do well
without it ? to endeavor to render themselves competent interpreters
of what they see, and until the accomplishment is obtained, to confine
themselves to a description of facts. [London Lancet.

A neio Quackery. In Naumberg a man named Mahner is preach-
ing the necessity of anew regeneration, not in the spiritual but physi-
cal sense. He warns a sickly race that it must return to the lost
state of " primitive health," or Urgesundheit, as the means of more
fully enjoying life and attaining a patriarchal old age. It is to be
secured by a diet of bread and water, going barefoot, and letting the
hair and beard grow ; in short, making a nearer approach to man's
original state in costume than the decencies or prejudices of modern
society will altogether permit. [London Lancet,

AmpiUation of the entire Lower Jaia, with disarticulation of hoik
Condyles. The January number of the New York Journal of Medi-
cine contains the details of the above operation, as performed by
Professor Carnochan. The result was completely successful, and adds
another to the many brilliant achievements of American Surgery. ^

Fluid Extract of Ergot. By Joseph Laidley, of Richmond, Va.
"It is prepared by treating fi esh and good ergot in powder first with

1852.] Miscellany. 191

ether, allowing the latter to evaporate spontaneously^ thus securing all
the oil then with alcohol, and lastly with water ; the last two liquids
are evaporated below 212 until the fluid measures one-third as many
fluid ounces as the ergot employed weighed in troy ounces ; sufficient
sugar is added to preserve it, and the oil is then thoroughly incorpo-
rated, and sufficient water added to render it of such strength that
one fluid drachm (one teaspoonlul) will represent 40 grains, or about
two doses of ergot.

"Prepared as above, fluid extract of ergot is in the form of a con-
centrated syrup, possessing the advantages of being pleasant to take,
of being always ready for use, thus avoiding the delay sometimes
attendant upon administering a medicine where delay is so hazard-
ous as in lalDour. The smallness of the dose is another recommenda-
tion in its favor. The writer believes that it will keep unchanged
for a long time. Some in his possession, after having been kept for
about two months in a moderately warm situation, is entirely un-
changed. Some of this preparation was furnished to Dr. C. S. Mills,
of this city, who tested it in a case of labour about the middle of No-
vember. He informs the writer that it proved entirely satisfactory ;
its action was almost immediate, and produced no nausea."

\_Stetlioscope.

Medical Institutions at Lima. Lima, the population of which is
about 85,000, has a medical school, where a great many efficient
professors are appointed. The students are eighty in number, and
are admitted in the four hospitals of the city. The Santa Ana Hos-
pital is exclusively devoted to women, and has 700 beds; that of St.
Andrew is for men only, and numbers 400 beds ; the third is a mili-
tary hospital, and the fourth an institution for incurable patients, with
80 beds. The latter hospital contains principally black people and
mulattoes, affected with local chronic diseases, especially lepra and
ulcers of a frightful description. In the other hospitals fever and
dysentery arc the most common diseases, particularly among the
poor. Small-pox destroys a great many patients, as also elephantia-
sis. In the winter bronchial affections are somewhat common, owing
to the dampness of the climate. [L' TJnion Med. London Lancet.

Statistics of the Medical Profession in Paris and Russia. On the
1st of January, 1349, there were 1389 doctors of medicine in Paris,
being 53 less than in 1847 ; and now, in 1851, the number is reduced
to 1351, being a still further diminution of 38. Duiing the last two
years 65 have died, while, during the two former years, only 56 died,
and still fewer during the prior periods. In 1843-7, the mean annual
mortality was 1 in 75 ; in 1848-9, 1 in 50 ; and in 1850-1, 1 in 42.
There have emigrated 86, of whom 12 have repaired to Calitornia.
Towards following up the vacancies, 113 new doctors have been
made during the last two years.

Officiers de Sante have, however, increased from 156 in 1849, to
178 in 1851, and the yharmaciens from 363 to 381. Sage femmes

192 Miscellany, [March,

have diminished from 480 in 1847, to 385 in 1849, and 350 in 1851.

Revue Medico-Chirurgicale.

According to the official lists, published Jan. 1851, there were, in the
entire Russian empire, 7957 doctors possessing the right to practice, ^52
veterinary surgeons, and 132 oculists, dentists, and others possessing
restricted rights of practice. There were also 714: pharmaciens hav-
ing authority to sell medicines, viz : 77 in the two capitals, 150 in the
governmental towns, and 487 in other parts. Siberia and the oriental
governments of the empire only possess 19 civil practitioners ; and the
insufficiency of this number has given rise to the establishment of a
medical school at the university of Kazan. In the course of the year
1850, there were treated 737,442 patients in the hospitals, of whom
609,564 are returned as cured, and 91,545 as dead, i. e. a mortality
of 1 in 13. L' Union Medicate. \^Brit. and For, Med. Chir, Rev,

Professor Henderson's Conversion to Homoeopathy. During the
discussion which followed the motion of Mr. Syme, in reference to
the exclusion of homoeopaths from membership of the Society, and
which was carried unanimously. Dr. Simpson related a very capital
story, which will doubtless amuse our readers. Some eight or ten
years ago, an old schoolmate of Dr. S., who was a homoeopathic drug-
gist in Liverpool, presented to him a small, but very beautifully
painted box of homoeopathic medicines. Dr. S. put it to a very natu-
ral use he gave it as a plaything to his eldest son, then a child. The
youngster, full of mischief, oftimes uncorked the tiny vials, and pour-
ing the contents into a heap, would re-fill them from the general mass.
It thus happened that the globules belonging to the different bottles
were more or less thoroughly mixed together, and then new and
strange compounds were produced. It also sometimes happened, that
when the child, wearied of his performance, others engaged in the
innocent amusement of re-filling the bottles from the general heap.
A professional brother calling one day on Dr. S., who was not at
home, saw this pretty box and pocketed it. Weeks elapsed ere the
two friends met, when Dr. S. was informed by him that he had been
trying to practice homoeopathically, and that he had seen some won-
derful effects and cures from the drugs contained in that precious
little box! At this interview Dr. S. did not disclose to his friend the
important fact that the globules he had been using were elaborately
commixed ; he was reluctant, cruel man! to spoil, at once, so good a
joke. In the progress of time, the physician became more and more
a homoeopathist, and then it became too serious a matter to joke about,
when he actually published a list of supposed homoeopathic cures.

[New York Med. Times.

Death of Priessnitz. Priessnitz, the celebrated founder of hydro-
pathy, died at Graefenberg on the 26th of November, at the age 52.
In the morning of that day, Priessnitz was up and stirring at an early
hour, but complained of the cold, and had wood brought in to make a
large fire. His friends had for some time believed him to be suffer-

1852.] Miscellany. 193

ing from dropsy of the chest, and at their earnest entreaty he consent-
ed to take a little medicine, exclaiming all the while, ''It is of no use."
He would see no physician, but remained to the last true to his pro-
fession. About four o'clock in the forenoon o{ the 26th he asked to
be carried to bed, and upon being laid down he expired. [London
Medical Gazette.

BIBLIOGRAPHICAL.

Carpenier^s Elements of Physiology new edition.
We have to acknowledge the receipt, from the publishers, Messrs.-
Blanchard & Lea, Philadelphia, of a new edition of Carpenter's
Elements of Physiology.

This, and other kindred works of the author are so well known in
this country, and so highly esteemed, that it is unnecessary to say
anything in commendation of them. It is proper to observe, how-
ever, that the present is not a mere re-print of former editions, but
has been carefully revised and subjected to material alterations :
several of the chapters have been re-written and made to conform
more nearly to ascertained facts in relation to the subjects of which
they treat. As a diligent compiler and as a successful cultivator of
the branch of science to which he has devoted himself, Dr. Carpen-
ter occupies a distinguised position.

It is refreshing to note, that this and some other re-prints of Eng-
lish medical books have recently slipped through the press without
being saddled with an American editor. We trust that we have seen
the end of the shallow system of quackery in authorship which has
made us the laughing stock of Europe. Hereafter, it is to be hoped
we are to have English books, unmutilated by omissions and unde-
faced by notes and interliaeations. M....r.

Lectures on Materia Medica and Therapeutics, delivered in the College
of Physicians and Surgeons of the tiniversity of New York. By
John B. Beck, M. D., late Professor of Materia Medica and Medi-
cal Jurisprudence ; prepared for the press by his friend, C. R.
GiLMAx, M. D., Professor of Obstetrics, etc., in the College of
Physicians and Surgeons, N. York. Samuel and William Wood,
publishers, 261 Pearl-st., New York. 1851. 1 vol. 8vo. pp. 581.

We learn, from the editor's preface, that the lectures which com-
pose this work were prepared for publication by the late Prof. B.,
with the exception of a few which were revised by Prof. Oilman.
This gentleman has also added notices of some subjects which Dr. B.
had not included in iiis course. Although the work cannot justly

194 Miscellany. [March,

claim any very high degree of merit, we think it a good digest of the
present state of knowledge on the subjects of which it treats. It is
handsomely printed, as indeed are all the medical books issued by
the Messrs. Wood. G.

The Elements of Materia Medica and Therapeutics. By Jonathan
Pereira, M. D., F.R. S. and L. S. Third American edition, en-
larged and improved by the author. Including notices of most of
the medicinaljsubstances in use; in the civilized world, and forming
an Encyclopaedia of Materia Medica. Edited by Joseph Carson,
M. D., Professor of Materia Medica and Pharmacy in the University
of Pennsylvania ; Fellow of the College of Physicians of Philadel-
phia, etc. Vol. 1st. Philad. Blanchard & Lea. 1852. pp. 838.

We are pleased to see that Messrs. Blanchard & Lea are ensjaged
in publishing another edition of this valuable work. The first volume
is before us, printed in handsome style, and containing all the "recent
discoveries in Natural History, Chemistry, Physiology and Practical
Medicine, relating to the Materia Medica. It is unnecessary to say
anything in commendation of this work, as it is universally admitted
to be the most comprehensive treatise on the subject in our language.
We presume that there will be no delay in the publication of the se-
cond volume. G.

Manual of Diseases of the SJdn, from the French of MM. Cazenave
and Schedel, with notes and additions. By Thomas H. Burgess,
M. D., Surgeon to the Blenheim Street Dispensary for diseases of
the skin, &c. Second American from the last French edition,
with additional notes by H. D. Bulkley, M. D , Physician of the
New York Hospital ; Fellow of the College of Physicians and
Surgeons, New York, Lecturer on Diseases of the Skin, &;c., &c.
New York: Published by Samuel and William Wood, 261 Pearl-
street. 1852. 1 vol. 8vo. pp. 348.

This work is so well known and so highly appreciated that it is
unnecessary to do more than to call attention to the fact that a new
and enlarged edition is now offered to the profession. We think it
the best manual extant, and should have a place in the library of
every physician. G.

The Pocket Formulary and Synopsis of the British and Foreign Phar
macopoeias, comprising standard and approved FormulcB for the
preparations and compounds employed in medical practice. By
Henry Beasley. First American from the last London edition,
corrected, improved and enlarged. Philadelphia : Lindsay and
Blackiston. 1852. 1 vol. 12mo. pp. 443.

This work has been favorably received in England, and has reach-

1852.] Miscellany. 195

cd a third edition. It appears to be carefully prepared, and was
probably called for by the profession in that country. We have now
several Formularies, quite enough for all useful purposes ; but to
those who have none of these, this work may prove convenient.

G.

Essays on Life, Sleep, Pain, SfC. By S. H. Dickso??, M. D., Pro-
fessor of Institutes and Practice of Medicine in the Medical College
of the State of South Carolina, &c. Philadelphia: Blanchard &
Lea. 1852.

We regret not having room to notice at some length this very
creditable little work. It treats of subjects of general interest and in
the distinguished author's happiest style.

An Analytical Compendium of the various iranches of Medical Science,
for the use and examination of Students. By John Neith, M. D.,
&c , &c., and F. G. Smith, M. D., &c., &c. Second edition,
revised and improved. Philad. Blanchard d: Lea. 1852.

An excellent work for students who are preparing themselves for
the ordeal of the "Green Room" and may be consulted advantage-
ously by practitioners who have allowed themselves to grow "rusty"
in reference to first principles.

A Chapter on the Climate of the Isthmus of Panama, and its effects on
Health. By C. D. Gkiswold, M. D., recently one of the Surgeons
of P. R. R."^ Co., New York. Dewitt & Davenport. 1852.

A pamphlet that ought to be procured by those who are going to
California by way of the Isthmus.

Logic, in its relations to Medical Science : an address delivered hefore
the Starling Medical College at its third Annual Announcement. By
Edward Thompson, M. 1)., D. D., &c., President.

A very logical and readable production.

[Circular.)

Paris, Jan. 12th, 1852.
At a recent meeting of American physicians in Paris, an associa-
tion was established whose object is the promotion of Medical Science.
This association, essentially national, is progressing under the most
favorable auspices. It is intended to be permanent in its nature, and
is designated the " American Medical Society hi Paris.''

Notwithstanding the vast advantages afforded by the French metro-
polis for the study of medical and surgical science, we feel ourselves

174 Miscellany.

isolated from our national medical literature, and, therefore, confident-
ly appeal to the conductors of American journals and periodicals.
We do this with the less hesitation, feeling assured that it will be not
only a medium of improvement to ourselves, but a means of a more
general diffusion and just appreciation of American literature.
By order of the Society.

A. J. SEMMES, M. D., Corresponding Secretary,

NOTICE.

The fifth annual meeting of ike American Medical Association
will be held at Richmond, Va., on Tuesday, May 4th, 1852.

All secretaries of societies, and of other bodies entitled to represen-
tation in this association, are requested to forward to the undersigned
correct lists of their respective delegations as soon as they may he
appointed.

The following is an exstract from Art. 11. of the constitution :

" Each local society shall have the privilege of sending to the association one
delegate for every ten of its regular resident members, and one for every addi-
tional fraction of more than half of this number. Thefaculty of every regular-
ly constituted medical college or chartered school of medicine, shall have the
privilege of sending two delegates. The professional staff of every chartered
or municipal hospital containing a hundred inmates or mare, shall hare the
privilege of sending two delegates; and every other permanently organized
medical institution of good standing shall have the privilege of sending one
delegate."

The medical press of the United States is respectfully requested to
copy.

P. Claiborne Gooch,
One of the Secretaries ^ Bank-st.y Richmond, Va.

State Medical Society. The annual meeting of the "Medical So-
ciety of the State of Georgia," will commence in Augusta on the
second Wednesday in April. As we anticipate a session of unusual
interest, it is hoped the members of the Association will come up
from all parts of the State in their full strength. The presence of the
Faculty, generally, is specially invited, and will be warmly welcomed.

C. B. Nottingham, Rec'g Sec'y.

Macon, 12th January, 1852.

SOUTHERN

MEDICAL AND SURGICAL
JOUKFAL.

Vol. 8.] NEW SERIES. APRIL, 1852. [No. 4.

PART FIRST.
r t g t n a I d o m nut n i c a t i o it 0 .

ARTICLE XI.

Cases treated with Veratrum Viride. By Dr. D. C. O'Keeffe.
(Reported by J. S. Clements, of Penfield, Ga.)

The notes of the subjoined cases have been kindly furnished
me by my friend and preceptor, Dr. O'Keeffe. In view of
what has been said, in this Journal, on the remedial properties
of the American Hellebore, by Dr. Norwood, and the erudite
exposition of its botanical characters, by Prof C. T. Quintard,
I shall not embarrass the subject with preliminary remarks, but
enter forthwith into the subject.

Case I. Nov. 3, 1851. Mrs. , aged 21, was delivered

of her first child one week ago ; progressed satisfactorily until
above date. Condition at that time : Skin hot and dry ; tongue
furred, white on centre, red at tip and edges ; mouth dry and
lips crusted; slight headache; pain in back and bowels least
pressure on abdomen causes pain ; pulse 115, small and hard ;
dysuria for last twenty-four hours; has had two stools during
same period from castor oil and spts. turpentine she had taken.
Diagnosis Incipient puerperal fever. Prescription : Pepper
poultice to abdomen, warm cloths to vulva, spts. nitre in pars-
ley tea every two hours, until dysuria is relieved.

5 o'clock, P.M. Has urinated tolerably freely since morn-
ing, less pain in bowels, pulse 120 ; other symptoms the same.

N. S. VOL. VIII. NO. IV. 13

198 O'Keeffe, on Yeratrum Viride. [April,

Prescription : Eight drops tinct. veratrum viride every three
hours until pulse is reduced.

8th 9 o'clock, A. M. Took but two doses of the veratrum
viride, before nausea was induced, and lasted two to three
hours. Simultaneously with the induction of nausea, perspira-
tion set in, the pulse was lessened in frequency, and continued
so all night. Present condition Pulse 100, skin cool, tongue
less red, feels but little pain and sleeps better, except during
existence of the nausea, than she had done in several nights.
Took a dose of oil and turpentine at 1 o'clock this morning,
which has not operated yet ; feels nausea occasionally.

9 o'clock, P. M. One stool; feels better, nausea occasional-
ly all day ; pulse 85 ; has taken none of the veratrum viride
since last night. Ordered, 10 gtt. tr. veratrum viride every
three hours, till nausea occurs, if fever returns. Has passed
wrine tolerably freely to-day.

8th. Has had no fever of consequence since last date, and
therefore needed no medical attention.

Remarks. This case would, in all probability, have termin-
ated in puerperal fever, of which it presented the essential
characters, but for the timely administration of the hellebore.
The febrile action could not have been owing to the dysuria
and consequent distention of the bladder, for after these symp-
toms were relieved, the pulse numbered 120; neither could it
be fairly attributed to want of action from the bowels, for they
had been moved twice the day the first note was taken. She
had had her "milk fever" three or four days before the date
first noted, and got on well during the interim ; the lochial dis-
charge was normal, and the untoward features w^ere attributed
by the family to " a cold she had taken." It is reasonable,
therefore, to infer that it would have run its coiii'se, as a case
of puerperal fever, had not the potent agency of the veratrum
viride curtailed its progress. This is the first recorded case of
puerperal fever treated by the American hellebore, and the
sanguine expectations of iJs worthy pioneer, Dr. Norwood,
have been fully answered.

Case II. Nov. 8th, 1851. ^Eliza, a negro woman, aged 25,

1852.] O'Keeffe, on Yeratrum Viride. 199

strong and vigorous constitution, was taken with pneumonia
of right lung on the 4th; was seen and treated by Dr. A. A.
Bell until the 8th, after the usual naanner. Calomel, tart, anti-
mony, ipecac, Dov. powder and blisters, constituted the treat-
ment. He had used the tinct. of veratruni viride freely for
two days, without producing any perceptible effect whatever,
in addition to the remedies above enumerated. The patient's
condition at above date was as follows : Skin warm and moist,
from ipecac and tart, antimony she had been taking freely all
day ; pulse 120-130, small, compressible under influence of
tartar-emetic; bowels disposed to looseness, and tender to the
touch. At 5 o'clock, P. M., she took 10 gtt. tinct. veratrum
viride to control the circulation, which had not been influenced
in the least by the calomel and tartar-emetic which she had
been taking for twenty-four hours.

7 o'clock, P.M. Pulse the same; still perspiring 15 gtt.
veratrum viride. 8 o'clock, P. M. Nausea and profuse per-
spiration ; griping in bowels, which was followed by a copious
watery operation ; pulse 110 took 60 gtt. tinct. opii. to check
bowels. 9 o'clock, P. M. Nausea and perspiration the same,
bowels easy, feels drowsy, pulse 100, intermittent. 12 o'clock
at night. Nausea and perspiration^ pulse 100, not intermittent
took 10 gtt. veratrum viride.

9ih 10 o'clock, A. M. One operation since last note, fol-
lowed by 30 gtt. tr. opii ; still perspires ; skin cOol ; pulse 100,
not intermittent; no pain; feels drowsy. Ordered, 10 gtt.
veratrum viride every three hours while the pulse numbers
100 should it fall before that, to be given less frequently.
Convalescence commenced at above date.

Remarks. This case Dr. O'Keeffe saw in consultation with
Dr. Bell, who had judiciously treated it with the usual remedies.
He had even given the hellebore a fair and impartial trial for
two successive days; but it failed signal!}^ failed. The pre-
sent case was the second in which the incomparable remedy,
hellebore, failed in Dr. B.'s hands to produce any effect what-
ever, and he was on the eve of condemning it as an insignificant
puff, when a different preparation proved to him satisfactorily
that his was an inferior article was inert. Should this disap-

200 O'Keeffe, on Veratrum Viride. [April,

pointment happen to others, they would do well to pause, and
consider the reliability and intelligence of their druggist. Dr.
B. obtained his tinct. of veratrum viride from his druggist,
while the preparation that fulfilled its mission told the heart's
arteries "so fast shalt thou beat and no faster," was prepared
by a physician, in his own office, in the proportion of two
ounces to the pint of alcohol.

It is difficult to say, with unerring certainty, what agency
the veratrum had in bringing on a favorable crisis in this case,
or how it would have terminated under the usual treatment.
She took the first dose of hellebore at 5 o'clock, P. M., the
tongue being moist and skin warm, but moist also; notwith-
standing these favorable efl^ects from the calomel and tart,
emetic, the pulse was not reduced any. Two doses of the
hellebore accomplished what several doses of the tart, antimo-
ny had failed to do. A c-risis might have taken place without
the veratrum, and its occurrence, after its exhibition, may
have been a coincidence instead of an eflTect ; but from the
infallible certainty with which it reduces the action of the
heart and arteries, I think it not unreasonable to attribute the
favorable change, in the present case, to its potency..

Case IIL Mr. B., aged 45, complained of cold chilb and
acute pain in left side on 12th of November. Poultices, baths,
diaphoretics and expectorants, failing to relieve him, he VTas
bled next day 20 oz., the pulse being 100, full and strong. The
v. s. and perspiration that followed relieved the pleuritic pain,
partially, for a time, but it returned next day with some severity.
A blister was applied to the aifected side, which removed the
pain; took 15 grs. of calomel, twice, in divided doses, which
produced three dark operations. During this time, the tongue
was covered on the middle with a whitish fur, natural at edges;
the mouth dry, clammy, and exceedingly unpleasant, required
cleansing frequently in the day ; the pulse during the whole
time 90-100.

8th day of illness. Skin hot, harsh and dry ; tongue furred,
clammy and sticking to roof of mouth; taste unnatural, very fee-
ble and extremely restless ; pain no where, pulse 90 to 100, va-
riable, feeble and hard. Took several doses of diaphoretic pre-

\

1852.] O'Keeflfe, on Veratrum Viride, 201

parations, until altering the condition of the skin, which was so
hot and dry that he said he felt like he should " burn up." At
10| o'clock, A. M., took 10 gtt. veratrum viride, the pulse be-
ing 100. At 11 o'clock, the skin was warmer and disposed to
become moist; pulse stronger and more frequent, 114; no
nausea. 1 o'clock, P. M. Skin moist, generally ; large drops
of sweat on face, drowsy, no nausea; pulse 114. 3 o'clock.
Vomited considerable quantities of bilious matter several times.
After he had vomited twice, skin became cool and dry, and
the pulse fell to 100; and after he had vomited two or three
times more, the pulse fell to 80, was small and weak.
5 o'clock. The vomiting having continued, and feeling griping
pain in lower bowels, he took two tea-spoonfuls of paregoric,
which checked the vomiting and griping. Expectoration, of
which there was little or none before nausea, became profuse
after it, and relieved the lungs very much. He took no more
of the hellebore, and his pulse fell to CO, and continued so for
several days, when convalescence commenced, and progressed
satisfactorily to recovery.

Remark?. Here is a case in which the usual diaphoretic
remedies had been used freely and faithfully, without effectincr
the desired result ; whereas 10 gtt. of the veratrum acted like
a charm. The hellebore was not given in this instance to
diminish the frequency of the pulse for that was not at all
imperative but to act simply as a diaphoretic, and to remove
the great heat of which the patient complained so much.
It is proper to note that, before nausea set in, and after taking
the veratrum, the temperature of the surface was heightened,

and the pulse accelerated from 100 to 114 in the minute a

result that ensued only in the present instance.

Without further notice of this case, which was considered
one of typhus fever, I propose to give, in detail, the notes of the
case of pneumonia in which the hellebore was administered as
a principal remedy during the whole progress of the disease.

Case IY. Nov. 23d, 1851, 9 o'clock, P. M. A negro girl,
aged 20, of strong constitution, in seventh month of pregnancy,
felt pain (slight) for the first time, in her left side, this mornin^,

202 O'Keeffe, on Veratrum Viride. [April,

but attended to her usual duties until three hours before she
was prescribed for. Condition: acute pain in her left side;
cough hard, painful and frequent ; skin hot and dry ; tongue
clean ; pulse 120, and strong. Diagnosis Pleuro-pneumonia.

Prescription : Venesection 1 quart ; poultice to left side,
and 10 gtt. tinct. veratrum viride. 12 o'clock. The same;
15 gtt. veratrum viride. 3 o'clock, A. M. The same ; 20 git.
veratrum viride.

24th, second day, 7 o'clock, A. M. Skin a little cool, vom-
ited some since last note, perspired some during nausea; other
symptoms the same 23 gtt. veratrum viride. 8 o'clock, A. M.
Nausea and vomiting several times, skin natural, pain almost
relieved ; pulse 80, small and weak ; deathly sick Ginger
tea to relieve nausea, and poultice to chest. G o'clock, P.M.
Took the veratrum every three hours since last note ; skin
warm and dry ; one stool ; pain in side returned ; pulse 112
15 gtt. veratrum viride. 8 o'clock. Vomited three times ;
skin moist ; pain in side the same ; pulse 80. ^. Calomel, Dov.
powder, aa 5 grs. ; ipecac, 3 grs. ; to be taken at once cups
over seat of pain, and poultice.

25th 9 o'clock, A. M. One stool ; emesis several times in
night; skin harsh and dry, but natural in temperature ; cough
hard and painful: pulse 120 15 gtt. veratrum viridc/every
three hours, poultice to chest, and expectorant to relieve cough.
7 o'clock, P.M. Took three 15 gtt. doses of the hellebore,
after the last of which she vomited three times ; no stool ; skin
cool ; pulse 80 ; respiration rapid, 50 in the minute. 1 1 o'clock,
P. M. Took no medicine since last note ; respiration rapid,
embarrassed and difficult ; skin cool, but harsh and dry ; very
restless, pulse 120, hard and constricted 15 gtt. veratrum
virid.e in 50 gtt. tr. opii., to produce sleep.

26th 1^ o'clock, A. M. Took since last note 15 gtt. vera-
trum viride: respiration and pulse the same; skin warm and
moist, is in a copious perspiration ; no nausea 20 gtt. vera-
trum. 8 o'clock, A.M. Respiration and pulse the same;
skin dry and warm ; no stool ; pulse 120 20 gtt. veratrum
viride. 9 o'clock, A. M. Was sitting up when last note was
made, which perhaps accelerated the pulse somewhat; skin a
little moist and warm ; pulse 100, lessened 20 beats without

i^'

1852.] O'Keeffe, on Veratrum Viride. 203

any nausea or vonniting; " felt worms creeping up her throat,"
attended with a flow of saliva and a desire to heave. (Com-
plained of this sensation of worms in the throat since she has
been taking the hellebore, and the same feeling was described
by another patient who was taking the veratrum at the same
time.) 15 gtt. veratrum viride every three hours, and inter-
mediately a powder of calomel, Dover's powder and ipecac;
blister to left side. 7i o'clock, P. M. Took the above ; no
stool : after second dose of veratrum, vomited freely ; skin
warm; perspired none; blister well drawn; cough loose;
pulse 90 continued veratrum every three hours, and gave
injection to relieve bowels.

27ih 9 o'clock, A. M. Two stools; emesis several times;
cough very troublesome, causing vomiting; respiration very
rapid, 50-GO ; pulse 100 15 gtt. veratrum viride, and same
powders intermediately ; blister dressed.

28lh 8 o'clock, A. M. Followed prescription: two stools;
constant nausea and vomiting ; cough hacking and toublesome ;
tongue slightly furred ; respiration same ; pulse 100 continu-
ed hellebore and powders. Night visit: No improvement; felt
labor pains since last note. Prescription : Discontinued hel-
lebore ; blisters to legs and right side ; quinine, Dov. powder
and ipecac, every three hours, and tart, antimony alternately.

29th 9 o'clock, A. M. Miscarried: pulse very frequent;
getting worse same treatment continued ; brandy and quinine
if pulse should sink. Night visit : Dead.

Remarks. This case of pneumonia tested the hellebore
to its utmost capacity, and brings home to our mind the very
reasonable conviction that it will not prove infallible in the
treatment of pneumonia. On reviewing these notes, it will be
seen that the heart and arteries seldom failed to respond to the
sedative influence of the veratrum, while the respiration was
not aflected by it in the least: it was a singular phenomenon
to observe the respiration as frequent as 50 or GO, the skin
cool and moist and the pulse 80. Hence, in this case, at least,
it did control the circulation, but did not afl^ect the res[)iration
or inflammation. There is every reason to believe that the
pneumonic inflammation received no check whatever, not with-

204 Havis' Case of Tetanus. [April,

standing the circumstance that the patient was kept fully and
constantly under the influence of the hellebore. But it is a
question of reasonable doubt, whether any course of treatment
would have averted the inevitable doom that awaited this pa-
tient in view of her advanced state of pregnancy. It is the
duly of physicians who submit this agent to the test of clinical
experience, to watch carefully its effects, and report them for
the benefit of the profession: the remedy is in a state of proba-
tion preparatory to its admittance into the sanctum of practice,
and nothing should be withheld that may add to its value or
detract from its merits. In view of the severity and well mark-
ed character of the diseases in which it is most likely to be
used, its effects can be early determined, either as positive or
negative: it will control the bounding pulse, or it will not;
there is no half-way ground no room for speculative propen-
sities. In a type of typhoid fever, in which pulmonic symp-
toms predominated. Dr. O'K. assures us it had the happiest
effects in curtailing the duration of the fever and expediting
convalescence. But in cases in which inflammation of the
intestinal mucous membrane exist, its exhibition may prove
somewhat questionable. It may be said, that as far as the cases
go, the claims of the American hellebore to a potent remedy
are founded on no fictitious representations : they rest on the
indisputable facts of rigid experience ; and we have little doubt
that when it shall have passed through an extensive trial, the
conviction of its importance will become universal, and in the
language of Dr. Norwood, a new era in the treatment of dis-
ease will be the consequence.

ARTICLE XII.

A Case of Tetanus successfully treated. By W. W. Havis,
M. D., of Houston County, Georgia.

Through the kind solicitations of my professional brethren,
I am induced to give the details of a case of Traumatic Teta-
nus, which came under my care in January last ; and if, by
reporting in a concise and unvarnished style the features of the
disease and the means used for its arrest, I contribute a mite

1852.] Ha vis' Case of Tetanus. 205

(by data) in elucidating the same, I \\\\\ realize an ample re-
compense for my labor.

January 11th 5 o'clock, P.M., I was summoned to the
bed-side of a negro man, set. 28, of athletic form and robust
constitution. On the 20lh of December, he exposed himself,
in a state of nudity, to the cold, which was severe, and from
this congelation of his feet supervened. I saw him on the 28th :
his feet were healing kindly ; had been no constitutional ex-
citement whatever ; removed the lost phalanges of 2d and
3d toes of left foot.

Jan. 3d. Toes nearly healed. Boy walking about the yard
without inconvenience, deemed farther attention unnecessarv.
Jan. 8th. Exposed bare feet to the frost.
Jan. 11th. Found him resting upon occiput and nates; teeth
separate I inch ; articulates with hissing; face awfully disfi-
gured ; muscles of trunk, neck and face perfectly rigid ; spas-
modic twitching of diaphragm ; extremities unaffected ; tongue
coated white; pulse 100, feeble; skin dry and hot; feet swol-
len, perfectly tense, very painful ; severe paroxysms, at intervals
of fifteen minutes, with aggravation of every symptom. Dura-
tion two minutes, pulse unchanged, articulation impracticable,
excrutiating pain at scrobiculus cordis, bowels not evacuated
since 8th. Placed him in w-arm bath; elm cataplasm to feet,
sinapism to abdomen, en?p. lytlas from occiput to sacrum.
Comp. ext. colo. and calomel aa grs. iij., follow^ed by oleum
ricini and ol. terebinth; pulv. Doveri, grs. x. every three
hours.

Jan. 12th 11 o'clock, A. M. Bowels unmoved ; pulse 98 ;
volume sine force; paroxysms unaltered; tongue dry, and
brown ; viscid, frothy saliva exudes through teeth ; dysphagia;
skin hot and dry ; feet very painful ; teeth clenched during
paroxysm ; fine vesication upon spine. Ordered, ung. hyd.
rubbed upon vesicated surfaces, enema of solution chloride
sodium, opium cataplasms to feet, and mustard to abdomen;
pulv. Dov. continued.

13th 11 o'clock, A.M. Pulse 88, tongue foul, paroxysm
in statu quo, spasm reduced by attempting deglutition, small
stool, pain in feet unabated, saliva yn'ofuse and ill-conditioned.
Ordered, calomel grs. v., pulv. jalap grs. xx., followed by

206 Havis' Case of Tetanus, [April,

enemata of chloride sodium; cataplasms; ale. ext.^ cannabis
indicus, grs. iss. every half hour.

14th 11 o'clock, A. M. Bowels moved, and no essential
change continued hemp. 15th. Pain at epigastrium very
poignant during clonic spasm, tongue foul, respiration acceler-
ated, saliva profuse, pulse 91, bowels unmoved. Ordered, salt
enema hemp continued. 16th. Dysphagia terrible, parox-
ysms irregular, induced by effort of any kind ; hiccough trou-
blesome ; three copious stools. Ordered, quinia grs. xx., opium
gr. i., every three hours. 17th. Clonic spasms greatly aggra-
vated, pulse 100, patient groans piteously, lachrymalion pro-
fuse, eyes blood-shot, fearful dyspnoea, pain at scrobiculus
cordis severe, extremities affected and opisthotonos complete;
every symptom u-npropitious. Ordered, tinct. veratrum viride
gtt. xii. every two hours; poultice, &c. 18th. Pulse 50, par-
oxysms modified in severity and duration, exacerbation one
minute, respiration more free, twitching of diaphragm during
tonic spasm, not present, tongue dry, skin hot and dry, suppu-
ration in feet established, and copious stools, stench intolerable,
breath offensive. Ordered, pulv. Dov. xv. grs. every two
hours, emp. lyttse to nucha, charcoal cataplasm, imbued with
tinct. opii., to feet; jalap xx. grs., calomel v. grs. 19th. Pulse
75, skin cool and moist, tongue cleaning, saliva losing foetor
and vicidity, deglutition improved, clonic spasm at intervals
of an hour, duration | minute, two copious stools, pain in feet
abating, swelling subsided, appetite capricious, (takes chicken
broth, the first nutriment of any consequence since invasion of
disease.) pain in epigastrium diminished. Cataplasms, pulv.
Dov., &:c., continued. 20th. Pulse 80, swallows without much
inconvenience, clonic spasm not appeared since 1 o'clock A.M.,
two copious stools, excessive nausea and emesis, tongue nearly
clean. Ordered, sinapism to epigastrium, pulv. Doveri grs. xv.,
pulv. zinjiber grs. ij., until nausea and vomiting is relieved,
every three hours. 21st. Pulse 100, tongue clean, red and dry ;
nausea and vomiting quelled, prostration great, severe pain at
hypogastrium, two stools, all blood, Ibj. aa.; tonic rigidity of
nnuscles unchanged. Ordered, enema acet. plumb, and tinct.
opii., sinapism to hypogastrium, Dover's powder, continued.
G o'clock, P. M. Two stools, blood and mucus; enema repeat-

1852.] Havis' Case of Tetanus. 207

ed, elm lea as potation, opium and tannin aa. grs. ij. 22d.
Pulse 90, small ; tongue moist, profuse diaphoresis, prostration
great, one stool semiloecal. Ordered, brandy 5iss. every three
hours, charcoal and opium cataplasm to feet, opium grs iss.
every four hours. 23d. Pulse 80, tongue moist, skin cool and
moist, sleeps, one stool, fcecal, small ; tonic spasm abating, feet
doing well ; amputated middle phalanges of 2d and 3d toes of
left foot, and gave flap. Ordered, quinia grs. ij., opium grs. ss,,
brandy 3ij. every four hours.

This treatment was persevered in until tonic rigidity of
muscles was overcome; then the quinia and brandy prescribed
until his wonted strength and health were restored. Tonic
rigidity was not reduced until the lapse of twelve days after
arrest of clonic spasm. From arrest of clonic spasm to the
23d of January, there was tonic rigidity, and at no time within
the period could his head be raised one inch without elevating
the body the same length. In using the terms clonic and tonic,
I wish to be understood as not employing them to express per-
fect relaxation from violent coniraction, but a medium ground :
from violent exacerbation, to mild. The risus sordonicus was
perfect during tonic spasm the violence of the clonic so dis-
torting the features as to banish anything like a risus. His
respiration was always difficult during clonic spasm, but easy
during tonic ; sore when twitching of diaphragm perturbed it.
He rested upon his nates and occiput all the time of his illness,
except one day and night, and then opisthotonos was complete.
The Indian hemp which I used, presented all the physical
qualities of a fine article, but was certainly devoid the action
ascribed to it by Dr. O'Shaughnesey. The quinia seemed
entirely out ci place, notwithstanding its merit as an altera-
tive and sedative ; it proved rather a conservative of the spasm
than otherwise, and I cannot attribute such a sudden exacerba-
tion of the disease to aught save the drug. The veratrum
viride effected such sedation as to give unwonted potency to
the Dover's powder, and it was for this I slopped it, feeling
confident that I could continue the sedation as vvell with the
Dover's powder as with the hellebore, and secure a more de-
cided action upon the gastro-enteritic functions.

The case may, by skeptics, (for want of autopsical facts,)

208 Long's Case of Onanism. [April,

be termed a mild one, a mere flash ; because its action was not
substantiated by the patient's death. But, because some cases
prove fatal in a few hours, it is not proof that other cases are
not as severe, because they procrastinate their "dead set" a
day or two, or even eventuate in restoration to health. But,
'' quantum sufficit.'^ I do not consider the case as one of the
most active, but as one of inveteracy, and requiring medical
aid. Further comment is unnecessary: let the case audits
treatment go for its worth, and I am content.

ARTICLE xiir.

A Case of Onanism, "presenting great difficulty of Diagnosis,
By J. A. Long, M. D., of McMinn Co., East Tennessee.

On the 15th of October, 1851, I was called to R. M., a young
man, aet. 25 years, of rather delicate constitution, had suffered
from several attacks of chill and fever, and was of a family
predisposed to renal affections. I found him sitting up by the
fire, complaining of a dull, heavy, listless feeling, with a general
aching and numbness all through his system, and particularly
in his limbs, more referable to the bones than other parts of the
body. He was somewhat cold, or rather chilly, at times, but
nothing like a distinct chill had he suffered from the onset of
his disease. His pulse was somewhat accelerated and rather
weak; skin warm, and perspiring; bowels costive; tongue
pale, and covered with a white coat ; feet and hands rather in-
clined to be cool, and said he felt as he generally did previous
to attacks of chill and fever, which I thought myself he was
about taking. From the inactive state of his liVer and bowels,
I gave him one or two calomel purges, followed by quinine,
with some benefit for a short time only.

In about a week I was again called, and found him in a simi-
lar condition, only somewhat worse, particularly in his back
and lower extreniities. Ordered, blue pill, followed b). oil, and
quinine to be given as before, and continued for several days.

I was again called in about a week, and found all of his
symptoms much aggravated, particularly in his back, of which
he complained greatly on being moved. Numbness and aching

1852.] Long's Case of Onanism. 209

down his legs, and in fact all over his body ; fugitive pains
through the abdominal muscles, and with more or less con-
striction around the abdomen; great soreness on pressure
along the spine, especially the lumbar and lower dorsal region ;
pulse 140 in the minute, skin warm and perspiring freely. I
now changed my opinion as to the nature of his complaint, and
thought I undoubtedly had a case of spinal meningitis to deal
with.

Treatment. Local depletion, followed by a blister along the
whole of the tender portion of the spine ; calomel, until a de-
cided impression be made upon the system ; low diet, (fee.
The effect of this course of treatment was only to ameliorate
the symptoms, reduce the fever and pulse, and to allay or re-
move the excruciating pains of the spine. The pains of the
back have become more dull and deep-seated, as if they were
in the kidneys; great soreness along the lumbar muscles, par-
ticularly on pressure; perspiration still profuse, and has a disa-
greeable acid odour; still complains much of his extremities,
aching in his bones, &c. He now presents unequivocal symp-
toms of rheumatism of the lumbar muscles, which, however,
only last a short time, and are followed by deep-seated pains
in the region of the kidneys, of a spasmodic character, severe
and excruciating, shooting down in the direction of the ureters
to the testicles, these latter organs being drawn up. He has
become greatly emaciated, notwithstanding his appetite has
been tolerably good, and he has been generally allowed a gen-
erous diet. His case remained stationary, under the form of
nephralgia, for at least two months, without fever or any excite-
ment of the arterial system. Throughout the whole of his
illness he has been remarkably restless, irritable (especially at
night) and slept but little. Opium was used, in large doses, to
allay his suffering, with only temporary relief. The whole
class of diuretics was used without advantage. He had the ap-
pearance of a man of at least 45 years of age : his face became
shrivelled and wrinkled, his countenance was bad and anxious,
he wore his cap pulled down over his eyes during the whole
of his sickness, and frequently exclaimed, " what a fix what a
fix to be in ! death is far preferable. Oh, I will die ! oh, I will
die !" &ic. In this stage of the disease, all hopes on the part of

210 Long's Case of Onanism. [April,

the patient and his friends were lost, and, in fact, death seemed
to be his inevitable doom, unless some speedy relief were af-
forded him. There was but slight alteration of the urine,
either in color, quality or quantity ; at times it was slightly
albianinoiis. His bowels continued costive, and were only
moved when oil was given or the syringe used.

One of my pupils, Dr. G. A. Long, on visiting the patient,

was asked by him if he knew what self-pollution was, and

what w^ere its effects. This conversation, on being reported
to me, immediately unriddled the mystery of the case my
suspicions were confirmed at my next visit by a full acknow-
ledgement of the baneful practice. I now put him upon a
more nourishing diet, and the free use of tonics, quinine and the
various preparations of iron, and directed as much cheerfulness
as possible on the part of the attendants. This course was
persevered in until he could go about the yard, and was able
to take the cold bath. He began to improve immediately, un-
der the iron and quinine treatment, though slowly and gradu-
ally.

Remarks. I have been thus tedious in the particulars of this
case, because I thought it would be instructive, especially to
the junior readers of the Journal. As this is the first case of
the kind I have met during a practice of eight years I natural-
ly conclude it is of rare occurrence, especially in country
practice, though occurring sufficiently often to deserve the
attention of medical men. By way of excusing himself, this
young man mentioned to me another, equally guilty with him-
self, who had abandoned the practice on account of a severe
spell of chronic rheumatism, affecting nearly everp joint of his
body, but especially his back and lower extremities. He was
down some twelve months, and his case was spoken of as a
very strange one. His appearance was that of my patient
downcast countenance, old look in the face, dejected spirits,
&c. There is nothing a young man can be guilty of that will
undermine and sap the foundation of his constitution sooner
and more effectually than this abominable practice.

1852.] Throat Diseases, 211

PART II.
Eclectic Dcipartment

Throat Diseases. By Ira Warren, M. D.

Folliculitis. This disease made its appearance in this
country, so far as is known, in 1830, and the attention of the
profession was first drawn to it, as a distinct disease, in 1832.
Some have supposed its origin to have had a hidden connec-
tion with the epidemic influenza, which spread over the civilized
world in 1830; but this is only conjecture. In its early de-
velopments, it attracted notice chiefly by its visitations upon
the throats of the clergy. Hence its popular name of " cler-
gyman's sore throat."" It was soon found, however, to attack
all classes of persons, whether engaged in any calling requiring
a public exercise of the voice or otherwise. It was more no-
ticed by public speakers and singers, by reason of the greater
trouble it gave them.

The disease consists simply in a chronic inflammation of the
mucous follicles or glands connected with the mucous mem-
brane which lines the pharynx, larynx, trachea, &:c. The oflice
of these little glands is to secrete a fluid to lubricate the air-
passages. When inflamed, it spreads an acrid, irritating fluid
over surrounding parts, and excites an inflammation in them.
This, if not arrested ends in ulceration ; the expectoration be-
comes puriform and undistinguishable from that of consump-
tion, and the patient dies with all the symptoms of phthisis.
Indeed, before its nature was understood by the profession, it
was thought the most fatal form of consumption, because it
could be affected only to a very small degree, if at all, by medi-
cines taken into the general system.

When disease lays hold of those follicles in the larynx which
supply a fluid for lubricating the vocal cords, and the secretion
conducted to those instruments of speech is acrid and irrita-
ting, the voice becomes hoarse ; and when at length the ulcera-
tion reaches the vocal ligaments themselves, the voice sufl^ers
a gradual, and finally a total extinction. I have treated a
large number suffering entire loss of voice, and am happy to
say it has been restored in every instance.

The approach of this disease is often so gradual as hardly to
attract notice sometimes for months or even years giving no
other evidence of its presence than the annoyance of something
in the troat to be swallowed or hawked up, an increased secretion
of mucus, and a sense of uneasiness and loss of power in the
throat after public speaking, singing, or reading aloud. At

212 Throat Diseases. [April,

length, upon the taking of a cold, the prevalence of an epidemic
influenza, or of an unexplained tendency of disease to the air-
passages and lungs, the throat of the patient suddenly becomes
sore, its secrerions increased and more viscid, the voice grows
hoarse, the difficulty of speaking is aggravated, and what was
only an annoyance, becomes an affliction, and a source of alarm
and danger. The disorder clearly belongs to the family of
consumption, and needs early attention.

It is amusing to reflect upon the theories which writers were
in the habit of constructing, a few years since, to account for
the throat affections among the clergy. It was attributed by
some to speaking too often, by others to speaking too loud.
One class of writers thought it arose from hi^h, stiff neck-stocks;
another, from a strain of voice on the Sabbath to which it was
not accustomed on other days.

The cause of the disease lies deeper than any of these trifling
things. So far as ministers are concerned, it may be expressed
in two words labor, anxiety.

The clerical order are placed just where they feel the force
of the high pressure movements of the age. They are the only
class of lecognized instructers of adult men, and are obliged ta
make great exertions to meet the wants of their position. The
trying circumstances in which they are often placed, too, in
these exciting times, by questions which arise and threaten to
rupture and destroy their parishes, weigh heavily on their spirits
and greatly depress the vital powers. And when we add to this
the fickle state of the public mind, and the shifting, fugitive
character of a clergyman's dwelling-place, and the consequent
liability to poverty and want to which himself and family are
exposed, we have a list of depressing causes powerfully pre-
disposing to any form of disease which may prevail. As we
have said, however, it is not the clergy only, but all classes of
people who are afflicted with this dangerous malady.

The long and rather awkward name which Dr. Green has
given to this disease is, Follicular Disease of the Pharyngo-
Laryngeal Membrane. I call it Folliculitis, or, as this term
does not describe its seat, follicular laryngitis, or follicular
pharyngitis, according to its position.

Through a general lack of acquaintance with this disease, it
has been often confounded with bronchitis. But bronchitis is
an inflammation of the mucous membrane which lines the
bronchial tubes, and of course has no existence except below
the bifurcation of the trachea. In strictness it is not a throat
disease at all.

Folliculitis is also often mistaken for laryngitis. But this
latter disease is an inflammation spread over the mucous

1852.] Throat Diseases. 213

membrane of the laryngeal cavity. Bronchitis and laryngitis
affect mucous memhraves ; folliculitis, the follicles of these
membranes. Each is a separate disease, and they arc' easily
distinguished by one who understands them. They are often
complicated and unite in one subject.

There is yet another form of these chronic diseases, with
which many are afflicted. Inflai.imation sometimes begins
behind and a little above the velum palati, in the posterior nares,
or back passages to the nose. ThuG seated, it generally passes
under the name of catarrh in the head. It often creates
a perpetual desire to swallow, and gives the feeling, as patients
express it, "as if something were sticking in the upper part of
the throat." When the inflammation is of long standing, and
ulceration has taken place, purifoim matter is secreted, and
drops down into the throat, much to the annoyance and dis-
comfort of the patient. Many tinnes the sufferer can only
breathe with the mouth open. Upon rising in the mornins:, a
great effort is generally required to clear the head, and the ex-
treme upper part of the throat. Even distressing retching and
vomiting are sometimes induced by the efl^ort to clear the back
nasal passages. There is occasionally a feeling of great pres-
sure and tightness across the upper part of the nose ; and the
base of the brain sometimes suffers in such a way as to induce
headache, vertigo and confusion. The smell is frequently de-
stroyed, and sometimes the taste.

If the inflammation be in the pharynx or larynx, there is a
similar sensation of something in the throat, but the desire is
not so much to swallow it as to hawk it up.

Beside these chronic forms of disease, there are a number
of acute inflammations which attack the air-passage?, and run
a rapid and very danorerous course. Croup is well known as
one of them. There is another, which attacks the mucous
membrane of the larynx and epiglottis, which reaches also the
sub-mucous cellular tissues of these organs, and which often
proves fatal in a few^ hours. The effusion of serum into the
epiglottis, in consequence of a high state of inflamm.ation of
that cartilage, causes it to stand upright, so that it cannot cover
and protect the opening to thela'-ynx; and the lips of the
glottis, distended by the same cause, approach each other, thus
closing up gradually the passage to the wind-pipe, and threaten-
ing immediate suff'ocation. It was this disease of which Wash-
ington died, as we learn from the clear account of the symptoms
given by his medical attendants, though they mistook" the dis-
order for another, the profession not being then acquainted
with it.

Treatment of Throat Diseases. Fifteen years ago, these

N. S. VOL. Vlir. NO. IV. 14

214 Throat Diseases, [April,

disorders were thought to be incurable ; and by all the appli-
ances of medical art then known, they were so. But time has
brought a successful method of treatment, as well as a clearer
knowledge of their nature. The honor of first employing such
treatment in this country belongs to Dr. Horace Green, Prof,
of the Theory and Practice of Medicine in the New York
Medical College. It had been previously used by Drs. Trous-
seau and Belloc, of Paris ; but this detracts nothing from Dr.
Green's just honors, as he had no knowledge of their discovery
for such it was until after he had done the same thing on
this Continent.

This treatment, as is generally known to the profession, con-
sists in topical medication, or the applying of the remedy direct-
ly to the diseased part. The medicinal agent, more extensively
used than any other, is a strong solution of nitrate of silver.
This substance is not, however, adapted to every case other
articles succeeding better in some few instances. Modern
chemistry has given us a variety of articles, from which the
skilful physician may select a substitute, should the nitrate of
silver fail. This article has, however, proved itself nearly a
specific for inflammation of mucous membranes, acute or chronic
not connected with a scrofulous or other taint of the system ;
and where such taints exist, it will generally succeed, if proper
constitutional remedies are used.

Instruments. ^The instrument employed by most physicians
is a piece of whalebone, bent at one end, to which is attached
a small round piece of sponge. I formerly used this instrument
myself, and am happy to know, that notwithstanding its de-
fects, it was generally successful. Yet where the larynx has
been highly inflamed, with a swollen and ulcerated condition of
the epiglottis and lips of the glottis, I have found the singular
powers of the argent, nitratis put at defiance by an irritation
evidently produced by the sponge of the probang. Upon its
introduction in such cases, the parts contract upon and cling to
it, and suffer aggravated irritation, almost laceration, upon its
withdrawal, however carefully effected.

A case of this sort occurred to me in the person of a gentleman
of great moral and intellectual worth, a teacher of a classical
school, to whom I was called in Plymouth county, in August,
1849. He was at the point of death from starvation, not having
been able to swallow anything, not even water for a number
of days. The epiglottis and lips of the glottis were much swollen
and deeply ulcerated, and the whole pharyngo-laryngeal mem-
brane involved in a high state of inflammation. The first two
applications of the nitro-argentine solution, made to the isthmus
of the fauces and pharynx on Saturday evening and Sunday,

1852.] Throat Diseases, 215

FO far relieved him, that on Monday morning he drank, with a
sense of unspeakable satisfnction, a tumbler of cold water.
Before I could see him on Wednesday evening, however, he
was again sinking, the full activity of the inflammation hav-
ing returned ; and every subsequent attempt to introduce the
sponge, and to carry it down to the seat of the disease, caused
such irritation as to exh:ui.=t the patient. He sank and died,
leaving a void in his neighborhood which it will be hard to fill.
I feel confident that with the instrument I am about to intro-
duce to the notice of the reader, I could have reached the seat
of the disease with so little disturbance of the parts, as to have
saved his life.

Such defects in the probang led me to contrive an instru-
ment, which I call a Laryngeal Shower Springe. Jt is in the
form of a syringe, the barrel and piston of which are of glass.
To this is attached a small tube, made of silver or gold, long
enough to reach and enter the throat, and bent like a probang,
with a globe at the end, from a quarter to a third of an inch in
diameter, pierced with very minute holes, which cover a zone
around the centre, one third of an inch or more in breadth.

This silver globe I daily introduce into highly inflamed and
ulcerated larynges, generally without any knowledge of its pre-
sence on the part of the patient, until the contained solutionis
discharijed. A single injection throws a very fine stream
through each of the holes in the globe, and thus all sides of the
walls of the trachea are washed at once. Moreover, the small-
ness and smoothness of the bulb allows of its easy and painless
passage through the rima glottidis, so as to bathe the walls of
the trachea as low as the bifurcation, and even of the large
bronchi. Physicians will understand the advantage of this in
the case of ulcers low down in the trachea. They will see its
advantage, too, in the case of croup in children, into whose
larynges it is not easy to introduce the sponge.

The introduction of this instrument into the larynx is easy.
Upon the approach of any foreign substance, the epiglottis
instinctively drops down upon the entrance to the larynx,
guarding it against improper intrusions. It has been found,
however, that when the root of the tongue is firmly depressed,
this cartilage cannot obey its instinct, but stands erect, its up-
per edge generally rising into view. Availing himself of this
fact, the surgeon has only to depress the tongue with a spatula,
I bent at right angles, so that the hand holding it may drop be-
jlow the chin, out of the way, and as the epiglottis rises to view,
|slip the ball of the instrument over its upper edge, and then,
with a quick yet gentle motion, carry it downward diudi forward
between the lips of the glottis, and the entrance is made. I

216 Throat Diseases. [April,

have often admired the heroic faithfulness of this epiglottic
sentinel, who, when overborne by superior force, stands bolt
upright, and compels us to enter the sacred temple of speech,
directly over his head !

This instrument I have used with great satisfaction. A
considerable number of physicians, in different States, have pro-
cured and are now using it.

For bathing the upper part of the throat, I construct it
with a straight tube, with holes over the outer portion of the
globe, and extending to the centre. This washes instantane-
ously the fauces and pharynx, without throwing the solution
back upon the tongue.

Inflammations in the back passages to the nose, haVe been
almost entirely inaccessible by any reliable healing agent, and
consequently incurable. The probang could only reach a short
distance, and caused great suffering. I have had this syringe
constructed with a short bend, and the globe pierced with a
few fine holes at the upper end. Carrying this globe up behind .
the velum palati, with a single injection I wash both passages
clear through. I have had the pleasure of curing a large num-
ber of bad cases, of several years' standing, to the surprise and
delicrht of the patients.

Many of these throat affections are connected with functional
disturbance of the liver and stomach. In such cases the inflam-
mation of the throat generally refuses to yield until the hepatic
and gastric troubles are corrected. Indeed, in a majority of
cases, the topical applications need to be accompanied, for the
above as well as for other reasons, by a constitutional and al-
terative treatment.

One word respecting the tonsils. They are chiefly *' an ag-
gregated mass of mucous folh'cles" ; and in many follicular dis-
eases they are found enlarged, inflamed, and sometimes indura-
ted. In such cases they secrete a thin, unhealthy, irritating fluid
which is spread over the throat, increasing and perpetuating
its disease. Much of this secretion, too, finds its way into the
stomach, and thence into the circulation ; and I am not sure that
many cases of scrofula are not engendered by the poison thus
conveyed to the blood. At all events, the throat seldom gels
well in such cases, until the tonsils are removed.

For the excision of these glands, I found the same lack of in-
struments, as for making topical applications to the throat. The
only one which had any claims to regard, was the guillotine in-
strument, invented some years since by Caleb Eddy, Esq., of
this city. It had, however, no facilities for drawing the tonsil
forward. Generally, all that could be done with it was to
trim the gland, which did little good, for it became again en-

1852.] Throat Diseases. 217

iarged. I attached the bull-dog tenaculum to it, with which I
have been able to draw the tonsil from between the pillars of
the fauces, and cut it through the root, so as effectually to pre-
vent a second growth. As there were still some defects in
this instrument, I have prepared an entirely original one, with
which the extirpation of these glands is so easy and expeditious,
and withal so little to be dreaded by the patient, as to leave, I
think, little further to be desired in this line.

As bearing directly upon this subject, I will add, that about
three years since, Dr. Chambers, of London, reasoned that if
nitrate ofsilver have a specific influence over inflammations of
mucous membranes, it would cure bronchial consumption, and
perhaps other forms of that disease, if it could be got into the
lungs. He accordingly made a powder of that article and
lycopodium to be breathed into the lungs. His account of it
was published in the London Lancet, and has appeared in this
Journal.

In August, 1849, I prepared the same powder ; and not only
in the cure of bronchial consumption, but in the treatment of
\.\\Q first and third stages of the tubercular form of this disease,
I obtain results from it which I can derive from no other article.

I also use lycopodium for preparing powders in the same
way, with sulph. of copper, crystals of nitrate of mercury
(sometimes useful in secondary syphilitic troubles of the
throat,) iodide of potassium, &:c.

For breathing powders of every kind, I have constructed a
I neat inhaler, which consists of a glass tube and a receiver the
[latter being something like a tube vial, perforated with holes
j around the lower end. The powder is poured into the receiver,
I which is placed in the larger tube, and twirled between the
i thumb and finger while inhaling.

1 In the bronchial forms of consumption, the local disease is
confined to the mucous membranes ; and in the tubercular tvpe,
the deposite begins upon the same tissue. Breathing medicine
directly into the lungs is therefore the rational mode of attack-
ing the local disease. The time must soon come when this
'form of treatment will be universally adopted. The mode of
lapplying it will doubtless be improved, and the articles employed
ibe multiplied. But we are on the right track, and the period
may not be distant when this fearful malady, taken in proper
season, will be held as curable as chronic diseases of the stomach
or liver. [^Boston Medical and Surgical Journal.

218 Yeast in Putrid Sore Throat. L-^P^^^

Cerevisia Fermentum. On the use of Yeast in Putrid Sore
Throat, SfC. <^c.

To the Editor of the Boston Medical and Surgrcal Journal:

Sir, The gratifying effects of the use of yeast, and the very
happy result, in a case of putrid sore throat, that I have just had
under my charge, induce me to offer the following sugges-
tions for publication in your excellent Journal.

The case alluded to was a boy 12 years old. For a week
previous to my being called in, he had complained of common
sore throat. He had had the usual domestic remedies applied,
and among them a flannel bandage around the neck. He con-
sidered himself well on Monday, 11th inst., and imprudently
took off the bandage, going out and exposing himself to the
inclement weather. He was taken severely ill on Monday,
with a high fever, headache, &c., and early on Tuesday morn-
ing I was sent for, and found him laboring under all the symp-
toms of malignant inflammation of the throat, accompanied by
an eruption on the face and neck, of a dark-red color; face
somewhat swelled ; skin of face and neck exceedingly rugous^
like the surface of the leaf of sage; tongue of a fresh meat color;
rima glottidis tumefied and inflamed ; epiglottis erect and almost
immovable from tumefaction, and the whole mouth and fauces
dry and harsh. There was considerable cough, but the tough
ropy sputa could not be expelled. 1 applied the usual antiphlo-
gistic treatment, except bloodletting. A sinapism on the throat
enabled the patient to swallow his medicine. The usual course
of such a disease went on regularly till Thursday morning, the
eruption having extended over the whole body. On that morn-
ing, unequivocal symptoms of ulceration and typhoid showed
themselves. The pulse was small, thready, feeble and quick:
the mind wandering, with incessant murmuring; inability to
articulate intelligibly ; alternate severe pains in the head and
abdomen; little sensibility in the throat ; small white and grey
spots throughout the mouth, tongue and fauces, and numerous
petechias on the face and abdomen. I immediately ordered
half a pint of fresh brewer's yeast, mixed with half a pint of
water, \\\\\\ brown sugar sutficient to give it flavor, and to
take a table-spoonful of the mixture every two hours, suspend-
ino" all other remedies, except the gargle (made of borate of
soda, honey and infusion of sage) and occasional sinapisms to
the throat. Up to this time the fever and eruption had been
regularly intermittent, coming on about 2 o'clock in the morn-
ing, and subsiding about 12 M., at which time the skin becnme
quite smooth, and very slight signs of the eruption. On Fri-
day morning, a great change had taken place. He had rested

1852.] Yeast in Putrid Sore Throat, 219

tolerably well durinj? the night ; his tongue and mouth were
nearly relieved and clean ; the fever and eruption were quite
nnoderate, and passed off before 9 o'clock. On Saturday, still
further improvement was manifested. He could eat with fa-
cility, and begged for food, which was allowed him freely. On
Sunday morning, all symptoms of the disease had disappeared,
except the swelled and sore lips, and edges and point of the
tongue. On Monday, all he required to constitute him per-
fectly well was strength ; but even in that respect he was not
very unwell, for he got up, in the absence of his mother from
his room, and went to the window ; and when I saw him last,
on Tuesday, he was about the house with the rest of the fami-
ly. He continued to take the yeast until Monday evening.

I have been rather particular in relating the case, that it
might be understood ; though I fear some will think, from the
the rapid recovery aiid my imperfect description, that it was
not a very severe one. I have seen many cases, during my
thirty years' practice, of putrid sore throat, scarlatina ma-
ligna,* or whatever else it may be called, but I have never
seen a more threatening one than this, particularly on Thurs-
day morning. Jts happy termination I attribute entirely, under
Providence, to the free use of the yeast. I had used this article
ever since the Rev. Mr. Cartwright, of Louisiana, published
his account of its successful employment in nervous fevers
some thirty years ago. 1 prescribe it in the typhoid stage of
all eruptive diseases, especially small-pox, and generally with
the happiest effect.

And now, sir, to the object of this paper. Do we not sacri-
fice too much in our endeavors to refine our remedies ? Nearlv
all our writers discourage the use of yeast, saying we can avail
of its active principles in far more elegant and convenient
forms, I do not believe this. Who, 1 beg leave to ask, who
knows what the active principles of yeast are? We can
analyze and obtain from it potash, carbonic acid, acetic acid,
malic acid, lime, alcohol, extractive mucilage, saccharine mat-
ter, gluten, water. But can we say that these ingredients or
principles, artificially combined, in part or in whole, individual-
ly or collectively, will make yeast? And will the article thus
made have the same effect as the natural article or compound
does? Who can say that the effect of an article like this is
attributable to its generation of carbonic acid, or to its tonic
power derived from the bitter principle, or to the stimulating
principle of its alcohol? We all have used carbonic acid in

* This boj' had scarlet fever (scarlatina simplex) very severely, six years
ago, and was attended by myself.

220 Yeast in Putrid Sore Throat, [April,

the form of carbonated water, effervescing draughts, &c. ; and
stimulants in the form of ammonia, alcohol, wine, &c. ; and
tonics in the form of bark, quinia, &c. ; but never have I seen
the effects from all these equal to those of yeast. Who can
say that in the process of analyzation some very active prin-
ciple is not lost ? I think yeast exerts a direct and most pow-
erful influence upon the de,2jenerated blood, restoring it speedily
to a healthy condition. It seems to generate some active
principle while in the stomach, which acts upon the blood and
nervous system. Certainly its effects on the system, in dis-
eases of a typhoid character, are entirely unlike those of any
other remedy. In our endeavors to render our remedies more
' elegant," and '* convenient," therefore, by the extraction of
active principles, we should be careful lest we sacrifice utility
to nicety. We all know that even quinia is not in all cases a
substitute for Peruvian bark, although this article approaches
nearer to a perfect embodiment of the active principle of a
natural product than any other. Quinia is not always bark,
nor morphia opium. But in the case before us, for yeast, in
my opinion, no substitute can be obtained, even by a combina-
tion of every one of its active principles artificially; for, as
before observed, there seems to be an active principle in the
original that cannot he found by analysis, and that is destroyed
by it. This principle seems to me to resemble the principle
of life.

In conclusion, I hope your professional readers will bear
these suggestions in mind, and when they have a case suitable
for it, give the article a trial, and the patient a chance to be
benefited by it. It is proper to say that brewer^s yeast is the
article I always use. Distiller's, baker's and common family
yeast, do not act so well ; though either are very far better than
none. When prepared as above, it is by no means disagreea-
ble. With children, I generally call it porter sangaree, and
they are not aware of the deception.

Yours, Gideon B. Smith, M. D.

Baltimore, Md., Jan. 22, 1852.

Baltimore, January 27th, 1852.

Dear Sir I feel it to be my duty to place at your disposal
the following statement of facts, at the earliest moment.

I had scarcely returned from mailing my article to you on
the subject of the use of yeast in putrid sore throat [see above],
when I was called to visit a family of four children. I found
them all laboring under severe symptoms of scarlatina malig-
na. The mother informed me they had been for two or three
days complaining of dryness and some soreness of the throat,

1852.] Yeast in Putrid Sore Throat. 221

headache, nausea, and pain in the back and stomach ; but on
Friday evening, 23d inst., three of them went to bed, viz :
John, 13 years; Mary, 8 years; and Robert, 4 years of age:
Charles, aged 10 years, not in bed, but complaing greatly.
When I saw them, on Saturday morning, the eruption was
fully developed on the face and neck of the three first, of a
dark dull red color; the throat very sore; the tongue dry,
with a dark fur on the middle and back portion ; grey spots on
the tonsils and fauces; great mental uneasiness; eyes quite
red, and great anxiety of countenance. In fact, all three had
strong symptoms of the worst form of scarlet fever. The
pulse was alinost too quick to be counted, and heat of the skin
very high. The skin of all three had also assumed the pecu-
liar rugous appearance described in my previous article. I
had come to the conclusion that brewer's yeast was an anti-
dote to the specific poison of scarlet fever, and I immediately
ordered its free use in these cases, administering it also to
Charles, who was not yet in the eruptive stage. I ordered the
yeast to be mixed with an equal portion of water, and to be
well sweetened with brown sugar, each patient to take a table-
spoonful every two hours, unless it affected the bowels, in which
case the quantity to be reduced one half I gave no other
medicine, and did nothing else except applying sinapisms to all
their throats to enable them to swallow. On Sunday morning
I found they had all passed a tolerably comfortable night.
Their tongues were all clean, moist, and of a healthy color;
thmats slightly sore ; the eruption extended over the whole
body, but evidently on the decline. Charles, who was one day
later in the various stages than the other three, was now on an
equality with them. On Monday morning all of them were
so well they begged hard to be allowed to leare their beds,
except Robert, the youngest. This morning, Tuesday, 27th,
I have pronounced them all well. Robert had been dreadfully
burned several months ago, by the bed being accidentally set
on fire while he was in it. All the burnt surface had been healed,
except a place as large as my hand on the lower part of the
abdomen. His long confinenent and debility from that accident
rendered his attack of the scarlet fever much to be dreaded ;
but even in this case the disease had passed away. The fact
that this remedy acts as an antidote to the poison of scarlet
fever, seems to derive great support from the case of Charles,
who commenced taking it before the fever and eruption were
developed, and who, though one day later than the others in the
development of the disease, got well at the same time they did.
Now here are four cases, three of which commenced on
Friday night, the other on Saturday night, all presenting the

222 Observations on Diseases of the Ear. [April,

worst form of the disease, and all well on Tuesday morning
three days and a half in three of them, and two days and a half
in one of them ; and no remedy whatever used except brewer's
yeast and occasional sinapisms!

As stated in my former paper, 1 have long used this remedy
in scarlet fever, measles, small pox, and all other eruptive febrile
diseases, when they degenerated into the typhoid state or
collapse, as it is generally called I have never before admin-
istered it in the first or eruptive and febrile stage, in which,
from its success in these cases, it would seem to be even more
efficacious than when delayed till the collapse takes place. I
know you will think me very enthusiastic on this subject, and
too easily led away by a single success with a remedy ; but,
when you consider the nature of the disease, its extreme dan-
ger when it assumes a virulent form, and the uncertainty of all
remedies heretofore used ; and when you consider, also, the
formidable character of the case first reported in my former
paper, and also that of the four now presented, and the very
happy and speedy termination of all of them, I feel assured you
will excuse me for calling the attention of the profession to the
subject in the most earnest terms. I have rather underrated
than exaggerated a single symptom of any of the cases. When
1 commenced attending them, the parents immediately became
hopeless of any one of them, as soon as they learned what
the disease was. The parents of the four children had lost a
son, a few years ago, of the same disease, and they declared all
these children were much more se\;erely attacked than he was.
I therefore feel it my duty to lose no time in making these facts
public. Respectfully,

Gideon B. Smith, M. D.

Observations on Diseases of the Ear; with practical Remarks
on their varieties and Treatment. By Thos. Barrett, Esq ,
M. R. C. S., L. S. A., (fcc, Surgeon to the Ear and Eye In-
firmary, Bath.

Acute Myringitis, with perforation of Membrana Tympani.

Case 1. The Rev. J. H , aged forty-five, on the 2nd

March, 1850, performed the burial service in a damp country
churchyard, and in the same evening felt he had ''taken cold."
He was attacked during the night with great pain in the left
side of the face, extending into the ear, which increased and
was followed by difficulty of swallowing, and tenderness round
the angle of the jaw, and over the mastoid process; all which
symptoms, as he had previously suffered from neuralgia and

1852.] Observations on Diseases of the Ear. 223

rheumatism, he attributed to these causes, and took for his re-
lief large dcses of quinine and opium. The pains and discom-
fort continued to increase, and he began to experience deafness
and confused sounds in the ear, with great irritation over the
whole of the auricle, and extending far into the ear-passage.

This alarmed him, and on the 9th of March he consulted me.
I found him then labouring under considerable pain, as before
mentioned, penetrating deeply into the head, and increased by
every effort to swallow or open the mouth wide. He feels the
carotid of that side beating loudly in the ear ; has tinnitus ; the
noise, he says, at one tiuie is like the scraping of a saw-mill
at another like the rushing of the wind. He does not fancy he
is very deaf, but I find the hearing distance is less than three
inches. I take this opportunity of mentioning that, with a
view to ascertain and note carefully the variation in the hear-
ing power of patients, whilst under treatment, I always employ
a metronome for this purpose ; its steady, distinct, and uniform
beat is more to be depended upon, and therefore is a much
better and surer test than the ticking of a w^atch as ordinarily
used.

An examination of the ear showed the auricle in a state of
phlegmonous inflammation, and the tragus and commencement
of the ear-passages so swollen that no inspection could be
made by the speculum.

The next day after free leeching over the mastoid process
and in front of the auricle, and the application of warm fomen-
tations and bran poultices, I was enabled to examine the con-
dition of the ear-passage and membrana tympani.

The whole length of the canal was covered with a muco-
purulent secretion. On this being washed away w^ith warm
water, the canal was found tender to the touch, swollen, and
very red. The membrana tympani, from its excessive vas-
cularity, was bright rose colour; the projection of the malleus
could not he detected ; its whole surface looked pulpy and
villous. The tonsils on both sides were enlarged and slightly
ulcerated ; the fauces generally relaxed ; and no air could be
passed through the Eustachian tube on the affected side, the
effort to do so being attended with great pain. There is a
good deal of constitutional disturbance. The appetite is bad,
and the night sleei)less. Leeches in tVont of the meatus were
again ordered, and counter-irritation to be freely kept up over
the mastoid pi'ocess. A pill, composed of extract of hemlock
and colchicum, and blue-bill, was directed to be taken three
times a day.

March 13. The pain and irritation in the ear, and difficulty
of swallowing, had considerably lessened ; there is otorrhoea.

224 Observations on Diseases of the Ear. L^^P^'l

The noises in the ear continue most distressing. He is now
able to force air through the Eustachian tube ; the otoscope
detects the air as gurgling through a mucous fluid, and with a
peculiar hissing sound indicative of a rupture of the membrane.
The speculum shows the membrana tympani still deeply red,
though darker in colour, with two distinct vesicles on its sur-
face, though so swollen and pulpy that the exact situation of
the perforation could not be detected. The hearino^ distance
is not an inch ; indeed, the deafness is nearly complete. The
medicine, and counter-irritation over the mastoid process, were
ordered to be continued.

16th. the constitutional symptoms much improved ; the
pain and irritation in the ear and the adjacent parts are lessened ;
the noise he likens now to the lowing of cattle. The discharge
is very profuse : no improvement in hearing.

The ear was washed out with warm water, and I found a
polypus excrescence had shot out from the interior wall of the
canal and completely filled up the passage. I removed it by
means of Mr. Wilde's ingenious and very useful " snare," and
found the membrana tympani of a pale pink colour, with very
little remains of its former villous and pulpy appearance. The
perforation could not be seen ; it was of an irregular shape, and
situated near the anterior and inferior portion of the membrane.
The removal of the fungus extended the hearing distance at
once to about four inches.

As the mouth was rather tender, the pills were discontinued,
and the iodide of potassium in bitter infusion was directed to
be taken three times a da3\ A fine point of nitrate of silver
was applied very lightly to the edge of the perforation, and gen-
tle syringing with a weak tannin solution ordered twice a day.

This patient continued improving under treatment, both in
his general health and in the local malady. On the 15th April,
I found the membrana tympani rather thick and studded with
opaque spots ; there is slight discharge ; the hearing distance
is about one foot ; the tinnitus still continues. Counter-irrita-
tion behind -the ear with tartrate-of-antimony ointment ; the
occasional pencilling of the membrane and auditory canal with
a solution of nitrate of silver (5grs. to 1 ounce) ; and the Bath
waters, formed the local and constitutional treatment for anoth-
er month. At the end of that time the general health was per-
fectly restored ; the discharge had quite ceased ; there is still
some tinnitus, and occasionally loud crackings, on gaping or
swallowing, are heard by him.

I may observe that this gentleman has suffered a long time
from dysphonia clericorum ; the throat is always more or less
relaxed, and the Eustachian tube, I doubt not, partakes of the

1852.] Observations on Diseases of the Ear, 225

same irritation of the membrane. The perforation in the tym-
panal membrane is of an irregular shape, occupying about a
fifth of the membrane, the remaining portion of which has now
assumed a tolerably healthy appearance ; the auditory canal is
dry, and without any secretion of cerumen. The hearing dis-
tance is about two feet.

I considered this a favorable case for the use of the hydrated
cotton, as recommended by Mr. Yearsley, and to the value of
which, in judiciously selected cases, and when applied with due
care and tact, I have before borne my full testimony.

Its application increased directly the hearing distance to
nearly three yards.

I instructed my patient in its application, and on his visiting
me about three months afterwards, I found him still deriving
the same comfort from its use, though he says he cannot al-
ways " hit upon" the exact point of the membrane to which it
should be applied, and then it not only fails in giving relief, but
generally produces pain and irritation. An examination of
the membrana tympani at this time showed it opaque and
slightly vascular, the perforation existing as before. There
were no remains of any polypoid growths, and a healthy secre-
tion of cerumen was being established.

Tympanitis ; Exfoliation of the Ossicula ; Periostitis and
Caries of a portion of the Mastoid Process.

Case 2. Miss S , aged 37, first consulted me in 1849.

She stated that she had had scarlet fever at the age of nine
years, which was followed by discharge from the left ear, and
subsequent deafness in both ears. Her recollection of symp-
toms at that early period is, of course, not very clear, but she
thinks the right ear was first affected. She never remembers
having discharge from this ear, but from the left the discharge
has been present at intervals from tiiat period until now. On
the right side the hearing distance is only two inches; on the
leftj four inches. The right membrana tympani is thick, opaque,
and studded with pearly deposits, and very much collapsed ;
air is easily pressed into the tympanal cavity, but from probably
old fibrous adhesions, the shape of the membrane is but little in-
fluenced by it. The ear-passage is dry and scaly. The left
membrana tympani show^s a large perforation, occupying its
inferior portion ; the lining membrane of the tympanum seen
through it is of a dark red colour; there is otorrhoea; air is
freely passed by the Eustachian tube through the aperture.

Although from the extent and long standing of the disease, I
felt little confidence in any treatment being productive of much
good, I advised the application of glycerine to the right ear,

226 Observations on Diseases of the Ear. [April,

and the hydra ted cotton wool to the left. The glycerine cer-
tainly did much to improve the condition of the former, and
the wool that of the latter, for the hearing distance was in-
creased so much in each ear as to enable her to hear tolerably
distinctly across a small room.

I frequently saw this lad}" during several months after this
date, and she always spoke in the strongest terms of the im-
rnense addition to her comfort this treatment had induced.
Not content, however, with this, in an evil moment she made
application to one of the advertising quacks, and received, by
post, a nosti um, w^ith directions to apply it freely to each ear.
This I afterwards showed to an experienced chemist, who in-
formed me that it was an etherial tincture of horse-radish.

On the evening of July 1, 1850, she first used this applica-
tion to both ears. Early the following morning she was awoke
by pain in the left ear, which continued increasing during the
day, but as she was led to expect pain from the application, she
not only bore it patiently, but even applied the drops again at
bed-time. The pain now became excessive, and her sufferings
were such that at an early hour of the morning, I was request-
ed to visit her. Slie then told me what she had done. She
was experiencing no inconvenience in the right ear, but in the
left ear and letl side of the head, she described her sufferings as
agonizing.

I could make no internal examination of the ear ; the
whole auricle was so inflamed and sensitive, that the least
touch was unbearable to her. Leeches and fomentation locally
with salines and anodynes, formed the treatment, and when on
July 5, five days after her misfortune, I was able more easily
to inspect the parts, it was indeed sad to see the ravages that
this attack of inflammation, acting on a part already much dis-
eased, had produced. The meatus was filled with a profuse
and offensive purulent discharge; its removal, by the most
gentle syringing, showed the membrana tympani nearly entirely
destroyed, throwing open the tympanal cavity, the lining mem-
brane of which is of a dark red colour, pulpy and granular,
and covered with purulent discharge ; the power of hearing,
even b}^ contact is quite lost.

It is unnecessary to follow this case, step by step, in its pro-
gress. The general health, never good, now began to suffer
considerably from the increased local irritation, and it w^as to
improve this, that the treatment was principally directed. She
was put under a course of very mild alteratives and bitter ton-
ics, with the iodide of potassium; but in spite of the most ju-
dicious rr?anagement and careful watching, the local disease fast
extended. Large polypoid growths sprung up from the lining

1852.] Observations on Diseases of the Ear. 227

membrane of the tympanal cavity. The^otorrhcea became pro-
fuse and most offensive, and it was soon apparent that in addi-
tion to the disease of the soft parts, the bony structure was
becoming involved; caries and exfoliation of the ossicula fol-
lowed, and she began to experience great and continued pain
over the mastoid process, with slight swelling, redness and
soreness on pressure Leeching and counter-irritation locally,
and the most steady perseverance in constitutional treatment,
failed, however, to arrest these symptoms, and the periosteum
itself quickly became involved in the inflammation; a free in-
cision down to the bone allowed the escape of offensive matter,
followed afterwards by a considerable exfoliation of bone.
The wound healed, and the general liealth improved, but deaf-
ness, permanent and incurable, remained, the consequence of
her unfortunate error.

Acute Myringitis from the introduction of a Foreign Body
into the Meatus.

Case 3. Master O , aged nine years, a scrofulous lad,

dropped, while at play, a glass bead into the right ear. Four
days after, he complained of ear-ache, for the relief of which,
laudanum and stimulating applications were freely used. On
the next day he first told his parents of the accident, and the
removal of the bead was ineffectually attempted by forcible
syringings, poking with forceps, bodkins, probes, &:c. I first
saw him on the seventh day after the occurrence. An exami-
nation by the speculum showed the foreign body at the bottom
of the meatus, and it was removed without difiiculty. He was
suffering great pain in the ear, extendinn; over the side of the
head ; he was feverish and excited. The auditory canal in its
whole length was dry and red ; the membrana tympani was
exceedingly vascular, the vasculai'ity being greatest nearest
the attachment of the malleus. Warm fomentations and saline
purgatives were then prescribed.

On the following day (November 14) the little patient was
so ill that I was requested to visit him at home. I found that
he had passed a night of great suffering from intense ear-ache.
His pulse was quick; tongue loaded; face flushed; the pain
extends over the whole head ; he is slightly delirious, and his
sensibility to sound is so great that the slightest noise excites
and disturbs him. An examination of the ear showed great
redness and swelling of the auricle ; great pain over the mas-
toid process, extending round the angle of the lower jaw ; the
auditory canal was so swollen as not easilv to admit of the in-
troduction of the speculum ; a sufficient examination, however,
could be made to show the dry, puffy, and vascular state of the

228 Observations on Diseases of the Ear, L^P^i^

passage ; the membrana tympani was of a bright-red colour,
the vessels branching and uniting in all directions, so as to form
a mass of red. His sensibility to sound is not so acute indeed
he is rather deaf, and complains now of strange noises in the
ear.

This was a case of acute myringitis, in which, from experi-
ence, I felt assured of the necessity of bringing the system
quickly under the influence of mercury a practice, in the
early stages of myringitis, so strongly urged by Mr. Wilde, in
his valuable communication on the subject, and to the import-
ance of which I can well bear my testimony. In addition,
therefore, to the free fomentations, and the appMcation of leech-
es round the meatus, I ordered one grain of calomel, with two
of James's powder, every four hours, with low diet and saline
purgatives. The leeches gave temporary relief, but during the
night the pain returned with increased violence. In the morn-
ing I found the constitutional disturbance very great. The
pain in the ear was acute, and the cerebral irritation very
alarming. He is now quite deaf; the noises in the ear remain
as before ; the tumefaction of the meatus, and the general vas-
cularity of the membrana tympani still continue. Leeches
were again applied, and the calomel continued.

Nov. lf)th. Slept better; in less pain; the noises in the
ear, he says, are like the squeaking of trumpets. He cannot
hear a loud-ticking watch when close to the ear ; hears it when
it touches the auricle or mastoid process. The pulse is very
quick, and the febrile excitement considerable. The mem-
brana tympani is still very red ; two or three ecchymosed spots
are seen near the attachment of the malleus. The auditory
canal is swollen and dry, and has several distinct vesicles on its
surface.

18th. Gums very tender ; general symptoms much relieved ;
is free from pain ; sleeps well ; bowels much purged. He says
he does not hear the trumpet-sound in the ear: it is now like
the constant whistle of a railway engine. Can hear at three
inches from the ear. The auditory canal has now no swelling ;
it is paler and dry; the vesicles have healed; the membrana
tympani is much less red indeed, except over the attachment
of the malleus, it has assumed a yellowish-brown colour; it
looks dry and inelastic. The calomel was discontinued, and
three grains of mercury with chalk ordered every night ; coun-
ter-irritation with tartar-emetic ointment was directed to be
used over the mastoid process.

21st. Very slight tenderness of the gums ; the constitutional
condition continues improving ; the hearing distance extends to
six inches ; the membrana tympani shows a marked improve-

1852.] Observations on Diseases of the Ear. 229

ment ; any vascularity is scarcely perceptible, except when
air is forced through the Eustachian tube, when vessels are
seen starting over its surface ; it still looks dry and muddy ;
there is no secretion in the auditor}' canal, which is very dry,
and covered with scales of exuded cuticle. The tinnitus con-
tinues. He was directed to continue the grey powder, and to
take three grains of iodide of potassium three times a day.
The tartar emetic ointment having been rubbed in incautious-
ly and too freely, the whole of the covering of the mastoid
process and back of the auricle is a mass of pustules, which are
exciting a good deal of general irritation, to relieve which a
poultice was ordered.

28th. The little patient is considered by his friends to be
nearly well. He is stronger, slee">s well, except that he is tor-
mented by the irritation of the pustules behind the ear, which
are healing very slowly; says he hears very well. I find,
however, on testing his hearing, tliat though greatly improved,
it is far from perfect ; he is a sharp, intelligent, and attentive lad,
and catches conversation quickly. The auditory canal is less
dry and scaly, and is secreting a small quantity of pale ceru-
men. The membrana tympani is regaining its transparency ;
its surface is smooth, has lost its granular appearance, and now
no longer shows any vascularity, even on pressing air into the
tympanum. He lost all sound in the ear for two days, when it
returned slightly, but has again left him. I directed the bro-
mide of potassium in infusion of cascarilla to be taken twice a
day, with generous diet and change of air, and the discontinu-
ance of all local treatment.

From this time the symptoms all gradually improved ; the
membrana tympani acquired its natural colour and elasticity,
all tinnitus ceased, and the hearing povv^er became perfectly re-
stored. The auditory canal continued very dry for some
time; the application of glycerine appeared to make up for the
deficiency of ceruminous secretion, but a healthy formation of
wax was at last fully established.

I need scarcely say that any ettempt to treat ear disease
without a full and complete examination of the organ, must
always end in unsatisfactory results. The speculum which I
am in the habit of using, consists of a funnel-shaped tube, with
a polished interior ; the light of a -ax taper is concentrated on
a small polished mirror, and is reflected by a double reflector
into the tube: the tube does not expand like Kramer's specu-
lum ; indeed, there is so much bony matter and so little soft
parts in the auditory canal, that I have rarely found any advan-
tage from a dilator.

This speculum, originally made by " Jordan, Manchester,"

N. S. VOL. VIII. NO. IV. 15

230 Vaccine Fluid in Small Pox. [April,

and to be had at Weiss's, enables nne distinctly and easily to
examine the condition of the membrana tympani, if present, or,
if destroyed, deeply into the tympanal cavity. I know objec-
tions have been made to artificial light as being likely to mis-
lead, and I admit that the sun's rays are to be preferred ; but
kow seldom in this country can we avail ourselves of them ! I
feel that diffused light will very rarely enable the practitioner
to gain anything like the opportunity of a certain examination
of the lower part of the ear passage, and in the absence of the
sun's rays, I know no speculum which gives such advantages
as the one I have described. [London Lancet.

On the Vaccine Fluid as an Internal Remedy in Small Pox.
By Dr. Jose Alves Nogueira, of Porto- Algre, Brazil.

The great number o^i patients which I have lost from smalF
pox, during fifteen years of practice, both whib in charge of
military hospitals, in which this disease is very prevalent, and
i-n private practice in the city, has led to the use of a variety
of remedies, none of which has produced such satisfactory
effects as the vaccine pus diluted in water and taken internally.
My first case was a negro, attacked with confluent small pox,
which in spite of all the ordinary antiphologisti'c remedies, in-
creased in violence until it threatened the life of the patient.
At this tinr>e it occurred to me to make trial of the vaccine pus,
which being a preventive, it might possibly possess the power
of curing the disease ; on the same principle that belladonna, so
eflicacious in the treatment of scarlet fever, is also a preserva--
tive against it. Experience alone will decide, and as my
patient was rapidly growing worse, I resolved to put it to the
test. Procuring a lamina of vaccine pus, of the purest quality, I
dissolved it in an ounce of water, and g'ave him a tablespoonful
in the morning. In the afternoon the iexQV had diminished, and
I gave him another dose. He passed the night comfortably,
and slept for the first time in three or four days ; he awoke with
some appetite, his face was much less swollen, and he could
open his eyes. I gave him the remainder of the remedy, and
he convalesced withoat farther treatment, except a dose of
castor oil.

Case 2d. Child three years of age, whose body was com-
pletely covered with variolous pustules, nearly united to each-
other, especially on the face and extremities. It had an intense
fever, disturbed sleep, vomiting, difficult deglutition, diarrhoea
and delirum. Under the use of the ordinary remedies, the pus-
tules had arrived at their greatest perfection, and at this
Etvoment I resolved to administer the vaccine pus. Soon afte?

1852.] Nitrate of Silver Stains of the Conjunctiva. 23 1

the first dose the little patient had a quiet sleep, the delirium
ceased, the swelling diminished and it rapidly recovered.

Case 3d. Was a child, thirteen years of age, robust, and of
sanguine temperament ; two cases of this disease, in the same
family, had recently proved fatal. When first called, I found
the symptoms of small pox well developed, the pustules being
so united that it was difficult to separate therri ; the mother and
others of the fiimily, terrified at the fatality of the disease, had
abandoned their home, and although they had never been vac-
cinated, could not be induced to submit to this operation.* My
little patient was left in charge of two ladies, who, with com-
mendable charity, offered to nurse her. The disease ran ail
unusually violent course, the face appearinf;: at one time to be
a single pustule. With the exception of mild sudorific infusions
at first, I used no other remedy than the vacine pus, taken as
before described, and with the most complete success ; the
disease not leaving that disfiguration of the skin which is usual
after recovery.

In conclusion, I may remark, that before using the vaccine
internally, I applied it externally in the usual way, but without
the least result. It is necessary that the pus be of the purest
quality, taken from a healthy subjectj before the period of sup-
puration, generally on the seventh or eighth day, while in a
limpid state, and preserved on glass plates, or better, in glass
lubes. I am not aware that any specific remedy, for combat-
ing the morbid effects of this terrible disease, has been sugges-
ted ; but the vaccine matter, so well known to the profession
as a preventive, when taken internally, I have found to be the
most powerful agent that can be used for its cure, and may be
considered as the specific remedy. [iV. Y. Jour, of Medicine^

Observations on Nitrate of Silver Stains of the Conjunctivai
Case of absolute Blackness. By James Vose Solomon, M.
R. C. S., Surgeon of the Birmingham Eye Infirmary.

The application of a solution of nitrate of silver, if long and
injudiciously applied to the conjunctiva of the eye, produces a
discoloration which is indelible. The sclerotic conjunctiva
becomes of a dusky brown, or of an olive color ; the palpebral
linings, more particularly of the lower lid, assume a brownish or

*Ii appears incredible that, notwithstanding? the government of Brazil spends
a g^reat amount of money, annually, for vaccination, there die every year of
small pox, upwards of a thousand persons; and still more incredible, that there
are many families who will not be vaccinated, because they consider it entirely
useless; this ignorance of the benefits of vaccination, however, exists principally
in the interior.

232 Nitrate of Silver Stains of the Conjunctiva. [April,

livid hue, or as will be presently shown, become black ; the
sulcus between the inferior lid and globe is more deeply dyed
than the other parts. In the majority of cases the conjunctiva
of the superior lid retains its natural color. In a few rare in-
stances the salt becomes incorporated with ulcers of the cornea,
forms a subchloride of silver, and perpetuates one or more black
lines in their cicatrices.

A still more uncommon, and I believe hitherto unrecorded
change of color consists in absolute blackness of the conjunc-
tiva, an instance of which, the only one that has ever come under
my notice, is probably of sufficient interest for publication in
your journal.

Case. A young v;oman, aged 29, came from a small town
in Radnorshire to consult me for a dimness of vision.

Both cornese were extensively covered by opacities, which
were irregularly streaked with black lines. The caruncula
lachrymalis and tarsal borders were of a jet-black color, giving
the appearance, at a cursory glance, of soot or dirt settled ou
those parts. The palpebral conjunctivae were smooth, and in
color not quite so black as their margins. The sclerotic con-
junctiva presented a deep olive color. I found on inquiry,.
that she had, at one time, suffered from strumous ophthalmia,
for the cure of which a strong ointment and some drops had
been prescribed and freely used. These applications had been
continued for three or four months.

The black streaks which traversed the corneal opacities, and
the olived sclerotic conjunctiva, decisively indicated the na-
ture of the other discolorations.

There is a much greater susceptibility to these. stains in some
Individuals than in others. They are more common to adults
ihan children : possibly because ophthalmic disease among the
latter is for the most part either of the strumous or purulent kind
in both af which the surface of the eye and its appendages are
continually bathed in secretion.

If we excise a portion of discolored sclerotic conjunctiva, a
white cicatrix is formed, indicating that the sclerotic maintains
its natural color.

At present we are unacquainted with any micans for remov-
incr the stains under consideration. Our obvious duty is to-
prevent their occurrence by vigilant attention and care. This'
may be accomplished by prescribing the preparations of nitrate-
of silver in short and intermitting courses, and by frequently
notinf>- the condition of the lining membrane of the inferior
palpebra. In public ophthalmic practice, it would be well if
the solution were not dispensed in larger quantities than two
drachms at one time.

1852.] Medical Properties of the ScuUcap. 233

Since writing the above, a man 60 years of age, "who has
been all his hfe a martyr to rheumatism, has become my patient
at the Eye Infirmary. The right globe is collapsed ; the left
eye retains some vision; it has been repeatedly inflamed ; the
iris is of a dull leaden color, and convex towards the cornea;
the pupil is puckered, adherent to the lens, and filled within a
third of its area by opaque lymph (art^sia irridis imperfecta.)
Near the centre of the cornea is a leucoma.

Fifteen or eisfhieen months as^o, he for the first time consult-
ed a surgeon, who prescribed caustic drops, which he has ever
since applied. The conjunctiva of the inferior palpebral sinus
is of a greenish black color. The inner surface of the superior
lid has lost somewhat of its natural polish ; a few black drops
assume an arborescent shape near the superior j'lunctum ; a light
brown and well defined narrow stripe extends along the con-
cave aspect of its tarsal cartilage.

I have cited this case to show the impropriety of allowing
patients to use the preparations of lunar caustic ad libitum;
and as an interesting example of how well the superior lid
escapes serious change of color, even in the worst and most
neglected cases. It also illustrates the destructive character of
uncontrolled rheumatic ophthalmia. \_London Med. Times.

Medical Properties of the ScuUcap. By C. H. Cleaveland
M. D., of Waterbury, Vermont.

Dr. Parrish. I have received from Ariel Hunton, M. D.,
of Hyde Park, in this State, a communication in regard to his
experience in the use of the Scutellaria laterifolia, and as it
embodies some observations that may be of use to the profes-
sion, I am led to offer it through the medium of the columns of
the Reporter.

He writes: " I have been in the habitual use of this article
some fifteen years. When I recommended the use of the blue
side-flowered scullcap to my patients, I was in the habit of in-
forming them, especially nervous femabs, that I had a new
remedy, reputed to possess excellent and active wertv'Tie proper-
ties, which I wished them to use according to directions, to
mark the effects, and to inform me if it did not prove to be far
superior to valerian, foreign or domestic, (manv in this vicinity
have, of late, become accustomed to use the root of the cypripe-
dium under the name of American valerian.) x\fter a trial,
those who had used it informed me they considered it prefera-
ble as a nervine to anything they had previously used, for, after
taking a cup of the infusion of this herb, they 'were insured a
happy exemption from their former nervous pains.

^34 Paracentesis in Acute Pleurisi^. [April,

" It is now nine years since I was called to a Miss C, in this
vicinity, who was suffering from convulsion of her limbs. They
would jerk for an hour at a time, with such force that the jar
might be plainly felt on the floor of an adjoining room. I had
never previously seen a case of this character, and it, of course,
was one of uncommon interest to me. The paroxysms did no^
recur at stated periods, but there were as many as two in the
twenty-four hours. The patient had already taken a variety
of medicines previous to my seeing her, but w'ithout any appa-
rent benefit. I ordered a pill of the extract of stramonium, of
my own manufacture, of half the size of a kernel of wheat, once
in six hours, and a strong infusion of scujlcap, a large spoonful
each hour. Under this course of treatment, the patient shortly
recovered, and has since been entirely exempt from any diffi-
culty of the kind.

' Case second was a Miss of about twelve years of age,
afflicted with chorea. Iq this case I was called as counsel, and
was requested to adopt and carry out any course I might prefer.
"As the/>W/7zce r/ce had already been thoroughly cleansed
by cathartics, the patient was at once put upon the use of the
infusion of the scullcap, a large spoonful each hour, and a pill of
the stramonium once in six hours, and, before the end of the
second week, convalescence was fully established.

" Case third was also a young lady, of about fifteen years. I
was called to see this patient in January, 1851. She was also
suffering from chorea, and was continually in motion. In this
case I adopted the same course of treatment as in the former,
hut the pills of the extract were used but a few davs, while the
infusion was continued longer and until recovery, which occur-
red after a short time. The father was of the opinion that the
recovery was v^- holly attributable to the infusion of the Scutel-
laria."

Dr. Hunton is of the opinion that the ^.galericulata possess-
es medicinal properties similar, and of equal potency with the
S. laterifolia, and would prefer to use it, as it is less disagreeable
to the palate, but it is by no means as common in this vicinity,
and we have both been accustomed to use the latter. He also
considers the scutellaricB as one of our most valuable vegetable
fqnics, \_New Jersey Med. Reporter.

Paracentesis in Acute Pleurisy.

In an article contained in the Medical Examiner, No. for
Jan. 1852, entitled extracts from a lecture 'On the present
PQsition in Europe of sonie of the most interesting and inr^poft*

1852.] Paracentesis in Acute Pleurisy. 235

ant points of modern Suro^ery,' recently delivered as an Intro-
ductpry Discourse, by Thomas D. Mutter, M. D., Professor of
Surgery in Jefferson Medical College, Philadelphia, we observe
the following notice of paracentesis in Pleurisy :

''Pleurisy. An operation altogether novel in the disease for
which it was practiced, has been introduced by Prof. Trous-
seau, of Paris, one of the most distinguished practitioners of
that city of eminent medical men. Prof. Trousseau told me
that he has succeeded in relieving several patients who were
almost in articulo mortis : and I have myself known it to ac-
complish the same end. The operation is nothing more than
the evacuation of the fluid in cases ot' acute pleurisy. You
are aware that the secretion is here often exceedingly rapid,
and unless the lung be relieved, the patient must die of suffoca-
tion. When, therefore, you find a patient thus situated, recol-
lect that paracentesis thoracis, promptly performed, will proba-
bly afford immediate relief."

That the rapid secretion of the fluid contained in the pleural
sac in acute pleurisy, often exposes the patient to death by suffo-
cation, is a novel fact. It is to be hoped that young practition-
ers who may discover the chest on oi^e side to be filled with
fluid, will not deem it necessary to perform the operation of
paracentesis without a reasonable delay, notwithstanding this
injunction to resort to the operation promptly, by so distin-
guished a surgeon.

Dr. Walshe, a pretty fair authority, says that in acute pleu-
risy, "Death is so rare a result of the disease when attackincr
individuals ive,Q from organic affections, that I have neither
myself (and I have carefully attended to the point since mv
attention was first drawn to it, a year ago, by M. Louis) lost a
patient from pure primary idiopathic pleurisy, with or without
eflusion, nor known of an occurrence of the kind in the prac-
tice of others. " We may commend this statement to those
who might be induced by Dr. Mutters recommendation to
puncture the thorax, as the reviewer of Dr. Walshe's treatise
in the American Journal of Med. Sciences does to the " consid-
eration of those who regard the disease as demanding bleeding,
blistering, mercurials, and the whole armament of antiphlogis-
tics."

The operation of paracentesis in cases o^ chronic pleurisv, in
which the absorbing property of the membrane has been great-
ly impared by the quantity of fibrinous exudation, and the degree
of distension, has been proposed and practiced in this country
within the past year, by a method simple and devoid of pain and
danger. We allude to the plan originated by Dr. Morrill,

236 Genu Valgum, or Knock-knee. t April,

Wyman, of Cambridge, Mass., which was communicated to the
profession by Dr. H. I. Bowditch, of Boston. Dr. Bowdijch's
article on this subject was copied into this Journal, and may be
found in vol. VJ. We observe in the January No, of the
American Journal of Med. Sciences, a report, by Dr. Bowditch,
of several cases in which paracentesis with the small trochar
attached to a suction apparatus was resorted to with marked
advantage.

This procedure in the large accumulations of chronic pleu-
risy, certainly merits farther trial, but the proposition to tap
the chest to remove the serum rapidly effused in cases of acute
inflammation, is another matter, and, as it seems to us, should
be protested against. \_Bujfalo Med. Journal,

On the Nature and Causes of Genu Valgum, or Knock-Knee,
By Professor Bock.

The most common deforfiiities of the knee-joint may be ar-
ranged under the four following heads.

1. Contraction of the ki'.ee (contractura genu) is the name
given to the condition in which the knee is in a state of abnor-
mal constant flexion, with considerable, little, or no power of
motion in the joint.

2. Recurved knee (genu recurvatum.) Here the knee is in a
state of superextension, and the popliteal space forms the apex
of an angle pointing backwards.

3. Genu varum, or bow-leg: called by the Danish wheel-leg
(Hjulhenet.)

4. Genu valgum, or knock-knee: in Danish, calf knee (Kal-
vekncBet ;) in German, goats leg (Ziegenbein,) X-leg {X bein.)

The name genu valgum is borrowed from an imperfect analo-
gy with pes valgus. In the latter, the foot is thrown outwards.
In genu valgum, it is not the knee, but the tibia which is pressed
outwards ; and the more correct denomination would, there-
fore, be tibia valga, if the analogy with the foot were preserved.
The same is the case with genu varum.

Genu valgum has been but imperfectly described in surgical
works. Prof Bock has for some time been collecting materials ^
for a more accurate knowledge of this deformity, and now
publishes the results at which he has arrived.

Pathology. In the norn :.l condition, the knee-joint deviates
from the long axis of the lower extremity, on account of the
greater extension downwards and inwards of the inner condyle
of the femur.

The thigh-bones hence converge downwards, especially in

1852.] Genu Valgum, or Knock-knee. 237

females, in whom the pelvis is wider, and the neck of the thigh
bone is larger and directed more outward. It is the unnatural
exaggeration of this condition to which the name of genu valgum
is given. It might be supposed, that this atfection is more fre-
quent in the female sex : such, however, is not the case, for it
is far more rare in women and girls than in men and boys.
Both knees may be affected, but one is generally more so than
the other: and it is then almost always the right knee which
is the chief seat of the disease. When one knee alone is affect-
ed, it is the right in about tvv'ce as many cases as the left. The
origin and progress of the disease are gradual and almost im-
perceptible.

The knee forms the apex of a triangle, the other angles of
which are at the ankle and the great trochanter, so that the
base consists of the straight line which may be drawn between
these points. The altitude of the triangle, or the perpendicular
line from the knee to its base, points out the greater or less
degree of the disease ; this may naturally be denoted by the
anomalous proportions of the angle at the knee, which, from
being very obtuse, becomes, in the more advanced stages, a
right or even a very acute angle.

On examining the knee, the following changes are found :
On its anterior surface, the united large tendons of the extensor
muscles, and the ligamentum patellae, are found much stretched ;
and the more so, in proportion as the knee is bent backward
as well as inward. The patella is displaced outwards; so that,
in a more advanced stage of the disease, it rests on the exter-
nal edge of the knee, in front of the condyles of the femur and
tibia. The knee loses its natural convexity forward, and be-
comes acute-angled on its anterior and outer edge; and the
anterior part which lies more interiorly forms a plano-convex
region in front of the inner condyle. On the outer surface of
the knee, or in the angular bend, we often find the tendon of the
biceps much stretched, as well as one or two portions of the
external ligaments extended into sharp strings. The external
condyles, both of the femur and of the tibia, are small, and can
scarcely be felt in the more advanced stages of the disease.
When the curvature is very remarkable, there is a transverse
furrow in the skin on the exterior part of the knee. The natu-
ral hollow of the ham is obliterated; and the posterior surface
of the knee joint is more or less plano-convex. The inner
surface of the knee forms the obtuse apex of the angle; and
here the internal condyles of the femur and tibia are felt always
prominent, usually hypertrophied, and, in rachitic cases, enor-
mously swelled.

The condition of the whole extremity is at the same time

238 Genu Valgum, or Knock-hnee. Y.A.'^xW,

changed. The thigh assumes an oblique direction downwards
and inwards, towards the opposite knee. The knee is direct-
ed inwards, against or behind the sound knee, and the shin-bone
assumes a direction downwards and outwards, so that the foot
is at a great distance from that on the sound side. As the dis-
ease advances, the direction of the foot is changed : but this
will be treated of under the head of complications. In children,
where the affection is of a truly paralytic nature, and has fol-
lowed convulsions, there has been constantly observed a sink-
ing of the temperature, as much as two degrees, in the diseased
hmb. In grown persons, the author has not found this svmp-
tnm. In consequence of the bending of the limb, the distance
jrom the pelvis to the sole of the foot is diminished ; the direc-
tion of the pelvis in walking consequently becomes oblique, so
that the anterior superior spine of the ilium may be found an
inch lower on the affected than on the sound side. This obli-
quity of the pelvis becomes gradually permanent, so that it is
observed both during walking and standing. In cases where
tl.e deformity has not yet reached a hio;h degree, and in chiK
dren, the limb can generally be brought back with the hands to
its natural position : but the tension is felt to increase in the
biceps femoris and external ligament of the knee-joint ; and,
when the force is removed, the limb instantly resumes the bent
position. In rachitic cases, not only the internal condyle of
the femur, but also, in a still higlier degree, that of the tibia is
enlarged. The concavity inwards, which is naturally formed
by the tibia, is obliterated ; and, in the more advanced stages,
there may even be a pretty conspicuous convexity, so that the
whole extremity more resembles a bow curved inwards than an
angular bending. The knee-joint generally retains it mobility.
In the higher de^^rees of curvature, this is indeed soniewhat
limited ; but either true or false anchyloses are seldom met
with as consequences of the affection of the knee which has
been described.

When both legs are curved, the right leg is always slightly
more bent than the other, and the apices are turned towards
each other. This has given rise to the German designation of
the disease X-lex (X-bein).

In this affection, the patients halt in a peculiar manner. If
one bone only is affected, there is a lameness {a) because one
extremity is too short ; {h) because the foot of the diseased limb
falls beyond the centre of gravity of the body ; (c) because
the affected knee, in walking, both hinders the free swinging
motion of the healthy knee, and is in its tui'n impeded by the
latter. Each of these causes has distinct results, which modify
both the direction of the limb and the lameness. When the

1652.] Genu Valgum, or Knoch-hiee. 239

extremity is too short, there is a natural attempt to compensate
the defect ; and this is effected partly by the already mentioned
obhquity of the pelvis, and partly by the formation of a curve
in the healthy leg. In healthy individuals, who have for some
time had genu valgum, there will almost always be found a
slight but true contraction of the knee in the sound leg. But
in children, almost without exception, the other knee will be-
come curved, either as genu varum or valgum. The outward
direction of the tibia and foot causes the peculiar up-and-down
lameness to become rotary and swinging, like mowing, and
this swinging is increased, to prevent the collision of the
knees during walking. In the more remarkable modification,
the body seeks to maintain its equilibrium ; and it attains this
object more completely than in many other forms of lameness
e. g., from congenital dislocation of the thigh. This is partly
affected by the position of the pelvis, and partly by a greater
degree of mobility in the lumbar vertebrae. The diseased leg
is generally sufficiently powerful, in persons affected with genu
valgum, to enable them to walk for some distance. Naum^
burg has compared their gait to that of ducks ; but this is scarce-
ly correct. The gait is more swinging than waddling, as in
persons with rachitic distortion of the pelvis or double congeni
tal dislocation of the hip-joint. The patient who has genu valgum
in one leg, endeavors, while standing, to preserve the centre of
gravity by mjoving the sound leg somewhat outward bevond its
natural position. Hence the points of support in the ieet are
at a greater distance from each other, and the surface within
which the centre of gravity of the body can tail is greatly in-
creased. Patients with double genu valgum usually, w-hen
standing, support the knees against each other, so as to form
there a mediate resting point tor the body, while the feel stand
out from each other.

Complications and Secondary Deformities. These are more
various in this than in any other deformity w^hatever. Where
the disease has commenced in youth, a curvature of the spinal
column will generally be produced by the obliquity of the pel-
vis and the lameness. The affected limb is not unfrequently
more or less atrophied. Anchylosis of the knee-joint rarel v
occurs, unless some chronic disease have preceded or accom-
panied the deformity. Prof Bock has, however, seen two
cases of anchyjosed knock-knee in elderly persons; in these
the limb was also directed backwards. But it is the feet which
are especially influenced by the gait produced by genu valgum ;
and hence knock-kneed patients have, almost without exception,
some deformity or other of the feet. The patient mav, in con-
gecjuence of the abduction of the tibi^, treacj and walk or^ the

240 Genu Valgum, or Knock-knee. [April,

inneredgeofthe foot, which hence often becomes callous. Hence
there is a disposition to flat-foot, which is the most frequent
complication. But, almost as frequently, the genu valgum is
complicated with club-foot; and, as the shortness of the limb
leads the patient instinctively to endeavor to touch the ground
with the points of his toes, it is evident that these forms will
be accompanied by a greater or less degree of talipes equinus.
It has been hitherto impossible to determine the reason, why
these secondary deformities of the feet should in some cases
assume one form, and in others another. In certain peculiar
cases, the deformity of the knee is secondary. A patient in
Dieffenbach's ward had had, from childhood, cyphosis accurvata
of the lumbar vertebrae ; in his youth varus had been developed
in both feet, and, in his sixteenth year, he had become knock-
kneed in both legs. Not uncommonly there is genu valgum on
one side, and genu varum on the other, accompanied by the
same, or by distinct deformities in the feet.

Causes. There is no doubt that genu valgum may be con-
genital ; this is, however, a rare occurrence. The causes of
the development of the affection in latter years are partly ex-
ternal, partly internal, but most frequently both are combined.
The greater convergence of the thighs in women may be sup-
posed to be a predisposing cause; and Lessing says that this
affection is more frequent in females than in males; this is,
however, incorrect, for the deformity is twenty times more
frequent in the latter sex, than in the former. Scrofula and
rickets may be considered as predisposing causes, especially
the latter. It still more frequently produces genu varum, in
which case the external condyles of the femur and tibia are
most affected and enlarged, while a similar swelling of the in-
ternal condyles give rise to genu valgum.

Genu valgum may, as a general rule, be considered as a dis-
ease of a paralytic nature, and its most usual cause as a depressed
state of innervation. Hence the commencement of the affec-
tion is limited to certain periods of life, in which the nervous
centres undergo a more than ordinary degree of disturbance,
connected with the state of development. Genu valgum is de-
veloped either during the first dentition or during puberty.
This rule is so constant, that the only exceptions are the cases
in which some local malady has given rise to the deformity : but
these are comparatively very rare. In children, the disease has
always, in the author's cases, arisen between the eighth month
and the completion of the second year, and has always been
preceded by difficult dentition, with fever, convulsions, violent
hooping-cough, or, as in one case, acute exanthematic fever.
This agrees with what has been stated by Heine, with regard

1852.] Genu Valgum, or Knock-knee. 241

to nine cases of knock-knee observed by him. The external
causes, which may give rise to the affection at this a<;;e, and
under the circumstances which have been mentioned, are, that
the children walk too early, or too soon after a weakening ill-
ness, while they have not yet recovered strength, or that they
are constantly carried on one arm, by which one knee is press-
ed inwards.

Among 221 cases of genu valgum, whicli the author has ob-
served, 17 originated during tfie first dentition. In a few in-
stances he has not been able to ascertain the period ; but in
almost all the rest, or about 200, the deformity commenced
between the fifteenth and eighteenth years, or at the time of
puberty. In all these cases there was an evident external
cause for the deformity the patient's position or occupation :
but the lin)itation of the age referred to above, together with
the fact that many following the same occupation, under appar-
ently similar external circumstances, do not become deformed,
seem to show that the external conditions are not sufficient to
produce the disease, unless they meet with a corresponding
disposition in the system of the individual, or rather in his de-
velopment. We correctly consider the periods of dentition
and of puberty as stages of development, in which the body is
more obnoxious, than at any other period, to the hurtful opera-
tion of various extrinsic or intrinsic influences. That the de-
formity in question less frequently arises during dentition than
during puberty, may be ascribed to the fact, that the influences
above referred to, are more easily resisted by the system in the
former than in the latter period.

This deformity is more frequent in smiths, joiners, bakers,
and grocers. In 1846, there were in Copenhagen 644 smiths,
among whom were:

225 blacksmiths and anchorsmiths ; of whom 42 had genu
valgum in the right leg, 7 in both legs=19 per cent.

359 locksmiths; of whom 23 had genu valgum in the right
leg, and 3 in both ]egs=7 per cent.

30 nailsmiths; of whom 17 had genu valgum in the right
leg, and 5 in both legs=73 per cent.

There were thus, in all, 97 cases of the deformity among 644
smiths, making an average of 15 per cent.

The following are the immediate causes of the frequency of
the deformity among smiths. Almost all smith's work necessi-
tates the long maintenance of the same position, w^hether at the
bellows, the anvil, or the vice; and, while standing in this po-
sition, they often have to use much force, which leads them to
seek a firm and solid footing. The feet are hence removed

242 Genu Valgum^ or Knock-knee. [April,

from each other, either both sideways, or one ahvaVG the
left forwards. In both these positions, any powerful effort
Avill tend to produce genu valgum ; for a great part of the
weight of the body will, under the powerful movements of the
arm and upper part of the body, act on the knee like a pressure'
from above and below. In blowing bellows, a work in which
apprentices aregeneially employed, they must often stand un-
interruptedly at work for several hours. At the vice and anvil,
the left foot is placed forwards, the right backwards and rotated
outwards, so that the toes are turned to the side. In this posi-
tion they often stand with the leg and foot unmoved for several
hours, while the upper part of the body is subjected to constant
and violent swinging, in order to use the file or hammer. The
influence of the position on the knee will be easily seen by any
one who will make a trial of it. Blacksmiths and anchor-
smitfis are besides constantly liable to have to bear heavy bur-
dens. The fact that nailsmiths are most liable, in spite of their
work being least laborious, is explained by the circumstance
that they almost constantly use a kind of vice, which is fixed
near the ground, and against which they all, without exception,
|)lace the inner surfaces of both knees, " because it is impossi-
ble for them to work in any other way."

Of 1340 journeymen carpenters, about 60, or 5 per cent., had
genu valgum. It has been impossible to make very accurate
observations on this class, as they endeavor to conceal the de-
formity as well as they can. It does not reach in them so high
a degree as in smiths. Notwithstanding that the work of car-
penters is less laborious than that of smiths, considerable exer-
tion is required : most of the labour of carpenters, as sawing,
planing, and polishing, requires the same positions as are here
described in speaking of smiths. The author has also observed
that carpenters carefully watch foi- this deformity, and endeav-
or to prevent its development. Many masters have told him
that they have had to set free their apprentices, or, in the fii'st
\ear to caution them against habituating themselves to the pos-
ture which favors the comm.encement of the disease.

Of 334 journeymen bakers, 27 were knock-kneed ; 24 vvere
affected in both knees, the right being generally more bent
than the left. One individual had the curvature only in the
right knee. In 16, deformity had not reached a very high de-
gree. Notwithstanding that bakers seem to be affected with
this malady more than the other classes above named, and sev-
eral of them have some difficulty in walking, the deformity is
not strongly developed. The disease does not arise from the
position in which they stand w^hile kneading dough ; for in the
first years, when this malady is developed, the apprentices arer

1852.] Genu Valg^tm^ or Knock-knee. 243

not employed at this labour. But the deformity is produced by
slandin^^ at night at the board, often half asleep or contending
with sleep, seeking for rest in the most varied positions; or
partly by carrying water or sacks of corn. It is possible also
that the great changes of temperature in attending to the oven
may have some influence ; but the author considers the night
watching as the most essential cause, for the constant struofgHnix
with sleep produces a relaxation of the muscles. All the bakers
in whom he observed i^enu valgum, also had flat-foot ; and the
latter deformity, in several cases, had preceded that of the knees.

The generally received opinion, that grocer's apprentices
should be liable to jienu valgum, from standing long, or from'
shutting drawers with their knees, Prof. Bock has not found
supported by facts ' for, among 2000 individuals of this class,
he has in vain sought for any examples of this deformity. Jt is
said to have been more frequent formerly; and what has most
surely contributed to its removal, is the reform in working
hours, it having been formerly the custom to keep the shop
(>pen much later at nigb.t, and to open it earlier in the morning.

It hence results, that the general causes of this deformity are
certain positions and habits, where these are often repeated^
and especially at times when the body is more susceptible of
their influence than at others. Other more accidental causes
are, allowing children to walk too early, carrying heavy bur-
dens, ulcers on the inner border of the foot, a burn on the out-
er side of the knee, resection of the upper end of the tibia,
tuberculosis in the legs, caries, necrosis, rickets, syphilis, chronic"
abscesses, inodular bodies, (fcc.

The knee-joint is properly speaking, a ginglymoid articula-
tion, and its essential movements are merely flexion and exten-
sion ; but the hinge-like movements are not so absolutcfy
limited as in other analogous joints. The knee possesses a
slight power of pronation and supination, but only when bent:
and this power is dependent on the rotation of the tibia on its
long axis, being limited, when the lim.b is extended, by the cru-
cical ligaments. It is not connected vvithany peculiarapparatus,
as in the rotary movements of the radius and ulna, and may
properly be considered as a slight twisting, which becomes
possible on the tolerably flat upper surface of the tibia, when
the knee is in such a position that rotation is net prevented by
the extensor muscles. The knee has hence no power of abduc-
tion or adduction; and therefore the motions of this joint do-
not help to explain a deformity, which is characterized as ar>
abduction of the tibia. Its immediate cause must be sougirt foi-"
in the parts which form, hold together, and strengthen the joint.-

Although the part which these structures play in the produc-

244 Genu Valgum, or Knock-knee. lApr'i],

tion of this deformity is for the most part passive, the biceps
femoris seems to be active in those positions in which genu
valgum is chiefly produced, and to exercise the greatest inflii-
ence on the increase, if not on the origin, of the deformity.

Supposing that one of the external influences which have
been referred to should steadily act on the knee-joint, at a time
when either convulsive disease (first dentition) or an unequally
powerful development, perhaps in connexion with a rapid slen-
der growth (puberty), have weakened the nervous system ;
then the parts on the inner side of the knee have no power of
opposing the pressure outwards. They are overstretched and
slackened; and thus the conditions arise for the commence-
ment of genu valgum. The most important relaxation takes
place in the internal lateral ligament, which is lengthened and
thinned in its whole extent: in the more advanced stages, the
four tendons on the imier side of the knee are also lengthened.
On the other side of the knee, the tendon of the biceps, and
both the external lateral ligaments, as well as the posterior, are
strongly stretched.

When the deformity commences, the angle at which the bi-
ceps femoris acts constantly, becomes more and more favoura*
ble to its increase. This is, however, still more favoured by
the circumstance, that the weight of the body, which in the
normal state is uniformly difflised over the upper surface of the
tibia, is now transferred to the upper surface of the outer con-
dyle of that bone. The inner condyle of the tibia, and that of
the femur to some extent, are atrophied even in cases which
are not of rachitic oi'igin. This hypertrophy is greater, in
proportion to the youth, or small size of the patient at tF)e time
when the deformity commenced. In rachitic cases, it some-
times attains an enormous degree. It is probable, also, that
the internal semilunar cartilage is somewhat atrophied.

Prognosis. As genu valgum is a deformity which depends
rather on relaxation than on active contraction, the prognosis
in general may be considered as scarcely favourable. It is,
however, curable, when it comes under treatment in an early
stage, and, which is more important, when the circumstances
which have produced and kept it up can be removed. In your
children the knee can be brought with the hand into its normal
situation ; and in these the prognosis is most frequently good,
when the necessary continued watching of the growth can be
maintained, and when the general condition of the child does
not give a tendency to the continuance of the disorder, or to
relapses. In young men, also, the deformity can be cured,
when there are as yet no consecutive changes. But, under
all circumstances, the removal of the deformity must not be

1852.] Aphorisms on the Treatment of Wounds, <^c. 245

looked on as complete ; for, even when the curvature is com-
pletely removed, it will still be necessary to employ fitting
means to insure the result desired.

Treatment. The treatment of genu valgum in young chil-
dren, consists in mechanical means to keep the knee outwards,
and this must be always supported by such general treatment
as the constitution of the child may indicate. The most sim-
ple apparatus is a splint, either straight or convex outwards,
reaching from the hip-joint over the outer ankle, and fastened
at the ends with circular bands. This apparatus, however,
hinders the child from walking, and therefore can only be used
constantly at night ; hence it can only be used in the more un-
important cases. It is preferable to make use of a steel spring,
convex outwards, furnished at the height of the knee with a
hinge, fastened at the hip to a bow which can be stretched
round the pelvis ; just over the outer ankle, the lower end of
the spring passes into another bow, which can be fastened round
the tibia. The spring is furnished on the outside, through its
whole length, with buttons, on which are fastened small leather
straps, four or six in number. These are brought round the
legs ; and on the inner side of the knee they glide between flat
pelottes, which exert a pressure from within outwards, when
the straps are stretched or buttoned. An apparatus of this kind
may be worn for along time, and its action gradually increased.
It must be used for at least a year after the deformity is
removed, and even then it must be gradually ascertained wheth-
er it can be left off.

The same apparatus, on a larger scale, and with greater
strength of spring, can be used in grown persons. The patient
can easily accustom himself to use it indeed, he feels comforta-
ble with it. In grown persons it will generally be an indication,
before employing mechanical treatment, to divide the tendon of
the biceps, or of the most stretched fibres of the lateral hga-
ments, but generally only of the posterior lateral ligament. The
mechanical treatment, after tenotomy, may appear tedious ; but
the result will be more perfect ; but without great perseverance
on the part of the patient, and careful watching of the deformity
lor several years, the treatment of genu valgum will in general be
ineffectual. [Bihliothek fur L(sgen and London Jour, of Med.

Aphorisms on the Treatment of wounds and injuries of the
Abdomen. By G. J. Guthrie, Esq., F. R. S.

1. A blow on the wall of the abdomen, from any solid sub-
stance, causing a severe bruise, often, if not always, gives rise
to the absorption of muscular fibre, and the subsequent forma-

N. S. VOL. VIII. NO. IV. 16

246 Aphorisms on tht Treatment of Wounds ^ <^c. [April,

tion of a ventral herna. It is desirable, in all such injuries, to
prevent or to subdue inflammation as soon as possible, in order
to obviate the formation of matter between the layers of mus-
cular fibres, which is a disagreeable, if not always a dangerous
consequence. Severe blows or contusions from falls may rup-
ture the hollow as well as the more solid or fixed viscera, causing
death. A child just able to walk was placed under the author's
care in the Westminster Hospital, having been tossed up into
the air by its father with his right hand, and caught in its de-
scent in the crutch formed by the thumb and fingers of the left,
on the thumb of which it at last fell. The integuments seem-
ed to be unhurt, the small intestine was ruptured and the child
died. The author has seen all the viscera of the abdomen rup-
tured, at different times, from non-penetrating blows or wounds,
the sufferers usually dying from hemorrhage.

2. When an incised wound is made through the wall of the
abdomen, except perhaps in the linea alba, the parts, when vas-
cular, are rarely found to unite in a permanent manner, so that
a ventral hernia is the result. The knowledge of this fact,
acquired during the war in Portugal and Spain, led Mr. Guthrie
first to doubt the propriety of, and when confirmed by subse-
quent experience, to forbid the introduction of ligature, through
muscles for the purpose of keeping in apposition parts which
could not ultimately cohere.

In all simple wounds of the abdomen, of even a moderate
extent, the edges of the wound should be brought together by
means of a small needle and silk thread, precisely in the man-
ner a tailor would fine-draw a hole in a coat, or a lady a cut in
a cambric pocket-handkerchief, sticking plasters over it, no
bandage. The position af the patient should be of the gentlest
inclination of the body towards the wound, the limbs being
bent so that the parts may press against each other. Absolute
3'est is no less to be observed, and steadfastly continued. In
the position the patient is placed in he should remain. When
Mr. Guthrie became an examiner of the Royal College ofSurj^
geons, the practice of the older surgeons he found there was t^
purge such patients vigorously, in the same manner as the]
purged persons who had undergone the operation for hernia]
against both of which practices he protested until they wei
condemned and reprobated inriprovements the surgery of civi
life owes, among many others, to her elder but less fortunat
sister, the Amazonian of warfare.

The custom of directing a man to be bled forthwith, as well
as purged, because he had been stabbed, was another and not
less esteemed error, with the author's older colleagues, which I
experience did not sanction, and which he could not approve.

1852.] Aphorisms on the Treatment of Wounds, ^-c. 247

The abstraction of blood before reaction has begun, after the
constitution has sustained a severe shock, delays it, as well as
the commencement of the inflammatory stage necessary for the
cure of the wound. The abstraction of blood is to be directed
and regulated by the signs of reaction which have taken place,
and by the augmenting intensity of the symptoms of inflamma-
tion which may follow. The quaritity required is often large,
although too much will do harm. Leeches are very beneficial,
and the author has often applied from twenty to a hundred with
the greatest advantage.

ThQ pulse is by no means a guide to be relied upon, a small,
low, and sometimes not even a hard pulse, being more strongly
indicative of an overpowering state of inflammation than a
quick and full pulse ; and much more depends on the fixed pain,
the anxiety, and the general oppression, than on the apparent
state of the circulation. Long before general and local bleed-
ings cease to be of advantage, calomel and opium will render
most important services, particularly the latter.

3. Penetrating wounds of the abdomen are frequently fol-
lowed by an immediate protrusion of some portion of the con-
tents of the cavity. When the omentum has protruded, it
should be returned as gently as possible ; the finger should not
follow, to ascertain its position ; it should be left free from
strangulation within, but in contact with the cut edges of the
peritonaeum, to which it is desirable it should adhere, as they
are not likely to unite one with the other. The external wound
is then to be sewed up as the author has directed, and the
stiches are not to be carried through all the intervening parts
down to the peritonaeum, as is directed by most, if not all,
authors whose writing are of ancient and even of modern date.

4. When the opening through wliich the omentum and intes-
tine, or both, have passed, seems too small to admit of their
being returned, the latest writers on this subject recommend
that a director should be introduced between the upper portion
of the wound and the protruded part, upon which a blunt-ended
bistoury is to be passed into the cavity as far as the enlargement
of the wound seems to require, when they are to be withdrawn
together ; -from all whicfi the aut/ior dissents. The difficulty
does not usually lie with the opening in the peritonaeum, but
with that in the aponeurotic or tendinous expansions, and it is
this part only should be divided. A small cut in the peritonaeum
is not dangerous ; a larger one is, and should always, if possi-
ble, be avoided, for however indifferent a quarter of an inch,
more or less, may be in a large wound, it is not so in a small
one. The protruded parts should be gently cleansed with
warm water, with which the fingers of the surgeon should be

248 Aphorisms on the Treatment of Wounds, <^c. [April,

wetted, and then returned, the mesentery first, then the intes-
tine, and the omentum last. At a later period, if the omentum
be found protruded, adherent, inflamed, in a state of suppuration
or gangrene, it should be left to itself, and treated in the most
simple manner. A ligature should never be applied to it as
whole, although it may be applied to a bleeding vessel of any
part which has been cut, or which it may be necessary to re-
move. It should not, however, be spread out in these cases, and
cut off, as is usually recommended, as it will gradually retract,
and be withdraw^n into the cavity of the abdomen, if the patient
survive. An omentum wounded in the first instance, is in the
best situation when placed just within and against the cut edges
of the peritonaeum ; it is never in a better under any circum-
stances, except when it adheres to them.

5. When an intestine is protruded, it is to be treated in a
similar manner, and the three great directions on this subject,
of modern surgeons, are to be avoided: do not therefore cut
the peritonaeum, do not unnecessarily introduce your finger
into the cavity of the abdomen, and be most careful to avoid,
above all, the third direction, " that the patient is to be placed
in such a posture, that the intestines should Zea^i press against
the wound." On the contrary: relax every part, keep the
patient perfectly at rest, and if you can so manage, that the
intestine shall be steadily applied against the cut peritonaeum,
without protruding between the edges, so as to be in the best
possible situation for adhesion. The external w^ound should
be accurately closed by the continuous suture, supported by
adhesive plaster and a compress, and a proper bandage, if it can
be methodically applied.

6. When the intestic is wounded, as well as protruded, the
case is complicated ; a mere puncture, or a very small cut, is
not to be dreaded, the bowel should be cleaned and returned,
and the excess of inflammation closely watched. When the
wound in the bowel is larger, but is less than a third, or not
more than a quarter of an inch in length, it is less apt than
might be supposed to permit the extravasion of its contents in
consequence of the Tillous coat protruding through the opening
in the other tunics, the edges of which beins^in great part mus-
cular, have separated from each other. This eversion of the
lining membrane, so conspicuous in wounds, is not seen in ulcer-
ations, the previous inflammation having solidified the parts.
Whenever then an opening in a bowel is not filled up by the
internal coat, the edges must be brought together by ligature.
A ligature placed around an intestine of a dog, cuts its wayi
through, into the cavity ; and if the animal should survive some-
months, the part which had been injured will not be easily dis-
covered.

1852.] Aphorisms on the Treatment of Wounds, ^c. 249

When the wound in the intestine is small, and yet larger than
it would be safe to leave to nature, a ligature should be applied
firmly around the opening, which should be raised with a pair
of forceps, so as to admit of its application. When the wound
is larger, the edges should be brought together by the continu-
ous suture in a parallel line. A common needle carrying a fine
well-waxed silk-thread, is to be introduced about half a line
from the peritonasal edge of the opening, and brought out at the
corresponding point on the opposite side, a knot on the end of
the thread preventing its slipping. The first slitch should be
a line from the end of the wound, and he last should terminate
with a knot at a similar distance. Ti.e stitches should not be
tightened when made, but left loose ui.til all are inserted, when
they may be drawn close, one after the other, the cut edges be-
ing turned in by a probe, so that the peritonseal surfaces m.ay be
in contact under the stitches, the divided edges being turned
into the cavity of the bowel. It has been advised not to pass
the needle through the mucous coat, br.' only through the strong
areolar tissue connecting it with the transverse muscular coat.
It is apprehended that if this could be accurately done, which
may be doubted, the ligature might not ulcerate its way through
to the cavity of the bow^el. It is therefore better to pass the
needle through all the coats, until further observations shall
have been made on man on this point.

When an incised w^ound in the intestines is not supposed to
exceed a puncture in size, or is less than a third of an inch in
length, no interference should take place : for the nature and
extent of the injury cannot always be ascertained, without the
committal of a greater mischief than the injury itself. When
the wound in the external part is made by an instrument not
larger than one-third, or from that to lialf an inch in width, no
attempt to probe, or to meddle with the wound, for the purpose
of examining the intestine, should be permitted. When the
external wound is made by a somewhat broader and longer
instrument, it does not necessarily follow that the intestine
should be wounded to an equal extent ; and unless it protrudes,
or the contents of the bowel be discharged through the wound,
in the first instance, the surgeon will not be warranted in en-
larging the wound, to see what mischief has been done. For,
although it may be argued that a wound four or more inches
long has been proved to be oftentimes as little dangerous as a
wound of one inch in length, most people would prefer having
the smaller wound, unless it could be believed, from calculation,
that the intestine was also injured to a considerable extent.
Few surgeons, even then, would like t'* enlarge the wound, to
ascertain the fact, unless some considerable bleedinar, or a dis-

250 Aphorisms on the Treatment of Wounds, ^c. [April,

charge of faecal matter, pointed out the necessity for such ope-
ration ; when there would be reason for believing that the
patient would have a better chance of recovery after the appli-
cation of a suture to the wounded artery, or bowel, than if it
were left to Nature.

If the first two or three hours have passed away, and the
pain, and the firnn, not tympanitic swelling in the belly, as well
as discharge from the wound, indicate the commencement of
effusion from the bowel, cr an extravasation of blood, an en-
largement of the opening r'one can save the life of the patient,
although the operation may probably be unsuccesbful. It is
not, however, on that account, to be alway laid aside, when
the state of the patient offers even a chance of success. The
external wound should be enlarged, the effused matter sponged
up with a soft, moist sponge, and the bowel or artery secured
by a suture. When a penetrating wound, which may have in-
jured the intestine, has been closed by suture, and does not do
well, increasing symptoms of the inflammation of the abdomi-
nal cavity being accompanied by general tendernes of that part,
and a decided swelling underneath the wound, indicating effu-
sion beneath, and apparently confined to it, the best chance for
life will be given by reopening the wound, and even augment-
ing it, if necessary, to such an extent, as will allow a ready,
evacuation of the contents of the bowel. It is a point in surgery
which a surgeon should contemplate in all its bearings. The
proceeding is simple, little dangerous, and, under such circum-
stances, can do no harm. Mr. Guthrie has seen instances in
which it has been done, and others in which it might have been
done, with some hope of its being beneficial ; and he recom-
mends it for the serious consideration of those who may hereaf-
ter have the management of such cases,

8. When the abdomen is penetrated, and considerable bleed-
ing takes place, and continues, it becomes necessary to enlarge
the opening, and look for the wounded vessel. If the hemorrhage
should come from one of the mesenteric arteries, or the epigas-
tric, two ligatures are to be applied on the injured part. If it
should be presumed that the enlargement of thQ wound and
the search for the wounded vessel is not likely to be effected
with advantage to the patient, the wound should be closed by
suture, and a compress laid over it. If the bleeding should
continue internally, and the wounded part become distended
and tense, the sutures may be in part removed to give relief.

If the belly should become very painful, tense, and manifestly |
full after a punctured wound, and not tympanitic, the wound!
should be enlarged to allov/ the evacuation of the blood, which
cannot, in such quanity, be absorbed. Extravasations of blood

1852,] Stimulant previous to using Chloroform. 251

of a determinate quantity are not found to be diffused all over
the surface, and between theconvolutions of the small intestines,
provided the person has outlived the period of extravasion, and
may be readily evacuated, provided tha wound be sufficiently
open. It may, when confined without an external opening,
be absorbed, but it is more likely to give rise to suppurative
inflammation, and the formation of matter, requiring with it to
be discharged by an opening made for the purpose. Cases of
extravasion, terminating in this manner, are very rare in our
northern climate, where inflammation usually runs high in the
first instance. That they do sometimes occur should not be
forgotten, and that surgery should not be wanting to give its
aid.

For the proper treatment of gunshot wounds of the belly the
author refers to his work on '' Injuries c^ the Abdomen/' where
it is fully pointed out. [^Lancet.

On the necessity of administering a Stimulant in certain cases,
previous to using Chloroform. By Dr. C. Fleming.

The most important point in the information contained in
Mr. Fleming's pamphlet we consider to be that of the admin-
istration of a stimulant before allowing the patient to inhale
the chloroform, in cases, where, from extreme depression of the
vital powers, it becomes a serious risk to attempt the induction
of anaesthesia. He says :

**The first case of this kind in which it struck me that salu-
tary anaesthetic effects might be secured, occurred in one of
the constabulary force, a patient in Stevens' Hospital. He
was the subject of disease of the knee-joint, advanced to a
stage to demand amputation, and was in a state of such ex-
treme exhaustion that the operation was not free from danger.
It was most desirable to save him the shock and pain of it ; and
yet his condition appeared to militate against the use of chlo-
roform, for which he was most anxious. It struck me that
some dietetic stimulant might answer as a protective, and I
gave him, about half an hour before the operation, some bran-
dy beat up with the yolk of an egg. The chloroform was now
administered in his ward, previous to his removal to the oper-
ation theatre ; the limb was removed by Mr. Wilmot, and he
was replaced in bed, without knowledge or pain throughout
the w^hole proceeding, and in a condition not appreciably dif-
ferent from that which preceded it."

The idea of giving a stimulant as a protective against the
injurious effects of anaesthetic agents, in cases of extreme ex-
haustation, appears, as far as we know, to be original with Mr.

252 Inversion of the Vagina during Labor, [April*

Fleming, for we are not aware that the plan was before adopted.
Simple as the suggestion may at first appear, we are of opin-
ion that it is one of the most important practical points we
have recently gained regarding the administration of chloro-
form. We have known surgeons refuse -to allow patients in
a weak condition to be brought into an anaesthetic condition,
preferring that they should suffer the torture of even a pro-
longed and exquisitely paintul operation to risking their lives by
the action of chloroform ; and we have to mourn over the fatal
consequences we have heard recorded, from the employment
of that agent, when much debility existed. If the precautionary
measure of exhibiting a stimulant before the inhalation of the
chloroform had been known and adopted, we are certain that,
upon the one hand, many sufferers might have been spared
unnecessary pain, and, upon the other, a large number, if not
most of those who fell victims to its agency, have been rescued
from death ; and this suggestion receives increased importance
by reflection, for, in reality, it is in cases where vitality is low
that anaesthesia would be most desirable, since, during that
state of Jhe system, the shock of an operation must be greatly
lessened. [Dublin Quarterly Jour,

Case of Inversion of the Vagina coming on during Labor,
Jjy. JDr. Lambert.

The patient was a laboring woman. During the last six
months of her third pregnancy she suffered from prolapsus of
the vagina whenever she was working at out-of door labor.
The swelling thus produced attracted her attention, but did
not alarm her, as it disappeared when she lay down in bed.

When labor came on, the tumor again appeared between the
limbs. The midwife in attendance finding the labor tedious,
and ignorant of the nature of the case, recommended the wo-
man to make the most of her pains, and ordered her a vapor
bath. The only apparent effect of this advice was the increase
of the tumor to double its former size. When Dr. Lambert
arrived, he found it projecting from the vulva, of the size of the
two fists, of a blueish-red color, round, wrinkled, and of con-
siderable consistence. At its lower extremity was an opening
through which the finger could be introduced to the os uteri.

Dr. L. recommended rest in the horizontal posture, with the
pelvis a little elevated, co:d applications to be made to the tu-
mor, and slight pressure applied to replace it during the inter-
vals between the pains. After considerable delay the tumor
w^as reduced, and the woman delivered with the forceps. She
made a good recovery, and the swelling has never returned,
\Lond. Monthly Journ,, from Revue Med. Chir.

1852.] Sympathy between the Uterus and iMestinesr. 253

The Sympathy between the Uterus and Intestines.

Dr. Vandeen, a Dutch physician, has published in the Presse
Medicale Beige, a few judicious observations respecting the
sympathy whrch exists between the functions of the uterus and
intestines at certain periods. He considers that the reaction-,
of the uterus upon the bowels at the time of menstruation pro-
duces diarrhcea, as both the uterus and large intestine (the lat-
ter sympathetically) are at that period in a congested state,,
and their secretion therefore abundant. During gestation,
however, a great deal of functional energy is transferred to4he
breasts and uterus, and thus constipation is a frequent symp-
tom both during the development of the foetus and for son^e-
time after parturition. The author looks upon these facts as-
brought to light for the first time by himself; we were, howe-
ver, in reading his remarks, forcibly reminded of a paper read
by Dr. Tilt before the Medical Society of London. In this
communication, Dr. Tilt pointed out how frequently diarrhoea
is a precursory symptom to menstruation, and the following
passage of Dr. Vandeen's remarks shows h.ow identical facts
may be simultaneously observed in different countries. The
Dutch physician, namely, says : *' The sympathy between the
uterus and the large intestine is rendered evident by the fact,
(which to my knowledge has not been pointed out before,) that
with most women the aivine dejections are much more frequent
and loose when menstruation is about to set in." [London
Lancet.

On the Post-mortem Duration of the Ciliary Movements in the
Human Subject. By M. Gosselin.

The body of a decapitated criminal having been conveyed
to the Ecole Pratique, the ciliary movement was recognised
on the mucous membrane of the trachea, of the nasal fossae,
and on that lining the maxillary, frontal, and sphenoidal sinuses,
8 hours after death. The movements were still distinguisha-
ble, especially on the mucous membrane of the trachea, 32
hours after death. The movement had ceased on the mucous
membrane of the nasal fossae and of the sinuses, 56 hours after
death ; but this was perhaps due to the free exposure of these
parts to the air; for the vibration was still active on the mu-
cous membrane of the trachea, where it was distinctly seen to
the IGSth hour after death, after which putrefaction came on,
and the movement ceased. In another case of the same nature
the ciliary movements were much less durable ; and this seem-
ed to be consequent upon the earlier supervention of putrefac-
tion, brought about by a higher temperature, the thermometer
having ranged from 46 to 54 in the first case, and having risen
to 68 in the second. [Gaz. Medicale, Medico-Chir. Rev.

254 On the Nerves of the Uterus, L^P^i'*

On the Nerves of the Uterus. By M. Boulard.

The author states that his dissections were carried on with-
out any knowledge of the 'Memoirs' of Dr. Robert Lee and
Mr. Snow Beck ; which he only consulted after the termination
of his own inquiries. He states that these have led him, in all
essential particulars, to^concur with the latter anatomist ; and
he particularly affirms that the nerves do not augment during
pregnancy. He has made two comparative preparations of the
uterus of a girl of 12 years old, and of a woman who died near
the end of pregnancy ; and he affirms that there is no differ-
ence in the arrangement of their nerves, except that which
arises from the closeness of the elements of the plexuses in the
first case, and their separation in the second. ^Ibid.

On some of the Histological Characteristics of Malignant
Growths, By Prof. Albers, of Bonn.

1. No form of grow'th other than the malignant consists so
exclusively, even io the acquisition of a large size, in cell-
formation, all non malignant ones containing a great abund-
ance of fibre-formaiions. It may be objected that epithelial
tumours consist of cells, and yet remain innocent. It is to be
observed, however, that such tumours always remain small,
and have not proved so generally innocent as the polypus and
fibroid. Epithelial tumour, too, frequently relapses, and is some-
times as destructive as cancer itself. Among other innocent
tumours, Xhefatti/ especially exhibit cells, but the regular fibrous
network, which is also present, essentially distinguishes them
from all malignant tumours.

2. In innocent growths the cells decrease with the duration
of these, while in malignant ones they increase. At the com-
mencement of the so-called tumours of the cellular tissue,
among the predominant fibres, cells are to be seen, which at
an older date are entirely absent; and the same is observed in
polypus and fibroid. In malignant tumours a great number of
fibres are found at first; but the longer the tumours exist and
the larger they become, the more completely do such fibres
diappear, leaving the cells ^s the sole histological element.

3. Certain peculiarities are observed in these cell-formations,
among which may be mentioned the incomplete formation of
the greater part of the cells, when the tumour is old and large,
and especially in the case of relapsing and secondary forma-'
tions. The cells exhibit either a different form, an unequal
size, or an irregular degree of development. The equal de-
velopment of the structural elements of polypus, fibroid or fatty

1852.] Malignant Growths. 255

tumour, furnishes an entirely different general innpression from
that derived from any kind of malignant tumour.

4. Besides the incompleteness and irregularity of the devel-
opment of cells in malignant growths, they are found in these
to undergo a rapid disintegration, examples of which, though
more frequently met with in the older tumours, are not want-
ing in the younger ones, showing the retrograde changes which
are taking place. The elements proving this, are granules,
granular bodies, and granular cells; and these are to be found
in a greater or less number in every cancerous tumour propor-
tionate to its age. If on the other hand, we consider the regu-
lar and unchanged conditions of the cells in fatty tumours or
polypus, in which scarcely any granular bodies or cells are
found, it becomes certain that the duration of the life of a cell*
is much longer in innocent than in malignant tumours.

5. Malignant tumours are remarkable for the rapidity of
their cell growth. In a few days an entire lung may undergo
tubercular transformation, or a cancerous tumour acquire dou-
ble its size. A relapse may occur in five or six days, and a
few days later may attain enormous dimensions. No innocent
tumour comports itself thus.

6. In malignant swellings we always find a more abundant
juice, which flows out on pressure, and contains some of the
elements of the disease, as the cells, and the same fluid blastema
is obtainable from tubercular lungs. When fluid is pressed
out from a polypus, it contains no cells or fibres, or very few,
while in that obtained from cancer there are numerous cells in
every stage of development. It follows from this, that the
textural connection in the malignant tumor is always looser,
and the proportion of fluid blastema always larger, than in the
innocent ; and that these slightly connected elements are easily
separable, and are incapable of the degree of development ob-
served in the innocent, being, therefore, endowed with a shorter
duration of life than these.

It results from the above observations, that there is less vital
energy and durability in malignant growths, as is shown by
the fewer stages of development they are capable of: and by
the great disposition of the cells to terminate their life, and to
pass into granular bodies and granule-cells This retrograde
course explains the inordinate increase of cells, just as we see an
immense reproductive power in animals placed low down in
the scale. The lower its vital energy sinks, the more rapidly
does the growth increase, so that the second or third relapse
takes on a much larger and more rapid development than did
the original tumor a point well deserving the attention of the
operator, lest, by his interference, he lowers the amount of vital

256 Miscellany, [April,

energy, and hastens death more rapidly than it would have
occurred had the case been left to nature. It is to this diminu-
tion of vital activity, that the peculiar softening of these tumors
is due. Iq the softened mass are found the elements of the
degenerated structure with incompletely formed pus globules ;
and when the vital power is increased, and, as in tubercule,
stationary condition of the disease produced, a more complete
pus formation takes place. [CanstaWs Jahrh, Ibid.

ill i 5 1 1 1 a n J.

A Singular Epidemic. The history of Epidemics is one of the
/nost interesting departments of Medical Literature. Whether studi-
ed by the medical philosopher, the philanthropist, or the theologian, it
furnishes the most fertile themes for observation and speculation. It
has in all ages been made the subject of special research by minds of
the first order. And yet, what do we know of Epidemics ? Nothing
more than the dates of their occurrence and the extent of their rava-
ges ! We are still in total darkness in reference to their cause, and
powerless in our attempts to arrest their progress ! Facts upon facts
have been diligently accumnlated from the Mosaic and Hippocratic
eras to the present time, without yielding the data from which we
may deduce one single law of practical utility to the physician ! We
should not, however, be discouraged, but continue to keep a record of
their manifestations, until, piled like Ossa upon Pelion, they furnish us
the knowledge we need.

Upon returning to our post about the 1st of October last, we
were surprised at tha frequent occurrence of sore fingers among
our employers, and on inquiry found that they were equally com-
mon in the practice of other physicians, and had been so for several
months. In some families nearly every inmate suffered more or less.
Upon a large plantation in this vicinity they were so numerous as
seriously to interfere with working the crop, and to lead to the suspi-
cion that they were designedly induced in order to furnish an excuse
for idleness. We learn from physicians residing at various points
between this city and our northern frontier counties that they also
saw a very unusual number of whitlows during the same period.
The cases commenced in July, and continued to present themselves
until the beginning of November. We are not informed whether
such a state of things existed in the counties south of this.

The disease generally assumed some one or other of the forms of
Paronychia or Whitlow the majority of them being superficial, and

1852.] Miscellany. 257

the smallest number affecting the theca of the tendons and the perios-
teum. Although occurring spontaneously in most instances, the
slightest abrasion or irritation of the finger or hand would terminate
in suppuration rnore or less troublesome Erysipelas complicated
some of the cases, and proved fatal in one of them here.

The season was one of the warmest and dryest ever known in Geor-
gia. The health of the city, and indeed of the whole State, is repre-
sented as having been unusually good. The supervention of cold
weather put a stop to the sore fingers, and the writer has not seenone'
since.

It may perhaps be deemed out of place to dignify so trivial a dis-
ease with the epithet " Epidemic," although its general prevalence
may really constitute it one. Other slight affections are occasionally
seen occurring in this way. We think we have seen the common
Furunculus prevail as an epidemic here several times. The mere
fact that they are not often fatal is no reason for not classing them
with epidemics whenever their prevalence becomes general in a com-
munity.

Our object is now simply to add one more fact to the record ; and
to ask our readers, if they have observed the same in other localities..

Medical College of Georgia. The exercises of the annual Com-
mencement in this institution took place on the 2d day of March,
when the Degree of Doctor of Medicine was conferred upon fifty
gentlemen. A learned address was delivered to the Graduates, by
the Rev. W. G. Connor, and a most appropriate and felicitous Val-
edictory to his class-mates, by Dr. P. C. Winn.

The Dean of the Faculty reported to the Board of Trustees, that
there were in attendance upon the Course of Lectures just concluded
one hundred and fifty-eight students, of whom, there were from Geor-
gia, 128 from Alabama, 19 from South Carolina, 14 from North
Carolina, 1 and from Tennessee, 1.

The following is a list of the Graduates :

FROM GEORGIA.

T. G. Andrews,
C. H. Bass, ..
E. T. Bell, .
J. W. Barber,
E. J. Berrie, -
J, W. Bowdoin,

- Thesis on Dysentery,
" " Foetal Brain,
" " Pleurisy,
" " Intermittent Fever.
" " Croup,
" " Lymphatics,

258

Miscellany,

[April,

R. L. Cummins,

Thesis

on Inflammation,

J. A. Carter, -

.

.

((

" Uterine Cancer,

L. P. Dozier,

.

((

" Erysipelas,

R. E. Fryer, -

.

((

" Scurvy,

J. J. W. Glenn,

_

u

" Cynanch. Trachialis,

R. A. Gowin,

.

((

'.' Croup,

W. J. Holt, .

_

((

" Rheumatism,

N. L. Hudson,

.

((

" Gonorrhcea,

W. T. Jernigan,

-

u

' Signs of Pregnancy,

F. M. Jones, -

.

((

" Remittent Fever,

J. S. Lane,

.

((

" Colo.Rectitis,

T. G. Macon,

-

(<

" Typhoid Fever,

Elijah Mattax,

-

li

" Typhoid Fever,

B. R. Rives, -

.

((

" Professional skill,

William Rhodes,

m

<(

" Menstruation,

W. J. Reeves,

.

((

" Intermittent Fever,

J. FI. Ragan,

.

((

" Pleurisy,

Robert Ragland,

.

((

" Menstruation,

W. R. Ruffin,

-

u

" Syphilis,

E. J. Setzp, -

.

((

" Gonorrhoea,

J. M. Saunders,

.

u

" Typhoid Fever,

J. N. Smith, -

.

u

" Typhoid Fever,

Lawrence Smith,

.

((

" Intermittent Fever,

J. H. Trippe,

.

t(

" Pneumonia,

J. F. Trippe,

((

" Delirium Tremens,

J. R. Tucker,

((

" Scarlatina,

J. S. Wilson,

.

((

" Gastritis,

W. H. Wilson,

.

((

" Tetanus,

Jubal Watts, -

.

((

" Gastritis,

B. A. Ware,

_

((

" Concussion of Brain,

C. R. Walton,

.

<(

<' Infantile Rem. fever,

Z. L. Walters,

.

((

" Apoplexy,

W. T. Wilchar,

-

((

" Inflammation,

J. W. Whitlock,

-

((

" Sub. Nit. Bismuth.

FROM SOUTH CAROLINA.

J. A. Evins,

.

.

Thesis

3 on Typhoid Fever,

R. J. Gilliland,

.

.

((

" Scarlatina,

J. A. Glenn,

.

.

ii

" Cholera,

D. M. Laffitte,

.

.

a

" Aneurism,

R. W. Quarles,

.

.

(I

" Functions of Liver,

R. M. D. Russel,

.

-

ti

" Cholera,

P. C. Wait, ^-

-

-

<(

" Hepatitis.

FROM

ALABAMA.

Alexander Donald,

-

.

Thesis on Electricity,

Christopher Montgomery,

-

n

" Pleurisy,

P. C. Winn,

-

-

ii

" Spinal Irritation,

1852.] Miscellamj. 259

BIBLIOGRAPHICAL.

A complete Treatise on Mididfery ; or the Theory and Practice of
Tokology ; including the diseases of Pregnancy, Laior and the
Puerperal state. By Alf, A. L. M. Velpeau, M. D. Translated
from the French, by Charles D. Meigs, M. D., &c., &c. Fourth
American, with the additions from the last French edition. By VVm.
B. Page, M. D., &;c., &c., with numerous illustrations. Pliiladel-
phia : Lindsay &; Blakiston. 1852.

The work before us is one of three productions of Velpeau's pen,
either of which would alone have made him distinguished among the
medical authors of the age. His Surgipal Anatomy, his Midwifery
and his System of Surgery are all monuments of his erudition and
sound practical sense. The profession in our country should feel
grateful for the zeal manifested by the learned translators, in issuing
this new and fine edition.

A Treatise on the Diseases of the Chest : being a course of Lectures

delivered at the New York Hospital. By John A. Swett, M. D.,

&c., &c. New York : D. Appleton & Co. 1852.

The diseases of the chest have been for many years a favorite study

whh Dr. Swett, whose opportunities as physician to the New York

Hospital and as an extensive practitioner in a community very much

disposed to those affections, must entitle his deductions to great weight.

As an original American work of merit, we cordially welcome it and

wish it a favorable reception.

The Medical Stndent^s Vade Mecum : A compendium of Anatomy,
Physiology, Chemistry, Materia Medica and Pharmacy, Surgery,
Obstetrics, Practice of Medicine, Diseases of the Skin, Poisons, (Sz;c.,
d:c. By Geo. Mendenhall, M. D., d:c., &c. 3d Edition Re-
vised and greatly enlarged. With 224 Engravings, pp. 690.
Philadelphia: Lindsay & Blakiston. 1852.

The nature and object of this work may be inferred from its title
page. Lazy students, fond of the multum in parvo, will here find a
capital work.

Discourses delivered hy appointment, before the Cincinnati Medical
Library Association. By Da>-iel Dr'Ake, M. D. Cincinnati :
Moore & Anderson. 1852.

The subject of the first of these discourses is "Early Physicians,
Scenery and Society of Cincinnati," and that of the second is "The
Origin and Influence of Medical Periodical Literature ; and the bene-
fits of Public Medical Libraries." Like every thing from the pen of
the distinguished writer, these discourses are full of interest, and will
constitute a valuable contribution to the Medical History of the Uni-
ted States.

260 Miscellany.

Outlines of ike arteries : with short Descriptioms, Designed for the
use of Medical Students. By John Neill, A.iVL, M.D., dec, &c.,
2d edition. Philada. : Ed. Barrington & Geo. D. Haswell. 1852.

As a nnere remembrancer of the general distribution of the arterial
system, it may be useful. The plates are, however, very coarse.

Review of Materia Medica, for the use of Students. By John B.
BiDDLE, M. D., formerly Professor of Mat. Med. in the Franklin
Med. College of Philadelphia, &c., &c. With illustrations. Phil-
adelphia : Lindsay & Blakiston. 1852.

A very convenient and well gotten up manual, well aclculated to
aid medical students.

HomoBopathy : an examination of its doctrines and evidences. By
WoRTHiNGTON HooKER, M. D., author of " Physician and Pa-
tient," and " Medical Delusions." New York : Charles Scribner.
1851.

We have always believed that the best way to destroy quackery is
to pay no attention to it. Physicians are never regarded by the com-
munity as ex parte witnesses, and their invectives therefore have no
weight, save to enable the charlatan to cry " persecution." The
work of Dr. Hooker, however, differs vastly from the ordinary tirades
upon the subject. It is a calm and sensible appeal to the common
sense of common intellects of those who need the aid of others to
enable them to see the truth, and to distinguish it from falsehood.
The " Fiske Fund Prize " was awarded it by the Rhode Island Medi-
cal Society, and it will doubtless do much to open the eyes of the
people.

Another Journal Discontinued. The British American Medical
and Physical Journal, published at Montreal, has been discontinued
because subscribers would not pay up as punctually as the publisher
was obliged to do. It is succeeded by the " Canada Medical Journal,"
edited by Drs. Macdonnell and David, to whom we cordially wish a
successful career. ^

Death of Dr. Sidney A. Doane. The ship-fever which has been
prevailing to such an alarming extent among the emigrants daily ar-
riving at New York, has numbered among its victims Dr. S. A.
Doane, the distinguished physician at Quarantine on Staten Island.
Dr. D. was the translator of a number of French medical works.

Medical Society of the State of Georgia. We would remind our
readers that this society will convene at Augtusta on the second Wed-
nesday of the present month (April). A large meeting is expected.

SOUTHERN

IHEDICAL AND SUEGICAL
JOUKML.

Vol. 8.] NEW SERIES. MAY, IS^l. [No. 5,

PART FIRST.

(Driginal (Eommunications*

ARTICLE XIV.

Pathology : its relations to Physiology, as based upon Ahnor^
mal Nutrition being one of a series of Lectures upon
Physiological and Pathological Microscopy, delivered at the
Medical College of Georgia in February last. By W. J.
Burnett, M. D.,. of Boston.

The domain which we have just left, Physiology, is by no
means so widely separated from the one upon which we now
enter, Pathology, as might be supposed from the commonly
received doctrines of medical science. I do not make this re-
mark, however, as applicable to anything but their material
expressions ; for the difference as to essential nature between
truly normal and abnormal phenomena, must, of course, be wide.
But in our conversation with the material world, either natural
or unnatural, we can learn about it only through the interven-
tion of material forms. It is in this way that we have learned
all we truly know in physiology, and it is in this way that we
are now to inquire into Pathology, and if from the minute char-
acter of our inquiries, the expectation is raised that thereby
will be solved the mystery of the intimate nature of disease,
that expectation will certainly remain unfulfilled and disappoint-
ed. In a general way it may be said that pathology is but an
erring physiology. This expresses a great deal that is true of its
nature ; and although, perhaps, not the whole truth, it approxi-

N. S. VOL. VIII. NO. v. 17

262P Burnett, on Pathology. [Mar?.

mates so closely, that it will serve as the basis of our inquiries^
Such a view is well calculated to remove from the mind many
erroneous notions ; one of which, for instance, is that disease is
a self-existing entity, which notion, if well entertained, cannot
but impede our correct interpretation of its phenomena, for we
shall be constantly struggling between a fancy and a fact.
Then, again, the ideas which we have of health and disease
must be relative, since we have no positive data by which the
one can be determined in contradistinction to the other. Our
idea of normal life must be extremely indefinite, and especially
so when the steps of its transition to that which is abnormal,
have not been well made out.

Another question, which arises at the outset, is Does disease
always have a material expression, and that, too, of a corres-
ponding and invariable character ? A negative answer to this
would be deemed by many as quite unphysical, not to say un-
scientific; but in the present state of our knowledge, I must re-
gard it as by far the one most correct, for we are to reason from
what we know, and although analogy is of great service in such
matters, yet we cannot be too careful of its use. We should
very naturally say, that in virtue of the great fact constantly
before us, viz., that vitality has its expression only in organiza-
tion, which is tangible and capable of being analysed, so should
we always have a tangible expression of any perversion of that
vitality. This may be very scientific, but at present it is nega-
tively so only, for there are many transitory morbid changes
of the vital phenomena many morbid conditions, known by the
name of functional, which leave no traces in the matter or organ
in which they occur, at least as far as we can now detect by
the most careful research. Too high an estimate must not there-
fore be placed upon these intimate microscopical studies of
pathological conditions and phenomena. In the first place,
with all the material product at our command which we could
ask, we must expect to know of disease only subjectively ; and
in the second place, we must not be surprised to meet with Jj
many of the best expressed pathological phenomena holding
apparently no corresponding material relations.

If these two points be well borne in mind, much error and
confusion will be avoided.

1852.] Burnett, on Pathology. 263

But let us return to our original proposition : Pathology is
only an erring physiology. We can understand from this why
that the genesis and general laws of pathological cells should be
the same precisely as those of physiology. And I make here this
general statement founded upon a pretty widely extended ob-
servation that, both as to their genesis and general aspect, as
cells, those which belong to abnormal, cannot be distinguished
from those belonging to normal conditions of life. The genetic
and general relations of cells in physiology and pathology are
therefore the same, but the bifurcating point in the road appears
when we begin to inquire about the destiny of each. Physi-
ological cells must always be considered teleologically, that is,
as having relations with a future and determinate result, in the
attaining of which, they fulfil their destiny ; with pathological
cells, however, all these conditions are absent. They exist as
cells in virtue of the previous existence of a formative material,
which must have an organized expression of its forces. This
expression is necessarily a cell, but there it ends, it sustains no
higher and future relation for a definite result.

Abnormal cells, or rather cells produced under abnormal
conditions of life, therefore, are not characterized by any type
or true individuality. I know very well that some, such as
those of pus, tubercle and cancer, have an uniformity of appear-
ance quite remarkable, but I cannot regard this as having any
teleological signification at all, but rather as due to a correspond-
ing uniformity of condition of the abnormal plasma in which
they are found. I do not think that this view at all disparages the
scientific accuracy with which they should be described, for
experience has shown us that this uniformity of abnormal
plasma is so constant, that it may always be counted upon in
our determination of its products. With these considerations,
founded on fact, the distinctions between physiology and patholo-
.gy as based upon cells, are therefore not only broad, but definite
ias far as they go. I may say, farther, that they are the only
distinctions upon which we can at present insist ; remove
them and I can perceive no reason whj- all our pathology
should not at once be resolved into physiology. It may be asked
if this resolution of the two into one is not desirable, as simpli-
fying our ideas of organic life, both normal and abnormal ? I

264 Burnett, on Faihology. [May,.

say no, even were it possible, for it immediately takes away
from the phenomena of organic life their philosophy as mani-
fested in their teleological bearing.

There is one other result which may well be deduced from
the foregoing remarks : it is that all pathological products are
necessarily iTifr a- formations they are below the standard of
those of health, of which they may, or may not, take on some
of the characteristics. Pathological formations may be divided
into two kinds, only; viz: 1st, those which simulate the type
of the healthy tissues, called homeomorphous, and 2d, those
which have characteristics of their own, called heteromorplious.
All abnormal products are necessarily one or the other of these
kinds. It is true that the latter are most important in a practi-
cal point of view, on account of their peculiarity of life, widely
separated as it is from that of normal forms. Such, for in-
stance, are cancer, tubercle and pus. Under the former, on
the other hand, are included all those forms of tissue which are-
abnormal, not so much because they are dissimilar from healthy
forms, but because they w^ant very much their definite charac-
ter as active tissues towards a conservative, economical end in
the economy. They are therefore less severe and more ame-
nable to treatment ; but still, in an histological point of view,
they are not the less worthy of our consideration.

It is difficult to get hold of this subject unless we take it up*
in a particular manner. Pathological products, as material
forms, are superventions in and upon the healthy parts. In a
causative point of view, they are therefore referable to nutri-
tion and its perversions. And 1 shall take up the subject in
this light, even though there is necessarily a blending of physio-
logical and pathological phenomena.

Two conditions mark the existence of the healthy living
tissue these are decay and repair ; the former occurring be-
cause the tissue is living ; the latter because to live it must
preserve its physical identity.

This round of actions constituting the sum total of those
making up the live adult tissue, have their foundation in a func-
tion which we term nutrition. A w^ord to which in later days
we have been inclined to give a more pregnant signification
than in former times ; and this, because it thus embraces in

1852.] Burnett, on Pathology. 265

function, either directly or indirectly, the whole phenomena of
animal life. Many have thought that the relations of repro-
duction, or the origin and rise of the new being, should be
viewed as belonging to another category of actions. But they
have allowed themselves to be deceived by the importance of
these processes ; for we have seen on a preceding page, that
such phenomena are only cellular, and are therefore only those
of nutrition seeking an individuality of expression.

Nutrition, then, being considered as the basis of physiological
science, it will be my object to show that its perversions can
be viewed as the foundation of our rational pathology.

But, that my meaning may be fully comprehended, I will run
over briefly the leading features of this nutrition as a physiolo-
gical function a task which I have hitherto omitted, anticipa-
ting as I did, its consideration more properly in this connection.
This is not a new, but it is a most important physiological
truth, that the blood or its analogue is that from which all the
conditions of nutrition arise. It therefore follows that in it
we should clearly recognise the elements of all these different
tissues. The blood-vessels form a series of channels permea-
ting the tissues, and terminating as it were in a set of vessels,
functionally different from either arteries or veins the capil-
laries which are the dispensers of the nutritive fluid to the
tissues ; and although they cannot be traced minutely into every
tissue or part, yet their function on such tissues is always indi-
>rectly felt.

It is asked how these capillaries are the immediate agents
of this nutritive function. It is by their transuding through
their parietes into the parts through which they pass, the hya-
line plasma of the blood, and which is immediately appropri-
ated by the contiguous tissue, or transferred by endosmosis
through granular or cell-structure, to those more distant. This
hyaline blastema is structureless, but it contains within itself
the elements of structure. It is entirely amorphous, but it
possesses in a latent form all the individualities of the different
tissues. After effusion, it may serve its function as a pure
plasma, by bathing the tissue and filling the vacancies made
by liquids passed away. But this, I think, is not common, and
belongs almost exclusively to the sclerous tissues. It gener-

266 Burnett, on Pathology, [May,

ally gives rise to more solid products. These are utricles
and cells with all their various metamorphoses. The primitive
utricle appears as the first material expression, and in tissues
of a purely utricular character, such as the muscular, the de-
velopment does not extend beyond this point, but as such they
are appropriated. But in tissues having an existing cell-struc-
ture, these utricles pass on to cells, replacing those passing
away. I believe that this hyaline plasma, immediately upon its
effusion, and before the primitive utricles have appeared in it,
is, whatever be its locality, identical in character. The reason
why it has afterwards so many ultimate expressions or devel-
opments, appears to me due to another cause. It is that di-
rectly upon its transudation it receives in coming in contact
with a tissue, the impress or type of that tissue ; so that what-
ever the former may be, the plasma in serving any purpose
follows directly in train of the idea on which the tissue is ex-
pressed.

Let me illustrate this doctrine by referring, for example, to
the epithelial tissue. This, as we have already seen, is composed
of a layer of cells, situated upon, and attached to a basement
membrane. The cells thus attached, whatever be their func-
tion, are constantly passing away, and must be renewed. To
effect this last, a plasma is effused by the contiguous vessels ;
this, as soon as it comes in contact with this tissue, takes on its
epithelial type, and the primitive utricles developed in it, im-
mediately pass on to that ulterior condition of epithelial cells.
Other examples might be cited to shov/in the same way this
beautiful type-form of tissue ; without which the continuity of
structure could not be maintained. The full appreciation of
this idea cannot be two strongly insisted upon, and I will again
express it in a laconic way : A liquid containing the elements
of structure, upon being brought in contact with a living solid,
is immediately impressed with the type-character of the latter,
and therefore must subserve its repair. It is not properly a
selective power of the tissue, but a living act, occurring because
the tissue has an individuality of its own which it can impart.

I wish that I could illustrate this by any reference to common
examples of animal life : but as it is one of those immaterial
acts in physiology, we can appreciate it only by the recogni-
tion of the fact.

1853.] Burnett, on Pathology. 207

I might, perhaps, liken it well to the act of fecundation, in
which a spermatic particle, by simple contact with the ovum,
i-mpresses upon it the full type of the male parent ; and, to carry
the comparison still farther, if the completeness of an individual
can, in this way, be thus stamped upon an ovum ; so, in the
same way in the act of nutrition, may the singleness of a tissue
be stamped upon a hyaline plasma. *

I regard the recognition and application of this type-jjower
of tissues, as one of the happiest results of modern physiology,
not only as illustrative of the higher tone of our present studies
in this direction ; but also, as enabling us to grasp many of the
hitherto hidden forms of function in this science.

On account of its value as the hidden spring of the various
nutritions, let me still farther notice its character.

If it is asked what is this type-power, I should say that its
nature can be best expressed by an imperfect metaphor. It is
the memory of the immaterial idea on which a tissue is devel-
oped, still persistent during its material life. And to carry the
metaphor still farther, this memory may be bright and active,
or may be fast fading away, according to the age of the tissue.

The younger the tissue, the more full and complete is its in-
dividuality and type-power, and if it suffers a lesion in its very
early life, this breach of continuity is thereby so thoroughly
repaired, that ^its physical identity is preserved. This is the
reason w-hy in wounds with very young children, the healing
of them leaves no cicatrix. The type-power extends fully and
completely into the plasma effused for repair, and this repair
therefore has all the character of true interstitial nutrition. As
the individual advances in life, and passes into, or beyond its
adult period, this type-power appears to die out, or at least to
loseome of its strength. This is the reason why at that time
lesions are not perfectly repaired ; the material not taking on
the character of the contiguous tissue, and an adventitious pro-
duct occurring in the pla<:e of the lost part. The same reason
may be assigned for the fact, that tissues having suffered no
lesion, sometimes atrophy, the plasma effused not being appro-
priated, but which, taking on a new character, may give rise to
new and morbid forms.

I might enter more fully into the consideration of this moat

268 Burnett, on Pathology. [May,

interesting subject, and it would afford me much pleasure to
take up its illustration in some of the most delicate tissues in
both man and the lower animals. But at this time, I have
thought proper to sketch only its general character, and which
is to serve as the foundation of considerations of another char-
acter soon to follow.

It is quite necdisary that we should be very familiar with
this great high road of physiology, in order that we may well
know where the hy-road of pathology divides from it.

Thus far, we have seen that two conditions are necessary
for correct and healthy nutrition. These are : 1st, that the
plasma effused shall be healthy, and such as may be lit for ap-
propriation, and 2nd, that the type-power of the tissue to be
nourished, shall be sufficient to make the appropriation. Such
being the requisites of the healthy nutritive process, the per-
version or suspension of one or both of these conditions, gives
rise to what has been justly termed abnormal nutrition a
state of the animal tissues, which we have good reason to be-
lieve is at the very foundation of pathology. To illustrate clear-
ly this point, we will take up separately each division.

I. Perversions of the character of the Plasma. There
appears to be a law of affinity, or congruity of action in tissues,
which must be regarded as a very powerful conservative of
their integrity. By this, I mean, that when the circulatory ves-
sels do not contain the proper elements for the tissues, the
latter do not call for the effusion of their plasmatic liquids or,
to impersonate the matter, as would, perhaps John Hunter, I
should say, that the tissues perceiving the incongruity of the
nutritive fluids, refuse to have them effused ; but still it often
happens that this inappropriate plasma is effused, and then, not
being at all reconcilable to the type of the tissue, yet possessing
a certain vitality of its own, and which perhaps is still further
urged on by the very fact of its being in contact with, a living
tissue, the course which it pursues is wayward and thus we
have heterogeneous pathological products. This perverted or
abnormal plasma varies much as to its capacity, but is always
helow that of health. Its capacity is expressed in the character
of its products ; when quite low, granular and low cell com-

1852.] Burnett, on Pathology. 269

pounds are the result. Such, in fact, diXepiLS and tubercle which
appear to constitute the lowest expressions of a plasmatic for-
mative power. When of a higher character, it gives rise to
the highest pathological products, which often seem to have a
kind of individuality of form and function. A good example
of this is seen in cancer.

The heterogeneous products, then, of pus, tubercle and can-
cer, I have considered as due to perversions of plasma. But,
perhaps, the subject will come home more clearly to the mind,
if I say that inflammatory products may be regarded as due to
this same perversion of plasma. I do not mean to say that
such products can always be traced as the results of inflamma-
tion ; but, as far as yet studied, there appears to be here a con-
nection, at least, assuring us that when we shall know more of
the matter, our most comprehensive idea of inflammation will
include all the conditions under which heterogeneous products
occur. In touching, then, here upon the subject of inflamma-
tion, I shall not be considered as diverging from the main point
of our discourse.

I do not pretend to define inflammation, because I think we
have not yet sufficient data to convey to the mind a clear idea
of its character ; still, if I say that there appears to be coex-
istent with it a want of healthy relation between the bloodves-
sels and the blood, I think I have stated pretty clearly all that
which is really known about the matter; and even then, it is
very far from being certain if their absence of relation is not
the first known effect^ instead of the cause of the inflammatory
process.

It is therefore a waste of time to dwell upon that, the nature
of which we have yet so feeble an appreciation of. We must
take the results as we find them, waiting for the ultimate cause
until we have more data. I have said that the first visible sign
of inflammation is an absence of the healthy relation between
the bloodvessels and their contents : this leads to a partial sus-
pension of the function of both, and also that that function which
does occur is of an abnormal character.

When the otherwise nutritive processes are very active,
scarce any appropriation of this plasma takes place, and the
products arising in it, viz: granules and corpuscles seem so

270 Burnett, on Pathology. [May,

alien to healthy tissues, that they are expelled as foreign sub-
stances ; such is pus in all its forms, and such, I think, there
is reason to believe, is tubercle also. When, however, the
process is less active in its character, the plasma is appropria-
ted to a certain extent, but the tissues thus badly nourished
sink below their normal type, and when these conditions are
kept up for any length of time, they seem to take on a char-
acter of their own. This is often seen as one of the conse-
quences of a previously acute inflammation of an organ, but
especially is it observed in indolent ulcers. It is thus that we
see that the long continued use of a perverted plasma, by a
tissue, serves to modify the type-power of the latter. And,
in speaking of the minute yjathology of some organs, at a future
time, I shall have occasion to enter more fully into the peculi-
arities of these changes and their consequences.

It may be asked how the etiology of cancer can be consid-
ered as belonging to the perversions of the plasma. The re-
ply to this, is, that although eminently a morbid product, it
differs widely from those of which we have just spoken, and
this, in possessing in a high degree, a life of its own. The
plasma in which it takes its origin has a capability not much
below that of health, but still has a character as different as the
results produced. Although passing on to the higher cell-
structure, its inferior character is betrayed by the objectless
iiature of its termination^, for these cells appear to be the ulti-
mate result of a morbid action, rather than the material agents
^through which a higher function is to be performed.

The cancerous structure, however high it may appear in an
Anatomical poi-nt of view, is aimless and without function.

In speaking then of pus, tubercle and cancer, as the results
of a perverted plasma, heteromorphous products, I think I can
fcest express their mutual relations and dissimularities, if I use
a figure, and say that normal nutrition being considered the
^reat high road, those forms of abnormal nutrition producing
pus and tubercle would be considered as small roads diverging
from it at nearly right angles ; whereas, that form producing
cancer would be considered as a much larger road, and diverg-
ing at a smaller angle ; in fact, often afterwards running paral-
lel with it. But all these diverging roads never get backupcui

1852.] Burnett, on Pathology. 271

the main one, and therefore have a termination unlike any thing
of true function.

In concluding this section, the relations which this perverted
plasma holds to inflammation, may be thus briefly stated. We
cannot conceive of this want of harmony between the action
of the capillaries and the constituency of the blood, unless we
suppose at the same time an existing cause. Now, as it is true,
that the more we investigate minutely their conditions, the more
do we find the inflammatory process co-existent, and, as in the
instances of pus and granular forms, the relations of cause and
eflfect can be directly traced, we have a right to infer that the
same is true, even although their relations cannot be fully made
out.

And so, on the whole, we seem to be justified in regarding
inflammation, whatever is its nature, as a condition always pre-
ceding, and in all probability causing this perversion of the
effused plasma, and therefore the immediate cause of patholo-
gical heterogenous products.

II. Perversions of the type-power. We now enter upon
the consideration of quite another class of phenomena. The
vessels being healthy and the blood normal, they cannot be
viewed as being in the same category as those of inflammation
w^e have just considered. I have therefore thought proper to
designate the results of such conditions as the homogeneous non-
inflammatory products : in fact, they are forms, which, while
they are really morbid, partake nevertheless of the type of the
healthy tissue, as far as that condition will allow.

We have just seen how, when the type-power was good and
the plasma bad, the dissimilar results were referable almost
entirely to the plasma. We shall now see that where the in-
verse is true, the results produced have more an affinity with
the tissue, than with the plasma. In one sense, it can scarcely
be called a perversion of type-power, but rather a decrease or
increase; but on the other hand, these words do not express
the whole ; for, besides these variations of amount, there is in-
volved a pathological principle not easily or readily expressed.

Suppose that, from some unknown cause, the type-power of
an epithelial tissue in the body had become changed. The nor-

272 Burnett, on Pathology, L^^^iy,

mal plasma is thrown out as usual, but it is not delicately and
nicely appropriated as in health ; and although the tissue has
given it its impress, yet this is all, for the relations of size and
shape appear to be absent. There therefore appears a new
form, which, while it bears the outward aspect of the healthy
tissue, is an abnormal product ; it is, as it were, the represen-
tation of disease, under the garb of health. This product is
epitheloid, but not epithelial. Such, for instance is the so-called
cancer of the lip, the cancer of the antrum, &c., &c.

In the same category may be considered many, if not all, the
hypertrophies of tissues. Where a product appears with the
general character of health, but with the profligacy of disease.

It is not difficult for us to understand how, in some of these
immense growths, a sufficient amount of plasma is supplied;
for it appears to be a law in the nutrition of tissues, that the
greater the demand the greater the supply ; and, so when the
demand has once been made, even by a morbid product, it is
furnished and the whole may go on increasing, the vessels con-
forming to these changes exactly as though a healthy tissue
was experiencing a rapid normal growth. But, if we thus have
products, from what, in one sense, may be called an increase
of type-power, constituting hypertrophy, there is quite a differ-
ent class arising t>om a decrease^ in fact a suspension of it, and
which ought in this connection be noticed. I cannot say that
it is primitiveJy of tissue-origin, but, at any rate, it seems to be
a dying out of the type-power ; in fact, so thoroughly is this
the case, that the individuality is gone and nothing is appropria-
ted ; and in accordance with the law just mentioned, there
seems ultimately to be scarce any supply ; and then the tissue
loses its physical identity and gradually recedes to its primitive
utricular condition. This condition of things has generally
been considered in the light of an atrophy, but I have thought
that it merited a distinction, and have proposed for it the name
of retrograde metamorphosis. Its leading characteristics may
be thus briefly stated. Bichat's definition of life, as applied to
an individual, was, " the sum total of the functions by which
death is resisted." Now, what applies to an individual, may
be taken as at least applicable to a tissue. Its life consists is
the conservation of those two conditions by which its integrity

1852.] Burnett, 07i Pathologrj, 273

is maintained. These, I have already regarded as involved in
what is called nutrition; the balancing of decay and repair.
Now, whatever function a part may discharge, it is necessary
that it (the function,) should be kept up in order that the nutri-
tion should continue normal ; when, from either an unknown
cause, or from suspension of function, it ceases to have that
even changing vitality, then it seems to lose its type-power, and
the small quantity of effused plasma is feebly appropriatec?, the
vital cohesion of the tissue in part disappears ; so that although
there is strictly no decomposition, yet the individuality of the
part is gone, and with it all those forces that elevated and sus-
tained its character above that of the primitive elements^ We-
have, then, in place of the normal tissue, what is called a granu-
lar mass ; and as such it cannot be called a special product, for
it is alike, whether it occurs in a muscular or a glandular organ.
It consists simply of oil and albumen, uniting in their usual
way. This point, however, will be touched upon at a future
time. I have said that this condition differs from true atrophy ;
for this last can scarcely be regarded as an abnormal state, it
being only a decrease of tissue-function, and which we see daily
exemplified in the muscular tissue. The same is true in an
inverse sense of true hypertrophy ; and which is not, as I have
before said, the cause of homeomorphous products. They are
both rather variations of nutrition, as to quantity, than as to
pervei'sion.

Such is a rapid survey of some of the perversions of nutrF-
lion which lie at the foundation of many of our best views of
pathological changes. It may be asked, if under this head may
be included the causes of all pathological phenomena having
their expression in a material product ? With our present
knowledge, I do not think that the question can be positively
answered. Nevertheless, I think I am safe in saying that the
tendency of the present enquiry is to show that in abnormal
nutrition is to be found the causes of all organic pathological
changes.

These considerations may perhaps serve as the ground-work
of our subject, it being now our task to look into the specific
character of its details. I shall therefore, take up first, the sub-
ject of hetero-morphous products, each in its proper character,

274 Summer, on Typhoid Fever, ^c. [May,

commencing with the lowest. But before this, the phenomena
of inflamation as elucidated by the microscope should be con-
sidered, and this will serve a sa proper prologue for the next
lecture.

ARTICLE XV.

Report of Cases of Typhoid Fever and Typhoid Pneumonia,
treated principally with Veratrum Viride. By W. J. Sum-
mer, M. D., of Lexington, S. C.

Since the publication of Dr. Norwood's articles on veratrum
viride, I have extensively employed it in the treatment of
Typhoid fever and Pneumonia, and with the most gratifying
success. I would, therefore, most cordially adduce my experi-
ence in support of the remedy, as being at once safe and effi-
cient. Before I became acquainted with this valuable agent, I
regarded the treatment of a severe case of typhoid fever with
something like dread, as to its results, but now 1 am less con-
cerned about my cases of this disease, than of other affections
generally deemed more trivial. A brief notice of a few cases
treated with this remedy, will not, I hope, prove unacceptable
to the profession, and will, perhaps, induce others to make
trial of this valuable agent.

Case I. Rebecca, aged 8, daughter of Mr. F. I was called
to see her on the 5th Oct. last. She had been suffering under
the premonitory symptoms of typhoid fever for four or five
days, and the disease was now fully formed. There was head-
ache ; hot, dry skin ; small and frequent pulse ; tongue coated
with a whitish fur, with tip and edges red and rather dry ;
loss of appetite, amounting to a disgust for food. There was
tenderness of the abdomen in the right iliac region, pressure
over which produced the gurgling noise, so characteristic of
this affection no diarrhoea. I prescribed pil. hydrarg. gr. v.,
to be followed, if it did not act on the bowels, by castor oil.
Scarified cups were applied to the abdomen pepper poultices
to be used subsequently. After the bowels were cleared, neu-
tral mixt with a minute quantity of tartar emetic. (I had no
veratfum viride with me.)

1852.] Summer, on Typhoid Fevei\ ^c. 275

Oct. 6th. Called and found my patient in pretty much the
same condition : had two evacuations from the bowels, without
taking oil ; headache somewhat relieved ; abdomen still a little
tender; pulse 130. Discontinued previous treatment, and or-
dered tinct. verat. vir., to be given in doses of three drops every
three hours, and if nausea, emesis, or a reduction of the pulse
did not take place after giving three or four doses, to increase
the dose one drop each time. Pepper mush to be kept con-
stantly applied to the abdomen.

7th. Called eighteen hours afterwards. Patient had vomited
once, a short time previous ; skin cool ; pulse reduced to 80 :
the vomited matters consisted of a quantity of mucus and wa-
tery fluid. The dose of tinct. veratrum had bee increased to
six drops. Directed it to be given in doses of four drops every
four hours. At my visit next day, the patient seemed entirely
free from fever pulse 72, soft and full. Bowels had acted
twice since previous visit, dejections resembled what had been
vomited. The dose was now reduced to three drops, repeated
at intervals of three or four hours and continued for several
days, for fear of a return of the fever, after which it was dis-
continued the patient convalesced rapidly.

Case II. Henry, aged 10, brother to the above. Called 20th
^ct. Found this patient with symptoms very much resembling
the first, though more severe, particularly the headache. The
parents had administered a dose of epsom salts, the bowels
having been constipated. The salts, however, operated drasti-
cally, and diarrhoea was subsequently very obstinate. There
was considerable tenderness in the right iliac region, and
gurgling on pressure. Cups were applied to the temples and
abdomen, followed by poultices to the latter ; hyd. c. creta et
pulv. Dover, in small doses, for the diarrhoea, and the patient
at once put upon the use of tinct. veratrum, in small doses,
gradually increased. Gum- water was the only article of drink
or food allowed.

Oct. 21st. Patient complains less of headache; pulse reduced
from 130 to 84 ; has vomited once or twice without much nau-
sea ; diarrhoea still persistent, yet the discharges are not so
watery. Continue same prescription the veratrum in slightly
diminished quantity.

276 Summer, on Typhoid Fever^ ^c, [May,

22(1. Diarrhoea rather worse, there being frequent watery
discharges, telling rapidly on the strengh of the patient ; tongue
dry and red, but the skin cool, and pulse only 70 ; no nausea.
The family were averse to using the syringe, or I should have
directed opiate enemeta ; as it was, I had recourse to acet.
plumbi combined with pulv. Dover., a dose of which was given
every two hours, veratrum to be continued in small doses.

23d. Patient is better to-day. Bowels have acted but three
or four times in the last twenty-four hours ; tongue less red and
dry ; pulse still about 70, full and soft ; skin cool and moist, no
tenderness of the abdomen, though it is still a little tympanitic.
Continued same treatment.

24th. Better in all respects ; diarrhoea is sufficiently checked;
tongue is becoming moist and clean ; abdomen more natural ;
pulse and skin about natural. Discontinued my visits. Next
day the pulse showing a disposition to rise ; the father called
on me again, and not being well enough to ride, I gave him some
of the tinct. veratrum, of which he gave small doses for a few
days, with the same happy results. Recovery was slow, but
steady and perfect.

Case III. A negro girl, aged 7, the property of Mr. H ^ ,
was called to her on the 6th Dec. She had been ill for more
than a weak previous, and the disease was now fully formed^
and unusually severe. The pulse was feeble and very frequent,
amounting to 140 ; the tongue was quite dry and red ; the abdo-
men tender and very much distended ; diarrhoea, also, was pres-
ent, there being from six to ten discharges daily of a watery
fluid, resembling new cider. She was more or less affected with
delirium, particularly at night. Scarified cups w^ere applied to
the abdomen, followed by poultices ; small doses of acet. plumbi
with Dover's powder were given every two hours, and tinct^
verat. vir., every four hours, commencing with three drops and
increasing one drop at each dose until its ordinary effects were
obtained.

7th. Patient has less fever this morning ; pulse 110; diar-
rhoea almost as bad as ever ; patient rested better through the
night, though there was slight delirium. Ordered in addition
to the lead and Dover's powder, laudanum injections, and ap-
plied a large blister to the abdomen. The veratrum to be con-
tinued in full doses.

1852.] Summer, on Typhoid Fever ^c. 277

8th. No fever to day ; pulse 80, full and soft. Patient this
morning passed about eight ounces of nearly pure blood from
the bowels blister drew well and the abdominal distention is
diminished. Directed acetate lead and opium in large doses,
to be repeated as often as could be well borne veratrum to be
continued in diminished doses.

9th. Patient is much better: no hemorrhage from the bow-
els nor watery stools ; pulse 75 and natural ; tongue is becom-
ing moist and clean. Left off all medicine except veratrum,
which was still to be given in very small doses.

13th. Saw this patient, and she seemed so much improved
that I ceased visiting her directed the owner to watch her for
a day or two, and if she took fever again, to resume the use of
veratrum and send for me.

16th. Was summoned in haste to this patient. She had, a
few hours before, been attacked with severe pain in the lower
part of the abdomen, which rapidly spread over its whole ex-
lent the abdomen was so tender as not to bear the weight of
the bed-clothes without pain. The pulse was a mere thread,
and so frequent as scarcely to be counted; respiration short
and hurried ; stomach very irritable in short, she had all the
symptoms of peritonitis, and caused, undoubtedly, by perfora-
tion of the intestines, allowing the contents to escape into the
cavity of the abdomen.

I attempted the administration of large doses of opium,
hoping that under its influence, in connexion with perfect rest
and the avoidance of all substances internally, which could in
any way disturb the bowels, the system might be supported
until adhesive inflammation might possibly unite the perforated
intestine to the adjacent parts. But such was the irritability
of the stomach, that nothing could be retained, and reluctantly
I had to abandon the case as utterly hopeless. She died 18
hours after the commencement of the symptoms of peritoneal
inflammation.

I regret exceedingly that I had not the privilege or time
to make a post-mortem examination ; yet I am confident that
the disease was in the first place typhoid fever, and that the
fatal termination was due to perforation of the intestines, fol-
lowed by general peritonitis. Equally certain am I, also, that

N. S. VOL. VIII. NO. V. 18

278 Summer, on Typhoid Fever, <^c. L-'^^y*

had not perforation of the intestine occurred, this patient would
have recovered.

Case IY. Mr. S., aged 30, and of dehcate constitution. I
was called to him on the 4th Jan. last he had been in bed for
fjour or five days I found him with the usual symptoms of
typhoid fever, in addition to which he had pain in the left, side,
a distressing cough, and was expectorating the rust-coloured
sputa, as characteristic of pneumonia. On examining his chest,
I detected inflammation involving the lower half of the left
lung, and, seemingly, verging into the second stage, or that of
real hepatization. His tongue was covered with a whitish fur,
with tip and edges red and dry ; bowels acted about twice a
day, without medicine ; abdomen a little full, though nearly
natural ; no appetite whatever. Pulse 128, and without much
strength; respiration hurried and laborious.

He was already much prostrated, so I contented myself with
the abstraction of a couple ounces of blood from the side by
cupping. I at once put him upon the use of tinct. veratrum
viride, in doses of eight drops every three hours, gradually in-
creasing the dose until nausea, vomiting, or a reduction of the
pulse was induced. Not feeling satisfied to trust the life of
my patient to this remedy alone, (I had not used it in such
cases,) I desired to employ, in conjunction with it, an alterative
mercurial course, but no reasoning or pei'suasive power of
mine could induce him to give his consent. He had once been
under the specific influence of mercury, and now declared that
he would take no more of the subtle mineral.

5th. Patient seems in much the same condition, with the
exception of fever. On increasing the veratrum to twelve
drops, slight vomiting, without (as the patient said) nausea,
was produced, and the pulse came down to 90, at which I found
it. Has still some pain in the side, particularly on coughing ;
expectoration free, and redder and less viscid than in sthenic
pneumonia. Applied a blister, 6 by 8 inches, over the inflamed
lung ; directed veratrum to be given, in full doses, until the
pulse was reduced to 70, then diminished one half, and con-
tinued.

6th. Better to-day ; veratrum is well borne, has reduced the
pulse to 68. Respiration slow and easy ; cough less triDuble-

1852.] Summer, on Typhoid Fever, <^c. 279

some, and expectorates freely ; no pain ; blister has drawn
well: tongue tremulous and pointed, but moister; bowels move
about twice daily; abdomen slightly distended. Veratrum to
be continued in doses sufficient to maintain the reduction of the
pulse, and along with it, small and frequent doses of the decoc-
tion of px)lygala senega.

7th. Patient still belter ; feels stronger since taking the sene-
ka. Pulse rather below 70, and strong enough; respiration
good, though, of course, a little hurried. Continue same treat-
ment.

9lh. Patient still improving ; has gained a little more
strength ; takes light nourishment with some relish. Blister
is healing, and the solidified portion of lung is becoming per-
meable to air, though slowly; the cough is better, and expec-
toration diminished and more natural. Still to take small
doses of veratrum, and sulph. quinine grs. ij. thrice daily, as a
tonic.

nth. Called and found patient doing well in every respect,
except that his bowels were much too irritable, there having
been three or four watery discharges in the last twenty-four
hours. Prescribed a combination of acid, sulph. aromat. with
tinct. opii. in sufficient quantities to check the diarrhoea ; the
tr. opium then to be continued, or omitted, as should be neces-
sary ; the acid to be taken freely as a tonic. The patient now
improved, and has recovered without farther treatment.

One or two remarks, and I have done. It will be seen that
I have not depended on veratrum viride alone, in the treat-
ment of the cases in which I was employed, but have called
into requisition other agents of acknowledged therapeutic va-
lue, and, as I believe, with better effect than could be obtained
from its single action. At the same time, I am confident that
without the use of this extraordinary medicine, I should, within
the last few months, have lost many patients by typhoid fever
and pneumonia indeed, since I have learned its valuable pro-
perties, I would not know how to dispense with it. About a
year ago I had a case of typhoid pneumonia, similar to the one
above stated, which, in spite of my best directed efforts, ran on
to a fatal termination. Had I, at that time, been acquainted
with the properties of this invaluable medicine, I have not a

280 Remarks upon Mrs, Willards Theory, ^c. [May^

doubt but I could have saved this patient. Something was
wanted to control the excited circulation, which was beyond
my reach. Although it is not the only medicine to be depend-
ed on, it is certainly the chief one. I have used the remedy in
at least a dozen cases of pneumonia, after depletion, when that
was indicated, and with a success beyond any thing I 'ever an-
ticipated. With the exception of the case reported in this
communication, (Case iii.,) I have not lost a case in which I
have used the remedy. In a general way, I have not found the
medicine act harshly or disagreeably, it is true, it sometimes
makes the patient deathly sick, but its unpleasant effects are
easily obviated, and after the system is fully under its influence,
its unpleasant effects usually soon pass off It is applicable to
many diseases, but is particularly suited to pneumonia. By
reducing the circulation, it very materially lessens the amount
of labour thrown upon the lungs, a circumstance greatly to be
desired, when we remember that well established principle
an inflamed organ must have rest. I have found it to possess
all the powers and properties ascribed to it by Dr. Norwood,^
yet I have usually found it necessary to continue it a day or
two longer than he directs. I use the saturated tincture of
the root.

ARTICLE XVI.

Remarks upon Mrs. Willarcfs Theory of the Motion of the
Bloody and Dr. Cartwrighfs Experiments. By Wm. T.
Grant, M. D., of Culloden, Ga.

We feel considerable embarrassment in writing an essay on
a theory advocated by so celebrated a member of the Medical
profession as Dr. Cartwright ; but, as we are writing for infor-
mation, we think we may dismiss this without more ado.

Dr. Cartv/right establishes his theory of the motion of the
blood, by ocular demonstration, in the form of experiments on
the alligator. In reply to this, we would cite an animal, that be-
longs to the same class as the alligator, and also to the same
order, by which we can prove the very opposite to that which
lie has so satisfactorily proved by his experiments on the alii-

1852.] Remarks upon Mrs. Willards Theory, ^c. 281

gator. The animal to which we refer, is the frog. It is a
Physiological fact in natural history, that in the frog, the circu-
lation is carried on, without any assistance from the air ; when
the animal is in the dormant state. Now, as said above, the
alligator and frog are animals, both of which belong to the class
called Amphibia ; so then, everything being equal on this point,
in these two animals, the argument deduced from experiments
on the frog, performed by Naturalists long ago, serves us to
counterbalance that drawn from experiments performed on the
alligator by Dr. Cartwright, and as they are equal, it is neces-
sary for the advocates of his theory to advance others in its
support.

But, then, there are objections to his theory, some of which it
is our object to bring forward ; and we will first lay down a
premise, viz : if the theory be true, it is consistent wath every
anatomical and other truth with which it has any connection,
and furthermore it harmonizes with every fact that is a fact, by
w'hich it is surrounded.

In the first place, then, " like causes will produce like effects,'*
under any circumstances, at any time, and in any place. Now,
to apply this to the point in question : it means, that as the
motion of the blood is produced by the action of the air on the
blood, under certain circumstances, it ought, c ceteris paribus^
to do the same in certain other circumstances. Or, in other
words, if the air acting on the blood, which is the cause, pro-
duce the motion of that blood, which is the effect, under certain
circumstances, then the same cause must produce the same ef-
fects under other circumstances. If then this cause produce
this effect in a living man, ought not the blood to flow in the dead
man, if artificial respiration keeps the air acting on the blood,
from the moment that natural breathing ceases ? And cannot
the system, in the same way, be made to perform all the func-
tions natural to it, in the dead as w'ell as the living man; the
warmth of the body be kept up : the different organs secrete the
juices peculiar to them and indeed, everything that is not de-
pendent on the will, be carried on as well after as before death ?
This new theory would answer these questions in the affirma-
itive, but it is useless to say that reason proves the fact, that
such is not, cannot, and will not be the case. So then the theo-
ry is inconsistent here.

282 Remarks upon Mrs. WillarcTs Theory, <^c. [May,

The second objection is axiomatic : if, in any case, the cause
ceases to act, then the effect is no longer produced ; but, if the
effect ceases, it does not follow that the cause must likewise
cease. Now, to apply: If the action of the air on the blood, the
cause, ceases, then must the motion of the blood, the effect, also
cease, which is not always true, as is proved by reference to
several of the lower animals. This latter opinion, was held as
Dr. Cartwright says, by Bichat. So, then, the theory is incon-
sistent here.

The third objection may be embraced in the following words :
*' This theory mistakes the effect for the cause." Now, to prove
this. " When the chest expands, the lungs follow, and conse-
quently a vacuum is produced in their air-cells. The air then
rushes through the nose and mouth into the trachea and its
branches, and fills the vacuum as fast as it is made.* And when
the chest is contracted, the air is expelled from the lungs. This
then is breathing. Now, then, whatever causes this alternate
contraction and expansion of the diaphragm and chest, must
be the prime cause of breathing. The blood does this, there-
fore it is the cause of breathing ; and we can prove that the
blood does do it. All the muscles are divided into two sets
the voluntary and involuntary ; the involuntary muscles act in-
dependent of the will ; and their action must have a cause, and
this cause must be inherent, or dependent on something external
to the muscle. It cannot be inherent, for in that case, if one
of these muscles be taken out of the body, it must move about
in consequence of its inherent principle of action. Therefore,
it must depend upon something in connection with the muscle ;
now then, when this is taken in connection with the fact that
the power of the muscles is greatly exhausted by a copious
depletion, it proves beyond a doubt that the blood produces the
action of the involuntary muscles ; therefore, we come to the
conclusion that respiration is the effect and not the cause of j
the motion of the blood. It is not necessary to explain how thes
blood produces the action of these muscles, but it can be done^
in a few words : it acts as a vivifying and stimulating principle]
in all parts of the system and especially on the muscular fibre.]
So then the theory is inconsistent here.
Cutter on Respiration.

1852.] Healthij and Morhid Menstruation. 283

As it seems that some of the profession are dissatisfied with
the oid explanation of the motion of the blood, and as new
theories are advanced on almost every subject, we think it
could not be considered presumption in us, if we were to ad-
vance a new theory ; and we embrace this as being a good
opportunity, more especially as it is on the very question that
we have been discussing. Our theory of the motion of the
blood is simply this : the motion of the blood is caused by
galvanism, the heart, arteries, veins, and capillary vessels act-
ing as a battery, one pole of which is situated in the heart, and
the other in the capillaries. This is only our opinion, and as
such we advance it in the form of a theory, hoping that those
who have more advantages than we, may put it to the test and
sift it well. We have reasons for entertaining this opinion, but
think it unnecessary to give them to the public at present.
We think with this theory of the motion of the blood, a great
many things that are now considered as inexplicable, can be
easily explained ; the why and wherefore of the different secre-
tions, &c., we think could be explained on this principle.

PART II.
clEttu UDeparttntnt

On Healthy and Morhid Menstruation. By J. Henry Ben-
nett, M. D., late Physician-Accoucheur to the Western
. General Dispensary, etc.

The Physiology of Menstruation; Dysmenorrhosa ; Menor-
rhagia ; Amenorrhoea. The function of menstruation has been
much elucidated during the last ten years by the labours of the
numerous physiologists who have investigated the phenomena of
generation,amongst whom stand prominent, Pouchet, Gendrin,
Negrier, Barry, Wharton, Jones, BishofF, Raciborski, &c. I
would, however, more especially, refer to the elaborate work on
" Spontaneous Ovulation," by M. Pouchet,*' in which will be
found a full and complete account of his own important re-
searches, as also of those of nearly all the ancient and modern
writers on the subject. To M. Pouchet, whose life appears to
have been partly devoted to the study of this interesting and

* Theorie Positive de I'Ovulation Spontanee, par F, A. Pouchet, Professor
of Zoology to the Museum of Natural History of Rouen, Paris : Bailliere. 1847,

284 Healthy and Morbid Menstruation. [May,

important physiological point, belongs the credit of having been
one of the first to broach the doctrine of spontaneous ovulation
as a law in the females of all mammiferse, and also of having
established this law in the most irrefutable manner by numerous
experiments, and by a close and powerful analysis of all that had
been done by his fellow-labourers in this field of observation.

The researches to which I refer prove, in the most satisfac-
tory and conclusive manner, that menstruation is intimately
connected with the evolution from the ovary of matured ova,
which takes placa periodically in the virgin as well as in the
married female. In the human female the maturation and
evolution of ova occur at frequent intervals, and are marked by
the exudation from the uterine cavity of a greater or less quan-
tity of blood. In the lower animals, the interval is generally
longer, and the menstrual phenomena are less marked, consist-
ing merely in congestion of the sexual organs, accompanied by
the exudation of mucus, mingled with a few blood-corpuscles.
But in both, the phenomenon is the same ; in both, nature
directs a tide of blood to the uterine organs, as the ova con-
tained in the ovary arrive at maturity, in order that the uterus
may be in a fit state to receive and nourish them should they be
fecundated after their emission from the Graafian vesicle.

A decided physiological connexion exists between the difl^er-
ent organs which constitute the sexual apparatus in the female
viz : the ovaries, the uterus, the external sexual parts, and
the breasts. All are dormant as it were, until the advent of
puberty, the great and essential characteristic of which is the
developement of the Graafian vesicles or ova. Previously
deeply imbedded in the tissue of "the ovaries, small, and rudi-
mentary, as puberty approaches, some of their number begin
to enlarge, and gradually to approach the surface. The instal-
lation of puberty and the first menstrual show coincide, and
are evidently connected with the arrival of one or more of
these vesicles at the full period of development. A few red
streaks formed by capillary vessels are first observed on the
surface of the Graafian vesicles, which protrude from the sur-
face of the ovaries. These capillaries gradually increase in
number and intensity of colour, giving the membrane on w^hich
they ramify the appearance of being the seat of acute inflam-
mation, until at last, in the centre of the vascularized surface, an
opening shows itself, the result of a tear or rent, or of absorptive
inflammation ; the ovule is expelled, and having been grasped
by the fringed extremity of the Fallopian tube, passes down its
canal, to be lost, no doubt, in the uterus, if not fecundated.

According to M. Pouchet, the opening of the Graafian vesi-
cle and the evolution of the ovule take place either at the epoch

1852.] Healthy and Morhid Menstruation. 285

that menstruation ceases, or one or two days later. If this
view be correct, the progressive vascularization of the proper
membrane of the ovum or Graafian vesicle would coincide
with, and to a certain extent occasion, the uterine congestion
that precedes and accompanies menstruation ; as also the sym-
pathetic irritation and swelling of the breasts which so frequent-
ly precede and accompany the menstrual flux.

I have qualified the above statement by the words " to a cer-
tain extent," because it appears to me that the uterus is not
merel}^ a passive organ, receiving and responding only to im-
pressions originating in ovarian phenomena, but that it exercises
a marked influence over their development. Thus we find
that its diseases very frequently arrest and modify in various
ways the function of menstruation, and also diminish and anni-
hilate sexual feelings and appetites. We may therefore fairly
presume that they exercise the same unfavorable influence over
the maturation and evolution of the ova. In other words the
attentive consideration of the reciprocal influence of the uterus
and of the ovaries on each other in disease, must lead all impar-
tial observers to the conclusion that in health they constitute
one system of organs, the integrity of which in its component
parts is necessary for the normal accomplishment of the func-
tions of ovulation and menstruation.

The above, I am firmly convinced, is the only true and
rational view that can be taken of the uterine system both in
health and in disease. To attribute both the healthy and the
morbid conditions of menstruation all but exclusively to ovarian
influence, as has been done by some pathologists, is to take
much too narrow a view of uterine pathology, and is as far
from the truth as would be the negation of all ovarian influence
on uterine phenomena. The ovaries, it is true, preside over the
function of menstruation, as we have seen, but the uterus cannot
certainly be considered a "mere reservoir" or bladder, destined
only to receive and nourish the ovum after impregnation.

The more accurate knowledge which we now possess of the
cause, seat, and mode of manifestation of the menstrual func-
tion, tends greatly to corroborate the view at which I have
long arrived from clinical experience, respecting irregular or
morbid menstruation, viz : that it is nearly always, when strong-
ly marked and inveterate, the result of positive disease of some
portion of the uterine system, and, generally speaking, of the
uterus. That such is the case must be admitted as probable,
when we consider that the function, although presided over by
the ovaries, is accomplished by the uterus, which contains an
extensive mucous surface. Those who have hitherto written
professionally on menstruation are, however, so totally unaware

286 Healthy and Morhid Menstruation. [May,

of this important fact, that their works, even the' most recent,
are replete with cases the true nature of which they do not
even suspect cases in which it is most evident to me that men-
struation was modified by positive disease, but which they view
as physiological, or as the result of constitutional causes. In
the present essay, I shall endeavor to point out tlie data by
which mei'e physiological modifications in the menstrual func-
tion may be distinguished from modifications the result of
actual disease. Although a difficult task, I hope to be able to
accomplish it satisfactorily by bringing to bear on the question,
the facts respecting uterine disease which I have developed at
length in my work on Uterine Inflammation. I must first, how-
ever, be allowed to enter into a few details respecting the mode
of manifestation of the menstrual function in the normal state.

From what precedes, it is evident that the term menstrua-
tion ought in reality to be applied to the totality of the condi-
tions that co-exist with the maturation and evolution of ovarian
vesicles. Until recently, however, the exudation of blood from
the uterine organs in the human female, the all but invariable
concomitant of this periodical function, having been alone ob-
served, it has been to it only that the term menstruation has
been given. The necessary connexion between the ovarian
and uterine phenomena having only been discovered and estab-
lished of late years, it is not surprising that the meaning of the
word menstruation should have been thus limited. Henceforth,
however, it will have to be taken theoretically in its more ex-
tended and truer sense, although, practically, we may still be
obliged to limit the term menstruation to the uterine element,
or the exudation of blood, as it is the ostensible indication and
evidence of the changes that are taking place in the ovaries.

It is now universally admitted that the menstrual secretion
takes plaee from the mucous membrane lining the uterine cavi-
ty. For one or two days before it commences, in the healthy
uterus, a tide of blood sets in towards the uterine organs ; and
if the cervix uteri is then brought into view, its mucous surface
is found greatly congested, and of a livid hue. When the se-
cretion has commenced, the blood may be seen to ooze gutta-
iim from the os uteri. After it has ceased, the tide of blood
gradually recedes, and in the course of one, two, or three days,
the uterus is restored to its normal condition, the cervix assum-
ing its naturally pale, rosy hue. If the uterus is the seat of
disease, the flux to it begins earlier often a week before.
After menstruation has ceased, there is also, in disease, a great
tendency to the perpetuation of the menstrual congestion, the
uterus frequently not appearing to have the power to expel the
menstrual blood.

1852.] Healthy and Morbid Menstruation. 287

Menstruation in the human female oscillates physologically
between great extremes, or, in other words, it -may vary to an
extreme extent in its mode of manifestation, and yet these va-
riations may be compatible with health, and with the perfect
integrity of the uterine organs. Indeed, there is not a greater
difference between the human female and the female of the
lower mammiferse, in which the menstrual function only shows
its presence by a congested state of the genital organs and a
slight mucous secretion, than there is between different females.
Thus, for instance, in some, the menstrual flux only shows it-
self for a day or two, or even for a few hours, throughout life,
and is very scanty ; whereas, in others, it lasts seven or eight
days, and is always so profuse as to be all but haemorrhagic.

The physiological variations of menstruation may be referred
to its epoch of first manifestation, to its duration, to the quan-
tity of blood lost, to the amount of pain experienced, and to the
periodicity of its return.

The epoch at which menstruation first sets in, is very varia-
ble, but may be said to range between eleven and nineteen or
twenty, the cases in which it occurs before or after these ages
being rare. The medium age, in temperate climates, accord-
ing to Raciborski, who deduced it from the analysis of a large
number of cases, is about fourteen a statement which my own
experience completely corroborates. There are cases on re-
cord, in which menstruation has set in as early even as the
third or fourth year, but they can merely be considered freaks
of nature. Climate was formerly considered to exercise great
influence over the epoch at which menstruation appears, but
this influence appears to have been greatly exaggerated. So
far from cold greatly retarding, and heat greatly accelerating,
its appearance, it would appear, from the valuable researches
of Dr. Roberton,* of Manchester, that the medium age is
pretty nearly the same all over the world. Raciborski finds a
difference in the medium age of the cases he investigated for
the north and south of Fance, but that difference only amounts
to a few months, and would require to be deduced from a larger
number of persons, to be definitely accepted. Menstruation
generally ceases between forty-five and fifty, but the menopause
may occur much earlier or much later.

The duration of the menstrual flux, and the quantity of blood
lost, vary very considerably in different females. The average
duration may be said to be about four or five days, but many
are only unwell two or three, and with many again, it lasts six
or seven. When menstruation is of short duration, the loss
of blood is generally scanty, whereas it is greater when it lasts

Essays and Xotes on the Physiology and Diseases of Women. 1851.

288 Healthy and Morhid Menstruation. L^^y,

a long period ; not only on account of its longer duration, but
also because it generally flows more freely. The influence of
climate in this respect also appears to have been much exag-
gerated. The fact of menstruation being constitutionally of
long duration and profuse, I have found to be a powerfuly pre-
disposing cause of uterine inflammation, owing probably to the
intensity of the mollimen haemorrhagicum, and to the length of
time during which it persists, during which the patient is exposed
to many perturbing causes. The intensity of the physiologi-
cal congestion is evidenced by the fact, that for one, two, or
three days before and after menstruation these females often
have a slight white or leucorrhoeal discharge, even when in per-
fect health.

With many females the first manifestation of the menses is
unaccompanied by pain. The menstrual flux makes its appear-
ance with scarcely any previous admonition of its advent, and
continues to appear without pain or uneasiness ; or if pain is
present, it is slight and limited to the first few hours. This is
the most favourable mode in which the menstrual function can
take place, and the one which affords the greatest guarantee of
future immunity from inflammatory disease. It is, however, by
no means the rule ; with many women, the first advent and the
subsequent appearance of the menses, are attended, physiologi-
cally, throughout life, with great uterine pain. With some the
pain is limited to the first fevv hours, with others it exists for a
shorter or longer period before, and lasts throughout, the period.

The periodicity of menstruation also varies physiologically
to a great extent. I have found that four weeks or twenty-eight
days, the lunar month, is the most general term ; but the periodi-
cal return of the menses may take place at any time between
the third and the fifth. Most authors allow even a greater
latitude ; but I believe that the constant return of the menses
at an earlier or later period will nearly always be found, on a
careful inquiry, to be a pathological symptom, and to be con-
nected with local disease.

From what precedes, it will be perceived that the physiolo-
gical variations of menstruation variations quite compatible
with health are so numerous and so great, that it is impossible
to lay down any standard by which the integrity of the func-
tion can be generally tested. The above fact would much
diminish the importance of the changes that occur in the men-
strual function in disease, as an element of diagnosis, were it
not that this irregularity is not observed, physiologically, in
each individual case. In other words, every female has her
own individual standard, to which she generally remains true
throughout her life, unles the uterine organs be the seat of dis-

1852.] Irritable Uterus. 289

ease, or the general health be deeply modified by some other
cause. Once, therefore, we have ascertained the mode in
which menstruation occurs in any particular female, at an epoch
when it may be fairly presumed that she was in good uterine
Jiealth, w^are authorized to surmise the presence of uterine or
ovarian disease and, generally speaking, the former if any
marked and permanent change takes place.

It is the ignorance of this important fact that has filled with
errors, as I have already stated, all existing treatises on men-
struation, at nearly every page of which are narrated, as
physiological,. cases which I at once recognise as most decided-
ly pathological. This circumstance, therefore, must greatly
invalidate the value of the conclusions at which these authors
have arrived, whether statistical or otherwise, with respect to
the physiology of menstruation. [London Lancet.
[To be Continued.]

On Irritable Uterus. By F. W. Mackenzie, M. D.

The term Irritable Uterus is applied to a painful condition of
the organ, not caused by displacement, inflammation, or appre-
ciable organic disease. It is met with in various degrees of
intensity, from slight uneasiness to excruciating suffering. Al-
though apparently a simple lesion of innervation, it is found to
be a very obstinate disorder.

The slighter forms of the disorder are characterized by pain
in the uterine region, increased by standing or walking, and
relieved by lying down. The pain radiates from the uterus
to the groins, loins and hips. A sensation of bearing down is
often complained of, and there is leucorrhoea or dysmenor-
rhcea. On examination, the uterus is found to be excessively
sensitive to the touch, but not displaced, or sensibly diseased.
The general health is generally feeble, the circulation languid,
and the digestive organs are generally in a faulty condition.
The patient will often be found to have suffered from severe
mental affliction, or has undergone physical privation and fa-
tigue, and that, as a consequence, spinal irritation and ansemia
have resulted.

The more severe form of this disease has been very graphi-
cally described by Dr. Gooch. He remarks that a patient,
suffering from irritable uterus, complains of pain in the lowest
part of the abdomen along the brim of the pelvis, and often also
in the loins. The pain is worse when she is up and taking
exercise, and less when she is at rest in the horizontal posture.
If the uterus is examined, it is found to be exquisitely tender.
As soon as the finger reaches, and is pressed" against, the uterus.

290 Irritable Uterus, [May,

it gives exquisite pain ; this tenderness, however, varies, at dif-
ferent times, according to the degree of pain which has been
latterly experienced. The neck and body of the uterus feel
slightly swollen ; but this condition also exists in different de-
grees ; sometimes being sufficiently manifest, sometimes scarce-
ly or not at all perceptible. Excepting, however, tfiis tender-
ness, and the occasional swelling, or rather tension, the uterus
feels perfectly natural in structure. There is no evidence of
scirrhus in the neck ; the orifice is not misshapen, nor are its
edges indurated. The circulation is but little disturbed ; the
pulse is soft, and not much quicker than is nat.ural, but it is
easily quickened by the slightest emotion. In a few instances,
however there has been a greater and more permanent excite-
ment of the general circulation. The degree in which the
health has been reduced has been different in different cases.
A patient who was originally delicate, who had suffered long,
and has used much depletory treatment, has been, as might
reasonably be expected, the most reduced. She has grown
thin, pale, weak, and nervous. Menstruation often continues
regular, but sometimes diminishes or ceases altogether. The
functions of the stomach and bowels are not more interrupted
than might be expected from the loss of air and exercise ; the
appetite is not good, and the bowels require aperients ; yet
nothing more surely occasions a paroxysm of pain than an ac-
tive purgative. Such are the leading symptoms of this distress-
ing complaint. To embody them in one view, let the reader
imagine to himself a young or middle-aged woman, somewhat
reduced in flesh and health, almost living on her sofa for
months or even, years, suffering from a constant pain in the
uterus, which renders her unable to sit up, or to take exercise ;
the uterus, on examination, unchanged in structure, but exquis-
itely tender, even in the recumbent posture ; always in pain,
but more or less frequently subject to great aggravations.

With regard to the pathology of these cases. Dr. Gooch ob-
serves, that the causes, to which this disease has been attributed,
are generally considerable bodily exertion at times when the
uterus is in a susceptible state ; but he remarks, that the pa-
tients had previously manifested signs of a predisposition to it.
They, were all sensitive in body and mind, and many of them
had previously been subject to painful menstruation. As to
its proximate nature, he is satisfied by stating that it consists
in a morbid condition of the uterine nerves, attended by pain,
and sometimes vascular fulness ; and he likens it to the irrita-
ble breast, the irritable testis, and the painful condition of the
joints which is sometimes met with in hysterical females. He
does not venture to explain its pathology any farther.

1852.] Irriiahle Uterus. 291

A consideration of the cases of this disease which have come
under my notice, appears to me to justify the following conclu-
sions :

First. That, in the majority of instances, irritable uterus is
rather a sympathetic than an idiopathic disease of that organ.

Secondly. That it is sympathetic of irritative disorder of
various organs with which the uterus Jias intimate relations,
the irritation of which is reflected, either partially or entirely,
upon the uterine ganglia and nerves.

Thirdly. That whilst such reflected irritation is its immedi-
ate cause, it is remotely dependent upon a defective condition
of the blood, which would appear to operate by producing a
morbidly irritable state of the nervous system generally, and
of the uterine ganglia and nerves in particular.

[These propositions are supported by the detail of nine well
selected cases, upon which Dr. Mackenzie makes the following
general observations:]

Cpon a general review of the preceding cases, the first infer-
ence I would venture to draw from them is, that they are
aflirmative of the truth of the propositions which were ad-
vanced at the commeneement of this paper. In all, the uterine
afllection appeared to be consecutive to, or sympathetic of, con-
stitutional derangement or irritative disorder of other organs.
In none could it be regarded as dependent upon idiopathic dis-
ease of the uterus ; and additional corroboration is derived
from the fact, that it disappeared, in most instances, under the
influence of treatment of a general rather than of a specific
character.

Another inference which may be drawn from them is, that
the influence of gastro-intestinal disorder and spinal irritation
are very considerable in the causation of uterine derangements.
In the majority of the cases reported, these co-existed, and
would seem to have had a similarity of origin. In all, they
were associated with ansemin, and had been preceded by much
mental anxiety. How much, therefore, is due to each in the
production af the uterine symptoms in these cases, it is impos-
sible to say. Many circumstances, however, which have come
to my knowledge, lead me to believe that derangements of the
uterus, involving more particularly its nutritive and secretory
functions, such as leucorrhcea and disorders of menstruation,
have rather a gastro-intestinal origin when sympathetically
induced; whilst those which afl^ect more particularly its senso-
ry functions, producing neuralgia and various irritable condi-
tions, are, for the most part, connected with an irritable or
morbid condition of the spinal cord.

But it is not contended, that hysteralgia is in all casfes neces-

292 Irritable Uterus. [May,

sarily connected with spinal irritation, or gastro-intestinal
disorder. I believe them to be very frequent causes, but I
have met with instances in which it existed irrespectively of
either. In gouty and rheumatic subjects, considerable uterine
pain, more or less of a persistent character, is often met with,
doubtless of a gouty or rheumatic nature; and I believe that
severe irritation of any important organ or nerve may, under
certain circumstances, be reflected upon the uterus, so as to
give rise to very distressing symptoms.

[In further illustration of the pathology of these affections,
the author has made the following analysis of thirty-seven
cases, in which the uterus was in a morbidly irritable state, not
in consequence of displacement or appreciable disease. In all
there was marked pain and uneasiness in the region of the
uterus, which varied in intensity in diflferent instances, and in
some had been of long continuance :]

1. Uterine Complications were observed in the following proportions :
In 3 there was no other uterine disease.

" 15 the pain was complicated with leucorrhoea.

** 7 " " leucorrhoea and dysmenorrhcEa.

' 3 " " leucorrhoea and amenorrhoea.

" 1 " " leucorrhoea and menorrhagia.

" 4 " " leucorrhoea and irregular menstruation.

" 4 " " dysmenorrhoea alone.

" 2 " " menorrhagia.

" 1 " " fibrous enlargement of the neck of uterus.

2. Antecedents. The irritable state of the uterus had been preceded:

In 4 cases, by weakening discharges, such as profuse hemorrhage, and pro-
tracted suckling.
'* 5 " mental anxiety and distress.

" 8 " mental anxiety, with disorder of the digestive organs.

" 2 " sudden fright.

"18 " disorder of the digestive organs.

3. Concomitant Affections :

In 18 there was well-marked anaemia, with disorder of the stomach and diges-
tive organs.
"12 " anaemia, wiih spinal irritation. .

" 3 " spinal irritation.

" 4 " great irritability of stomach and digestive organs.

[The facts contained in the foregoing analysis appear, to the
author, to justify the following conclusions :]

First. That, from the operation of the same causes, various
and dissimilar uterine diseases may be occasioned. Thus the
principal antecedent circutnstances in these cases were^ for the
most part, the same, and yet very different disorders were the
consequence. In some, there was simply a painful condition
of the uterus ; in others, this co-existed With leucorrhoea, amen-
orrhoea, dysmenorrhoea, menorrhagia, &c. The probable ex-
planation of this is, that the operation of the different causes in
question is primarily upon the nerves of the uterus, and that

1852.] Pelvic Abscesses. 293

irregular actions, in regard to these, precede and give rise to
those particular symptoms, which, in the aggregate, constitute
disease as known by a given appellation.

Secondly. That, all these lesions may arise from constitu-
tional disorder, may be perpetuated by it, and in many instances
will cease on its removal. In these cases the chief circum-
stances which had preceded were either of an enervating or
depressing nature ; such as loss of blood, over-suckling, &c., or
mental depression or uneasiness. The obvious effect of these
would be to lower the tone of the nervous system generally,
and to render it morbidly susceptible to impression. Thus it
W'ould happen in regard to the uterine ganglia and nerves, that
they would be prone to irregular actions, and to participate
readily in the morbid affections and conditions of other organs.
If, again, the impressions leading to such abnormal actions are
received from or through the medium of the ganglionic system
of the nerves, it is reasonable to suppose that the functions to
which these are more immediately subservient, such as nutri-
tion and secretion, would be more particularly disturbed, whilst
^ose received from or through the medium of the cerebro-
spinal system would rather give rise to painful and uneasy
feelings ; and thus may arise the difference in the uterine de-
rangement, which is consecutive to chylopoietic disorder and
spinal irritation. ^London Journal of Medicine.

Some Practical Observations on Pelvic Abscesses. By Fleet-
wood Churchill, M. D., Fellow of the King and Queen's
College of Physicians, Ireland, &c., &c.

The peculiar disease, then, to which I would very briefly
call your attention, is that phiegmonoid inflammation, which,
by some, is termed pelvic abscess, and by others inflammation
and abscess of the uterine appendages, according as the attempt
is made to be more or less explicit. Of the nature of the dis-
ease, there is n difference of opinion among modern writers;
the older ones, indeed, regarded it as a metastasis of the milk,
and termed it " milk abscess."

I have no doubt that the attack is much more common than
is even yet believed, although the attention of the profession
has been latterly a good deal directed to the subject by writers
in Dublin, London, Edinburgh and France. Within two
months this year, for example, I was called to three such cases.

We find this local inflammation occurring under very difTer-
ent circumstances, some of which we should hardly have anti-
cipated.

N. S. VOL. VIII. NO. v. 19

294 Pelvic Abscesses. l^^Yf

1. It may occur, not only unconnected with parturition, but
in unmarried persons at different ages, and independent of all
the ordinary irritants of these organs. A case occurred in
the person of one of the nurses at the Meath Hospital, a
single woman, about 50 years of age, and without apparent
cause. It exhibited the usual symptoms which I shall notice
by and by, and ran the usual course, softening and opening into
the rectum, after which the patient recovered.

2. I have seen several cases of the disease in married women
who never had had children ; in two instances it occurred
within a few months of marriage ; in both the tumefaction was-
considerable, but both terminated in resolution.

3. In some few cases, it occurs as a secondary complication
of severe uterine irritation, apparently from the use of local
irritants, the too frequent employment of the uterine sound, the^
introduction of the pronged pessary, &c.

4. I have seen the disease follow a smart attack of ephemeral-
fever several times ; in one case it terminated in resolution
after several weeks ; in another in suppuration and evacuation
by the rectum ; and a third is at present under treatment.

5. It not unfrequently complicates or terminates an attack of
simple hysteritis, of which several examples have come under
my notice, terminating most generally in suppuration. One-
such case was the largest abscess of the kind I have ever seen,,
occupying about one-fourth of the abdomen ; and in another,
at present under my care, the tumor acquired the size of an
orange, and after remaining stationary for some months, is now
nearly resolved.

6. In certain epidemics of puerperal fever, inflammation of
the uterine appendages appears as a special variety, with or
without a corresponding affection of the uterus.

It is not unlikely that the disease may occur under other
circumstances, but these have each and all come under my own
observation, and I can therefore vouch for their accuracy.

With regard to the nature of the disease, as I have said, there"
is no diflference of opinion, it is a phlegmonoid inflammation of
these parts, but there is a distinction of some practical value as^-
to the locality and the parts affected. In this respect all the
cases I have seen may be divided into two classes :

1. The first and largest exhibits a tumour just above the brim-
of the pelvis, and closely connected with it, fixed and immovea-
ble, extending downwards internally outside the vagina, through;
the sides of which it can be felt.

2. In the second class the tumour is distinct from the pelvis,.,
rounded, and quite moveable in every direction.

In the latter cases, the inflammation appears limited to the?

1852.] Pelvic Abscesses. 293

uterine appendages i. e., the ovary, broad ligament, and Fallo-
pian tubes. In the former, the soft parts which line the anterior
and lateral wall of the pelvis are also involved in addition to the
uterine appendages ; these are more properly named pelvic
abscesses.

I may add, that although either side indifferently may be
affected, I think the left side is more frequently the seat of the
inflammation.

As to the causes of the disease, it is not easy to be very pre-
cise.

1. In certain cases, to which I have alluded, the abscess is
undoubtedly the result of mechanical injury, and the cause is
quite intelligible.

2. In others, again, there would appear to be a sort of metas-
tasis of inflammation from the uterus, which in these cases
occurs towards the termination of the uterine affection.

3. In a third class of cases, especially when the patient is un-
married, it seems more fairly attributable to cold than to any
other cause ; but what may be the influence which determines
the attack to this region, it is quite impossible to say. In one
of the cases, to which I have alluded, all the uterine functions
had been some time quiescent.

4. Lastly, in puerperal epidemics, when the uterus is in-
volved, we could hardly expect, that its appendages would
escape ; and accordingly we find that they generally share in
the disease, though much more remarkably, in some epidemics
than in others. In another place I have given statistics of the
comparative frequency.

JVow, with regard to the symptoms, I must beg you to bear
in mind what I have said as to the two varieties of the local af-
fection ; the one involving the soft parts lining a portion of the
pelvis, and the other limited to the ovary and its appendages,
strictly speaking.

The disease may, and generally does, I think, commence by
a febrile attack ; but this is not always the case. There may
be a rigor, followed by heat, or this may be entirely absent.
Sooner or later the patient complains of pain or uneasiness in
the lower part of the abdomen ; but the amount of suffering
varies a good deal, and pretty much in accordance with the
amount of fever.

If we examine the abdomen carefully, we shall either find a
tumor just above Poupart's ligament, of varying size and thick-
ness, and firmly fixed to the pelvis, or a moveable tumor,
rounded, firm, and elastic, lying above the pelvis in the abdo-
men.

In the former class of cases, a vaginal examination adds

296 Pelvic Abscesses, [May^

nothing to our information, as the tumour is out of reach ; but
in the latter, we can trace it extending more or less down into
the pelvis, adding a lateral thickness, extremely tender on
pressure. Generally speaking, the uterus is pushed a little to
one side, is not tender on pressure, but moving it gives pain.
In one or two cases I have seen the uterus fixed and nearly
immoveable ; in one case only have I seen both sides affected.
This occurred in a married woman, unconnected with delivery.

In the former class, also, in addition to the pain, tenderness,
&c., the movements of the leg of that side are affected ; the
patient cannot stretch it out straight without great pain, nor
can she walk or stand up without bending forward.

In the latter cases the movements of the limb are quite un-
affected. This distinction is, I think, of considerable practical
value.

The tumour, I have said, varies in size ; it is, however,
always tender, on pressure, and not less so as the disease ad-
vances. When it attains a considerable size or is attended
with much irritation, I have seen the bladder and rectum sym-
pathetically affected ; the former more frequently so, giving
rise to a frequent desire to evacuate their contents. In only
one case have I had reason to believe that the tumor offered a
mechanical impediment to the passage of the faeces.

These are the principal symptoms present in a simple case
of pelvic abscess ; but they, as well as the course of the disease,
will vary much according to the extent of the local affection,
the amount of constitutional disturbance, and, in some degrees-
according to the circumstance under which the attack has oc-
curred.

1. In some cases I have seen, the affection had a purely
local character. There was the tumour tender, firm, moveable,,
or immoveable ; but the pulse was scarcely quickened from
beginning to end ; the appetite but little affected ; the bowels
regular, &c. The patient was confined to the sitting or recum-
bent posture, and suffered pain locally, but that was all.

2. In other cases, the local suffering was very considerable
and unceasing ; the pulse very quick, at least 120, with sweat-
ing at night ; utter loss of appetite ; irregularity of bowels ; no
sleep, and great emaciation.

3. Lastly, the cases which occur during an epidemic of puer-
peral fever will present its general characters in addition to the
local symptoms already mentioned.

With more or less of these symptoms, but with the local
ones always, the disease runs its course not quickly ; often, on
the contrary, very slowly, but with an uncertain duration in
each case. I do not think I ever saw the tumour disappear or

1852.] Pelvic Abscesses. 297

suppurate in less than a month ; and I have known it run on
to three or four, as in two cases at present under my care.

The disease may terminate either by resolution or suppura-
tion.

1. By resolution. I have seen repeated instances of this
termination, both when the tumour is free and when it is at-
tached to the pelvis, though more frequently in the former than
in the latter, and much more frequently in those cases where
there is but little constitutional irritation. In such cases, the
tumour may increase to a certain degree with the symptoms I
have described ; it then remains pretty stationary for a time,
often a considerable time, after which it gradually and slowly
subsides. It is worthy of notice, that if the patient be impru-
dent during this process, the morbid action in the tumor may
be re-excited, and the case may terminate in another manner.
In one of my cases the tumour had nearly disappeared when
the lady's servant became suddenly insane, and so frightened
her that the tumor enlarged, and all the symptoms re-appeared.
The time occupied by the process of resolution is generall}^
considerable. I have two cases under my care at this moment
illustrative of this ; in one, the tumour, which was free, has
all but disappeared, after nearly five months ; and in the other,
the fixed tumour has considerably diminished after three
months.

2. In the majority of cases, however, the tumour suppurates,
softens, generally perceptibly, and after a process of absorp-
tion of the intervening tissues, terminates by the evacuation
of the purulent matter ; this formation of matter being generally,
though not always, marked by the occurrence of rigors. The
-channel, through which this takes place, varies a good deal.

1. In some cases it has been evacuated into the peritoneum,
giving rise to peritonitis ; but this must, I think, be very rare
at least, in upwards of twenty cases which have come under
cny notice it never occurred. I recollect a case which ocurred
to my friend the late Dr. Haughton, which now appears to me
to have been a case of the kind. The poor \Voman had recov-
ered badly from her confinement, and some time afterwards,
when at the night-chair, she felt something give way, and peri-
tonitis immediately followed.

2. Cases are on record in which the abscess opened into the
bladder. If I mistake not, I savv" one recently in one of the
Journals; but such" cases I believe to be the most uncommon
of all.

3. The tumour may soften at its lower part, and the matter
may find its way through the coats of the vagina, and be dis-
charged through that canal. I have seen several cases of this

298 Pelvic Abscesses. [May,

termination, the results of which have been very favourable.
It has been suggested that we should puncture the tumour in
this situation, when the situation of the softening is suitable ;
nor do I see any objection to the plan. I have, however, not
found it necessary.

4. The most common situation, certainly, for a spontaneous
opening, is into the rectum, and then the matter will be found
discharged along with the stools. On this account, when the
tumour is observed to become softer, and we have reason to
suspect that matter is formed, the alvine evacuations should be
carefully examined. Except w^hen the matter escapes into
the peritoneum, no degree of pain seems to accompany its
evacuation. It often passes unobserved by the patient, and
sometimes seems marked by a sense of relief in the tumour.

5. In a considerable proportion of cases, the tumour ap-
proaches the surface gradually, and engages the integuments,
which become tense, fixed, and sometimes red and shining.
The fluctuation can be felt, the intervening integument is ab-
sorbed, and the matter points, as it is called.

The extent of these abscesses superficially, is generally not
much beyond the size of the tumour at an earlier period, but in
some cases I have seen them very large ; in one case, scarcely
less than one-fourth of the abdomen seemed involved. I do
not think it would be wise to wait for such an extent of disease,
but we ought to open it at an earlier period, and thereby save
the patient much suffering.

The symptom which most surely indicates this mode of ter-
mination, or rather this locality, is the skin becoming fixed over
the tumour, not rolling freely, but being adherent to it.

Diagnosis. There can hardly be any difficulty in the diag-
nosis or pelvic abscesses which occur after delivery, and as
part of a mere general puerperal affection ; the attention being
directed to the uterine system, a careful local examination will
detect the tumefaction, whether it be fixed or not. If it be
situated deep in the pelvis, and scarcely appearing above the
brim, still the pam down the leg, and the difficulty of extending
the limb, will leave but little doubt.

Perhaps an equally careful examination might be equally
successful in the unimpregnated condition ; but as the disease
is not generally expected under such circumstances, a less
minute investigation may, and often does, lead to a false con-
clusion. I have myself known a case of pelvic abscess pro-
nounced to be a fibrous tumour by very competent authority.

Now, the pathognomonic symptoms are, the pain in the tu-
mour and down the leg, the impossibility of standing quite
upright, or extending the leg completely, and the tumour de-
tected on external and internal examination.

1852.] Pelvic Abscesses. 299

1. From fibrous tumours it is distinguished by its compara-
tively quick growth, the amount of uneasiness, and the termina-
tion. The former increase very slowly, and insensibly give
rise to few or no symptoms, and, above all, are not common in
the uterine appendages.

2. In women of a certain age, the filling up more or less of
the pelvic cavity, might be supposed to result from cancerous
disposition ; but here we have no general cancerous diathesis,
the uterus is always unaffected, and the occurrence of suppu-
ration or resolution solves the difficulty.

3. That one variety of abscess which is unconfined resem-
bles much ordinary ovarian enlargements, at first ^ight, but it
differs in this, at least according to my experience, that it never
occurs except in connexion with childbirth or miscarriage ; and,
as a general rule, the growth is much more rapid in the cases
under consideration.

The affection, then, may be considered as well marked, and,
with care, not difficult of appreciation, but requiring special
care and attention when it occurs independent of parturition.

Prognosis. For so serious an attack, involving such impor-
tant organs, and liable to such various terminations, the prog-
nosis is very favourable. I have seen more than twenty such
cases, and have never seen one in which any unpleasant result
occurred. Some fatal cases are on record, but they must be
very rare, and probably in consequence of secondary peritonitis.

The disease is, however, very tedious, and may reduce the
patient considerably, so that there may be some risk of the in-
cursion of other diseases, if the patient be predisposed thereto.

Treatment. Whether the attack come on after delivery or
independent of it, if we see the patient during the acute stage,
it w^ill be necessary to apply leeches over the tumour, to repeat
these, if required, in numbers according to the amount of irri-
tation and the patient's strength and to follow them by constant
poulticing.

The bowels should be kept quite free, and I have found bene-
fit from small and repeated doses of calomel or blue pill, but
not continued so long as to affect the gums.

The diet of the patient during this period must be low, and I
need hardly say that she must be confined to bed.

After we have somewhat subdued the acute inflammation,
we must still continue the poultices until suppuration is estab-
lished ; but if the pulse be quiet, we may allow a little better
diet, such as chicken-broth or beef-tea.

When we are satisfied that suppuration has taken place, that
matter is formed, then our anxiety is as to the place where it is
to be evacuated. If by the bladder or intestine, we can do

300 Epithelial Cancer. L^^^}%

nothing but continue the poultices ; but if, on a vaginal examina-
tion, we find the tumour soft and the intervening parietes thin,
we are advised to make a puncture with a bistoury into the
tumour, first ascertaining the presence of pus by an exploring
needle. If we succeed, the after-treatment is simple ; so long
as purulent matter escapes, the poultice may be continued, and
occasional pressure made upon the tumour, so as to empty it as
much as possible.

But if the tumour enlarges above Poupart's ligament, involves
the skin, and becomes soft, with a sense of fluctuation, it must
be opened freely in this situation : and it will save the patient
some suffering if we make an incision reasonably early. Some-
times a large amount of matter is discharged with great relief,
sometimes only a small quantity, but the discharge will continue
so long as suppuration goes on. When it ceases, the poultices
may be omitted, and some dressing substituted if the wound re-
mains open.

When once the abscess is opened, we may allow the patient
a more generous diet, with wine, &c., and in many cases bark
may be given with benefit.

But if the tumour shows a disposition to resolve itself, it will
be advisable by degrees to leave off the poultices, and substitute
cotton wool or flannel. In some cases, this process is hastened
by a small blister applied occasionally, or by painting the part
with strong tincture of iodine, and I have seen great benefit
and improvement result from warm hip-baths twice or thrice a
week.

Such, Mr. President, is the imperfect sketch I have ventured
to lay before you. No one can be more sensible than I, that
it needs an apology, and I trust it will be found in the fact, that
it has been written in the midst of great anxiety and hurry,
without time to refer to books, and from an earnest desire to
show my willingness to co-operate wdth you in your noble ef-
forts to advance the science of medicine and surgery.

[Dublin Med, Press.

On Epithelial Cancer. By G. Murray Humphry, Esq., Sur-
geon to Addenbrooke's Hospital.

[We extract the subjoined remarks from a Course of Lec-
tures delivered in the Medical School of Cambridge, and to
which we have before been indebted for contributions. The
author divides cancer into four varieties : 1. Epithelial can-
cer. 2. Schirrous and encephaloid. 3. Melanic cancer. 4.
Alveolar or gelatiniform cancer. The first only is here spo
ken of.]

1852.] Epithelial Cancer, 301

The epithelial cancer affects usually the skin or a mucous
surface in the first instance. It differs from the other forms
of cancer in being composed almost entirely of cells more or
less flattened out, and closely resembling those of ordinary
epithelium ; it does not present the malignant qualities in so
marked a degree; it is more tardy in its progress, sometimes
remaining for months or years in a quiescent state, or growing
very slowly ; it generally appears at some part of the skin or
mucous membrane which has been exposed to a long-contin-
ued irritation, and its ravages are confined to the vicinity of
that spot and to the adjacent absorbent glands ; that is to say,
it does not often make its appearance in any other organ, being,
in a greater measure than the other forms of cancer, a local
affection, less associated with any particular diathesis, and
much less likely to return after extirpation.

For these reasons some pathologists are inclined to exclude
the epithelial species from the family of cancer ; mistaking, as
it appears to me, differences in degree for differences in kind,
inasmuch as the epithelial disease does really present all the
leading features of cancer, though it may do so in a less decided
and less active manner than the other members of the class.
It is attended with the destruction of the original tissues when-
ever it occurs ; it possesses the quality of spreading from point
to point, assimilating the adjacent tissues of every kind and in
every direction, and reducing them all to one homogeneous
structure ; it affects the neighboring absorbent glands, conver-
ting them also into a substance like the parent mass ; and it is
prone to decay and ulceration ; moreover, it is unceasingly
destructive ; it yields to no treatment, and pursues its relentless
course till death puts a stop to its ravages.

Watch the progress of the disease when it affects the lip, by
far its most frequent seat. It usually begins on the edge of the
lower lip, a little to one side of the middle line, probably at the
spot where the pipe is habitually rested. I have seen it in the
middle of the lip, originating in one of those cracks which are
often so troublesome in that situation, and in two or three cases
have met with it in the upper lip ; in one of the latter it origi-
nated in the cicatrix of a wound inflicted several years previ-
ously. A slight thickening or wart-like elevation of the skin is
generally the first symptom ; the cuticle is also thickened at the
part, and, in course of time, becomes rubbed or scratched off,
leaving the surface a little abraded or cracked, or superficially
ulcerated. Upon this a succession of scabs are formed and
detached, while an increasing lump is produced underneath
them, and the ulceration proceeds deeper; so that in the
course of time a considerable ulcer is engendered with an in-

302 Epithelial Cancer. [May,

durated basis, an excavated, or deeply fissured, or warty surface
covered with white dirty secretion, or perhaps with pale firm
granulations, and having a sinuous, raised, everted margin.
The discharge from these ulcers is thin and pale, like serum ;
occasionally it is mixed with blood. They are not painful or
tender, and the patients often think little of them. However
they gradually increase, extending along the margin of the lip
and towards the chin, the thickening and induration preceding,
the ulceration following, till the whole lip and part of the cheek
may be involved in the disease. Before such extensive ravages
have been effected, the absorbent glands under the jaw are
generally found to be enlarged and hard, the skin over them
becomes adherent and inflamed, and ultimately giving way, an
ulcer is formed which extends deeply, presents the usual can-
cerous aspect, and leads to the like fatal termination. If a sec-
tion be made through the ulcer in the lip, even in an early stage,
its indurated basis is found to consist of a compact, opaque
white, pearly substance, of uniform appearance, or speckled, it
may be, with small yellowish spots, which are softer than the
rest of the mass, and which are generally situated in greatest
numbers near the ulcerated surface. In this substance all the
natural tissues of the lip are blended and lost. Not only are the
skin, the mucous membrane, and the labial glands trans forrrjed,
or assimilated by the new structure, but the muscular fibres of
the orbicularis as well as the areolar and fibrous tissues are
traceable into the mass and are lost in it. When examined
under the microscope, the new substance is found to be com-
posed almost entirely of flattened cells, like those of epithelium,
compressed together, and arranged in laminae superimposed
upon one another. Some of those which are newly formed or
which are swollen by the imbibition of moisture, are round, oval,
or fusiform, and present nearly the characters of the ordinary
cancer cell. It is an interesting fact, first announced, I believe,
by Mr. Paget, that the microscopical characters of the diseased
absorbent glands correspond with those of the primary disease
in the skin ; the glands, like the tissues of the lip, being conver-
ted into masses of flattened and closely compressed scales, in-
termixed with cells in various stages of transformation. This
fact, taken in conjunction with the acknowledged success that
attends the removal of epithelial cancer of the skin, makes us
somewhat bold to extend our incisions for the purpose of ex-
tirpating also the morbidly affected glands.

The disease is most commonly seen in elderly men, though
middle aged and younger men are sometimes affected by it.
The patient's health generally appears to be good till it be-
comes impaired by the distress, discharge, and inability to

1852.] Epithelial Cancer. 303

masticate, occasioned by iFie extensive destruction of parts
about the mouth. A complete and permanent cure in most
instances follows the entire removal of the mass by the knife,
which should be done at an early period ; before the absorbent
glands are involved, if possible, because they are sure to en-
large and lead to the results just described when they have
begun to participate in the disease. Occasionally we find this
to be the case after the operation, although there was at the
time no evidence of their being in a morbid condition. In
three or four cases, after the removal of the mass from the lip,
and when the cicatrix remained perfectly sound, I have known
the disease spring up in the periosteum, make its way through
the jaw, and destroy the patient. Even the complete excision
of thfe portion of the jaw thus involved does not always save the
patient.

In the cancer of the penis and of the scrotum the progress of
the disease is very much the same as in the lip : the ulcer ori-
ginated in a pimple, a wart, or a little thickening of the skin,
has the same foul or coarsely granulating surface, everted edge,
and indurated base, goes on increasing with equal or even
greater virulence, involves the inguinal glands, and destroys
the patient in a shorter space of time than the corresponding
affection of the lip. I have seen the disease at the anus, on the
anus, on the extremities, the trunk, the face, and head, and be-
lieve it may attack the integuments at any part of the body. It
presents very much the same characters, and runs the same
course in whatever situation it occurs ; exhibiting the qualities
of malignancy in a sufficiently marked manner, quite as strong-
ly, indeed, as we could expect, considering that it is very gen-
erally the result of some local irritation.

Nevertheless, it must be admitted, and this is one of the most
interesting features in their pathology, that these cutaneous
growths vary a good deal in their malignancy; so much as to
constitute, it would seem, a very instructive link between sim-
ple hypertrophy and genuine cancer between an ordinary
wart and well-marked scirrhus, proving that these diseases
must be studied in their relation to one another no less than in
their points of difference, if we would attain a correct idea of
their real nature. There is good reason to think that the neg-
lect of this mode of considering the subject, together with the
too great stress which is usually laid upon the distinctive fea-
tures of cancer, has been the source of many narrow views, if
not of much misconception, upon this very important class of
disease. Any information upon this subject which the cutane-
ous growths may afford, is peculiarly valuable, because they
are directly under our observation ; and if there beany rela-

304 Epithelial Cancer. [May,

tion between simple and malignant disease, we may expect to
find some evidence of it in them.

Now, there are numerous instances of warts occurring upon
the skin in elderly persons, respecting which we have- a diffi-
culty in deciding whether they be cancerous or not, and which
we are in the habit of extirpating, because we know that if they
are allow^ed to remain they will go on increasing, will in the
long run ulcerate, affect the adjacent glands, and terminate fa-
tally. For example, a healthy man, ast. 63, was in John's ward,
a year ago, with a broad, flat, warty growth on the right tem-
ple ; it overhung the surrounding integuments, which was
purplish and a little pimply. The surface of the growth was
covered by a soft, white secretion, and when this was washed
away it was seen to be granular and warty, with supei'ficial
ulceration at places. There was no induration about its base,
and no enlargement of the adjacent absorbent glands. It had
commenced a year and a half previously. About the nose was
several small pimply or warty elevations of the cutis, which
he said had existed for a longer time than that on the temple,
though the latter at its commencement resembled one of them.
I removed the growth, completely dissecting it away from the
temporal fascia, to which it was loosely connected by cellular
tissue. After the wound had healed, there was a return of the
disease at one spot in the edge of the cicatrix, requiring a second
operation, which left him quite well. A short time ago the
part was sound, and the warts on the nose remained unaltered.
A section of the mass showed it to be composed of pale, blunt,
thick fibres, parallel to one another, and at right angles to the
surface of the body, doubtless enlarged and elongated papillae,
together w^th epithelial sheaths of papillae. This appearance
is often seen in cases of the like kind, and is probably the result
of a change analogous to that which causes the thickened stria-
ted condition of the intestinal muscular coat accompanying
cancer of the bowel. The association of an actively increasing
warty growth with a number of others of similar appearance
which remain in a quiescent state is very common. I remem-
ber a chimney-sweep, the subject of cancerous ulcer of the
scrotum, whose skin was covered in many parts of the body
with little wai'ty elevations, attributed by him to the same
cause as the more malignant disease in the scrotum, viz., the
irritation of the soot. They were in a quiescent state, and
hardly attracted attention.

[The author here narrates two cases of warty growths, both
of which ultimately caused death. He then proceeds as fol-
lows :]

These warty growths, which exhibit the stubbornness, and

1852.] Epithelial Cancer. 305

are apt to assume the destructiveness of malignant disease, are
almost always met with in elderly persons. It is the best plan
to extirpate them at once, where that can be done, and not to
waste time in the anticipation of caustic and other remedies,
which are more likely to excite than to repress the grow^th,
and which often hasten the enlargement of the absorbent glands.
I remember regretting that I had treated with nitrate of silver
a warty growth of this kind on the labium, in a woman, set. 60;
for though the growth was without induration, presenting the
appearance of a simple affection, and was diminished in size
for a time, yet it subsequently advanced more rapidly, the ingu-
inal glands participated in the disease, ulceration took place,
and proceeded as in ordinary cancer, and the patient died.

Perhaps it may be stated, as a general rule in these and in
other affections of a similar kind, that the degree in which the
natural structure of the part is altered, will be found to be pro-
portionate to the malignancy of the disease. Thus, where the
change consists sim.ply in an outgrowth of the papillae, with a
thickening of their epithelial coats, after the manner of the
wart, there the mass is slow in its increase, slow to extend to
the stratum of tissue under the skin, slow to ulcerate, slow to
make any impression upon the absorbent glands, and may be
removed with great prospect of a complete cure. Secondly,
where the warty disposition is less manifest, the alteration of
structure being attended rather with a destruction of the papillae
than their hypertrophy, and with the substitution of flattened
cells, like those of epithelium, for the natural tissue of the cutis ;
there the malignant qualities are more evidently displayed, the
mass increases more quickly, extending beneath the skin, in-
volving the subcutaneous areolar tissue, muscular fibres, and
even the bones; it ulcerates at an earlier period, the absorbent
glands are more quickly affected, and we are not quite so Uqq
from apprehension of a return after removal. Still the disease is
generally local, unattended with any constitutional indisposi-
tion, and is not likely to appear in distant parts. In the third
class of cases, which comprises the scirrhous or encephaloid
cancer of the skin, the morbid elements iiave still less relation
to those naturally existing, the tissues are replaced, not by
epithelial, but by cancer cells, or nuclei that is to say. the new
products do not exhibit a tendency to liken themselves to any
one of the components of the skin, but assume the form, and
are endowed with the endogenous productive qualities of can-
cer-cells; they breed others in their interior, instead of being
themselves transformed into any kind of tissue. In these cases
the disease commences, not with a wart, but with a tubercle,
spreads quickly in all directions, ulcerates, attacks the absorb-

306 Epithelial Cancer. [May,

ent glands, and is commonly associated, either as a primary or
secondary affection, with cancer of some other organ ; its re-
moval, therefore, is attended with comparatively little hope of
a permanent cure.

The warty growths described by Mr. Caesar Hawkins and
others as cicatrices, more particularly in the cicatrices of burns,
partake, 1 suppose, in a greater or less degree, of the nature of
epithelial cancer, being, for the most part, intractable by or-
dinary means, and requiring extirpation for their cure. I have
not happened to meet with any cases of this kind.

Epithelial cancer attacks mucous surfaces, no less than the
skin ; sometimes commencing under the tongue, about the ori-
fices of the salivary ducts, in the form of an indurated elevation
of the membrane ; it extends upon the jaw, and the under sur-
face of the tongue, as in the case of the woman from whom I
lately removed the mental portion of the jaw, the anterior and
under surface of the tongue, and the parts intervening between
the two. The patient recovered, and has not at present (six
months after the operation) suffered any relapse. In another
woman the disease, commencing at the same spot, had involved
the submental and submaxillary absorbent glands to too great
an extent to admit of extirpation, and proved fatal within two
years from its commencement. More commonly it attacks the
tongue, beginning on one side, opposite the molar teeth, with a
little thickening and induration of the part ; the papillse being
sometimes prominent, so as to give a warty appearance, ulcer-
ation soon follows, and extends into the substance of the organ.
The pain or inconvenience attendant on the early stage of the
disease not being great, we frequently do not see the patient
till an excavated ulcer of considerable size has been formed,
with a raised indurated base which extends probably to the side
of the fauces, and involves the mucous membrane between the
tongue and the jaw. The ulcer has a foul, grayish surface ;
and the induration is caused, as in other cases of the like kind,
by the infiltration of a new product in the structure of the or-
gan, and its substitution for the natural tissue. Examined mi-
croscopically, this new product is found to consist of epithelial
cells, compressed and matted together, perhaps concentrically
arranged, or elongated, and showing some tendency to split into
fibres. In the further progress of the disease the palate and
lower jaw, and submaxillary glands become involved, the move-
ments of the tongue and jaw are impeded, deglutition is diffi-
cult, the flow of saliva increased, the breath fetid, and the pa-
tient's condition is altogether very miserable during the short
period of life which remains.

On the whole, there can be no doubt that, although it often

1852.] Hysterical xifections of the Hip-Joint. 307

is excited by a local source of irritation, such as a decayed tooth
or stump, the epithelial cancer of the mucous membrane of the
tongue and mouth, is far more actively malignant in its progress
than when it affects the skin. Indeed, I think it exhibits in
this situation as rapid and as determined destructiveness, with,
perhaps, as great disposition to return after extirpation, as do
the scirrhous and encephaloid cancers in other parts of the
body ; though it is not so likely to affect distant organs. Our
hopes, therefore, of ultimate success from operative interfer-
ence, are far less than in the treatment of the corresponding
affection of the skin. Nevertheless, we may give the patient
the benefit of the chance, when there is a fair probability of our
being able to remove the entire mass. [Provincial Med. and
Surg. Journal.

On Hysterical Affections of the Hip-joint. By Mr. Coulson.-

Mr. Coulson gives the following diagnostic signs of nervous,
as contradistinguished from organic, disease of the hip-joint:

In the nervous affection pain is felt from the commencement
in the hip, and extends to the loins and dow-n the thigh. There
is great nervous excitability and extreme sensitiveness in the
part ; and the patient, from the first, is unable to walk. Com-
bined with this extreme suffering, the trochanter major retains
its proper bearing to the spine of the ilium. There is not the
characteristic wasting of the glutasi muscles, and, consequently,
no flattened appearance of the nates. Pressure in these situa-
tions, when the bone approaches the surface, does not excite
greater pain tljan elsewhere. There are no involuntary start-
ings during sleep. On the contrary, the patient sleeps calmly
through the night. In true hip disease the reverse is the case,
the sleep, if unaided by opium, is broken by sudden shooting,
pains and frightful dreams, or vague anticipations of coming
pain.

Of the pathology of the disease Mr. Coulson admits that little
is known. The joint is healthy in structure. He asks whether
the spine is not in a morbidly excited state, and responds truly,
or whether the brain is not itself perverted as to its functions,
and the pain is not a delusion? His own opinion inclines the
other way, and he looks to the sensorium as the organ chiefly
affected.

With regard to the treatment, he remarks, that if it be mis-
taken for organic disease, the line of practice adopted on that
supposition will be positively injurious. The patient must be
persuaded to leave her couch, and to take air. The diet must

308 Diseases of the Hip -joint. [Ma}^

be plain and nutritious. Among medicines, he prefers the vege-
table tonics and antispasmodics as valerian. Copland has
found most benefit from turpentine internally by enema, but he
also associates various tonics and local sedatives. \_London
Journal of Medicine.

On the Position of the Limb in Diseases of the Hip-joint. By
Holmes Coote, Esq., M. R. C. S.

Mr. Holmes Coote makes the following observations on the
difficulties attending the diagnosis of this affection : There are
but few surgeons who have not experienced occasional difficulty
in forming an accurate opinion as to the character of the mor-
bid changes which occur during life in chronic disease of the
hip-joint. In the early stages there is frequently but little pain,
and children so affected, especially amongst the poorer classes,
are permitted to walk about and pursue their daily avocations,
without notice being taken of their lameness, until at last a fall
or some other accident excites more acute symptoms, and in-
duces the parent to seek professional assistance. The surgeon
finds the pelvis oblique ; the affected limb apparently elongated,
and slightly everted ; he finds that in bending tne thigh upon the
trunk, the whole pelvis moves with the femur ; pressure over the
hip-joint excites, perhaps, little pain ; there is flattening of the
buttock, and the trochanter major appears more sunken that
natural. The history accompanying such a case is often as
follows : The child was in perfect health, and able to run
ahout until about a week or two ago, when, in consequence of an
accident, it was thrown down upon the side. Upon being taken
up, it was found to be lame and has been unable to walk ever
since. The history of the case, and the position of the limb,
might lead to the belief that the head of the bone was dislocated
upon the thyroid foramen, especially amongst those who con-
sider that inversion and not eversion of the foot, is the position
assumed by the inferior extremity in the earlier stages of hip-
disease. I propose offering a few remarks upon the position of
the limb, granting that, as is commonly asserted, there may be
inversion and not eversion ; that there may exist a resemblance
to dislocation on the dorsum ilii, or to dislocation on the thyroid
foramen ; but denying that such varieties can ever be referred
to accident.

In the commencement of an inflammatory affection of the
hip-joint, the thigh is bent upon the body ; the whole limb is-
slightly everted and abducted ; the anterior superior spinous
process of the ilium of the affected side is either raised, when

1852.] Diseases of the Hip-joint 309

the limb appears to be shortened, and the sound hip more
sunken than the opposite, or it is depressed or thrown forwards,
when the whole limb appears elongated, the knee being bent,
and the toes touching the ground a short distance in front of
the toes of the sound limb.

The elevation or the depression of the anterior superior spinous
process of the ilium of the affected side depends upon whether
the patient happens to have been forced to follow his occupa-
tion during the early stages of the disease, or whether he has
been in circumstances which allowed him to rest when in pain
or uneasiness. The spine of the ilium is generally sunk and
thrown forwards, and the limb apparently elongated; that po-
sition being the one in which the diseased joint will he easiest,
the patient standing upright. But if he be forced to walk
about, the pelvis becomes oblique in the opposite direction, the
spine of the ilium is raised, and the limb is apparently shorten-
ed. The patient, throwing as much as possible of the weight
of the body upon the sound side, limps upon the extremities of
the toes of the affected limb, the foot being extended that its tip
may just touch the ground.

The flexion, eversion, and abduction of the limb constitute
the position into which it would be naturally thrown by the
combined action of the powerful muscles which surround
the hip.joint. The synovial membrane is inflamed and tender,
and unfit to bear pressure; the patient, therefore, instinctively
endeavors to relax every muscle directly in contact with the
joint. The psoas and iliacum, passing over the front of the
synovial membrane and tightly pressing upon it where the limb
is extended, flex and evert the thigh, the gluteus minimus will
contribute to flex it ; the pyriformis will abduct the limb ; the
gemelli and the two obturators, especially the obturator exter-
nus, will evert the limb; it is unscientific to refer the position
of the limb to effusion of fluid into the synovial membrane; it
is but rarely that we find the joint so distended, especially at
the commencement of the disease, when eversion is the com-
mon symptom. It may be true, that if the joint be tightly dis-
tended by the artificial injection of fluid after death, the limb
will assume the position above described. The attachments of
the capsular ligament are in harmony with the sphere of action
of the muscles w-hich surround the joint. That the muscles
which evert the limb may act with greater freedom, the fibrous
capsule is unconnected with the posterior part of the neck of
the femur; it forms there a ring not very unlike that which
surrounds the head of the radius in the forearm. After a sud-
den fall, or a blow on the hip, the limb becomes at once everted,

N. S. VOL. VIII. NO. V. 20

SIO Presence of Sugar in Pus. [May,

if the joint is bruised, long before sufficient time has passed for
the capsule to become distended by fluid.

In course of time, as has been proved by innumembie7?os^
mortem examinations, the disease produces thickening of the
synovial membrane, absorption of the articular cartilage, and
ulceration both of the head of the femur and of the acetabulum ;
the shortened neck of' the femur slipping upwards and back-
wards in the enlarged acetabulum, approximates the fixed points
of insertion of all those mus^cles which have everted the limb.
They waste and become atrophied, being no longer in action,
and the buttock appears much flatter than on the sound side.
The gluteus medius and the adductor muscles then influence
the position of the limb, their power being increased by the ab-
sorption of the neck of the femur. We may therefore say that,
in the second stage of the disease, the limb passes from abduc-
tion to adduction ; from eversion to inversion. Still flexed it
is drawn across the sound thigh, the toe pointing downwards,
when the position somewhat resembles that of a limb in dislo-
cation upon the dorsum ilii. [J^Iedical Times.

On the Presence of Sugar hi Pus. By George D. Gibb, M. D.,
L. R. C. S. I., Lecturer on the Institutes of Medicine, St.
Lawrence School of Medicine of Montreal. Physician to
the Montreal Dispensary.

In January, 1850, I opened a large abscess situated on the
back below the right scapula, in a female aged 23, the subject
of general external scrofula. The fluid withdrawn, was of a
j'ellowish colour, spec : gr : 1028 ; inodorous, neutral, and of a
creamy consistence. In the course of a chemical examination,
I applied thedifl^erent reagents for testing the presence o^ sugar ;
when, to my surprise, I found that Moore's test, and Trommer's
tests gave positive proof of the presence of a considerable quan-
tity of that substance. Microscopical observation showed the
usual characters of tuberculous matter, in the presence of cells
filled with granular matter, free granules and fat globules,
together with pus and lymph corpuscles. In February, this
large abscess having become again filled, was opened, and exit
given to a thick cream-like fluid of a dark drab colour. On
examination for sugar, the results were again positive, and the
microscope showed a larger number of pus corpuscles.

These experiments were not sufficient in themselves to prove
that pus necessarily contained sugar ; and to test the subject
further, other kinds of pus were examined with the following
results :

Pus from Chronic fisj^ula in left breast of a female in which

1852.] Delirium Tremens treated with Chloroform, 311

Cyanuret of iron was found. (This case was published in the
6th volume of the British American Medical and Physical
Jourjial.) Moore's and Trommer's tests, quite satisfactory.
Pus fronn sac of an abscess over the right malar hone in a girl,
very foetid : all the tests satisfactory.

Crude and softened Tubercles from left lung of a Phthisical
patient, aged 40. Tests satisfactory, but sugar not large in
quantity.

Fatti/ liver, same case, that variety described by Louis ; su-
gar found in large quantity by the usual tests.

Pus from a Bubo. Tests satisfactory.

Large Mammary Abscess. Healthy laudible pus, sugar in
small quantity, by Moore's and Trommer's tests.

These results conclusively prove, that sugar is one of the
normal constituents (so to speak) of pus, and it is to its presence
that the sweetish taste is due.

Dr. Mason Good, in the second volume of his Study of Medi-
cine, in describing pus, says "It has a sweetish, mawkish taste
(apparently from its containing sugar,) very different from that
of most other secretions."

He appears to have been the first author who has supposed
its presence in this fluid. Its presence may possibly be due to
the albumen found in pus, which, according to Dr. Wright, *
contains 58 to 83 per cent. It has been shown elsewhere, that
sugar exists largely in the serum of the blood, f which contains
albumen principally, and also in the albumen of eggs. J Pus
also contains fatty matters which may likewise account for its
presence. In fact, the presence of either fat or albumen, both
being proximate principles, is a sufficient proof of its elaboration
from the body.

That fat may have some influence in the transformation, is
supported by the evidence afforded in the amount of sugar con-
tained in the fatty liver examined, which was very large. And
in some experiments performed on the livers of Birds, (which
will be described in a future number of this Journal) the amount
of sugar was found to be large in those containing much fat, as,
for example, in the liver of the goose. [Canada Med. Jour.

Cases of Delirium Tremens successfully treated by the admin-
istration of Chloroform. By Stephen H. Pratt, M. D.,
of Baltimore.

Case I. May 7th, 1850, 1 called to see E. B., laboring under
delirium tremens.

* Ranking's Abstract ; vol. 1, 1845. t Bernard in Archives Generdes, 1848.
X Gazette Medicate. 1849.

312 Delirium Tremens treated with Chloroform, [May,.

E. B. had, that day, been taken from the Infirmary,

where he had been for the last seven days under judicious treat-
ment for the above named disease. During the time (seven
days) he had not slept any, as I had been, that morning, inform-
ed by the resident physician; and his case was deemed almost
hopeless. His friends became alarmed, and (very injudiciously,.
I thought) removed him, and placed him under my care.

It was 1 o'clock, P. M., when I saw him. He was very fee-
ble, and much exhausted by disease and protracted wakefulness.
His pulse was feeble and frequent. There was subsultus, mut-
tering, great incoherence, with cold and clammy extremities.

Having been advised that he had been on a mixed opiate and
stimulant treatment, at least a part of the time, and having had
some success previously in ihe use of chloroform, I determined
to use it now. Accordingly one drachm of chloroform, diluted
with water, was exhibited. At 5 o'clock, P. M., another drachm
was administered ; and at 9 still another, diluted as before. At
10, he fell asleep and slept till morning. At 8, in the morning,
he waked and drank some gruel, after which he soon fell asleep
and slept till noon.

He now waked with a good appetite, which he too freely
indulged by partaking of soup. However, he was quite com-
fortable during the afternoon, and slept well through the night.
Next morning he vomited two or three times freely. The
emesiswasnot violent, and was easily controlled. From this
time, paying strict attention to his diet, he rapidly convalesced.

During tliis sickness no medicine was exhibited but chloro-
form (not even aperients), and this but three times. On the
fifth day, the patient left the house to attend to his affairs, and
was soon in health.

Case II. Vv^as called to see J. H., June 4th, 1851, laboring
under delirium tremens. Put him upon a mixed opiate and
stimulant treatment through the day, and exhibited opium in
full doses through the night. This was continued two days
and nights, without benefit. Indeed the patient grew worse.
The third morning I put him upon: ^. Spts. sulpha setheris,
comp., tinct. Valerianae, ana 5iss. ; to take 3 ii. every two or
three hours, intermediately giving tinct. opii. At 8 P. M., gave
a large opiate. At 10 P.M., gave tinct. opii. 3j. At 12, re-
peated the dose ; and at 2, again repeated it. All this time the
patient grew worse, and became " furiously delirious," frighten-
ing all the household.

Three men were appointed to prevent him from jumping out
of the windows (several attemps at which he had made), or
otherwise injuring himself. At times he was a match for them
alL At length he grew weak, becoming more and more pros-

I

1852.] Delirium Tremens treated with ChloroforiJi. 313

trated by his great exertions. Tiie family became alarmed,
and wished further advice. A consulting physician was called
in. A hot stimulating pediluvium and an opio tartar emetic
treatment was agreed upon.

I suggested chloroform internally, which was not wholly ob-
jected to, though not preferred by the consulting physician.
Accordingly the former was tried, but unfortunately without
success, the patient rapidly growing worse.

He was now beyond control, a raving maniac, a terror to all
present. His pulse was feeble and frequent; so frequent it
could not be counted with the existing tremor. His tongue
was dry ; there was also muttering, subsultus, and perfect inco-
herence, with cold and clammy extremities.

Under these circumstances, I determined to exhibit chloro-
form as a dernier resort. A tea-spoonful nearly, diluted with
water, was administered. After one hour, the following was
given: ^. Spts. sulph. setheris comp*. tinct. Valeriana, aa f3ii,,
chloroform f 3i., at a draught.

(The compound spirit of sulphuric ether and tinct. valerian
were added in order to obviate, if possible, the danger of fatal
prostration.) Fifteen minutes after its exhibition, the patient
fell asleep, and slept soundly three and a half hours. Mean-
time, perspiration ceased ; his extremities became warm; his
pulse grew calmer, fuller ixnd fii^fner. He then awoke much
refreshed and quite rational, and had a free, natural dejection.
Three tea-spoonsful of the mixture, l^. Hoff.'s anodyn. and
tinct. Valeriana, with half a tea-spoonful of chloroform, were
then exhibited. After this, he washed his hands and face, and
bathed himself generally. In one hour, I exhibited f 3iv. of the
mixture, with fsi. of chloroform, and persuaded him to lie
down. In a few minutes he was asleep, and slept compara-
tively soundly four hours, when he arose, went down stairs, and
evacuated his bow^els. In fifteen minutes he was again asleep,
and slept three hours, when he walked and drank a tumbler of
milk, took a dose of spts. sulph. setheris comp. and tinct. Vale-
riana ; fifteen minutes afterwards he w^as asleep again, and
continued sleeping through the night, rising, meantime, but
once.

In the morning he rose, drank some milk and beef tea, and
after evacuating his bowels again went to sleep. His pulse w'as
now good; extremities warm, glov/ing; subsultus greatly di-
minished ; delirium almost entirely wanting. He slept till
about noon, and then waked still more tranquil. During the
afternoon, he slept and waked alternately, and rested well the
following night. His sleep was not comatose. When awake, he
was wide awake, cheerful and lively. A day or two passed

314 The Skin as a Diagnostic of the General Health. [May,

thus as he rapidly convalesced. On the 9th, he was walking
about the city a comparatively well man. He has continued
well since.

Such are the facts. From a furious delirium, with subsultus,
perfect incoherence, cold, clammy extremities, a feeble, flutter-
ing, frequent pulse, costiveness, &c., by the tranquilizing and
peculiar (shall I say specific ?) influence of chloroform, he was
rescued, in a little more than an hour, and thrown into a condi-
tion the most favorable possible ; from which in a few days, he
was restored to his usual health. No emesis, or irritation of
the bowels, occurred. No cathartics were exhibited, yet gen-
tle motions followed the administration of chloroform.

The methodus medendi of this wonderful agent, I will not
here attempt to explain. Facts are of more importance than
inferences, and if, by this contribution, I add one to \\\q facts
already recorded, I shall be satisfied. [Amer. Jour, of ^Med.
Science.

The Skin as a Diagnostic of the General Health. By Mr.
Hunt.

The author commenced by observing that the subject natu-
rally divided itself into two parts, viz : 1. The indications
presented by the healthy skin. 2. Those presented by the
skin in a state of disease.

Having alluded cursorily to the former, by pointing out some
of the indications presented by changes in the condition of the
skin as to smoothness or roughness, moisture or dryness, tem-
perature and color. Mr. Hunt proceeded to discuss the con-
stitutional indications presented by the diseased skin, confining
his remarks to a single topic, viz : the rapidity or slowness of
development, which characterized respectively the various
orders of cutaneous diseases, as arranged by Dr. Willan. To
explain this point more fully and forcibly, he placed the first
seven orders of Willan in a new rotation, selecting two diseases
as types of each order, by way of illustrating the subject, as
follows :

Orders, Types.

1. Exanthemata | E^Ea.

9 T{nl]e Erysipelas.

^- -^^^^^ \ Pompholyx.

-^7- . , ( Eczema.

3. Vesiculffi I H^,.p^^

1 S::

1852.] The Skin as a Diagnostic of the General Health. 315

^ Pinnlfp S Lichen.

5. Papulae j Prurigo.

a c { Lepra.

^ ( rityriasis.

7.Tubercula | ^^^ _

The first three of these orders, viz : Exanthemata, Bullae,
and VesicuIcB, were described as comprising for the most
part diseases of rapid evolution or development : the last
three, viz : Papulce, Sqammce, and Tuherculce, as containing
diseases of slow development ; the order Pustules taking an
intermedite position in this respect. Oq this basis the author
proposed to establish a theory, for the support of which he pro-
duced many curious facts relating to the artificial production of
the various forms of skin disease, as well as facts connected
with the development of spontaneous eruptions.

The theory consisted in regarding eruptions as defensive
eflforts of nature, tending either to prevent the absorption of
poisons, or to eliminate them when absorbed ; those poisons
or injurious agents which are most actively mischievous, being
most rapidly eliminated or repelled : e;5citing the blush, {Ex-
anthema,) the blister, (Bulla) or the vesicle, (Vesicula ;) those
which are less rapidly destructive, exerting a slow and feeble
effort at elimination, as observable in the pimple, (Papula) the
scales, (Squamma,) or the tubercle (Tuherculum :) while those
poisons which are of intermediate intensity of action originate
the pustular form of eruption.

Taking seven diseases as so many types of these orders res-
pectively, the author observed that their average duration
when unchecked by treatment was strikingly illustrative of the
truth of this theory of development. Thus

Urticaria continues usually a few hours only.

Erysipelas - - - a few days.

Herpes - - - twice as long.

Ecthyma - - - a few weeks.

Lichen - - - as many months.

Lepra - - - as many years.

Lupus - - - for the whole life.

Each eruption showing the relative degree of intolerance of
the poison manifested by the system, and thus becoming a sig-
nal of danger. Mr. Hunt contended that if this theory prove
to be true, it might throw some light on ihe prognosis, the^fl-
thology, and the therapeutics of cutaneous disease ; assisting tiie
prognosis by determining how long the disease might be expec-
ted to last ; the pathology, by pointing out the sudden cause of
ihe disease, and its relative activity or destructive power ; the

316 Nitrate of Silver in Hooping Cough. L^^y>

therapeutics, by sugesting long perseverance in one judicious
plan of treatment in the diseases at the bottom of the hst, and
by indicating some error of treatment when the cure of those
at the opposite end of the chain does not proceed at a rate cor-
responding with their natural rapidity of development.

These positions were illustrated by allusions to the action of
external agents in the production of various eruptions, as well
as to internal sources of cutaneous disease ; and among other
important facts it was stated that, while the diseases included
in the first four or five orders were producible by external
agents, with a readiness diminishing from above downwards, it
was impossible to establish the eruptions at the bottom of the
list, (Lupus, Acne, Lepra, Psoriasis, &c.,) by any external appli-
cation whatever. \^London Medical Gazette.

Application of the Nitrate of Silver to the Pharynx and Lar-
ynx in Hooping Cough. By Dr. E. Watson.

I think that one great cause of the want of success hitherto
experienced in the treatment of hooping-cough, has resulted
from the prevalence of .unsound ideas regarding its seat. It is
very generally treated with emetics and expectorants, with
embrocations over the chest, or perhaps with leeches, as if it
were some inflammatory pectoral afl^ection. No wonder that
with such treatment the disease generally runs its course, and
either wears out itself or the patient.

I think a much more correct theory of the disease is, that
it is the product of a poison which exerts its first influence
on the mucous lining of the pharynx and larynx, and on the
sentient nerves viz : branches of the superior laryngeal sup-
plying these parts ; that in the next place the inferior laryngeal
becomes excited, and partial spasm of the glottis follows. It is
a peculiarity of the action of this morbid poison, as of most
morbid poisons acting on the nerves, that the symptoms caused
by its presence are of a periodic or intermittent character.
Hence it is that the disease commences with a periodic cough,
diflfering in many respects from that which accompanies bron-
chitis ; hence arise the pains of the neck generally complained
of by the patients, and hence, finally, the hoop, or back-draught,
when the tendency to frequent spasms of the glottis has super-
vened. In like manner the vomiting which generally accom-
panies the fits of hooping-cough, is caused by an extension of
the morbid excitation to the branches of the pneumogastric
nerve supplying the stomach.

Such are the symptoms which, in my opinion, are alone es-
sential to a case of hooping-cough, and which of themselves

1 852.] Salivation and Sloughing caused by Mercury. 3 1 7

constitute the disease. But whether this disease be or be not
complicated with other affections, it ought to be treated per se,
and not, as is too often the case, as if" it were bronchitis or
pneumonia, or some affection of the head or even of the stomach.

Entertaining these views, and being aware of the powerful
influence of topical apphcations of solution of nitrate of silver,
in allaying nervous irritability of the glottis, it occurred to me,
about eighteen months ago, when hooping-cough was more
than usually prevalent in this city and its neighborhood, to em-
ploy that remedy in the disease just named. I therefore gave
up all the usual treatment in the cases which I was attending
at the time, and contented myself with confining my patients
as much as possible to one apartment, well aired and properly
heated, attending to the functions of the alimentery canal, and
touching the pharynx and larynx every second day with solu-
tion of caustic. Pursuing this treatment, I met with very
considerable and unwonted success. My first cases, which
occurred in summer, ceased to hoop in about ten days or a
fortnight after the solution had begun to be applied ; and of
late, in our worst winter weather, I have treated several cases
to a favorable termination in from tv/o to six weeks.

In November last, I read to the Glasgow Medical Society a
paper, detailing the results of this treatment, which induced
several gentlemen to use the remedy proposed. Most of them
report favorably of their success, and I earnestly hope that a
more general trial will soon be given to it, and that its true
therapeutic value will be speedily recognized. [Lon. Lancet.

Profuse Salivation and Sloughing, caused by three small doses
of Mercury. By Robert Harper, M. R. C. S., L. S. A.,
London.

W. W , aged eleven years, a delicate boy, was attacked

in the early part of last month (November,) with fever, and for
which he was treated in the usual manner, namely, salines,
antimonials, &c., followed by wine and other support, and un-
der which he greatly improved. The bowels, however, being
in a torpid state, mild aperients, with mercury and chalk, were
administered, when required. Altogether only three doses of
this mercurial were given, one of six grains on the 14th, a simi-
lar dose on the 17th, and four grains on the 20th; but most
profuse salivation followed, the salivary glands and features
becoming swollen to an enormous size, the saliva flowing con-
stantly away, and the breath havincr the foetid mercurial odour.
Port wine, arrowroot, good beef-tea, in fact all the support
that could be got down, was given, and lotions employed to the

318 Yeast Mixture in Petechial Typhus. [May,

mouth ; but nothing would stop its fearful ravages : sloughing
commenced in both checks, and rapidly extended through them ;
that on the right cheek was not larger that a shilling, but on
the left side it extended from one-third across the lips back-
wards to the edge of the great masseter muscle, and from the
malar bone to the lower edge of the inferior maxilla ; it pre-
sented a frightful appearance, the whole of the teeth on that
side being exposed. Everything that could suggest itself was
done for the poor boy, but all was of no avail, and he died four
days after the commencement of the sloughing. [London
Lancet.

I

Yeast Mixture in Petechial Typhus.

Dr. Jones (in Dublin Quarterly Jour, of Med.) speaks very
highly of the stimulating and antiseptic properties of the follow-
ing mixture in cases of typhus attended with petechiee and other
forms of passive hemorrhages :

l^. Cerevisiae fermenti, !x;

Camphorse, 3ss;

TEtheris nitrici, 3iv. ^j to be taken every first,
second or third hour. This removes the dark livid hue of the
skin within a few hours; administered in cases of dysentery,
attended with great fetor of the dejecta, it has speedily removed
all odour, and at the same time rather counteracted the fre-
quency of the discharges from the bowels. [Northern Lancet.

k

Use of Diluted Pyroligneous Acid as a Gargle. By John
Evans, M. D., Prof of Obstetrics, &c. in Rush Medical
College.

I have for several years been using diluted Pyroligneous Acid
as a gargle in case of inflammation of the fauces and tonsils
with better success than any other article that I have prescri-
bed.

I put a teaspoonful of the Acid obtained from the shops into
a wine glass of water and direct the patient to gargle the throat
frequently with it.

In the sore throat caused by exposure, so common throughout
the country, it generally relieves the soreness and stiffness felt
in swallowing very promptly.

In chronic inflammation, with or without ulceration, of the
throat, I have found it a very valuable remedy.

In the sore throat of Scarlatina it has generally afforded a
very prompt amelioration of this symptom of the disease.

In several cases of habitual tonsilitis, by using this gargle

1852.] Cannabis Indica as a suhstituie for ErgoL 319

freely at the commencement of the disease, I have been able
to arrest the progress of the inflammation and secure a resolu-
tion.

Its use is not unpleasant; it is safe, even if used for hours
continuously, and has an additional advantage in removing the
foetor of the breath. \_Nortk- Western Med, and Sur. Journal.

Cannabis Indica as a substitute for Ergot.

Dr. Christison, of Edinburgh, considers Indian hemp (Can-
nabis Indica) to possess a remarkable power of increasing the
force of uterine contraction dui'ing labor. He reports, in the
August number of the Edinburgh Journal of Medical Science,
some cases in which it was given, with this view, at the Ma-
ternity Hospital of Edinburgh. As compared with the action
of ergot, that of Indian hemp presents the following points of
difl^erence : First While the effect of ergot does not come on
for some considerable time, that of hemp, if it is to appear, is
observed within two or three minutes. Secondly The action
of ergot is of a lasting character, that of hemp is confined to a
few pains shortly after its administration. Thirdly The ac-
tion of hemp is moie energetic, and perhaps more certainly
induced, than that of ergot. [Med. Examiner.

HI X 0 c 1 1 a n g.

Anonymous writers and Personalities. Although fully appreci-
ating the benefits of a free press, and of the multiplication of media
for the diffusion of knowledge and morality, we cannot refrain from
the expression of the profound regret with which we have observed,
especially during the last twelve months, certain periodicals ostensi-
bly devoted to the cause of Medicine, allowing their pages to be
prostituted by anonymous writers to the grossest personalities and
misrepresentations, and occasionally containing even Editorials equal-
ly objectionable. If licentiousness in secular newspapers be an evil
deeply lamented by all good men, how much more must it be desecra-
ted when found invading the sacred arena until now reserved exclu-
sively for the efforts of minds in search of scientific truth and
usefulness !

We would not do injustice to the Medical Profession of our country,
by supposing that such Journals can ever secure or retain any coun-
tenance. Yet their demoralising influence is incontestihle, and can
only be arrested by an immediate withdrawal of patronage.

320 Miscellany. [May,

The whole Medical Profession of Georgia and some of its members
in particular, the iMedical Society and the Medical College, have been
repeatedly and are still being made the subjects of most scurrilous
anonymous communications to Medical Journals published at a dis-
tance, and in various quarters of the Union. The articles are not
dated from any particular point, and bear different ^'noms de guerre ;^'
yet their style and general bearing show them to be all written by the
same pen, and to have been indited in Georgia. Editors at a distance
can surely have no good reason for not rejecting at once such misera-
ble productions ; and we have been induced to make the above pointed
allusion to articles bearing upon our own State, in the hope that their
eyes may be opened to the plan by which they have been misled.

Medical Society of the State of Georgia. We are indebted to the
politeness of Dr. O'Keeffe, Recording Secretary, for the following
abstract of the proceedings of the Medical Society of the State of
Georgia.

This Society held its third annual session at Augusta on the 14th
and 15th April, when quite a respectable number were in attendance.
In the absence of the President, (Dr. R. D. Arnold, of Savannah,)
the Society was called to order by Dr. A. Means, the 1st Vice-Presi-
dent. But little business had been transacted, however, when Dr.
Arnold arrived and took the Chair. 44 new mem.bers were now ad-
mitted, which makes the whole number of members 152.

The election for officers to serve until the next annual meeting then
look place, and resulted as follows:
President - A. Means, M. D., of Oxford, Newton Co.
1st V. President H. F. Campbell, M. D., of Augusta, Richmond Co,
2d V. President C. T. Quintard, M. D., of Roswell, Cobb Co.
Rec'g Secretary D. C. O'Keeffe, M. D., of Penfield, Greene Co.
Cor'g Secretary G. F. Cooper, M. D., of Perry, Houston Co.
Treasurer R. C. Black, M. D.-, of Augusta, Richmond Co,

The President elect took the Chair, and in a few pertinent remarks
returned thanks for the honor conferred upon him.

The following gentlemen were then elected Delegates to the
approaching meeting of the American Medical Association in Rich-
mond, Virginia.

Drs. H. F. Campbell, Juriah Harriss, J. D. Mackie, J. J. Robert-
son, C. B. Nottingham, L. C. Pynchon, R. C. Black, T. P. Janes,
W. N. King, H. A. Ramsay, E. W. Alfriend, R. Campbell, A. C.
Hart, E. Girardey, VV. R. Ruffin.

1852.] Miscellamj. 321

On motion, it was Resolved that the President be authorized to fill
any vacancy that may occur in the Delegation to the American Medi-
cal Association.

The South- Western Medical Society of Georgia, the DeKalb
Auxiliary Medical Society, and the Medical Society of Greene and
adjoining counties were admitted as Auxiliaries.

On motion of Dr. Quintard, it was Resolved that Committees be
appointed to furnish Essays upon such subjects as shall be designated
by the Society.

On motion of Dr. H. F. Campbell, it was Resolved that the Stand-
ing Commitiees on the several branches of Medicine be abolished.

On motion of Dr. Dugas, it was Resolved that a committee of five
be appointed, whose duty shall be to report upon the Contributions
to Medical Knowledge by Physicians residing in Georgia during the
year preceding. The Chair appointed Drs. L. A. Dugas, R. D,
Arnold, G. F. Cooper, J. A. Eve, and H. Rossignol, this committee.

Dr. Robert Campbell, Chairman of the Committee on "Empirical
Remedies," read an able Report, which was received and ordered io
be printed.

Dr. G. F. Cooper read an interesting Report, prepared by Dr. Cul-
ler, upon "Health Statistics," based upon data obtained from the U. Sr
Census, which was ordered to be deposited in the archives of the So-
ciety, and for which the thanks of the Society were voted to Dr.
Culler.

Able and interesting Reports were read by Drs. G. F. Cooper,
C. T. Quintard, P. F. Eve, H. F. Campbell, and L. A. Dugas all
of which were received and ordered to be printed.

Dr. Juriah Harriss, of x\ugusta, w^as appointed to deliver the address
at the next annual meeting of the Society, and Dr. W. Gaston Bulloch,
of Savannah, the alternate. It was determined to hold the next annu-
al meeting in Savannah, on the second Wednesday in April, 1853.

The thanks of the Society were voted to Dr. H. F. Campbell for
his chaste Address, (a copy of which was requested for publication,)
to the Committee of Arrangements, to the Faculty of the Medical Col-
lege of Georgia, and to the officers of the past year. '

On motion of Dr. Arnold, it was Resolved, to assess each member
of the Society Two Dollars to defray the expenses of publication, dec;
and on motion of Dr. Cooper, it was also Resolved, that the Transac-
tions of this Society, when published, be withheld from such members
as may fail to remit their assessment to the Treasurer, Dr. R. C^
Black, at Augusta.

322 Miscellany, [May,

The following resolutions were offered by Dr. Dugas, and adopted :

Resolved^ That a Committee of three be appointed by the Presi-
dent for the purpose of proposing subjects for Essays to be presented
at the next annual meeting. (Drs. L. A. Dugas, H. F. Campbell and
L. D. Ford, were appointed.)

Resolved, That the President appoint Committees of one for each
of the Essays above referred to, whenever he shall have been furnish-
ed with the subjects selected.

Resolved, That a Committee of two be appointed to superintend the
publication of the Transactions of this Society, with authority to draw
upon tlie Treasurer for the necessary funds. (Drs. I. P. Garvin and
T. B. Phinizy were appointed.)

On Wednesday evening the Society partook of a fine collation pre-
pared in one of the College Halls by the Faculty of this Institution.
This entertainment, as well as the whole proceedings of the Society,
were characterized by the warm-hearted cordiality and good feeling
so peculiar to associations of men devoted to Science and to the cause
of humanity.

The National Institute of France, has recently awarded the follow-
ing prizes :

"The prize of experimental physiology was given to M. Claude
Bernard, for a paper on a new function of the liver in men and ani-
mals. M. Masson and M. Sucquet obtained prizes of 2000fr. each ;
the first for his method of preserving vegetables, and the second for
his disinfection of dissecting theatres. The Monthyon prizes for
physic and surgery were awarded as follows : 2,500fr. to M. Jules
Guerin, for the generalization of sub-cutaneous Tenotomy ; 2,000fr.
to M. Huguier, for his researches into female maladies; 2,000fr. to
MM. Briquet and Mignot, authors of a practical treatise on cholera ;
2,000fr. to M. Duchenn, of Boulogne, for his electro physiological
researches, applied to pathology and therapeutics ; 2,000fr. to M. Lu-
cas, for his physiological and practical treatise on hereditary maladies ;
2,000tr. each to MM. Tabarie and Pravez, for the medical use of
compressed air ; 2,000fr. to M. Gluge, for his pathological histology ;
l,500fr. to M. Gosselin, for his researches into the obliterations of
spermatic channels ; l,500fr. to M. Garriel, for his application of vul-
canized caoutchouc to medicine and surgery; l,000fr. to M. Serres,
for his researches respecting the phosphenes; and lOOOfr. to M. Boinet,
for his work on the treatment of chronic abscesses by injections of
iodine."

Medical Colleges in the State of Neio York. An application has
been made to the Legislature of New York, for a charter for a seventh

1852.] Miscellany. 323

Medical College, and an adverse report presented by the Committee
to whom it was referred. Among other reasons assigned, is that of
the inability of the existing Colleges to sustain themselves, as evinced
by this indebtedness. The College of Physicians and Surgeons, owes
$15,000 ; the Geneva College, $400 ; the New York University Col-
lege, $47,000 ; and the Buffalo College, $3,300. We derive the
above information from the New York Medical Gazette.

Neio Medical Periodicals. A new feature in the periodical medi-
cal literature of our country, is the publication in New Orleans of
" L'union Medicale " in the French language. A portion of the
" Canada Medical Journal " is also published in French. This will
doubtless enable many of our medical men to keep up their knowledge
of that polite and useful tongue. We have received " The East
Tennessee Record of Medicine and Surgery," edited by Frank A.
Ramsey, A. M., M. D., Knoxvills. It is to be issued in quarterly
numbers of 100 pages each.

A New Method of Whitening Bones. By Ellerslie Wallace,
M. D., Demonstrator of Anatomy in Jefferson Medical College,
Philadelphia.

To the Editors oi the Medical Examiner.

Gentlemen, During the past year, I have used sulphuric ether for
the purpose of extracting the greasy matters from bones of which I
have desired to make preparations, and have uniformly found it entirely
satisfactory. I have used it for entire skeletons where they have been
of value.

Twenty-five or thirty pounds of ether (which can be obtained for
18 cts. per lb.,) is enough for a skeleton, if the bones be closely
packed in a proper case. After pouring the ether on them until they
are entirely covered, they may be left for some hours, or a day ; then
removing them, they should be allowed to dry thoroughly. This pro-
cess should be repeated as often as may be necessary.

Six immersions have been enough for a very greasy skeleton. It is
prudent to wash the ether before using it, to remove free acid, and we
may have the ether re-distilled after it is saturated with the oil. To
morbid specimens, as of caries, &c., it is admirably adapted, as it re-
moves the grease entirely, without injuring the delicate structure at
all, which is not the case, as we all know, with any of the ordinary
alkaline solutions.

Mortality of Children. According to Quetelet, 22,472 children in
every 100,000, die within 12 months after birth ; and more than 2 in
every 7 within the first 2 years. This may be true in Europe, but
we think that, it is certainly not so in our country.

324 Miscellany.

Tribute of Respect. At the regular meeting of the Georgia Medi-
cal Society, held on the evening of March 4th, the Committee appoint-
ed for the purpose, reported the following Preamble and Resolutions,
\vhich met with unanimous adoption by the Society :

Since the last re^uilar meetincr of the Georrria iVIedical Societv, our
esteemed President, Dr. Cosmo P. Richaedsoxe, has departed this
life. The many and various tributes to his worth as a citizen, which
were poured in on all sides, the distinguished honors paid at the inter-
ment of his remains, truthfully attested the high estimation in which
he was held by his fellow-townsmen. While we rejoice that one of
our number should have so faithfully fulfilled all the duties of his social
position, as to have descended to his grave amidst the sorrow of a
whole people, it becomes our duty to pay our tribute to him more ex-
clusively as a member of our Society, and as an ornament to his Pro-
fession ; a Profession which we are pioud to consider as inferior to
none in dignity of calling and humanity of purpose.

To a mind of great quickness of perception, he united a decision of
character and action which rendered hirfi ever prompt and energtic in
ministering to the sick. A large practice and the unbounded confi:-
dence of his immediate patients were the legitimate results of these
qualities. His intercourse with his Brother Physicians was marked
with all the courtesy and liberality due to his own high sense of the
requirements of a liberal Profession, whose standard he ever labored
to elevate. While he endeavored to do this he treated with the con-
tempt of conscious superiority, those self-styled systems of medicine
which are tried more as a royal road to money than to learning, and in
the success of his own practice gave ample evidence that in following
the lights which had been hung out by the experience of ages, he fol-
lowed no ' Will-of-the-W^isp.'"

It is therefore Resolved hy the Georgia Medical Society, That in the
death of Dr. Cosmo P. Richardsoxe, they have lost one who was
endeared to them as a man by his kind and generous feelings ; one
who from his large experience and great natural qualifications, and
his high tone in all situations, in which he came in contact with his
Brother Physicians, was an ornament to his Profession, and whose
loss in the meridian of life and usefulness, they unaffectedly deplore
as a most serious one to them.

Resolved, That this Society do most deeply sympathize with the
Family of the deceased, and that a copy of these Resolutions be fur-
nished them ; and that they also be published in the Daily Prints of the
City, and in the Southern Medical and Surgical Journal of Augusta.
R. D. ARNOLD, Chairman Committee.

J. Gaxahl, Secretary.

i

Errata.

Page 264, fourth line from bottom, for "live," read life of the.

" 265, sixth line from top, for "page," read lecture.

" 266, thirteenth line from bottom, for " type-form," read type-poicer.

" 269, fourteenth line from bottom, for "their," read <Az5.

" 270, eighth line from bottom, for " dissimularities," read dissimilarities.

" 271, seventh line from top, for " existing," read exciting.

" 274, second line from top, for " inflamation," read infUtTnTiiaUon.

SOUTHERN

MDICAL AND SURGICAL
JOUKML.

m. 8.] NEAV SERIES. JUNE, 1852. [No. 6.

PART FIRST.

rtgxnal (HommunicatiottB.

ARTICLE XVII.

Remarks on Craniotomy, with a case. By Wm. Nephew
King, M. D., of Roswell, Georgia.

Instrumental parturition has probably been practiced from
the earliest times. Indeed, it is impossible to trace the history
of many operations of obstetrical surgery to their origin or to
say who were the originators of them.

The Coesarian operation, for example, is of very great anti-
quity. Dr. Mansfield, in his work on the Antiquity of Gas-
trotomy and Hysterotomy, on the Living, informs us that in the
Thalmud, Gastrotomy is mentioned under the article on Here-
ditary Rights, and re-asserts that in an earlier work called
Mischuajoth, bearingdate A. M. 140, this passage occurs *'in
a twin-birth neither the first child, which by the section of the
belly is brought into the world, nor the one coming after, can
attain the rights of heirship or the priestly office." But even
this great antiquity is lost in the still remoter period fixed by
fabulous historians: thus, Jupiter snatcfied from the abdomen
of the wretched Semele, his son, yet unborn, when the Goddess
was killed by the thunder and lightning in which her divine
lover was obliged to approach her. The Romans held that
iEsculapius was delivered in the same way by Apollo. Virgil
states that Lycus was born in the same- manner. Pliny is,

N. S. VOL. VIII. XO. VI. 21

326 King, on Craniotomy. [June^

ijowever, considered the first writer of authority on this points
Although the operation is of undoubted antiquity, yet it is
not mentioned in the works of Hippocrates, Celsus, Paulus
iEgineta, or Albucasis, and the earhest account of it in any
medical work is said to have been published about the middle
of the 14th century. In 1491 Nicolai de Falconiis, recorded a
case ; but Velpeau states that it was performed in 1424. Spreng-
el asserts that it was not performed upon the living subject be-
fore the year 1610, while many writers deny altogether that it
was known to the ancients ; among whom are Deleurye, Levret?,
Mauriceau and Mendel. In proof of its remote antiquity,
Plenck, Dionis and Gardien refer to the thirty-fourth book of
Pliny's Natural History.

Organikotocia or Instrumental Parturition was practiced by
Hippocrates, and in his works are recommended all the obste-
tric instruments now in use ; but of course imperfect in their
construction, and some of them difficult of application. Thus,
for a perforator, he used and recommended a small sword, and
his forceps had teeth he speaks of a blunt hook also.

The application of instruments in obstetrical practice, always
requires delicacy and decision; the practitioner is often swayed
by the opinions and prejudices of those around him impercep-
tibly, it may be, but none the less certainly : in those operations
which require a solution of continuity, not only the prejudice
of ignorance, but religious^, faith often determines the- character
of the operation.

One instinctively shrinks from the destruction of a living
infant, and is anxious to delay all action until death shall have
supervened; and in every case requiring the operation of em-
bryotomy, the accoucheur is glad to observe a want of pulsa^
tion at the fontanels an absence of motion in the child' the^
shivering fits the placid breasts and foetor of the uterine dis-
charges in the woman that are characteristic signs of the death
of the foetus, before proceeding.

These, d\\hong\i sign^ of death, are not true diagnostics;
and many instances are recorded in whiciif the operation has
been performed and the child been born alive. This is readily
accounted for when we remember the origin of the cerebral
nerves, and the functions of which are not alwavs destroyed.

1852.] King, on Craniotomy. 327

In those cases in which the child is hving, and where the brim
or outlet of the pelvis is so deformed as not to admit of a
delivery, the accoucheur has the choice of two formidable oper-
ations : in the one, the life of both mother and child may be
saved in the other the child must be sacrificed.

That the child is often unwarrantably sacrificed, in this and
in other Protestant countries, no one can doubt, and indeed, we
understand that, in a medical society in our State, a gentleman
not long since, argued that the destruction of the child was
proper, in order to avoid the probable contingency of a vesico-
vaginal fistula. In England, the preference given to Cranioto-
my, arose from an essay by Osborne ; but his deductions are
abundantly answered, exposed and ridiculed, by Dewees ; and
since the great success which has attended the Caesarian section
Embryotomy has gone somewhat into disfavor. Craniotomy,
says Ryan, is impracticable in cases of extreme deformity, and
from mature consideration of the history of the Caesarean sec-
tion, it is obvious that the extraction of the infant by Cranioto-
my is as fatal an operation to the mother, and there is often
much more injury inflicted on her than by timely removing the
infant through the abdomen. " I would venture to predict,"
says he, "that Embryotomy will be nearly discarded in a few
years;" and again, "the absence of a religious motive, is a
cause of the comparatively frequent performance of embryoto-
my in this empire the necessity of its too frequent performance
in all Protestant countries, is almost exclusively founded on the
impracticability of delivery by the natural passage." " I know
these are unpalatable assertions, but truth is great and will
prevail." Tyler Smith, in his work on Parturition, says, "The
Catholic doctrine of the value of extreme unction, as regards
the mother, and the necessity of baptism to infant salvation ;
the different views on these points held by Protestants, are visi-
bly written in theprecepts of practical midwifery, and taking
France and England as the types of the two great varieties of
practice, he presents us with the characteristics of each type.
Protestantism^ always considers the social relations always
preserves the mother, when the destruction of the infant will
secure that object. It considers the child as already dead
Catholicism, ' ari contraire,' makes the life of the child practi-

328 King, on Craniotomy, [June^

cally of more importance. The mother receives the sacrament
of extreme unction, and being thus secured, her life is sacrificed
and the child saved, if possible, that it may be spiritually washed
with baptismal water."

The following is the division of Dr. Smith.

PROTESTANT PRACTICK GIVKS THE PECI- ROMAN CATnOMC PRACTICE, LEANS TO
DED PREFERENCE TO THE LIFE OF THE THE LIFE OF THE INFANT.

MOTHER. This is seen

This is seen In the fa\-orable opinion entertained

In the partiality for Craniotom}-, of the Caesarian operation in Roman

In the induction of premature labor. Catholic countries.

In the proposed separation of the pla- In the high opinion in which the

centa in placenta praevia. Sigauliian operation has been held.

In the dislike of the Caesarian sec- In the frequent use of the long for-

tion, the Sigaultian operation, and the ceps.

frequent use uf the long forceps. In the great dislike to Craniotomy,

and the induction of premature labor.

In our country, the attempt to save both mother and child,
by Caesarian section, is rapidly growing in favor, and very just-
ly so, from the success which has attended the operation
but there is beyond question, too little attention given to the
life of the foBtus. Practitioners do not esteem the foetus in utero
as having sufficient claims upon their consideration, to author-
ize the jeopardizing the life .of the mother ; though the risk, in
which that life is placed, may be comparatively trivial. In-
many instances, in which the interest of the mother and the
offspring clash as in the plan of detaching the placenta, and
extracting it before the child, in placenta presentations, there-
is as much indifference shown to the life of the child, as in Cran-
iotomy. This "revived plan," of practice has been termed,
"an excessive and unjustifiable application of the British rules ;"
but it finds very many advocates among us, although it does^
not hesitate to sacrifice the life of the fcetus, for "an assumed,
but improved advantage to the mother,"

We have thus briefly glanced at some points in obstetricr
practice, more for the purpose of suggesting reflections, tha
from any expectation or intention of deciding any disputed
points of practice. The case which we have to offer is one in
which we were not called upon to question the propriety of our
course. Indeed, we have thought, that had the case come under
our care, at an earlier period of its progress, we would have
been able to have effected the delivery without the use of in-
struments. We should not have hesitated however had there

1852.1 King, on Craniotomy. 329

been signs of life in the fcctus, and such deformity as to have
rendered deh'very impossible by the natural way to have
made an attempt to save the lives of mother and offspring, by
the Caesarian section, after the manner we saw the operation
performed, with great skill and perfect success, by M. Paul
Dubois, in his wards in Paris, during tfie last season.

On the morning of the 13th December last, was called to Mrs.
T., aged 18 years, first child, said to have been in labor 52 hours,
her attendant "w?ie sagefemme de la cam-pagner

The pains were during this time of short duration and at
long interTals, of course very ineffectual. At the time we saw
the case, there was considerable acceleration of the pulse, and
the pains were severe, and had been so since the "waters," were
-discharged, some eight hours previous; as they were described
to us, they must have been strong, vigorous, expulsive labor
pains.

Upon making an examination per vaginam, found the exter-
nal organs in a soft and relaxed state, and the head of the foetus
wedged very firmly within the pubic arch, the presentation was
the "occipito sacree second aire" of the French. An attempt
was made to introduce the forceps^but it was found impossible.
Turning was out of the question, and now all that remained
was to perform the operation of Craniotomy, which was accord-
ingly accomplished in the manner recommended by M. Chaiiiy
of Paris which may be found in his excellent work L'artdes
Accouchements. (See page, 582.)

The position there mentioned, viz. the Dorsal, is that usually
selected by the obstetricians of continental Europe, while the
left lateral is preferred in England. The left hand being greased,
the fingers introduced into the vagina, and having them placed
on the fontanel (or in the course of the sagilal suture) the per-
forator was then introduced along the palmar surface of the
hand great care being taken to avoid wounding the soft
parts of the mother, when by a rotary motion, the perforator
was passed through the cranium, and the cerebral mass broken
up. The perforator, now having been closed, was carefully
withdrawn. In the case under consideration, the brain was
removed, it not escaping, as is usually the case when uterine
action is present. Slight traction was then made upon the
foetus, when it escaped without difficulty.

330 Robert, on Veratrum Viride. [June,

After the foetus had been extracted, we perceived that the
abdomen remained unusually distended, and on introducing the
hand, another foetus was discovered. By this time, the female
was almost exhausted ; we administered brandy and carb. am-
mon., which revived her the pains came on, and the last foetus,
very diminutive in size, was expelled.

The case terminated very favorably; was attended with no
hemorrhage. She was discharged on the 10th day after, and is
now in the enjoyment of as fine health, as at any time prior to
her accouchement,

ARTICLE XVIII,

Ohservations on the use of Veratrum Viride, By W. H.
Robert, M. D., of Orion, Pike county, Alabama.

Although several articles have appeared in this journal, since
Dr. Norwood's first communication, the importance of the sub^
ject must justify the present. I now propose to notice the use
and effects of the Veratrum Viride, as observed in my prac-
tice.

Pneumonia. It was in May, 1851, that I first used the
article. I was called to a case of Pneumonia of the right lung,
The patient was a man, 45 years of age, who had been suflTer-
ing for a few days from general inflammatory symptoms, and
was apparently relieved, when he suddenly took a chill, follow-
ed by high fever. I saw him 24 hours after the onset of the
chill and fomid him laboring under confirmed Pneumonia.
Difficult and hurried respiration, frequent coughing, severe
pain in the right side, and bloody expectoration ; pulse, 126 in
the minute, full and hard. Without any hesitancy, I applied a
very large blister to the affected side, and put him on the use
of the tinct, veratrum viride, in doses of twenty drops every
three hours, until it produced sufficient nausea to affect the
pulse. I then reduced the dose to 15 or 10 drops, provided
the latter dose controlled the action of the heart. On my next
visit, I found the pulse reduced to 75 in the minute ; respiration
easy and natural, expectoration white and scanty, skin very
0iuch relaxed, and the surface cool. The blister had drawn

1652.] Robert, on Veratrum Viriie. S31

y/ell, and relieved the pain in the side. The medicine had pro-
duced very distressing sickness and vomiting during the first
part of the night ; now it only produces sickness immediately
after taking each dose. I pronounced the patient safe from
that time, but directed the continuation of the medicine for
some three or four days, in gradually reduced doses. At the end
of that tfime, he complained of nothing but the medicine, nor
had he since the first 24 hours after commencement of the medi-
cine.

I would here take occasion to remark, that in pneumonia, I
always apply a very large bhster to the affected side, and
sometimes cups. I find that very free vesication gives more
relief in subduing the pain and calming the respiration than
any other remedy. While the blister is doing this, the veratrum
viride is producing its specific effect upon the heart.

^Case 2, occurred in September last. The right lung was
inflamed ; very similar in its onset to the first ; was treated
in the same manner, and with precisely the same results re-
ducing the action of the heart in about 18 hours. In this case,
the medicine produced its hiccough effect, which alarmed the
patient very much.

Cases 3 and 4, occurred at the same house, in J^fovember last.
'One was a negro woman, six months advanced in pregnancy :
she had been very sick for four days previous to my visit.
The secretion from the left lung was so abundant as to threaten
suffocation ; expectoration could not clear the lung long enough
to procure any rest constant coughing, pulse 125 per minute,
and very irritable. After applying the blister, I commenced
the Veratrum Viride, in 20 drop doses. On my next visit, 24
hours after, I found the patient no better; the system had not
been affected by the medicine in the least ; the distress of the
lung fully as great as the day before ; added to all this, she was
now threatened with abortion. I immediately gave half tea-
spoonful of the tinct., and directed the 20 drop doses continu-
ed as before. As I lived but two miles off, T requested to be
informed if abortion took place before morning. At 10 o'clock
P. M., a messenger informed me that abortion had taken place.
I sent word to continue the medicine.

On my visit next morning, I found such ^a decided relief of

332 Robert, on Veratrum Viride. [June,

the distressing symptoms, that I was truly afraid to express
myself. The pulse had fallen to 70 ; respiration free, expecto-
ration easy ; sputa (before very bloody) now scarcely tinged.
I continued the medicine a few days longer, which sealed the
convalescnce.

So confident was the master that the woman would die after
the abortion, that he was not willing to bury the foetus until
he saw there was no probability of putting the mother with it,
that time.

The other case (4th) was a young lady, sick (at the same
time as the negress,) with double pneumonia, and who was re-
lieved entirely in a few days, by the tinct. veratrum viride
and extensive blistering.

Case 5, occurred in December, in a man, aged about 28
years. He had pneumonia of the left lung, blistering and the
linct. veratrum viride relieved him in a few days. He had
no fever after the first day.

Case 6. From some peculiarity attending this case, I must
give a more minute account of it than of the preceding :

The patient, (a ditcher by occupation.) contracted pleuro-
pneumonia of the right side, early in January last. He had
been bled and purged before I saw him, which was two days
after the onset of the disease. I found him suffering intensely
"with pain, (which was confined to the posterior and innrer parts
of the,right side of the chest,) and difficult respiration, and was
unable to lie down or to cough. Pulse 115 per minute, and an
intermission of every fourth pulsation. I cupped the side very
freely over the seat of the pain; after which, I covered the
part with a very large blister, I then put him on the use of the
tinct. veratrum viride, in 20 drop doses, every three hours.
On my next visit, I found that the blister had drawn very w^eli,
but with only partial relief to the distressing symptoms. Ex-
pectoration was however batter established, and the matter
expectorated, was a mixture of mucus and pure blood.

No perceptible effect of the medicine. I ordered the blister
dressed with basilicon ointment, and continued the medicine
as before. On my third visit, I found less pleuiitis, but more
pneumonia, which was gradually extending to the superior and
anterior part of the lung. There was less pain, except in

1852.1 Robert, on Veratrum Viride. 333

coughing; the secretion from the lung was not very copious,
and when expectorated, appeared to be a lump of coagulated
blood. The medicine had produced its specific effect in a very
singular way : the pulsations at the wrist appeared to be only
40 to the minute; yet on a careful examination of the heart, I
could detect an effort made by it to produce a contraction be-
tween each pulsation at the wrist ; but apparently. too much
depressed to perform its office ///?/ more than 40 times to the
minute ; added to this, the bowels had become very irritable,
and the attendants were of the opinion that the tincture operated
on the bowels. Not liking the depressed condition of the heart,
and the irritable state of the bowels yet not perfectly willing
to suspend the use of the veratrum, I determined to persevere
with it in combination with opiates, for at least 24 hours longer.
The opiate controlled the bowels, but produced a good deal of
stupor. The depression of the heart continued the same. I
suspended the use of all remedies, only such as particular oc-
casion would demand, such as opiates, &c., internally, and re-
lied upon the effects of the blister. The pneumonia gradually
advanced so as to affect the whole lung. I covered the whole
anterior part of the right side of the chest with a blister; on
the drawing of this, thg heart became regular in its action, but
pulsating only sixty times per minute. This was some days
after the entire suspension of the veratrum viride, and yet
with active pneumonia all the time. Every mouthful of sputa
"Was of the character last mentioned that is, having the appear-
ance of coagulated blood ; gradually, the respiration became
easier, expectoration better, the case progressed on favourably,
and recovery took place, without any increase whatever in the
action of the heart. The last time I examined his pulse, I count-
ed only GO beats to the minute, and this when he was going
about. This is the only case where I have ever entertained
the least idea that the veratrum viride would purge, and this,
too, the only case where the heart failed to react upon a sus-
pension of this medicine after so short a trial.

Case 7. Was under treatment at the same time as the pre-
ceding. It was a much milder case of pneumonia, but com-
plicated with rheumatism of both knees : both complaints were
relieved at the same time. I blistered the chest, and gave the

334 Robert, on Verairum Viride. [June,

tinct. veratrum viride for some four or five days, with the
happiest result.

I have some 6 or 8 cases more on my note book, treated in
precisely the same way, but I consider the above to be enough.

I have supplied some of my brother practitioners with a
small quantity of the tincture for trial, and all are well pleased
with it. In a conversation recently with Dr. A. S. Johnston of
Troy, upon the effects of it in pneumonia, he made this an-
swer to me " I do not know how I have been treating Pneu-
monia, nor what I could do without it."

Cynanche Trachealis. I have used this remedy in one case
of the above disease. I produced the specific of the medicine,
on the child, and continued it so, for two days, but without
any beneficial effect. The child died.

Typhoid fever. I have used it in five cases, and I cannot
say that I derived any benefit from it, except in one of them.
This was a relapse. The patient suffered no pain ; there was
some tympanitis of the bowels ; the tongue was but slightly al-
tered in colour or appearance ; bowels were not relaxed ; the
pulse 125 to the minute, and rapidly increasing in frequency,
and just such a case as 1 have in my practice denominated the
nervous form of the disease. For two weeks, I had been using
all such remedies as are commonly resorted to in cases of the
kind, but without avail. As a last resort, I determined to try
the effect of veratrum viride. I succeeded in twelve hours
in producing its specific effect in a very powerful degree, at-
tended with considerable prostration. I kept up the effect of the
medicine eight days, and convalescence was fully established.
I continued the remedy thus long in the above case, because
experience had taught me, that a much shorter time would
have no permanent effect, at least in typhoid fever.

In the other cases of typhoid fever, in which I used the
remedy, I could produce its specific effect ; but, as soon as I
relaxed in giving the medicine, the disease would resume again
its regular course.

In Mammary Abscess, I used the remedy in one case, with
the happiest effect. The lady had been confined two weeks
previous, and was taken with a very severe chill, which lasted
half a day. I was called to her in the afternoon of the same

1852.] Robert, on Veratrum Viride. 335

day, and found her suffering very much with pain in the left
breast, and in the axillary glands of the same side. There was
some nausea and tenderness of the bowels, which were costive ;
pulse very rapid and irritable. She was purged freely, and
warm poultices were applied to the breast ; small portions of
spts. of turpentine were administered internally. On my visit
next morning, I found the patient no better ; the breast more
painful than yesterday, glands also very sore, pulse exceedingly
rapid. I determined to try the effect of the veratrum viride
in this case. I produced its specific effect in about ten hours :
the prostration was so great as to alarm the friends of the lady,
and I was sent for. On my arrival, I found reaction had taken
place as much as I cared for it to do ; the pulse had come down
to 70 per minute, the pain in the breast and glands had sensibly
diminished. I did not give any more of the medicine ; she had
no more fever, and escaped one of the most painful of diseases,
mammary absess.

Some may imagine, that the cases of Pneumonia above de-
tailed were slight, and not a fair test. In answer to this, I
only say, that before the employment of quinine to the present
extent, bilious fever always lasted from 7 to 13 days ; but who
sees a case of bilious fever last that long now? Those who
are prejudiced against the free use of Quinine, can best answer.
I look upon the action of ver. vir. on the system, (at least
in pneumonia,) as giving such a decided check to the disease,
as to effectually prevent its progression to that severe type
which it so commonly assumes, under any other mode of treat-
ment.

I have to record aaly one fatal case of pneumonia occurring
in my practice, since i haf/e employed this remedy and that
case was a dear infant of my own, sixteen months old. In this
case, the medicine produced violent vomiting and great pros-
tration ; but I never could reduce ihe frequency of the action
of the heart. The disease became chronic^ and proved fatal
in .three months.

While practicing. medicine in Middle Georgia, in 1844, '45,
and '46, there occurred a very severe epidemic, (pneumonia,)
producing great distress^ in a large scope of country. I saw

S36 Robert, on Veratrum Viride. [June,

fully the fatality attending it in the ordinary modes of treat-
ment ; and I am perfectly satisfied that had this remedy been
used then, the result would have been far different.

In a few words, I will give the effects of the tinct. vera-
trum viride, as I have seen them*. The first appreciable, is
its emetic effect : gradually, during the nausea and vomiting,
the pulse loses its fulness and frequency, very free diaphore-
sis comes on during the vomiting, and sometimes continues so
long as the medicine is kept up ; at other times, only when nau-
sea exists ; this is accompanied generally with a cool state of
the surface. I have found that the depression of the pulse will
generally continue twelve or fifteen hours after the vomiting
is first produced, if no more medicine is given. I generally
reduce the doses from 25 drops down to such doses onl}^ as
will produce nausea, not caring to produce any more vomiting
after the first time, unless the heart reacts too much under the
nauseating doses. In some cases, I have found the stomach so
susceptible to the presence of this medicine, that I have been com-
pelled to disguise 8 drop doses in a draught of sweetened water.
For the first two or three days after taking the medicine, there
is a very free discharge of mucus from the fauces, afterwards
the whole buccal cavity becomes very dry. Hiccough is
sometimes a very distressing effect of its long continued use.

As I have said more than I intended in the first instance, I
will close with but a few more words. If I can induce some
physicians to listen to the appeal of Dr. Norwood, and give this
medicine a fair trial, I have no fears that they will reject it.
In conclusion, allow me through the medium of this valuable
journal, to present to Dr. Norwood my sincere thanks, for his
efforts to introduce properly to the profession this medicine ;
one which I now consider second to none. I do not claim for
Dr. Norwood the discovery of this medicine, but I do claim
for him, the discovery, in this medicine, of certain effects upon
the system which he ascribes to it, which he has fully proven
to belong to it, and which any one may observe who will use it.
The tincture I use, is made by digesting \ lb. of the root in a
quart of alcohol.

1852.] Donald, 072 Electricity. 337

ARTICLE XIX.

Cases demonstrating the utility of Electricity in the treatment
of disease. By A. Donald, M. D., of Alabama.

Case I. On the 27th day of September last, I was invited
to see Mrs. G. C, a lady about 47 years of age. She com-
plained of severe pain in the ends of the fingers of her right
hand I examined them, and found them to be insensible to
the touch and to cold, and of a deep purple hue, presenting over
the back of the hand a shrivelled appearance, with some longi-
tudinal depressions on the palmar surface of the fingers. She
was a lady of the sanguine temperament, with round, full fea-
tures, blue eyes, light hair and small extremities, and when in
health a florid complexion; but, at this time, she looked pale
and manifested some slight agitation ; there were also some
purple spots over the palmar surface of her hand, about the
size of a dime ; the pujse at the wrist very small and some-
what irregular in its action ; the pain at night prevented sleep ;
but little appetite for food; constipation, and occasionally very
sick at the stomach. Diagnosis : a tendency to mortification^
or gangrena senilis, caused by obstructed circulation. Having
observed that the treatment generally resorted to, under such
circumstances, had failed, I resolved to try Electricity, as I be-
lieved it to be, if not vital force, at least capable o^ performing
the office of the vital jorce. I at once began the use of this
agent, with one of Dr. S. B. Smithes Torpedo-Electro-Magnet-
ic Machines. After putting the machine in operation, I made
the first application, by placing the negati^'e pole on the back of
the neck, and the positive pole on the ends of her fingers ; and
finding that she gave no evidence of its power, I then placed one
pole on each side of her fingers, and, as before, she gave no evi-
dence of its presence. I continued the application for half an
hour, and still there was no impression made; I then ordered a
basin of water, quite warm, placed her hand in the water and
then put the positive pole in the basin, with the negative pole on
the back of her neck. After some ten minutes had elapsed, she
experienced very slight sensations; but after continuing this
application for one hour, the pulsations were more distinct,
though only slight. I then discontinued the application for

S38 Donald, oh Electricity. [JUneli

that day, and ordered that the hand be kept continually warm
and dry. This application was made for twelve days, in suc-
cession, arid a perfect and complete cure was effected at the
end of this tfme ; the hand looked to be at least ten years
younger than the other hand. I would remark that I occa-
sionaliy applied it to the whole system in this case.

Case II. J.M. a highlyrespectable planter, of Butler county,
Alabama, had been afflicted with chronic rheumatism, in both
knees, for several years, and had tried nearly all the remedies
generally resorted to in such cases. I determined to try elec-
tricity in this case i I did so, and in one month had the satisfac-
tion of seeing him perfectly cured. In this case, I made the
application by placing the negative pole on the sacrum, and
the positive pole over the parts affected.

Case III. Mrs. B., of Lowndes county, Alabama, about 60
years of age, had been vaccinated in January, 1851, which oc-
casioned high fever for several days, aftei" which she found
herself to be quite blind : she could not distinguish a man from
a horse across the road. After being in this condition about
seven months, she came to me for relief. Finding no structur-
al change in her eyes, I concluded that the blindness depended
upon debility of the optic nerve, and began the use of electrici-
ty, by applying the positive pole to the back of the neck, and
the negative pole over the eyelids, (the eyes being closed,) as
I only wanted its tonic effect. I continued the application
from fifteen to twenty minutes, each day, for two weeks, at the
end of which time she was so much improved that she could
see how to take up * stitch in knitting.

Case IV. Jacob, a negro man, the property of Mr. J. M.
Yeldell, of Butler county, Ala., had rheumatism in his left vastus
externus muscle, and in his right ankle, which was very much
swollen. I put him tipon a long table, and began with electri-
city, by placing the negative pole on the sacrum, and the posi-
tive pole freely over the parts affected. The first application-
was continued one hoar, for the purpose of producing a per-
fect reaction in the parts ; the application was made about
candle-light in the evening; the next mornit)g I was astonish-
ed to find that the swelling in the ankJe had entirely disappear-
ed, and that there was no pain in the parts. I applied the poles

1852.] Donald, on Electricity.

again, as before, and have understood that he has been well
ever since.

Case V. Two years ago, I was seriously troubled wilb
rheumatism in the whole of the deltoid muscle of the left shoul-
der, and tried naany remedies, with only partial relief. My
arm continued to be almost paralysed I could not support any
degree of weight, with my arm in the horizontal position.-
Finally, last spring, I had another attack, involving the right
arm, in the same manner, and tried colchicum, guaiac, nitrate'
of potass., and various other remedies, without relief. I began
to think that I should lose the use of both arms, and commenced
the use of electricity, by applying the negative pole to the cer-
vical region, and the positive pole over all the parts affected.
Jn about ten days I was much improved. One fact I observed
in my own case, was that, in a few moments after the applica-
tion of electricity, the pain, however severe before the applica-
tion, would be entirely relieved, and, in many instances, would
not return again for twenty-four hours.

Case VI. On one occasion, I was afflicted with dyspeptic
head-ache, with nausea and vomiting ; I used electricity, and
in a moment (after taking one pole in each hand) the sickness
at the stomach was entirely relieved, and the pain in the head
disappeared as suddenly. I am satisfied, from repeated trials,
that nothing in the materia medica will relieve vomiting so
soon as electricity.

Case VIL Mrs. C, after delivery and removal of the pla-
centa, was threatened with dangerous uterine haemorrhage.
Electricity was employed in the following manner ; the posi-
tive pole was placed upon the sacrum, and the negative pole
(being properly insulated) was applied to the os uteri ; in an
instant the contraction was effected, and the haemorrhage suc-
cessfully arrested.

Case VIII. Mr. G., had been afflicted for several years
with a fistula in-ano. After syringing the parts with warm
water, the negative pole was placed over the external orifice,
and the positive pole over the sacrum : the applications were
continued for thirty minutes, twice a day, (always after cleans-
ing the parts,) and in ten days the cure was complete, and has
continued so ever since. In this case, the opening was in the
cellular tissue.

840 Donald, on Electricity, [June,

Case IX. A lady about 45 years of age, had been afflicted
with menorrhagia for seven years : she had taken a great deal
of medicine during this time, with but partial I'elief. I had
treated her myself with tonics, to improve her general health
and with the secale cornutum, for its specific effect, without
success. I finally had recourse to Electricity I placed the
positive pole over the sacrum, and the negative pole to the os
uteri, and after daily application for two weeks, it was discon-
tinued, and the lady is now" entirely well.

Case X. Miss H., aged about 22 years, had, from puberty,
been afflicted with that most painful malady, dysmenorrhoea.
She had been treated for it, under the presumption that it ori-
ginated from a rheumatic condition of the uterus. I had used
Dr. Dewees' famed remedy, " comp. tinct. of guaiacum," with-
out success, and then proposed Dr. Mcintosh's treatment of
the bougie. This was objected to, and I then proposed Elec-
tricity, believing that the canal was subject to spasmodic con-
striction ; for I found that this painful condition did not last
more than eight hours, whereas, if it had been a permanent
constriction, the pain would have continued throughout the
four or five days. Having found by observation that the pos-
itive pole w^as expansive, and the negative contractive, and
that one of the effects of electricity was to soothe pain, I be-
gan by placing the negative pole on the sacrum, and the posi-
tive pole to the os uteri, with a moderate power, for from 15
to 20 minutes each day, for two weeks. A complete cure.

Case XI. A young man, aged about 23 years, had a gleet
of about 12 months standing. When he came to me, he look-
ed pale; his appetite was bad ; it was evident from the history
of the case, that debility existed, which had perhaps been in-
duced by excessive sexual intercourse. Without doing any
thing else, I advised electricity, which he used about 3 weeks,
and was perfectly cured. In this case, I placed the negative
pole on the end of the glans penis, and along the urethra, from
the frsenum backward, and the positive pole on the sacrum.

Case XII. A young gentleman had been troubled with
chronic gonorrhoea for about 12 months. I advised him to use
Electricity (he had used many other remedies) he did so,
for about one month, and the cure was completed. It was
used, in this case, in the same manner as in the one of gleet.

1852.] Donald, on Electricity. 341

Case XIII. Miss L. C, of Butler county, Ala., about 17
years old, was affected with partial paralysis of the right side,
from the time that she was six months old. At that time she
had an attack of fever, which terminated in the affection above
mentioned ; she could not, by volition, control the action of her
hands or feet; if she attempted to place her toes outward,
they would be just as likely to turn inwardly; if she attempt-
ed to take hold of any thing, she could not grasp it at will. In
this case, I also advised Electricity. I began, by applying the
negative pole to the back of the neck, and the positive pole
over the whole of the affected side, from the toes upward. I
continued this application every night for two weeks, one hour
each time. In this case, the improvement was beyond my
most sanguine expectations. Miss C. can now use her foot
sufficiently well to dance, and can grasp a dipper and take a
drink of water, which she never could do before. I am now
sanguine enough to believe, that if the treatment were con-
tinued, she would get well, or recover the use and fullness of
the affected side completely.

[Note. I am under promise to continue the case, and will
report the result.]

I have seen a great many painful affections relieved, by the
use of electricity such as head-ache, tooth-ache, neuralgic
pains about the face, neuralgia of the head, sciatica, &c., &c.
In amenorrhoea, where it is caused evidently by a want of
capillary circulation, electricity would be suggested to my
mind as a most valuable remedy for we have seen our Pro-
fessor of Chemistry cause water to flow in a stream, through
a tube, by running a current of electricity through the tube
with the water, when previously this only went through by
drops. We have also seen persons relieved of boils or furun-
cles in a few days, which had been very troublesome before.

We see in the Dublin Journal of Med. Science, May, 1849,
that an obstinate case of hydrophobia was successfully cured
by the use of Galvanism, applied by Dr. Rossi; also, in the
same Journal, 1847, that it is announced that a case of poison-
ing by opium was successfully treated by the same agent. We
[ have seen also, in the London Medical Gazette, that Archord,
of Berlin, made an experiment upon himself, which, if true, is

N. S. VOL. VIII. NO. VI. 22

343 Donald, on Electricity. [June,

worthy of notice: He placed a plate of Zinc in his mouth,.
and a piece of silver in the anus, and having connected them
by a piece of copper wire, his bow^els were immediately dis- .
charged of their contents. I

We have seen that Professor Means, of the Medical College
of Georgia, (in the South. Med. and Surg. Journ., vol. 4, No. 3,
March, 1848,) says,. "Under the generating power of a large
electro magnet and revolving armature^ I have seen a case of
paralysis, of the muscles of the eye, cheek, lips, &c., entirely
relieved, after a few applications, of fifteen minutes ehch, which
had I'esisted the ordinary treatment for several months pre-
vious." And again, he says, page 150, "My esteemed col-
league, in the Chair of Surgery, has kindly furnished me with
a case of spasmodic contraction of the flexor muscles of the
knee joint, which yielded to the^7'5^ application of a moderate
magneto-electric current."

We have it stated by A. D. Bacon, M. D., of Massachusetts,
that he cured a case of tetanus, by the use of electro-magnetism.
Dr. Wilson Philip observes, " that in cases where there was a
failure in the secreting power of the liver, I have repeatedly
seen from Galvanism, the same effect on the biliary system,
which arises from calomel, a copious biliary discharge from
the bowels coming on a few hours after the employment of
Galvanism." (Sturgeon's Galvanism, p. 112.)

M. Martinet reports the case of a man aged 66 years, ad-
mitted into one of the clinical wards of Prof Recamier. For
a long time he had suffered from asthma, which, two days be-
fore his admission to the Hotel Dieu, was very much increased.-
When the use of this agent (Galvanism) was begun, the asth-
matic disorder was in full force ; but before the first essay was-
over, the respiration was free. Galvanism was continued
every second day, and at the end of twelve applications, the
patient was perfectly cured of his dyspnoea he ran up a stair
of fifty steps, with a quickness and facility, and without being
at all oppressed. (Dublin Quarterly Journal Med. Sci., May,
1847.)

1852.'] Wilson, on Tartar Emetic. 343

ARTICLE XX.

Specific Cutaneous Eruption, produced hy the internal use of
Tartar Emetic. By John S. Wilson, M. D., of Air Mount,
Ala. (formerly of Georgia.)

Case I. In November, 1851, J. H was attacked with pneu-
monia of the upper lobe of the right lung. He was treated at
first by venesection and an emetic of tart. ant. and ipecac ;
the antimony was then continued, as a contra-stimulant, until
the disease was subdued : it was given in doses of | gr. every
three hours, for about 12^days, and then in \ gr. doses, every
four hours for three or four days longer. (The medicine was
sometimes suspended during the night.) No symptoms ofgas-
tric or intestinal irritation occurred during its administration ;
and the disease, though obstinate, progressed favorably under
this treatment, aided by cups and blisters. But soon after con-
valescence was established, I was much surprised on finding
the chest and abdomen thickly studded with the peculiar and
characteristic pustular eruption of taitar emetic. The pus-
tules were at first small, but they gradually enlarged and spread,
extending themselves over the arms and forearms. They con-
tinued much longer than they usually do, when the tart, emetic
is applied externally, and is discontinued after the crop of pus-
tules have appeared. I did not learn that he had ever used the
tart, emetic ointment, previous to his attack. The eruption
was 50 well marked and characteristic, that I cannot entertain
a doubt as to its nature, althougli I have seen but one similar
case during several years' free use of the remedy.

Case II. In January last, I treated Mrs. L. for acute ca-
tarrh, with the tart, ant., giving it nearly in the same way as
in the first case the only exception being that the medicine
was used but three or four days, when the subsidence of the
ilisease rendered its continuance no longer necessary. This
patient had used the tart, emetic ointment, to the spine, for a
nervous affection, many months previously ; and in her case,
the eruption was confined to that part : she was perfectly con-
scious of its nature, for she said that she experienced the very
same feelings that she did when she applied it locally.

Remarks. Authors mention an eruption on the mucous

844 Wilson, on Tartar Emetic, [June,

membrane of the mouth and fauces, as an occasional effect of
the long-continued use of tart, emetic, and they may notice
this cutaneous eruption ; but I do not remember seeing any
thing of the kind in my reading, nor can 1 find any such, by
referring to the works at my command: but my opportunity A
for consulting authors being limited, at this time, I may be^
mistaken in supposing that they have not noticed it, and it
may be more common than I imagine. If it be common, it
may be made available in practice, as an evidence of satura-
tion, by warning us not to persist in the antimonial, for fear of
bad consequences if it be unusual, (as I suppose it is,) its oc-
casional occurrence should still be borne in mind, lest we fall
into errors of diagnosis, by mistaking this eruption, for itch or
something else, as a practitioner of medicine did in one of the
above cases. Another interesting feature of these cases is
this: they add to the list of disagreeable effects sometimes re-
sulting from the use of this truly valuable article. It is true
that the unpleasantness produced by the tart, emetic in the
above cases, is of small moment, when compared with the
''fatal effects," so strikingly described by Dr. Wm. M. Boling;:
(vide his article in this Journal, Jan. 1852, taken from the Am.
Journ. Med. Sciences,) but still it is a disagreeable effect, and'
it should make us cautious in using this medicine after the Ra-
sorian plan.

While on this subject, I would remark that I have never
ventured on the use of tart, emetic, in enormous doses, regard-
less of emesis or catharsis, as recommended by the Italian
school of contra-stimulant physicians : I give it in pneumonia,
in small doses, regulating these by the effects on the stomach
and bowels, as I would in any other disease. I have thus been
able to avoid, so far, the very bad effects mentioned by Dr.
Holing, but still, notwithstanding this cautious use of the rem-
edy, 1 must confess that I have been in sight of the breakers;
and I think I have seen a few cases of inflammatory pneumo-
nia, become complicated with intestinal irritation, and assume
a typhoid type, by the use of the antimony in the cautious man-
ner above described. But in this I might have been mistaken,
as there was a prevailing tendency to adynamic fevers. While
I adduce these examples of the disagreeable effects of the

1852.] Healthy and Morbid Menstruation. 345

tart, ant., I must be allowed, in conclusion, to add my tribute
to its merits, for I consider it superior to all other remedies in
the treatment of pulmonic affections.

PART II.
tit tilt department.

On Healthy and Morbid Menstruation. By J. Henry Ben-
nett, M. D., late Physician-Accoucheur to the Western
General Dispensary, etc.

[Contiiiaed from Page 289.]

Dysmenorrhcea. By the term dysmenorrhoea, is implied
painful and difficult menstruation. Most females experience
slight uterine and ovarian pains, accompanied by slight exter-
nal tenderness in the hypogastric region, with or without aching
pain in the back, for the first few hours previous to and after
the advent of menstruation. When these feelings are not usual-
ly experienced, they will often manifest themselves accidental-
ly, as the result of over-fatigue or mental emotion, or without
any appreciable cause. To such conditions, however, the ap-
pellation of dysmenorrhcea cannot be applied ; it must be re-
served for those cases in which a very considerable amount of
pain is experienced, either invariably or by exception.

Dysmenorrhoea may exist Istly, Permanently as a consti-
tutional condition, or accidentally or temporarily in connexion
with general morbid states. 2dly, It -may be the result of the
presence of uterine or ovarian disease, or of a contracted state
of the cervical canal.

Constitutional DysmenorrhcEa. This form of dysmenor-
rhcea is often observed in the females whose uterus appears na-
turally predisposed to congestion, and with whom menstruation
is very abundant and is preceded and followed bya whiteleucor-
rhceal discharge. It is met with also when this is not the case.
It may be limited to the first day or two, or extend throughout
the entire period. In such women the dysmenorrhoea is evi-
dently functional, the result of the distention produced by the
over-congestion, or of a peculiar susceptibility of the uterine
innervation. The pain is by no means the same in intensity at
every period, but varies according to hygienic and mv>ral cir-
cumstances. Under the influence of fatigue, excitement, or
anxiety, and frequently without any appreciable cause, the
dysmenorrhcea will become much more intense than usual, and

346 Healthy and Morbid Menstruation. [June,

last a much longer time. In some instances I have known it
to exist every second period only. This form of dysmenor-
rhoea may persist with varying intensity throughout the entire
duration of the menstrual function, ahhough occasionally it is
modified or even removed by marriage, by parturition, or by
the mere influence of time. Constitutional dysmenorrhoea can
scarcely be considered a morbid condition, although verging
on disease. It may be said to be characterized by its com-
mencing with the menstrual function, by the entire and com-
plete absence of all uterine symptoms in the interval of the
monthly period, and by the general similarity of the menstrual,
epochs. Ahhough one period may be, and often is, more pain-
ful than another, on comparing menstruation during any two
given periods of several months, the amount of pain suffered,
and the mode of manifestation of the function, are found to be
pretty nearly the same. If a permanent increase of pain oc-
curs, it is a suspicious circumstance, as indicating the possible
or even probable existence of some inflammatory condition of
the cervix uteri, to which these females, as we have seen, are
peculiarly liable, or of some morbid ovarian condition.

Accidental dysmenorrhoea. Dysmenorrhoea may occur ac-
cidentally in a female who usually menstruates without pain,
as the result of over-excitement or fatigue, from exposure to
cold, or as the result of some temporary disturbance in the
general health. When this is the case, the dysmenorrhoea is
probably occasioned by a disturbed or congestive state of uter-
ine circulation, or by an exaggeration of the nervous suscepti-
bility of the uterine organs. It is characterized by its merely
temporary existence, and by the fact of its passing away with
the cause that has produced it.

Inflammatory dysmenorrhoea. Non-constitutional dysmen-
orrhoea, however, according to my experience, is much more
frequently the result of inflammatory disease of the uterine
organs, and })rincipally of the cervix, than, as is generally sup-
posed, of functional derangement, or of nervous susceptibility.
When menstruation, naturally easy, becomes permanently
painful, or when, naturally but slightly painful, it becomes ex-
tremely so, we are warranted in looking for local disease. Such
a change does not take place without a cause, and that cause is,
generally speaking, inflammation of the cervix or body of the
uterus; dysmenorrhoea being one of the most prominent and
most ordinary symptoms of that disease.

This fact applies to the virgin as well as to the married fe-
male, and is of extreme importance, as affording a key to those
extreme cases of dysmenorrhoea, accompanied sometimes by
spinal irritation and hysterical epileptiform convulsions, which

1852.] Healthy and Morbid Menstruation. 347

appear to resist every form of treatment, and are alike dis-
tressing to the patient, her friends, and her medical attendant.
Since 1 have ascertained that such is the case, nearly all the
instances of extreme dysmenorrhoea in the unmarried female
that have come under my notice have proved to be of this
description, and, however intractable before, have yielded as
soon as a proper antiphlogistic treatment has been adopted.

The history of two patients formerly under my care, which
'I have elsewhere published, strongly illustrates these facts, and
their importance. In the younger ifemale, a young, unmarried
lady, dysmenorrhoea from the first was the prominent symp-
tom. She had always suffered slightly from painful menstrua-
tion, but not carried so far as to inconvenience her. About
two years before I saw her, the dysmenorrhcea became much
more intense, and at last so agonizing, as immediately to pro-
duce hysterical epileptiform convulsions, which ended in par-
tial paralysis. In the other lady, who was thirty years of age,
and the mother of a family, the uterine inflammation com-
menced six years before, with a laborious c'onfinement. The
most prominent symptom with her, also, was dysmenorrhoea,
which increased rapidly, so as at last to bring on intense con-
vulsions at every monthly period, and thus to occasion partial
paralysis of the left side, as in the former case. Both these pa-
tients were considered to be merely suffering from hysteria,
spinal irritation, and functional derangement of the uterus, and
had been treated for several years, solely in accordance with
these views ; whereas, in reality, they were labouring under
severe inflammatory ulceration of the uterine neck.

In these cases the dysmenorrhoea is a mere symptom of the
inflammatory condition of the uterine organs, and is only to be
removed by their restoration to a healthier state. Generally
speaking, it is the neck of the uterus that is found to be the seat
of the disease that occasions the dysmenorrhoea. The latter
is nearly always very intense when the body of 'the uterus is
affected. Sub-acute inflammation of the ovaries may also give
rise to dysmenorrhoea, but I cannot agree with Dr. Tilt that it
is a frequent cause. This difference of opinion is connected
with that which exists between me and my esteemed friend re-
specting the frequency of sub-acute inflammation of the ovaries,
inasmuch as I consider the symptoms which Dr. Tilt supposes
to indicate the existence of such inflammation pain and tender-
ness in the ovarian region to be merely symptomatic of disease
of the uterus or of its neck, in nineteen cases out of twenty in
which they are observed.-

We may connect with inflammatory dysmenorrhoea that
form which has been described under the head of pseudo-mem-

348 Healthy and Morbid Menstruation. [June,

branous, and which is characterized by the expulsion of shreds
and casts of plastic lymph from the cavity of the uterus. I
believe that the formation of these membranes coincides almost
invariably with the present or past existence of uterine inflam-
mation. In other words, I have found, in the great majority of
cases of this description that have come under my observation
that there has been at first inflammatory disease, although the
removal of this disease has not always freed the patient from the
liability to the formation of the pseudo-mem.branous casts. It "
would appear as if habit alone sufficed in some instances to
perpetuate their formation, or at least their occasional formation
even after the removal of inflammation, once they have occur-
red under its influence. M. Pouchet states that in all females,
even in virgins, a delicate decided membrane or cast is formed
in the cavity of the uterus atevery menstruation, and is thrown
out about the tenth day. If so, the deciduous pseudo-mem-
branes of dysmenorrhoea may be considered as merely an exag-
geration of a natural condition, but occurring, generally speak-
ing, only under the influence of inflammatory disease. The
expulsion of these psendo-membranous shreds is always prece-
ded by an aggravation of the uterine pains, which are evidently
occasioned by the eflforts of the uterus to get rid of the casts
formed in its cavity. That the difficulty of expulsion is partly
the cause of the uterine tormina, is proved by the fact that I
have repeatedly relieved them by dilating the cervical canal in
the interval of menstruation, in females who continued to ex-
pel pseudo-membranes, and to suffer after the removal of all
uterine disease.

Inflammatory dysmenorrhoea may be said to be characterized
by the development of pain as a permanent menstrual condi-
tion, in a female previously ^vqq from it, or by the increase of
pain experienced constitutionally, but in a less marked degree.
In other words as pain during menstruation may exist constitu-
tionalh' without local lesions, its value as a symptom of disease
can only be ascertained by comparing the past'state of the pa-
tient with the present. Generally speaking, there are other
uterine and general symptoms present during the interval of
menstruation which tend to assist the diagnosis. This, however
is not always the case. I recently attended a young unmarried
lady, only twenty-one, who had suffered ever since the menses
appeared, at seventeen, from severe dysmenorrhoea. The pain
was indeed so severe, that for the first five days she was always
. obliged to keep her bed, writhing in agony, and for eight days
out of every lunar month she was confined to her room. In
the interval she had not a uterine symptom, and beyond a cer-
tain amount of general languor and anaemia, which the mere

1852".] Healthy and Morhid Menstruation. 349

physical pain siie had to go through at short intervals sufficient-
ly explained, the general health did not appear to have much
suffered. Previous to my seeing her, she had been under con-
stant medical treatment, and the total inefficacy of the remedial
means usually resorted to in such cases had been over and over
again tested. Under sucfi circumstances, after treating her
without any result for sub-acute ovaritis, I considered myself
warranted in making an examination of the uterine organs,
being impressed with the idea that dysmenorrhoea of so severe
a character, and so rebellious to general treatment, must be
occasioned by some local morbid condition, and probably by
congenital contraction. To my surprise, I found the cervix
the seat of decided inflammatory ulceration. I may also add
that the dysmenorrhoea has quite subsided under the influence
of the appropriate treatment of the local disease. This case,
however, is an exceptional one, from the entire absence of all
uterine symptoms in the interval of menstruation, and shows
the difficulties that occasionallv surround the diasrnosis of these
forms of uterine disease.

Physical dysmenorrhoea. Dysmenorrhoea may also depend
as detnonstrated by Dr. Mackintosh of Edinburo;h, on a phy-
sical imperfection of the uterine neck, on contraction of the
OS internum, of the canal which constitutes the cavity of the
cervix. This contraction may be either congenital, or the re-
sult of inflammation. The peculiar character of the dysmen-
orrhoea, when caused by congenital contraction, is the absence
of any uterine symptom during the interval of menstruation,
and intense agonizing pain for a few hours before the flow of
blood appears, either then disappearing, or lasting throughout
the period ; these pains commencing with menstruation in early
youth. If they are occasioned by inflammation, there are the
same symptoms at the time of menstruation, but there is not
the same immunity from uterine symptoms in the interval of
the catamenia.

The cause of the pain experienced under these circumstan-
ces is evident. The cavity of the non-pregnant healthv uterus
not containing more than about ten or eleven drops of fluid, as
soon as the catamenial secretion commences from the lining
membrane of the uterine cavity, unless the blood find a free exit
through the os internum and the cavity of the cervix, it distends
the uterus, and gives rise to great pain. The obstruction may
merely be at the os internum, spasmodically contracted ; in
which case, as soon as it has been overcome, the blood escapes
freely, and pain disappears. But if the os internum, is perma-
nently contracted, or the contraction exists in the cervical ca-
nal, the pain may continue throughout the catamenial period.

S50 Healthy and Morbid Menstruation. [June,

A contracted state of the upper part of the cervical canal,
or of the os internum, is not, I believe, an unfrequent compli-
cation of inflammation of the cervix, from the swelling and hy-
pertrophy of the substance of the organ which it occasions.
This remark, however, does not apply to the inflamed region
of the cervical canal, which is uniformly dilated by the exist-
ence of inflammation.

I do not, however, think that Dr. Simpson's criticism of the
existence of contraction of the os internum is entirely to be
depended upon. Dr. Simpson believes, if I am right in my
interpretation of his views, that unless the uterine sound pass
without efl!brt into the uterine cavity, there is contraction of
the OS internum. Now the careful examination with the sound
of many hundred females has led me, as I have elsewhere ex-
plained, to a diflferent conclusion. There evidently exists at
the OS internum a kind of muscular sphincter formed by a
strong band of the circular muscular fibres of the cervix, and
destined to close the uterus during the latter stages of preg-
nancy. Generally speaking, the sphincter, in the natural state,
is sufficiently closed to prevent the uterine sound passing into
the cavity of the uterus, unless a considerable amount of pres-
sure be exercised. In nearly all the females I examine, in the
interval of menstruation, the sound passes easily along the cer-
vical cavity, but stops at the os internum ; and that when there
is no reason whatever to suppose the existence of a morbid
coarctation.

It appears to me, on the contrary, as I have elsewhere stated,
that a free communication between the cervical and uterine
cavities, allowing the easy introduction of the uterine sound, is
generally an anomalous condition, indicating the existence of
disease, unless observed soon after menstruation, when the os
internum relaxes, or soon after parturition, when it has not yet
had time to recover its normally contracted state. The prin-
cipal morbid conditions in which I have observed a free com-
munication between the two cavities, are inflammation and
uterine tumours. If the inflammation which exists at the os
uteri, and in the lower part of the cervical cavity, ascends as
far as the os internum, it appears to release the muscular con-
tractility of that region. The os internum is always open
when the inflammation passes into the uterine cavity, and im-
plicates its lining membrane. Tiie same effect is also produced
by the development of the uterine cavity, through the forma-
tion of tumours in the substance of the uterus, or from any
other cause; the os internum gradually opening as the uterus
enlarges, probably by the same mechanism as in pregnancy.
This is so generally the case, that the fact of the uterine sound

1852.] Healthy and Moi hid Menslruatlon. 351

penetrating easily through the os internum into an enlarged
uterine cavity, may be considered a valuable symptom of the
existence of such tumours, to add to those with which we are
already acquainted.

Extreme dysmenorrhcea from congenital contraction of the
cervical canal and os internum, independent of inflammation,
is, I believe, of rare occurrence. This is a fortunate circum-
stance, as it is most embarrassing to treat, requiring an amount
of interference with the uterine organs which it is very painful
to have to propose to an unmarried female. Dilation of the
contracted cervical canal is., however, sometimes the only means
we have of remedying an amount of suffering at the catamenial
period, so ejjtreme as to render life nearly a burden, and as to
re-act deeply on the general health.

A very strongly marked illustration of this fact occurred to
me some time ago, in dispensary practice : A young female,
aged twenty-two, was sent to me by a medical practitioner in
town, for dysmenorrhcea. It appeared that she had suffered in
the most excruciating manner at every menstrual period, since
the menses first appeared, at the age of eighteen. The pain
always continued without intermission throughout the three
days and nights that the catamenia lasted, and was of so se-
vere a character that she never closed her eyes, and was con-
fined to bed for the whole time. She had generally been under
medical treatment, and the usual remedies had been repeatedly
tried anti-spasmodics, anodynes, sedatives, &c. Laterly she
had been taking very large doses of opium without the slightest
benefit. On inquiry, I found that after the menstruation ceased
the pain gradually subsided, and that during the menstrual in-
terval she was perfectly w^ell, and was then altogether free from
any uterine symptom. In appearance she was rather stout and
healthy-looking. The hymen was intact, but dilatable, and I
was thus enabled carefully to examine the neck of the uterus,
which I found perfectly natural in size, colour, texture and
density, and free from any tenderness. The cavity of the cer-
vix, however, was evidently very narrow, not even admitting
a very small-sized bougie. Thinking this might be the cause
of the dysmenorrhcea, I at once decided on dilating it. This I
eflTected to a considerable extent in the course of the three
weeks which ensued before the next monthly period, by means
of small sponge tents. I had not, however,[dilat,ed the os inter-
num sufficiently to admit of the sound penetrating into the cav-
ity of the uterus, and was consequently rather surprised to
hear from the patient, after a week's absence, that not only
had the catamenia been more abundant than usual, but that she
had been entirely free frona pain. The dilatation was continued

352 Healthy and Morbid Menstruation. [June,

irregularly, and as the next period was equally free from pain
I ceased all treatment, although the os internum was still undi-
lated ; at least, it was only sutficiently open to admit of the en-
trance of the small extremity of the wax bougie.

The dysmenorrhosa which accompanies inflammation of the
cervix, is evidently increased in some cases by the narrowing
of the cervical canal, which the inflammation occasions, inas-
much as it may persist in a mitigated form after the inflamma-
tory disease has subsided, and be readily removed by dilatation.
The persistence of dysmenorrhoea from this cause after the
removal of uterine inflammation, is not, however, of itself
sufficient to necessitate or even to warrant dilatation of the
cervical canal being resorted to, except in some special cases,
until a few months have been allowed to elapse. After the re-
moval of inflammatory disease of the uterus and of its cervix,
a resolutive action is set up by nature, which will often soften
and relax the still swollen and indurated tissues, and thus open
the cervical canal, and render mechanical dilatation unnecessa-
ry. It is therefore well to give the patient the benefit of this
chance of recovery without further surgical treatment.

Whatever may be the cause of dysmenorrhoea, the mode in
which the menstrual secretion takes place is modified by its
existence : instead of a flow of bright blood, regular and con-
tinuous, although genei'ally increasing by exercise and dimin-
ishing by rest, we have a dark, interi upted, clotted discharge.
After severe uterine pains which may last many hours, and are
often accompanied by tenderness and swelling in the ovarian
regions, and pain in the back and down the thighs, more or
less dark, clotted blood is thrown out. Its expulsion is gener-
ally follov^'ed by relief, and by a freer flow for a while, when it
again diminishes, and the same ordeal again takes place. Some-
times the interruption will be complete for one, two, or three
days, the pain subsiding with the menslrual flux, and returning
when it again makes its appearance. The venous condition of
the menstrual secretion shows plainl}^ that, either from inflam-
mation, congestion, or some other cause, the uterine circulation
is defective, the blood stagnating in the yessels of the uterus,
remaining in its cavity, and distending it after it has been se-
creted.

Treatment. Constitutional dysmenorrhoea may be palliated
in its attacks, but can seldom be removed by medical treat-
ment. A great deal of subsequent uterine disease would, how-
ever, be spared to those young females who unfortunately pre-
sent it, were mothers more generally aware that its existence
constitutes throughout life a strong predisposition to uterine in-
flammation, and that they cannot take too great care of such

1852.] Healthy and Morbid Menstruation. 353

of their daughters as suffer from it. For such young females
the discipline of public schools may be said to be nearly always
too severe, and often to lay the foundation for much future
physical and mental misery. That this must be the case, will
beeasily understood when we reflect that the domestic treat-
ment of this form of dysmenorrhoea consists principally in I'est
and warmth. Females who sufler habitually fromdismenorrho&a,
whatever their age, should remain quietly at home, taking care
to preserve themselves from atmospheric vicissitudes during
the first day or two of menstruation, which is the period during
which the pain is mostly felt. A warm hip-bath will often be
found useful. If the pains are very decided it is even best to
confine the sufferer to bed, and to apply warm linseed poultices
to the lower abdominal region, a valuable and simple mode of
soothing pain.

In mere constitutional dysmenorrhoea, these simple means
nearly always suffice to render the pain very bearable. If they
do not produce relief, that fact alone constitutes a suspicious
circumstance, and should induce the medical attendant to scru-
tinize narrowly the state of his patient, lest there should be
some morbid or physical cause.

In severe dysmenorrhoea, connected with uterine disease, the
only efficacious treatment is that of the cause of the disease
which occasions the dysmenorrhoea. As time is required,
however, we are often called upon even in these cases, to treat
the dysmenorrhoea as a symptom ; and, warmth and rest fail-
ing, recourse must be had to medicinal agents. By far the
most efficacious remedy with which I am acquainted, is the
injection of laudanum, or any other preparation of opium, into
the bowel. From fifteen to thirty minims of laudanum, mixed
with a little warm water, should be injected into the rectum, and
will generally exercise, if retained, as much influence in sooth-
ing the uterine pain as would double the quantity taken by the
mouth. Moreover, the nausea and headache which opiates
occasion are much less likely to be produced when they are
thus administered. If the first opiate injection is not retained,
a second, half an hour later, will generally be more successful.
I have also found chloroform of great value in these cases. It
may be inhaled or administered by the mouth in ^oses of from
twenty to forty mininis, mixed with mucilage, the yolk of an
e^g, or with camphor, which favours its suspension in water.
I have given it by injection, but with less success, as it appears,
generally speaking, to irritate the rectal mucous membrane,
and is consequently not retained. When it is retained, the se-
dative effect is nearly always effectually produced. Although
chloroform may thus often be resorted to with great benefit in

354 Healthy and Morbid Menstruation. [June,

dysmenorrha3a,I do not find that as much reliance can be placed
in it as in opiates.

There are various other medicinal agents, principally anti-
spasmodics and narcotics, which may be administered with
benefit in dysmenorrhoea. We may mention more particularly
the various ethers, and especially sulphuric ether, hyoscyamus,
belladonna, musk, valerian and camphor. It must not, however,
be forgotten that these remedies are mere temporary palliatives;
that dysmenorrhoea, when constant and not constitutional, near-
ly invariably recognizes some physical cause generally speak-
ing, uterine or ovarian inflammation, and that it is this cause
wiiich we must find out, and remove, during the interval oi
menstruation.

-It is the fact of dysmenorrhoea being so frequently caused by
inflammatory disease, that explains the success which often
attends bloodletting, both general and local, and which has
induced so many authors to recommend it, although unaware
of the pathological state which it relieves. General bloodlet-
ting acts by revulsion ; whilst local bloodletting directly re-
lieves the congested and embarrassed abdominal circulation.
I seldom, if ever, resort to general bleeding in dysmenorrhoea,
because the relief which it gives is obtained at too great a
sacrifice of the strength of the patient, and cannot, moreover,
be depended upon. A few leeches applied to the groin, or,
better still, to the neck of the uterus, when possible, if the dis-
charge is scanty or temporarily arrested, is much more likely to
mitigate the pain, and with less loss to the economy. Purgatives,
which are frequently useful, act in the same way as leeches, by
depleting the abdominal circulation. Some authors amongst
others. Dr. Gooch have considered dysmenorrhoea to be fre-
quently akin to rheumatism, and have recommended colchicum,
guaiacum, and other medicines usually given in rheumatic af-
fections. That the utepus may be the seat of such an afl!ection,
is undeniable ; but I am persuaded that its frequency has been
greatly exaggerated, as likewise that of irritable uterus. In-
deed these two conditions may be said to have been, to a great
extent, mere theoretical creations, destined to account for pa-
thological conditions, the real nature and meaning of which
has, until recently, been a mystery to the profession.

It will be seen, by what precedes, that dysmenorrhoea is
by no means so simple a disease, or so easy to treat, as has
been generally supposed, involving, as it often does, the ques^
tion, whether or not local disease requiring local treatment
may not exist as the real cause of the morbid state. Kit re-
sists all general treatment, it is probably the result of such dis-
ease, and the health and happiness of a young female are seri-

1852.] External Diuretics. 355

ously endangered.. Of course the medical practitioner has a
duty to perform to his patient, before which all scruples must
be made to succumb. J, however, here repeat, what I have so
often said elsewhere, especially with reference to unmarried
females, that nothing can warrant manual or surgical investi-
gation and treatment, but months, or even years, of unbuccess-
ful treatment, and the conviction with the latter, that unless
they be resorted to, the case must be abandoned as hopeless.
I would also repeat the advrce given in my work on Uterine
Inflammation, that a consultation should always be held first
when the patient is unmarried, to decide the point, whether the
examination of the uterine organs be warranted and necessary,

[To be continued.].
#

External Diuretics. By D. J. Cai:^, M. D.

In reporting the three following cases, illustrative of the ef'
fects of external diuretics, I would remark that it must be ob-
vious that the conditions in which they are indicated and would
prove beneficial, are identical with those in which their internal
exhibition would be resorted to. In cases of local or general
dropsy, resulting from structural lesion of the heart, liver, me-
senteric glands, peritoneum, etc., their effect can, as a matter of
course, be but palliative.

The employment of diuretics externally, instead oHnternally,
dates only a few years bacL According to Dr. Christison,
the idea of substituting the one for the other originated with a
French physician, who reported several succesful cases from
their use. But it would seem that the medical world did not
adopt this mode of practice, for we hear nothing more of the sub-
ject until the appearance of Dr. Christison's paper in the Edin-
burgh Monthly Journ. of Med. Sci., of last November. With
the contents of that communication, all present are doubtless
familiar. So favourable was the opinion expressed by him, in
reference to their action, that I determined to use them in that
manner, in the first case of effusion that should present itself
to me.

I was soon furnished an opportunity, by a patient who was
admitted into the Marine Hospital, Jan. 28th, 1851, labouring
under extensive inflammation of the medius finger of the right
hand, with caries of all the phalanges, rendering amputation
necessary. This was performed while he was in a state of com-
plete anaesthesia from chloroform.

^ *' While the healing process was going on, I perceived that
his abdomen began to enlarge, and, on examination, fluctuation

356 External Diuretics. [June,

was very evident. On inquiry into his antecedent history, I
jearned that his general heaUh fiad not been previously very
good ; he had been troubled with diarrhoea from childhood, but
he had had violent attacks, from time to time, during the last
five years, and his bowels were, at the time I speak of, much
disordered, the stools being more or less fluid and frequent, and
of a white or ash colour, denoting inactivity in the hepatic
organ. He also told me that, about four years ago, he had a
hydropic collection in his abdomen for which he was treated in
Baltimore, and from which he recovered in about a month. I
prescribed for him small doses of taraxacum, with a view to
its effect upon the liver, and cinchona with iron as a tonic.
The swelling increased to so great a degree, in the course of
tm^o weeks, as to sensibly impede respiration. I now began
the administration of watermelon seed tea, and continued it for
a few days, without any great increase in the quantity of urine.
It was still scanty and red.

" I then used the formula recommended by Dr. Christison,
viz : equal parts of the tinctures of digitalis, squill and soap of
which compound two drachms were rubbed upon the abdomen
three times daily. In forty-eight hours, the efl^ects were mani-
fested by a considerable increase in the quantity passed. By
the fourth da}', I found him discharging between three and four
quarts, by measure, which reached nearly five quarts, by the
7th, when the whole dropsical collection had disappeared.

"After keeping up the action of the kidneys for two or three
days longer, the diuretic was discontinued, and the urine began
to diminish in quantity.

"It may be well to observe here, that, during the use of the
diuretic, t caused the patient to be restricted to about one pint
of fluid for the twenty-four hours thus carrying out the plan
I have always followed in allowing the patient the smallest
quantity of drink, for the reason that, if the watery portion of
the blood is evacuted by diuretics, either alone or by cathartics,
and its place is not supplied by the introduction of water through
the stomach, the blood will become inspissated, and, in accor-
dance with physical laws, an endosmotic movement will go on
from the rarer to the denser fluid : that is to say, the dropsical
effusion will permeate the tissues, enter the blood-vessels, (the
veins,) and will be carried into the circulation, where it will
dilute the blood.

"But, although the eflfused fluid had disappeared, the cause
was not removed, and, after an interval of about two weeks,
his abdomen again began to swell. I again resorted to the diu-
retic, but this time with by no means such marked efl^ects, the
quantity of urine not being materially increased, and, after using

1852.] External Diuretics, 857

it about two weeks, it was abandoned. I then made trial of the
digitalis, squill and colchicum internally, which was attended
by complete failure.

" On careful examination of the patient, and from a considera-
tion of his antecedent history, I diagnosticated chronic (per-
haps scrofulous) inflammation of the peritoneum, with, perhaps,
obstruction to the portal circulation. The fluid continued to
increase, and tapping was had recourse to, in order to relieve
him. About three gallons were drawn off*. It re-accumulated
rapidly, and the patient died on the April. At the necropsy,
we found extensive and violent inflammation of the visceral
peritoneum ; slight enlargement of several of the mesenteric
glands ; and, lastly, an obstruction to the circulation of the blood
through the vena portae, caused by two large tubercular or
scrofulous masses.

"From the lesions observed after death, (and which confirmed
my diagnosis,) it is obvious that the diuretic could have been
of no permanent benefit.

" Case II. Peter Rose was admitted into the Hospital, March
31st, 1851, laboring under intermittent fever. Being at the
time sick, Dr. F. P. Porcher, who visited it for me, succeeded,
in a day or two, in checking the fever. On resuming my du-
ties, a few days after, I found that his abdomen began to swell,
and I soon detected fluctuation ascites due, in all probability,
to the engorgement of the liver and spleen, resulting from the
repeated paroxysms of the fever. Being encouraged by the
success that attended theircxhibition, the first time, in case No. 1,
I immediately resorted to the use of the diuretics externally.
The effect was very prompt in this case as in the foregoing.
In less than forty-eight hours, the quantity of urine was nota-
bly augmented, and, by the fourth or fifth day, he was passing
upwards of a gallon per diem. The hydropic accumulation
had entirely disappeared by the ninth day. This patient I ex-
hibited to several of the Counsellors of the South ^Carolina
Medical Association.

"Case III. George Bond was admitted, January 22d, 1851,
to be treated for congestion of one or both kidneys, with the
ordinary symptoms, such as discharge of blood, etc., the result,
apparently, of cold. Cupping, blistering, soda, sweet spirits
nitre, watermelon seed tea, digitalis, colchicum, etc., variously
combined, were used, as counter-irritants, and as depletives of
the kidneys, but with partial effect. I then substituted the vege-
table astringent, tannin, without any decided benefit. I gave
him turpentine, and, in a few days, the hemorrhage ceased.
From time to time, however, it returned, from imprudence on
the part of the patient, such as a fatiguing walk, getting the

N. S. VOL. VIII. NO. VI. 23

358 External Diuretics, [June,

feet wet, etc., showing that the congestion had not been com-
pletely resolved. In this state of the case, I thought that the
diuretics, externally applied, might be of some service. They
were used, consisting of the substances above named, with the
addition of colchicum, which suggested itself to my mind as
likely to assist the action of the other ingredients. Its effect was
soon shown by an abundant discharge of urine ; but, so great
was the action setup in the kidneys that it recalled the hemor-
rhage, which ceased on the discontinuance of the diuretic."

1 have also used it in two other cases, with decided advan-
tage : the one an old lady, who had an almost complete sup-
pression of urine, from indigestion ; the other, a lady of middle
age, who had anasarca from the impoverishment of the blood
in chronic diarrhoea.

A medical friend informs me that, at my suggestion, he has
employed it in a case of scarlatinal dropsy, and in three other
cases of effusion, from various causes, with happy effect.

The external application of diuretics possesses, it seems to
me, a manifest superiority over the internal use in this, that it
may be employed in all states of the system, without causing
any general or local disturbance, even if it does no good.
Every one is aware that the stomach is sometimes so irritable
or weak, or the bov/els so relaxed, etc., no medicines can be
retained by it, or, if retained by the stomach, they may increase
the action of the bowels. Beyond this, no advantage is claimed
for the external over the internal use. It appears, however^
from one of Prof. Christison's cases, that the diuretics succeed-
ed externally, when the same combination failed internally.

I have v/atched closely the action of the diuretics, when ap-
plied externally, and have observed but the single effect nponr-
the kidneys.

The combination recommended by Prof. Christison is a good-
one : but other substances may be added, or they may be com-
bined in different proportions. To the tinctures of soap, digitalis,
and squills, may be added vin colchic, tinct. cantharides, etc.

I have deviated somewhat from the quantities and the inter^
vals spoken of by him. He used but 3ii. or 3iii. of the coi
pound, rubbed upon the abdomen three times daily. In two
the cases above reported, I ordered from 5ss. to i., four, fiv(
and even six times in the twenty-four hours. In one case. Pro!
Christison simply applied a linen rag, saturated with tinctur^
digitalis, upon the abdomen, and with equally marked benefit.

I have observed, while experimenting with diuretics in thi
way, the fact that, when they fail externally, (as they have, "
two or three instances, since the above cases were treated,]
the same, or other combinations, invariably fail internally.

__5_i

1852.] Diseased Joints, 359

In mentioning this circumstance to two medical gentlemen
of this city, they remembered that the same thing had occurred
in their trials with them. Thus, it would seem that the kidneys
are sometimes wholly insusceptible of the influence of this class
of agents. \_Charleston Med. Jour, and Review.

On a Novel Method of Treating Diseased Joints. By Mr. Gay.

[The following synopsis of a paper read before the Medical
Society of London, November 15th, 1851, bears so close an
analogy on a mode of treatment set forth in previous numbers
of this Journal, that we are constrained to copy it entire, as
we find it in a late number of the London Medical Gazette.
Ed. N. Y. Jour. Med.]

Mr, Gay commenced his paper by observing, that to the
present time there was no department of surgery in which the
powers of art have been comparatively so feeble as when appli-
ed to the relief of those diseases of the joints, which, from their
results, might be termed destructive. Hence, let the articular
surfaces of the joint be bereft of their cartilages, asinusor two
be formed around it, and tTie health of the patient show symp-
toms of exhaustion, and the joint, and probably the whole limb,
is doomed to amputation. He adverted to the causes of the
removal of the cartilage from joints, and gave it as his opinion,
that in addition to primary synovial and osseous disease, the
cartilages were sometimes removed by absorption, in conse-
quence of degeneration of their own tissue, without any trace-
able affection of the contiguous textures. In all cases of
removal of cartilage the tissue degenerates into a kind of fibrous
texture, antecedent to the final process ; and as portions of car-
tilage were sometimes observed to be removed without any
apparent disorder of either the synovial or osseous surfaces,
and, moreover, as cartilage was known to be inadequate to its
own repair, Mr. Gay thinks it most probable that the portions
of cartilage so removed had first spontaneously degenerated,
and then become absorbed. Mr. Gay went on to remark, that
if a series of joints be examined in which the removal of the
cartilages is taking place, the appearances will be as follows :
If it be presumed to follow disease of the synovial capsule, the
cartilage will be found in some to maintain its connection with
the bone, whilst it is thinned by absorption at its free surface.
In others, however, the bone is found inflamed at various
points of its connection with the cartilage ; and at these points
the cartilage is loose, and may be peeled off, so that portions
of thin "Attached and unattached cartilages are found in the

360 Diseased Joints. [June,

same joint. When entirely denuded, or almost so, the surfaces
of the bones may exhibit simply a state of increased vascularity,
which precedes the effusion of plastic lymph for the purposes
of reparation by anchylosis, or may be observed to be in a con-
dition of ulceration. This ulceration may exist as a simple
abrasion, or be of considerable depth ; but there is generally a
uniformity in this respect over the whole surface. With this
state of ulceration there is also a softening of the osseous struc-
ture, and frequently disintegration ; the contents of the joint
consisting of broken up cartilage, and osseous and other debris
together, or osseous matter, with ichorous or sanious discharge.
When the disease originates in the bone, as in by far the greater
number of cases, in Mr. Gay's opinion, it does, the separation*
of the cartilage is effected by another process, which he terms
" shedding," and the cartilage is then reduced to^ the condition
of a foreign body within the joint. Shreds of cartilage thus
situated in a joint may be observed after months and even years
of disease ; and as, on the other hand, its separation from the-
articular extremity of the bones may be accomplished in an
almost incredibly short period of time, it is fair to infer that the
time thus passed must have been occupied in the process of its-
extrusion from the joint, and that this is accomplished, neither
by ulceration nor absorption, but disintegration by, and solu-
tion in, the discharges of the joint. But the bone itself beings
diseased, adds its exfoliated or disintegrated particles to the
cartilaginous debris, which, with its own discharges, constitute-
generally the contents of a joint in which the disease com>-
menced in its bony elements. The result of these discharges is-
to set up inflammation in the sound textures contiguous to the
joint, and general systematic irritation. Sinuses form around
the joint ; the disease extends itself; the ligaments become ul-
cerated ; the spongy tissue of the bones infiltrated with pus-,^
and broken down ; osteophytes form around the heads of the
bones ; abscesses extend themselves into the surrounding soft
parts, separating the different structures, and' setting up un-
healthy and destructive action amongst them ; and, in short, -
climax is arrived at in which the local mischief reacts upon the
constitution, and life is only to be preserved at the sacrifice of
the joint or of the limb. Mr. Gay inferred from these remarks,
of which only an imperfect abstract has been given

1. That there appears to be no reason why disease effecting'
the constituents of a joint should be slower in their course of
reparation than diseases of any other part or structure.

2. That the removal of cartilage from its osseous connection
in a joint is occasionally effected by absorption, but most fre-
quently by a process of " shedding," or exfoliation.

1852.] Diseased Joints. 361

3. That cartilages thus shed become, by their being pent
up in a joint, sources of local and constitutional irritation, and
thus promote disease in the osseous and other structures apper-
taining to,a joint, supposing that such affections do not exist
primarily ; and in case they do, these cartilages, by the same
influence, maintain and extend these diseases also.

4. That the natural outlets lor these discharges, the sinuses.,
are inadequate for that purpose.

5. That therefore the exfoliated contents of a diseased joint
have to be minutely broken up by, or dissolved in, the dis-
charges of the joint, in order to their removal ; processes which
are necessarily of a very protracted order, and which account
for the tardiness in general characteristic of joint diseases.

6. That the exfoliated contents of a joint, after its cartilages
have been removed, and even after extensive diseases has been
set up in the bones and other textures, have only to be com-
pletely removed, and processes of reparation will, in the ma-
jority of instances, immediately commence.

Mr. Gay then alluded to the usual modes of treatment, and
remarked, that the operation of resection of a joint is not only
a useless but an unphilosophical mode of treatment for diseased
joints, in the first place, primary disease is generally limited
to one of the articular extremities of the joint ; it is therefore a
useless mutilation to remove more than that disease, supposing
the operation were for a moment admissible. But, moreover,
dissections show that disease originating in bone, when arrived
at that stage at which the operation of resection is generally
employed, has extended itself far beneath the surface, and fre-
quently along the shaft for a third of its whole length, so that
resection cannot accomplish its purpose, which must be mani-
festly the removal of all disease. The plan Mr. Gay recom-
inends, then, is free and deep incisions made along each side of
a joint, so as to lay open its cavity freely, and to allow of no
discharges being by any possibility retained within its cavity.
They should be made of such a length, and so treated, that they
do not heal into the form of sinuses. They should be made, if
possible, one on either side of the joint, and in the direction of the
long axis of the limb. They should extend into the abscesses in
the soft parts so as to lay them open. If sinuses exist, the incis-
ions should be carried through them, if this can be done without
departing from a slight curve. If either of the bones be carious or
necrosed, the incisions should be carried deeply into such bones,
so as to allow the dead particles of bone to escape. Ligaments
which stand in the way of free discharge from the joint should be
cut through. Of course important vessels should be avoided.
The wounds should be kept open by pledgets of lint, and free sup-

362 Diseased Joints. [June,

puration encouraged. The constitutional powers have in each
case rallied immediately after the operation ; and as the dischar-
ges from the joint have altered in character and become healthy,
which they in general do in the course of two or three weeks,
these become invigorated, and improve with the improving
joint. Mr. Gay then narrated some cases in corroboration of his

views : Peter D , aged thirty-eight, admitted into the Royal

Free Hospital in 1842, for diseased elbow joint of three years'
standing, with ulceration of the cartilages and sinuses. The
joint was opened on either side, and healed in eleven weeks.
The next was a case of disease in the articulation between the
first and second phalanges of the thumb of eighteen months'
standing. Cured in six weeks. The third case was that of a
man with "longstanding" disease of the tarsal articulation.
One sinus led to the interior of the joint. Incisions were made
on each side of the foot, and complete anchylosis followed.
The fourth case was that of a little boy with strumous consti-
tution, with disease of the knee joint consequent upon suppura-
tion of the bursa behind that joint. The little fellow was re-
duced by fever to a very low ebb, so that bed-sores formed on
parts of his body. The joint was opened ; anchylosis took
place at the end of four months, and the knee bent on the
thigh. The fifth case w^as that of a German, with disease of
the wrist joint, which had resisted treatment. One sinus led
into it. One incision was made at the back of the joint, and
anchylosis followed, but was not observed to be perfect for six
months. The sixth case was that of a young Irishwoman, with
disease of the tarsal articulation, following upon traumatic
erysipelas of the leg and foot. She was reduced to an exceed-
ingly low condition, and from cough with bloody sputa, night
sweats, (according to Dr. Heale.) the physical symptoms of the
chest, and extreme emaciation, she was supposed to be phthisi-
cal, and so diseased, that amputation, which was supposed to be
the only remedy for the disease, so far as the joint was concern-
ed, was forbidden by the authority of Dr. Heale. Mr. Gay
made an incision on either side of the foot in this case, and the
change both in the joint and constitution was remarkable. Her
health rallied from that moment, and the joint assumed a more
healthy aspect. In a fortnight the joint was fixed by the exuda-
tion of lymph between the bony surfaces, and in five weeks
perfect anchylosis had taken place, and the wounds had healed.
She soon after left the hospital, and was, a week or two since,
to Mr. Gay's knowledge, in perfect health. The seventh case
was that of Highley, a report of which has been published.
The eighth case was that of a little boy with disease of the
articulation of the first and second phalanges of the thumb. In

IQSa.] lodo-Hydrargyrate of Potassium. 3G3

this case the cure was not accomplished. The incisions re-
solved themselves into sinuses, and after several months the
Eecrosed phalanx came away." [iY. Y. Journal of Medicine.

Observations on lodo-Hydrargyrate of Potassium. By Thos.
J. Garden, M. D., of Wylliesburg/Va.

The February and August numbers of the American Medi-
cal Journal for the years 1834 and 1840 contain papers on a
combination of iodine, mercury and potassium, by Doctors
Channing of New York, and Hildreth of Ohio. These papers
present some discrepancy of opinion with regard to its effects in
diseases of the chest and some other acute affections. Both,
however, describe it as an agent of no ordinary power, admitting
ofa wide range of applicability in the treatment of diseases. I
was lead by these papers to make trial of the agent ; and as its
virtues are not generally understood in this country, I have been
induced to present you for publication some cases of disease I
have been enabled to relieve through its agency within the last
fifteen years. The remedy is an universal alterative, and seems
to be an excitant of particular organs and functions.

The judicious practitioner will bear in mind, (in imitating the
practice which was so successful in the cases now reported.) that
numerous exceptions are to be found. Disease is an integer,
and each individual case must stand for itself.

The invaluable agent w^hich is the subject of this paper has
been prescribed by myself almost monthly for the last fifteen
years, and is certainly a signal instance of the power and effi-
cacy of combination. The formula for its preparation is as
follows : R Deuto-iodide mercury grs. iv ; distilled water 5 i ;
iodide potassium e i. Mix. The solution is ofa beautiful straw
color. The medium dose 5 gtt., taken three times per day in
some bitter infusion to disguise the strong metalic taste. This
dose to be gradually increased until its morbid effects are man-
ifested. A suspension of its use for a day or two will quiet these
morbid effects ; but when it is recurred to, begin with the medi-
um dose of 5 gtt., and gradually increase. In very many cases,
susceptibility to its action is enhanced by the system being once
brought under its influence, so that even a reduction of the me-
dium dose is required.

Dr. Channing asserts, that under such circumstances the one-
four hundredth part of a grain administered during the day
.evinced the most indubitable action.

The morbid effects demanding a suspension of its use, accor-
ding to my observation, are nausea and vomiting, griping and
purging, giddiness and a peculiar sensation of heaviness about
the frontal region,

364 lodo-Hydrargyrate of Potassium. [June,

The remedy being an all pervading, universal alterative, it
has been recommended in a variety of pathological conditions,
amongst which may be enumerated chronic bronchitis, amenor-
rhoea, leuchorrhcea, diabetes, apthatonsilitis, pharengitis, chron-
ic gastro-enteritis, habitual constipation, dyspepsia, ascetis, ana-
sarca, herpes, scrofula, chronic eczema, and a variety of others.

Case I. John, a colored man, carpenter, aged 40, of athle-
tic frame, had gonorrhoea some years ago, which was treated
by an early resort to astringent injections and followed by her-
nia humoralis; complains of weakness and pain in the region of
the lower lumbar spine; frequent micturition; skin dry; pulse
full and strong not accelerated ; tongue coated with a short
white fur ; loss of appetite ; costive bowels. He was cupped
over seat of pain. Ordered rest, abstinence, alterative mercu-
rial aperients, followed by infusion of buchu. This treatment
followed by no good results. Upon a more rigid investigation,
I ascertained that he not only had frequent desire to pass wa-
ter, but that the quantity of urine passed daily greatly exceeded
the standard of health ; and that the case was one of renal
disease, with diabetic symptoms. Having but little confidence
in the treatment usually recommended for diabetes, and be-
lieving that in this intractable affection some active modifier
of the system of nutrition was plainly indicated, I determined
to try the deuto-iodide of murcury,and at once to test its efficacy
fairly and fully. Five drops were accordingly directed three
times per diem for one week ; the second week the dose was in-
creased to 8 gtt. per diem, and so on, increasing one droy every
day until the morbid effects of the agent presented themselves.

The use of the agent was now suspended for a few days
until these latter subsided, when its use was again resumed
without being able afterwards to bear as large doses as he did
at first. Under this treatment all the symptoms were improved,
and under its steady use for two months they entirely disappear-
ed, without any adjuvant whatever. I find that according to
Dr. Channing's uniform observation, diabetes is more promptly
benefitted by this agent alone than any other known treatment.

This case occurred thirteen years ago.

This man was again sent to my care in September last to
be treated for hydrocele of the tunica vaginalis testis, attended
with the same renal and diabetic symptoms that had existed
before to a more moderate extent. I gave him 2 oz. of sol.
deuto-iodide of mercury, with directions for its use.

Under its use the symptoms enlirely disappeared. About
Christmas these symptoms were reproduced in a modified form
by exposure and excesses. A resort to the remedy again gave
relief, and he is now in enjoyment of perfect health.

1852.] lodo-Hydrargyrate of Potassluni. 3G5

In describing the symptoms of this man's case in his first
attack, thirteen years ago, I omitted to mention in its proper
connection, that he labored under functional, though complete
impotence, and that the remedy displayed its powers in a most
happy manner in restoring his virile powers ; but J shall offer
other evidences of its efficacy, in another case of the same
character more in point.

Case II. This was a case of chronic eczema ; patient aged
35 ; disease had existed for a number of years, and been treated
by a number of physicians. The affection of the dermoid tissue
was seated on the outside of the right thigh, from the hip to
the knee joint, embracing about half the circumference of the
leg. The pruritus and burning pain at night were almost in-
supportable. General health bad; dyspeptic symptoms of an-
cient date ; complexion sallow ; bowel's costive ; tongue loaded ;
considerable emaciation. The patient had strong prejudices
against the use of mercurials ; he was purged efficiently with
blue pill, and placed under the use of deuto-iodi. mercury. Its
action was manifested by copious purging of dark, offensive
matters. His general health improved rapidly, with manifest
improvement of the local disease. An ointment of the salt was
now applied. (Deut. iodide mercury, grs. xv, lard 2 oz.)

This treatment was continued two months ; an astonishing
improvement followed ; he fattened 25 pounds in a short time,
and the skin affection has given him but little trouble since.

Case III. This is a case of complete impotence, occurring
in a young man in his 19th year, of perfectly sound constitution,
perfect genital organs and chaste habits. I was unable to trace
his defect to any satisfactory cause. Without entering into a
detailed mode of the treatment in this case, (it being similar to
the plan pursued in the cases already reported,) suffice it to say,
his virile powers were restored to complete and full vigor in the
space of four weeks, under the exciting agency of the sol. deut.
iodi. mere. This case occurred during the summer of 1851.

Case IV. This is a case of vicarious menstruation of
four years' standing, and is a signal triumph over disease.

Miss , aged 19, had never had but one natural menstrual

period, the stomach performing the double function of digestion
and menstrual secretion. The regular periodicity of the menses
was often lost, and this distressing deviation from health at-
tended by the most frightful train of nervous symptoms. The
patient had been under the care of different practitioners, and
after a long course of medication, abandoned as hopeless.

I found her with most distressing symptoms of indigestion ;
feeble and sallow ; bowels constipated ; altogether a pitiable
example of human suffering. An examination per vaginam re-

366 Treatment of Fractures, S^c, [June,

vealed no deviation from nature in structural formation, and
no pathological degeneration. The lactiferous apparatus, and
other external concomitants of the puberie age, were present.
I suspected the existence of ovarian disease. The dyspeptic
symptoms being most urgent, I made trial of argent, nitras,
acet. morphine, and subnitrate of bismuth successively v^ithout
any manifest amendment. The deuto-iodide of mercury nov^r
presented itself to my mind as an article worthy of trial, and
more likely to meet the varying indications of the case than
any other with which I was acquainted. Six weeks' use of
the deuto-iodide of mercury restored the catamenia, quieted a
most refractory and rebellious stomach, imparted tone and vigor
to the nervous system, removed the cedema, improved the ap-
petite, and there is every encouragement to hope for a perma-
nent cure of the case. She is still under treatment, but has been
rid of all her distressing symptoms for the last three months,
and is now anxious to discontine farther treatment.

I vv^ould add at the conclusion of this paper, that for the last
12 years I have been constantly in the habit of prescribing this
agent in chronic gastric derangements unaccompanied with
serious structural lesion, and have been seldom disappointed in
the results. If sufficiently persevered in, together with proper
dietetic measures, it will seldom fail of relief Dr. Hildreth
reports a case of dyspepsia of 20 years' standing, in which the
remedy was in use for three or four months with unequivocal
benefit. In these cases it should be taken after meals and in
medium doses, as its salutaiy effects depend upon administering
it so as to avoid its morbid action. \_Stethoscope.

On the treatment of fractures in the vicinity of the ankle-joint ;
with observations on the 'practice of tenotomy, as facilitating
reduction of the broken hones. By Richard G. H. Butcher,
F. R. C. S. I., Examiner on Anatomy and Physiology in the
Royal College of Surgeons of Ireland, Surgeon to Mercer's
Hospital, &c., &c., &c.

In the Dublin Quarterly Journal of last month, there is a
practical paper by Mr. Butcher, illustrative of the treatment of
fractures in the vicinity of the ankle-joint. A number of in-
stances are recorded, some of them of the most complex nature,
yet, by the treatment laid down, and the apparatus recommend-
ed, the "integrity of the limb and its normal functions were in
every instance preserved to the sufferer." Space will not
permit a lengthened detail of the several cases and their man-
agement, but the concluding observations on the practice oi

1852.] Treatment of Fractures, <^c. SG7

tenotomy in similar cases, we shall transcribe in the author's
own words :

" One of my chief reasons for wishing to place these cases
on record is the practice lately brought into requisition in
London, in the management of the special fractures under
consideration. I allude to tenotomy, the division of the exten-
sor tendons, to facilitate reduction, as practised by Meynier,
Berard, Laugier, and other French and German surgeons. A
lengthened discussion not long since took place before the
Medico-Chirurgical Society of London, on the practice of
tenotomy, in some cases of fracture, when Mr. C. De Morgan
related some cases in illustration." In the first cited, the ten-
don was not divided until the day after the accident. ' The
second case occurred in the author's own practice. The patient
was a female, aged 66, of drunken habits, and was admitted
into the Middlesex Hospital in March, 1849. She had been
knocked down by a cab, and both bones of one leg were frac-
tured a little above the ankle.' The report goes on to say :
* The author divided the tendo-Achillis on the ninth day, with
instant relief to the suffering of the patient, and immediate re-
moval of all untoward symptoms.' A very important feature
in the management of these cases has been omitted altogether :
the manipulation adopted for the reduction of the fracture, and
the position in which the limb was placed afterwards. In the
second case, it is stated that ' the tendon was divided on the
ninth day.' I can easily understand that this might be requisite,
if the fracture, with its attendant deformity, was left unreduced
for that length of time ; failure of the therapeutic means em-
ployed ; and the spasmodic actions of the extensor muscles
thus prolonged ; for if fractured bones be left unreduced for
such a lengthened period as this, permanent spasm seizes on the
muscles and becomes established ; a fact clearly pointed out
and insisted on by Sir A. Cooper. Mr. De Morgan goes on to
say : ' In the case related, the chasm between the divided
portions at first did not exceed a quarter of an inch, that being
sufficient to get the bone into position ; and in a short time
after there was no appreciable space at all.' This admission
goes still further to proclaim that there is no necessity for di-
vision of ttie tendon to effect reduction, if the case is seen
early ; for, by flexing the thigh as I have recommended, we can
relax the extensor muscles more than ' the quarter of an inch,
Ihat being sufficient to get the bone into position.' I am of
opinion that, in ninety-nine cases out of a hundred, there will
be no necessity for division of the tendon to effect reduction, if
the limb be treated as I have advised ; nay, on the contrary, I
think, in some instances, the division of the tendon would' be

368 Sulphate of Bebeerine. [June,

very injurious, as removing the support posteriorly from the
ends of the broken bones, and thus permitting displacement in
that direction. The mode in which the fracture box, which I
have described, supports the leg in a horizontal line, with the
thigh slightly flexed, padded, and cushioned, as illustrated by
the foregoing cases, meets every requirement of the surgeon.
Dupuytren's splint, in conjunction with these means, as used in
some of my cases, is a most admirable adjunct; but, taken by
itself, it will not answer as well for the management of the
form of fracture under consideration ; for if the limb be done
up as directed by Dupuytren, and placed flexed upon its side,
some lateral displacement will take place ; or if, with the splint
so applied, the leg be allowed to rest upon the heel, it is un-
steady, and rolls about, and the entire limb is in the extended
position a posture very objectionable, as making tense the
tendo-Achillis.

From a review of these cases, and the observations upon
them, the following facts are, I think, deducible :

1st. That by proper position of the limb, and early reduction,
co-aption of the broken fragments can be effected, and spasm
averted.

2nd. As the result of the broken bones being kept in accu-
rate position, irritation is subdued, excess of callus prevented,
and the motions of the joint left unimpaired; a fact of great
practical importance here, for the experiments of M. Cruveilhier
prove that various forms of irritation will make the periosteum
and ligaments ossify, and it has been ascertained that in some
cases of fracture near the joints the ligaments have sometimes
been converted into bone, and M. Rayer has observed, from
numerous interesting experiments, that a similar change may
be exerted not only in the fibrous but also in the cartiliaginous
structures.

3rd. That tenotomy is not called for in the vast majority of
cases, being perhaps only admissible when permanent spasm
has located in the extensor muscles, owing to neglect of early
reduction." \_Canada Medical Journal.

Note on Sulphate of Bebeerine. By Henry S. Patterson,
M. D., Professor of Materia Medica in Pennsylvania Medi-
cal College.

At a time when the discovery of a substitute for Sulphate of
Quinia is a topic of general discussion, it may not be inappro-
priate to call the attention of the profession to a substance,
heretofore noticed, but too generally neglected. The Sulphate
of Bebeerine has been shown, by Dr. Maclagan, of Edinburgh,

1852.] Sulphate of Bebeerine. 309

to be a medicine of very considerable anli-periodic power,
closely resembling the corresponding salt of Quinia, and in
many respects equal to it, possibly superior. It is obtained
from the Bebeeru or Green-heart {Nectandra Rodiei) of British
Guiana, a tree of considerable size and extremely abundant.
The bark yields the alkaloid largel}^ but it is particularly
abundant in the nut. A decoction of the latter is the ordinary
popular remedy for intermittent fever in Demarara, and, as 1
am informed by an intelligent gentleman of that place, seldom,
if ever, fails to arrest the disease. The nut may be collected
in almost indefinite quantities, and could be obtained here, if a
demand were created, for little more than the expense of col-
lection and transportation. The process for separating the
alkaloid is almost identical with that for quinia, and not more
expensive. If, therefore, it proves on trial equal in efficacy to
that alkaloid, we will have a cheap and effective substitute
within the reach of all. The subject certainly deserves a more
extended investigation than it has hitherto received. The ob-
ject of the present communication is to invite attention to it,
and induce the profession, in miasmatic districts, to give the
remedy a fair ti'ial.

Sulphate of Bebeerine occurs in shining brown plates, (some-
times with a greenish tinge.) is inodorous, and has a bitter,
harsh, somewhat astringent taste. Like the Sulphate of Quinia,
it requires an excess of acid for its perfect solution. It may
be given in pill, solution, or powder. That it is a good general
tonic, in small doses, is very evident. In the full anti-periodic
dose it is more apt to disturb the stomach than the same quan-
tity of Sulphate of Quinia, and occasionally vomits ; but it pos-
sesses the advantage of being much less stimulating, and does
not affect the head as that salt does. Dr. Maclagan asserts
that it is "not so liable to excite the circulation or affect the
nervous system," and Dr. Meligan adds, that "this conclusion
is fully borne out by his experience." The patients who have
used it under my care expressly state that it did not occasion
in them the same headache and vertigo as the quinia had pre-
viously done. Its dose is stated at gr. i. v., three or four
times in the day. Neligan directs it made into pill with con-
serve of roses, or in solution, with the addition of a few drops-
of Acid. Sulph. Arom. The anti-periodic dose may be stated
at gr. XV. XX.

A letter from my friend and former pupil, Dr. H. J. Richards^
of Grey Town, Nicaragua, of the date of March 25th, 1852,
contains the following: "I have used the Bebeerine, as you
suggested, with uniform success in quotidian intermittents. I
have since had no opportunity to prescribe it in remittents^

370 Sulphate of Beheerine, [June,

All the intermittents of this coast, however, are comparatively
easily treated at this season, and yield readily to both quinine
and arsenic. The remittents and even intermittents of the fall
months, are more virulent and often speedily fatal." Those
months will certainly furnish a fairer test of Bebeerine ; but it
is something to know that, under existing circumstances, it
produces the same effect as the Quinia.

Dr. Watt, of Demarara, thinks that it is tardier in its effects
than the Quinia, not interrupting the paroxysms so immediate-
ly, but he also thinks that its effects are more permanent. The
cases in which I have had an opportunity of using it, seem to
confirm the latter opinion.

1st. A gentleman residing in Blockley township consulted
me in September last concerning an obstinate and constantly
recurring tertian intermittent, under which he had labored for a
length of time. He stated that the Quinia always interrupted
the disease, but that it inevitably recurred in two or four weeks.
I gave him Sulph. Bebeer. 3ss. dissolved in ! viij. water, a
table-spoonful to be taken every four hours during the apyrexia.
The next paroxysm was prevented, and he has had no return of
the disease up to the present time (April).

2d. A. J. applied to me in October last, with a very similar
statement. While residing in New Jersey, about six years
since, he had a violent and protracted "bilious fever," since
which time he has had, every month or two, an attack of "in-
termittent fever," which has been generally speedily arrested
by quinine. Such was his account of the case. I found his
tongue furred, his eyes icterode, his breath offensive, his urine
scanty and high colored. The anorexia was complete and
thirst considerable. He had a daily slight chilliness, followed
by considerable fever and a slight sweat. I gave him a mer-
curial purge, and on the next day fifteen grains of the Sulphate
of Bebeerine. He complained of some nausea, but no disturb-
ance of the head. The same quantity of Bebeerine was given
on the two succeeding days, when, the paroxysms no longer
recurring, it was discontinued. He remains free up to this
period (April), and says that he enjoys better health than he
has done for years.

If the permanent character of effect, which these cases seem
to indicate, should be established by a more extended experi-
ence, w^e will have in the Bebeerine an agent of very great
value, adapted to cases which have hitherto seemed uncontrol-
lable, except by arsenic, to which there are so many objections.
It is also much more speedy in its eftects than the arsenic.
Bouchardat (Ann. de Therap.) expresses his surprise that the
Bebeerine has been so entirely neglected in France, where

I

1852.] Bandaging after Delivery, 371

trial is daily made in agues with substances of inferior efficacy.
I trust that the same remark may not \o\-\% be made with re-
gard to the American profession, but that the precise value of
the medicine may soon be established by an adequate extent of
observation. [Medical Examiner.

On Bandaging the Abdomen after Delivery. By W. B Kes-
TEVEN, Surgeon.

[Mr. Kesteven, although sensible that the weight of opinion
is against him, records his conviction that too much stress has
been laid upon the importance of the bandage after delivery,
and that the rationale of its usefulness has been misunderstood*
In order to arrive at a correct conclusion on the subject, he ex-
amines it under the following points of view : 1st. The alle-
ged object to be gained by the bandage. 2d. Its real effects.
3rd. Its proper object, and the right period for its application.
With this intent, he thus proceeds :]

1st. The objects alleged to be gained by the application of
the roller directly after the completion of labour, are : a, to
promote the contraction of the uterus ; ft, to lesson the severity
of the after-pains; c, to prevent hemorrhage; d, io prevent
syncope ; e, to protect the patient against the consequences of
sudden alteration of the balance of the circulation, by which
syncope, inactivity of the uterus, hemorrhage, and subsequent
diseases, have been produced.

On examining, at the bedside, the validity of these several
objects, it may be observed, in the first place, that all or any, of
these supposed ends may be gained without the use of the ban-
dage.

a. In the vast majority of cases the uterus contracts rapidly,
firmly, and permanently, directly upon delivery, without the
aid of bandaging. That such is the case a very short expe-
rience among the labouring poor will soon convince the clinical
student. The poor women who are delivered by mid wives,
and the hundreds, ay thousands, who are yearly delivered with-
out any aid, would, were it not so, have all the dangers of un-
contracted uterus to contend with. That such is rarely the
case admits of no doubt.

b. That measure which shall promote the contraction of
the uterus can hardly be seriously recommended as a means of
lessening the severity of the after-pains; the contradiction is
too manifest to require further comment.

c. For the prevention of hemorrhage the application of a
roller certainly possesses no claim. Every practitioner who

372 Bandaging after Delivery. [June,

has diligently applied the bandage has had to remove it, in order
to apply that efficient pressure to the uterus which is most im-
portant in promoting its contractions, hemorrhage having taken
place in spite of the compression that had been made by the
bandaoje. In fact the tightly bandaging the hypogastric region
with the addition of pads, compresses, basins, &c., &c., has pro-
bably frequently given rise to hemorrhage by interfering with
the gradual tonic contraction of the uterus. The early appli-
cation of a binder and compress is a complete obstacle to that
vigilant attention to the state of the uterus after labour, which
it is the wisdom as well as the duty of the medical attendant to
pay for some little time after delivery. Where pressure is pro-
perly made, hemorrhage is not frequently met with. The very
officious accoucheur, who loads his patient's abdomen with di-
vers pads, and other similar contrivances, must frequently have
had occasion to remove them. Without these, the earliest
signs of hemorrhage may be recognised; with them, they are
often concealed ; without these hindrances, therefore, the oc-
currence may be arrested at its outset. It is not the purpose
of the present communication to dwell upon the treatment of
uterine hemorrhage, but the above hints may serve to show that
the bandage has few claims for adoption on that score.

d. The prevention of syncope is undoubtedly an object of
paramount importance ; it calls, therefore, for very full exami-
nation, as obtainable by the use of the bandage after labour.
The indication for its use in reference to the prevention of syn-
cope is theoretically deducted by analogy from the necessity
Ihat exists for the application of abdominal compression during
the operation of paracentesis. Here, although an analogy does
undoubtedly exist, the cases are far from parallel the conditions
not identical at least not in labour unattended with flooding.
When hemorrhage from the uterus occurs, the heart is then
physiologically affected in the same manner as where a large
quantity of dropsical effusion has suddenly been removed from
the abdomen. The removal of the pressure from surrounding
vessels in the one case being performed in the upright or sitting
posture, suddenly empties the heart of its blood, in the same way
that it is emptied by a sudden gush from the uterus. In natu-
ral labour there are these points of physiological difference : the
heart is not suddenly deprived of a quantity of blood, because
the mass of blood previously circulating in the enlarged ves-
sels and hypertrophied structure of the uterus is thrown back
upon the diOviQ, pari passu with the diminution of the tumour
by the contractions of the uterus. The consequent removal of
pressure from the surrounding vessels is therefore compensated
by the non-abstraction of blood from the arterial system, which

1852.] Bandaging aftei' Delivery. 373

so far may be regarded as the equivalent of the compression
which is had recourse to for the purpose of obviating the sud-
den change in the state of the circulation that takes place in
tapping. Cases of excessive quantity of liquor amnii, triplet
and quartet cases, form instances in which the analogy with
the effect of tapping becomes closer. The difference in posi-
tion must also be borne in mind, when an analogy is attempted
to be drawn between these two conditions. In tapping, the
position is erect in labour, it is horizontal. To this rule of
difference, however, exceptions occur, parturition sometimes
occurs so rapidly, and so unexpectedly, that delivery takes
place before the parturient woman can assume the recumbent
posture. That such exceptional cases do not invalidate the
rule is sufficiently shown by their rarity, and also by the evil
consequences that often follow thereon. It may be remarked
then for these reasons, that it is obvious that women after de-
livery have not to thank the bandage for their exemption from
syncope. The writer has never seen a case of mere syncope
occurring after labour, where the horizontal posture has been
carefully observed for some hours, although he has systemati-
cally neglected to apply the bandage. He has occasionally
seen it, and has heard of even fatal syncope where this precau-
tion of the horizontal position has been violated.

e. Having above disposed of the futility of the argument
for the use of the bandage to prevent hemorrhage or syncope,
other evils supposed to be consequent upon a disturbance of the
circulation are obviously as likely to be benefited by that con-
trivance.

The second division of this subject is next examined.

2d. The real effect of bandaging the abdomen after delivery.

a. It affords support to the abdominal walls, if applied
moderately firm,

b. It gives comfort to the patient, and meets her wishes or
prejudices w'ith reference to the preservation of the figure.
Among its effects, which are not so harmless as these, are its
aggravation of after pains, and the inducement of irregular
contraction of the uterus ; its obstruction to manipulations ; its
interference with the action of the diaphragm ; its displacing
the uterus, and causing obliquity, prolapsus, &c., of that organ ;
its interference with a most valuable means of controlling
uterine hemorrhage, viz : the compression of the aorta. All
these are highly important matters, and are to be found among
the consequences of the tight bandaging which is adopted by
some practitioners.

3d. The consideration of the two preceding topics leads to
that of the third, the proper object of, and right period for

N. S. VOL. VIII. NO. VI. 24

374 Alvine Discharges in Children. [June,

the application of the bandage. The first point may be very
briefly expressed in the words of Dr. Blundell. It is to be ap-
plied " with that degree of tension which may yield a sense of
grateful support." This is the whole truth of the question
the sole object of the bandage is to afford a comfortable degree
of support ; it is not to effect forcible compression of the abdo-
men.

The proper period for its employment is therefore not until
the uterus has firmly contracted, the patient having been left
to undisturbed rest for at least two hours, has had her linen
changed, and is being " put to bed." Before this period it, as
has been shown, is but an incumbrance. At this time the ban-
dage will afford " a sense of grateful support," and will meet
the patient's prejudice with reference to the preservation of
her figure a prejudice which may in this way be harmlessly
humoured ; it being emphatically impressed upon the minds of
the patient and her attendants, that the application of the ban-
dage is of infinitely less importance than quiet rest ; that the
contraction of the uterus is more effectually and naturally in-
duced by the child's mouth at the nipple, than by all the screw-
ing and squeezing machines that ever were contrived.

If the necessity of any proceeding may be measured by the*
end it is intended to serve, most assuredly the importance of the
abdominal bandage has been much over-rated. The preceding
remarks have shown that its alleged objects are not obtainable^
even if they are desirable ; that its real effects are either triflings
or evil; that its proper object is of a very subordinate charac-
ter, and pertaining rather to the functions of the nurse than to
those of the medical attendant. [Medical Gazette.

On the Varieties of Alvine Discharges in Children. By Dr^
Merei.

[The intestinal discharges mentioned by the author are :]

1. The yellow discharge. This is the regular kind of stool
in infants. It is a mixture of intestinal secretions with bile.
As children advance in age^and begin to take substantial food,
the colour of their regular discharge becomes more and more
of a li^ht brow colour.

2. The mucous discharge. With mucous matter, more o?
less thick or liquid, and mixed with serum, sometim.es with a
proportion of bile. This discharge is preceded by but moderate
pains, and frequently by no pains at all. It denotes a catar-
rhous, sub-inflammatory, or irritable state of the intestines,,
and is almost always of local, and not of sympathetic, origin ;

1852.] Alvine Discharges in Children. 373

in general it is not dangerous, and at its commencement is easily-
manageable by opiates, warm poultices, and convenient hygiene*
If neglected, it becomes pertinacious and severe, and not sel-
dom connected with swelling, softening, or granules of the
mucous membrane, or ulceration of the follicles. If stripes of
blood are mixed with the mucus, and pain be present, it denotes
a higher degree of inflammation, in particular of the follicles.
The highest development in this direction constitutes enteritis
or colitis (dysentery.)

Sometimes we find among the mucus, consistent plastic con-
cretions of a more or less tubular shape, similar to those of
laryngeal croup, but larger in proportion to the volume of the
intestines. This is the strongest degree of the catarrhous
process which I might term the croup of intestines. Among
the whole number of my little patients, which may be about
30,000, 1 met with this discharge perhaps only twenty or thirty-
times. The discharge is effected with very painful efforts at
a stool.

3. The serous. In general, after more or less severe pains,
the discharge takes place with a certain rigidity and noise, after
which the pains lessen or subside. It consists of an abundant
quantity of serous liquid, dirty whitish, yellowish, or greenish,
as besides mucus, bile is the most common mixture with the
serum. The serous diarrhoea is commonly the effect of rheu*
matism in the peritoneum, in the serous and fibrous membranes,
or in the nerves of the intestines. I found in these cases the
abdomen very hot. If a great deal of mucus and some blood
are mixed with the serum, we may suspect parenchymatous
enteritis ; if the serous membrane alone enters into the state of
acute inflammation, frequently transudation takes place on its
free surface.

I have seen cases of profuse serous discharge, in a very short
time, even in less than twenty-four hours, produce collapse
and death, and in some of these instances necroscopy could
not discover an adequate alteration either in the mucous or in
the serous membrane.

The serous species of discharge is frequently merely a pro-
duct of sympathetic secretion. I observed it sometimes con-
nected with large transudations in the chest, and with chronic
hydrocephalus.

Speaking in general, serous diarrhoea, if even arising from
rheumatism, is more difficult to manage than the mucous.
Very minute doses of calomel, with Dover's powder and mus-
tard poultices, are frequently beneficial.

Pure serum, like ricewater, is a less favorable quality than
the dirty-white or yellowish. Dark-brown serum frequently

376 Alvine Discharges in Children. [June,

denotes a disorder in the portal system, present in some severe
gastric or typhoid fevers, but I have seen a similar quality also
in chronic affections of the brain, and very frequently in scrof-
ulo-impetiginous children. This is worthy our attention, in
particular if eczema or impetigo has disappeared from the head
and face. This brown and fetid discharge accompanies some-
times the commencement of chronic hydrocephalus. I treated
it successfully, in this last case, with high but very diluted doses
of iodide of potash.

4. The green bilious discharge. If pure bile, then the voided
matter is in general not abundant. In young children it is of
a more yellowish than green colour. The essential character
of bile is, to be of a greenish colour (in infants it is voided green)
at the very moinent of its evacuation. This kind of discharge
is very frequently present in acute inflammatory and febrile
affections ; if dependent upon an affection of the brain, then we
may find the colour to be rather brown, and the abdomen re-
tracted. If a similar source produces abundant serous-bilious
discharges, then w^e find the abdomen much collapsed. But I
must observe, acute affections of the brain are almost always-
connected with constipation, only in some cases of chronic
hydrocephalus I met with the mentioned diarrhoea. Bilious-
discharge, as arising from bilious fever, or from derangement
of the liver, is rare in young children. In this case the right
hypochondrium will be more or less bloated up. We must be
careful not to confound the green bilious discharge with the
following:

The discharge, like chopped eggs, mixed with mucus, some
clots of bile, and caseous coagula of indigested milk, or other
kind of food, accompanied almost always by gripes and flatu-
lence ; its smell is disagreeably acid, and the whole matter,
some minutes after being discharged and exposed to the atmos-
phere, becomes green. We know not exactly the chemical
change which produces this coloration, it seems to be an oxy-
dation of som.e of the elements. Then the essential character
of this discharge is, that it is yellow at first, and becomes greea
by exposure to the atmosphere, whilst bile is green at the mo-
ment it comes out. I shall call this the acid saburral discharge,
which is the most obvious before the sixth month of age, in
particular if the sucking child takes, besides the milk, some
farinaceous food. Practitioners commonly prescribe in this
case rhubarb, with magnesia. For my part I prefer, in tender
infants, to rely more upon a convenient change in the diet, and
as a remedy, aromatic frictions of the epigastrium, and internally
bicarbonate of soda, dissolved in mint w'ater.

6. The bloody discharge. Pure red blood is seldom dis.'

1852."] Ahine Discharges in Children. SW

charged by children ; in some rare cases I have seen half or
one table-spoonful come out, as the product of active conges-
tion and hemorrhage. Very frequently, on the contrary, blood,
is combined with the mucous discharge, and in this case, if it is
preceded by pain, without tenderness, it denotes an inflamma-
tion in the upper parts of the intestinal tube, at least not near
the rectum. Tenesmus signifies that the seat of the inflamma-
tion is in the lower parts of the colon, or in the rectum. This
form is commonly called dysentery, not dano;erous, if it is
without bilious complication and fever, and if treated in its
early stage with Dover's powder, some doses of castor oil, and
warm poultices ; in a stronger degree leeches at the anus ; but
if neglected in the commencement, it becomes dangerous to the
life of the child. Professor Rokitansky, of Vienna, describes
most exactly what he calls the " dysenteric process," in three
gradual degrees of anatomical change. The highest degree,
presenting a dirty red and gray marbled surface, with consid-
erable thickening, granulation, and ulceration, I never saw in
the tender age. Young children die before this stage is devel-
oped.

Passive hemorrhage of the intestines very seldom occurs in
children. I have seen, however, some cases where, without
adequate pain, a considerable quantity of dark thin blood was
discharged. Lastly, we have seen in this town, with Mr. Wil-
son, a case in a child six years old, where, during the course of
a gastro-typhoid fever, more than one pint of carbonized blood
was discharged in two days. The case recovered. The boy is
aflTected with an enlarged spleen.

Moderate quantities of red blood, discharged without pain,
frequently occur, mixed with mucus, and are, without significa-
tion, sometimes even connected with the advance of recovery
from gastric aflfections. This is the same case as with epistaxis.

Golding Bird and Simon state, as the result of chemical
analysis, that some dark green stools of ciiildren owe this colour
to blood which has suflered a certain chemical change ; but
those chemical inquiries are not yet arrived at a satisfactory
exactness ; we do not even know exactly what kind of green
-discharges were the subject of these inquiries.

7. Calomel stools. Green, more or less thick, or mixed with
serum, and in this case more abundant, produced by full doses
of calomel. Calomel stools resemble bile, and contain much
i)ile, but they contain also some particular chemical elements
which we do not exectly know. In many instances it happens
that the calomel diarrhoea commences some days or weeks
after the use of mercury, and we must be aware of this, and
t xjonfound it with the primary bilious discharge. In tLe

378 Effects of the root of Podophyllum Peltatum. [June,

former case the region of the liver is in general softer than in
the latter. A clever practitioner will never try to stop directly,
and with astringents, a green discharge, whatever be its origin
and nature.

Calomel stools sometimes contain blood. After what I have
seen in dissection, I incline to attribute this circumstance to a
sub-inflammatory state, with superficial erosions of the mucous
membrane, which sometimes take place in children after the
continued use of calomel.

[The author states that he considers all these qualitative and
physical distinctions of the discharges of children as very im-
perfect outlines of a sketch, which, by farther physical and
chemical inquiry can become corrected and perfected.]

[Provincial Med. and Sur. JoiirnaL

Peculiar Effects of the root of the Podophyllum Peltatum or
May Apple ; and its Alcoholic Extract. By Charles W,
Wright, M. D., of Cincinnati.

Having been called upon to make an analysis of some cocoa,
which it was supposed had been poisoned by having been pul^
verized in a mortar in which cantharides had been reduced to
powder a short time previously, and which it was believed had
not been properly cleansed ; but, being unable to detect the
presence of cantharides by any of the proposed tests or the
scales by means of a microscope, I was induced to attribute the
symptoms of poisoning to the presence of some other agent;
and upon investigation the following appears to have been the
cause of the symptoms observed :

Upon inquiring of the person who pulverized the cocoa
beans, it was found that the mortar, a short time before, had
been used to pulverize the alcoholicextract of the podophyllum
peltatum, called by the self-styled eclectic practitioners podo-
phylline, and by whom it is almost exclusively used, being their
substitute for calomel.

Now it is found that if a person take the powdered root, or
the alcoholic extract of the May apple for a considerable period
of time, a peculiar papular eruption makes its appearance on
the scrotum, accompanied by an irritation of the neck of the
bladder, especially when the dose is not sufficient to produce
free catharsis. This eruption not unfrequently makes its ap-
pearance on those employed to pulverize the root, and occurs
so frequently in the practice of the eclectics that they have
given it the name oi Scroteritis.

All of those persons who used the cocoa containing the ex-

1S52.] Amputations in Children. 379

tract of May apple, were affected with irritation of the neck of
the bladder and tenesmus; and in some of the cases the pain
was so severe that they would lay hold of the nearest object
for support until it subsided.

The powder of the root and extract is excessively irritating
to the eyes, producing, in considerable quantity, an inflamma-
tion which is extremely difficult to treat. [Western Lancets

On Amputations in Children. By M. Guersant.

The amputations at the Hbpital des Enfants are of frequent
occurrence, not less than from eighteen to twenty taking place
annually ; being usually performed for white-swelling or other
chronic disease. M. Gaersant is, however, no advocate for
hasty operations in such cases, as the lymphatic habit upon
which the disease of the joint depends may often be ameliora-
ted, and a valuable though an imperfect limb be preserved.
Much depends upon the social position of the parents. The
working-man has not at his command those resources which
may be required for years during an endeavour to preserve
the limb of the child ; and after the operation the latter may
be apprenticed to many trades, even though he has a wooden
leg. The child placed in easy circumstances can command
prolonged medical attendance, sea-air, change of climate, or
whatever may be deemed beneficial, and amputation need not
be performed until all other means have been exhausted. Af-
ter a long period, however, all the chronic disease in a scrofu-
lous child suffering from arthritis seems to concentrate itself in
the diseased joint ; and upon the removal of this, his health
may become re-established. Amputation frequently succeeds
better in debilitated than in very strong and vigorous children.

Whenever possible, M. Guersant prefers the months of May,
June, and July, for the operation, as unfavorable complications
are of more common occurrence in the cold and changeable
seasons of winter and spring. The child requires but little
preparation ; the means which have already been employed
for the improvement of its general health, is iodine, bitters,
cod-liver oil, &c., all placing it in the best condition for
undergoing the operation. If a large eater, the food should be
somewhat diminished two or three days before ; and any exist-
ing diarrhoea must be arrested by anodyne injections and bis-
muth.

M. Guersant sometimes employs the oval operation, but
iiardly ever the circular. In most cases he prefers the flap,
whi-ch renders the co-operation of the assistants easier, occa-

380 Treatment of Varicose Veins. [June,

sions little inflammation or suppuration in children, frequently
allowing of union by the first intention, and affords a better
covering for the bone. Chloroform is employed, and the prin-
cipal artery of the limb carefully compressed, so as to avoid
haemorrhage. In very hot weather, the edges of the wound
are united by some points of suture, and the stump left exposed
to the air. When bandages are employed, the stump is dressed
daily. On the evening of the operation a little broth is allowed,
next day a stronger soup, and the day after that sometimes a
little roast-fowl.

By observing these rules, M. Guersant finds, as a general
rule, that eight or nine cases in ten recover. If erysipelas
occur, leeches are applied to the nearest lymphatics ; and if
these do not suffice, a circular blister is placed around the
stump ; emetics and purgatives, but especially the former, being
given. In cases of purulent resorption, he has obtained some
benefit from aconite. If the surface of the wound takes on a
greyish colour, and becomes covered with false membranes,
chlorined water or lemon-juice is the best application. When
union by the first intention does not take place, the inner lip
of the wound should be stimulated, and then strapping applied ;
and when fistulse occur, they will usually be found dependent
upon small portions of bone tending to necrosis. Gaz, des
Hop,

[A writer in the Bull, de Therap. (torn. xl. p. 81) observes,
that M. Guersant did not lose a single case of amputation dur-
ing 1850, though the thigh, arm, foot, and shoulder, were
among the parts removed. The great success of operations
on the young has long been known, and is usually attributed
to the greater vitality of childhood and the absence of mental
disquietude. However this may be, M. Guersant's especial
success is probably, in a great measure, due to his habit of order-
ing good, nutritious diet as soon after the operation as possible.
Under the influence of this, the children rapidly recover strength
and flesh, the wound assumes a healthy aspect, and the colliqua-
tive diarrhoea, so common prior to the operation, ceases. Ab-
stinence is ill-borne at this tender age, and most of these
children have become exhausted by suppuration prior to the
operation.] Medico- Chir, Review.

I

Treatment of Varicose Veins.

An entirely new method is coming extensively into vogue,
in England, in the management of enlarged veins of the lower
limbs, that merits the attention of American surgeons. An
India-rubber stocking is manufactured in Liverpool, expressly

1852.] Infantile Marasmus. 381

to meet this particular condition of the veins. It is a loose net-
work, reaching to the knees, but which uniformly compresses
the vessels, supports their outer wall, and yet gives no sensation
of tightness, or otherwise any unpleasant feeling. We exam-
ined a gentlemen, a few days since, who is habitually wearing
one of these stockings, which he represented as a great com-
fort. Some years ago, Dr. Mott, of New York, operated on
one of the largest veins, but with no particular benefit. Till
the India-rubber stocking was drawn on, he was haunted with
an apprehension of the possibility that some of the over-disten-
ded vessels might burst. This has been completely prevented
by wearing this article, and fears of a contingency of that kind
are now entirely gone. This pain and sense of weight, after
being on foot through the business fatigues of the day, and not
felt, and the patient urges upon, sufferers from the same afflic-
tion, to procure the simple palliative of an India-rubber stock-
ing. [^Boston Med. and Sur. Journal.

Wine and Honey in Infantile Marasmus.
Dr. Baun states, that in the marasmus of infants he has de-
rived truly remarkable benefit from the employment of a mix-
ture consisting of one part wine and two or three of honey,
giving several tea-spoonfuls daily. Not only Madeira but
good Burgundy may be so employed, or when diarrhoea is not
present, the Rhenish wines. Refreshing sleep, and an increase
of animal temperature, are the first effects, and an improved
digestion a latter one. \Journ, fur Kinderkrank. Medico-
Chir, Rev,

Treatment of Asphyxia Infantum.
Dr. Tott states, that he has often succeeded in restoring life
in the asphyxia asthenica infantum after the failure of the usual
means, by causing a person to stand on a table, and pour cold
water from a tea-kettle on to the pit of the stomach. In this
way Professor Hasselberg saved many lives. [Ihid.

Purgative Syrup of Jalap. By M. Yiel.

Take of powdered jalap, an ounce ; alcohol, 3| fluid ounces ;
water, 26^ fluid ounces ; sugar, 30 ounces. Digest the jalap
in the water and alcohol, previously mixed in a flask, during
five or six hours, at the temperature of 90 to 100 F., filter,
add the sugar and dissolve it, aromatise and preserve for use.

This syrup, which is an agreeable purge for young children,
may be given in tea-spoonful doses. [/owr. de Cliimie Med.
Amer, Jour, of Phar.

382 Solution of Aloes and Soda. [June,

Solution of Aloes and Soda. By Professor Mettauer.

In this preparation the aloes is held in solution and its action
modified by the presence of bicarbonate of soda. It is a useful
aperient for persons of costive habit, and may be employed
without the unpleasant effects that sometimes result from the
employment of aloes alone.

Take Socotrine Aloes, two ounces and a half, troy ;

Bicarbonate of Soda, six ounces ;

Compound Spirit of Lavender, two fluid ounces ;

Water, four pints.

Macerate the mixture for two weeks with occasional agitation,
and filter.

The dose is from a fluid drachm to a fluid ounce half an hour
after meals. \_American Journal of Pharmacy.

Disulphate of Quinia rendered soluble by Tartaric Acid.

M. Righini has proposed to substitute tartaric acid for sul-
phuric acid to render the commercial sulphate of quinia soluble
in water when directed in solution by prescriptions, as being
less austere and disagreeable to the taste. M. Casorati, of Tu-
rin, gives the following formula: Sulphate of Quinia, six
grains ; Tartaric Acid, three grains; Syrup of Oranges, a
fluid ounce. [UAbeille Medicale., and Ibid.

Gentianin recommended as a substitute for Cinchona.

Dr. Kuchenmeister affirms that impure and uncrystallized
gentianin can be substituted for sulphate of quinia, and he has
noticed : 1st, that this substance acts on the spleen at least as
efficaciously as sulphate of quinia. 2d. Its action is not less
rapid. 3d. That it is sufficient to administer 15 to 30 grains
twice a day ; and 4th, that gentianin constitutes probably the
most valuable substitute for Peruvian bark. [Jour, de Chimie
Med., and Ibid.

Antidote for Poisoning by Corrosive Sublimate.
The Boston Medical and Surgical Journal- contains the de-
tails of a case in which a large quantity of the Bi-chloride of
Mercury had been taken, and which was successfully treated
by Dr. Cummings, with repeated draughts of a solution of
salaeratus. The alkali deprived the mercury of its acid, and
thus rendered it inert. The whites of eggs were also given.

1852.] Miscellany, 383

ill i s r c U a n s .

American Medical Association. We are indebted to the politeness
of the Editor of the *' Stethoscope " for the Proceedings of the fifth
meeting of the American Medical Association, recently held in
Richmond, Va., from which we condense the subjoined details. The
meeting having been called to order by Dr. Moultrie, President, and
twenty-three States being represented by two hundred and seventy-
five Delegates, the following officers were elected for the present
year: President Beverly R. VVelford, M. D., of Virginia; Vice-
Presidents Jonathan Knight, M. D., of Connecticut ; James VV.
Thompson, M. D., of Delaware ; Thomas Y. Simons, M. D., of South
Carolina, and Charles A. Pope, M. D., of Missouri ; Treasurer D.
F. Condie, M. D., of Pennsylvania ; Secretaries P. C. Gooch, M. D.,
of Virginia, and Edward L. Beadle, M. D., of New York.

The Committee on Prize Essays awarded the prize of $500 to Dr.
Austin Flint, of Buffalo, for his essay " On Variations of Pitch in
Percussion and Respiratory Sounds, and their application to Physical
Diagnosis."

The Report of the Committee on the Medical Botany of the United
States for 1850-1, was presented by Dr. A. Clapp, and referred to the
Committee on Publication. The reports of the regular standing com-
mittees were then called for in order, and were severally laid over
or continued.

Dr. Pinkney, of the Navy, read a memorial he had prepared to
present to Congress, on the subject of assimilated Rank which was
referred to a committee. It was then resolved, that no member should
speak more than ten minutes at a time, nor more than twice on the
same subject. Dr. T. Y. Simons offered a preamble and resolutions
in reference to the evils of crowding emigrants on ship- board. Dr.
Storer vindicated himself against certain attacks as chairman of the
committee on Obstetrics. Dr. J. B. Flint proposed the establishment,
by the Association, of a Quarterly Journal, instead of issuing a volume
of Transactions which was laid over to the next meeting.

Dr. Hays, chairman of the Com.mittee on the Constitution, made a
Report, and Dr. Yardly a counter Report, both of which were referred
to a committee of three, for the purpose of reconciling the differences
between them, if possible. The City of New York was then select-
ed for the next meeting of the Association. A communication from
the New York Academy of Medicine, in reference to the " College
Cliniques," was read and referred to the committee on Publication.

384 Miscellany. [June,

The Report of Dr. H. Adams, of Massachusetts, on the " Action of
Water on Lead Pipes, and the Diseases resulting from it," was also
referred to the same committee. Dr. Williman, of South Carolina,
read the Report of the Committee on " The blendinjT and conversion
of the Types of Fever," and Dr. Hay ward, of Massachusetts, read
that of the Committee " on the permanent cure of Irreducible Her-
nia both of which reports were ordered to be printed. The applica-
tion of the representative of the late Dr. Horace Wells for the ap-
pointment of a committee to inquire into and report on the claims of the
contestants for the priority of the discovery of Anseslhesia, was laid
upon the table.

It was determined that, in future, all Reports, &;c., exceeding ten
pages, must be accompanied with a synopsis of the contents, which
may be read before the Association.

The following amendments to the Constitution were read and laid
on the table for farther action :

Article I. Title of the Association. This institution shall be
known and distinguished by the name and title of *' The American
Medical Association," It shall be composed of all the members of
the medical profession of the United States of good standing, who ac-
knowledge fealty to and adopt the code of ethics adopted by the asso-
ciation ; and its business shall be conducted by their delegates or
representatives, who shall be appointed annually in the manner pre-
scribed in this constitution.

Strike out the whole of Article II, referring to " Members," and
insert the following :

Article II. Of Delegates. 1. The delegates to the meetings
of the association shall collectively represent and have cognizance of
the common interests of the medical profession in every part of the
United States, and shall hold their appointment from county, state and
regularly chartered medical societies ; from chartered medical col-
leges, hospitals and permanent voluntary medical associations in good
standing with the profession. Delegates may also be received from
the medical staffs of the United States army and navy.

2. Each delegate shall hold his appointment for one year and un-
til another is appointed to succeed him, and he shall be entitled to
participate in all the business affairs of the association.

3. The county, district, chartered and voluntary medical socie-
ties shall have the privileg-e of sending to the association one delegate
for every ten of its resident members, and one more for every addi-
tional fraction of more than one half of this number.

4. Every state society shall have the privilege of sending four
delegates ; and in those states in which county and district societies
are not generally organized, in lieu of the privilege of sending four
delegates, it shall be entitled to send one delegate for every ten of its
regular members, and one more for every additional fraction of more
than one half of this number.

1852.] Miscellany. 385

5. No medical society shall have the privilege of representation
M'hich does not require of its members an observance of the code of
ethics of this association.

6. The faculty of every chartered medical college acknowledg-
ing its fealty to the code of ethics of this association, shall have the
privilege of sending one delegate to represent it in the association :
Provided, That the said faculty shall comprise six professors, and
give one course of instruction annually of not less than sixteen weeks
on Anatomy, Materia Medica, Theory and Practice of Medicine,
Theory and Practice of Surgery, Midwifery and Chemistry : And
provided also, That the said faculty requires of its candidates for
graduation 1st. That they shall be twenty-one yearsof age ; 2d. That
they shall have studied three entire years, two of which must have
been with some respectable practitioner ; 3d. That they shall have
attended two full courses of lectures, (not however to be embraced in
the same year.) and one of which must have been in the institution
granting the diploma, and also where students are required to continue
their attendance on the lectures to the close of the session ; and 4th.
That they shall show by examination that they are quaiilied to prac-
tice medicine.

7. The medical faculty of the University of Virginia shall be en-
titled to representation in the association, notwithstanding that it has
not six professors, and that it does not require three years of study
from its pupils, but only so long as the present peculiar system of
instruction and examination practised by that institution shall continue
in force.

8. All hospitals, the medical officers of which are in good stand-
ing with the profession, and which have accommodation for one hun-
dred patients, shall be entitled to send one delegate to the association,

9. Delegates representing the medical staffs of the United States
army and navy shall be appointed by the chiefs of the army and navy
medical bureaux. The number of delegates so appointed shall be
four from the army medical officers and an equal number from the
navy medical officers.

10. No delegate shall be registered on the books of the associa-
tion as representing more than one constituency.

11. Every delegate elect, prior to the permanent organization of
the annual meeting, and before voting on any question after the meet-
ing has been organized, shall sign the constitution and inscribe his
name and address in full, with the title of the institution which he rep-
resents.

The Association adopted the following Resolutions presented by the
Committee on rank and grade of Navy Surgeon :

1. Resolved, That the American Medical Association, represent-
ing the medical profession of the United States, reaffirm the resolutions
passed at the meetings held in Bahimore in 1848, in Cincinnati in
1850, and in Charleston, South Carolina, in 1851, by pressing their
approbation and support of the establishment of the assimilated rank

386 Miscellany, [June,

conferred on the navy medical officers by the regulation of the navy
department in 1847.

2. That this association is not aware of any disadvantage attending
on the regulation of 1847 ; that they can perceive no just cause for its
alteration, and disapprove of the change proposed.

3. That it is the opinion of this association that it would be for the
interest of the naval service that this question should be settled defini-
tively during the present session of Congress, and if conformable with
the usages of the military service, by legislative enactment, to which
request they respectfully invite the attention of the honorable senate
and house of representatives.

It was also resolved to memorialize Congress on the subject of pub-
lishing the medical statistics of the census of the United States, sepa-
rately, for distribution to the medical profession.

Resolved, That the Committee on Epidemics be constituted in rela-
tion to the division into districts as they were the last year, and that
they be continued in service during a period of five years.

Resolved, That the chairman appointed for each district shall have
power to select associates, not exceeding four in number, to assist him
in his labors.

Resolved, That the several State Medical Associations be request-
ed to use their influence to procure the appointment, by the Legisla-
tures, of Sanitary Commissions.

Dr. Drake read a paper on the " Influence of Climatic Changes on
Consumption," which was referred to the committee on printing.

A committee of five was appointed to solicit subscriptions from the
members ot the association, for the purpose of procuring a suitable
stone, with an appropriate inscription, for the Washington monument,
now in progress of erection in Washington City.

It was resolved to accredit one member from each State represent
ed in the Association to travel in Europe, and to report upon foreign
medical affairs. Also, that the Association hereafler grant two prizes,
of $100 each, for the two best essays.

The following reports were then presented, read by their titles, and
referred to the committee of publication ;

" On the Toxicological and Medicinal properties of our Cryptogamic
Plants," by F. Peyre Porcher, of S. C.

" On the Epidemics of New Jersey, Pennsylvania, Delaware and
Maryland," by J. L. Atlee, of Pa.

*' On the Epidemics of South Carolina, Georgia, Florida and Ala-
bama," by Dr. W. M. Bolixg, of Ala.

Together with this report, which was handed in by Dr. Drake, of
Ky., there was also presented a paper by Dr. D. J. Cain, of S. C. j
which was ordered to be appended to the report when published.

1852.] Miscellany. 387

"On the Epidemics of Mississippi, Louisiana, Texas and Arkan-
sas," by Dr. Ed. H. Barton, of La.

" On the Epidemics of Ohio, Indiana and Michigan," by Dr. Geo.
Mendenhall, of Ohio.

Dr. Stewart, of N. Y., then presented the report of the committee
on the amendments to the constitution, and read the following additions
which the committee had made since its recommitment :

To section 1, article 2, add "Delegates may also be received from
the United States army and navy."

In section 6, article 2, add the words " Comprise six professors
and" after " provided said faculty shall."

In section 6, add to 3d requisition on faculties, the words " aiid also
where students are required to continue their attendance on the lec-
tures until the close of the session."

Add section 7. " The medical faculty of the University of Virginia
shall be entitled to representation in the association, notwithstanding
that it is not composed of six professors, and that it does not require
three years of study for its pupils, but only so long as the present pe-
culiar system of instruction and examination practised by that institu-
tion shall continue in force."

Add section 9. " Delegates representing the medical staff of the
United States army or navy shall be appointed b} the chiefs of the
army and navy medical bureaux. The number of delegates so ap-
pointed shall be four from the army medical officers and an equal
number from the navy medical officers."

Special Committees, were appointed " On the Causes of Tubercu-
lar Disease ; on the Mutual Relations of Yellow and Bilious Remit-
tent Fever; on Epidemic Erysipelas; on Acute and Chronic Diseases
of the Neck of the Uterus ; on Dengue ; on Milk Sickness, so called ;
on the prevalence of Idiopathic Tetanus ; on Diseases of the Parasitic
Organs ; on the Physiological Peculiarities and Diseases of Negroes :
on the Alkaloids which may be substituted for Quinia ; on results of
Surgical Operations for the Relief of ^Malignant Diseases ; on Statis-
tics of the Operation for the removal of Stone in the Bladder; on
Sanitary Principles applicable to the Construction of Dwellings ; on
Toxicological and Medicinal Properties of our Cryptogamic Plants ;
on Agency of the Refrigeration produced through Upward Radia'ion
of Heat as an exciting cause of Disease ; on the best means of making
Pressure in Reducible Hernia; on Cholera and its relation to Conges-
tive Fever their analogy or identity ; on Displacements of the
Uterus ; on Typhoid Fever ; on Epidemics of New England and New
York ; on Epidemics of New Jersey, Pennsylvania, Delaware and
Maryland ; on Epidemics of Virginia and North Carolina ; on
Epidemics of South Carolina, Georgia, Florida and Alabama ; on
Epidemics of Mississippi, Louisiana, Texas and Arkansas ; on Epi-
demics of Tennessee and Kentucky; on Epidemics of Missouri,
Illinois, Iowa and Wisconsin ; on Epidemics of Ohio, Indiana and
Michigan.

Committee on Volunteer Communications. Drs. Joseph M. Smith,

388 Miscellany,

Jno. A. Swett, Wiilard Parker, Gurdon Buck, and Alfred C. Post, of

New York.

Rarity of Repeiilion of Attempt at Suicide hy Fire-arms. By M. H.
Larrey. M. H. Larrey, in a recent discussion, observed, that accord-
ing to his experience suicidal maniacs may make repeated attempts at
terminating their existence by poison, drowning, or other means of in-
ducing asphyxia, and even by the sword or dagger ; but that individu-
als who have once attempted to kill themselves by fire-arms scarcely
ever renew their suicidal endeavour, but resort eagerly to all surgical
means capable of correcting or effacing the etiects of their mutilations.
Among numerous others he might allude to, he referred to two young
soldiers, now at the Val de Grace, who having in vain endeavored
to blow their brains out, have never since shown the slighest attempt
to repeat the act. A case occurred to Dupuyiren in the person of a
soldier, who alter having in vain attempted his life several times, at
last endeavored to blow out his brains, but only succeeded in mutila-
ting his face. Cured, however, of the effects of this serious accident,
he became also for ever cured of his suicidal mania. M. Larrey in-
quires, whether the cerebral commotion produced in these cases effects
a salutary perturbation in the mental condition ?

M. Brierre confirmed M. Larrey's statements; and observed, that
it may be advanced, if not as an absolute, at least as a very general
rule, that individuals who have once endeavored to shoot themselves
never repeat the attempt. Frequently, at the end of several years,
they make new attempts at suicide by other means. Persons, on the
other hand, who have failed in accomplishing their death by the vari-
ous other means, frequently recur to those among them which they have
already uselessly employed. [L' Union Medicah. Medico-Chir. Rev.

On the Employment of Sulphate of Zinc for the Preservation of
Animal Matter. By M. Falconet. According to the author, the
substances the most difficult to preserve, as the brain, the intestines,
and other pathological preparations, may be most effectually preserv-
ed in a solution of the sulphate of zinc, retaining all their characters
without the least alteration, and, what is very important, not experi-
encing the contraction observed when alcohol is used. The steel
instruments employed for operating on the substances which have
been injected with the preserving liquid, are not injured even when
immersed directly in the liquid, and left there for twenty-four hours.
[Comptes Rendtis. Amer. Jour, of Phar.

Filter Accelerator. M. Dublanc describes an arrangement to ac-
celerate the filtering process, which consists of a funnel-shaped tissue
of plated or tinned wire on which the filter is supported in the funnel.
It is shaped like a plaited filter, and is made from a flat circular piece
of wire gauze, crimped in plaits running from centre to circumference
so as to give it the shape of a funnel with fluted sides. [Joum. de
Fharm,, and Ibid.

SOUTHERN

MEDICAL AND SURGICAL
JOUEML.

Vol. 8.] NEW SERIES. JULY, \M. [No. 7.

PART FIRST.

rtjinal dommuntcations.

ARTICLE XXI.

A brief Sketch of twenty cases of Typhoid Fever, successfully
treated. By N. H. Moragne, M. D., of Abbeville, S. C.

On the 28th of August last, I was requested to see Lyra, a
negro woman, about 30 years old, whom I found in a very low
state of fever; skin hot and dry; pulse ranging from 130 to
140 ; tongue redish on the tip and edges, parched and dry a
brownish fur upon the centre, with distinct papillae appearing
through the coating; the abdomen distended, slight pain from
pressure, gurgling sound emitted. On enquiry into the previous
history of this case, I learned that ^'diarrhoea had only supervened
a short time back, but that the patient had been sick for three
weeks, having a paroxysm of fever every day, slight intermis-
sion in the forenoon," her owner having treated her for inter-
mittent fever with calomel and quinine; seeing, however, that
siie grew worse daily, he called in " medical aid," without insti-
tuting further examination. I pronounced this fever to be the
" slow nervous" of the ancients the '\fehris lens et nervosa "
of Fluxham, or, as it is now familiarly termed, typhoid fever.

My attention was principally directed to the exhausted state
of the system, the extreme debility, the high nervous excite-
ment, &c. I therefore, without delay put her upon stimulants ;

N. S. VOL. VIII. NO. VII. 25

390 Moragne, on Typhoid Fev^r, [July,

though first prescribing alterative doses cal. and Dover's pow-
der, ill order to establish the secretions ; having particular
reference to the bowels, not suffering " watery dejections" to
come from them. Gave the "camphor stimulus" composed;
of camph. par. and pepper tea a very happy formula, I think,
in this disease, owing to its cheapness, and the facility with
which it is obtained ; applied mustard poultices to the abdomen,
Dover's powder at night. Administered sulph. quin., not
however with a view to its anti-periodic effects, but merely as
a tonic. This case assumed a slow but steady convalescence ;
duration 30 to 40 days.

Case II. On September 1st, was called to see Kinchy, a
girl aged 13, who was attacked with, fever two or three days-
before. Pain in head ; pulse soft but full, ranging from 90
to 100 ; tongue red on the edges, brownish fur upon the centre ;; |
papillae visible ; bowels not much distended ; no gurgling sound \
occasioned by pressure ; extreme prostration ; inattention ; in- I
tollerance of light. I

This case was a very obstinate one, pneumonia supervening |
about the 8th day, came near proving fatal. I prescribed, in the
first instance, calomel, Dover's powder and ipecac, in alterative"
doses, every five or six hours for twenty-four hours ; bearing
in mind that none of those evacuations should be produced,
which were calculated to debilitate. Kept this up every two
or three days UDtil my patient exhibited a better looking-
tongue. For the severe pain in the chest, applied blisters and
mastard poultices; warm pediluvia and Dover's powders at
night. As I write from memory alone, I cannot give the full
particulars, but only a synopsis of the treatment of these cases.
Notwithstanding my efforts to combat the complication in thi*
case, the patient grew worse, and had subsultus tendinum, coma>
delirium, &c &c.

Gave the " camphor stimulus" more frequently, alternating it
with brandy toddy ; Dover's powder and warm foot bath still
kept up at night. In this, and all my cases, when giving Dover's
powder, I did not suffer the patient to be disturbed in order
to give other medicine ; finding sleep to be more *' refreshing"
than any thing I could administer. She had a slow but steady
convalescence, duration from six to seven weeks.

1852.] Moragne, on Typhoid Fever, 391

Cases III and IV. While attending to the above, I also saw
Chloe, a woman aged 30, and James, a man aged 22. I was
now satisfied that this fever was prevailing as an endemic on
the plantation. These cases presented symptoms similar to
the foregoing: pulse compressible; tongue red on the edges,
furred ; papillae distinct, &c. &c. They were treated with
calomel, Dover's powder and ipecac in alterative doses, cam-
phor stimulus, quinine, &c. They had a paroxysm of fever
for twenty days, slight intermission in the forenoon, without
any complication.

Case V. Philip, aged 13, was attacked with fever a week
or ten days before I saw him. Severe pain in the head ; skin
hot and dry ; great prostration and aversion to light ; tongue
red on the edges, thickly coated upon the surface.

This was an extremely obstinate case, not running its course
under forty days. His symptoms were not threatening until
the third or fourth week, when his abdomen become enor-
mously distended ; great meteorism, tympanitis, diarrhoea, and
his face and inferior extremities "oedematous."

This is the only case in which I remember observing the
"superficial eruption." The tympanitis was relieved by injec-
tions of linct. assafoetida, emolient poultices over the abdomen,
&c. The camphor stimulus losing its efiJect, he was literally
fed upon French Brandy. He had a speedy convalescence.

Case VI. Flora, aged 4. Case VII. Charlotte, aged 11.
Case VIII. Prince, aged 8 were all attacked in the same
house ; but the fever was of a mild type, running its course in
twelve days.

Case IX. Pinder, aged 11. Case X. Primus, aged 8. Case
XL Isaac, aged 6. The fever ran its course with little inter-
ruption in two weeks.

Case XII. Phylis, the mother of the two latter, aged 30,
was attacked with fever. For the sake of brevity, we will sav
that her symptoms w^ere " typhoidal," also her tongue presented
the same condition. She had a paroxysm of fever every day for
a month, slight intermission in the forenoon. Treated as before
indicated. This was the only case in which I was compelled to
use injections of nitrate of silver, so much extolled by Dr. Dick-
son, to check the obstinate diarrhoea which had supervened.

392 Moragne, on Typhoid Fever. [July,

Case XIII. Nelly, aged 15; severe cerebral excitement;
tongue " typhoidal," parched and dry. So great was the deter-
mination to the brain that she became stupid for several days,
extreme deafness, inattention, &c., &c. Besides the treatment
before observed, I applied a blister to the spine, warm foot and

hip bath. Gave the spt. nit. dulc. freely, &c. Dr. T , of

this District, saw this case, also case 5th. His prognosis was
unfavorable. She, however, after an illness of thirty days,
convalesced.

Case XIV. Sam, aged 13. Case XV. Hannah, aged 11.
Case XVI. Chloe, aged 6 were all attacked in the same
house with the latter. The former ran its course with little
interruption in twenty days. Extreme deafness attended these-
cases : you could scarcely make them hear by raising your
voice to the very highest pitch. Treatment as before indica-
ted with few alterations.

Case XVII. Leah, aged 19, living in a house a hundred
yards distant from the quarter. This was a case of typhoid-
pneumonia ; the complication presented itself doubtless fronnp
the severe and sudden change of the weather, which occurred!
at this tin?e. Treated as before indicated : blisters and warno
mustard poultices to the chest; pulv. Dov. and hot loot bath at
night ; leaving orders for the patient not to be disturbed. She-
had a slow but steady convalescence.

Case XVIII. Grace, aged 13, of a delicate fibre ; nervo-
melancholic temperature. The fever ran its course in twenty
days ; she w^as gradually recovering; had dismissed her fror
my care. Owing to great neglect on the part of her nurse,,
she relapsed ; two or three days afterwards, I was sent for i
haste to see her, but too late. Found her delirious, raving ra
alow muttering tone; extremities cold ; dry hacking cougF^
&c. &c. ; learned from some of the attendants that she had
been exposed to the inclemency of the weather : suffered by
her nurse to lie out in the rain, for some time, a few nights
previous applied blister to the chest, bowels ; sinapisms to the
extremities; brandy toddy internally. All in vain, she died.

Cases XIX and XX. Mr. C , the overseer, aged 30.

Mrs. C , aged 28, about this time attacked the former

liad a severe and obstinate attack : duration, from six to seven

1852.] Moragne, o?i TypJioid Fever. 393

weeks. Owing to imprudence in diet, he relapsed the second
time, but recovered by assiduous care and attention. Treated

upon the same principle as the foregoing: Dr. F , saw

this case two or three times, concurred with me in the treat-
ment. Mrs. C , suffered with a mild and benignant attack,

which ran its course in eight or ten days. Other cases occur-
red, but of a mild type, and I shall omit to notice them.

Remarks. The above is a very hasty and imperfect sum-
mary of twenty cases of typhoid fever, occurring on the plan-
tation of Captain Petigru, upon Little River, in the lower part
of this district. In offering them to the Journal, I will only
make a suggestion or two. Typhoid fever, tor the last few
years, has made fearful ravages in this locality : it not only pays
us annual, but I may say monthly visits it has usurped the
place of the simple jntermittent and bilious remittent of former
days it spreads from hammock to hammock, as the ''Simoom
sweeps the blasted plains," leaving tl>e mournful truth behind,
that some one has fallen a victim to its fury.

I do not presume to give any thing new, or offer any specific
in the treatment of this disease. All informed medical men
have their minds made up in regard to this matter, that they can
palliate, not cure this fever. My only object in reporting
these cases, is to state facts as they occurred. It will be per-
ceived that the convalescence in most of them was extremely
slow and tedious this I conceiv-e to be partly attributable to
the malignancy of the type, and also to the inferior nourish-
ment we were compelled to administer.

Much has been said against the " mercurial treatment" in
ithis fever; but I pursued it here as elsewhere, with success,
Iwhich the result of my cases will abundantly testify. " The
'statistics of France show a miortality of one-third." It is with
a careful hand though, I should advise calomel to be measured
fout to the prostrated invalid ; also, a close investigation as to
its effects. And last, though not least, a prving search in the
nursing department, which in many cases, is the only ''plaiik
! safety in the wreck."

394 O'KeefFe Reports of the Society for [July,

ARTICLE XXII.

Extracts from the Records of the Physicians'' Society for
Medical Observation, of Greene and adjoining Counties.
Georgia. By D. C. O'Keeffe, M. D, of Penfield, Ga.,
Secretary.

March 8th. Lobelia Injlata, by Dr. J. E. Walker, of
Greenesboro'. Dr. Walker, in directing the attention of the
Society to this article of the materia medica, said: I am aware
that I am running some risk, if not of censure, at least of ridi-
cule ; but my motto is '^je prends le Men oil je le trouve.'^ I
stand upon the broad platform of medical science, and care
not from what source, or by whom discovered or recommend-
ed, my remedies are, if after a faithful trial they fail me not,
then, independent of all sectarian feeling, I shall use them, and
will feel bound as a member of our liberal profession, to re-
commend them to my brother practitioners. Laying aside,
then, all prejudice, let us examine briefly the therapeutic pro-
perties of the plant which heads this article.

From a youth I have had much opportunity of observing the
effects of lobelia upon the human as well as the brute system*
and although 1 have seen it used in almost every form and
variety of disease, and without the least discretion, still I have
never seen the first accident or ill-result from its use, but in a
majority of cases, decided benefit.

As an antispasmodic, lobelia stands unrivalled, when its
power and safety are considered. There is scarcely a prac-
titioner of any experience who has not witnessed its beneficial
effects in that distressing affection, spasmodic asthma. I have
often tried it myself, not only in asthma, but in spasm of the
stomach and bowels, and have found nothing equal to it. And
here I may also state that I have administered it to horses and
seen it frequently used by others, for colic in that noble animal, i
and I have not known it fail, in a single instance, to give speedyi
and entire relief. In spasmodic croup and hooping cough, I
know of no substitute for it; in truth, for spasm, of whatever
character, I know of nothing which I could use with equal con-
fidence. I have not seen it used in tetanus, but have reason to

1852.] Medical Observation. 395

believe it might be of service in the treatment of that fearful
disease.

There are many nervous affections in which its beneficial
^fTects are manifest: in hysterical convulsions, even when de-
glutition was impracticable, I have seen the convulsions cease
upon pouring the tincture between the teeth, so as to bring it
in contact with the tongue and fauces. In one individual who
has periodical attacks, simulating epilepsy, the tincture of lo-
belia will not only cut short an attack, but (if taken when the
first symptoms appear) will entirely prevent one. So true is
this statement, ihat for several years past, this patient has not
suffered, e:sce[)t when without the medicine in which event
she seldom escapes. From this circumstance, it is reasonable
to infer that lobcHa exerts no curative agency, but averts the
attacks by its anti-spasmodic -^povver. I have no doubt, however,
that if this patient had used the lobelia, when she first became
subject to the disease, and continued its use in her youth, the
habit might have been broken in upon, and entire exemption
have been the result. In further illustration of its antispasm-
odic properties, I will adduce another case.

On Saturday morning, 23d .August ult., I was called to see
Martha, a negro woman about 24 years old, and foimd her af-
fected with some very strange hysteroidal disease. There was
complete spasm of the oesophagus extending partially to the
tongue and jaws. She had not swallowed a particle of any
substance since the Sunday evening before. Previously to my
seeing her, another practitioner was called in who treated her
for five successive days and yet was unsuccessful in restoring
deglutition. Cups were used and blisters to the spinal column
and .epigastrium and temples the blistered surfaces dressed
with morphine all to no purpose. She remained in statu quo.
The indications were obvious to relax the spasm was the
, paramount object. I felt confident that if I could effect emesis,
) that result would follow ; but how to get an emetic into the
I stomach was the question for my decision. I concluded to
I give lobelia atrial, by pouring the tincture into the mouth, and
I holding the head in such a position as to bring it in contact
; with the tongue and fauces. I took the precaution to combine
I with it 5 grs. sulph. zinci, to insure speedy vomiting, if she

396 O'Keeffe Reports of the Society for y^^\y*-

should swallow the mixture. After it had remained a short
time in the mouth, the spasm gave way, she swallowed the
mixture, free emesis ensued, and there was no return of the
spasm. Under the use of tonics and a nourishing diet she had
a speedy recovery, except that there remained complete apho-
nia, which persisted some days after all other symptoms had
subsided. I removed the tonsils which were enlarged, gave
her quinine, used local stimulants and galvanism. Under this
course she entirely recovered and has had no return, although
she had been obnoxious to them for several years.

As an emetic, I seldom use lobelia, unless its relaxant effects
are desired. I much prefer ipecac, over which lobelia pos-
sesses no advantage as an evacuant of the stomach, or for re-
vulsion to that organ. In strangulated hernia, I have no doubt
it is a valuable medium, preferable to many articles in com-
mon use. Dr. Eberle used it successfully in a case where to-
bacco seemed to be indicated. The relaxation resulting from
the free use of lobelia, is, in my opinion, sufficient almost for
any emergency. I am sure I would never use a tobacco ene-
ma, if I could obtain lobelia.

I now proceed to notice one of the properties of lobelia,
which has escaped the notice of experimenters generally, viz.,
its power as an antidote for poisons. And since lobelia has
been denounced as a narcotic poison itself (its narcotic proper-
ties, if it have any, being very feeble) I fear this announce-
ment will startle some of my brethren. I have seen great
prostration, but never narcotism, follow repeated doses of it,
when it was not vomited ; and before I conclude, you will see
what opportunities have been afforded me for gaining some
knowledge of the effects of this article. So far from being a
poison of such virulence as many have supposed, lobelia cer-
tainly possesses antidotal qualities. The following experiment
will serve to corroborate the above statement. Some years
ago, I had two favorite dogs which were both bitten by the
same moccasin, one in the moulh, the other upon the foot. (I
mention the locality of the wounds, to show that one must
'have been more unfavorable than the other.) They both were
very sick, and seemed as if ready to die. Having heard of the
success of lobelia in snake bites, I determined to try it on my

1852.] Medical Observation. 397

dogs, and accordingly mixed half an ounce of the pulv. seeds
with a sufficient quantity of milk, and ofTered it to the one
least affected, (the one wounded on the foot) he however re-
fused it, and I could devise no means by which to introduce it
into his stomach. I then gave it to the other, whose head by
this time was swollen to nearly twice the normal size ; he
drank it all, as if by instinct, and by next day was entirely re-
lieved, while the other was no better, nor did he recover for
many days.

The success of this experiment has induced me to make fur-
ther trials. I have used it with the best results for the sting of
the common bee, and other poisonous insects, and confidently
recommend it to be kept in every family in these cases I ap-
ply the tincture to the affected parts. In the eruption follow-
ing the Rhus Toxicodendron, the tincture is equally successful.
For diseases of the skin generally, and especially those of the
scalp, it makes an excellent wash,* and to foul and indolent
ulcers it imparts a peculiar stimulus, and favors the process of
healing.

Lobelia also possesses febrifuge powers. I have known
many cases of intermittents relieved by it alone, when admin-
istered in small and oft-repeated doses, so as to keep up a con-
tinual nausea for several hours before the expected paroxysm.
It is not so good as quinine, but is much cheaper and deserves
a trial. It also possesses, in an eminent degree, expectorant
properties, and is especially useful in pleurisy and pneumonia
not however from its expectorant properties alone, but from a
peculiar influence which it exerts over the circulation. I may
truly say of lobelia, in this respect, what Dr. Norwood has said
of the American hellebore. I have used nothing which so
completely controls the circulation, equalizing it by relaxing
the whole system ; with a pleasant, soothing sensation that ex-
tends over the entire system it produces gentle diaphoresis
hence its value in inflanmiatory diseases. It has been stated
by some that lobelia acts as a cathartic, but this statement

Since the reading of this essay before the society, we have used the tincture
of lobelia in a case of lepra; after a fe\r applications, the inflammation of the
derma was arrested, the hypertrophy diminished, and the scales of morbid der-
ma thrown off and never replaced. (i&cre/ary.)

398 O'Keeffe Re}) ort of the Society for [July,

needs confirmation. I have had much opportunity of testing
that point, but I have had no reason to believe it ever acted in
that way. Having stated that my opportunities for observing
the effects of lobeh'a on the system were numerous and good, I
would remark that, for more than half my life, it has been ex-
t-ensively used in my neighborhood, and in the family in which
I have lived ; for twelve years, scarcely a week passed but
some member was taken through a course, and while suffering
from continued fever, I have myself taken twenty-seven emetic
doses in as many consecutive days. Now I do not consider
that was Judicious practice, and yet I cannot say it was in the
least detrimental. It is a matter of much regret, that this valu-
able article should have been brought into disrepute by a set
of empirics, to such an extent that Allopathists are almost
afraid to pronounce its name. " This ought not to be." The
indiscriminate use of the article, by those who are selt'-constitu-
ted "Doctors,"' should not deter us from its prudent employ-
ment : their boldness should teach us that it is far less dangerous
than has been apprehended. We have no better reason to
discard lobelia, than we have to dispense with quinine, opium,
and a host of others. If we must leave off the former because
"Botanies" use it, and arrogate to themselves and their found-
er the credit of introducing it into practice, the latter should
share the same fate. I would warn these Thomsonian gentle-
men, however, to examine some o'i our books, and they may then
be able to '' render unto Ccesar the things that are Caesar's."

Allow me, in conclusion, to urge a trial of lobelia upon the
members of this Society : in inflammatory diseases, I employ
an infusion of the dried plant ; in spasmodic affections I use the
tincture.

Drs. Park, Rea and King spoke very favorably of the lobelia.

The Spontaneous Origin of Scarlet Fever, by Dr. B. F-
Rea, of Greensboro'. It cannot be denied that we country
physicians as we may correctly term ourselves occupy a
more advantageous position for the investigation of some sub-
jects, connected with the ills to which flesh is heir, than those
dwelling in cities. It has occurred to me, that the origin of
that large and important class of diseases denominated conta-

I

1852.] Medieal Observation. 399

gioiis, is one of these; for, moving in a community where all
are individually known to each other, where the modes of liv-
ing, habits, and intercourse of all are understood and freely
commented upon, it will consequently be in his power, often,
to trace a contagious disease to the cause producing it to as-
certain when and where it has been imbibed, and decide in
regard to its spontaneousness.

My observation leads me to believe that, in wigtz?/ instances
those diseases supposed to be wholly the result of contagion,
have a spontaneous origin. I am aware that, upon this subject
I ditfer with many, who are disposed in every instance, to sup
pose that exposure to, or even contact with a diseased subjec
must have taken place, before the disease made its appear
ance although when and where the exposure occurred, they
are unable to affirm. Such seem to forget that all diseases must
at some previous time have been spontaneous at some point
in the history of the human race, I care not how remote the
period, they had an origin. A combination of circumstances,
internal or external, or both combined, produced them ; and
the question arises, did this combination occur but once? and
have the diseases then produced, been transmitted ever since
by the subtle influences of contagion ? Is it not more reason-
able to suppose, that the causes then producing a disease, mmj
have occurred again and again, and that the physician will
many times meet with similar cases?

I am inclined to think so, for w^e have instances recorded,
and in our own experience, where individuals living in isolated
situations, remote from all exposure, have become the victims
of small-pox, scarlet fever, &c.

The principle of contagion is, I know, very subtle. It is
transmitted many times, doubtless, by ways and means of
which we have no cognizance; but, as I before said, I cannot
see why the causes which were once adequate to produce a
disease, may not be found always so ; nor can I believe that
these causes have only once existed. The most violent poi-
sons are sometimes generated within the systems of animals,
without apparent extraneous aid.

No one will deny that, Rabies incorrectly termed hydro-
phobia in the canine species and Equinia, in the quadrumana,

400 O'Keeffe Report of the Society for [July,

may originate spontaneously, as well now, as at any former
period. Nor can their contagiousness be denied; and "may
it not be reasonably inferred, by analogy, that all the poisons
to which the human system is liable, may occasionally be gen-
erated in the same way?" 1 see not why the inference may
not be drawn : nor can I see that scarlet fever, measles and
small-pox, (and some others might be mentioned,) should al-
ways be ascribed to contagion.

I will proceed to mention a case oi Scarlet fever, the origin
of which I believe to have been sjjontaneous, I presume others
among you may have met with similar cases, in which no ap-
parent opportunity for contagion existed.

This case occurred last May in the family of Mr. J., residing
eight miles from town. His family of children consisted of
four boys. On the night of the 27th inst., his third son, *'four
years old, was taken with fever, nausea and vomiting, &c,, and
on the following morning his tongue was coated with a thick
white fur. Some purgative medicine was given to him, and he
seemed to be a little better through the day." I will remark
that, he was noticed to be unusually dull during the day pre-
ceding his attack. On the following night, the youngest son,
set. 15 months, *'was attacked in precisely the same way," and
the next day, 29th, I was called for the first time to see them,
when I received from the father the above statement. The
iirst case grew rapidly worse, becoming in a few days so deaf,
that the loudest calling, with the mouth placed close to his ear,
could not make him hear the deafness taking place before any
coma had appeared. At the same time, there was a copious
and steady acrid discharge from the Schneiderian membrane.
He died on the seventh night of his attack. The other case,
the youngest, had a very protracted recovery a general ana'
sarca following, and desquamation continuing irregularly for
some weeks.

In seven days, (counting from the time the disease appeared
in the first case,) two negro children, who had not been in the
room occupied by the first cases, though they had been in the
house," were attacked about the same time, and in a day or so
thereafter the eldest son of Mr. J. was attacked ; and in two
or three days, the second son took the disease ; then, at inter-

1852.] Medical Observation. 401

vals of a few days, others of the negro children were attacked
till some twenty had it some having it very lightly, with
scarcely any efflorescence ; but in eveiy case there was more
or less soreness of the throat complained of. A number of the
children, although exposed, escaped entirely.

Very little treatment was required in the greater number of
the cases, and the disease, in each case, progressed regularly
to a favorable termination. I should not neglect, however^
to mention, that the plan first proposed by Taylor, viz., that of
inunction, was pretty freely used, especially in' the cases occur-
ring among the negro children ; but as these cases were gen-
erally mild, I cannot say whether it did much good or not.

Now two questions arise here: Did the first case originate
spontaneously? or, was it the result of specific contagion?
The latter question, I think, can be fully settled in the negative^
when I affirm that there was not a case of scarlet fever, at the
time, within fifteen miles of the family, nor had there been,
in twelve months, that I could ascertain by careful inquiry ;
nor had any of the family been exposed at any time to the con-
tagion, either by visiting from home, or by being visited by any
one, having this, or an analogous disease, indeed, so far as I
could ascertain, there was no scarlet fever prevailing in any of
the adjoining counties.

As to the question of the spontaneousness of it, which I am
compelled to believe, I leave the society to form their own
opinion.

Cazenave says, '* Scarlet fever is the result of an unknown
contagious principle," Churchill says, " It is very difficult to
say whether the disease may originate spontaneously by any
combination of predisposing causes. The best writers think
not, and seems to me unlikely."

Now the two authors above cited, reside respectively in the
large cities of Paris and Dublin, where the disease in question
is, perhaps, at all times prevailing to a greater or less extent;
for " its appearance is confined to no particular season "
hence their opinion that it is the result of contagion, which is
certainly true to a very great extent ; but the disease may
have a spontaneous origin, as well in a city as in the country.
Professor Dunglison, of whom I am an unworthy pupil, whose

402 O'KeefFe Report of the Society for [July,

- -

opportunities for observation have been second to but few,
says : " It is probable that the disease (scarlatina) arises, at
times, from other causes than contagion. It can scarcely be
maintained, that its universal mode of propagation is by some
specific miasm disengaged from an individual labouring under
the disease, and that no combination of influences can now
arise, capable of generating it de novo'"' So we see a difference
in the opinion of these authors.

The opinion ef Cazenave, as of most authorities, that " scar-
latina is most contagious during the period of desquamation,'*
seems not to hold good in the above cases.

The first case, you will observe, was attacked on a certain
night, and the second case on the night immediately following,
before any desquamation, according to the nature of the disease,
could have taken place, which, in the mildest forms, does not
usually begin till the seventh or eighth day.

A different question arises here, which is, to me, very inter-
esting viz: Did the second child, which was attacked twenty-
four hours after the first, contract the disease from the first, or
was it also of spontaneous origin ? I know the period o^ incu-
bation in scarlatina is stated in books to be one iveek, but this is
by no means strictly true. Dr. C. A. Clark has shown that
this may be, in some instances, only three days, (New York
Med. Times, for Feb.,) and in the case I refer to, it could have
been only twenty four hours, at farthest, admitting that the
second case was contracted from the first, and that \.hQ poison
was taken into the system of the second at the very time the
disease manifested itself in the first.

That the "contagion" of eruptive fevers is given off, in the
majority of cases, during the desquamative period, may be true,
but I do not believe it is essentially necessary that there should
be any desquamation, nor even eruption, to render these dis-
eases communicable, especially scarlatina and rubeola, for we
may have either of these, without apparent eruption; yet, un-
der favorable circumstances, such cases, I am inclined to think,
are as transmissible as the more completely developed forms.

I believe the morbid poison or the '' contagious something''^
call it what you wish which exists in the blood, is given off
by the lungs, in the expired air, &c. We may reason so, at

1852.} Medical Observation. 203

any rate, from analogy; that is, if I am correct, when I say
that, in mumps, hooping-cough, and perhaps some other dis-
eases which are contagious, I believe their contagious poison
is given off in this way.

We may more reasonably believe this, than that the conta-
gious principle emanates from the surface of the body ; for, in
the latter diseases, there never is any eruption. We must infer
that the blood is fully charged with the poison ; for, in the ex-
anthemata, we have several well authenticated instances of
their having been propagated by inoculation with the blood.

In numerous instances, also, children have been born with
scarlatina. " Dr. Gregory mentions that a child of his own
was born with it;'*' and it is through the blood of the mother
alone, that the disease is communicated to the foetus inutero,.
unless we say it originated spontaneously.

Upon the conclusion of Dr. Rea's essay, a lengthy discussion
ensued concerning the nature of scarlatina, in which several of
the members participated. Dr. Walker considered it of spon-
taneous origin. Dr. Randle was firmly of the opinion that it
was not a contagious disease, for he had frequently inoculated
healthy persons w^ith the secretions from scarlatina patients,
and no propagation followed : he considered it an epidemic,
and he had met with numerous mild epidemics. In reply ta
Dr. Randle, Dr. Rea said it was epidemic, and also contagious,
and thought that many of the epidemics which Dr. Randle had
seen were not genuine scarlatina, but what some of the German
authors describe under the head of Falschen Maseru^ or spuri-
ous measles, which has some resemblance to both measles and
scarlatina a sort of intermediate disease which he (Dr. Rea)
has seen, and which is not a protection against either.

Various opinions were expressed on the treatment of scarla-
tina. Dr. Rea spoke favorably of anointing the surface with
bacon rhind. Dr. Foster stated that he had never found any
benefit from blisters or emetics. Dr. Randle's experience led
him to follow the expectant plan do as little as possible. Dr.
Callaway spoke with confidence of sponging the surface with
whiskey and water.

Dr. R. S. Callaway, of Public Square, mentioned a case of
congestion or oppression of the brain, to which he was called

404 Dugas' Surgical Cases. [July,

on the night of the 31st of January. The subject was a negro
man, aged about 35, and was found in the following condition:
Appearance, that of a person in a deep sleep could not be
aroused by shaking or calling; pulse about 75, rather feeble;
surface cool ; respiration sonorous, deep and rather slow : his
sensorial system in a state of perfect stupor.

Prescribed : Sinapisms to spine and epigastric region exten-
sively. These means restored sensibility sufficiently to enable
the Doctor to administer an emetic of ipecac, which operated
well in the course of an hour, causing the ejection from the
stomach of at least onepound of new bacon, with almost entire
relief to the brain. A dose of ol. ricini completed the cure.

Dr. R. H. Randle, of Penfield, detailed the symptoms of a
case of what he considered "misplaced rheumatism." On his
first visit, the symptoms (rational) were those of pneumonia ;
but at the second and future visits, he had to treat an attack of
acute rheumatism in the joints of the inferior extremities.

\

ARTICLE XXIII.

Cases occurring in the Practice of Professor Dugas. Repor-
ted by H. RossiGNOL, M. D., of Augusta, Geo.

Case I. An Eye destroyed by a bird-shot. Mr. , was

hunting birds on the 11th March, 1843, when, in order to secure
their game, he took one side of the field and his brother the
other, the distance between them being supposed sufficiently
great not to incur any risk in firing towards each other. His

brother fired, and a single shot seems to have reached Mr. .

This passed through the cornea and lodged within the globe of
the eye. There being but little pain, and several days passing
without much inflammation, the patient flattered himself that
the accident would not prove very serious. The pain, how-
ever, began to be acute, inflammation rapidly increased, the eye
swelled out enormously, and the patient was finally relieved by
excision of the cornea, which allowed the disorganized humors
to escape with the shot in their midst. Recovery took place
in the usual time, and a glass eye was substituted, which very
efl^ectually obviates the deformity.

J

1852.] Dugas' Surgical Cases. 4Q5

The reporter finds in the Southern Medical and Surgical
Journal, for 1838, (vol. 2, p. 647,) several cases recorded, in
which Prof. Dugas resorted to excision of the cornea for the
purpose of relieving great local pain and constitutional disturb-
ance consequent upon a disorganization of the contents of the
eye. Whenever the eye is irretrievably lost and proves a source
of serious annoyance. Prof. D. thinks that it should be at once
emptied, both as a measure of relief, and as a security against
symoathetic disease in the sound organ. He has never found
any bad effects from such a course.

Case II. Ex-ophthalmia caused hy a tumor in the orbit.
Peter, a negro boy about 5 years of age, had been suffering
for a number of months v/ith pain in the left eye, and with a
gradual impairment of its vision. Placed in charge of Prof.
Dugas on the 6th January, 1848, the eye was found to pro-
trude so much that the eye-lids could not cover any portion of
the cornea; this was opaque and the conjunctiva highly inject-
ed ; vision was and had been for some time entirely lost. The
opacity of the cornea prevented the condition of the humors of
the eye from being seen. The boy suffered incessantly most
excruciating pain in the eye and in the front of the head, which,
added to febrile excitement, loss of sleep and impaired appetite,
had very much reduced him.

After watching the case for a few days. Prof. D. determined
to excise the cornea and to empty the eye. This was followed
by only temporary relief. In a iew weeks the sunken eye be-
gan to protrude again ; the pain in the forehead returned, and
increased in severity, if possible. The boy became delirious,
and gradually comatose, and died in March, after being appa-
rently at the point of death for a month.

The existence of a tumor of some kind behind the eye be-
came evident, upon the reprotrusion of this organ, but its nature
was uncertain, and the brain had become too much implicated
to warrant an attempt to relieve the patient by extirpation of
the contents of the orbit.

Post-mortem examination revealed the presence of a fibrous
tumor in the orbit, which, in pressing the eye forward, had put
the optic nerve very much upon the stretch. Within the cra-

N. S. VOL. VIII. NO. VII. 26

406 Dugas* Surgical Cases. U^^Y,

nium the optic chiasm was found drawn towards the affected
side, and surrounded with a stratum of pus which extended
beneath the whole of the anterior lobes of the cerebrum. The
brain itself did not appear to be softened, nor otherwise affected.

Case III. Gunshot wound of the face. Mr. Beal, being ori
a hunting excursion on the 17th November, 1850, was passing
through an old field with his gun in the trailing position, when
a vine catching the trigger, fired off the gun, and wounded the
carrier in the face. He was brought to town (a mile distant)
and seen by Dr. Dugas and myself immediately upon his arrival.
The gun was charged with bird shot, nearly the whole of which
appeared to have been received by the right side of the face.
The upper lip was torn from the angle of the mouth to the-
nostril ; the entire nose, from its attachment to the frontal bone
down to its lower extremiiy, including the septum, was thrown
ever upon the left side of the face and hung by the skin of that
side alone, leaving a frightful chasm in its stead. Some of the
shots had passed through it, but it was not as much lacerated
as might have been expected. One shot penetrated the right
lachrymal caruncle, and other minor wounds were- to be seen
about the face.

The face and wound being well cleansed, the nose was re-
placed and secured with stitches and adhesive plaster; bits of
lint were rolled up and placed in the nostrils ; and lastly the
lip was secured by sutures and plasters. A linen handkerchief
was now dipped in cold water and placed over the face, with;
orders to keep it cool.

Under this treatment the case progressed without any un-
pleasant accident whatever. Nearly the whole wound healed
by the first intention, and the remainder was well in ten days.
The patient was so little disfigured that no one, on seeing him
after recovery, could form any adequate idea of the hideous^
ness presented by the wound prior to its having been dressed.
This case is reported merely as an illustration of the extraordi-
nary restorative energy of the system in some persons. It may
not be amiss to add that the patient was intoxicated at the time
of the accident.

1852.] Dugas, on Intestinal Wounds. 407

ARTICLE XXIV.

Wounds of the Small Intestines : Recovery. By L. A. Dugas,
M. D., Professor of Surgery in the Med. Col. of Georgia.

Mr. W. T., the subject of this case, is about 25 years of age, of
spare habit and not robust health. Being in a state of inebria-
tion on the 12th of April last, (1852,) he got into an alterca-
tion with another man, and at 4, P. M., was stabbed in the
abdomen with a bowie knife an inch and a half in diameter.
The abdominal walls presented but one wound, which was of
the diameter of the knife just described, and situated about
midway between the umbilicus and left anterior-superior spi-
nous process of the ilium. After receiving the wound, he walked
three or four hundred yards to the office of Dr. E. Girardey,
where I found him a few minutes after, lying upon a bed, with
a mass about the size of a common fist protruding from the
wound. His face was extremely pallid, his surface covered
with cold sweat, his pulse small and frequent, and his stomach
very irritable. He had eaten a hearty dinner, which he threw
up, strongly impregnated with alcoholic liquor.

Dr. Girardey and myself examined the protruding mass,
which proved to be a portion of the small intestines with a lit-
tle of the omentum, in a state of partial strangulation. At one
point, the intestine was almost completely severed in two; at
another, about half its circumference was cut open, and at a
third, there existed another and still smaller cut, about an inch
long. These three intestinal wounds were transverse, and
there were other scratches which did not transfix the coats.

After cleansing the parts, the intestinal wounds were neatly
closed by Dr. G., with the glover's stitch. Feeling the import-
ance, in soch cases, of animal sutures, which would be readily
dissolved and absorbed, we used a violin string of the smallest
size, previously softened with water. The protruding mass
was then returned into the abdomen, the external w^ound
stitched with good silk, and covered with an adhesive plaster,
over which a compesss was placed and secured with a roller
bandage.

The patient was now carried home upon a litter and put to
bed, with strict injunctions to keep the abdomen continually

408 Dugas, on Intestinal Wounds, [July,

covered with a napkin dipped in cold well water as often as
necessary to keep it cool. These directions were effectually
carried out by having two napkins in use, which were alter-
nately applied to the body, and thrown into a bucket of cool
water every five minutes during the first six days, and gradu-
ally at longer intervals until the twelfth day, when the process
was discontinued.

A full dose of opium was given in the evening, and ordered
to be repeated, if he did not rest well. Cold water allowed, in
small quantities at a time.

13th April. Passed a very uncomfortable night took the
opiate freely, but was continually annoyed with nausea and
painful efforts to vomit, and could not sleep; no febrile excite-
ment ; pulse less frequent. At 10 o'clock this morning the
matters vomited began to assume a stercoraceous character,
and continued so during the day. A little mint tea, essence af
peppermint, or cold water alone, were occasionally taken, and
the mouth rinsed with vinegar and water to correct the un-
pleasantness after vomiting.

14th. Resorted again to opiates during last night,, with better
effect stomach still irritable, and ejected matters stercoraceous
and very offensive. No febrile excitement ; pulse better.
Same treatment continued.

15th. Vomiting ceased this^ forenoon ; slight febrile reaction ;
pulse better ; skin warmer and of a better color. Drinks still
used sparingly.

16th. Feels very comfortable ; pulse and temperature natu-
ral ; passes flatus from the rectum.

17th. Still improving; would like a Tittle nourishment, but
is not allowed to take it.

29th. On the 18th he was allowed chichen broth in small
quantities at a time, and afterwards his diet was gradually
thoufrh cautiously improved. Opiates were occasionally given
until the end of the first week. To-day an inclination being
felt to evacuate the bowels, this was facilitated by an enema of
tepid water, which was followed by a good, natural and fecal
discharge, without pain ; the first since the reception of the
wound.

It ie particularly worthy of remark that the abdomen did nat

1852.] Healthy and Morbid Menstruation. 409"

at any time become tumefied ; that it was at no time tender
upon pressure, except in the immediate vicinity of the wound^
where it was a litile so for a few days. After the third day the
pulse remained at 80 beats per minute.

On the 1st of May, he. dressed hiniself and walked about the
room. On the 3rd, diarrhoea supervened in consequence of
exposure or of (he atmospheric constitution, bowel affections
being then very prevalent in the city. The diarrhoea changed
to dysentery on the 5th, but was checked by an anodyne enema.
Since then he has had no other difficulty, and is now (1st June,)
attending to his business, apparently as well as ever. He is
made to wear a truss bandage over the seat of the wound in
order to prevent the tendency to hernia, which usually follows
such cases.

In conclusion, I may be permitted to add that the singular
exemption from general peritonitis, and the ultimate success of
this case may very reasonably be attributed to the use of ani-
mal sutures instead of silk, and the free application of cold wa-
ter to the abdomen,

I cannot let the opportunity pass without complimenting my
young associate in this case for his skill and attention.

' PART II.
tic tilt 13c^avtmtnt.

On HeaWiy and Morbid Menstruation. By J. Henry Ben-
nett, M. D., late Physician-Accoucheur to the Western
General Dispensary, etc.

[Contiimed from Page 355.]

Menorrhagia. By menorrhagia is meant profuse, prolonged,
and too frequent menstruation, and uterine haemorrhage gene-
rally in non-pregnant females, when not occasioned by the
existence of uterine tumors, or by malignant disease.

From this definition it will be perceived tliat the forms under
which menorrhagia may manifest itself are varied. Thus, it
includes menstruation normal as to duration and periodicity,
but hasmorrhagic in quantity ; menstruation normal as to pe-
riodicity and the amount of blood lost during a given time,
but hcemorrhagic from its being prolonged beyond the physio-
logical duration ; and menstruation normal as to quantity and

410 Healthy and Morbid Menstruation. [July,

duration, but too frequent in its return. Again, all these modes
of haemorrhagic manifestation may be combined, and menstrua-
lion may be too profuse, too prolonged, and too frequent ; or
the haemorrhage may be continuous, with irregular or periodical
exacerbations denoting the menstrual nisus. In a word, a
nnarked increase in the quantity of blood usually lost during
the menstrual flux by the individual in question constitutes
menorrhagia. It must, however, be borne in m.ind, that, as we
have already seen, there is no general standard by which the
menstrual flux can be measured, and by which the normal
state can be separated from the abnormal. What is normal in
one woman would be haemorrhagic in another, and vice versa.
The only standard for each individual female is her own condi-
tion, when indisputably in health.

Menorrhagia is generally considered to be the result of an
active or passive state of congestion of the uterus, existing in-
dependently of local disease, and connected with or occasioned
by general conditions of the economy. This, the opinion ot
both ancient and modern pathologists, is founded on ignorance
of the facts elucidated in my work on Uterine Inflammation. In
reality, the quantity of blood lost during menstruation is seldom
increased so as to constitute haemorrhage, and the menstrual
periods are seldom morbidly approximated, for a continuance^
(apart from tumours, polypi, and cancer,) unless there exists
some chronic inflammatory disease of the cervix or of the body
of the uterus, or unless menstruation be finally disappearing.
Idiopathic menorrhagia, except at the change of life, is as rare
as haemorrhage from the lung under the influence of mere con-
gestion, apart from any organic disease, tubercular or other.
In the uterus, as in the lung, there is nearly always some organic
lesion which produces the congestion that precedes ha3morrhage.
This assertion is not the result of theory, but of scrupulous
observation, and must become equally evident to all practition-
ers who will accurately investigate the state of the uterine
organs of patients so afl^ected. Congestion of the uterus exists,
it is true, in confirmed menorrhagia, but it is all but invariably,
with the exceptions above made, the result of uterine inflamma-
tion, and assumes an active or passive character, according to
the natural constitution of the patient, and to the amount of
reaction produced by the disease and by the loss of blood on
the system at large. If the uterine inflammation is of an active
nature, and has not had time sympathetically to debilitate the'
patient, haemorrhage is considered active or sthenic. If, on the:
contrary, the local disease has long existed, and has produced
great anaemia, and been attended with great haemorrrhage, the
haemorrhage is said to be asthenic.

1852.] Healthy and Morbid Menstruation. 411

Accidental Menorrhagia. The above remarks, however,
apply only to confirmed rnenorrhagia, and not to those cases in
which menorrhafria appears in a casual and evanescent form,
under the influence of some accidental and temporary cause,
such as mental emotions or violent exertion. Under such influ-
ences the mentrual flux is not unfrequenlly increased in quantity,
prolonged in duration, or morbidly approximated, in the absence
of local disease. Thisismoreespecially observed in those lemales
who are habitually menstruated profusely, and with whom men-
struation presents the extreme physiological duration. These
casual hasmorrhagic manifestations, however, very rarely be-
come permanent, ceasing without treatment ; the function, as
it were, soon righting itself

Injiammatory Menorrhagia. Menorrhagia originating in
chronic inflammation of the cervix or body of the uterus, occa-
sionally persists after the removal of the morbid condition which
at first occasioned it. When this is the case, its persistence is
generally the result of a torpid, languid state of uterine circu-
lation, giving rise to obstinate congestion ; a not unfrequent
sequela, as I have elsewhere stated, of long-neglected uterine
disease. This congested condition of the uterine circulation
may or may not be connected with chronic enlargement or
hypertrophy of the body of the uterus. I have, however, met
with such enlargement in most of the cases of rnenorrhagia
which have obstinately persisted after the subdual of local in-
flammatory disease. In these cases, the uterine hypertrophy
did not appear to be connected with actually existing inflamma-
tion of the body of the uterus, but to be traceable to a pieviously
diseased state of the cervix or uterus, which had prevented the
latter organ returning to its normal size after parturition. In-
deed, I think I may state, as the lesult of observation, that the
actual existence of chronic inflammation in the tissue of the
body of the uterus, generally diminishes the menstrual flux, and
retards its appearance, whilst inflammation of the cervix ren-
ders it more profuse and more frequent than usual. Inflamma-
tion of the mucous membrane lining the uterine cavity, on the
contrary, is often a cause of haemorrhage.

A congested state of the portal circulation, connected with
hypertrophy and passive congestion of the liver, or with other
abdominal lesions, has occasionally, in my experience, given
rise to obstinate uterine ha^moi-rhage, especially in cases in
which the tone and contractile powers of that organ had been
simultaneously weakened by chronic inflammation.

Menorrhagia from Omiritis. Sub-acute inflammation of the
ovaries may no doubt sympathetically re-act on the uterus,
and produce rnenorrhagia. Notwithstanding, however, the in-

412 Healthy and Morbid Menstruation, [J^^y*

limate physiological connexion between the ovaries and the
function ot" menstruation, 1 have not often been able to trace,
clinically speaking, menonhagia to such disease, unacconi))a-
nied by uterine lesions. At the same time, it is quite possible
that the irritable state of the ovaries, which inflammatory
disease of theuierus so very frequently induces, may re-acton
the menstrual function, and contiibute to exaggerate and per-
vert it. In these cases, however, the uterine lesion is generally
according to my experience, the primary and principal cause
of the nienorrhagia ; on its removal the ovarian irritation disap-
pearing along with the menorrhagia.

Menorrhagia at the Dawn and Close of Mensti^uation. Men-
orrhagia is occasionally met with at the dawn and close of
menstruation, from mere uterine congestion, apart from any
local inflammatory disease.

Thus, the first manifestation of the menses may be charac-
terized by a severe attack of hcemorrhage, the subsequent
periods being physiological ; or the menses may continue
to appear haemorrhagically at irregular intervals for several
months. This latter type of menorrhagia, however, is much
less frequently met with than the first. When, also, the men-
ses are about to cease definitively, and become physiologically
irregular, profuse menstruation, amounting: to flooding, is not
unusual, as a result of mere congestion. Thus the menses will
disapr>ear for two or more months, and then return with exces-
sive abundance. It is very seldom, however, even at this
period of life, that ha3m.orrhagic menstrual fluxes occur fre-
quently, and assume a continued character, in the absence of
tumours or malignant disease, unless there be inflammatory ul-
ceration of the cervix. In nearly all the instances of very ob-
stinate haemorrhage at the change of life which I meet with, I
find, on examination, that the congestion and hcemorrhage are
kept up by inflammatory and ulcerative disease. Indeed some
of the very worst instances of protracted and severe hiemor-
rhage that I have ever seen, have been cases of this description ;
and what satisfactorily proves that the inflammatory affection
is the cause of the continued haemorrhage is, that when it is
cured the haemorrhage generally ceases. This is not, however,
invariably the case. I have occasionally met with females at
the critical period of life, in whom haemorrhage obstinately
persisted after the removal of the inflammatory and ulcerative
disease of the cervix, which had probably in the first instance
given rise to it. In several of these cases, however, time or
dilatation of the cervix has subsequently proved that the haemor-
rhage did not pi-oceed from a sound uterus, but was connected
with the presence of a polypus, or of a fibrous tumour, so small
and obscurely situated as not to have been recognized at first.

1852.] Healthy and Morhid Menstruaiion. 413

Menorrhagia during Pregnancy. The periodical haernor-
rhaf]^es which occasionally occur during prefxnancy, are consid-
ered by some wi-jters to be of a menstrual character. Without
denying the possibility of a true menstrual flux taking place
from the cervical canal during pregnancy, I would mention,
that in nearly all the cases of this form of hcTemorrhage not
merely temporary, and not proceeding from sepaiation of the
ovum that have come under my observation, 1 have discover-
ed inflammatory ulceration of the cervix. This i'act certninly
ofl^ers the most natural explanation of the presumed menstrua-
tion of pregnant women, at least in the mnjority of instances.
On examining these patients, I have generally found blood es-
caping from the ulcerated uterine neck, the ulcerations present-
ing the peculiarly turgid and luxuriant appearance which I
have elsewhere described Cis characteristic of such leisons du-
ring pregnancy. When a pregnant female suffering from
ulceration of the cerv^ix is instrumentally examined, the ulcera-
ted surfnce bleeds freely on the slightest touch, and women in
whom abortion or premature confinement is brought on by such
disease are very frequently found, on inquiry, to have experien-
ced repeated haemorrhagic fluxes during the pregnancy, which
are often mistaken for menstrual periods.

Menorrhagia after Parturition. The continued and obsti-
nate haemorrhage which is often observed after parturition, both
before and afier the return of menstruation, is nearly always
complicated with and occasioned by inflammatory ulceration
of the neck of the uterus, with or without disease of the body
of the uterus. This form of menorrhagia may be protracted
for months after the labour, until the patient be reduced to the
Inst stage of anaemia, if the real cause is not discovered and ef-
ficiently treated.

In the various forms of menorrhac^ia occurring in the non-
pregnant females, and accompanied by ulcerative lesions, does
the blood escape from the lining membrane of the uterine cavity,
as in ordinary menstruction, or fi'om the ulcer^^ted surface? I
believe that both these surfaces are often simultaneously the
sources of the haemorrhage, although sometimes it may proceed
from one only. I have frequently seen the blood oozing from
the diseased surface under all tlie circumstances mentioned,
and have often checked it instantaneously by freely cauterizing
with the solid nitrate of silver the entire ulcerated surface, both
internally and externally to the os uteri.

Treatment. The views and facts which I have above de-
veloped are of extreme practical importance. Not only do
they render unnecessary, in the immense majority of cases, the
hair-drawn distinctions of pathologists with reference to the

414 Healthy and Morbid Menstruation, [July,

constitutional state of the patients suffering from menorrhagia,
but they also greatly sinaplify treatment. The haemorrhage
being in reality nearly always the result of local disease, the
latter is in most cases, the real element to be attacked and sub-
dued. Instead, therefore, of an intricate and complex system of
therapeutics, founded on a host of indications, the practitioner
has, generally speaking, merely to bring to light and treat the
disease which causes the mischief. By so doing, he removes
the morbid condition which keeps up the haemorrhagic state,
and menstruation spontaneously returns to a natural state.

In those tbrms of menorrhagia in which the absence of any
local disease is evident, or at least to be presumed, at the be-
ginning and termination of the menstrual function, for instance,
or when the haemorrhage occurs in an accidental manner from
some easily assiojnable cause, mental or bodily, very little
medicinal treatment is, generally speaking, required. If the
patient is kept at rest in a horizontal posture, and the cause be
removed, the haemorrhage \v\\\ generally subside of itself,
without leaving any trace in the general health beyond tempo-
rary debility, w'hich quiet and a moderately nourishing dietary
soon remove.

This is not, however, always the case ; the haemorrhage may,
even under these circumstances be so severe and so prolonged
that it would be imprudent to trust to the unassisted efforts of
nature. When such is the case, the indications are, to moder-
ate the activity of the circulation by the means of sedatives,
such as opium, hyoscyamus, digitalis, hydrocyanic acid, Indian
hemp, and other medicinal agents similar in their action ; to
modify the plasticity of the blood by the administration of
vegetable and mineral acids; and to exercise a revulsive action
on the intestinal canal by the means of saline purgatives. The
application of cold to the lower abdominal region, and the in-
jection of cold astringent injections into the vagina, may also be
resorted to, should these means fail. It is as well, however, to
W'ait, unless the haemorrhage be excessive, until the normal du-
ration of the menstrual flux in the patient have y)assed, lest the
impression of cold should suddenly arrest the excretion of blood
whilst the physiological flux towards the uterus is still in force,
as extreme congestion, and even inflammation, might ensue.
This appears to me a desirable precaution, and one which I
usually adopt, although the direct impression of cold to the
uterine organs during menstruation, does not appear to be in
reality as dangerous as it is usually considered.

In this the most simple form of menorrhagia, it is seldom ne-
cessary to resort to those medicinal agents which have a direct
influence upon the uterus, such as ergot of rye and savine. . It

1 852.] Healthy and Morbid Menstruation. 4 1 5

must not, however, be forgolten that they are very valuable anti-
menorrhagic remedies, and often succeed when all other
medicinal means fail to arrest the haemorrhage. As a last
resource, we can resort to plugging the vagina; but this is a
means of treatment which may be said to be scarcely ever ne-
cessary in mere accidental menorrhagia, and which may be
kept in reserve for the more formidable forms of haemorrhage,
of ihe treatment of which we have yet to speak.

Should the antecedents of the patient, carefully scrutinized,
reveal the existence of any decided uterine symptoms, or lead
to the impression that uterine disease may exist, as soon as the
haemorrhage has stopped or has been temporarily arrested by
the means above-mentioned, the state of the uterus and of its
cervix ought to be investigated firstly, by the touch, and
secondly, by the speculum, should the finger detect disease, or
a suspicious condition of the uterine neck and of its cavity. In
those cases in which the haemorrhage is continuous, or all but
continuous, it is not necessary to wait for its entire subsidence
to examine the patient. When the exacerbation which corres-
ponds to the menstrual epoch in the patient has passed, and the
haemorrhage has abated, the state of the uterine organs should
be ascertained without delay.

When inflammation, and more especially inflammatory ulcer-
ation of the neck of the uterus, is discovered, and the absence
of cancerous lesions or fibrous growths has been ascertained,
the practitioner may consider that, in nineteen cases out of
twenty, he has found the key to the menorrhagic state, and that
the most efficacious and prompt means of treating it is to treat
the disease he has discovered. From that moment l.e may look
upon all medicinal anti-haemorrhagic agents as mere adjuvants
useful no doubt, but of very secondary importance compared
with the treatment of the local disease. Very often the hae-
morrhage stops as soon as the irritability of the inflamed sur-
face is modified, and long before the disease is cured.

The menorrhagia, however, may persist with more or less
intensity, notwithstanding the gradual improvement of the local
disease. It is with sucli patients more especially that great
advantage may be derived from the administration ofergnt of
rye in substance or infusion, of savine in powder, of gallic acid
and of the other medicinal agents mentioned. I generally be-
gin with scruple doses of the ergot or savine two or three times
a day, gradually increasing the dose if required.

In those cases in which, as we have seen, the haemorrhage
persists after the entire removal of local disease, owing to en-
largement of the uterus, to the presence of a small unrecogni-
sed polypus or uterine tumour in the cavity of the uterus and

416 Healthy and Morbid Menstruation. [July,

its neck, or from the mere haemorrhagic habit, I have of late
resorted with encouraging success, to plugging the os uteri it-
self, instead of the vagina. It occurred to me that the usual
plan of filling up and distending the vagina by pieces of sponge
or a handkerchief, was a very clumsy, painful, and inefficient
mode of opposing mechanical resistence to the exit of blood
from the undeveloped uterus, v^^hen its orifice could be so easily
brought into sight. Acting on this idea, I have, in several in-
stances, brought the cervix uteri into view, and passed inside
the OS two or three small pieces of cotton, tied to a piece of
thread, which I wedged in firmly, covering the whole cervix
with two or three larger pieces left in close contact with it on
the withdrawal of the instrument. Inmost of the cases in
which I have resorted to this plan, I have easily arrested the
haemorrhage. Indeed this modification of the ordinary practice
appears to me so simple and so consonant with common sense,
that I cannot but think it will be adopted in severe cases. In
the ordinary operation of plugging the vagina, that canal has to
be distended by a large mass of sponge or linen, soaked with
clotted blood, which often interferes with the functions of
the bladder and rectum, is always a source of great discom-
fort to the patient, and is not always efficient ; whereas, by the
plan I describe, the end proposed is much more effectually en-
compassed, with scarcely any annoyance to the patient beyond
that which the use of the speculum occasions.

Owing to the natural contractility of the cervical canal, and
the pressure of fluids from behind, if the cotton is not well pushed
in, it is soon forced out. The plug may be left without renew-
al twenty-four or even thirty-six hours ; but in the latter case
it is generally expelled .spontaneously. A small piece of sponge
may be used and is more likely to remain in situ, owing to its
expansion ; but as it must necessarily be very small, it is more
likely to be pernieated by the blood. If sponge is used, great care
should be taken to extract the piece passed into tho os, to which
a small piece of thread should always be tied, as the os uteri
might not be able to expel it alone, owing to its great expansion.

In the class of cases of which we are now treating, I have
occasionally found that a few leeches applied after menstrua-
tion to the cervix uteri, have arrested the haemorrhage,

I need scarcely add that any disease of the abdominal viscera
that appears to favour the haemorrhage, s[)ou!d he treated, and
that the debility occasioned by menorrhagia must be met, du-
ring the intervals of the attacks by as nourishing a diet as the
patient will bear, and by those tonics which are suited to her
state. It must, however, be borne in mind that when the hae-
morrhage is accompanied or occasioned by inflammatory uterine

1852.] Bright' s Disease. 417

lesions, the stomach is generally sympathetically affected, and
unable to digest much food, so that a We^ dietary may be pos-
itively injurious and increase the mischief.

I have not spoken of the haemorrhage that is observed in
fibrous tumours and polypi of the uterus, and in cancer, because
it is so much a symptom of these diseases, that it can only be
properly treated of in connexion with them.

[To be Continued.]

Bright s Disease,

*' Bright's Disease and its Treatment" are still among the
vexatce quesiiones of pathology and therapeutics, and as Dr.
Frerichs is so well known and highly esteemed in this country
on account of his physiological inquiries, we feel assured that
an analysis of his pathological researches will be more welcome
than any lengthened critique upon their results.

It is not easy to condense into smaller compass a work so
crowded with facts as that before us ; but, limiting ourselves to
the observations and opinions of its author, and placing in the
most prominent position those which have the greatest share of
novelty, the probability of his receiving justice at our hands will
be greater than if the attempt were made to weigh the merits
of his treatise with those of others who have preceded him.

The first chapter contains an " historical retrospect," into
which it is not necessary to enter, as the facts are more or less
familiar to every student of pathology. It is interesting to
observe the early date at which groups of symptoms were
recognized as bearing more than an accidental relationship to
each other, and it is still more so to perceive that the links con-
necting them were discovered only when inquiry proceeded
upon the truly inductive method, for we are conscious that
there is in it the germ of a power which will eventually be great
enough to grasp facts apparently more widely separated, and
penetrating enough to perceive their bonds of union.

The anatomical changes in the kidney are divided into three
forms, which may also be considered as stages of the process
of disease. They are the following :

I. The stage of hyperhsemia, and of commencing exudation.

II. The stage of exudation, and of its commencing transfor-
mation.

III. The stage of degeneration atrophy.

In the first of these, which is frequently attended by haemor-
rhagic eflfusion from the glomeruli, from the capillary plexus
surrounding the urinary tubuli, or from the veins upon the sur-
face of the cortex, the epithelium of the tubuli is not essentially

418 Bright' s Disease, [July,

changed, allhoufrh the canals thenriselves, especially those of
the cortical substance, are commonly filled with coagulated
fibrin. These coagula are sometimes perfectly simple, and
present themselves in this condition as casts of the tubes in
which they were formed, while at other times parts of the
epithelial lining, or more or less changed blood-corpuscles, may
be found imbedded in them. This condition is not often met
with anatomically (20 times in 292 post-mortem examinations,)
and is then the accompaniment of an acute, violent illness.
The disease when chronic is rarely fatal at so early a period.

In the second stage the progress of exudation increases,
while the hyperrhscmic condition becomes less marked. Meta-
morphosis of the exuded matter follows; the epithelium and
the fibrinous-casts of the tubuli break up into fatty molecules.
In the Malpighian corpuscles similar exudation and fatty mat-
ter are seen lying between the capsule and its contained glom-
erulus, and then these bodies are raised above their natural
size ; but as long as the stream of secretion, poured from the
glomeruli, is sufficiently powerful to remove the coagula of
fibrin, this increase of dimension is not observed. In the urin-
ary canals, especially those of the cortical substance, important
changes are in progress; the epithelium undergoes complete
transformation, losing gradually the form of its cells, present-
ing fatty infiltration to a variable extent, and ultimately losing
its characteristic appearance and function, and becoming re-
placed by granular detritus and fat. This second stage was
found in 139 in 292 examinations. It embraces the 1st and
2(1 forms of Bright ; the 2d, 3d, and 4th of llayer and Rokitan-
sky ; the 2d, 3d^4th, and 7th of Christison ; and the 2d and 3d
of Martin Solon.

In consequence of the degeneration of fibrin in the urinary
tubuli and the Malpighian corpuscles, and the removal of this
with the more or less transformed epithelium, the walls of these
structures collapse, and part of the kidney is atrophied. It is
this which constitutes the third stage of Bright's disease. This
atrophy is brought about in some cases by the contraction of
plastic matter, when the latter has been exuded into the inter-
stitial textures. This is rare, however, and when present is
only a co-operative cause of atrophy. This 3d stage of Fre-
richs corresponds with the 3d of Bright, the 5th and 6th of
Rayer, the 5th and 7th of Rokitansky,and the 4ih ofM. Solon.

Among the not constant anatomical changes of the kidney,
Frerichs enumerates and describes 1. Apoplexy; 2. Suppu-
ration; 3. Cystic formations; 4. Calculous deposits; 5. Tu-
bercle, etc. In the paragraphs upon the chemical changes in
the kidney, the amount of solid constituents is given, and the

1852.] Bright' s Disease. 419

proportion offal in a hundred pnrts of dried kidney substance.
In health the latter varies from 4*4 to 4 05 per cent. In mor-
bus Brightii, it was found varying from 4*40 to 139. Gener-
ally speaking, the quantity of fat was greater when the disease
had advanced to the third"^ stage, but this is not invariable ; and
the fact, that by chemical examination the quantity is often
found so much less than microscopic observation would lead U3
to expect, must, according to Frerichs, be considered as a
proof that we are not justified in naming as fat all those glo-
bules which resemble it in form. In the kidney of a cat, and
in that of a dog, the fat was found by Frerichs to vary from
2720 to 32"50 percent. Both animals were perfectly healthy ;
their urine contained not a trace of albumen, a sufficient proot"
that morbus Brightii cannot be considered dependent solely
upon fatty degeneration.

A statistical report, and tabular representation of the changes
found (post mortem)\x\ other organs, concludes the second chap-
ter of the book. The cases are gathered from Bright, Christi-
son, Gresjory, Martin Solon, Becquerel, Rayer, Bright and
Barlow, Malmesten, and the author's own observation.

The third chapter presents a short account of the general
course of the disease in its two forms, acute and chronic ; and
we pass from it to the fourth, entitled " Special Symptomatolo-
gy." In this the appearances (merely sketched before) are
described in detail, their frequency given numerically, their
causation examined, and their clinical value in respect of
diaornosis, prognosis, and treatment, pointed out.

The symptoms are treated under the following heads r I.
Those of disordered uro-poesis, embracing, (a) pain in the
region of the kidney ; (b) percussion and palpation ; (c) fre-
quency of micturition ; (d) changes of the urine. 2. Those of
changed blood. 3, The habitus of the patient. 4. Dropsy.
5. Changes in the action of the skin. G. L^rsemic intoxication,
(chronic and acute.) 7. Disturbances in the functions of the
primae viae. 8. Pseudo-rheumatic pains.

It would be impossible to present anything but the most un-
satisfactory analysis of this chapter, if we attempted to embrace
all its contents. We shall limit ourselves to those included
under the 6th and 7th heads ; and we shall do so simply because
the statements there made have more of novelty than the others,

1. The Chronic Form of Urcemia. This steals slowly and
unobservedly upon its victim, and is in almost every instance
fatal. In the early stages of Bright's disease, there is a peculiar
dulness, or sleepiness, in the expression of the face, and in the
demeanor of the patient. He complains of dull headache, a
" light" feeling, the eyes are expressionless, the whole physr-

420 Brighfs Disease. [July,

economy is depressed in its features, he is forgetful, and listless.
These symptoms diminish if the secretion of urine becomes^
more abundant, and sometimes they disappear entirely for
time. In other cases they gradually increase in intensity; thel
sleepiness passes into stupefaction ; the patients, who at first
can be roused by speaking to them loudly, or by other meanSjj
and will then give rational replies, now sink into everdeep-
enincr lethargy ; it is impossible any longer to arouse them ;j
respiration becomes stertorous, and is replaced only by the]
gurgling of death. They generally lie perfectly still, without
speaking. Delirium is rare ; when it does occur, it is of the,
low muttering description ; the patients repeat, times without
number, a few words or sentences. Death is often precedec
by convulsions ; trembling of the hands : distortion of the fea-
tures, becoming quickly followed by clonic spasm, extendin|
over the whole system of voluntary muscles. This is th(
more common form of nervous disturbance in Bright's disease.
It may last for a longer or shorter time, and is often capricious
in its course. Nevertheless, it is more to be dreaded than any
other complication, for it is the most certain herald of a fatal
termination. Differing from it in its manner of appearance,
and very essentially different in respect of prognosis, is the

2. Acute form of UrcBmia, which commences suddenly, and
in a short time reaches its full intensity. It appears to attack
the patient in one of three ways, the first symptoms being either
those of depressed cerebral function, of irritation of the spinal
cord,orof a combination of thetwo. Frerichs confirms, from his
own experience, the statement of Dr. Addison, that when (un-
der depressed cerebral function) the respiration becomes ster-
torous, there is not the deep guttural tone heard in hsemorrhagic
apoplexy, from the movements of the velum palati,but that the
sound is of higher pitch, and is caused by the passage of air
against the hard palate and the lips. He also adds his tes-
timony to that of Dr. Bright with regard to the persistence of
consciousness in some cases where uraemia has evidenced itself (
first by convulsion. Although the prognosis is more favorable j
when the attack has this acute character, inasmuch as it gen- i
erally follows a sudden suppression of the urinary secretion, yet j
it may prove fatal in a few days, or even hours; and the result i
must be anticipated as very unfavorable when acute uraemic i
intoxication occurs, as it does not unfrequently. during the !
course of chronic Bright's disease. A sudden change in the
quantity or quality of the urine, disturbances of the organs of
sense, etc., are insisted on as of importance in the light of |
warning symptoms. There are cases, however, where these
are entirely wanting, and the diagnosis may be attended with

1852.] Brighfs Disease, 421

great difficulty. A very constant, and in the earlier periods of
uraemia, a prominent symptom, is vomiting. Altered ingesta
are thrown up at first, but subsequently a thin, watery sub-
stance only. Its re-action, seldom acid, is generally neutral or
alkaline; it emits fiequently a sharply ammoniacal odour ; and,
if a glass rod dipped in hydrochloric acid is brought near it,
copious white fumes are developed. If the inodorous, neutral,
or even shghtly acid fluid is heated with liquor potassae, the
presence of an ammoniacal compound is demonstrated. Fre-
richs has frequently sought for undecomposed urea in the vom-
ited matters, but always without success. Aitificial uraemia,
induced in animals by extirpating the kidneys and injecting
urea, is attended by the vomiting of similar matters containing
a large quantity ofcarbonate of ammonia, but no undecomposed
urea, 'fhe decomposition of urea into carbonate of ammonia
does not (according to Frerichs) take place in the stomach
through the action of the gastric fluid, (as Bernard and Bar-
resvvil maintain,) but it is brought about in the blood within
the vessels.

This form of vomiting must not be confounded with others,
which are very common in the course of morbus Brightii, and
which have their origin in chronic catarrh of the stomach,
simple perforating ulcer, the misuse of spirits, etc., etc. The
chara(*ters described serve to distinguish them from that of
true uraemic character.

Serious disturbances of the nervous system appear to be in
many cases delayed or altogether avoided by this vicarious
excretive process. This has, however, been too confidently
asserted to be a general rule by Bernard and Barreswil. In
the stomachs of animals whose kidneys have been removed,
ammoniacal compounds are constantly found ; but the uraemic
condition is not thus delayed in the majority of instances. It
gives evidences of its presence at the time that the described
change takes place in the secretion of the stomach. Ammo-
niacal salts are then found in nearly all the secretions, and
compounds of that base may be discovered in the expired air.
The relation of diarrhoea to uraemia requires further elucidation,
and Frerichs does not give his opinion upon the subject.

The conditions of the perspiration and of the expired air are
then closely examined. The former has been tested princi-
pally by the noses of pathclogists, and is left doubtful ; in the
latter, the presence of ammonia is established ; and in artificial
ura?mia, it was not until this base could be detected that any
sijrns of disturbance in the nervous system were observed.
Pathological anatomy is then shown to throw no certain and no
constant light upon the nature of uraemic intoxication; and it

N. 9, VOL. VIII. NO. VII. 27

422 Brighfs Disease. [July,

is believed, that in the condition of the blood the key to the
mystery is to be found. lis physical properties, in respect of
consistence, colour, odour, etc., present no unvarying change
of character. Its chemical relatio-ns are aUered, and the ahera-
tions are essential. In all cases where the symptoms of uraemia
presented themselves, carbonate of ammonia, and, in addition,
undecomposed urea, were found in the blood. The quantity
of the former is variable to a high degree ; but in no one
instance did it remain undetected. Frerichs gives another
historical sketch of the theories of this branch of his subject.
For a long time the opinion has been almost universally held,
that the cause of these symptoms was to be found in the reten-
tion of some urinary elements in the blood. Osborne and G.
Owen Rees form the exceptions ; the former being of opinion
that arachnitis was the cause, to which pathological anatomy
returns the most satisfactory answer; and the latter, question-
ing the influence of urea in the production of coma, etc., from
the perfectly correct observation, that the appearance and
intensity of such symptoms in morbus Brightii, hold no constant
relation to the quantity of the urinary secretion ; and further,
that the blood may be surcharged with urea, and yet cause no-
symptom of ursemic poisoning. Rees considered hydrsemia
as the essential condition ; but this cannot be so important as
be would make it appear, since coma, convulsions, etc., occur in
acute morbus Brightii, during either theearlier or later stages
of scarlet fever, typhus, etc., without there being any evidences
of such thinning of the blood. The question remains to be
answered, in what way suppression of urine exerts the influence
assigned to it, and which of its elements 'is the active agent?
By the experiments of Vauquelin, Segalas, Bichat, Courtin, and
Gaspard, repeated with additions of his own, Frerichs proves, ,
that the presence in the blood of a large quantity of uiea,,
of uric acid, or of urine itself, with extractives and sahs^
cannot cause the symptoms commonly observed when suppres-
sion of the secretion takes place. The result of a course of
inquiry undertaken by Frerichs in 1849 and 1850, is that for
the production of ursemic intoxication, the presence of any or
all of these substances is insufficient, but that the urea must be
decomposed through the agency of a peculiar ferment substance,
and carbonate of ammo-nia set free within the blood-vessels.
The production of this decomposing agent in febrile aflections
is not difficult to suppose^ and the rapidity with which symp-
toms of uraemia are developed when morbus Brightii supervenes
upon scarlet- fever, typhus, etc., together with the suddenness
of their appearance in a person whose blood has been for a
long time overladen with urea (without them) lend support to

1852.] Catarrhal Pneumonia, SfC. 423

the view. The injection of carbonate of ammonia into the
blood induces all the symptoms of uraemia, and without defining
the precise nature of the ferment body, but asserting that a
very slight modification of one of the normal elements of the
blood would be sufii(Ment for the purpose, Frerichs, by a course
of experiments, considers that he has established his theory with
regard to uraemia.

It would be impossible, within the hmits of this review, to
follow our author closely through the minutiae of the concluding
chapters. We can but indicate the topics which form their
basis, so that our readers may form some estimate of the book.

In the chapter upon the complications of morbus Brigfitii,
the several diseases of the heart, arteries, veins, liver, and
spleen, &c., &., are examined and described. The frequency
of Brighi's disease, its duration, course, and terminations, are
then considered ; and separate chapters are devoted to the
questions of etiology and pathogenesis, essence of the disease,
diagnosis, prognosis, varieties (ibrms,) and therapeia. An Ap-
pendix, containing clinical reports of sixteen cases, and the
results of a series of experimental researches, concludes the
volume.

Frerichs describes the following forms : 1. Simple. 2.
Cachectic. 3. That of the drunkard. 4. That occurring m
acute blood-disease, (cholera, scarlet fever, measles, typhus,
fef..) 5. That accompanying pregnancy.

In the chapter upon "treatment, the disease locally and gen-
erally, its more constant and its occasional complications, are
severally dwelt upon. The author does not commit himself
to the system of depletion, of strengthening, of continually pro-
duced diuresis, y)urgation, or diaphoresis, but gives the moderate
and judicious employment of all the various agents mentioned
a position in his list, the peculiarities of the case under consider-
ation leading to the choice of that which is most suitable.

In respect of the treatment when uraemic intoxication is
present, Frerichs recommends acids, which should form innocu-
ous compounds with ammonia in the blood, such as the vegeta-
ble acids. [Medical Times.

On the Catarrhal Pneumonia and Lobar Pneumonia of Chil-
dren. By MM. Trousseau and Lasegue.

Catarrhal (or lobular) pneumonia is a disease as distinct
from simple (lobar,) as variola is from erythema. This is seen
in their respective mortality. Of twenty children who have
been admitted to the hospital clinique, suffering from simple
pneumonia, in six months all have recovered ; of nearly thirty

424 Catarrhal Pneumonia, ^c, [July,

who were attacked with catarrhal pneumonia, not one survived.
Most of the first class of cases exhibited an excessive degree of
acuteness which burnt out like a fire of straw ; while several of
the second, notwithstanding their fatal termination, commenced
with very mild symptoms.

Sim])le pneumonia hardly ever afiects a child below two
years of age, and rarely those of two or three, but becomes of
more and more frequent occurrences as the child approaches
adolescence. Its cause and symptoms resemble those of the
adult, with some modifications. After twenty-four or thirty-
six hours, the souiTle and bronchophony can alone be heard ; the
crepitant rale, which is often observed in the adult when the
patient coughs, even when much souffle is present, is hardly
ever heard in the child. So afterwards, from dny to day, with-
out the crepitation of resolution, the souffle disappears, leaving
only a feeble respiration. The proo;ress of the disease is also
more rapid than in the adult. In the mild form of the disease,
recovery takes place rapidly, and in large proportion ;. but in its
grave form, many cases are lost by any nwde of treatment.
M. Trousseau generally bleeds the child, gives it an emetic of
sulphate of copper, and then a mixture, containing Kerme*
mineral and extract of digitalis.

Catarrhal pneumonia commences with a catarrh, which rapid-
ly extends to the small bronchi, and then we hear numerous and
small sub-crepitant rales disseminated over both lungs, and
especially posteriorly. These rales m'ay persist for fouv, six,
eight, or fifieen days, without any souffle becoming manifest;,
but sooner or later we hear a souffle, the resonance ol the cries
or the voice, or at least a prolonged res[)iratory murmur. While
these latter sounds, common to simple and catarrhal pneumonia
are thus manifesting themselves, we find, by the subcrepitant
rales, that the capillary catarrh is still persisting in the rest of
the lung. The disease has extended from the mucous mem-
brane to the parenchyma of the organ. Febrile action is less
than in ordinary pneumonia, being predominant at som poitions
of the day, and entirely ceasing at others ; and these alterna-
tions of better and worse may continue for fi.fteen, twenty, or
thirty days ; the disease being originally a pulmonary catarrh,
and partaking of the obstinacy and uncertainty of catarrhal
complaints. As more and more of the parenchyma becomes
implicated, the fever becomes more continuous and intense, and
the respiration more difficult, until the children die exhausted.
In other cases, in which the bronchial phlegmasia was very
intense from the first, and the lung became rapidly invaded over
a great extent, death takes place with rapidity. The progress
of the disease has usually been n:iore rapidly fatal, when it has

.J

1852.] Hyper CBS thesia and Ancesthesia. 426

succeeded to measles, chronic disease of the skin, or laryngitis.
All means of treatment that have been tried have proved impo-
tent.

These two affections m.ay be compared, exceptis cxcipiendis,
wiih erysipelas and [)hlegmon. Erysipelas ti'averses the surface
like the catarrh ; and when it persists too long, it induces ulcer-
ations of the skin, furuncles, and circumscribed subcutaneous
abscess, just as the cnpilhjry catarrh induces suppuration of the
lobules, little abscesses of the lungs, and circumscribed pneu-
monias. Simple pneumonia, on the other hand, progresses like
simf)le phlegmon, violent in its febrile reaction, but terminating
abruj)tly and rapidly.

It must not be supposed, from what Ims been said, that catar-
rhal pneumonia is almost invariably fatal. Although this is the
case amidst tl^e miarnata of an hospital, which exert effects at
once so terrible and so difficult to avert, it is not so in private
practice. In this, one-half the patients may be cured by repeat-
-ed vomiting, flying blisters, antimonials, and digitalis ; but how
terrible are the ravages of a disease, which, under the most
favorable circumstances, kills one-half its subjects !

[L^ Union Medic ale. Med. Cliir. Rev.

On the Simullaneous Occurrence of Hypercesthesia and Aucbs^
ihesia of the Skin in Neuralgia. By Dr. Turk.

During or after an attack of severe neuralgia, there is some-
times a more or less considerable amount of hyperaesthesia of
the superficial layers of skin seated over the affected parts, so
that not the least contact can be borne. Much oftener, howe-
ver, the contrary is the case viz, anaesthesia of the superficial
layers over the points of deep-seated pain. The degree of this
superficial anaesthesia is proportionate to the amount of pain in
the deeper layers of the skin ; and it is sometimes so considera-
ble that nipping the skin with the nails, or blistering it by the
application of heat, is unfelt. These opposite conditions of the
same part may be observed for some lime after the attack of
spontaneous pain has disappeared. The two conditions do not
always observe the same limits. Sometimes the most superfi-
cial layer of ihe skin only is anseslhetic, and the formation of a
moderately thick fold of skin causes pain ; while at other times
the choi'ion is anaesthetic throughout, and thick folds of the
skin nmy be pinched up, pain being only felt at the subcutane-
ous layers.

The intensity of the anaesthesia diminishes in proportion to
the distance from the site of the spontaneous pain. An entire
side of the body has been observed to be aneethetic; but the

426 External use of Chloroform, L^^^y*

insensibility has usually become so diminished towards the
boundary, as to be incapable of being tested by irritation by
the fingei*, though readil}' so by the apphcation of hot or cold
bodies. This hemiastfieenia sometimes extends to the wall of
the mouth, and side of the tongue. Oftentimes it has been only
observed over the greater part of half the body, certain portions
of the trunk or head being exempted. In some cases the func-
tions of the s.-nses have also been found disturbed.

The hypersesthesia of the deeper layer of the skin rarely as-
sumes such an extension as the an3e.4he?ia of ihe superficial
ones; though cases have been observed in which it, loo, has
occupied one entire half of the body. In double-sided neural-
gia, the anaesthesia and hyperaesthesia are also double, being
more intense on one side than the other, if that is the case also
with the neuralgia. In some cases, both sides of the body are
aflected symmetricallv, having their limits then drawn horizon-
tally.

Besides the occurrence of these conditions in neural<zia, it
not unfrequently happens, according to the author's experience,
that in typhus there is a more or less intense hyperaesthesia of
the deeper layers of the skin in various parts of the body, espe-
cially the calves of the legs. It is sometimes so considerable,
that the half-soporose person utters expressions of pain under
the influence of even but moderate pressure. Examined after
the fever had run its course, no abnorinal conditions of sensibil-
ity were observed in some of the patients; bnt in other sponta-
neous pains, accompanied by hyperaesthesia and anaesthesia of
different parts (especially the leg and foot,) and in different
degrees, remained for weeks. Frot iep^s Tagsberichte. Ibid.

External Use of Chloroform.

Dr. Channing read the following paper on this subject :
"I have made some trials of the external application of chloro-
form. It has often been entirely successful in the present relief
of pain. In some, the relief has been permanent. 'J'his use of
the remedy of pain is not new. It has been said that a free
application of chloroform to a part on which a surgical opera-
tion is to be done, will render such part insensible to the
violence done it. Thus, immersing a finger in chloroform
will prevent the suffering which accompanies the deep cuts
which some of the diseases of this member require, and which
are described as exquisitely acute. These statements rest on
good authority. In such use of chlorofortTi consciousness;
remains unimpaired, the brain not being at all affected by it.

Having frequently applied chloroform externally for thei

1852.] External use of Chloroforui. 427

relief of pain, in many and various cases, and often with speedy,
and generally with continued relief, I propose to present sonne
of them to the Society:

Case I. 1848. Mrs. , about 30, has children. For

some years has had symptoms of uterine disturbance. Among
these, have been suffering on intercourse, leucorrha:ja, tumoral
pains in and about the pelvis, always increased by walking,
and which, except pain in the spine, are relieved by lying down.
For the uterine conditions the usual means were faithfully
employed, and her complaints there were entirely and perma-
nently removed. Tlie dorsal trouble, however, was as great
as ever.

For this I recommended the external application of chloroform
over the whole course of the spine which was involved in the
disease. The effect was immediate and complete. I saw this
patient, a few days since, Nov. 1851, and found her well in
regard to the back, and speaking of herself as very well in all
respects.

In this case, the pain in the spine was doubtless the result of
the reflex function, the womb being the original seat of the
malady. But when the uterine affection was relieved, the sym-
pathetic dorsal difficulty remained, and only yielded to the use
of chloroform. The quantity used was an ounce.

Case II. Mr. , ap^ed 22. A very feeble man in appear-
ance ; very thin in flesh ; pale ; and an almost constant sufferer
from headache. This pain occupied but a small part of the
iiead arc, and most frequently the right temporal region. It
was accompanied by constant nausea, frequeiV. vomiting, great
prostration of strength, and demanding for its present relief
firm pressure over the part affected.

The last attack, which happened a few weeks since, I applied
chlorform to the seat of pain. A few drops were applied by
means of a handkerchief. The immediate effect was redness
of the skin and a tiniiling sensation in the spot. The pain was
at once relieved. He raised his head from a friend's shoulder,
opened his eyes, looked round, and expressed his utter surprise
and deep pleasure at the entire relief which had followed the
use of such apparently simple means. He called on me the
next morning, and reported himself perfectly well. I have not
been called to him since.

The relief in this was sudden in its occurrence, as it had been
in others. It has not been less permanent on that account, or
in such cases. It has acted at once to remove pain, and with
a rapidity which distinguishes the relief entirely from that which
follows etheaization by inhalation. The brain does not seem
to have anything to do with the matter. Local pain is abolish-

428 External use of Chloroform. [Jul}',

ed and at once ; and the nerves have no story of suffering to
tell to the brain. The sentinel is at his post, but his Junction is
not needed. The part does notjose its natural sensibility at all.
On the contrary, it feels the tingling, the irritation of the ohloro-
Ibrin, just as distinctly as at first. Nothing has been lost of
natural power and healthful function. All that has happened is
this : the pain has ceased, and the patient is well.

Case III. 185 K Mrs. , aged 36. lias long suffered

from uterine disturbance. The most exhausting and annoying
symptom was leucorrhoea. This was a perpetual drain, and
made her exceedingly uncomfortable. I was occasionally con-
sulted in this case ; but as her general health continued tolerably
firm, no systematic attempt at recovery was thought necessary
by the patient. She became pregnant, and su[)posed herself
between two and three months advanced in that state, when
hemorrhage and severe uterine pain occurred, on account of
which I was desired to see her. She had lost a great deal of
blood before I saw her. I found her perfectly blanched lips
and whole face ; skin cold ; hands bloodless; faint; almost
pulseless. Various means were used, and the hemorrhage was
stopped. I considered her case, however, so pressing, that I
passed the whole day in the house. She now began to com-
plain of pain in the back. This had exacerbations in the night,
becoming too severe to allow of sleep, and continuing three or
four hours without mitigation. For this I recommended chloro-
form, which was applied by means of a handkerchief, and with
excellent results. After three applications, on as many days
or nights, the paifi ceased, ana has not now, at the end of some
weeks, returned.

Case IV. Mrs. - , aged about 40. Last child, thirteen
years old. I was called in consultation in this case, because
of vomiting, attending pregnancy, of about three months stand-
ing. The vomiting ceased under treatment, and food was
taken in sufficient quantities, and was well borne by the stomach.
A comatose state supervened, which increased, with entire
abolition of mind, and death was its consequence. The ter-
mination of cases of fatal vomiting by coM)a has occurred in
many instances which have come under niy notice or knowl-
edge. I do not, however, recollect a case in which apparent
recovery has been followed by coma ending in death.

This case is reported here, because of the use of chloroform
for one of its symptouts. This was pain in the back, in the
course of the spine. It was very severe, taking the lead, in
distress, of all the rest. For this pain I prescribed an ointment,
if so liquid a substance as was pioduced by the union of lard
and chloroform deserves the name. It was applied twice or

1852.] External use of Chloroform, 42^-

thrice a day, and with most excellent effects, the pain entirely
disappearing. It was used in the sanne way in the first ut' these
cases.

Case V. Mrs. . Has had four premature labours ; the

first at about five months, the fourth at about the eighth. They
were all still-born, or neither ot" them lived over an hour or two.
The fifth pregnancy was terminated at the full time by the
birthof a living, healthful male child, on the 17th October, 1851.
I visited her for the usual time alter delivery, and left her in
rapid progress towards perfect recovery. 1 was called to see
her on the 27th October, and found her apparently very ill.
Pulse rapid ; skin fiot ; face flushed ; much pain in head and in
both breasts, making all attempts at nursing absolutely agoniz-
ing. A thick eruption had appeared over the whole chest.
Upon examination, the breasts were found exquisitely sensitive,
not bearing pressure at all. Sufficient pressure, however, was
made to enable me to ascertain that there was no unusual
liardness, or, in short, any other sign of disease in either organ.
The pain was confined to the skin, and seemed to involve its
whole tissue. The eruption proved to be a very full crop of
sudamina of unusual size, resembling exactly an exaguerated
form of the same kind of eruption in typhoid fever. Various
means had been used before my visit, but without any good
efi^ect.

I recommended chloroform, and with the best eflfects. I
regret 1 had not used it in combination with lard or rose oint-
ment, both ol" which I have used, and for the reason that it may
in this way be more extensively applied, with more continuous
benefit, and with less of the unpleasant tingling which so gener-
ally accompanies the uncombined substance.

On what did this aching pain depend? It resembled that
which at times makes s/nngles so very distressing. Was it
owing to the eruption ? I have never known the skin in
sudamina to be complained of as the seat of pain, and I have
examined it when c<'Vered by this eruption after a manner
to have produced pain had morbid sensibility existed. In
Mrs. 's case, the pain was persistent, being much aggra-
vated by handling, thougii never so gently. The pain in this
case subsided, under the use of chloroform, long before the
eru[)tion disappeared.

Cask VI. Mrs. , aged 25, married very young, and had

a premature labour within a year or two afterwards. I was
desired to see her, October, 1851, on account of an enlarge-
ment of the abdomen, on the left side, and for various signs of
ill health. The tumour was found to be an excessively enlarged
spleen. It filled the left hypocjioadrium, extending forward

430 External use of Chloroform. [J uly,

to the epigastrium, and downward to Poupart's ligament. Its
anterior boundary was the linea alba. From this point or line
itexlended laterally and backward, filling accurately one whole
side of the abdomen. She has been always regular in regard
to the catamenial function, with the exception of the last two
periods. Nausea, vomiting, and other unusual and disagreea-
ble feelings have led to a suspicion that pregnancy may exist.
She has recently taken a fatiguing journey of three days, and
has suffered much since. The pain has been most troublesome
in the head, and in the seat of the tumour. Diarrhoea and
flatulence, with general anasarca, involving the face and head,
are also present. Chloroform to the forehead and to the seat
of the tumour has given her much comfort, more than has been
derived from any other means used.

Case Vll. Mrs. was delivered of her second child, a

daughter, December 25th, J 850. Since that event she has
been liable to diarrhoea, which, however, has not impaired her
general health. She has long been annoyed by a spasmodic
catching of her breath, almost resembling hiccup, but producing
more general agitation of the body than does that. After her
last confinement, this affection was for some time unusually
troublesome.

I was called to see Mrs. , October Gth, 1851, and found

her apparently vei-y ill. She was ht)t ; feverish ; pulse rapid ;
severe pain in head, which it wasatten^pted to relieve by band-
age, and difi^erent washes ; vomiting large quantities of watery
fluid, colourless, having floating in it masses of a dense, white
substance, resembling coagulated milk. No milk has been
taken for some time. Copious diarrhoea, with very severe,
intermittinoj pain around the umbilicus. No sleep at night, and
for a week or more has suffered many of present symptoms.
Means were used to check vomiting and diarrhcca, but without
any useful result, and I determined to try chloroform externally.
Its efliects were most grateful. The head, stomach, and bowels
became easy. They were, in short, relieved of all their trou-
ble. This was in the evening. At my morning visit, I found

Mrs. up and dressed, nursing her child ; and, except

weakness from so much suffering, and forced total abstinence,
in her usual health. I forgot to mention above, that, during
this very severe attack, the catching respiration revived, as it
does, I was informed, whenever she is at all indisposed, and
continued till she recovered.

Case VJII. Mr. , of strongly-marked nervous tempera-
ment ; very impressibh ; an excellent mesmeric subject. I
was called to this gentleman on account of violent pain in the
head, and to which he was very liable. I found him in bed.

1852.] External use of Chloroform. 431

He could not sit up at all, and any noise in the room, or house, or
jarring of the furniture, increased the pain to ogony. Pressui-e
to ihe head gave some leiief. While I was examininfr his case,
he said he could bear his sufferings no longer; thai he must
get up, and walk round the room ; do anything which might
afford some relief He was hot ; skin diy ; pulse rapid. I .<ent
for leeches ; biit before they could be got, and because of the
increased suffering, I made a free application of sulphuric ether
to the forehead. The relief from its use was soon apparent.
It was strongly expressed, until, worn out by his long agony
and sleeplessness and now relieved he fell asleep ; and, after
long and perfectly quiet rest, awoke without pain, and next day
went to his business.

The relief here was quite as striking as from chloroform. A
good deal of ether was used, indeed, and the patient may have
found some of the relief he experienced in the unavoidable
inhalation of the ether vapour. This was not at all the casein
the instances in which chloroform was applied. The quantity
was very small, hardly damping the handkerchief beyond the
limits of a twenty-five cent piece, and with the wet surface close
to the skin, and often under the bed and other clothes. This
case is reported, not on its own account only, but also to allude
to another mode of employing local etherization. A profes-
sional friend of the highest reputation amongst us, and very
cautious in forming opinions concerning the direct eflfects of
remedies, once told the writer that he had been much gratified
with the agency of sulphuric ether in procuring sleep in cases
in which he was desirous to avoid the employment of opiates.
His method was gently to have the forehead and face wiped
with a cloth damped with sulphuric ether, and very often most
grateful sleep followed this use of it.

Case IX. Mrs. , aged 19, in seventh m.onth of preg-
nancy. Of excellent health before marriage, she has sufiisrcd,
in an unusually severe form, the signs and diseases of pregnan(!y.
Vomiting occurred very early, and such was its excess that it
seemed impossible that she could live through its ordinany con-
tinuance. To this succeeded ptyalism, which has been quite as
uninterrupted and severe as was the vomiting. She is con-
stantly in bed, having no power to sit up. Violent headache ;
pain in abdomen ; in back ; in short, pain occurring in all
possible localities, has made her life, for months, wretched.
Having tried the ordinary means of diminishing these troubles,
I have at length applied chloroform. The pain in the head
has entirely ceased since she began this course. All other
means are omitted. Pains elsewhere are sensibly diminished.
She has no nausea, no vomiting, and the ptyalism is less. She

432 External use of Chloroform, LJuly,

bears milk, in small quantities, quite well on her stomach. As
the pain in the back and abdomen continues to recur when the
efiecis of the chloroform have passed away, I have to-day,
November 10, 1851, directed an ointment of chloroform, two
drachms to an ounce of lard, to be applied to the spine and to
the epigastric region.

Cask X. This case occurred in the person of the writer.
The disease was toothache. It was in one of its severest
forms ; had continued many hours ; extended to the temple
and lower jaw, and made the least application to it, a touch
merely, exquisitely painful, (chloroform on a handkerchief
was applied to the third branch of the fifth pair, where it passes
out upon the face, and to its ramifications, and especially to
that part of the cheek which was over the diseased tooth. The
usual sense of tingling and burning was experienced, and the
skin became slightly red. After a few minutes, a most grate-
ful sense of relief was experienced. The pain disappeared as
entirely as it does after an aching tooth has been diawn. No
tenderness remained. The tongue or finger could be freely
pressed against the tooth, and without producingany uneasiness.
Chewing was possible and grateful. Cold water ^ave no agony.
It may be inferred that 1 have exaggerated tlie suffering. Said
a patient to me once, to whom I had suggested the idea that
she might be in error as to her suffering, ''Sir, I know by my
feelings how I feeV I can say that what I have said of the
pain, and of the relief from chloroform, need not to be questioned.
1 felt and understood both.

Relief continued for some time. Pain recurred, but it was
at once treated as above, and was at once relieved.

Remarks. I have written off these cases that 1 might report
tliem to the Society, because I think this method of using
anaesthetics may often be useful. It is not on account of the
novelty of this mode of application of chloroform that the cases
are presented, for the suggestion of such use will be found else-
where. They are read because they present a number of cases,
of facts, in which it has been a purpose to afford relief by the
remedy, and especially by a faithful trial of it.

Another reason : These cases are sufficiently numerous to
furnish some basis for generalization. By adding to them, they
may at length authorize the establishment of rules of practice,
whicii may not only contribute to the comfort of the sick, but
exert important influences over disease.

Again. This use of chlorof"orm is perfectly safe. Not the
least disturbance of system or organ has been produced by the
external employment of this substance. Consciousness re-
Hiains undisturbed. The pulse, breathing, temperature, are

1852.] External use of Chloroform. 433

natural. The expression of relief is very striking. In other
uses of chlorofonn, or ether, consciousness is more or less
abolished, and we know nothing of the relief but what comes
of absence of complaint. From its externa! use we learn at
once the whole story of the con)fort, the extreme pleasure which
is experienced.

A^ijain. I present these cases in the hope that olhers will be
induced by their to seek for their patients' relief from other
sources than those ordinarily employed, and which so ofien do
little more than occupy a certain amount of lime in a self-limi-
ted disease. These cases show that we have the means of
shortening this time, nay, of giving relief at once, and thus of
anticipating recovery. I have used chloroform extei-nally but
once in acute inflammatory disease puerperal peritonitis. In
this case, after-pains continued until the fourth day from delivery,
with retention of urine, and pain in the lower part of the abdo-
men, which broke sleep and produced extreme discomfort.
This case was some miles from town, and I was attending in
consultation. I advised a trial of chloroform to the part, and
used it as above described. Its effect was not agreeable. The
skin had been sodden with hot rum, brandy, hop-bags, &c., and
had been made so tender that unusual smaiting, tingling, and
heat were at once produced, so as to make it necessary to
remove the chloroform. There were recent leech-biies near
the seat of pain, and these may have been irritated by the
application. Should I as[ain use chloroform externally in simi-
lar cases, I would combine it with some ointment, say rose
ointment, in proportion of one or two drachms to the ounce of
the ointment, and apply it on cloth, or, which would answer
better, sheet or woven lint.

Has not our subject important physiological and therapeutic
relations? The nerves, under ordinary circumstances and in
their healthful state, convey at once to the brain morbid occur-
rences whenever or wherever such happen, and thus most
important information is given of the state of the system, or of
a part of it. So, when the body in every part of it is in health,
the nerves communicate the knowledge of this fact to the brain
and mind. The result of such agency is that consciousness of
universal physical soundness health which constitutes the
highest enjoyment of life. But chloroform, as we have seen
and said, abolishes pain we do not say cures disease and, int
this freedom from suffering, leaves it to the nerves to aid in
such living processes as are themselves tending to the recovery
of the diseased organ to health, and to aid the therapeutic
powers of medicine. The mind remains ignorant of the state
of the diseased part, so far as pain has given it knowledge of

434 Treatment of Cancers, [July,

such state; but recovery is not thus delayed. We believe, on
the contrary, it is hastened.

Of tlie mode of applying chloroform endermically, a word.
A handkerchief fresh from the drawer, and a phial o\' chloro-
form, are all that is needed. Apply the handkerchief to the
open mouth of the phial, and invert the latter so that the chloro-
form may wet a spot in the centre of the cloth. Do this two
or three times, and then apply it to the seat of pain by moderate
pressure and without friction. Let it remain till it is dry, and
then wet and apply it again if ne-^J be. Ordinarily, the pain
soon becomes less, and will even be found often to disappear
entirely, with no further application of chloroform. Some
redness is commonly produced, and some tingling or smarting.
These, how^ever, disappear when the handkerchief is removed.
To prevent evaporation, and especially to prevent inspiration
of the chloroform, always cover the cloth which contains it
with another dry one. [Amer. Jour, of Med. Science,

On the Treatment of Cancer hy the Lactate of Iron taken hy
the Mouth and injected tnto the Veins. By Daniel Brain-
ARD, M. D., Professor of Surgery in Rush Medical College,
&c.

About two years since I communicated to Prof. Mussey,
Chairman of the Committee on Surgery of the American
Medical Association, some reasons which I had for supposing
that the lactate of iron was possessed of more influence over
cancer than any medicine yet known.

I have, since that time, had occasion to prescribe it often
M^ith results which, while they confirm the views expressed in
regard to its efficiency in checking it, have not shown that it
was capable of entirely curing it. This result was to me neither
surprising nor discouraging, as I have already formed and
expressed the opinion that to effect a cure "the whole of the
solids and fluids of the body must be brought under its influ-
ence." That this is not efl'ected by the simple introduc-
tion of medicines into the stomach is sufficiently obvious, and
indeed to be expected, since the medicine, used in that way, is
subjected to the action of the same nutrition and absorption
under the influence of which the disease has originated. It is
necessary to go behind this ; and one of the means of doing so
is by injecting it into the veins. It is only recently that I have
had an opportunity of putting this method to the test of prac-
tice.

Case. December 13th, 1851. Wm. H. Plumb.set. 5G years.
Englishman, applied to me on account of a tumour of the
left orbit.

1852.] Treatment of Cancers. 435

He gave the following history of his disease : About 25 years
ago he had a disease of that eye, called by his physician cata-
ract, which entirely destroyed the vision, but lor which no
operation was perfornr)ed. About five years ago lie received
an injury of that eye from a stick striking against it, which
was slight and gave but little pain. About seven months after
this blow, he noticed a tumour, no larger than a pea, at the
inner canthus " sending off roots into the eyeball." At this
time, the tumour and eyeball were removed together by Prof
Smith, of Baltimore. The wound cicatrized weli.

He remained in pretty good health about four years, when a
tumour made its appearance at the lower and inner part of the
orbit ; which, in eight months, allained the size of a large
hickory nut. It was then operated upon again, but at the end
of six weeks recommenced to grow, and, at the time of this
examination, was of the size of an orange, filling up the whr)le
of the orbit and projecting in front of it. Its surface was
nodulated, elastic, pulsating, ulcerated to a great extent, and
from this point there oozed a blood)" serous fluid. He was
thin but not sallow, and his health was not vei"y much impaired.
He complained, however, of acute lancinating pains through
the orbit and head.

16th. Extirpation was performed in presence of the hospital
class. It was found so firmly attached to the lower part of the
orbit that it was necessary to remove the periosteum with it,
and at the back part it could not all be removed. There re-
mained a muscular mass which bled profusely, and which was
so soft as to break under the ibrceps or tenaculum. Alter
several ineffectual attempts to apply a liorature the actual cau-
tery was resorted to and succeeded. The wound was dressed
with lint. No inflammation followed. There was a copious
discharge of red serum for a day or two, which gradually
became yellow, and afterwards changed to pus. He was put,
from the day of the operation, on the use of lactate of iron gr. v,
three times a day in solution.

31st. Injected into his viens f 3j of the following solution ;
Ferri lactis gr. viij ; Aq. dist. 3J. Carefully filter through
paper.

Jan. 3, 1852. Injected 5ij of same solution; Gth, f3iij
thrown in ; 14th, 3ijss injected ; 22d, 3 i j ; 26lh, 3 i j ; 28th, 3ij.

Feb. 3d. 3ij injected ; 9th, 3ijss.

DurincT the whole of this time the wound cicatrized rapidly.
At first luxuriant granulations :praps from the surface, which
were repressed by the application of nit. silver. Lancinating
pains continued for some time, but gradually diminished and at
length subsided.

436 Treatment of Cancers, [July,

In six weeks from the operation the cicntrization was nearly
complete. In eight weeks he returned home perfectly well.

The question whether the discMsed mass was cancer I do
not hesitate to decide in the affirmative. Jts history and
appenrance sufficiently indicate this ; its interior perfectly re-
sembled tlie brain of an infimt in a vascular slate, and under the
microscope it exhibited tl)e most perfectly formed cancer cells.
Dr. Johnson, resident physician, fully coincided in this point.

Whether it would have cicatrized without the use of the
lactate of iron cannot be determined with the same degree of
certainty. Taking into consideration the return, when last
extirpated, with the fact that it was afterwards impossible to
remove the whole of it, I think the probability of obtaining
cicatrization by ordinary means was slight. I should not, how-
ever, have thought of performing, or attempting extirpation,
but that the patient (who is intelligent and trusting) expressed
his desire to be submitted to the treatment when it was explained
to him.

I am aware that many surgeons, under the influence of pre-
conceived opinions, may regard such treatment as hazardous.
I had fully convinced myself that such was not the case. I
have repeatedly thrown gr. x lactate of iron, imperfectly dis-
solved in an ounce of water, into the veins of a small dog
without, in any case, peculiarly bad results.

It will be seen that gr. iij was the largest quantity thrown
in at a single time. It was passed in gradually and cold, and,
as soon as sensible effects were produced, it was stopped. The
efl^ect noticed was a flush of the face, a fullness of the veins of
the head, and a tendency to sneeze, which all passed over in a
few seconds. The circulation otherwise was unaflfected. ]f
the case had not progressed fav(;urably, and it had seemed
advisable to change the nutrition more profoundly, I would
have had the solution warnied and put it in slowly until its
effects were ]')erceptible, then, allowing it^ to pass over, have
repeated it as far as appeared safe.

Up to the timeof his departure the injection had been per-
formed nine tiines, and grs. xix in the aggregate injected.
When the activity of the salt is considered, it will be concededj
that such a quantity is capable of having an effect on the sys-|
tern by being thrown into the blood.

In addition to that he has during this period, eight weeks,
taken 5 xix of the lactate by the mouth, to what extent this may
have been absorbed and carried into the circulation, or what
changes it may have undergone, it is impossible to determine.

In case of a cancerous disease seated upon an extremity I
should in addition to the two methods of administration resorted

1852.] Amputation of the Lower Jaw. 437

to in ihis instance, infiltrale the whole of the diseased nnd the
heahhy tissue hbout it wiifi a weak solution of the medicine.
This can readily be eflected by putting a liiralure moderately
tight about the member until if becomes oedematous, when by
the aid of frictions the infiltration and maceration may be
efTected. I had omitted to mention that all the injcjctions were
made into the veins at the elbow.

In submitting this case to the profession, lam far from claim-
ing for it any merit which it does not possess, or drawing
inferences which no single case could warrant. It is offered
as an evidence of the practicability and safety of rnaceratioa
through the medium of the blood systematically pursued with
active substances, and to invite attention to other means of
treating this inveterate disease than those which hitherto have
been arlmitted by consent to be unsuccessful. \_Amer. Jour, of
Med. Science.

Ampiiloiion of the entire Jjoirer Jaw, ivith disarticulation of
both Condijles. By J. M. Carnochax, M. D., Professor of
the Principles and Operations of Surgery in the New-York
Medical College, Chief Surgeon to the New-York Emigrants*
Hosjjital, &c.

Notwithstanding the repeated instances on record of large
portions of the lower jaw having been lost by accident or dis-
ease, surgeons appear to have been slow in admitting the possi-
bility of practising amfutation, citler partial or total, of this
bone. To Dupuytren was reserved the glory of havino^, in
1812, first removed, by a methodical operation, a portion of the
body of the inferior tnaxilla ; but since the innovation of the
celebrated French surcreon, the operation for the partial exsec-
tion of this bone has been repeatedly performed. In the annals
of surgery, there is an aJbision made to the amputation of the
entire lower jaw, by Walther, of Bonn ; but I have not been
able to trace the truth of it to an r)fScial source.

The follfwing case will prove that this operation can be per-
formed with success; and that the patient, although deprived
of the chief in=!trument of mastication, may survive, and enjoy
the usual condition oi" health.

Nicholas Donegan, a^red 43, a farmer by occupation, was
admitted into the New- York Emigrants' Hospital, March 7th,
]8ol. He was treated for some weeks, in the Medical Divi-
sion, for typhus fever, and was afterwards transferred to the
SurjTical Department, under my charge. Upon examination
of the patient, his face presented much tumefaction, and he com-

y. s.* VOL. viii. NO. vn. 2f8

I

438 Amputation of the Lower Jaw. [July,

plained of great pain, seated chiefly in the region occupied by
the inferior maxilla. Upon carrying the examination lurlher,
the lower jaw was found to be extensively afiected with necro-
sis. All tlie external appearances denoting a cachectic condi-
tion of the constitution, with extreme debility and general pros-
tration of the vital functions were present. The })atient slated
that, daring his recent voyage to this cous^try, he had received
a sevei'e blow upon the lower jaw and side of the face. This
circumstance, coupled with the cachectic condition following
the attack of fever, appears as far as can be learned, to have
been the origin of the disease of the bone.

A tonic course of treatment was prescribed for him, and
various local applications and lotions were resorted to, in onier
to allay the initation in the mouth, and abate the fetor emana-
ting from the disease. In a short time the teeth became loose,
and had to be extracted ; the alveolar ridge became partially
denuded; the swelling increased towards and over the rami and
condyles; and the patient complained of excruciating suffering
and depression. Nutritious diet and the various iherapeutMS
agents, proper to imf)rove and renovate his system, weie per-
severed in ; and soothing and astringent lotions and applications
wei*e unremittingly used. This plan of treatment was pursued
for about three months; at the expii-ation of which time, it
became evident that the disease of the osseous tissue was too
deeply rooted to be affected by mere remedial agents. In fact,
they were found to be entirely unavailing. The disease had
now apparently seized upon llie entire jaw ; pus was abundant-
ly secreted into the cavity of the mouth ; the saliva was also'
thrown out in great quantity ; and the fetor became almost
intolerable to the patient himself, and to those around him in'
the wan]. Constitutional irritation and hectic of a grave char-
acter had also set in ,- diarrhoea made its attack j and the patient
was gradually sinking under the complications of his disease^
and the terrific pain by which he was unceasingly tortured. It
was apparent to me that the speedy death of the patient could
only be avoided by removing the source of such intense suffer-
ing and constitutional derangement. The integuments over
the disease, although much tumified^ ocdemalous, tense and red
remained free from ulceration ; the vitiated secretions taking
their exit l)y the cavity of the mouth.

On the 13th of July, a consultation was held, and an opera-
tion foi' the removal of the bone decided upon. The formida-
ble nature of (he operation proposed, together with the debilita-
ted and cachectic condition of the patient, induced me to enter
into full explanations, and to inform him of the great risk that
would attend it. The matter was then left to himself, and ati

1852.] Amputation of the Lower Jaw. 439

his urgent request, I proceeded to use my efforts for his relief.
It was not thoug}jt expedient to administer either chloroform
or ether, on account of the habiHty to asphyxia from the pas-
sage of blood into the wind-pipe.

The patient being seated on a chair, and the assistants pro-
perly arranged, an incision was first made, commencing oppo-
site li)e left condyle, passing downwards towards the angle of
the jaw, ranging at about two lines in front of the posterior
border of the ramus, and extending thence along the base of
the jaw, to terminate by a slight curve on the mesial line, half
an inch below the U'qq margin of the lower lip. The bone was
now partially laid bare, by dissecting upwards the tissues of
the cheek, and by reflecting downwards, for a short distance,
the lower eAgo, otthe incision. The tissues forming the floor
of the mouth, and situated upon the inner surface of the body
ofthe bone, were separated from their attachments from a point
near the mesial line, as far back as the angle ofthe jaw. The
attachments of the buccinator were next divided. The facial
artery, the sub-mental and tfie sub-lingual, alieady cut, were
then secured by ligature. It was now seen that the bone was
partially separated at the symphysis, and that the necrosis was
comf)lete from that point to the inleiior portion of the ramus.
The ramus itself was found diseased ; the periosteum external-
ly was inflamed, and in some parts easily detached. The tongue
was now grasped and held forwards, while the attachments of
the genio hyo-glossi muscles were divided. A double ligature
%vas passed through the anterior part ofthe root ofthe tongue,
and entrusted to an assistant, in order to prevent its retraction
upon the superior orifice ofthe larynx. A latal case from the
falling backwards of the tongue, occurred a few years ago, in
the piactice of an eminent surgeon of this city ; and a similar
misiortime should always be guarded against, when the muscu-
lar attachments ofthe tongue to the posterior part oTthe bone
behind the symphysis are divided. A slight force exercised
upon the left half ofthe body ofthe jaw, broke the connec-tion
at the syujphysis and at the angle, and this part was easily
removed. The next step consisted in the removal of the left
ramus. The external surface of the branch ofthe jaw, and of
the temporo-maxillary articulation were exposed, by dissecting
the masseter upwards, as iar as the zygomatic arch. Seizing
the ramus in order to pull the coronoid process downwards
below the zygoma, it was found that the temporal muscle was
rigidly and permanently retracted. This circumstance pie-
sented an unexpected difficulty, which was increased by the
unusual development of this apophysis, and by the retraction
also of the pterygoid muscles. Passing the forefinger along the

440 Amputation of the Lower Jaw. [July,

inner aspect of the ramus, the sitiintion of the internal and exter-
nal carotids was sought ior and recognised. The insertion of
the pterygoideus internus was then telt and cut, grazing the
bt")ne in doing so; the lingual nerve, here in close proxiruity,
being carefully avoided. Passing still higher up, the orifice of
the dental canal, indicated by an osseous projection, could be
felt ; and the instrument, still guided by the finger, divided the
dental artery and nerve. The knife was thus niade to separ-
ate the tissues attached to the inner face of the bone, as high up
as a point situated above a line below the sigmoid notch, be-
tween the condyle and the coronoid process. On a level with
this point, at the posterior margin of the ramus, the transverse
facial, internal maxillary and temporal arteries form a kind of
tripod, the two last named branches of which should not 1)6
divided, if possible. It now became necessary to detach the
tendon of the temporal muscle. As the coronoid process could
not be depressed, I proceeded cautiously, by dividing the lower
attachments of the tendon, by means of blunt curved scissors;
and by using" them and a probepomted bistoury, alternately
keepinfT close to the bone a considerable portion of the tendon
was divided. Deeming it not prudent to use freely a sharp
cutting instrument, deep in the temporal fossa, where the cor-
on(id process was situated,! made use of a pair of bone scissors^
curved flatwise ^ and by pas3ing the blades of this instrument
over the process, as far as its position would permit, the tempor
al muscle was detached ; a small portion of the apex of the cor-
onoid process being cut through. The ramus, now nwvable,
could be made use of as a lever to aid in the disarticulation of
the bone.

In order to effect safely the disarticulation of the condyle, I
began by penetrating into the joint, by cutting the liijaments
from before backwards, and from without inwards. The arti-
culation Was thus opened sufiiciently to allow the condyle to b^-
completely luxated. Blunt scissors were now used to cut carei-
fully the internal part of the capsule and the maxillary insertion
of the external pterygoid muscle; and by a slow movement of
rotation of the ramus upon its axis, the condyle vvas detached,
and the operation was completed on this side. By proceeding"
to disarticulate by the method here described, injury to the teni-
poral artery, as well as to the internal maxillary, was avoided.

To effect the removal of the other half of the lower jiw, |[
same incision v.'as made on the opposite side, so as to meet th^
first on the mesial line. The dissection was also similar; ai
by disarticulating the second condyle in the same manner a^
had been observed for the first, I was successful again in avQi4-
inglesicn of the temporal and internal maxillary arteries.

1852.] Amputation of the Lower Jaw, 441

The obj?ct I fiad in view, in shnping ihe external incision?,
in such a way ihat an inverted V should be funned in front of
liie insertion of the genio-hyo-glossi muscle?, was to leave a
]K)rlion of integument so iashioned, that the sutuie-pins could
be passed through tfie integument, and, at the same time,
through the root of tlie tongue, at the point where its muscles
hnd been detached Irom the inner surface of the lower jaw.
The several tissues becoming thus incorporated in the resulting
cicatrix, served to form a new bridle, somewhat analogous to
the natural muscular attachments of the tongue to the genial
processes.

The amount of blood lost was inconsiderable ; the arteries
divided, besides those mentioned, where the transverse facial,
the anterior masseteric, the anterior parotidean, &c., and these
were secured as soon as divided. The bone being disnrticula-
1ed, the flaps were adjusted, and the lips of the incision unitecJ,
by eighteen points of twisted suture. The tongue was retain-
ed forwards a ft ei' the dressing, by attaching the ends of the liga-
ture fdready passed thronrrh its l)nse, on each side, to a bandage
passed vertically around the head. Forty-eight hours after the
operation, the first dressing was removed. Union by first inten-
tion had taken place, and eight of the suture-pins were taken
out. Jn ninety-six hours, the wound was again examined.
Union was found to be entirely competent and the remaining
pins were removed. On the seventh day, it was thougtit safe
to remove the ligature from the tongue. On the tenth day, the
arterial ligatures came away ; and un the fourteenth day, the
patient was pi-onounced cured; not having had an untoward
symptom since the pei'formance of the operation.

The operation occupied fifty-five minutes, the patient having
been allowed intervals of repose to recruit. It was performed
in the presence of a number of professional gentlemen ; and I
was al)ly assisted by my colleague, Dr A. V. Williams, l)y Drs.
Dewees and Dixon, of New- York, and by Drs. Thompson,
Whitehead, Smith and Bailey, resident assistants attached to
the surgical stafi^of the Hospital.

The present appearance of the patient, presents much less
deformity than might beexpected from the severe mutilation
"which he has undergone. His general condition and health
are good ; and he is nowabieto perform anyordinary vocation.
The ducts of Steno, on both sides were necessai'ily divided in
the suj eriicial incisions; but there is no salivary .fistula, the
saliva taking its course into the mouth. Tlte division of the
[branches of the facial nerve has not been followed by paralysis
of the face ; although for a time after the reunion of the incision
he orbicularis palpebrarum of the right side appeared to h\xvB

442 Removal of the Knee-joint, [ Jul}',

lost its action to some extent. In graspinor the chin, a thin car-
tihjoinous deposit can now be felt, extending, crescent-shaped
for about three inches, and occuj)ying the posiiion at which tlie
bone was most diseased. Higher up, toward the glenoid cavity
no deposition of bone or cartilage has taken phice. Injury to
the bag of the pharynx, during the detachment of the soft tissues
from the angle of the jaw, was carefully avoided, and fluids
could be swallowed, in small quantities, imniediately alter the
operation. Deglutition is noweffected without ditBculty. Arti-
culation is suliiciently distinct to render his words iiitelligihle,
and although unable to masticate, he d(^es not complain of difli-
culty in eating, breaking up, as he says he does, hisfood between
the tongue and the palatal vault of the superior maxillae.

\_New-York Jour, of MecL

Successful removal of iJie Knee-Joint. By A. J. Wedderdurn,
M. D., Professor of Anatomy in the University of Louisiana.

Gsorfje Chandler, born in England, aged 18 years, was ad-
mitted into the Charity Hospital, January 9, 1852, with a pnin-
ful enlargement of the knee-joint had only been attacked
about a month previous to his admission. His health had
previously been very good ; attributes his attack to exposure
alone, having received no injury. The tumor being fluctuating,
the usu:d remedies for hydrarthrus having been resorted to,
without eflect, and the enlargement progressing, I determined
to settle an opinion, by the introduction of an exploring trocar
legarding its being an abscess of the joint ; about two ounces
of its contents were removed by this method, containing a
large proportion of pus. Being satisfied that the disease liad
progressed so far as to have produced at least a partial destruc-
tion of the cartilages, and not being willing to defer an operation
longer until the character denoting the true nature of the dis-
ease should be more distinct, rendering the success of an
articular exsection iDuch more doubtful, and having taken fully
into consideration the advantages of a stifl* leg over the loss af
the same from amputation, I determined upon the former, and
made the operation on the 18th day of February.

Operation by the H. incision, the transverse part of which was
made immeiliately at the lower portion of the patella. The flaps
were turned back, the joint bent at right angles, and the lateral
ligaments divided with a piobe-pointed bistoury, directed by
the forefinger of the left hand, which was passed respectively
beneath both, and under the surface, next the cavity of the

152.] Morbid Habit of Swallowing Hair. 443

jfiints. The divison of llie ligaments having been cfTected,
rendered it easy to project the articulating surlhceof the lemur
so iar forward as to facilitate the passage of an amputingsaw
from a line above the incrusted part of the joint from its
anterior to its central portion, and in an oblique direction down-
wards, removing hy this section something more than one half
of the articulating surfaces belonging to I he two condyles of
the femur. The next stai^e in tfie operation was to divide the
crucial ligamenis from their two points of attachment, and then
to dissect them away together with the greater part of the
synovial membrane of the joint which was very much thicken-
ed, and elevated hy thesub-synovial cellular tissue; the patella
was removed also in the progress of this dissection. The pos-
terior half of the articular suifaces of the condyles wei'e then
reinoved by the chain saw, in such an oblique direction from
behind, foi'wards and downwards, as to occasion a loss in the
length of the bone not exceeding three-iourths of an incb. A
very slight dissection was then made around the head of the
tihia upon its anterior and lateral surfaces, and lhe entire
articulating suiface removed by the passage of an amputating
saw fronfi before and backwards.

The constitutional sym[)toms following this operation were
violent for a few days, but since theie have been no bad svmp-
loms. Without entering into a description of the different
tinethods by whifth thi^ operation has been done, I will only
state that there will be, from the manner of this, only a short-
ening ot something less than an inch, and a much larger surbice
exposed for the formation of callus. The different methods hy
which the knee-joint has been removed will be found in Vel-
fetxus Operative Surgery, by Motl. [N. O. Medical Register.

Morbid habit of swalloming Hair ; Prolonged sojourn of the
foreign bodies in lhe gastro-intestinal canal. Evacuation of
Fochets of Hair Ijy vomidne' and alvine dejections. (Under
the care of Dr. Crawford, Middlesex Hospital.)

Dr. Thompson has alluded, in this journal, to the case of a
girl who used to swallow her hair, and had lately vomited pack-
els of it. The patient has, since tlien, passed, per anum. a large
mass of the same organic product; this circumstance induced
us to inquire more minutely into the case, and we learned from
the girl the following facts.

She is a servant, twenty-three years of age, now pale and
;diin, but formerly ruddy and stout, and was admitted i\ov. IG,
[3851^ under the care of Dr. Crawford, with verv obstinate

444' Treatment of Ununited Fracture. [July^

constipation. The patient began to menstruate at the anfe of
twelve years, and at thirteen, while in a conilortable situation,
contracted the liabit of picking otlher [i;iir, bitinij, chewing,
and at last swallowing it. She went on satisfying this depraved
laste fr lour or five months, when, being reprimanded, she
gave it up. and has never resumed the custom since.

Soon alter this, the patient began to feel a pain under the
false ribs, on the left side,jnst over the spleen and the large ex-
tremity of tlie stomach. She was treated in various ways, and
at difierent hospitals and dispensaries, durinfx several years, for
this pain, no one, nor heiself, suspecting that the above-men-
tioned habit was the source of her malady. The general belief
was, that she suffered from a tumour in the vicinity of the
spleen ; pain in that region, constipation of bowels, and wasting,
being the principal symptoms.

At last, about a fortnight before admission, she was seized
"with fits of vomiting, and, among the reJecUed matters, a solid
concretion, about the size of a walnut, was noticed ; but this
attracted no attention, until a second and much larger one was
likewise brought up in the hospital. The nature of the affec-
tion became now apparent, but the constipation was very ob-
stinate, and went so far as to proiiuce stercoraceous vomiting.
]Vo more hair was noticed after these symptoms abated, until
Jan. 2{>, about nine weeks after admission, when a very large
hairy concretion was discovered in the fcjeces. It was of the
size of the dilated rectum, measured five inches in length, and
was of a rleep black colour. (The girl's hair is of a lis^ht tint.)
The patient states that she felt this in the right iliac tossa, and
she is now under the im]:)ression that more hair will be evacua-
ted. The health has of" late been rather weak, l)ut the ap]:)etite
is pretty good, and the intellect clear; but the patient com-
])lains of flatus, and of the bowels rolling in knots. This is
another and very strikingr example of the difficulty of treating
disease, when we do not know ever rj j) articular of the history.

\_London Lancet.

On the Treatment of Ununited Fraciure hy the suh-cutaneous
perforation of the hone, loith a Cane. By Danikl Brainard^.
M. D., Professor of Sur^j^erv in Rush Medical College.

No one acquainted with either the literature or the practice
of surixery, will doubt that our knowledi^o of the treatment of
false j )int is extremely imperfect. The puhjisfied cases and
statistical tables prove this ; but it is rendered still more evident
by the far greater number of uncured and unrecorded cases to

1852.] Treatment of Ununited Fracture. 445

be met with in prnctice, in the more remote sections of our
cnuntrv. Tliese. but a small proportion of uliicli Ihll under
the notice of a single pe;>on, would foim, if they C(juld l)e col-
lected together, an nnay calculated to weaken our confidence
in the means usually resorted to for their cure. I have been
led to the conclusion from having, during the last fourteen
years, met almost yearly with one or more cases of the kind,
and from having found that they present themselves to such of
my pro'essionai friends as I have liad o[)purluniiy of consulting
on the subject.

These cases are in this country almost invariably treated by
the seton, and when this is unsuccessful they are sjiven up as
hopeless. Of lour cases which have presented themselves to
my observation during the current year, two were of that kind.
One of these, of the arm, was of eleven years standiiifj, the
seton had been used a year without benefit ; the other will be
given in detail.

It is greatly to berefrretted that Dr. Physick, whose experience
with the seton must have Ifcen extensive, did not liave a record
of its results. It is asserted on the one hand he lost (tonfidence
in it. This is denied on the other hand by Norris, who had
every means of information, who says : *' We have authority
ftH' Slating that up to the period of his death \)\\ Physick always
advocated the treatment of ihese cases by the seton." * Never-
theless we find in the same article, that "The caustic potash
has been successfully used in three or four cases l)y Dr. J. 11.
Barton, of this city, in one of which" the leg, "Dr. J^hysick
discouraged the use of the seton for tear of its failui'e." Gibson
also states, that Dr. Physick discouraged its use in cases of frac-
ture of the letnur.

1 make il.ese remarks not from a disposition to undervalue
the seton, which is probably the m<)st useful means yet known,
but to show that it is not universally successful or applicable
to all cases. Dr. Norris, in the article referred to, which is the
best source of information to which I could refer, says that,
"in the femur it has often failed." I was myself in the habit,
uniil about four years ago, of abandoning most cases in which
the seton had failed, not clioosing to resort to resection or am-
putation. In J 848 T treated a case successfully by passing a
silver wire around the ends of the fragments. Fuiiher reflec-
tions suggested diflerent modes of treatment which 1 have
applied.

A little reflection will, with the aid of otir present knnwlednre
of pathology, convince us tliat the seton is not calculated to be
generally succesful.

Amer. Joiir. Med. Science, Vol. Ill, New Series, pp. 5u

44G Treatfnent of Ununited Fracture. LJ^'y

The first condition most favorable for the production of callus,
is ilie effusion of a blastema, which sliould nut be converted
into |)us and dischartrcd.

The second is. tliat tins blastema should be in contact with
n freshlv wounded sufrnce of bone the law of " analogous
formal ion" holding good here.

" The blastema between areolar tissue becomes areolar tis-
sue, at the extremity of divided nerves it forms nervous sub-
fstance, &c. (Vogel.)

Now the seton necessarily causes liie conversion of the
efl'used blastema into pus, while its introduction pr(xluces no
fi-eshly wounded surface of bone ; the case is converted into a
compound fracture where it was desirable to only reproduce a
simple one.

Can subcutaneous wounds of bones be made without
danger of suppuration? To determine this point 1 at dif-
erent times perforated all the principal bones of the mem-
bers of a dog, and did not find that suppuration in any case
resulted.

Case treated by perforation of the ends of the bones:

Allcett Barnes, aged twenty-six years, received, June 10th,
1850, a simf)le fracture from being cai'ried by a belt around a
shaft. It was dressed by Dr. Ilawley, of Yorkville. Mich., two
splints l)eing [)roperly applied. The dressing was changed,
peihaps, once a week i'or eight weeks, when the ulna was
found to be united, but the radius was not. A simple bandage
was placed about it for four weeks, when he consulted Dr.
White, of Kalamazoo, who put on carved splints for a month,
^vhen, finding no sign of union, he put through a skein of silk
for a seton, which was allowed to I'emain three weeks. It
caused much pain and suppuration. When the seton was taken
out, a bandage was put about it for a week, when splints were
aj)plied and continued five weeks. They were then taken off
and no union found to have taken place. Such was the account
given by the patient himself.

Feb. 4th, 1851. Ununited fracture of the radius found above
one-third of the distance from the wrist to tlie elbow, partially
overlapped, obli<pie, moveable, and the hand of little use.

Operation. Having provided several brad awls, such as
are used by shoemakers, and had them well tempered and tried
on dry bones, I carried one of them through the skin opposite
the fracture, and by movements of partial rotation perforated
both fragments where thev overlapped. The awl be:ng then
withdrawn from the bone, (but not fiorn the skin,) wasdirecied
obliquely upward, then obliquely downward, so as to make
three perforations. It was then entirely withdrawn, and

1852.] Treatment of Ununited Fracture. 147

collodion put upon ihe puncture of the skin. The memher
was dressed vviih the immovable apparatus. Some tenderness
was the effect.

Feb. 17(h. The tenderness havinfj subsided, I removed the
bandage, repealed the operation in iliesame manner, chocjsing
a dilTerent point of punciure, and re-applied the dressing.

March llth. Repeated tlie operation again, and dressed as
before; mobility scarcely perceptible.

March 21st. Dressings removed, union perfect.
The dressings weie in this case continued on near seven
weeks, but it is probable the last perforation and dressing might
well have been omitted.

The occurrence of union in so short a time where the seton
had failed, and with no operation which interfered with the
comfort or amusement of the patient, was a most favoraijle
result, but not different from what was anticipated. I do not
know that this sub-cutaneous perforation had been used by any
one. Perforations by incision and inserting pieces of metal
liave been tried. I, myself, treated a case in this manner. It
was on a man thirty-six years of age, who had long deposited
phosphatic gravel in the urine, and in his youth been alfected
wiih necrr)sis of the femur. It was near the middle uf the
femur, and the fragments extremely moveable.

Sept. 20, 1850. I made an incision an inch in length over
the false j'>int and down to the bone. I then pei'forated the
extremity of each fragment with a hitt, and putting in a director
from a pocket case dressed the limb in the angular apparatus
for the lower extremity. The director was taken out in about
ten days.

In this case the dressing was removed in eleven weeks, and
the patient was able to walk at the end of f>)ur months. At
the present time, (Jan. 1852,) he is pursuing an active occupa-
tion with a good lind).

Notwithstanding the favorable result of this care, it must be
admitted that the symptoms were severe, like those resulting
from resection. Such were they also in the case treated by
the wire, so that although it seems probable that in both these
cases the result was at least as favourable as could be expected
from resection, it is also true that the danger incurred is not
materially less.

In all these cases the operation is severe, while the sub-cuta-
neous perforation is free from danger, and reasoning from the
analogv of simple fractures, or judging froin the result of a
single case, promises to be much more efficient. \_NorLk'Wes*
tzrn Med. and Surg. Journal,

448 Chloroform used locally. [July,

Chlornform applied locally in Fractures and Dislocations.
By H. x\. HuuLBUT, M. D., of Chicago, III.

Messrs. Editors Permit me to cal! the attention of the pro-
fession to the local npiiiication of chloroforin to remove pain
and induce insensibiiiiy of parts to be operated njion. I have
made use of it for two years past as a local remedy with the
most happy results. In cases r)f comrvjinuted fra-ctures, pro-
ducing as it does insensibility and relaxation of parts, it enables
the surgeon to overcome the resistance of muscles, and to re-
duce the fractures u'ithout pain or suHerinnj to the patient. In
dislocations, I have ^no doubt iis local af)p!icalion would beat-
tended with the same happy results. I have used it in a sirTiilar
manner in i'elons, neuralgia, &c. The best mode of applicati)ii
1 think is to saturate a cloth with it, apply immediately, and
over that a piece of oil silk (to prevent evaporation), allowing
it to remain some four or five minutes, which will be sufficient.
A second application may be necessary in fractuies of the su-
perior third of the femor, or in dislocation of the same bone.

The frequent deaths reported from the inhalation of chloro-
form has induced me to call atteniion to il>s local use. If in the
'iiands of othei's it shall [)rove as safe and efficient a remedy as
it has in mine, I shall be amply rewarded. \_lbid.

Cold Water in the Treatment of Croup.
(Translated for tliis Journal )

Dr. Hauner, of the Children's Hospital at Munich, having
jiretty generally seen leeches, emetics, calomel, &:c. fail in the
treatment of genuine croup, has had recourse for several
months to the employinent of cold water. The cases below
^viil show this method of treatment.

Case I. A girl, 4 years of age. In this ca^e cold affusions
-were used every three hours, to the neck, hack and chest, then
the patient was wrapped up for a half or three quarters of aa
iiour in wet sheets and put in a large blanket. Every half hour
cloths wet wiih ice-water, were applied to the neck, and these
covered with dry ones. At the end of 12 hours thei'e was a
-very marked improvement: the cough was looser; poriionsof
membrane were thrown off by expectoration and by the bowels.
'She took allernatelv warm and cool water. Two injections

1852.] Miscellany. 449

were administered per day. The child recovered, but remain-
ed hoarse for a length of time.

Case II. A boy, 2| years of age and of strong constitution,
was suddenly taken with croup. Four leeches were immedi-
ately applied, and as soon as they fell off the cold applications
were applied to the neck as above, and renewed every halt" hour.
In 12 hours the patient was out of danger, but the applications
were continued fjr two days.

The method employed by M. Ilauner may act powerfully as a
perturbaling cause and thus prevent the formation of membranes,
but we think that the olher known remedies in croup, particu-
larly emetics and calomel, miglit well be combined with it.

\_Jour. des Con. Medico- CIdr.

ill i s c cl 1 a n 1} .

T^eic Treatment of Deafness. " One of ihe latest efforts to restore
to a deaf ear its oritrinal tunctions, consist:; in applying a ctjp that fit*
cloitdy to the side of the head, round the outer ear, and exhausting it
with an air-pump. A common cuf)ping apparatus answers every
purpose, provided the gla-s will lit so well as to prevent the ingress of
atmospheric air under the edge. In a variety of cases, the simple
process of carrying on this exhaustion till a new sensation is telt,
something like extronse tension in the lining rriembrane of the meatus
externus, is represented to restore the organ to its normal state Un-
der such circumstances the theory of the remedy is, that deafnrss
results from an impoverished flow of cerumen, in conseq=nence of the
inertia of the excretory ducts ; and hy taking off the atmos[)heric
pressure, their proper fluid oozes out upon the tube and instantly
modifies the condition of the mechanism, exterior to the drum. Hav-
ing thus been roused from a slate of torpor and suspended activity^
they continue afterwards to act with energy. If they subsequently
fall partially back to their abnormal condition, the pump must be
re-applied, as occasion may sugjjest. As there is no witchcraft ab( ut
it, and almost every practitioner has a breast-pump or similar contriv.
ance, by whicli an experiment could be made, nnd there being no
hazard attending it, it may be worth a trial, and it is very possible
that one out of a djzen cases might be essentially benefited by thi.^
simple operation."

Tlie above notice taken from the editorial department of the Boston
Medical and Surgical Journal, will serve the purpose of directing
attention to a new remedy for deafness ; but we cannot transfer it to

450 Miscellany. [July,

our j ages without comment. In the first place, deafness being a com-
mon symptom or result of various and very dissitnilar pathological
conditions of the auditory apparatus, it is evident that the remedy
cannot be applicable to all cases. Nor are we prepared to admit with
our resppcied brother editor that there is "no hazard attending it."
It is highly probable, nny certain, that by undue exhaustion of the
cups, the membrane of the tympanum may be ruptured. We have
not tried the "experiment" upon the dead body so as to determine
what force may be necessary to produce this rupture, nor do we know
how much may be borne by the living without giving pain. Deafness
is sometimes the consequence of an inflammatory condition, more or
less acute, of the organ, in which state of things it is difficult to con-
ceive how the process can be otherwise than injurious.

When there is a defect of circulation or an atony of the parts,
cupping, judiciously resorted to, may be useful. It may possibly
be advantageous in cases in which the membrane of the tympanum is
already ruptured, for then it might tend to dislodge matters con-
tained in the cavity of the tympanum, by drawing a column of air
through the Eustachian lube, and even to re-open this tube if it were
obstructed.

A similar procedure has been somewhere suggested for the treat-
ment of impaired vision. It may be remembered that a few years
ago the newspapers were filled with the discovery, attributed to the
venerable ex-president John Quincy Adams, of a simple method by
M'hich the use of spectacles might be dispensed with by the aged. This
consisted in the frequent, though gentle, compression of the sides of the
eye-ball, by placing the thumb upon the external angle of one eye
and the middle finger upon that of the other eye, and slowly approxi-
mating them towards the root of the nose, so as to elongate the axis of
vision. We know persons of intelligence who affirm that they have
been thus very much benefitted. W^hether the relief be attributable
to the effect assigned or to the tonic influence of the combined pres-
sure and friction, is not the question before us. For the purpose of
elongating the visual axis, however, an india rubber cup has been
invented and is to be found in the shops. It is simply a half globe
which when flattened and applied to the orbit, reacts by its elasticity,
and in resuming its original form tends to draw out the eye by the
vacuum thus occasioned. Now this little instrument must have the
effect of producing a congestion of the eye which is not without risk,
especially if often repeated. [Editor.

1852.] Miscellany. .151

I

BIDLIOGRArillCAL.

We are indebted to publishers, societies, colleges, and other insti-
tutions, for a large number of works and documents, for which w^c
return our grateful acknowledgements, and hope that we may be able
to notice them more particularly. The following jjooks received
through our booksellers, IMsssrs. J. A. Carrie & Co. and T. llich-
ards & Son, are kept for sale by them :

The Principles of Surgery. By Ja3Ies Miller, F.R.S E , &c., &c.
3d American from the 2d and enlarged Edinburgh edition. II. us-
trated with '240 engravings on wood Revised, with additions, by
F. VV. Sarijext, M. D., &;c. Philadelphia: Blanchard &; Lea.
1852. Pp. 751.

The very high estimation in which the s-orgical works of the dis-
tiBguished Edinburgh Professor are generally held, will insure for
the present improved edition of his " Principles of Surgery " a cordial
reception by the profession in America. The numerous illustrations
add very much to it.^ value, especially for students, and will make it a
popular text-book for college classes.

The History, Diagnosis, and Treatment of the Fevers of the UnPed
Stales. iJy Elisha Bautlett, M. 1)., Prof, of Materia Medica
and Medical Jurisprudence in the College of Physicians and Sur-
geons of xNew York, &c , d:c. 3d edition, revised. Philadelphia;
Blanchard and Lea. 1852. Pp. 595.

We are happy to find that this truly American work has been so
well appreciated as to require a third edition. It is decidedly the best
treatise on fevers in our language, and the only one adapted to the
nccess'ties of this coL^ntry. It ought to be in the possession of every
practitioner.

An Analysis of Physiology ; heing a condensed view of its mosi
iniporlant facts and doctrines designed especially for the use of
Students. By John J. Rek?e, M. D., Lecturer on Materia Medica
and Therapeutics in the Medical Institute of rhilad'l[)hia, &c , <!tc.
2d edition, revised and enlarged. Philadelphia: Lindsay &; Blak-
iston. 1852. Pp. 3G8.

A very good manual of Physiology remarkably well adapted ta
the wants of first course students.

Elements of Chemistry; including the applications of the Science in
the Arts. By Thomas Graham, F. R S., Professor of C hemistry
in University College, London, &c., &;c. 2d American edition.

452 Miscellamj,

from an entirely revised and greatly enlarged English edition-
Avith numerous wood engravings. Edited, witii notes, by Robert
BuiDGES, M. D , Professor of Chemistry in the Philadelphia (JoLege
of Pharmacy, &;c., &c. Philad. : Blanchard & Lea. 1852.

AVe feel assured that all cultivators of chemistry will be grati-
fied to learn that Graham's Classical work is i^eing re-published,
"greatly enlarged," by such a house as that of Blanchard & Lea.
It is to be issued in two parts thj fir^t of which we have received.
The elegant style in which it is presented is a just tribute to the
intrinsic merits of the work.

Astringent or Anti-cUarrlixal Mixture*

Tinct. Catcchuj two parts.

Tinct. Opii,

Tinct. CamphoroD,

Tinct. Myrrha3,

Tinct. Capsici, of each one part.

Mix dose, from one to two teaspoonfuls.
This is a prescription we have been using constantly for the last
ten years in the treatment of ordinary cases of diarrhoea and cholera
morbus, with such marked success that we have been very frequently
applied to for it. It should not be given until the discharges have
been sufficient to empty the bowels completely. In most cases of
diarrhoea a teaspoonful given in a wine-glass full of water morning
and night, or three times a day, will speedily arrest the disease. In
cholera morbus the dose should be doubled. If it be borne in mind
that it contains one part of laudanum in six, the dose may be easily
graduated for children. To a child one year of age we usually give
from 12 to 24 drops, and by its timely use may generally arrest the
attacks to which they are so subject i.i spring and summer. The
remedy is rarely useful in dysentery. [Editor.

Georgia is, we believe, the only State in the Union, that has drawn
upon its Treasury for the encouragement of quackery. The last
session of her Legislature appropriated five thousand dollars to the
Thompsonian or Botanic School, located at Macon.

"We have quite a number of communications on our table, which
will be attended to in due time.

SOUTHERN

MEDICAL AND SURGICAL
JOUENAL.

Vol. 8.] NEW SERIES. AUGUST, 1852. [No. 8.

PART FIRST,
rxginal donimunitattona.

ARTICLE XXV.

A Synopsis of Reports made in 1848 to the Parisian Academy
of Medicine, by eminent Surgeons, upon Gun-shot wounds.
By JuRiAH Harriss, M. D., of Augusta, Ga.

Accidents attending gun-shot \vounds are so varied in their
form and position, and so serious in their nature, as frequently
to demand a large amount of anatomical and surgical know-
ledge to meet them with discriminating promptitude. Many
of them require immediate and decisive action on the part of
the surgeon, without allowing time to consult authorities or to
call in additional counsel. A limb may be heedlessly and rash-
ly removed, or an individual's life be sacrificed, by injudicious
delay or indecision. In this day of advancement, when the
facilities for medical education and improvement are so multi-
plied, ignorance is considered a crime by the public, and de-
clared such by law.

It is in consideration of the interest, importance, and many
difficulties that accompany the treatment of gun-shot wounds,
that I ask the indulgence of the readers of this Journal, while
I lay before them the experience and results of the practice
of many of the first surgeons of France upon this subject, as
reported by them to the Academy of Medicine. If their
experience and observations are worth any thing, they must be

K. .;. VOL. VIII. XO. Vlil. 29

454 Harriss, on Gun-shot Wounds. [August,

valuable ; and as their individual reports cannot reach the pro-
fession generally in this country, I have presumed to give a
synopsis ot them. Their observations, owing to recent strug-
gles in France, have been vast, and will probably induce im-
provements in military surgery, from which civil surgeons may
draw useful instruction.

It is to be regretted, that surgeons are so divided as to the
mode of treating gun-shot wounds and their consequences.
Military surgeons disagree upon nearly every point connected
with gun-shot wounds ; but the greatest discrepancy exists, be-
tween military and civil surgeons, upon the question of imme-
diate amputation and the attempts to preserve the limb.

The questions which elicited most discussion among the
reporters to the Academy of Medicine, were

1st. Should gun-shot wounds be enlarged by incisions so as
to reduce them as nearly as possible to simple incised wounds?

2d. Should free incisions be made to extract foreign bodies
and fragments of bone, or should these be left to be expelled by
suppuration ?

3d. Are refrigerants, as ice, suitable applications to gun-shot
wounds?

4th. The comparative advantages of immediate and second-
ary amputations.

1st. Should Gun-shot Wounds he enlarged by Incisions.
M. Larry and the early French military surgeons recommend-
ed this practice almost universally and without discrimination.
In latter days, says M. Roux, surgeons not only doubt their
utility, but presume to reserve them for exceptional cases.
M. Roux raised the question of incisions only in relation to
simple wounds, where the object is solely to enlarge them for
the escape of pus and the debris of sloughing. Incisions for
extracting foreign bodies, arresting hemorrhage, &c., he dis-
cusses in their proper places. The question, he thinks, does
not extend itself to consecutive incisions that are made for the
exit of pus, after it is known that it has been formed and bur-
rowed in the soft parts. As to their propriety there can be no
doubt ; they are warranted and sanctioned by all surgical au-
thority. M. Roux is of the opinion that there are but few cases

1852.] Harriss, on G^iin-shot Wounds. 455

in which incision of simple gun-shot wounds is advisable : they
seem to him to be but useless complications.

M. Baudens, the chief surgeon to the Military Hospital of
Val-de-grace, in Paris, rejects incisions entirely, and believes
that no circumstances will warrant them.

Blandin, I think, more philosophically, takes the medium
ground between the contending parties. He neither agrees
with those who contend that all gun-shot wounds should be
incised, nor coincides with those who universally blame this
practice. He reserves incisions for those cases in which the
thickness and strength of the aponeurosis will probably con-
strict the part, and by its resistance will not give room for the
distension of the tissues, which is so common in inflammation,
and which so frequently leads to gangrene. He contends that
in such cases they lend no complication to the wound, as the
superficial aponeurosis alone act as constrictors, and the incis-
ions are therefore always superficial and not at all serious.

M. Yelpeau, with Blandin, reserves incisions for exceptional
cases. He says, afterwards that they have generally, perhaps,
no other inconvenience than being useless. M. Jobert is most
decidedly opposed to them. It will be perhaps remembered
that J. Hunter strenuously objected to them.

2d. Should free incisions he made to extract foreign bodies
and fragments of hone, or should these he left to he expelled hy
suppuration ? The acts of the economy, when a foreign body,
such as a ball, has penetrated the tissues, are among the most
beautiful processes of nature. The presence of the body
causes inflammation in the part, the latter condenses, and an
effusion of plastic lymph forms a sac and becomes more or
less organised, and thus the tissues accommodate themselves to
its volume, weight and presence. This is the case even with
some of the most vital organs, such as the lungs. I recollect
a case in w^hich a ball entered and buried itself in the brain so
deeply that it could not be extracted. There was a large
opening in the cranial bones, through which could be seen the
distension of cerebral masss at each contraction of the heart
and the rise and fall of the brain during the acts of respiration.
This patient lived six weeks, and such was his condition at this

456 Harriss, on Gun-s^hot Wounds. [August,

time, that the Surgeon, M. Michon, expressed very decided
hopes of his recovery. He died suddenly, in attempting to
raise himself in bed. There is yet another process of nature
in such cases, which has been very graphically described by J.
Hunter, and styled by him the "ulcerative process." When
a foreign body is deeply imbeded in the soft parts, says this
author, it gradually and without constitutional disturbance
makes its way near the cutaneous surface and there forms an
abscess, at which time it can be easily extracted. They but
seldom cause an abscess when deeply imbeded in the soft tis-
sues. The abscess in such cases usually forms in the subcuta-
neous cellular tissues. The sufferer is not, however, always so
foi'tunate. The foreign body frequently induces intense pain
and constitutional derangement, and finally carries the patient
to his grave.

M. Roux, with other surgeons, adopts the rule, that if the-
ball or other body is easily extracted, if the position of the body
is well detected and can be reached by a direct passage, with-
out interesting too much the soft parts, its extraction should be
attempted, but not otherwise. M. Roux recommends large
and free incisions. All surgeons agree that splints of bone
should be removed immediately. This is a well established
precept.

M. Jobert agrees WMth Hunter, in considering foreign bodies
as almost inoffensive to the tissues, with which they are in con-
tact. Out of 17 foreign bodies in different persons, he extract-
ed only 3, and these were immediately beneath the integuments*

3rd. Are refrigerants, as ice, suitable applications to Gun-
shot Wounds? The object of ^these applications is to prevent
too great inflammatory action and suppuration, which always
have a tendency to exhaust the patient and cause constitutional
disturbance. M. Roux objects to them, but there can be no
doubt, that they are in many cases far preferable to the warm?
poultices which he usually applies. They not only subdue or
prevent excess of inflammation, but are generally more agreea-
ble to the sufferer. Where cold applications are desirable, the-
roller bandage is objectionable ; the more simple the dressing
she better. A compress lossely applied so that it can be re*

1852.] Harriss, on Gun-shot Woiinds. 45T

moved, and moistened at pleasure, and that allows the wound
to be inspected without inconvenience to the patient is much
preferable. M. Velpeau does not use cold applications in
general. His remarks upon this point in his report are excel-
lent and we will give them in full. " The object and effect of
the refrigerant treatment in gun-shot wounds are to prevent or
cut short the inflammation, but it must be remembered that a
certain degree of inflammation is necessary to heal a wound
of this nature. The contused layer of tissues cannot be
expelled save at this price. Besides the temperature is not
modified by ice to the same degree, through the entire thick-
ness of the wounded limb ; hence the external part of the
wound is cool, while the internal preserves its great heat.
'This produces an inequality in the inflammation, which is evi-
dently less favorable than a frank and regular phlegmasia.
There is thus produced a bastard inflammation, a sanious and
badly elaborated discharge, and the wound consequently
marches slowly to cicatrization. If there is a flap, if the
circulation of the member is already embarrassed, ice will
manifestly favor mortification. I have even seen refrigerants
produce eschars upon the healthy skin. The only cases in
which refrigerants are advisable, are those in which there are
violent pains, or a sensation of great heat, without much swel-
ling or inflammation. They may perhaps be advisable in very
warm weather." M. Velpeau reasons well, as he always does,
even when upon the wrong side. He urges that a certain
amount of inflammation is necessary to heal a gun-shot wound.
This is very manifest and is quite true in every variety of
wounds. I presume, that the same course of reasoning induces
him never to attempt to heal a wound of any description by
the first intention. He never calculates upon this result, and
'is always surprised when the w^ound heals without suppuration.

4th. The comparative advantages of immediate and second-
ary amputation. The question of amputation is the most
complex and difficult in the whole range of gun-shot wounds.
Rules in regard to the character of the wounds requiring am-
putation, and the time at which operations should be resorted
to, are far from being determined. Indeed it would seeni^ in

458 Harriss, on Gun-shot Wounds. [August,

reading different authors, that each surgeon lays down his own
rules. There can be little doubt, but where an operation is or
will probably be necessary that it should be primary or imme-
diate. Secondary amputations have this very decided incon-
venience, that the suppuration and sloughing debilitates the
patient to an incalculable degree, produces an immense amount
of constitutional disturbance and thus lessens the chances of
final success. It is unquestionably in accordance with well
established rules of surgery, to operate early, when an operation
is necessary, before suppuration debilitates the system and the
efforts of nature are exhausted in attempts at reparation,

M. Malgaigne enters more largely upon amputation than the
other reporters, but confines himself more particularly to am-
putations of the thigh. We will translate soaie of his remarks,
as they are very concise. He says that, " it is a very generally
accepted doctrine, especially among military surgeons, that
fractures of the femur by projectiles from a gun require ampu-
tation."

Larrey contended that if the femur be fractured in the lower
fourth or even third, the limb may be saved, but if in the centre
or superior third, amputation is indispensable.

Ribes expresses himself thus upon this subject : " However
serious a gun-shot wound of the superior extremity, the limb
may be attempted to be saved, and that without endangering
the life of the patient,* but in the inferior extremities, when the
bones are broken, the least hesitation may cost the life of the
individual." He confirms the doctrine of Larrey in regard to
the middle and superior part of the femur, but also extends the
rule to the inferior part of the bone. He adds, "the fracture
of the inferior part of the bone is about as serious as that of the
centre." Upon 4,000 patients, Ribes did not see a single con-
solidation of the femur, when fractured by projectiles from a
gun. At Toulouse there were 47 amputations and 9 died.

Dupuytren, in 1830, (at Hotel Dieu,) had 12 fractures of the
femur not operated upon, 5 cured, 7 died.

There is another very important question to be determined,
that of immediate or secondary amputation. Guthrie, at the

* This is a practice taught by Guthrie. London Lancet. April, 1852.

1852.] Harriss, on Gun-sliot Wounds. 459

battle of New Orleans, performed 45 immediate amputations,
7 died or 1 in 7. Upon 5 secondary amputations 3 died.

M. Malgaigne ends his report by repudiating the doctrine of
military surgeons, and says that he never amputates but for
urgent necessities, and nearly always attempts to save the limb,
believing that there is not so much risk in this attempt as in
amputating it.

The following is the result of his practice in 1848.

5 Fractures of thigh, 2 cured, 2 died. 1 sec. amp.

6 do. of leg, 2 cured, 4 died.

2 do. of tibia, 2 cured, 0 died.

3 do. of fibula, 1 cured, 2 died.
3 do. of arm, 1 cured, 2 died.
5 do. fore-arm, 5 cured, 0 died.
2 do. metcarps, 1 cured, 1 died.

14 cured, 11 died.

Hemorrhage. This subject is discussed by some of the
reporters. Hemorrhages are divided into primary and second-
ary. The primary are rare in gun-shot wounds ; 1st. because
the yielding and elastic properties of the large vessels allow
them to give away to the force when applied to them ; and se-
condly, when they are wounded, the contusion is so great as to
cause a coagulation of the blood, which closes the w^ounded
orifice of the artery.

M. Roux states that in all the gun-shot wounds he has had
to treat, he has never seen a primary hemorrhage of any im-
portance. When they do occur, he is of the opinion that the
bleeding vessel should be immediately secured and ligated at
the point of injury. This is a disputed point among surgeons,
many believe that the main trunk should be ligated above the
point of hemorrhage.*

According to M. Roux, consecutive hemorrhages are more
frequent than primary ones. If the soft parts are alone inter-
ested, the hemorrhage occurs from the 7th to the lOih day,
rarely later. When the bones are fractured they occur later
still ; from the 12th to the 20th day after the receipt of the

* Guthrie sa}'s, that both extremities of the wounded artery should be secured.
See London Lancet. February 1851.

460 Harriss, on Gun-shot Wounds. [August^

injury. The reason of this, he remarks, probably is that the
spiculse of bones irritate and keep up the inflammation much
longer, and when in the vicinity of blood vessels, increase the
chances of the ulceration of their coats, to say nothing of their
sharp points penetrating directly the vessels.

Anel and Hunter have proposed to ligate the vessel above
the point of hemorrhage. Roux coincides with them, urging
that in secondary hemorrhage the difficulties of finding and
securing the artery are immensely increased at the seat of inju-
ry. He makes a distinction in the treament of primary and
secondary hemorrhage. In the first he prefers applying the
ligature at the point of injury and in the latter above.

The generally accepted opinion is that gun-shot, like lacera-
ted wounds, do not bleed, save in exceptional cases. M. Blan-
din, however, more exact in his observations and minute in
his descriptions, affirm that primitive hemorrhage is the rule,
for in all of his cases the patients clothes were bloody. Such
is also his experience in lacerated wounds. Hemorrhage, ac-
cording to this surgeon, takes place before nature can provide
against it, as she soon does by retraction of the wounded ves-
sels, formation of clots, &c. He admits that large primitive
hemorrhages are rare, he having seen but one case that required
the immediate ligation of the vessel. May not these small
hemorrhages, occurring immediately after the receipt of the
injury, be from the veins, and particularly the small veins? I
think I have observed in lacerated wounds, that while there
was no hemorrhage from the larger vessels, there would be
slight bleeding from the venous radicles occurring drop by
drop.

M. Blandin prefers, in secondary hemorrhages, to ligate the
artery above, and at a distance from the wound, thus adopting
the precept of Hunter.

Some of the reporters referred to the question of the relative
size of the openings of entrance and exit of a ball. This is an
interesting question, and if it could be determined with precis-
ion, would be a considerable step gained in a medico-legal point
of view. The belief that the opening of exit is larger than
that of entrance was universally sustained until 1830, when
Dupuytren advanced the contrary opinion.

1852.] Harris, on Narcotism. 461

M. Blandin says, that experience and extensive observation
have led him to side with Dupuytren, and advocate his posi-
tion. He gives the reason why the results should be as he has
been induced to believe they are: "When a ball strikes the
body, it encounters the skin supported by the subjacent soft
parts, and traverses it immediately without distending or al-
lowing it a play of its elasticity ; hence the opening will be
about the size of the ball. But, on the contrary, after the ball
has traversed the soft parts and comes in contact with the skin
upon the opposite side, it pushes it out, distends and finally
passes through it, only after having put in play its entire elas-
ticity; and, consequently, the opening ought to retract propor-
tionately to the distension and the elasticity of the integu-
ments."

M. Velpeau thinks that no rule can be established upon this
point, inasmuch as the ball is not always round, but sometimes
flat, pointed, or irregular, before it comes in contact with the
skin. Again: if circular, when it strikes the integuments, it
may become flattened or irregular by striking a bone before its
exit. It will be easily seen, then, that if a ball enters by its
point, and passes out by its base, that the opening of exit will
be the larger, and vice versa. The mobility,^elasticity, &c., of
the parts should be taken into consideration upon this point.
He concludes with the statement, that the opening of entrance
is generally larger than that of exit, but frequently smaller.

ARTICLE XXVI.

Application of Cold Water to the Head in Narcotism from
Opium. By E. J. Harris, M. D., of Fayetteville, Ala.

Interchange of medical opinion is one of the principal sources
from which the physician derives his knowledge of the treat-
ment of disease; deprive him of this, and all his knowledge
must be confined to the narrow sphere of his own observations-
There is no physician, of much experience, who has not met
with some case or cases, the history of which would be interest-
ing to the profession. Were he to give them publicity, which
is certainly his duty, our medical journals would then be filled

462 Harris, on Narcotism. [August,

with practical matter, and our physicians thereby made ac-
quainted, not only with the various diseases afflicting different
sections and localities of our country, but also with their treat-
ment. In a word, in doubtful and difficult cases, we could call
to our aid all the skill and experience of the land ; thereby in-
spiring us with confidence and, no doubt, lessening the mortality.
It is certainly the duty of every physician who is a friend to
suffering humanity, and loves his profession, to contribute his
mite even if he should not be learned in the law, and happen
to be in error, it will present an opportunity of having that error
corrected and he enlightened and if right, he will have the sat-
isfaction of knowing, that probably he has done some good.

I do not present to the profession the treatment of Narcotism
from opium by cold water to the head, as anything new or
original, but for the purpose of calling attention to it as a remedy
always at hand and of easy application. In the American
Journal of Medical Science, for April, 1852, Dr. J. Young, of
Chester, Pennsylvania, reports two cases, the lives of whom
were no doubt saved by this simple remedy. The first was
that of a child two years old ; the mother had given it a
portion of " Baker's Specific." The poison had been in its
stomach six hours when the doctor saw it it was aslimberas
a rag all muscular contraction had ceased, and it had lost the
power to swallow it could not by any means be aroused. The
doctor called for a pitcher of water and poured in one continu-
ous stream on the crown of its head, until a gallon had been
used, by the time the child showed signs of muscular contrac-
tion ; the water was continued a little longer and the child
roused up, cried lustily and soon got well.

The second was that of a negro girl aged 18 years, who had
been in the habit of taking laudanum for some time past, in
increasing doses, for the purpose of producing exhilerating
feelings. On this occasion she had bought a two ounce vial full
and drank it all at three draughts ; in two or three hours she was
unconscious, and the muscular system completely released.
Cold water poured on the back of her head for five minutes com-
pletely restored her, and nothing further was done but a dose of
oil to open the bowels. Immediate relief was obtained, and pro-
bably life saved ia Ipoth these cases by cold w^ater alone.

1852.] Harris, on Narcotism. 4G3

These two cases of doctor Young's brought forcibly to my
recollection three cases which came under my own observa-
tion, and which I treated in the same manner, long before I had
heard it recommended by any one else. In the winter of 1844,
while I was practicing my profession on the Yazoo River, in
Carrol county, Mississippi, I was summoned early one morning
to see an aged lady. A profuse diarrhoea, with which she had
been attacked the night previous, was fast wasting her little
remaining spark of vitality ; extremities cold ; pulse weak ;
quick and steady ; tongue and mouth dry and parched ; thirst
great ; skin hot and dry over the abdomen. Prescribed, mus-
tard sinapisms to the extremities, with hot brick to the feet;
i gr. morphine in a little w^arm brandy toddy, to be repeated
every four hours if the bowels required it ; a teaspoonful of
laudanum in six oz. decoc. kino by enema, if the morphine
should fail ; mustard sinapisms to the spine to arouse the dor-
mant energies of the spinal nerves. I then left my patient,
with a promise to see her again that night. Shortly after my
departure, two or three pretty profuse discharges from my
patient alarmed her friends : in consequence, they gave the
morphine about every hour and a half, at the same time using
the enema, so that in four hours after Heft she had taken | grs.
morphine and two teaspoonfuls of laudanum. This arrested the
diarrhoea, but it was well nigh at the sacrifice of her life ; she
became so drowsy that it was with difficulty she could be
aroused : the relatives, thinking "death w^as on her," sent after
me in great haste, as though I could stay the hand of Omnipo-
tence, and ward off at will the " king of terrors." On my arrival,
I found her completely narcotised, lying on her back, eyes
half open and turned back; muscular system completely re-
laxed, so that the under jaw hung down, bathed in a profuse
perspiration ; breathing deep, and very slow, not more than
four or five times in the minute ; lips and face somewhat livid
and could not arouse her by any means in our power. Noticing
the temporal arteries were completely on the strut, and think-
ing that cold water might produce contraction of these vessels
\and drive off the superabundant quantity of blood thrown to
-the head by the opiate, I called for a pitcher of ice water, had
her head held ofT the bed and poured it on in one continuous

464 Harris, on Narcotism. [August,

slow stream. By the time the contents of the pitcher were ex-
hausted, she spoke and called for water. I gave her coffee as an
anti-somnolent. We thus continued the cold water for half an
hour, when she seemed completely restored. In half an hour
after we stopped the water, she seemed to be sinking again
into her narcotic slumber. The water again relieved her, and by
keeping it up occasionally as the symptoms indicated, she was
permanently relieved in three or four hours after I commenced
its use. I, also, during all this time, gave her frequently hot
coffee to drink, without creaai or sugar, at the same timekeep-
ing the spine and extremities well burnt with mustard. Some
good probably resulted from the coffee and mustard, but the
principal relief is attributable to the cold water. She had no
more diarrhoea; nothing ailed her but debility, from which she
gradually recovered and got quite well.

In 1845, I was called to see Mrs. S , aged 30, married

10 years; no children; suffered much with dysmenorrhoea ; tall
and spare made ; scrofulous diathesis, subject at times to cramp
colic. On the morning of my visit, she had had a more violent
attack than usual of this painful affection, for which she had
taken something over a teaspoonful of very strong laudanum ;
she was talking wild and incoherent ; had a vacant expression ;
tossing her head from one side to the other ; throwing her
hands about in a word, she was perfectly deranged. I applied
the cold water to her head and in fifteen minutes she was per-
perfectly restored to consciousness the water was re-applied
whenever she began to " feel strange," as she expressed it, and
always with the same happy result, until the opiate influence
wore off, when she was as well as ever.

In 1849, in this place, Fayetteville, Fayette county, Alabama,

jVIiss M. W , in her 18th year, was attacked with dysentery.

I prescribed for hsr pills composed each of 1 gr. opium, 2 gr.
camphor, | gr. calomel, 1 gr. ipecac : one to be taken every
four hours. This was early in the morning. In two hours after
taking the first pill she had a mucous discharge from her bowels,
and being much pained she took another. In one hour after
this, she took a third, and feeling no better in two hours more,
she took two others, and continued to take them every hour or
two until by four o'clock in the evening she had taken eight

1852.] Kollock, on Cutaneous Eruption. 465

At six I was summoned to her bed-side, when I found her
perfectly distracted. The pills had seemed to exert no influence
until five o'clock, when they took effect and seemed to exert
as powerful an influence as though all had been taken at once.
She remained in this frenzy stale about an hour, when she sunk
into a deep stupor, from which nothing could arouse her but
cold water, and whenever this was discontinued 15 or 20
minutes, she would again become comatose. It was kept up
through the night, and by next morning she was as well as
ever, except weakness.

In all these cases the great beverage of nature evidently
relieved much suffering and probably saved life. I have no-
ticed in all the cases of narcotism from opium that the patients
got well of their dysentery or diarrhoea immediately after their
recovery from the narcotism. Does the opium produce a
change in the determination of the fluids ?

ARTICLE XXVII.

On the Cutaneous Eruption induced hy the internal use of
Tartar Emetic. By P. M. Kollock, M. D., of Savannah.

In the June No. of the Southern Medical and Surgical Jour-
nal, I read the description of two cases, by John S. Wilson,
M. D., of Airmount, Ala., of a "Specific Cutaneous Eruption
produced by the internal use of Tartar Emetic." Being thus
reminded of a similar case, which occurred in my practice
some years since, and, like the author of the communication,
never having seen any notice of such effects of the drug in
question in books, I send you a copy of the note which I made
of the case at the time of its occurrence.

September 1, 1848. Saw Mrs. C.'s little girl, about three
years old. Incipient laryngitis to which disease there is a
strong epidemic tendency at this time in the city. Her mother
had given her castor oil previous to my being consulted. The
disease proved extremely obstinate, but yielded to treatment,
consistingof vomiting with "Turpeth Mineral," 2 grs,, repeat-
ed at intervals of 15 minutes (two doses producing vomiting) ;
purging with calomel ; small doses of calomel and ipecac : and.

466 Wilson's Case of Catalepsy, [August,

lastly, a solution of tart, antim. gr. i. to water ii., gtt. 10 every
two hours. Of this last, she took in all Iss. of the solution,
which broke up the remains of the disease. Two blisters had
been applied, one on sternum, the other on dorsal spine. I
intended this last to be confined to nucha ; but owing to her
restlessness, its effects had extended over a much larger space.
She seemed, however, to be entirely relieved of the catarrhal
disease, and to have nothing more to contend with than the
irritation produced by the remedies. A little febrile excite-
ment continued. At this time an eruption, resembling prickly
heat, broke out all over the body; the blistered surfaces be-
came very much inflamed, and seemed very much disposed to
ulcerate, although I was assured by the mother that the blisters
had not been applied more than two hours. About the 6th or
7th, as the fever seemed to exhibit a paroxysmal tendency, I
commenced giving sulph. quinine. She took one grain, when
the stomach became exceedingly irritable and incapable of re-
taining any thing whatever. The eruption on the skin became
pustular, and extended all over the body, and the blistered sur-
faces continued to look badly in spite of the free use of chlor.
sod. She died on the morning of the 9th, and the eruption on
the trunk assumed a purple color. Previous to death she bled
from the nose.

ARTICLE XXVIII.

Catalepsy Relieved hy Ether Inhalation. By John S. Wil-
son, M. D., of Air Mount, Alabama., (formerly of Georgia.)

Since the introduction of Ether and Chlorform, the various
medical journals have contained numerous reports of their suc-
cessful use in almost every variety of nervous and spasmodic
disease ; but never having seen a case of that rare disease,
Cataleps}^ included in any of those reports, I have concluded
that the following case might not be uninteresting to the pro-
fession, and that it might suggest a valuable resource in a form
of nervous disorders that is so unusual and so little noticed by
writers as to produce some embarrassment in its treatment.

Case. On the 6th of March last, I visited a negro woman,

1852.] Wilson's Case of Cafalepsy. 467

the property of Mr.-W., for the purpose of deciding as to her
" soundness" Mr. W. having recently purchased her. I found
on examination per vaginam, that her uterus was prolapsed,
and that it was fixed in the pelvis, possessing but slight mobil-
ity it seemed moreover to be somewhat indurated. On the
9th I was called again, about 9 o'clock, A. M., when I learned
from her ovtrner that he had called her early that morning, but
receiving no answer, he w^ent to her, and found her speechless
and motionless. He could not tell how long she had been in
that condition.

When I saw her,she presented the following symptoms : Pulse
slow and full respiration the samiC, and without stertor mus-
cles rigid, but no convulsive movements except a slight twitch-
ing of the muscles of the eyes and lips. Sensation was almost
wholly abolished; none being manifested on pinching and
pulling the skin, and very little on the application of a live^re-
coal the arms retained any position in which they were
placed, as in the mesmeric state.

Treatment. I first abstracted a small quantity of blood, for
the purpose of removing or preventing cerebral congestion ; I
then used the Sulph. Ether freely, by inhalation, with the view
of resolving the tonic rigidity of the muscles.

After continuing the remedy about 20 or 30 minutes, and
when she had inhaled near 2 ozs, the muscles became gradually
relaxed : the Ether was then discontinued, and soon afterwards
consciousness returned : she then sat up and looked about with
a bewildered expression ; and on being questioned as to the
manner of her attack and her previous condition, she could not
give any satisfactory answers, expressing entire ignorance in
reference to the experiments made to test her sensibility, while
in the cataleptic state, and also, with respect to the bleeding.
Up to this date she has had no other attack. My object in
reporting this case having been already mentioned, it is need-
less to say more: I would merely observe that every one
who has seen a subject in the " mesmeric state," will, on seeing a
case of catalepsy, be strongly impressed by the remarkable
analogy existing between those two singular phenomena of the
nervous system.

168 Healthy and Morbid Menstruation. [August,

PART II.

(EcUctic JH^partm^nt.

On Healthy and Morbid Menstruation. By J. Henry Ben-
XETT, M. D., late Physician- Accoucheur to the Western
General Dispensary, etc.

[Continued from Page 417.]

Ainenorrho^a. By amenorrhoea is meant the absence, when
physiologically due, or the sanguineous discharge by which
menstruation is externally manifested. The menstrual function
consisting, as we have seen, not merely in the periodical secre-
tion of blood from the interior of the uterine cavity, but
also in the maturation and elimination of ova from the ovary,
it is necessary to make the above distinction. Ova may, by
exception, be matured and evolved from the ovary in the
human female, as well as in the lower animals, without any
sanguinous discharge taking place, as is evidenced by the re-
peatedly recorded facts of the conception of young females who
have never menstruated, and by the pregnancies which occur
in women who are nursing, without menstruation having return-
ed. Thus, the external excretion of blood can no longer,
in our present state of knowledge, be considered as comprising
the entire function, although, as the rule, its manifestation is the
evidence of the existence of those all-important ovarian phe-
nomena with which it is generally connected.

Amenorrhoea may be studied under two principal forms : in
the first w^hich we will call " constitutional amenorrhoea," men-
struation has never taken place ; in the second, which may be
termed " accidental amenorrhoea," it has manifested itself, but
has been suddenly or gradually suppressed.

Constitutional Amenorrhoea. In order to appreciate this, the
first form of amenorrhoea, we must recall to mind some of the
principal facts connected with the physiology of menstruation
noticed in a former paper. Thus we must recollect, that the
first appearance of this function follows no strict rule, oscillating
in health, between the ages of eleven and nineteen or twenty,
an interval of nine or ten years ; and that the average age of
fourteen or fifteen is obtained by the inclusion of the exception-
ally extreme cases. We must also bear in mind that, apart
from constitutional and family peculiarities, the acceleration or
delay of menstruation appears to be more the result of favour-
able or unfavourable hygienic conditions than of climate, as
was formely taught and believed.

Such being the physiological conditions of memstruation, it
is evident that its non-appearance after the average age of four-

1852.] Healthy and Morbid Menstruation. 469

teen or fifteen is not to be considered a morbid state, as long as
the delay is unaccompanied by any symptom of disease or ill-
health. Thus we occasionally meet with young females, non-
menstruated, of the age of seventeen or eighteen, or even older,
whose frame is well developed and healthy, and who complain
of no ailment beyond an occasional headache or backache, and
sometimes not even of that. With them, menstruation is mere-
ly late in its manifestation : they are not suffering from amenor-
rhoea.

In a considerable proportion, however, of the young females
who reach the age of eighteen or more without being menstrua-
ted, the delay is either attended with great discomfort and dis-
tress, apart from any physical deficiency ; or is connected with
defective general and sexual development ; or is occasioned by
some local or general morbid condition ; or is prevented by
some physical impediment. Each of these states may be said
to constitute a distinct form of amenorrhoea.

In those v;ho belong to the first category, we find a well-
formed frame, properly developed breasts, as also the other exter-
nal signs of puberty ; but the patient suffers from constant head-
ache and flushing of the face, severe pains in the back and loins,
extending to the lower part of the abdomen and down the thighs,
and often form a leucorrhceal discharge. It is evident that the
changes that precede and accompany menstruation, both in the
internal and external organs of generation, have taken place,
but that the function has a local difficulty in establishing itself:
thence an irregular state of circulation, determination of blood
to the head and face, congestion of the uterus, vagina, and
ovaries, with consequent pain in the uterine regions, and the
leucorrhoeal discharge. This state is not unfrequently connec-
ted with a plethoric condition of the system, and may last from
a few months to several years. The advent of the menstrual
haemorrhage generally relieves the patient at once, although
she may still continue to suffer at times as above described, if
menstruation fails to establish itself regularly.

The second division comprises non-menstruated females,
who, although they have attained, or even passed, the ordinary
age of puberty, do not present that development of the mam-
mae and other external organs of generation, by which this
period of life is usually characterized. They remain thin,
angular, and flat-chested, and retain all the characteristics of
girlhood, mental as well as bodily. It would appear as if in
these cases the ovaries remained dormant, and as if the general
stimulation which their progressive maturation imparts to the
economy were not supplied.

We have seen that, physiologically, menstruation is retarded

N. S. VOL. VIIT. NO. VIII. 30

470 Healthy and Morbid Menstruation. [August,

by bad living and unfavourable hygienic conditions; whereas,
its advent is accelerated by good living and favourable hygien-
ic conditions. From this fact alone, we might conclude that
all diseases that debilitate the economy would have a tendency
to retard the menstrual flux; and such is really the case.
Phthisis, scrofula, chlorosis, fevers, indeed all diseases that
weaken, produce this eftect. None, however, more frequently
occasion amenorrhcea than chlorosis, a disease of the blood, in
which the solid constituents of the vital fluid are diminished,
and the fluid or serous increased. The delay or suppression
of the menses, under the influence of this malady, is so promi-
nent a feature in its history, that many writers have very erro-
neously connected it with the uterus, and have described it as
a uterine disease. In reality, the state of the menses is a mere
symptom of the anaemia and debility occasioned by the morbid
state of the blood. It is only in a few exceptional cases that I
have found chlorosis connected with actual uterine disease.

Lastly, the menstrual secretion may have taken place, but
the excretion may never have occurred, owing to congenital or
accidental closure of the genital passages. The os uteri, the
vagina, and the hymen, may be all closed together, or they may
be each closed separately. If the closure exists at the os uteri,
the menstrual fluid accumulates in the cavity of the uterus, and
gradually developes it, so that the enlarged organ rises out of
the pelvis, and appears above the pubis, simulating pregnancy.
If it is the lower part of the vagina or the hymen that is imper-
forate, the menstrual fluid first accumulates in the vagina, which
it distends to an extreme degree before it enlarges the uterine
cavity. If the fluid collection reaches the hymen, it generally
pushes it forward, and forms a tumour, which appears between
the labia. This distention of the internal uterine organs is
generally attended with great suffering, both local and general,
and is marked by periodical exacerbations, corresponding to
the monthly periods.

Accidental Amenorrhcea, The second class of cases com-
prises those in which menstruation has existed, but has been
suddenly or gradually suppressed.

The sudden suppression of menstruation is generally the
result of exposure of the body, and especially of the feet, to cold
or to the wet ; of a mental shock, from fear, grief, pain, or anx-
iety, &c.; or of a sudden attack of disease. It not unfrequently
occurs, for a time, as a result of a sea voyage or of change of
climate, without giving rise to much distress, and without
requiring medical treatment, the return taking place spontane-
ously. The sudden suppression of the menses, under the influ-
ence of the other causes mentioned, is often followed bv the

I

1852.] Healthy and Morbid Menstruation. All

development of inflammation in the uterus, ovaries, or lateral
ligaments. Even when suddenly suppressed, however, the sup-
pression may be unattended with any unfavorable symptom
beyond slight pain in the back and hypogastrium, flushing, and
headache. Amenorrhoea, thus suddenly induced, seldom ex-
tends over more than one, two or three periods, under proper
management, although the suspension may be much more
lengthened, and is sometimes indefinite.

A gradual suspension of menstruation is sometimes observed
in those females in whom the function has set in late and with
difficulty, without there being any evident cause, general or
local. It would appear as if the ovarian and sexual vitality
were anomalously low ; and after making one or more eflx>rts,
at irregular periods to establish itself, menstruation ceases, not
to return, except under the influence of treatment. When this
occurs, the health is scarcely ever good, the constitution gen-
erally remaining delicate and weak.

In such cases, however, we are warranted in suspecting
ovarian or uterine disease. Generally speaking, in the absence
of the chlorotic or tubercular cachexia, the gradual suppression
of the menses is connected with such disease. The develop-
ment of the various tumours to which the ovaries are liable,
frequently entails amenorrhcea ; and the chronic inflammatory
aflfections which are so often observed in the neck and body of
the uterus, may have the same result. Menstruation first be-
comes irregular, being delayed days, weeks or months, and then
ceases completely. I have often been consulted for amenor-
rhoea by females who w^ere labouring under these forms of dis-
ease and in w^hom it had evidently come on subsequently to
the uterine affection.

When menstruation does not return, the uterus, and especial-
ly its cervix, even in the absence of positive disease, appear
sometimes to be the seat of a kind of permanent congestive irri-
tation, which ultimately may bring on hypertrophy and indura-
tion of the latter region. I have seen the cervix become thus
enlarged, under my eyes, as it were, in the course of four or
five years, although there was never any really tangible disease
during that time. In one instance, that of a married woman,
now twenty-eight, the menses, which from the first had been
irregular, stopped immediately after marriage at twenty-three.
Soon afterwards she began to suffer from uterine symptoms,
and when she consulted me, I found the cervix inflamed and
ulcerated, but not hypertrophied. The disease was soon sub-
dued, but the menses have only returned once or twice. The
uterus has appeared to remain in a state of semi-congestion, and
the cervix has gradually enlarged. This female remains delicate

472 Healthy and Morbid Menstrualioji. [August,

although in very tolerable health, free from pain, and not suffer-
ing under any other morbid state.

Suppressed menstruation, either sudden or gradual, is not
unfrequently followed, even when uterine inflammation is not
developed by serious general symptoms, obstinate vomiting,
severe hysteria, and sometimes by the establishment in the
economy of a supplementary haemorrhage, to which the name
of "vicarious menstruation" has been given. The mucous mem-
brane of the nasal fossae, of the lungs, stomach, and bowels, are
the most ordinary seat of this hfBmorrhage, which takes place
in some instances wnth the regularity of normal menstruation,
and in others at irregular periods. All the other mucous mem-
branes, as also the skin itself in various regions, have been the
seat of vicarious menstruation. It has not unfrequently been
observed from the surface of wounds or sores. Such being the
case, it is evident that haemorrhage occurring from any of these
sources in a young female in whom the menses are suppressed
has not that importance which it would have under other cir-
cumstances. The haemorrhage may be, and probably is, mere-
ly an effort of nature to establish a supplementary issue for the
menstrual secretion, which has not taken place.

Treatment. The rules which should guide the practitioner
in the treatment of amenorrhcca must be drawn from an atten-
tive consideration of the causes by which it is occasioned, and
must vary as they vary. In a general point of view, however,
the indications are, 1st, to give tone to the economy if tone be
deficient, and to remove general or local disease if such disease
be present ; 2ndly, to favour and promote, within reasonable
and judicious limits, the menstrual function. We will now
briefly see these indications are best carried out in the various
forms of amenorrhoea above described.

When the advent of the menstrual flux is retarded in well-
developed young females, who evidently suffer, both generally
and locally, from the delay, a little judicious management will
often determine its appearance. The state of the health should
first be carefully scrutinized, and any general or functional
derangement remedied by proper treatment. If the patient is
weak and delicate, the various preparations of iron, with a gen-
erous dietary, are often of great use. If on the contrary, she
is plethoric, and subject to headache and flushing of the face, a
licrht diet, gentle exercise, and alterative or saline medicines
are indicated. A young female suffering in this w^ay is better
at home, under the eye of a devoted and attentive mother,
should she be fortunate enough to possess such a parent, than
in a public school, where the rigid discipline usually enforced
renders it difficult to pay that attention to her state whi<;b it

1852.] Healthy and Morbid Menstruation, 473

requires. Under the influence of these general means, the mem-
strual function usually manifests itself, and becomes regularized
in the course of a few months. Should they prove ineflicient,
slight periodical stimulation of the uterine system should be
resorted to. The plan I most frequently adopt is, the applica-
tion of large mustard poultices to the breasts and inner and
upper parts of the thighs, alternately, night and morning, during
five or six days, every four weeks. The mustard poultices
should be allowed lo remain on until the skin reddens and begins
to feel painful, but not long enough to blister it, as that would
prevent their being replaced the following day. The feet may
also be put in hot water night and morning, for a few minutes,
and if there is any pain in the hypogastric or ovarian regions,
large warm linseed poultices, sprinkled over with laudanum,
may not only afford relief, but also promote the menstrual
excretion. When the symptoms of local congestion are very
marked, the application to the vulva of a few leeches every
month, or about the fifth day of the local treatment, may be of
great assistance. The commencement of this local treatment
should be made to coincide with the menstrual nisus, when it
manifests itself periodically. When it does not, a certain date
should be taken, and adhered to at the interval stated that is,
every twenty-eight days. In such cases the medicines known
as emmenagogues, which exercise a special influence over the
uterus, are scarcely in my opinion, admissible, the object being
to gently promote the natural function, and not to violently
stimulate, and probably irritate, the uterine organs.

In amenorrhoea connected with deficient uterine and bodily
development, the local treatment should be conducted on the
same principles only it generally requires to be carried out
more perseveringlyand for a greater length of time. In addition
to the means mentioned, I have also derived great benefit from
electricity, the electric current being carried through the pelvis
from the hypogastric to the sacro-lumbar region, for an hour
night and morning, during the week that local means are resort-
ed to. In these cases it is evident that the non- development
of the body is often in a great measure the ?^esult of the dormant
condition of the uterine organs, inasmuch as I have repeatedly
succeeded in rousing them to action by the local treatment
above detailed, w^hen the most judicious and perseveringly
general treatment had failed. In these cases I have invariably
seen the bodily structures subsequently develope themselves
with great rapidity. At the same time,*^the knowledge of this
fact must not for a moment prevent our employing every possi-
h\e means of invigorating the general health, of vitalizing econo-
my, and of promoting the regular play of the various functions

474 Healthy and Morbid Menstruation. [August,

After removing any morbid functional condition which a care-
ful scrutiny may detect, recourse should be had to the mineral
and vegetable tonics, and especially to ferruginous preparations,
to which should be added a generous diet, moderate food, or
horseback exercise, cold bathing or sponging, early hours for
retiring and rising, and residence in the country, if possible.

When amenorrhoea can be traced to a debilitating disease,
such as chlorosis, phthisis, scrofula, &c., the best treatment is
the treatment of the disease to which it isreferrible. Thus, in
chlorosis, the menstrual flux gradually diminishes, and may
finally cease altogether under the influence of the progressive
deterioration of the blood, without there being any uterine
disease or any other uterine symptom than the scantiness and
final disappearance of the secretion. As under appropriate
general treatment the blood becomes healthy, menstruation
returns or again becomes gradually more and more normal,,
without any local treatment being necessary in the immense
majority of cases. The same may be said of scrofulous and
other forms of constitutional debility. In pulmonary phthisis,
the falling offand final disappearance of menstruation is a symp-
tom of much more serious import, as it is generally connected
with the more advanced stages of the disease, and with an
amount of tuberculur deposit, and of consequent marasmus,
through defective nutrition, which renders the chance of a recov-
ery very problematical.

Amenorrhoea from physical obstacles can only be remedied
by surgical means. If the hymen is imperforate, or the lips of
the vulva are adherent, and the menses have collected behind,
a crucial incision in the center of the bulging hymen, or vulvar
protuberance, in all that is required. Care, however, should
be taken, once the menstrual fluid has been evacuated, that the
divided surfaces do not unite and cicatrize. This is to be pre-
vented by the use of small sponge or cotton tents for a few days,
or by the application of the nitrate of silver to the edges of the
incisions a more painful but equally efficacious process.
When the vagina is partially or wholly absent or closed, either
congenital or by adhesion from accidental causes, the case is a
much more serious one, and more difficult to remedy. If there
is merely adhesion of the walls of the vagina, this adhesion can
generally be removed by the dilatation of the vagina, coupled
with the gradual and careful division of the adherent surfaces.
When the vagina is partially or entirely absent, the symptoms
produced by the retention and accumulation of the menses in
the uterus may be sufficiently serious to render it imperative to
attempt to form an artificial passage by surgical means, o( the
distended uterus. In such cases the difiicultv and risk of the

1852.] Healthy and Morbid Menstruation. 475

operation depends on the distance that separates the vaginal
cnl-de-sac or the imperforate vulva from the uterus, the opera-
tor having to make his way between the rectum and the bladder.
Considerable assistance in diagnosis is derived from a careful
rectal examination. It is of great importance to find a vent for
these uterine accumulations of menstrual fluid, as, in addition
to the sufl?ering endured, there is positive danger to life. Cases
are on record in which the distention of the uterus extended
to the Fallopian tubes, and in which death occurred from the
peritonitis occasioned by their rupture.

Occlusion of the os uteri, as a congenital occurrence, is rare ;
^. but since I first recommended the use of potassa cum calce as
a last resource in'obstinate inflammatory disease of the cervi-
cal canal, I have seen several cases in which its use had been
followed by all but complete occlusion, and by partial retention
of the menses, or at least their difflcult excretion. This was
evidently owing to the want of due caution at the time of appli-
cation and during the period of healing afterwards. The ten-
dency of the tissues thus treated to contract being very great,
it should be counteracted, if necessary, by the occasional use of
wax bougies, until the process of repair has been fully accom-
plished. The possibility of this accident occurring through the
want of caution of the operator, does not in the least invalidate
the utility of the remedy as an exceptional and ultimate one. I
have generally, but not always, found this form of occlusion easy
to remove by progressive dilation. Should occlusion of the os
uteri exist congenitally, once recognised it is easily remedied by
a slight incision in the region of the os, and by subsequent dila-
I tation.

When menstruation is accidently arrested or prevented, by
exposure to cold and wet, by illness, or by any other of the
causes enumerated, the amenorrhoeais seldom of long duration.
The condition in which it originated having ceased to obtain,
the function generally rights itself; the only treatment usually
required being that which is most calculated to restore the gen-
eral health of the patient. In some cases it may also be neces-
sary to resort to the local means already detailed, when men-
struation appears to have a difficulty in re-establishing itself.

Thecatamenial function appears to be more especially liable
to arrest from accidental temporary influences in those females
who present the low degree of sexual vitality to which allusion
has been made in the first part of this paper, and with whom
menstruation appears late and with difficulty. In such consti-
tutions, indeed, it sometimes stops for many months, or even
permanently, if no treatment be resorted to, without any appa-
rent cause. Under the influence of decided general and locakl

476 Healthy and Morbid Menstruation. [August,

treatment, the menses will often return for a time, but flag and
cease as soon as the treatment is suspended. If there is no posi-
tive disease of the uterus or ovaries, the emmenagogues, such
as ergot of rye, savine, &c., may be cautiously tried. I have
knov^n also the married state, especially if followed by concep-
tion, produce a complete change in the functional activity of
the uterine system, and menstruation become regular and natur-
al. It is in these cases that the application of the nitrate of sil-
ver to the cavity of the uterus, or the scarification of its mucous
surfaces, has been proposed. 1 must confess, however, that I
do not think we are warranted in thus interfering with so deli-
cate and sensitive a region of the uterus for such a purpose. In
the unmarried female the application of leeches to the vulva,
and in the married to the neck of the uterus, answers every pur-
pose without being open to the same objection.

The development of inflammatory disease in the neck or body
of the uterus, or in the ovaries, and of cystic and scrofulous tu-
mours in the ovaries, is one of the most frequent causes of amen-
orrhcea in those in w^hom the function has once been fairly
established, and especially of partial amenorrhoea. When such
lesions exist, they generally give rise to other symptoms
which an attentive and well informed observer may easily recog-
nize. This remark, however, applies more to the uterus than
to the ovaries, for important morbid changes are not unfre-
quently found after death in the latter organs, which, during
life, have given little other evidence of their existence than the
modification or arrest of the catamenial functions.

In all these cases, the amenorrhoea is merely a symptom of
the ovarian or uterine disease. The latter is the condition to
be treated, the only indication the amenorrhoea itself supplies
being the advisability of having resource to such local means
as are calculated to promote menstruation, whenever nature ap-
pears to be making the least effort to establish the menstrual flux.

In vicarious menstruation, our first efix)rt ought to be direct-
ed to the restoration of the integrity of the uterine organs, if it
be impaired. We should then, by all the means enumerated,
attempt to divert the molimen hsemorrhagicum of menstruation
from its abnormal to its normal seat. The most important of
these means is the abstraction of blood from the vulva or cer-
vix uteri, which should be resorted to every month, a day or
two before the vicarious menstruation is expected, and may be
treated after it has begun, should the strength of the patient
admit of such a step. By this treatment the menstrual nisus
may be diverted into its natural channel ; whereas, any attempt
to stop the morbid haemorrhage, by means, applied directly to
the organ from which it takes place, might be productive of
mischief to the system at large.

1852.] Chlorosis of Pregnancy. 477

On the Chlorosis of Pregnancy. By M. Cazeaux.

M. Cazeaux recently read, at the Paris Medical Society, a
paper, the object of which was to show "that hydraemia or
serous polyaemia is the most frequent cause of the functional
disturbances in advanced pregnancy usually attributed to ple-
thora." The analysis of the blood of pregnant women exhibits
a diminution of globules and an increase of water, differing
indeed only from that of chlorosis by containing an increased
quantity of fibrine. The quantity of fibrine is far less than in
phlegmon, and the buff it gives rise to has been often observed
in the chlorotic. The functional disturbances of pregnancy
resemble those of chlorosis, many of these indeed being com-
mon to plethora and chlorosis. The effect of treatment con-
firms this view of their nature; for while here, as in chlorosis,
depletion may prove a temporary and fallacious means of re-
lieving serous plethora, it is from the employment of animal
food and iron that real benefit is obtained ; and this even in
cases wherein local bleeding may be deemed advisable. M.
Cazeaux does not, however, deny that true sanguineous plethora
may be met with occasionally, and especially in the early
months.

During the animated discussion which followed, M. Duparc-
que admitted that pregnancy may occasionally induce a condi-
tion analogous to chlorosis; but he referred to the marked
power of venesection in arresting threatened abortion from
active uterine congestion ; and believes that the practice fol-
lowed by our predecessors of bleeding at the middle of preg-
nancy, on account of the then active disposition to abortion,
may often be advantageously imitated. A similar plethoric
determination takes place at the seventh and ninth months ;
and when the mother does not suffer ill effects from this, it may
produce cerebral apoplexy, or that state of general congestion
termed asphyxia, in the infant the plethora killing the child,
though it spared the mother, when precautionary venesection
had been neglected. Puerperal convulsions n:iight often be
prevented, if bleeding were instituted for the plethoric condi-
tion in which they so frequently originate. In judging of the
presence of plethora, too much weight has been attached ta
the highly-coloured condition of the skin, especially that of the
face and its adjoining mucous membranes, and to the projection
of the veins. But it is very common to see persons who are
constantly plethoric, and who are liable to phlegmasise, conges-
tions, and haemorrhages, exhibiting so colourless a condition of
the tissues, that from their mere aspect, we might believe them
subjects of chlorosis. Such persons bear losses of blood, which

478 Cessation of Menstruation. [August,

those of a higher colour and apparently eminently sanguineous
temperament, could not endure.

M. Jacquemier stated that he had examined the blood of
about 200 women, in the eighth and ninth months of pregnancy,
most of them being persons from the country. The so-called
inflammatory crust was not met with so often as is usually
supposed ; but occurred much oftener in winter (when many
of the w^omen suffered from bronchitis and influenza) than
jn the summer ; it being met with at this latter period only
once in six or even in nine cases. Most frequently when the
buff did exist, the clot was pretty large and softish, and the
serum was not in excess ; the hard, retracted clot, covered
with a thick buff, and bathed in a large quantity of serum, as
seen in inflammation and chlorosis, being rarely met with. Ac-
cording to his observations, the excess of fibrine, whether
absolute or relative to the diminution of globules, is not consid-
erable enough to habitually give rise to the production of the
inflammatory crust. The diminution of globules is infinitely
greater in a chlorotic person than in a pregnant woman ; and
all the analogy that can be traced between the two conditions
may be stated in the fact, that a considerable number of women,
after the njiddle period of pregnancy, exhibit the commencement
of anaemia. Clinical observation does not favour the view of the
identity of the two conditions. Among many hundreds of
women auscultated at the Maternite, during the last two months
of pregnancy, M. Jacquemier only met with the carotid souffle
in two or three. [Rev, Medical. Medico-Chir. Review.

On the Management of Women after the Cessation of Men-
struation. By Dr. E. J. Tilt.

[The superabundance of blood and nervous energy after the
cessation of the menstrual flow may be safely and effectually
kept down by the habitual use of small doses of purgatives ; and,
as they may have to be continued for some length of time, it is
best to consult the patient as to what medicine would be best
tolerated. The purgative to be used depends upon the constitu-
tion of the patient. Perhaps the best is some mild purgative
which has been found to agree with the patient. Dr. Tilt con-
tinues :]

1 frequently prescribe the soap-and-aloes pill of the Edin-
burgh Pharmacopoeia, ordering five or ten grains to be taken
with the first mouthful of food at dmner. Hemorrhoidal affec-
tions I have never seen caused by this frequent use of aloes,
but 1 have seen them relieved by it ; and as I read in Giacomi-
ni's ' Treatise of Materia Medica' my experience on this point

1852.] Leucocythemia. 479

is confirmed by that of Avicenna, Stahl, Cullen, and his own, so
I think there must be some exac^fferation as to ihe extraordinary
property generally ascribed to this valuable drug, which can be
associated with hyoscyamus, and is thus said to be less liable to
induce piles. Kemp and Hufeland recommend the following
powder to be giveo to tliose who are advanced in years, and
who complain of a tendency to vertigo : Guaiacum resin, cream
of tartar, of each half a drachm, to be taken at night. This, no
doubt will sometimes be found a useful laxative ; so will the pop-
ular remedy called the Chelsea Pensioner, of which Dr. Paris
has given the following formula in his excellent Pharmacologia :
Of guaiacum resin, one drachm ; of powdered rhubarb, two
drachms ; of cream of tartar and offlour of sulphur, an ounce of
each ; one nutmeg finely powdered, and the whole made into an
electuary with one pound of clarified honey: a large spoonful
to be taken at night. I generally administer the flour of sul-
phur alone, or else to each ounce of it I add a drachm of sesqui-
carbonate or biborate of soda, and sometimes from five to ten
grains of ipecacuanha powder. One to two scruples of these
powders taken at night in a little milk, is generally sufficient to
act mildly on the bowels, and I consider such combinations as
very valuable when a continued action is required.

I feel obliged to class sulphur amongst purgative remedies
because such is its visible action, but I believe that it owes its
chief value, in diseases of cessation, to another action, much
more difficult to understand, and which has long rendered it
so valuable both in hemorrhoidal aflfections, where there is an
undue activity of the intestinal capillaries, and in skin diseases
marked by a morbid activity of the cutaneous capillaries.
Whether sulphur cures by acting on the nerves or on the blood-
vessels, or by modifying the composition of the blood itself, is
difficult to tell, but it does certainly cure the diseases I have
enumerated. It forms part of many popular remedies for the
infirmities of old age, was recommended by Hufeland, and is
lauded by Dr. Day in his work ' On the Diseases of old Age ;' but
its utility is not generally known in all derangements of the men-
strual function, at whatever period of life they may occur, and
particularly at the change of life, where, if required, its action
may be continued with impunity for months and years.

[^Provincial Med. and Surg, Journal.

On Leucocythemia. By Professor Bennett, Edinburgh.

[In the first article of our last volume (vol. 23) the reader will
find a very interesting paper on the subject of white cell blood
(Leucocythemia,) which is a proper introduction to the present

480 Leucocythemia, [August,

one. Prof. Bennett has established the existence in the blood
of an excess of the colourless corpuscles; a condition highly
important to the pathologist and physiologist. He says:]

The blood may be loaded with a multitude of cells, exactly
resembling those of pus ; that such blood may circulate in the
human subject for months, or even years, without destruction to
life, and that this condition is always associated with disease in
those organs, the functions of which have hitherto been involved
in the greatest obscurity, constitute facts which seem calculated
to exercise an important influence on many views that have
been long as^itated in science. The constitution of the blood
itself; the origin of its morphological elements and chemical
proximate principles ; the importance of the lymphatic system ;
the functions of the spleen and other blood glands ; the nature
of purulent infection, and other diseases of the blood, may be
expected to be more or less elucidated by a study of the ac-
companying phenomena, causes, and results, of leucocythemia.
With a view, then, of stating as succinctly as possible the con-
clusions which may be legitimately derived from the thirty-five
cases previously recorded, I shall divide this part of the inquiry
into several sections, in which all these important topics will
be shortly considered.

I. Symptoms ohsemed in individuals affected with Leucocy-
themia. The symptoms have been very carefully observed in
several of the cases recorded in the first part of this memoir,
but we have great difficulty in referring any of them to the
mere alteration in the blood. Several of those which were
most constant and best marked in advanced cases, were appa-
rently caused by the increased size of the spleen or liver, as
they have been seen to occur in other cases where these organs
have been enlarged, without the occurrence of leucocythemia.
No doubt the peculiar change in the blood of which we are
treating has been discovered in individuals affected with en-
larged spleen ; but this may arise from the circumstance, that
the circulating fluid has been more frequently examined in per-
sons laboring under that complication. When leucocythemia,
however, is more generally studied, it will very probably be
found associated with enlargement in other organs, especially
of the thyroid, thymus, supra-renal capsules, and lymphatic
glands. Hence, I am persuaded, no systematic history of the
symptoms connected with this morbid state can be given in the
present state of our knowledge ; and 1 shall therefore merely
content myself with an analysis of those observed in the cases
recorded.

Of the thirty-five cases which are given in the preceding
pages, leucoc}themia was demonstrated to exist, by careful

1852."] Leucocythemia. 481

microscopic examination, in twenty-five. The facts presented
by these may be afterwards compared with those offered by
such cases as were doubtful, or by those in which, associated
with large spleen, it was proved that the blood was quite
healthy.

Sex. Of the twenty-five cases, sixteen occurred in males
and nine in females.

A[^e. The youngest case in which leucocythemia was ob-
served was in a girl aged 9, and the eldest in a w'oman aged

09 years. In two cases the ages are not stated, but in the re-
maining tw^enty-three they may be arranged as follows : Under

10 years, one case; between 10 and 20, two cases; between
20 and 80, three cases ; between 30 and 40, seven cases ; be-
tween 40 and 50, four cases; between 50 and 60, three cases ;
and between 60 and 70, three cases. So far as this analysis
goes, the diseases would appear to be most common in adult
life, and more frequent in advanced age than in youth.

Abdominal swelling. Greater or less swelling of the abdo-
men was present in twenty out of the twenty-five cases,
evidently dependent, in the majority of these, on enlarge-
ment of the spleen and liver, singly or united. In five cases
ascites was also present. In several of the cases there was
more or less abdominal pain or tenderness, while in a few the
enlargement only produced inconvenience, from its size or
weight.

Respiration. The respiration was more or less aftected in
I twelve out of the twenty-five cases. Of these dyspnoea existed
i in eight. The respiration is said to have been hurried in one ;
' short in a second ; laborious in a third ; and slow^ in a fourth.
\ The disordered respiration appeared to be dependent in some
I cases on enlargement of the abdomen, and corresponding com-
' pression of the pulmonary organs, in others (five cases) it may

have resulted from disease of the lungs themselves.
j Vomiting was present in seven cases. In two at the com-
I mencement, in three it was occasional, in one there was
hematemesis, and in one it was connected with ulcer of the
i stomach.

i; Diarrhcea was present in tw^elve cases, and in some was the

leading symptom throughout the progress of the disease. In

Tinlay, for instance (Case 2,) during the six months he was in

the Infirmary, the bowels were opened from eight to twelve

times a-day for weeks together. In other cases this symptom

i only came on latterly, and in a few w^as not urgent.

Constipation is said to have existed in five cases.

Hemorrhages. Extravasation of blood occurred in fourteen

out of the twenty-five cases. Of these there was epistaxis in

482 Leucocythemia, [August,

six cases ; hematemesis in one case ; hemorrhage by stool, in-
cluding hemorrhoids, in four cases; hemoptysis in one case;
flooding after delivery in one case, and bleeding from spongy
gums in one case. In some of these cases bleeding from the
gums or bowels was associated with epistaxis, and this last
symptom was observed in some of the best marked cases of
the disease, with enlarged spleen.

Dropsy was present, more or less, in thirteen cases, generally
dependent on the abdominal tumour. There was anasarca in
two cases, ascites in four cases, and oedema of the lower ex-
tremities in seven cases.

Fever. More or less fever was observed in eleven cases,
indicated by increase of pulse, loss of appetite, thirst, and heat
of skin. It was occasionally present at the commencement, at
other times at the termination of the disease. In no case did it
exist to any extent, or was long continued. From the frequency
of splenic enlargement, it might be supposed by some that the
disease was connected with intermittent fever, but that this ever
occurred is very doubtful. It is said to have preceded the dis-
ease in three cases. In Case 8 the report says, that four months
previous to admission there had been intermittent fever, but
Dr. Walshe adds, " this point was not sufficiently inquired into."
In Case 10 there had been repeated attacks of ague, the last of
which occured nine years before he came under observation,
and seven years before the abdominal tumour was perceived.
In Case 19 the patient also had laboured under intermittent
fever, but seventeen years previous to the commencement of
the abdominal sw^elling. So far as the recorded cases are con-
cerned, therefore, there is every reason to believe that inter-
mittent fever is in no way concerned with the production of
leucccythemia.

Pallor of the surface. An unusual pallor of the surface was
observed in many cases, resembling that of anemia. The con-
junctivae, also, were of a peculiar light blue tint.

Jaundice. In one case only of all those in which the liver
was affected, was jaundice observed.

Emaciation. In most of the fatal cases emaciation was ex-
treme.

Complications. Disease of the lung was present in five
cases, including one case of bronchitis, one of phthisis, and three
of pneumonia. Bright's disease existed in two cases, cerebral
hemorrhage in one case ; cancer was present in three cases,
in one, in the form of an undescribed abdominal tumour (Case
10,) in a second, there was a cancer of the thyroid body and
neighbouring lymphatics, and in a third, cancer of the liver,
with ulcer of the stomach, stricture of the urethra, and hydro-

1852.] Leucocythemia. 483

cele. All these diseases were characterised by their peculiar
symptoms, or physical signs during life.

It must not be supposed that the above numerical account of
the symptoms exhibits even an approximation to the propor-
tion which any particular one holds to the number of cases on
record. Owing to the imperfection with which many of these
are described, important symptoms in some not being even
alluded to, this is obviously impossible. Statistics are no more
applicable to this subject than to any other in medicine, where
the cases have not been expressly drawn up in reference to
such an injury.

II. Condition of the Blood in Cases of Leucocythemia. Of
the twenty-five cases of undoubted leucocythemia, it was de-
tected after death only, in ten ; during life only, in six; and
both during life and after death, in nine cases. Thus it has
been detected in the living body in fifteen cases, and in the dead
body in nineteen cases.

On examining the blood of living persons (which is most
readily accomplished by extracting a drop from the finger by
pricking it with a needle, and then examining it between glass-
es under the microscope in the usual way), the yellow and
colorless corpuscles are at first seen rolling confusedly together,
and the excess in number of the latter over the former is at
once perceived. This, however, becomes more evident after a
short time, when the coloured bodies are aggregated together
in rolls, and leave clear spaces between them, which are more
or less crowded with the colourless ones. Means are altogether
wanting to enable us to determine with exactitude the rela-
tive proportion of the two kinds of corpuscles in dilTerent cases.
In some the colourless corpuscles are only slightly increased
beyond their usual number. In one case they are described
as five times as numerous as those in health. .They are also
said in particular instances to be '" greatly increased," " one
third as numerous,'' and " as numerous " as the coloured cor-
puscles. In all these statements there is nothing exact. Per-
haps the best method of judging is to regard the spaces or
1 meshes left between the rolls or aggregations of yellow blood
corpuscles. When these are completely filled up, the colour-
less bodies do not, in fact, amount to one-third of the coloured
I ones, on account of the large number of the latter which may
I exist in a small space, in the form of rouleaux.
! The size of the colourless corpuscles in the various cases giv-
I en differs considerably. Even when at first sight they appear
I to be of tolerably uniform size in any one case, it may be ob-
I served, when they are magnified, highly and carefully measured,
! that some are twice the size of others, with all the intervening

484 Leucocythemia. [August,

sizes between them. In some cases, though comparatively few
in number, they are described as being three or four times
larger than the coloured corpuscles, and in two cases recorded,
they were in one about the same size, or somewhat smaller,
and in the other of two sizes, one larger and the other decided-
ly smaller.

In the nineteen cases in which the blood was carefully ex-
amined after death, the same variations with regard to number
and size of the colourless corpuscles were found to exist, as
have just been referred to in blood drawn fresh from the finger.
It was always observable, however, that they were most nu-
merous in the clot ; and when they existed in any number, as
in Cases 1 and 2, they communicated to the colourless coagulum
a peculiar dull, whitish look, and rendered it more friable un-
der pressure. When less numerous, portions of the colourless
coagulum from the heart and large vessels might be seen to
present a dull cream colour, easily distinguishable from the
gelatinous and fibrous appearance of a healthy clot, and such
altered portions always contained a large number of the colour-
less bodies. This was especially observable in Case 34.

There is one remarkable fact which has been strongly
impressed upon me by careful observation of the preceding
cases. In no one instance has the condition of the blood been
observed to undergo any marked change after the excess of
white cells in it was discovered. In no case has this condition
of the blood been seen to appear and progress gradually, as is
observed in so many other lesions. In the case of Tinlay
(Case 2,) the patient was under medical observation for a period
of eighteen months, and the same excess of colourless corpus-
cles existed at the end of that time, as at its commencement.
In the case of Kerr (Case 19,) the corpuscles were only slightly
augmented in number, and yet at the end of eleven months
they were not more numerous than when first examined.
Cases are still to be met with, therefore, in which the commence-
ment and progress of leucocythemia are to be observed. Such
can only be expected to be found when the microscopical in-
vestigation of the blood is more generally practised in clinical
investigation, as it is commencing to be in the Royal Infirmary.

III. Chemical Composition of the Blood in cases of Lecocy-
themia. The chemical analysis of vi^hite cell-blood has been
undertaken in only five cases, a number far too few to arrive at
any important results. One cause of this is, that the majority
of the twenty-five undoubted cases were only discovered after
death, when any analysis of the blood in reference to the rela-
tive proportions of all its constituents cannot be determined.
Another cause is owing: to the circumstance, that several of

1852.]

Leucocythemia.

485

the cases observed during life were so weak and exhausted,
that the abstraction of even two oz. of blood, for the purpose of
analysis, could not be safely ventured upon. Of the five analy-
ses, three were performed by Dr. William Robertson, of Edin-
burgh, one by Dr. Parkes, of London, and one by Dr. Strecker,
of Giessen. Dr. Robertson also analysed the blood of a sixth
case (Case 28,) in which there was enlargement of the spleen
without leucocythemia. The following is a tabular view of
these analyses, the inferences from which will be given on a
future occasion :

Analyses of the Blood.

Case.

Sp. Grav.

Sp.Gr.of
Serum.

Fibrin.

Serous
Solids.

Globules.

Total
Solids.

Water.

No. 2.

1041-5

1026-5

60

72-0

67-5

145-5

854-5

d

s

3.

10360

1023-0

2-3

67-0

49-7

119-0

881-0

8.

7-08

75-22

101-63

183-93

816-07

-a

Later analysis.

4-75

77-52

97-93

180-2

819 8

19.

10495

10290

50

950

800

180-0

820-0

y

29.

4-46

82-35

97-39

184-2

815-8

i1

28.

10420

1025-5

3-9

75-7

76-3

155-9

844-1

IV. Morbid Anatomy of individuals affected with Leucocy-
themia. Of the twenty -five undoubted cases of leucocythemia
which have been recorded, the body has been examined after
death in nineteen. The information obtained from this source
may be still further extended by a consideration of four cases
in which the existence of this condition of the blood is highly
probable ; of seven cases recorded by Dr. Hodgkin of enlarge-
ment of the spleen and lymphatic glands, and of two cases ex-
amined after death where the spleen was hypertrophied without
leucocythemia. In all, thirty-two dissections.

The organs which have been found to be most uniformly
diseased are the spleen, the liver, and lymphatic glands, and of
these I shall speak separately. The other lesions found in the
brain, lungs, heart, kidneys, &c., alluded to in Section I., under
the head of complications, were evidently accidental or con-
secutive, and need not be alluded to especially, in this place.

Condition of the spleen. -Of^ the nineteen cases of leucocy-
themia in which the body was examined after death, the spleen
was found to be more or less enlarged in sixteen. In the other
three, although it was healthy, the pulp in one, is said to be '* a
little more compact than usual ;" in a second its condition after
death is not alluded to, although an encephaloid tumour occu-

N. S. VOL. VIII. NO. VIII.

31

486 Leucocythemia. [August,

pied the left side of the abdomen ; and in a third the spleen
was " healthy."

Of the sixteen cases in which the spleen was increased in
volume, it weighed above 7 lbs. in three; above 5 lbs. in tv^'o ;
above 3 lbs. in two> above 2 lbs. in four; and nearly 1 lb. in
one case. In four cases it was not weighed. The greatest
weight of a spleen was 7 lbs. 13 oz., and the largest measure-
rr^ent 16| inches long, and 9i inches broad. The texture of
the organ varied in different cases, in some being of unusual
density, in others natural, and in a third case more or less soft
and pulpy. In a few cases it contained yellowish masses, appa-
rently a form of deposit, but in reality degenerated tissue. The
structure was examined microscopically in seven cases, in all
of which it was demonstrated that the cell and nuclear elenvents
were increased, while the fibrous portion of the organ was ap-
parently normal.

In four cases in which the existence of leucocythemia is pro-
bable, changes similar to those just stated occured in the spleen,
and in Dr. Hodgkin's cases similar lesions were found associa-
ted with enlarged lymphatic glands.

It is clear, however, that mere enlargement of the spleen is
not necessarily connected with white cell-blood, for in case 27
it was simply hypertrophied and weiglied three pounds and a
half; and in numerous other cases where this organ has been
undoubtedly enlarged, it has been proved by careful examina-
tion that the blood was normal (Cases 26, 28, 35.) It remains
to be ascertained what are the structural differences in the spleen
existing between cases like these last, and those in which
leucocythemia exists.

Condition of the Liver. Of the nineteen cases examined
after death, the Uver was diseased in thirteen. In the other
six it is distinctly stated to have been healthy in five, while in
one it is not noticed in the report.

Of the thirteen cases, the liver was cirrhosed in two, one
in its incipient and one in the advanced stage of that disease. In
a third case there was cancer of the organ, and in the ten others
the liver was more or less hypertrophied. Of these it weighed
above 13 lbs. in one ; above 12 lbs. in one ; above 10 lbs. in
one ; above 6 lbs. in three ; and above 5 lbs. in two cases. In
two cases, though much enlarged, the weight is not stated. In
these cases the organ was more or less congested, and its con-
sistence varied from great firmness to a degree of softening
amounting to diffluence. The minute structure of the liver
was carefully examined in four cases, and found to be unaffect-
ed in three, while in the fourth it was infiltrated with cancerous
exudation. ,

1852.] Leucocythemia. 487

In the six probable cases of leucocythemia, it is said that the
liver was greatly hypertrophied in four. In the other two its
condition is not stated.

Condition of the lymphatic glands. Of the nineteen cases
examined after death, the lymphatic glands were more or less
diseased in eleven. Indeed, it is very probable that they were
affected in a larger number, as in most of the other cases they
were in no way alluded to, and may possibly have escaped ob-
servation from an unacquaintance with the importance which,
as we shall see, ought to be attached to them.

Of the eleven cases, the lymphatic glands throughout the
body were greatly enlarged in four, and more or less cancer-
ous in three others. The mesenteric glands were especially
affected in two ; the thyroid and epigastric glands in one ; and
the solitary and aggregate intestinal glands in one. In some
cases they were soft, presenting on section a granular whitish
appearance, and yielding a copious turbid juice on pressure.
In other cases they were more indurated ; and in one there
were slight calcareous deposits. The glandular structure was
carefully examined microscopically in eight cases, and in all
exhibited increase of the normal tissue, the juice abounding in
cell or nuclear elements. In two cases, cancer cells were min-
gled with the healthy textures of the glands.

In the 17th volume of the Medico-Chirurgical Transactions,
Dr. Hodgkin has recorded seven cases in which the lymphatic
glands were more or less enlarged, and at the same time associ-
ated with increased size of the spleen. He considers the en-
largement of both structures to be allied, and to depend upon a
primary lesion unconnected with inflammation or adventitious
structures. The appearance of a bloody serum in the thoracic
duct and absorbents struck him in two of these cases, but the
blood itself was not apparently noticed. At the time Dr. Hodg-
kin wrote (1832), the microscope was not much employed in
pathological investigation, but had the blood been examined in
these cases, I cannot resist the conviction that the discovery of
leucocythemia would not have been reserved for the year 1845.

In the concluding portion of this memoir, it will be my en-
deavour to establish from the foregoing facts, and from numer-
ous other observations and experiments:

1. That the coloured blood-corpuscle is derived from the
colorless one.

2. That the colourless blood-corpuscles are derived from the
glands of the lymphatic system.

3. That the lymphatic glandular system is composed of the
spleen, supra-renal capsules, thyroid body, thymus (pituitary
pineal ?) and lymphatic glands, and that these constitute an ex-

488 Chronic Rheumatism. [August,

tensive apparatus for the formation and elaboration of blood-
Gorpuscles.

4. That the fibrin of the blood is derived from the solution
of the blood-corpuscles, and the effete matter resulting from the
disintegration of the tissues.

5. That these propositions concerning the origin, develop-
ment, and disintegration of the blood-corpuscles are now as a
consistent theory advanced for the first time, receive proof of
their correctness from the cases of leucocythemia previously
detailed, and are in harmony with the facts elicited by the la-
bours of Hewson, Nasse, Wagner, Richert, Gulliver, Zimmer-
man, Wharton Jones, Simon, Kojliker, Milne Edwards, Goodsir,
and others. \_MonthIy Jour, of Med. Science.

On Chronic Rheumatism. By John Carghill.

[The following paper, read before the Newcastle and Gates-
head Pathological Society, comprises an analysis of one hun-
dred and forty-three cases, one hundred of which were treated
by the nitrate of potash in large doses, and the remaining forty-
three by colchicum.]

These cases have been treated during a period of nearly six
years, i. e. between 1842 and 1848, and they have been nearly
all in-patients of this Hospital, so that I have had them con-
stantly under my own eye, the few not so situated having been
out-patients.

I have compared the cases together under as equal circum-
stances as possible, and have endeavored to attain as much
accuracy as I could by carefully registering them at the time ;
this register comprises the following features : Age, sex, dura-
tion of malady previous to admission, seat of pains, dose and
combination of remedy, time of its employment, result, disturb-
ing or other effects on the system, temperament of the patient,
and concomitant treatment.

I shall first consider these points in reference to what was
observed in the colchicum patients, and then in those treated
by nitrate of potash, and shall conclude by recording certain
deductions, which I think have unfolded themselves from the
various facts, and likewise mention the views I entertain of the
pathology and intimate nature of rheumatism.

Of the forty-three cases treated by colchicum, fourteen only
were cured, or about one-third, and the average duration of the
treatment was fifteen and a half days ; the average duration of
the malady before admission being seventy-three days. In ad-
dition to the fourteen who recovered entirely, there were twelve

1852.] Chronic Rheumatism, 489

relieved, whilst twelve remained no better. In one the com-
plaint appeared to be worse, and in the other four, circumstances
arose which prevented any positive conclusions from being
arrived at.

Dose and combination of the Colchicum. In rather more
than half of those cured, that result was effected by the vinum
seminum colchici in the dose of from fifteen to thirty drops
thrice a day, with a little magnesia and sp. etheris nitrici. In
a very few intances ten grains of Dover's powder were given
a few times at bed-time. In six out of the forty-three, the col-
chicum was given in powder in four grain doses thrice a day ;
in one case it was given in six grain doses thrice a day, and in
one case in two grain doses thrice a day, all combined with pul-
vis cretse. In all but the last named it produced vomiting,
griping, and diarrhoea in two or three days' time, and had to
be left off for the vinum with magnesia. Of this latter combi-
nation, the dose before mentioned, viz : "^Uxv. to xxx. with
fifteen grains of magnesia, and 3ss. of sp. eth. nit. was the
most effectual, and the best borne. When the vinum was
given by itself it seemed slower in its curative effect, and when
given in 3jss. doses of 3j. doses thrice a day, either alone or
combined (a measure in a few instances adopted,) it invariably
had to be left off, from its producing very speedily its usual
severe physiological effects, with great depression, and often
cramps, the disease remaining at the same time unaffected. I
should add, that these results followed even when the above
doses were attained to very gradually.

Concomitant treatment, In seventeen out of the forty-three
cases the warm bath thrice a week was used, and in fourteen
out of this number manifest relief was obtained. In ten cases
out of the forty-three, Dover's powder was given in from ten
to fifteen grains each night, and in six of these cases it was
followed by beneficial effects. Cupping was occasionally used,
and generally with benefit. Bleeding from the arm w^as scarce-
ly ever practised, and calomel, Epsom salts, blue pill, or colo-
cynth, were used as preliminaries, if constipation existed. As to
the seat of the disease, it was in the several joints and muscles.
In four cases wherein the rheumatism existed along v;ith sciatica
as its chief feature, the treatment by colchicum was fruitless.

11. Chronic Rheumatism treated by Nitrate of Potash in
large doses. Of the one hundred cases treated by this method,
there were sixty-one cured, being more than six-tenths of the
whole, and the average duration of the treatment was thirteen
and three-quarter days. In addition to the sixty-one cured,
there were twenty who experienced great relief, but were not
entirely cured at the time of dismissal; there were ve wJie

490 Chronic Rheumatism. [August,

experienced very slight benefit only, three received no benefit,
and three got worse. In the remaining eight cases no positive
conclusions could be arrived at.

Dose and combination of the remedy. The usual dose to
begin with v^as 9ij. thrice a day in barley water ; this was
adhered to in many cases throughout, but in a large number it
was increased to 3j., 3iss., 3ij., thrice a day, and in one case
3iij. every four hours was begun with and continued without
intermission for twelve days, without the smallest inconveni-
ence to the patient, who was cured in that period. This was
a bad case of two and a half years' previous duration. The
dose was often begun with and continued at 3j., and with no
disagreeable effect ; sometimes 3j. thrice daily, and sometimes
3j every four hours consecutively.

Being desirous of ascertaining whether the duration of the
malady might be shortened, or good in other ways obtained by
combining the nitre with sp. nit., antim., tart, and tinct. opii, I
adopted this in a considerable number of cases, and the result
has shown me that no advantage is derivable from this practice.
The dose of sp. of nitre was generally from ^^Ixv. to 3ss. or
more ; that of the vin. antim. ^xv., and that of the tinct. opii.
^.v. to each dose of the pot. nit. Sweating and diuresis were
equally produced by the nitre alone as when given in the above
combination. Of the three, the tr. opii alone appeared useful
by frequently assuaging the severe pain.

Disturbing effects. It is of great importance to remark that
this remedy was invariably administered in a large quantity of
warm barley water not less than viij. to each dose. When
given in the above large dose, without a diluent and demulcent
like barley-water, it produces intense griping, with pallor of
the countenance and cold perspiration, the pulse and heart's
action flagging and coming down, and the greatest anxiety
being experienced. This is followed by a dry red tongue, with
enlarged papillae and much thirst. This I had an opportunity
of seeing to an intense degree in one case wherein the nitrate
of potash in those doses had been administered several times
w^ithout any diluent by the oversight of a nurse ; she gave it in
iss. of plain water. I was on the point of applying numerous
leeches to the epigastrium, fearing that gastritis was coming on,
when the symptoms at last yielded to diluents and warm ex-
ternal applications, leaving no appreciable effects behind.

I shall now mention what were the disturbing effects on the
system observed to be produced by large doses of nitrate of
potash in cases where it had been duly taken with barley-water,
but had not been well borne by the system. Those effects
were seldom manifested, the medicine, when properly diluted,

1852.] Chronic Rheumatism. 491

seeming lo act mildly and efficiently. When it is not tolerated,
hov/ev>er,its effects are primarily on the nervous system. They
are these : general debility of the limbs, especially the lower
extremities, and the knees, loo, particularly complained of. I
have seen this carried to an extent which made the patients
believe that they were seized with general paralysis ; the whole
body seemed to be made of wood, and for some hours it was
impossible for them to rise from their seat or to move hand or
foot. To this were conjoined general trembHngs, and the
speech was affected ; occasionally the names of things were
foro;otten or mistaken; there was also giddiness, and a painful
rushing sound in the ears. I n^ver in these rare instances saw
any distortion of the features, and the symptoms subsided in a
few hours by diuretics or copious perspiration. In the event
of such results occurring, the chief remedies I should recom-
mend would be hot diluents and hot blankets. The subjects of
them will be found generally of the purely nervous temipera-
weTzf, especially if associated with feeble power of the constitu-
tion. When the sanguine or bilious temperament is combined
with the nervous, the remedy is better borne and may be pushed
farther ; and it agrees with my observation that the bilious
lymphatic temperament, with its firm, harsh, muscular devel-
opment, is the one in which this plan of treatment the oftenest
succeeds, and may be used the most fearlessly, as it is the one on
which chronic rheumatism, when once established, displays
itself with perhaps the greatest relentlessness.

The concomitant treatment was simple, and most generally
dispensed with altogether (with a view to ascertain more accu-
rately the value of the nitrate of potash itself), except in cases
of severe complication, in which the need for additional means,
chiefly local, was urgent. It consisted in occasional warm
baths and vapour baths. Cupping and leeching were had re-
course to in such cases as showed a concentration of the disease
in particular joints, as evidenced by swelling, redness, and
acute pain not shifting its seat. In dull chronic pains local-
ized, occasional blisters v/ere applied, and often with benefit ;
and, towards the termination of the cases, a liniment of ammo-
nia and turpentine was frequently useful in restoring tne natu-
ral suppleness of the parts. When the pains were so great as
to prevent sleep, and to harass the patient in an unusual manner^
a draught of muriate of morphia, with solution of acetate of
ammonia and water, was given at bed-time The bowels were
kept free by means of occasional light cathartics; and the
treatment was generally commenced by giving a dose of calo-
mel and colocynth, followed by a draught of infusion of sennt
with sulphate of magnesia.

492 Chronic Rheumatism, [August,

The diet enjoined was nutritious, being the ordinary diet of
the house viz., meat once a day, milk, rice, broth. In such
cases as presented symptoms verging on the acute, low diet
was prescribed such as milk, tea, sago, &c. In all old stand-
ing chronic cases generous diet was found the best, accompa-
nied even by ale, porter, wine, or gin.

In the above 100 cases, the duration of the malady previous
to admission was widely different so much so, that no analytic
average could be struck with a view to results that would not
have a tendency rather to conduce to error than to elucidate
truth. I may state in general terms that the length of time in
these cases, previous to coming under the above treatment, was
from seven days to ten years, whilst there were a few who
could remember no period of their lives in which they had not
been victims, more or less, to the complaint. Two months, five
years, six years, six months, one year, were the most common
periods cited ; and it should be remarked that nearly all the
cases were of an unusually severe character, and had been un-
der all manner of practitioners ; for many, despairing of a cure
otherwise, had committed themselves to the tender mercies of
unprincipled quacks, from whose fiery ordeal they had emerged
with the conviction that now nothing but a residence in an in-
firmary with the reputation of our own could avail to benefit
them!

Sex, It is remarkable that, of the whole 143 patients, 17
only were women, the remaining 126 being men. The average
age of the women was 35f , that of the men 37|^. From this it
appears that, in this part of the country, men are about 8| times
more liable to be affected with chronic rheumatism than wo-
men, or for one woman attacked with chronic rheumatism
there will be between eight and nine men. This is in all pro-
bability owing to the greater exposure of men to cold and wet ;
for I have found that in all of these cases the exciting cause,,
when any could be given, was invariably cold and wet, or sud-
den transitions from a high temperature to the opposite. On
referring to MS. notes of M. Louis' clinical lectures on this
subject, taken down by me at the time of their delivery at the
hospital of La Pitie, in 1835, 1 find his experiments the same
as to the exciting cause invariably exposure to cold air or
draughts (un vent frais).

The difference as to the frequeney of rheumatism in France
and England seems to be very great. Louis says that, out of
100 cases of all sorts treated by him, he only found one of rheu-
matism ; and in the Paris hospitals, during two years, it was
rare that rheumatism, whether acute or chronic, ever fell under
my observation. That the difference is great among us will

I

1852.] Chronic Rheumatism. 493

appear from the following fact : On analysing, a good while
ago, a number of cases of all sorts, nearly all of them chronic,
treated by me in this hospital, embracing a period of five years,
and amounting to 959, I found that 86 were cases of chronic
rheumatism, being, on an average, one in eleven and a sixth of
the whole number. From this I think we may infer that cli-
mate exercises an immense differenc in this disease ; and doubt-
less the same cause is, in regard to all other diseases, more
powerful than we are generally aware of. How else can we
explain the entire exemption of some countries from certain
maladies ? In India and Egypt phthisis is unknown.

I will take the opportunity of stating here, that I believe
heart affections to be very uncommon associates with chronic
rheumatism ; nor do I think that this malady is apt to be fol-
lowed by cardiac disease. In the cases above analysed it was
constantly found that such of them as showed heart disease,
had been preceded by rheumatic fever, and the heart affection
could be traced to that period of acute disease. This is in
conformity with the opinion, now, I believe, generally enter-
tained viz : that acute rheumatism is frequently accompanied
by endocarditis, and without very vigorous measures, is apt to
be succeeded by permanent disorganisation of the heart. I
have seen this hold to the full extent admitted by Dr. Hope,
though not perhaps to the degree maintained by Boullaud. In
chronic rheumatism properly so called, heart disease is, in my
opinion, a rare occurrence.

In speaking of acute rheumatism I would record here my
experience that in patients under the age of puberty acute
rheumatism seldom or never happens without most seriously
involving the heart ; and the younger the patient (I have known
it occur at five years) the more certainly fatal is this heart affec-
tion. I have never seen a single subject in the above category
who eventually shook off the heart affection and recovered.
And, in addition to the ventricular hypertrophy and dilatation
constantly present in these cases, as well as the valvular disease,
I must mention a morbid appearance perhaps equally constant^
and which I think has been overlooked by pathologists, or only
casually if at all mentioned viz : a tough, dense, false mem-
brane lining the general interior of one or other of the dilated
auricles, generally the left, obliterating the musculi pectinati
almost entirely, and so converting the auricle into an uncon-
tractile sac : thus furthering mitral regurgitation, and, by its
undoubted eflect of congesting the lungs and brain according^
to the auricle affected, mainly producing the frightful dyspnoea
and brain symptoms which constitute the worst features of the
malady.

494 Chronic Rheumatism. [August,

Of what value is the nitrate of potash in large doses in acute
i'heumatisni ? I have had no experience of it myself in acute
rheumatism, trusting as I have done to calomel, opium, Dover's
powder, antimony, and, in the worst cases, bleeding; but my
friend. Dr. Fenwick, of North Shields, who afforded me valua-
ble assistance in preparing the first series of the above cases,
when clinical clerk in this house some years ago, as did also Mr.
Gibb, informs me that he has adopted it to a large extent in
private practice in Shields, and has found it to answer in a re-
markable manner. I would also refer you to Dr. Basham's
cases of the acute form, and his treatment by the nitrate of pot-
ash in large doses a paper read to the Royal Medical and
Chirurgical Society of London, and published in the * Medical
Gazette,' Nov. 24, 1848. His success was great, the urine ac-
quiring a high specific gravity, and the salt being detected in it.
The specific gravity was raised to 1030 and 1040, which he
thinks was owing to the nitrate, though Dr. C. B. Williams
attributes it to the urea and the lithates which are by its agency
made to be present in the urine. Dr. Basham states his belief
that, owing to its agency in acute rheumatism, there is a certain
degree o{ exemption from disease of the heart.

1 will conclude this paper (already too long) by recording
certain facts and deductions which have manifested themselves
tome from the careful investigation I made of the above cases.

In nine cases out of those wherein no relief or only slight re-
lief was obtained, there were either purulent collections some-
where, or the usual common inflammations which precede sup-
puration such as testitis, obstinate conjunctivitis, erysipelas.
Are we entitled to deduce from this the general therapeutic
principle, that in chronic rheumatism, when it is in that aggra-
vated ibrm in which we have pus circulating in the blood, the
treatment by nitrate of potash is not to be depended on, and
must be relinquished for another ?

Again, in 81 out of the 100, the cure was almost or altogether
eflfected in 14 days by the nitrate of potash in large doses, and
these were cases wherein, though severe, there was no suppura-
tion, nor ordinary inflammation of particular organs. It has
been before laid down that nitrate of potash acts primarily on
the nervous system. May we not infer, then, that those 81
cases were cases in which the nervous system was alone at
fault? And, from the two considerations taken together, may
we not look at rheumatism as a disease composed of two varie-
ties viz., that in which its assaults are expended on the nervous
system alone, and that other more severe one in which pus cir-
culates in the blood ? Various observations ana reflections
have led me to take this view of the subject. Rheumatism is

1852.] HcB?naturia. 495

first a nervous and then a blood disease, and it maintains a dis-
tinct individuality in both these phases in a manner more sin-
gular than other complaints. In what I call its nervous form
it is a kind of Harlequin inflammation, and less mischievous
than it seems. A little energy will knock it out of the system:
if uncontrolled, it undergoes -a transmutation, becomes grave,
enters the blood, and changes it, and walks into the heart itself,
the citadel of life. At present we want a set of careful micro-
scopic experiments on the blood in all the varied conditions of
rheumatism. Last year, at my request, Mr. Gibb took for mi-
croscopic examination small portions of the blood of several
patients affected with different diseases. In the blood of one
who had no trace of inflammatory disease of any kind w^e
found, to our surprise, numbers of pus globules. In a lew days
there was developed in this patient a severe erysipelas, which
finished by becoming phlegmonous. Here, then, inflammatory
disease existed in the blood for a certain time without betray-
ing its presence, until at length its increase became such (vires
acquirit eundo) that nothing but an acute attack upon the skin
sufficed for its elimination.

3. In cases wherein mercury has been previously extensively
taken, and cases where there is syphilitic malady present in the
system, whether mercury has been taken or not, the nitrate of
potash is without power. The remedy is the hydriodate of
potash.

4. In cases of general chronic rheumatism, in which sciatica
is the most painful feature, the nitrate of potash will banish the
complaint from the other parts, but will not avail against the
sciatica. In this event, arsenic, where it is borne," is the most
powerful remedy.

5. In cases wherein the symptoms are doubtful, being cir-
cumscribed though severe, and simulating such other common
inflammations as pleuritis, peritonitis, ordinary cerebral or spinal
meningitis, and even spinal irritation and hysteria, the state of
the tongue, if it appear as if overlaid with a coat of deep or light
white paint, so constant in the rheumatic condition, will most
essentially guide the diagnosis. [MeJ. Gazette.

On Hcematuria. By Dr. G. Owen Rees, F.R.S., &c.

[Blood may exist in the urine in different degrees ; either in
such quantities as that the red globules colour the urine by
their quantity, or they may be so minute in quantity as to re-
quire the microscope for their detection, or the paler parts of
rthe blood may be present, requiring chemical means for their

496 Hcematuria. [August,

detection. If it be effused in any quantity, the conditions of the
various parts of the urinary apparatus must be considered. The
treatment of the diseased conditions of these parts is so much
within the province of the surgeon that Dr. Rees counsels phy-
sicians to remember this whenever hsematuria cannot be satis-
factorily explained on other grounds. There are one or two
points to be noticed connected with the examination of urine
containing blood. And first, with respect to the recognition of
the blood corpuscles under the microscope.]

These bodies, as they float in urine, are seldom seen precise-
ly as they appear in serum. They are thicker at their edges,-
-and the colouring matter within them is paler. This condition
is caused by the entrance of urine into the corpuscle an effect
which occurs in virtue of the law of endosmosis. The blood-
corpuscle naturally contains within its membrane a fluid of the
same specific gravity as the liquor sanguinis ; and when there-
fore, it comes in contact with the urine, which is far below the
specific gravity of the liquor sanguinis, endosmodic currents
are immediately set up, an interchange takes place between the
-contents of the corpuscle and the urine without, and as the urine
is of less specific gravity than the contents of the corpuscle, the
interchange takes place in such manner that it enters the cor-
puscle in greater proportion than the contents pass out ; and
thus the body becomes distended.

I shall hereafter have occasion to allude to the presence of
pus and mucus in the urine, together with blood, and to the im-
portance of detecting them, inasmuch as we are thereby greatly
assisted in all our diagnosis in certain obscure cases of hemor-
rhage ; and I will therefore now describe the appearances pre-
sented by pus and mucus when so observed. Pus and mu-
cous corpuscles are both larger than those of the blood : they
-are colourless, and variegated on their surface : whereas the
blood corpuscle is smooth and of a light yellow colour. The
pus corpuscle very closely resembles the mucous ; but if care-
fully examined, we observe that it is dotted and granular rather
than variegated on the surface, and of looser texture than the
mucous corpuscle. The reactions of urine containing blood
-are easily appreciated ; and there is but one source of falla-
cy to which it is necessary to direct your attention. This
<jonsists in a condition of urine which will seldom be pres-
ent to confuse you, and I have not seen it more than twice. I
-allude to the brilliant red colour sometimes produced in urine
by certain articles of diet. Many vegetable matters colour the
urine of a fine amber colour; the pyrola and sumach possess
this property in a marked degree. Sometimes this colour will
Clearly approach to red ; and occasioaally, when beet-root has

1852.] HcBmaturia, 497

been eaten, the colour observed in the urine is so complete-
ly that of blood, that it is impossible to discriminate without
having recourse to the use of reageants. The distinction is
easily made, however. If the urine be tested by the liquor po-
tassae, a dirty brownish precipitate is produced if the colour be
owing to blood ; but in the case of vegetable colouring matter,
the urine will become of a fine green tint.

When blood is present as a deposit in urine, in any quantity,
we may be sure that albumen exists in solution ; and it is im-
portant that we should know, within certain limits, the corres-
-ponding degree to which we may expect the urine to be albu-
minous for any given quantity of red corpuscles which may
appear in it. An approach to tolerable exactness may be
attained by practice and attention to this point ; and it is one
of great value in the diagnosis of urinary diseases. When we
boil urine containing albumen, if it be acid, as is generally the
case, a precipitate is produced. Now when blood is present,
you will be surprised how much of it is required to produce an
amount of albuminous precipitate such as characterises cases
of ordinary albuminuria. Unless, indeed, the urine present the
appearance of being made up in very large proportions of blood,
the amount of albumen will generally be trivial. This will
not appear extraordinary to those who are in the habit of ob-
serving how much show a little blood can make ; and the quan-
tity of albumen in the urine of morbus Brightii may well appear
comparatively great, when it often amounts to as much as indi-
cates the disintegration of several ounces of blood per diem ;
and one ounce of blood will make a great show in the quantity
of urine passed in twenty-four hours. The importance of pay-
ing attention, then, to this point, principally consists in our being
able occasionally to detect the morbus Brightii by showing an
amount of albumen m the urine far above that indicated by the
red corpuscles present.

Returning to the pathology of the subject, let us now assume
that careful examination of the bladder and prostate gland has
satisfactorily showm that the kidneys or ureters are the source
whence the blood contained in the urine must be derived, and
consider to what condition of those parts the hemorrhage should
be attributed. First, as regards idiopathic haematuria. This
bleeding from the surfaces of the kidney, without any special
cause beyond exposure to cold or to the vicissitudes of climate
in warm and damp localities, has been considered as rare by
most writers. For my own part, it has so frequently occurred
to me to detect the cause of such hemorrhage in lesion of some
organ, that I am much inclined to deny hsenTaturiaever occurs,
except as an indication of decided disease of the kidnev or

498 Hcemaiuria. [August,

other part of the urinary apparatus. It is true, idiopathic
hsematuria sometimes occurs, together with hemorrhage from
other mucous surfaces, in those who ascend to great heights,
and who consequently suffer the loss of that amount of atmos-
pheric pressure which preserves the conditions of equilibrium
necessary to the safe circulation of the blood ; but we may at
once exclude such cases as these from the consideration.

With respect to the appearance of the urine, Dr. Prout con-
sidered that, when blood tinctured the whole fluid, appearing
equally dissolved throughout it, that the kidneys were generally
involved. This is an observation which experience certainly,
verifies. When such an appearance is observed, however, it
co-exists or alternates generally with blood as a deposit, and
we may conclude that there is calculus in the kidney, or that
the organ is the subject of other diseased condition, attended
either with great congestion, granular deposit, or malignant
disease. The detection of the real state of matters becomes
very important in such cases. The symptom is a prominent
one, and the patient's friends are sure to press the practitioner
urgently for his prognosis. Now, though in most cases, if cal-
cdus be present, the history or severity of symptoms will assist
us at once to the truth, yet it sometimes happens that such evi-
dence is not afforded ; and this is more especially the case when
oxalate of lime calculi are contained in the kidneys. Under
these conditions the urine may be bloody, and no other symp-
toms observed beyond dull lumbar pains. If oxalate of lime
crystals exist in the urine, there is also pain in the penis, which
does not affect the glans penis, as in stone in the bladder; but,
on the contrary, is most plainly felt at the root of the organ.

Now, though in these cases the hemorrhage will generally
follow upon some unwonted exertion, still it is not always so,
and the case is thus greatly obscured ; for we lose a most im-
portant adjuvant to our diagnosis. If the hemorrhage is the
result of any of those chronic states of disease to which the
name " morbus Brightii" has been given, we may easily detect
that it is so, for then the hemorrhage which may occur will soon
be found to give place to other conditions, in which the colour-
less matters of the blood alone become effused. We have here
only to wait; and, whenever the urine may be excreted of its
natural colour, to test it for the presence of albumen ; and if this
principle then be present in any quantity, without the colouring
matter of the blood, we may be nearly certain that the further
progress of the case will be marked by the continued exertion
of natural coloured urine containing albumen, and not by
hemorrhage, and that the patient is suffering from some form
of the morbus Brightii.

1852.] Hcematuria. 49D

If, however, the urine, on becoming of its natural colour after
an attack of haematuria, does not prove to contain albumen, then
we may feel nearl}' sure that the hemorrhage proceeded either
from a calculus in the kidney, or some malignant disease of the
organ.

The diagnosis between these two conditions must depend on
the observation of the following points:

1st. In malignant disease the blood is generally passed in
larger quantity than in calculus of the kidney.

2ndly. There is more frequent tendency to nausea on slight
occasion than in calculous disease.

3rdly. Microscopic examination of the urine will frequently
show pus or mucus in excess, if there be calculus ; whereas, in
malignant disease, this sign does not so frequently exist.

4th. The appearance of those suffering from malignant dis-
ease of the kidney, is nearly always indicative of a state of
anaemia more or less advanced.

5thly. In calculus, haematuria generally follows upon some
unwonted exertion.

6thly. Careful examination of the abdomen will frequently
lead to the detection of tumour if there be malignant disease of
the kidney.

To sum up, I should say, in the first place exclude from the
consideration, cases of what has been called idiopathic haema-
turia, which can scarcely exist under ordinary barometrical
conditions ; secondly, determine that the case does not belong
to the morbus Brightii, by ascertaining that when the red par-
ticles cease to appear the albumen also leaves the urine ; and,
thirdly, when the hemorrhage observed is placed within these
limits, determine whether it be owing to calculus in the kidney,
or to malignant disease, by especial attention to the following
points : The appearance and complexion of the patient; the
presence or absence of nausea on slight occasion ; the presence
or absence of pus and mucus in the urine mixed with blood
i corpuscles ; and, lastly, by careful exploration of the abdomen

I for the detection of tumour.

! Now as regards the treatment of the two forms of haematuria
' I have been speaking of, viz : that produced by calculus in
j the kidney, and that which is the consequence of malignant
i| disease.
\\ From what I have already brought before you with respect

II to the treatment of alkaline urine, as produced by irritation of
the urinary mucous surface, you will at once perceive that the
condition brought about by' the existence of a calculus can

\ never be benefitted by the exhibition of other than demulcent
and alkaline remedies. It matters not how the calculus may

500 HcBmaturia. [August,

be composed, be it uric acid, oxalate of lime, or phosphatic,
be it soluble in acids or alkalies, we cannot treat it chemically
while in the kidney. Our object must be to render the urine
as unirritating to the mucous membrane as possible, and enable
that membrane thus to bear the presence of the calculus with
as little inconvenience as possible. There is another indication,
however, which we answer by this alkaline and demulcent plan,
and a most important one. It consist in the relaxation of the
spasm of the canal. By effecting this, a small calculus may be
often brought away, which otherwise might remain to increase,
and perhaps destroy the patient. It is with this view that we \
should combine our demulcent and alkaline remedies with such
sedatives as the patient can bear without disturbance of stom-
ach. Our most favourable result, of course, will be the expul-
sion of the calculus. Next to this we must hope that it will
become encysted, and, by being so fixed in the kidney, cease
to cause irritation ; while we have to fear, as the worst result,
the setting up of inflammatory action in the body of the kidney.
This may terminate in the effusion of lymph in the tissue of
the organ, and in a subsequent contraction of the inflamed
part ; and sometimes the patient may be so fortunate under
these circumstances as to have the calculus which has caused
the acute nephritis should it be a small one, impacted in the
kidney, so as to create no further irritation. In a great many
of these cases, however, the acute nephritis terminates in sup-
purative disease ; and if there be any constitutional imperfec-
tion dependent on strumous or syphilitic taint, this is the way
in which we may generally expect the case to end. All we
can do under these circumstances is to support our patient,
exhibit opiates, and render the renal secretion as unirritating
as possible. It is absolutely necessary that such persons should
avoid exercise in any way beyond that necessary to walking
gently, or exercise in any easy carriage. Neglect of this dou-
bles the danger to the patient, while the difficulty of enforcing
the injunction is often very great.

With respect to the treatment of cases in which the haema-
turia depends on malignant disease of the kidney, of course we
cannot proceed with any hope of cure ; but much may be done
by attention to the general health, and by relieving those symp-
toms which arise as the result of the hemorrhage and the im-
paired state of the chylopoietic viscera. The anaemia so often
noticed in these cases, which causes dyspnoea on slight exertion,
and restless nights (from the facility w^ith which any error in
diet produces palpitation and throbbing of the carotids,) may
be to a great extent combated by the exhibition of iron in some
palatable form. Perhaps the best preparation for the purpose

1852.] Nitric Acid in Hooping Cough and Asth?na. 501

is the tinctura ferri sesquichloridi, taken in doses of from fUx.
to ^xx. three times a day, the bowels being watched the while,
and kept regular by the exhibition of mild and aromatic laxative
medicines.

It may be objected to the use of iron that it frequently tends
to produce hemorrhage, and that we ought scarcely, therefore,
to exhibit it; and it is quite true that care is necessary on this
point. Watch the effects of the remedy, however, and you will
constantly find you can exhibit it with advantage ; that it will
not induce haematuria, and especially if it be exhibited in the
form of the sesquichloride of iron tincture. With regard to
the use of styptics, they frequently appear useful in cases where
the disease is not much advanced. One of the best I know,
and which I have used several times of late, is the tannic acid,
exhibited, if necessary, at intervals between the doses of iron
in the form of pill. The dose should be from four to eight
grains three times in the day. I may here remark, with res-
pect to the use of this remedy, that, if you wish it should reach
the stomach as tannic acid, you must not exhibit it in solution.
You may, if you do so, have the good luck to give the first
dose before it becomes changed ; but tannic acid is rapidly
converted into gallic acid when dissolved, and the best means of
exhibiting it unchanged is io the form of pill. IMed, Gazette.

On Nitric Acid in Hooping Cough and Asthma. By F. C.
T. Arnoldi, M. D., Lecturer on Midwifery and Diseases of
Women and Children, St. Lawrence School of Medicine,
Montreal, &c., &c.

The few following remarks I take the liberty of communi-
cating to the profession, through the pages of this excellent
Journal, feeling perfectly confident they will be read with plea-
sure, inasmuch as they are somewhat novel as regards the
alleviation of hitherto supposed intractable diseases, viz : hoop-
ing cough and asthma. The modus operandi of the remedy I
will not at present attempt to explain, but from the results' of
my own practice and that of my medical confreres who have
watched it and adopted it, I confidently recommend its applica-
tion to all such as meet with similar cases. In hooping cough,
at whatever age, whether it be a child at the breast, or a full
grown adult, I administer nitric acid in solution, as strong as
lemon juice, sweetened ad libitum. I had given to a child of
two years of age, as much as one drachm and a half of concen-
trated nitric acid, in the above manner per diem, and I have
never known the disease to resist its use beyond three weeks.
In one instance, that of a child at the breast., only seven months

N. S. VOL. VIH. NO. VIII. 32

502 Nitric Acid in Hooping Cough and Asthma. [August,

old, the disease disappeared within eight days. In another in-
stance of a young lady fifteen years of age the paroxysms were
subdued within the first twenty-four hours, and the disease dis-
appeared within ten days. Again, in the cases of two boys
about ten years of age living at a great distance from one
another, w^ho had had the cough for several weeks, and to such
a violent degree, that both of ihem had the circumference of
their eyes ecchymosed as though they had been pummelled in
pugilistic combats, the acid acted positively like a miracle. A
medical confrere of mine had four of his children severely aflfec-
ted with the same disease in the middle of winter, and although
they had to be kept in-doors owing to the inclemency of the
weather, they were nevertheless all perfectly cured within three
weeks. I might go on to cite a hundred similar instances, but
these, I am satisfied, will prove sufficient to induce the profes-
sion to adopt this treatment. As regards asthma, the use of
nitric acid has proved not only in my own practice, but in that
of others who have adopted it, truly marvellous, and I trust
that the profession will remain satisfied by my quoting two
special cases. One is that of an elderly person, who had been
for five years a fi-equent inmate of the Montreal General Hos-
pital, a thorough victim to this disease. He generally remained
under treatment the winter, and used to be discharged when
the disease seemed to have exhausted itself. This patient,
about eighteen months ago, was again admitted into the Hospi-
tal, under the care of my friend Dr. David, who, observing the
obstinacy of the paroxysms, resolved on trying the use of nitric
acid, the result was that the first night was passed tolerably ;
the second night- he slept well ; the day after the third night he
reported himself perfectly convalescent, and on the fifth day he
was discharged at his own request, since which he has never
been heard of. The other case is that of a stout plethoric ser-
vant girl, about thirty-five years of age, who applied to me ir>
the early part of December last. She was then labouring under
very severe asthmatic distress, and told me that she had been
a martyr to repeated attacks, equally severe for four or five-
years past; that she had consulted many medical men, but
could never obtain any relief, until, as she said, the disease had
spent itself. I gave her a prescription containing half an ounce
of concentrated nitric acid, and I have never seen her since,^
but during the New Year holidays, happening to call at the-
house where she served, I made enquiry about her, when I was-
told, much to my merriment, that the reason why she never
came back to see me was that she thought that I had bewitched
her. She had often taken medicines which gave her no relief
but that the very first night after taking the acid, she slept per-

185*2.] Turpentine in Dysentery. 503

fectly sound, and had not, up to that time, had any return of
the synnptoms. Now, these are obstinate facts, and I trust that
this familiar method of communicating them will not diminish
their value, nor need any of the profession to be too sceptical
to follow the treatment. [^Canada Med. Jour.

Turpentine in Dysentery. By John Long, M. D., of Pleasant-
ville, Kentucky.

For more than twelve months past, I have been in the habit
of using Turpentine in the treatment of Dysentery, as it has
occurred in this section of country, and find it to be a most
valuable remedy in this often formidable disease. I have
employed it in cases where the irritation or inflammation seem-
ed to be confined to' the lower portion of the bowels, as well
as such as were complicated with typhoid fever. Dose, ten
drops of the turpentine combined wnth twenty drops of lauda-
num, for an adult every eight hours with mucilagenous drinks
and farinaceous diet. In obstinate cases it is necessary, in con-
junction with the above, to resort to the ordinary enemata of
laudanum and starch. Other remedies, as mercury, quinine or
astringents, may also be used as circumstances require.

I was first induced to resort to turpentine in the treatment of
I dysentery, at the suggestion of Dr. Wood of Philadelphia, w^ho
recommends it in typhoid fever.

During the past summer, I treated thirty cases according to
the above method, twenty-nine of which recovered and one
died ; the latter resided fifteen miles oflf, and I did not see him
but once. [^St. Louis Med. and Sur. Journal.

On the remedial virtues of Nitrate of Silver in Chronic Diar-
rhosa. By Professor A. H. Cenas, M. D.

f On taking charge of the Obstetrical department of Charity

I Hospital in November last, I found in the wards several chil-

I dren, between the ages of two and four years, laboring under

j Chronic Diarrhoea.

As they had been treated in the usual manner, viz : with
astringents, absorbents, opiates^ etc., etc., without success, I
resolved to try the efficacy of Nitrate of Silver in solution and

I by the mouth. The good effects of the remedy are shown in

' the following cases.

1 Case I. This child, a girl, aged about two years, came un-
der notice 6th November, she had been laboring'under diarrhcea
for nearly two months, and was very much emaciated, anemic

504 Nitrate of Siher in Chronic DiarrhcKa. [August,

and ulcerations in the lower extremity. Bowels were moved
about twenty times in the course of twenty-four hours and the
discharges were thin, glairy and greenish, and voided with con-
siderable tormina.

^. Nt. Argent Chrys. gr i.
Mucilag Acac, oz. iss.

Ordered a tea-spoonful of this solution to be given after each
stool. Diet, chicken broth ; drink, toast water.

Nov. !.__ Decidedly better, discharges from bow^els reduced
to twelve in twenty-four hours ; less tormina, but stool of the
same character. %. cont. treat, and diet.

Nov. 8. Improving rapidly, only eight stools in last twenty-
four hours, no tormina, stools of better color and constitutioUy
child more sprightly, complexion improving. R. cont. treat
and diet.

Nov. 9. From this date until the 15th improvement progres-
sive, medicine gradually withdrawn and child discharged well
on the 16th.

Case II. The child, also a girl, and aged about two years,
had been ill about two weeks; condition and symptoms pretty
much as above ; not, hov/ever, so many discharges from bowels,
being, as well as nurse could ascertain, about fourteen or fifteen
in twenty- four hours. R. Nit. Argent., as in the preceeding
case, with entire relief in four or five days.

Case III. This case, a boy, nearly four years old, had been-
laboring under diarrhoea for more than two months, was very
much reduced in flesh, and so debilitated as not to be able to
rise from bed ; about fifteen stools in twenty-four hours, which
were serous and almost inodorous, but acid, excoriating the-
anus and neighboring parts.

R. Nit. Argent, as above, chicken tea, drink, toast water.

Nov. 21. A shade better ; passages not quite so frequent;
nurse thought only two or three less than before medicine ; child
expresses himself as much easier. R. cont. 1;reat. and diet.

Nov. 22. Decidedly better, only eight stools since last visit,-
which were of better color, and constitution otherwise improv-
ed, disposed to set up. R. cont. treat.

Nov. 23. Still improving ; only four evacuations in last
twenty-four hours, and these were fecal in constitution and odor-
ous ; appetite improving, strength returning. From this date he-
continued to improve, getting out of bed for a few hours daily
and was finally discharged on the 28th.

Case IV. Nov. 24. Also a boy aged about three years ; this
child had been laboring under lienteric diarrhoea for several
months, with tumid abdomen and enlarged mesenteric and cer-
vical glands. Highly unfavorable symptoms, indicating a
advanced de^jree of marasmus and scrofula.

1852.] Suppositories. 505

Thus this case was decidedly unfavorable, and I had no ex-
pectation of affording relief; still, as the diarrha?a was incessant,
everything the child drank running through him, I ventured
on the solution, giving him the usual dose and in the usual man-
ner. Without detailing the case from day today, I will state that
for the first few days it acted like a charm, reducing the num-
ber of evacuations from more than twenty daily to only two or
three, and otherwise so greatly improving the little patient that
I began to hope for something permanent : when, however, on
the fifth day of the treatment, the efficacy of the remedy failed
and the little patient fell rapidly back to his first condition, in
which he lingered for a few days longer.

Case V. Occurred in female practice : the patient a little
girl aged about fourteen months, had been labouring under
choleriform diarrhoea for nearely three days before I saw her. I
found her, April 3d, pale, cold, and with a frequent pulse, and
having about twenty thin serous and fetid evacuations in the
twenty-four hours. I commenced the treatm.ent of the child by
a few of the ordinary remedies, and continued them for nearly
twenty-four hours, when perceiving no amendment,! resorted to
sol. of Nit. Silver as in the above cases, with the satisfaction of
restoring my little patient in the course of forty-eight hours.

I could enumerate other cases, but I think the above suffi-
cient to show the advantages of Nit. Silver exhibited in the
manner indicated, viz: in solution and by the mouth. I have
used the agent before under similar circumstances per anum,
but with indifferent success. This was principally owing to
the inability on the part of the infant of retaining the enemata,
or it may be to the want of precaution of the nurse in adminis-
tering it. By the mouth these objections vanish, the medicine
being tasteless, and any mother or nurse can properly adminis-
.ter it. INew Orleans Med. Register.

Suppositories. By A. B. Taylor.

As our National Dispensatory gives no account of this valua-
'ble class of medicinal applications, (suppositoria) a brief notice
'Of their preparation, in the "American Journal of Pharmacy,"
will perhaps be serviceable to some of its readers. Though
hitherto but little employed in this country, suppositories have
long been extensively used in France. They have recently,
however, attracted the attention of some of our physicians, and
bid fair to grow into much more general demand.

They may be described as medicated compounds of a stiff
consistence, designed to be introduced into the rectum, and
serving the purposes of the ordinary clysters or injections

506 Suppositories, [August,

{Enemata.) They are applicable in all cases of constipation,
or of irritability, or inflammation of the lower intestines ; and
have the advantage over liquid injections of more easy intro-
duction, as well as of greater comfort and cleanliness ; and they
may sometimes be retained, when liquors would not. There is,
perhaps, no substance so well adapted to serve as the vehicle of
these applications as the butter of cocoa, {oleum cacao,) as no
combinations of suet, spermaceti, or wax, &c., combine in so
great a degree the proper hardness or firmness of substance,
with the requisite fusibility.

The following formula, is a prescription of Dr. S. W. Mitch-
ell and has been considerably used.

Take of Cocoa Butter, I iss.

Powdered Opium, gr. xii.

Mix and make into twelve suppositories.

The butter of cocoa is to be melted by a gentle heat. The
opium is then to be well rubbed up with a small quantity of the
fluid, until thoroughly incorporated, and the remainder of the
melted butter gradually added. When cool and slightly thick-
ened, the mass, being well stirred, should then be poured into
paper cones. * If the cocoa butter is too fluid when transferred
to the moulds, the opium \V\\\ settle to the apex of the cone, and
not be properly diffiised through the substance. When perfect-
ly hard these cones should then be pared or scraped at the base,
until they weigh just one drachm, giving one grain of opium
to each suppository. Practically, therefore, it will be necessa-
ry to make one less than the required number, reserving the
parings for another operation.

The following formula has been prescribed by Dr. Pancoast :
Take of Cocoa Butter, ! i.

Extract of Krameria, 9ii.

Powdered Opium, gr. v.

Mix and make into ten suppositories, as ab(i.ve.

It is stated that cocoa butter is much esteemed in France, for
its supposed healing qualities, and is a favorite application in
cases of piles. With powdered galls, or tannic acid, this sub-
stance would therefore probably form a useful substitute tor the
ordinary pile ointment. The proportions to be employed, would
of course be regulated entirel}^ by the physician's order.

In Dorvault's French work on " Practical Pharmacy," sup-
positories are described as varying from the size of the little
finger, to that of the thumb; and weighing, from 3ii to Sii^j
(five to ten grammes.) The author gives as a formula for the

These moulds should be made of sized or writing paper, and may be con-
venieutly placed in shallow boxes of sand, to preserve their position.

1852.] Ckarcoal Cushions for Deodorizatlon. 507

vehicle, butter of cocoa melted with an eighth part, by weight,
of white wax : or as an inferior substitute, and one less used,
common tallow mixed with the snme proportion of wax. Soap
suppositories are formed by simply cutting soap into convenient
shapes. Suppositories are also prepared from honey, by boiling
down this substance till it becomes sufficiently hard to retain
its shape. There are also formuke given for anthelmintic, anti-
hemorrhoidal, astringent, emmenagogue, laxative, and vaginal
suppositories ; as well as belladonna, calomel, cicuta, mercurial,
and quinine suppositories.

In Gray's "Supplement to the Pharmacopoeia," there is
given the following formula for a suppository ; taken from the
Codex Medic. Hamherg, 1845.

>^. Aloes, 5vi.

Common Salt, ^iss.

Spanish Soap, iiss.

Starch, ^viii.

]Mix and make into a mass with honey, and then form into
<iones of the required size. \_A7nerican Jour, of Pharmacy.

Charcoal Cushions for Deodorization.

A. S , a patient under my care in the Hackney Union

Infirmary, has for some time "passed every thing under her,"
and thereby become a nuisance and cause of complaint to the
other patients in the w^ard. Eleven days ago, I adopted the
plan of placing beneath her a calico bag two feet square, partly
filled with Irish peat-charcoal, so as to form a sort of a cushion
and absorbing medium. It has had the happy effect which
continues even now, without any necessity for changing the
charcoal of completely neutralizing all unpleasant odor; and
if the bed becomes partly wet all the offensive ingredients are
absorbed and neutralized by the charcoal, which thus is a most
simple means of remedying a great nuisance, and one that re-
<|uires the most strict attention at best to prevent ; and that
attention is often difficult and always expensive to procure. In
Ksases of incontinence of urine particularly, and indeed all attend-
edwith foetid discharges, cancer, compound fractures, &c., this
plan or some modification of it might be adopted with advan-
tage. I have been informed that some of the same material
has been placed in the urinals of the South-Western Railway,
with equally good results, in the prevention of unpleasant odor ;
-and that even after it had been unchanged for some weeks, the
fluid that percolates has been found, by chemical analysis, to
-contain little or no trace of the organic or saline products of
ojrine. The fact induced me to trv it as above. An argument

508 NcBVUs of the Scalp treated by Tartar Emetic. [August,

in favor of its adoption in hospitals and lunatic asylums is, that
the peat, after its deodorizing properties are exhausted, becomes
more valuable for the purpose of manure, so that its use is with-
out expense \_Boston Med. and Surg. Journal, from Mr. How-
ell in London Lancet and Dublin Medical Press.

Ncevus of the Scalp treated by Tartar Emetic.

Anne Shellard, aged nine months, was admitted into the
Queen's Hospital, under the care of Mr. Sands Cox, February,
1851, on account of a nsevus situated over the right parietal
bone, about the size of a half-crown piece. The mother stated
that a slight discoloration of the scalp was observed at birth;
that it remained stationary for some time, but eventually began
to increase, and had during the last two months attained its
present size. There was no pulsation evident in the tumor,
which was of a bluish cast, and slightly raised above the adjoin-
ing integument. The child's general health was good, and all
the functions regular; but a branch of the temporal artery w^as
enlarged, and could be traced almost into the diseased parts.
On the third day after admission, Mr. Sands Cox ordered the
potassio-tartrate of antimony to be applied, which was accord-
ingly done. In two days, the application having been several
times repeated, the whole of the discolored portion was convert-
ed into a pustular mass, and this with but little or no inflamma-
tion or irritation of the scalp. Poultices were now applied, and
in the course of a week there was a healthy granulating surface,
which cicatrized entirely three weeks afterwards. The pa-
tient left the hospital without any appearance of returning dis-
ease, and some time after continued quite well. \_Frov. Med,
and Surg. Journal,

I

Case of a Large Subcutaneous Namts cured by Vaccination,
By John Woolcott, Esq., M. R. C. S., Surgeon to the Kent
Ophthalmic Hospital,

A lady brought to me her infant, a healthy-looking child, nine
weeks old, in January, 1848, with an extensive subcutaneous
naevus which had existed from birth. The tumor, which was
of a blue, livid colour, occupied the whole of the upper eyelid
and a small portion of the root of the nose on the right side, and
extended upwards upon the brow and forehead as high as the
upper border of the orbicularis palpebrarum muscle ; outwards
and downwards it reached nearly to the tragus of the right ear,
and then extended upwards and inwards along the lower mar-
gin of the zygomatic process of the temporal bone to the exter-

1852.] Novel Treatment of Aneurism. 509

nal angle of the orbit, where it joined the morbid product at
the upper eyelid ; there was no pulsation in the tumor ; it was
soft and compressible, and increased greatly when the child
cried, and it then assumed a dark purple color ; pressure on the
temporal arteries did not diminish its bulk. The application
of ligatures in this case was of course inadmissible on account
of the deformity which would arise from cicatrization of the
wound causing ectropium. The treatment for the first month
consisted in the application of tincture of iodine ; the abnormal
growth being freely punctured all over with a fine cataract
needle, and the iodine applied over the punctures. The bleed-
ing was considerable, and of arterial character, but it soon sub-
sided on the application of the iodine. These punctures w^ere
made twice a week, but the iodine applied daily, except when
it caused too great irritation and soreness of the skin, when it
was discontinued for a day or two, and then resumed. At the
end of the month, the disease remaining unidminished, 1 altered
the treatment and applied vaccine lymph: with a lancet armed
with the matter, punctures were made at short intervals all
around the circumference of the tumor, and several points in the
centre of it ; to insure its taking, I inserted into each puncture
a bone-point, also well armed wnth vaccine lymph ; most of these
punctures took, and the irritation they caused was considera-
ble, the child's face and head being swollen enormously. This
was attended with fever and much constitutional disturbance,
but at the end of a fortnight it had somewhat abated, and
at the end of a month the disease was evidently decreasing ;
and at the expiration of six months from the vaccine lymph
having been used, not the least swelling existed, and the skin
was assuminf]^ its natural color. I saw the child the beginning^
of January, 1852, and not a vestige of the morbid structure re-
mains; and it was only by looking closely for the vaccination
scars, that I could tell on which side the nsevus had been. I have
treated several cases in the same way at the Kent Ophthalmic
Hospital, and have succeeded in arresting their growth, but I
have never seen so large an erectile tumor cured by this treat-
ment, nor can I remember to have read of any such case. The
color of this vascular tumor was venous, the bleeding w^as arte-
rial. [^London Lancet.

Novel Treatment of Aneurism.

We have been much interested during the last few weeks in
Mratching the progress of a case of aneurism of the subclavian
rtery, under the care of Mr. Fergusson, in which a novel and
ingenious method of treatment has been adopted. In imitation

510 Treatjnent of Ununited Fracture by Iodine. [August,

of an occurrence which occasionally happeus by accident in
cases of aneurism, viz., displacement of the mass of fibrins, or a
portion of it, which is usually present in such tumours, whereby,
in consequence of alteration in the current of the blood, a spon-
taneous cure results, Mr. Fergusson has, by manipulation of the
tumour, thrown loose a portion of the fibrine in the case alluded
to, with the effect of instantaneously arresting all pulsation in
the upper limb. In four days a feeble pulsation at the wrist
could be detected, but the axillary has been pulseless since.
The tumour itself, which was at first about the size of a small
hen's agg, has diminished considerably, and the throbbing with-
in is now little greater than in the subclavian artery of the op-
posite side, while it has become more solid to the touch. To
those familiar with the pathology and treatment of aneurism,
and especially the fatal results which have hitherto followed all
attempts at cure by operation on the subclavian on the tracheal
side of the scaleni muscles, we need hardly point out the inter-
(Csting character of the case now under Mr. Fergusson's care.

\_Medical Times and Gazette.

Treatment of Ununited Fracture by the Application of Tinc-
ture of Iodine. By Professor Blasius.

Professor Blasius communicated, in 1847, an account of the
success he had obtained in the external application of iodine in
pseudarthrosis ; and in the present paper he furnishes three
other cases. The first was a healthy soldier, aged 28, who had
suffered a simple fracture of the tibia and fibula. The ends of
the bones had continued moveable for six months, when the
following tincture was ordered to be applied externally, night
and morning::^ lodin. Bj, lod. Pot. 3i S. V. R. ij. In three
weeks the callus was completely consolidated. In the second
case, the fragments of a fractured femur (occurring in a soldier,
aged 25) remained movable after thirteen weeks; but became
quite firm after three weeks' pencilling with the iodine. The
third case, occurring in a boy 12 years of age, was equally re-
markable. [Med. Zeitung. Med. Chir. Rev.

On Foreign Bodies in the Air-Passages. By M. Jobert.

The following is a summary of the principal conclusions with
which M. Jobert terminates a series of papers founded on clini-
cal and experimental observation.

1. Foreign bodies tend especially to lodge in the right lung,
owing to the direction and dimension of the bronchus of that
side. 2. They penetrate when the cordce vocales are most

1852.] Foi^eign Bodies in the Air-passages. 511

widely separated, and a strong column of air rushes into the
trachea, as occurs during the rapid inspirations and expirations
in the action of laughing. 3. They traverse the superior aper-
ture of the larynx without raising the epiglottis, which is never
closed down upon this, as has been stated. 4. The epiglottis is
always raised by virtue of its own elasticity ; and its chief office
seems to be to direct the passage of certain articles of food, as
alongagutter, during deglutition. 5. The bodies traverse the air-
passages rapidly, by reason of the laws of gravity, ihe impulse
of the column of air, and their own nature. 6. They are only
temporarily arrested at any particular point, and may change
their place, until they have excited the inflammatory process
which enables them to hollow out a receptacle, in which they
become lodged. 7. A peculiar sound is engendered by their
presence ; and the bronchial secretion is always increased, and
may become sanguinolent. 8. A louder respiratory sound, and
a more extended vesicular murmur, is heard on the opposite
side, than on the side in which the body is placed. 9. Foreign
bodies whose size exceeds four lines in all directions, cannot be
expelled by the sole efforts of nature, which are only efficacious
in the case of very small ones. 10. In dogs, on the other hand,
in whom the glottis is on a level with the upper aperture of the
larynx, the expulsion of foreign bodies easily takes place, by rea-
son of the dilatability and dimensions of the aperture. 11. In
the dead body, foreign bodies pass the glottis with difficulty,
even when aided by the impulse derived from a considerable
column of air. ]2. In the living body,they have to overcome, not
only this passive resistance, but the very active resistance of the
constrictor muscles of the glottis. 13. It is only quite excep-
tionally that the operation of tracheotomy can be dispensed
with ; and it should be resorted to as early as possible, in order
to prevent inflammation, local changes, and rapid or slow
asphyxia. 14. It is a delicate operation, which should be per-
formed by the successive division of all the tissues, and not by
an incision comprising all or the greater part of the soft parts
of the region at once. This is the best means of preventing
haemorrhage, the introduction of air into the veins, lesion of the
thyroid body, &c. 15. The trachea should be as widely opened
as possible, so as to facilitate the escape of the foreign body.
16. We can only be certain that the trachea has been open-
ed, when the air escapes with its characteristic sound. 17.
When the foreign body does not issue on the opening being
made, we must wait awhile, and excite the sensibility of
the trachea by the introduction of a blunt body, so as to
cause cough and expulsive efforts. 18. The trachea must
be more largely opened, when a foreign body of a nature to

12 Employment of Tracheotomy in Croup. [August,

swell from moisture has been long retained. 19. Re-union may
be obtained by the primary or secondary intention. 20. The
union by primary intention may be obtained by simple com-
pression, or by the interrupted suture, this only implicating the
dartroid lamella that surrounds the trachea. 21. Agglutina-
tion may be produced by another procedure, which consists in
traversing the walls of the trachea entirely, or in part, leaving
the sutures hanging externally, these coming away from the
fourth to the thirteenth day. 22. A. plastic production serves
as the means of union between the lips of the wound. 23. 1
Cicatrization only takes place by means of an intermediate pro-
duction, and not by the direct fusion of the lips of the trachea.
24. The suture comprising the thickness of the walls of the
trachea, may excite inflammatory action both within and with-
out the canal, and give rise to organized fistulas and encysted
abscesses. 25. The suture which only implicates the covering,
or a portion of the thickness of the trachea, only induces a
plastic inflammation, and is to be preferred. \_V Union Medi-
cale. Ibid.

On the Employment of Tracheotomy in Croup. By M. Trous-
seau.

In the present series of papers M. Trousseau relates the cases
in which he has most recently perform^ed tracheotomy for croup.
Adverting to his entire experience upon the subject, he states
that he has performed this operation altogether 169 times (11
for chronic disease of the larynx, and 158 for croup;) and that
43 of these cases, or a little more than a fourth, have recovered.
Among his last 18 cases, however, there have been 8 recove-
ries, or nearly one-half The results obtained at the Hopital
des Enfans have not been less satisfactory of late ; for of 19
cases operated upon, between January and August, 1851, one-
half have recovered, and M. Guersant has been as successful
in his private practice. M. Trousseau believes that one reason
of the greater success in later years is, that now the principles
of treatment in these cases are better understood ; the children
are brought to the hospital in a less exhausted state, their powers
not having been lowered by the application of leeches and blis-
ters, heretofore so common. Still more importance, however,
does he attach to the modifications he has made in the treat-
ment after opening the trachea. Thus, he has discontinued the
application of a strong solution of nitrate of silver to the trachea
and bronchi, which he used formerly to insist upon. He now
too employs a double canula, so that the inner one may be
taken out and cleaned when necessary, without disturbing th

185iJ.] Gradual Reduction of Her nice, 513

other; and after the wound is dressed he covers all the parts
over with a cravat, and thus avoids the difficult expectoration
and desiccation of the mucus which occurred when they used
to be left exposed. [^U Union Medicale. Ibid.

On the Gradual Reduction of Hernice long irreducible. By M,
Malgaigne.

In this article M. Malgaigne brings forward two new exam-
ples of the efficacy of his plan of reducing old and voluminous
herniae. This consists in subjecting the patient to a very low
diet and purgation, applying ice or cold poultices to the tumour
and employing the taxis daily. One of these cases was an
enormous inguinal enterocele, wMiich had remained unreduced
for several years, and now equalled in circumference the size
of an ordinary hat. Complete reduction was obtained after con-
tinuing the above means lor 17 days. The other was an ingui-
nal entero-epiplocele, which had remained unreduced for 7
years, and was reduced completely in 6 days. [Rev. Med,
Chir. Ibid.

Anonymous Writers and Personalities. We took occasion in our
May number to animadvert upon the evil of Scientific Journals "allow-
ing their pages to be prostituted by anonymous writers to the grossest
personalities and misrepresentations." We stated, in reference to
certain of the objectionable articles, that " their style and general
I bearing show them to be all written by the same pen, and to have
been indited in Georgia." W^e mentioned the name of no person in
connection with the matter, nor did we indicate the vehicle of such
I improprieties, preferring to leave both authors and publishers to ap-
propriate whatever they might deem justly applicable to themselves.
Of course none would complain but those who found the " cap to fit
I them."

Since then, we perceive that a Journal published near the frontiers
of Canada, is again filled with scurrilities such as could not be sur-
passed by anything emanating from Billingsgate a large portion of
, which is evidently from the same unworthy source as the articles to
; which we formerly referred. We understand that this publication
! has been extensively circulated in this State by being sent to physi-

>14 Miscellany. [August,

cians who have not subscribed to it, and who probably never heard of
it before. What relates to ourselves, individually, is too palpably
malicious and contemptible to provoke any reply; and the prosper-
ous condition of the Southern Medical and Surgical Journal, whose
long list of subscribers is continually receiving honorable acces-
sions, is not to be jeopardized by the vain invectives of unscrupulous
calumniators. We would, however, for the honor of the Medical
Literature of our country, again appeal to the Editorial fraternity to
discountenance such violations of decency and propriety.

Professorial Changes. Dr. Thomas D. Mitchell has resigned the
Chair of Theory and Practice in the Philadelphia College of Medicine.

Dr. John Bell has resigned the Chair of Theory and Practice in
the Cincinnati Medical College, and returned to Philadelphia, in con-
sequence of delicate health.

Dr. Van Buren has been appointed to the Chair of Anatomy in
the University of New York vacated by the death of Prof Pattison.

Dr Worthington Hooker has accepted the Professorship of Theory
and Practice of Medicine in Yale College, in place of the venerable
Dr. Eli Ives, who takes the Chair of Materia Medica.

Dr. Mussey has resigned the Chair of Surgery in the Medical Col-
lege of Ohio, and been replaced by Dr. H. W. Baxley. This school
has the good fortune to have secured Dr. Daniel Drake in the
Chair of Practice, and Dr. Jedediah Cobb in that of Anatomy,
these two gentlemen having left the University of Louisville.

Prof Benj. W. Dudley has accepted the Chair of Surgery in the
Kentucky School of Medicine (Louisville), in place of Prof. Flint,
and Prof Bullitt that of Practice, lately held by Dr. Annan.

BIBLIOGRAPHICAL.

Outlines of a Course of Lectures on the Materia Medica, designed
for the use of Students. Delivered in the Medical College of the
State of South Carolina, by Henry R. Frost, M. D. Fourth
Edition. Charleston, S. C. Steam-power Press of Walker &
James. 185L 8vo., pp. 384.

We have been favored by the author with a copy of his " Outlines
of a Course of Lectures on the Materia Medica," which we think
well adapted to the wants of the medical Student. The number of
lectures which are daily crowded into the space of a few hours, ren-
ders such abstracts of great value to the student, as it enables him,
by an effort comparatively slight, to recall many important facts

1852.] Miscellany. 515

which otherwise would probably be forgotten. On all the subjects of
which it treats, Prof. Frost's work furnishes all the most important
points, well arranged, and though briefly, yet clearly set forth. But
though we thus commend both the execution and plan of the work, it
must not be concealed that such works are very liable to be abused by
the idle, who manage to procure from them a smattering of the sci*
ence barely sufficient to squeeze them through the green room.
Nevertheless, it would be unjust to deprive the industrious and am-
bitious student of such helps, because they are liable to abuse. To
such we cordially recommend the "Outlines.'"' G.

Ohsteirics : the Science and the Art. By Charles D. Meigs, M. D.,
Prof, of Midwifery, d:c. in Jefferson Medical College, at Philadel-
phia, &c., &c. 2d Edition. Revised, with 131 Illustrations.
Philadelphia: Blanchard & Lea. 1852.

This improved edition of the great work at the very popular Phila-
delphia professor will be welcomed by the profession as the matured
production of one whose large experience and love of knowledge
must command respect. Prof. Meigs has added much valuable mat-
ter to this edition and entirely re-written some of the most important
parts of the work. It affords us much pleasure to recommend this
American book.

Lectures on the Principles and Practice of Surgery. By Bransby
B. Cooper, F. R. S., Senior Surgeon to Guy's Hospital, &c,
Philadelphia : Blanchard & Lea. 1852,

This is an eminently practical work, by an eminently practical
surgeon. Although not the equal of x\stley Cooper in some respects,
the author is generally regarded as a man of very sound discrimina-
tion and as an excellent practitioner. His Lectures constitute quite
I a valuable addition to surgical literature and will be read with advan-
I tage by all who devote themselves to this department of practice.

i

I Outlines of the Nerves : idtli short descriptions. Designed for the
use of Medical Students. By John Neill, A.M., M.D., Surgeon to
Will's Hospital. 2d Edition. Philadelphia : Ed. Barrinirton &
Geo. D. Haswell. 1852.

This little work consists principally of plates intended to facilitate
the study of the nerves. The lithographs are, however, so badly
executed that we doubt that they can be of much use to one not aU
ready acquainted with the subject.

516 Miscellany.

Philadelphia, June 24, 1852.

Dear Sir : The " Transactions of the American Medical
Association" at its Session of 1852, will, it is estimated, make a
volume of nearly one thousand pages. Notwithstanding the increase
in size, the Committe of Publication have not, however, considered it
expedient to charge the members of the Association, and the several
bodies represented therein, a greater price for the forthcoming volume
than was paid by them for either of the four already published. They
have resolved, therefore, to furnish to the members, and the institu-
tions represented, one copy for three dollars, and two copies for five
dollars ; provided, the same amounts are remitted previously to the
first day of September next ensuing ; after which period the price of i
the volume will be raised to five dollars.

The Committee of Publication would respectfully suggest the pro-
priety of an early answer to this circular ; the funds in the hands of
the Treasurer are insufficient to defray the expense of printing the
volume of Transactions, and until an additional sum of eleven hun-
dred dollars is received, the Committee will not be warranted in put-
ting it to press. Respectfully yours,

D. Francis Condie, Treasurer,

Erratum. Purgative Syrup of Jalap. In the formula for this
syrup in ihe last number of the Journal at page 169 read ^^ jalap
eight ounces'' instead of ^' jalap an ounce.'' \_Amer. Jour, of Phar,

The above error was copied in our June number, page 381, and
should therefore be corrected by the reader. [Ed. South. Med. and
Surg. Journal.

Hydrargyri lodium Rulrum,

New York, Feb. 10, 1852.

Editor of the American Journal of Pharmacy :

Sir : Under the article Hydrargyri Biniodidum, the U. S. Dis-
pensatory gives as the dose l-16th of a grain, gradually increased to
grain l-4th.

Under the same head, Christison's work, edited by Dr. Griffith, ed.
1848, gives the dose from gr. i. to gr. iv.

Has this great discrepancy been before detected, and the error cor-
rected ? [Student.

[Note. The profession will be obliged by the above hint. We
had not observed the error before. Since communicating the fact
to the Publishers, Messrs. Blanchard & Lea, they have informed us
that the error has been corrected in the unsold portion of the edition.
All who have the American edition of Christison should make the
correction with pen at once, and all Medical Journals should notice
it. Ed. Am. Journ. Pharm.]

SOUTHERN

MEDICAL AND SUEGICAL
JOURNAL.

Vol. 8.] NEW SERIES. SEPTEMBER, 1832. LNo. 9.

PART FIRST.
r i g i n a I (I o in in it in c a t i o n 0 .

ARTICLE XXIX.

Veratrum Viride. Cases, by E. L'Roy Antony, M. D., of
Burke county, Geo.

The novel articles from the pen of Dr. W. C. Norwood, of
Cokesbury, So. Ca., upon the therapeutic virtues of this article,
early and promptly arrested our attention. More recent ones,
published with ''cases" from every section of the country,
attest the professional ardour in the pursuit for the discovery of
an agent whose remedial action upon the living organism will pro-
duce effects corresponding to those triumphantly ascribed to
the Tincture of the Root of the American Hellebore.

We believe its virtues may be mainly attributed to the
veratrine contained in the tincture, which we are at this time
administering as suitable cases are presented, the results where-
of we will, after careful observation, give to the profession.
Regularly digested articles have already furnished the pro-
fession with Botanical descriptions of the plant, and theories
adlihitiun, of its mode or modes of operation.

Individual professional experience is the property of our pro-
fession : upon this basis, we propose to record a few cases,
illustrative of its adminstration, prophylactic and curative
powers. If the results exhibit apparently paradoxical proper-
lies, we are in no wise responsible, but remain confident that

N. S. VOL. VIII. NO. IX. 83

518 Antony, on Veratrum Viride, [September,

its heroic attributes will early win for Norwood historic im-
mortality, and for itself a partition of empire with the lancet
in the domain of Practical Medicine.

Case I. Pneumonia, {typhoid type.) ^Mr. A. W., aged 30,
strumous habit, had been attacked on the 14th April, 1852, with
an indistinct chill, followed by remitting form of a low grade
of reaction, which lasted until the 18th. Between 10 and 11
o'clock, on the night of the 19th, taken with rigors, upon which
developed a similar grade of reaction, as in the first attack,
accompanied with mucous cough, and free, glairy, uncoloured
expectoration of exceedingly tenaceous mucus, with large glo-
bules of air intimately mixed. These pneumonic indications,
with corded frontal headache dry, hot, harsh-feeling skin,,
(calor mordax) ; great thirst, and sense of weakness ; dry
tongue, brown in the centre; pulse 70, very small, quick and
corded ; restlessness, anxiety, and some apprehension as to the
favorable termination of his case.

Under my usual (and somewhat peculiar) treatment, with
no material alleviation, and the supervention of brick-dust
colored sputa, he continued the same until the 27th, 9 o'clock,
A. M., at which time I found the same small, quick, corded
pulse, beating 100 per minute.

This being the first case of Pneumonia occurring in my
practice, after the reception of the tr. veratrum viride from the
hands of Dr. Norwood, I was sufficiently anxious to try it, but
the pulse being heretofore only 70 and 80, I hesitated, and
would not try the lancet, as it had failed to do good in his re-
cent attack of fever ; but this morning, the 28th, beginning ta
equivocate, myself, as to the termination of his case, the 100
pulse being tense and corded, though small, I determined upon
its administration, and accordingly prepared ^

^. Tr. Verat. Virid. . . 96gtt. .,

Aq. Com. .... 12 coch. mag, .,

Sacch. Alb. ... q. s. ft. M.
Ordered one-twelfth of the mixture every three hours, until
vomiting or purging supervened; in either event, tr. opii. 25
gtt., to be repeated in one and a half hours, and continue th^,
V. v. in half the quantity first ordered.

1852.] Antony, on Veratrum Viride. 519

April 29th, 11, A. M. Had vomited and purged, thrice each,
between fourth and sixth portions ; skin soft and cool, almost
cold; tongue moist, with light mucous coat; pulse regular,
decidedly /wZ/er, soft and pleasant to the touch; coughed very
seldom during the night ; great improvement in the expectora-
tionsays, "if I had taken that medicine at fiist I would have
been well;" and, from the magical alteration in every fenture
of his case so speedily presented before me, I readily believed
him. Ordered, half table-spoonful (4 gtt. tr. v. v.) of the mix-
ture every five hours to double the dose if the pulse exceed-
ed 70.

30th. Passed the night finely ; pulse 65, no cough, perfectly
comfortable. Ordered 4 gtt. doses tr. v. v. every six hours,
for three doses ; then eight hours for three doses, unless he
gets worse.

31st. Pulse 70, soft and pleasant ; says he is doing sufficient-
ly well. Ordered 4 gtt. doses, every ten or twelve hours, for
three days. Discharged.

Case II. Acute Pleuro-PneMmony. April 28, 1852. W.
G.'s negro woman, Hannah, aged 30 ; well made, finely devel-
oped thorax; saw her at ] o'clock, P. M. Symptoms : severe
frontal cephalalgia extending over the vertex; conjunctivae
injected ; face tumid ; breathing 36, incomplete and cautious,
attended with audible expirations; pulse 130, full and bounding;
bathed in profuse general sweat in fine, general reaction of
high synochal grade ; sore pain occupying whole dorsal thorax;
decubitus, supine; rale crepitant; harsh but moist cough, accom-
panied with slight pleuritic pain in dorsal pleura ; expectoration
tenaceous, viscid, yet tolerably frank and partially striated with
arterial blood, but occasionally completely ensanguined ; had
been bled ^xx., and bowels thoroughly evacuated ill two and
a half days. At this time, a large blister, recently applied, was
removed from dorsal spine to give the tr. v. v. a fair field.
Ordered: l^. Tr. Verat. Vir. . . 96 gtt.

Aq. Com 12 coch. mag.

Sacch. Alb. . . . q. s. ft. M.
Dose, 1 coch. mag. tri-hourly until nausea, vomiting or purg-
ing supervened.

520 Antony, on Veratrum Viride. [September,

29th. Vastly better in every respect ; pulse 60.
30th. Got up, saying she was as well as ever. Discharged.
May 1st, still well.

Case III. Puerperal Convulsions before Labour. April
20th, 1852. Mrs. A. J. L., age 18: short, and full habit;
leuco-phlegmatic temperament; first pregnancy advanced
thirty-five weeks ; severe cephalalgia for last six or seven days.
This morning, at 6 o'clock, had two convulsions. At 10" or 11
o'clock, some one bled her I dont know how much. By 4
o'clock, P. M., at which time I saw her, she had had ten or
twelve violent convulsions: decubitus^ flexed on left side;
pulse 144, full and hard ; profound coma; pupils dilated, but
susceptible ; pallor : globe of eyes very prominent ; whole face
and neck swollen; fingers and toes cool ; body and head hot.
At 4i o'clock, ordered sinapisms to spine, cold to head, and
enemata. Struggling against the indication for the lancet, m
person, I attended the administration of 8 gft. doses of tr. v. v,
every three hours. DCJ^ At 7 o'clock, pulse 120; at 10, pulse
104, spoke incoherently ; at 12, (pulse 98,) answering correctly
in monosyllables ; at 3 o'clock, pulse 75, perfectly conscious ;
at 5 o'clock, pulse 60, calm, collected, conscious and comforta-
ble, except "I feel sore all over." At 6 o'clock, I left her for
home at 7 was re-called arrived at 8 ; pulse 57; had vom-
ited thrice and purged twice ; universal surface cool and pleas-
ant ; regularly recurring "bearing down" labour pains touch
exhibited second position, crown of Baudeloque entering supe-
rior strait the pains recurring with perfect regularity. Ex
pulsion occurred at lOf, A. M. ; fcetus still-born. During^
uterine contraction, pulse 60 during intermission, 57, uterus
contracting finely and firmly. At llf, removed placenta froni
vagina. Ordered ! iss. ol. ricini, and pulse to be kept at 60, foFj
I now believed that the number might be stated, and the pulse
put down to it, and maintained there.

30th. General but not severe soreness ; surface cool ; intel-
lect clear ; no after pains ; no abdominal tenderness w^hatever f
lochia about right ; pulse 65. Ordered 2 gtt. doses tr. v. v.^
every four or five hours, to be guarded by laudanum, as usual.

May 1st. Perfectly comfortable, except a sore tongue. Milk
formed without general reaction. Discharged.

1852.] Antony, on Veratriim Viride. 521

The subsidence of the pulse, the contemporaneous clearing
up of the intellect and return of sensation, the accession of
labour with the pulse at 57, its happy termination, the forma-
tion of milk with her habit, without general reaction all, with
the puIse/2?' below its natural standard, present a relationship
of cause and effect as striking as beautiful.

Case IV. Pneumonia, {typhoid type.) April 28th, 1852.
B. C.'s female slave, Eliza, age 20, has been ill four days at
12 M. to-day. At this time, suffering with headache; breath-
ing 36, incomplete and hurried; pulse 124, size of a knitting
needle, somewhat tense and quick ; skin hoi and dry ; decubitus
mostly on the back and right side, but great restlessness; con-
junctivae icterode ; tongue dry, dark and raspish ; sordes on
teeth ; short, jerking cough ; expectoration viscid, tenacious
plum-juice mucus, frank with occasional sputal ejections of
dark-colored nuclei enveloped in healthy-looking mucus; a
profound "sore pain" persistent in the right middle lateral
thoracic region, increased by pressure on abdomen, but slightly
by pressure over the affected spot; crepitous rhonchus : dull
sound on percussion over sore spot had been freely purged
on the first day with a black dose. Yesterday, 27th, took Bi.
calomel, followed by four copious dark-colored dejecta. At
this, my first visit, ordered

^. Tr. Verat. Virid. . . 96 gtt.

Aq. Com 23 coch. min.

Sacch. Alb q. s.

Dose, 2 spoonfuls (each containing 4 gtt.) every three hours,

until nausea, vomiting, or purging is produced, then 1 spoonful

every three hours: if vomiting be obstinate, or more than two

I alvine dejections in any given three hotir?, and they be watery,

1 20 gtt. laudanum, and repeat pro re nata.

29th, 12 M. Vomited and purged, three or four times each,
last night : is taking 1 spoonful, 4 gtts., tri-hourly ; skin coo/ and
soft, rather oily. than moist; expression of countenance good;
tongue soft, moist and natural ; pulse 76, crow-quill, soft, uni-
form and compressible, no quickness ; no sordes ; breathing 20,
complete and deliberate ; no headache ; no soreness at the seat
of inflammation, except on abdominal pressure, and then but

522 Antony, on Veratrum Viride. [September,

slight ; sputa collected on sand in a tin pan, so that a fair in-
spection is impracticable. Ordered, above continued in 4 gtt.
doses.

30th. Apparently well in every respect, except the pulse at
56. Discharged the patient, ordering 4 gtt. doses or i tea-
spoonful of the solution of the tincture every six, eight and
twelve hours, for three or four days.

Case V. Pneumonia, complicated with Eutocia, Flatulent
Colic and Puerperal Peritonitis. May 2d, 1852. B. C.'s
slave, Susan, age 20, full habit had been safely delivered this
morning, at 5 o'clock, of a still-born of 30 weeks: obstinate
constipation of six days; intense keen pains darting through
transverse and descending colon ; sense of fulness in epigastri-
um and left hypochondrium ; uterus mounted high in umbilical
region, and somewhat tender on pressure; lochia in abundance,
breasts sufficiently tumid, but not tender ; sore, diffused pain in
the left lung; sensation of great weight under the sternum;
short cough, producing great pain in the belly and left side;
expectoration invariably swallowed, and could not be induced
to throw it out; pulse 136, moderately full and quick.

I saw her at 2 o'clock, and learned that these symptoms had
preceded and ushered in labour. Had been bled ; quantity
unknown. Ordered, warm fomentations to abdomen ; | gr.
sul. morphia and 3i. tr. foetida ; also, ij. ol. ricini to be re-
peated ; warm water enemata, and mustard to entire spine.

May 3d, 5 o'clock, A. M. Abdomen enormously distended
and exquisitely tender ; uterus very tender to external and
internal touch ; lochia completely suspended, breasts collapsed ;
rigors, headache, no alvine evacuation, discharging large quan-
tities of straw-colored urine ; decubitus supine ; legs flexed on
thighs and knees widely separated ; arms extended, right and
left, at right angles v^^ith the body; original pain in the colon
still recognized by her as being present with greater sense of
fulness; countenance anxious; moist, soft and jerking cough;
sore pain in the thorax persistent; pulse 144, very quick, and
not so full as yesterday. V. S. i xl., repeated in one and a half
hours, 5 XX. (At this hour, learned she had eaten large quan-
tities of red clay as a substitute for chalk or magnesia.) Intro-

1852.] Antony, on Veratrum Viride, 523

duced 30 inch O'Beirne tube to the colon met no obstruction,
no escape of gas ; then threw an enema of warm water and
1 coch. mag. spts. terebinth, into the colon, and repeated ; de-
siring to stool, the tube was withdrawn, and she elevated at an
angle of 45, at which moment a voluminous gaseous eructa-
tion from the stomach occurred, continuing ineffectually to
throw off more. I had the tube thoroughly cleansed, oiled and
introduced into the stomach a very slight escape of gas, at-
tended with a syphonic discharge of Oij. of greenish colored
water: gave Oj. melted lard; stomach rejected it.

Knowing it would arrest the pulmonary, I believed it would
moderate or arrest the intestinal and peritoneal congestion,
and perhaps prevent effusion or gangrene. I ordered 10 gtt.
doses of the tr. v. v. tri-hourly, until her pulse went to 60 ; also,
20 gtt. Labarraque's chlor. sod. m half tea-cup of warm water,
every two or three hours; gave 9i. pil. hydrarg. ; vaginal
injections of warm water and tobacco enema pr. rect., with
turpentine frictions to abdomen, and warm fomentations.
Left her at 8|, pulse still 144, but smaller, with same quickness.

May 3d, 12 M., at night. Belly softer; pulse 120, not so
quick ; no evacuation : had not given the tincture regularly.
Ordered epispast., 6 by 7, to abdomen, with 8 gtt. dose of tr.
V. V. {Yi-YiouT]y,tobegivenrcguIarll/ ; also, 9j. pil. hydrarg.

May 4th, 5, A. M. Pulse 74 ; had five or six copious thin
slate-colored dejecta, with flocculi of the same, but more con-
sistent; vesication; belly not half the size it had been; slight
appearance of lochia; no headache; ver^Hittle cough; some
pulmonary pain ; uterus still tender, but allows it handled with
some freedom without complaint. Ordered, continuation of
tr. V. v. in 6 gtt. doses tri-hourly; Labarraque's liquid 15 gtt.
every four or five hours, and 25 gtt. tr. opii. off. Blister dress-
ed with scalded fol. persica.

May 5th. No headache ; tongue moist and pleasant, but
great thirst ; scarcely any cough, can make full inspiration
without coughing, but still some thoracic soreness ; occasional
hiccough ever since yesterday morning; abdominal intume-
scence continue to subside ; lochia same ; general surface
warmer than yesterday; still horizontal, with inferior extremi-
ties separated and flexed; pulse 112. (A new nurse having

524 Antony, on Veratrum Viride, [September,

been in attendance the v. v. had been taken irregularly, and
only in 2 gtt. doses.) Two slate-colored dejecta, mixed with
portions of red clay. Suspended Labarraque's liquid, and or-
dered l^. Pil. Hydrarg. ; Rhei. P. R. aa Bss. ; and continued
tr. V. V. in 8 gtt. doses.

May 6th. With the exception of partial retention of urine
and lumbar uneasiness, with slight strangury from absorption
of cantharadin, she is better in every respect. Pulse 90, no
quickness, more volume. Catheterism, with replacement of
uterus, afforded instant relief. Continued peach-leaf poultice
to the blister, and tr. v. v. in 4 gtt. doses.

May 7th. Bovv'els moved twice last night, tolerably thin, but
of uniform consistency ; neither thoracic pain nor soreness ;
no cough ; no colonic pain nor uneasiness; bladder acting fine-
ly ; lochia in abundance ; pulse 90, and skin soft and warm. I
think she will get well.

May 15th. I hear she is up and doing well.

Case VI. Dystocia. Md.y 3d, 1852. Mrs. J. M.'s negro
woman Lucy. Saw her at 1 o'clock, P. M., in a small, close
ill-ventilated log-house, covered with a thick quilt and a blan-
ket, thermometer 92, a fire on the hearth, and some smoke
pervading the room ; face and body covered with a profuse
active perspiration; carotids and pulse rapid and bounding at
172. Had the fire extinguished, door unhinged, slats, with
which the inside of the house was ceiled, ripped off the side
opposite the door, substituted a sheet for the quilt and blanket,
gave a light draught of cool water, and bathed her face and
breast with some of the same. In half hour pulse 160; expul-
sive throes every fifteen or twenty minutes ; touch exhibiled
left arm and pulseless funis occupying pelvis proper in 2d po-
sition left arm presentation of Baudeloque ; abdominal tender-
ness on pressure had been bled freely, and I would have bled
her again, but believing from recent experience that I held in
my hand the great desideratum, the controller of capillary ar-
terial and cardiac action, I risked her upon it. The result, I
apprehend, will at least speak well for its prophylactic powers.

At 11 o'clock, gave Jgr. morphine and 10 gtt. oftr. v. v., pre-
paratory to turning ; at 2\, gave \ gr. morph. ; at 3^, gave

1
I

1852.] Antony, on Veratrum Viride. 525

8 gtt. tr. V. V. ; at 4 o'clock, she, feeling the anodyne impress-
ion and pulse 140, I pioceeded to fillet the presenting arm, and
"turn," which I did readily, bringing the feet down to the first
foot Baudeloque by 51 o'clock ; at 6, removed placenta ; at
6|, pulse 104, surface quite cool.

Ordered, absolute diet ; mucilaginous drinks ; vaginal injec-
tions of warm milk and water &/s terve in diem; soft oiled com-
press to vulva; perfect rest, with shoulders slightly elevated ;
also, I^. Tr. Verat. Vir. . . 90 gtt.

Aq. Com 24 coch. mag.

Sacch. Alb. . . . q. s. ft. M.
Dose, 2 coch. mag. tri-hourly, regularly, until vomiting or
purging; in either event, tr. opii. 20 gtt., repeated p?'o 7'e Tza/a.
Dr. Milton Antony, the attending physician, was requested
to note particularly the eflTects of the tincture upon her pulse,
which I desired to be reduced to 60, and kept there for three
or four days, to prevent, if possible, the accession of any of
those fatal symptoms so frequently following the maneuvre in
such cases.

May 5th. Received the following from Dr. M. A.
"May 4, 1852. Dear Sir: I visited Mrs. Moore's Lucy
this afternoon, and found her pulse reduced lo 72 to the minute.
She says she is in no pain at all, but complains of being very
sore when moved : she has had three evacuations to-day, one
while! was there, which waswateiy; von)ited several times also.
I ordered Mrs. M. lo give the tr. opii., and lessen the dose of the
solution to half table-spoonful (2 gtt. tr. v. v.), as she had alrea-
dy, under your directions, lessened it to one (4 gtt. tr. v. v.)
continue the mucilage and vaginal injections. She says she
feels much better. I think she is doing finely much better
than I ever expected : she has a good appetite wants to eat.
Mrs. M. will give the last dose to-night at 9 o'clock ; so, if you
wish her to continue it send more by the bearer."

I sent more, with a request \o put her pulse at 60, and keep
it there. This last portion did not reach her until eighteen
hours after the first had given out, at which time there was
restlessness, with pulse at 125 ; the re-application of the tinct.
*in 8 gtt. doses readily brought her pulse to 65, at which it was
kept for three days.

526 Grant, on Theory of the Circulation. [September,

May 15ih. Doing well, except slight sdreness at vulva, v^^ith
lumbar uneasiness.

I would have been pleased to comment lightly upon each of
these cases, but the length of this article has already exceeded
the limits anticipated.

ARTICLE XXX.

Farther Remarks on Mrs. Willard's Theory of the Circulation.
By Wm. T. Grant, M. D., of Culloden, Monroe county, Ga.

Since writing my last article in the May number of the South-
ern Medical and Surgical Journal, on this subject, I have been
favored by the kindness of an acquaintance, with a copy of
Mrs. Willard's small book, entitled " Willard on the circula-
tion of the blood." After reading it, I was more than ever
convinced of the fallacy of the position assumed by its authoress,
in regard to the circulation.

Her position we will give in her own words : " Expansion is
a motive power the blood receives caloric at the lungs the
blood must therefore expand if the blood expands it must
move." We admit that expansion is a motive power (not
under all circumstances, however), we admit that the blood re-
ceives caloric or heat at the lungs, but, we deny that the blood
expands in consequence thereof. We well know that there is
a chemical process going on in the lungs at all times, and caloric
is a production of all chemical processes ; but the heat is not on
that account the primum mobile of the blood. The reason is
simply this : as soon as heat is disengaged by this chemical
action, it becomes latent immediately, and cannot therefore pro-
duce an expansion of the particles of the blood. That this heat
does become latent can be established on good authority,* and
we deem it unnecessary to say more about it, but pass on to
the consideration of some of Mrs. Willard's experiments.

The first experiment of any consequence (figure no. 1 of the
above mentioned work) "may be formed by joining three glass
tubes by india-rubber into a triangular form, and filling the
apparatus with water." This contrivance was then suspended

* Co mstock, Johnston, &c.

1852.] Grint, on Theory of the Circulation. 527

and heat applied to one of the sides, and the contained water
began to circulate in the tube. By an inspection of the figure
and the manner in which the heat was apphed, any one can
very quickly detect the fallacy. It will be observed that the
heat was applied to a side that hung in an oblique direction,
and as the air in the water expanded, as well also as the water
itself, they began to move upwards, and of course began the
circulation. If Mrs. Willard had applied the heat to the most
elevated part of the tube, the water would never have moved.
Besides, in this case the heat is free or uncombined and not
latent as is the case in the circulation. This experiment there-
fore proves nothing.

In her next experiment, Mrs. Willard's object seems to be,
to prove that the circulation cannot go on until the heart begins
to beat ; that is, the heart must begin to beat before the blood
begins to circulate. And she proves that it matters not how
much heat is applied to the blood in the lungs, yet, if the heart
does not begin to beat, the blood will not circulate. Then we
are to understand that the heart begins its motions first. If
that be the case (and we do not doubt it,) what makes the heart
move? Mrs. Willard does not and cannot say, and w^e have
to stop in our researches, on this point, for proofs of the new
theory.

(The reader would do well to examine Mrs. Willard's book
in connection with the above for a proper understanding of the
case as we are confident we have not rendered it very intelligi-
ble.)

Having now merely glanced cursorily over these two ex-
periments, we will proceed to relate some performed by our-
self on the living animal. There can be no possible cheat or
fallacy in them as they were performed on animals living
animals, in which Nature's immutable laws must take their
course. We shall relate them from notes which we took down
at the performance of each experiment.

Exp. I. Took a ^o<^^ and making an incision into the breast,
we extracted the sternum. After which we removed the liver.
We cut out the sternum and liver, for the purpose of exposing
the heart. Having bared that, b}^ these operations, so that we
could see it pulsate distinctly, we next cut out both lungs. Now

528 Grant, on Theory of the Circulation. [September,

we had the heart fully exposed, and had taken out the liver
and both lungs. Notwithstanding which, the heart continued
its pulsations and the blood its circulation. We let it stay thus
an hour and a half or two hours, at the end of which tii.je it
still continued to beat. It would be well to state that it was
becoming more and more feeble ; this is easily explained,
firstly, being exposed to the air it was getting dry and stiff;
secondly, the circulation was somewhat impeded by cutting
out the liver and lungs, in which we necessarily cut the hepatic
and pulmonary arteries ; and thirdly, the toad was dying. We
think that the roughness of the operation assisted in enfeebling
the heart. It were probably well that we state that we pierced
the brain of the toad with a small blade of our knife, before
doing anything else.

Exp. II. In this case we did not wound the brain of the
toad ; but bared the heart as in case first, with as little injury
to the contiguous parts as possible. In this case the heart beat
more than three hours after the excision of the lungs.

Exp. III. In this case, to prevent deception in any way we
cut out the whole of the respiratory apparatus, the trachea
bronchial tubes, and lungs, and the heart continued its beating
an hour and a half; it then became too feeble to pulsate, from
the cause mentioned in case first.

ExpT IV. Wishing to remove every trace of a doubt as to
the correctness of these experiments, we next took a toad, bared
its heart as before, without excising the lungs however, and
put it under the receiver of an air-pump. On pumping out the
air, the heart continued its pulsations. It was remarked by an
eminent gentleman, who saw the experiment performed, " how
very tenacious the animal was of life."

Some may object to these experiments because they were
performed on so lowly an animal ; but we hold them as good
as if they were performed on man himself, inasmuch as the toad
has lungs, a heart, a circulatory system, and breathes air.

Having now stated these things, we wish to make a few re-
rnarks upon them in connection with the general subject of the
circulation. In all of the above experiments, the blood circu-
lated as usual, impeded a little perhaps by local obstacles. Now
then, the question arises what causes it to circulate ? It is

1852.] GrdiWiy on Theory of the Circulation. 529

very evident that beat did not do it, as the generator of heat,
the air, was excluded. We will answer the question if we can.
The cause is to be found in the system, and is galvanism. We
can prove that the cause is in the system, but as yet we have
to theorize as to its identity. Air is the medium of communi-
cation by which everything external produces effects on every-
thing internal. By this we mean that the external things come
in material contact with the external parts of the body by the
air alone. I do not say that we cannot see without air, but I
say that a particle of dust, for instance, cannot come in contact
with the parietes of the air passages, without air. So then if
we exclude air from the body, we exclude everything that is
dependent upon the air for a conveyance. In the above experi-
ments we excluded air from the blood. Consequently neither
air nor any other external material thing did affect the motion
of the blood. But the blood circulated ; and we are therefore
justified in saying that the air and other externals do not pro-
duce the circulation. Then we arrive at the statement made
above, that the cause must be found internally. And as before
stated that cause can be found in galvanism. There is an ex-
periment, familiar with most chemists, that has some bearing
on this point, and shows that a circulation may be carried on
through tubes similar to the capillary vessels, by electricity.
" We can cause water to flow in a stream through a tube, by
running a stream of electricity through the tube with the water,
when previously this only went through in drops." There are
other things in support of this point that we would like to cite
if space allowed, but we fear that we might intrude on the
Journal, therefore we conclude by summing up the whole of this
article in a few words, viz : we have proved that air is not the
cause of the circulation, and that the cause is to be found in the
system. And in the end we see that everything points direct-
ly to galvanism as being the primum mobile of the blood.

530 SiSiYY, on Treatment of Dysentery. [September,

ARTICLE XXXI.

Remarks on the Treatment of Dysentery. By E. F. Starr,
M. D., of Rome, Ga.

This being the season for dysentery, it may be allowable to
make a few remarks upon its pathology and treatment.

My only apology for this intrusion is that an astonishing
number of deaths from this disease occurs all over the country,
seeming to justify a repetition of the opprobious language of
Macbeth,

'* Throw physic to the dogs I'll none ofit."

I am of opinion that ^'physic'' is not so much to blame as
physician. And as I expect to differ practically, if not theoreti-
cally, from many members of the profession, let me suggest that
we throw aside preconceived and vague notions and opinions
which have been acquired by the process of taking for granted,
rather than by reflection and observation, and that we come up
fairly, without prejudice or favor, to the consideration of this
interesting, because common, and fatal disease.

To premise: it will be admitted that dysentery consists in
an irritated or inflamed state of the mucous membrane of the
lower intestines usually slight at first, having a tendency to
increase to a dangerous extent or to diminish to convalescence,
according to circumstances. I need not enumerate its symp-
toms, as these are sufficiently well known ; but the question may
be asked, is dysentery a primary disease ? or does it depend
upon a depraved state of the secretions ?

I must advocate the former position as generally correct,
because I see no good reason for believing otherwise. That
the predisposing cause of the disease is a morbid impression
made upon the nervous system and reflected upon the intestines,
I think very probable ; but I must protest against the idea that
it depends upon a defective secretion of the neighboring organs.
I say this much, because the treatment of many practitioners
indicates that they are influenced by a different opinion or
theory. Yet, we find in some cases of dysentery a deficiency
of the bilious secretion in the alvine discharges ; but this no
more proves the disease in question to be produced by the want
of bile, than it does that the deficiency of bile is occasioned by
the disease.

1852.] ^{2iVV, on Treatment of Dysentery. 531

Again : there may be an apparent want of this product when
there is no real deficiency. In health there is only a sufficient
quantity of bile discharged to colour properly one evacuation
per day. How then is it to be expected that in dysentery a
dozen discharges in the same length of time will each be equally
coloured ? In dysentery, we have evident mucous inflammation,
more or less intense, producing pain, griping, tenderness, mu-
cous and bloody discharges, &c., &c. The indication is plain,
to cure the disease by acting upon it directly where it exists.
Have we the remedies to answer this indication ? We cer-
tainly have. Are they to be found in the catalogue of cathar-
tics ? When the physician is called to such a case, the bowels
have generally been discharging themselves until there are no
consistent matters left, therefore the peculiar service of this
class of remedies is not needed. If any cathartic possesses the
property of curing inflammation of the mucous coat, I do not
know it. I know of none upon which we may rely for this.
Why then is so much confidence placed in calomel and other
purgatives to the exclusion or partial exclusion of other more
efficient and rational remedies? Who does not know that the
preparations of mercury inordinary doses are highly irritating
under some circumstances ; and that too when such effect is
most to be reprehended and guarded against? And will any
body believe that an article liable to produce the very efl^ect
which we wish to combat is the safest and surest remedy
to be used ?

Not long since, I happened to hear a man speaking of the
prevalence of dysentery in a certain section and of the fatality
which attended it, that scarcely any of a number of cases which
he had known recovered, that nearly all died. Shortly after-
il wards, I accidentally learned that the practice of a physician
who attended among these cases was, to give at first, fifteen
grains of calomel at a dose. I did not marvel any more at the
tale of mortality. But to come directly to the question, what
is the remedy for this disease ? I answer emphatically, opium.
This should be considered as the leading remedy in its treat-
ment. The chief properties of opium are to relieve pain,
produce somnolency and cure inflammation of the mucous
membranes ; and I believe I may add, of most of the other tis-

532 Attaway's Case of Polypus Uteri, [September,

sues. But the most valuable, is that of curing inflammation
and arresting inflammatory tendencies of the system. But,
what ! give opium before you have cleansed the stomach and
bowels ? I say yes, give it, it will cure them, filthy as they are.
Give it, not in quarter grain doses, not in half grain doses, but
in from two to four grain doses, and repeat as often as necessary.
Cure the primary disease and the bile will flow beautifully
again and all will be right.

Thus, then, we have the remedy to answer the plain and un-
mistakeable indication of the disease, which used in time and
in connection with cold water injections, blisters, the astringents,
tannin, lead and zinc, creasote, &c., with the common efferves-
cing soda powder to allay nausea and vomiting, where that
exists, will rarely fail to secure a happy result. Try it, use it
liberally, try it fairly, perseveringly, early in the attack, and
the confidence of the community in the profession will be
strengthened and increased by its success.

A good combination is made of two grains of opium and
from half to one drop of creosote for a dose, to be repeated at
proper intervals; and for children an emulsion containing two
drops of creosote to the ounce, with the addition of as much
laudanum as may be desirable, to be given in teaspoonful doses
about three times a day.

ARTICLE XXXII.

A Case vf Polypus Uteri. By A. F. Attaway, M. D., of
Madison county, Georgia.

Louisa, a colored woman, aged 36 years, the property of
Mrs. M. M., of this county, was committed to my care in the
summer of 1851. She gave birth to a child in the 20th year
of her age, and her health, as reported by her mistress, began
to decline soon thereafter, and continued to grow worse by
degrees, despite of all the aid that could be afforded. She suf-
fered, however, no very great inconvenience until about three
years ago since when, she has sufiTered greatly from profuse
uterine hemorrhage, shortness of breath, anaemia, and other
phenomena characteristic of polypus uteri. Upon examina-
tion, I found the womb greatly enlarged, the os tincae consid-

1^52.] Robert's Case of Strangulated Hernia. 533

erably dilated, and the cavity of the organ completely filled
with a pyriform tumour of a firm, fibrous texture, insensible to
pressure, and which was attached to the fundus by a pedicle.
From the anaemic and general derangement of the system, I
prescribed a tonic and alterative course of treatment to im-
prove her general health. On the 21st November, I found that
half the bulk of the tumour had prolapsed into the vagina.
Believing her now to be in as favorable a condition as I would
probably find her for the use of the knife or ligature, I proceed-
ed to apply the latter. The ligature remained until the 26th,
being the fifth day of its application, when the tumour was re-
moved. During the operation, she had the usual treatment.
Gooch's double canula was the instrument used. She has now
fully recovered her former health and spirits. Five months
have elapsed without any unfavorable symptoms.

I cannot close this report, without contributing my modicum
of praise to the inventor of the invaluable instrument I used.

ARTICLE XXXIII.

A singular Case of Strangulated Hernia, operated ujjon and
reported, by Wm. H. Robert, M. D., of Orion, Alabama
in a letter to the Editor.

I was recently requested to go 45 miles to see a case of
strangulated hernia. I started on horse back at 6 o'clock, a. m.
and at 4 o'clock, p. m. I operated on the man. I found it a
very singular case. While a fold of the small intestine and a
portion of the omentum were very badly strangulated, another
very large portion of omentum presented a healthy and normal
appearance. This latter portion of omentum had been protru-
ding so long as to form extensive adhesions to the tunica vigi-
nalis testis, and hence its healthy appearance while the other
portion was so seriously affected. I returned the intestine, but
the omentum I thought proper to leave where I found it, hoping
that it would relieve itself by suppuration.

Eight days after the operation, there was free suppuration
from the opening and no constitutional disturbance. The bow-
els acted finely (aided by enemas,) in three or four hours after
the operation.

N, s. voT, vni. \n, i\. 84

534 Glycerine in the Treatment of Deafness. [September,

PART II.
(Eclectic JDcpartment.

Use of Glycerine in the TreMment of certain Forms of Deaf-
ness. By Thomas Wakley, Esq., F. R. C. S., Eng., Sur-
geon to the Royal Free Hospital, London.

The class of cases to which I would draw attention in this
report, are those of cuticular or epithelial thickening of the
meatus, either partial, affecting the membrane of the tym-
panum, or complete, being continued over the entire auditory
cul-de-sac. There is a greater or less degree of deafness,
corresponding with the amount of thickening ; cessation of
the secretion of cerumen ; frequently tinnitus, or a " singing
and hissing sensation" in the ears, and tickling irritation of the
meatus. The causes are, constitutional predisposition, ad-
vanced age, chronic inflammation, long-continued discharge
following eruptive fevers and the application of escharotics and
irritants. Amongst the latter, I would mention oily prepara-
tions, the globules of which adhere to the sides of the meatus
or membrana tympani, and become rancid, thus producing a
very frequent cause of inflammation. Upon examination of
the affected ear, we find the meatus shining and inelastic, of a
pearly whiteness, the membrana tympani either clouded or
streaked, sometimes having small elevations upon it. The
meatus is quite dry, the cerumenous glands being choked up by
the epithelial growth.

The mode of application of the glycerine, when treating this
state of the ear, is as follows : The meatus is well cleansed
with tepid water, and then dried by means of the forceps and
cotton. Glycerine is now poured into the meatus, and a plug
of gutta percha, softened in boiling water, made to fit the exter-
nal opening ; this takes the exact form of the ear, becomes
hard, and effectually prevents either the entrance of atmos-
pheric air or the exit of the glycerine. The ear should be
examined daily and the same process repeated. The lining
membrane can be examined with a blunt silver probe, passed
gently through the speculum auris, to ascertain the effect of
the glycerine upon the cuticular thickening. The meatus will
giadually lose its shining pearly appearance, and softened pieces
will fall off', and can be removed either by the forceps, or gen-
tle syringing. The practitioner should never attempt to tear
them away, but allow them to come away by the means just
stated. The treatment occupies ordinarily from two to four
weeks, and is generally without any pain or inconvenience of
any kind to the patient, and the results, in some cases, have!

1852.] Glycerine in the Treatment of Deafness. 535

been very gratifying. In the after treatment the patients are
directed to moisten the auditory canal at least once a week
with glycerine, applied by means of a camel-hair brush ; this
will generally prevent a recurrence of the cuticular thickening.

The modus operandi is simple enough the glycerine being
kept continually in contact with the part, acts mechanically,
either absorbing or penetrating the epithelial coating, and sepa-
rating the individual particles.

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 the glycerine tends to restore the
external meatus to a healthy condition, and fit it for the healthy
transmission of sound.

The mechanical power which glycerine possesses in separa-
ting this epithelial growth in some cases is very remarkable. I
was consulted about two months since by a lady of rank, a
patient of Sir James Clark, for deafness in both ears. In the
right ear there was almost total deafness, from r.n enormous
amount of epithelial thickening, which narrowed the calibre of
the auditory canal, so that it would not receive the smallest-
sized speculum. The depth of the cul-de-sac was also much
less than normal, from the same cause. The lady was between
seventy and eighty years of age, and told me that she had been
deaf from her childhood in that ear ; and there is but little
reason to doubt that the deposit had been accumulating and
hardening during nearly the whole of her life. The glycerine
was used in the manner already described, and its action was
very beautifully illustrated. A short time since, a large mass
of the softened growth w-as removed without any inconvenience
to the patient, a larger quantity, perhaps, than I had ever
before separated from the ear. The calibre and depth of the
ear will therefore be increased considerably when the swelling
of the lining membrane shall have subsided from its having been
saturated with glycerine ; this will gradually exude and come
away. This case is still under treatment, and I shall mention
it again at a future period, when the effects of the treatment
upon the hearing can be safely declared.

I may mention another case in the family of a nobleman, pa-
tients of Sir B. Brodie, where very considerable thickening
existed over the entire aural cul-de-sac, but which readily
yielded to the softening action of the glycerine, although it had
previously resisted the use of caustics and various applications
of the essential oils, &c., ordinarily employed.

The following cases are examples of the action of the glyce-
rine on this class of chronic diseases of the ear :

536 Glycerine in the TreatmenfafDecrfness. [September,

M. R , a clergyman of Hants, aged sixty-six, applied^

June 16, 1851, suffering from deafness of the right ear, which
had existed for more than twenty years ; indeed that organ had
become wholly useless. Upon examination, I found the meatus
polished and dry, quite inelastic to the touch, and of a dull white
colour. The central part of the membrana tympani presented
even more opacity than the othei' parts, and no secretion could
be detected in the ear. I applied the glycerine after having
well cleansed the meatus, fitting the gutta percha plug after the
manner already described. This treatment was repeated every
morning, and at the end of fourteen days I was enabled to re-
move a large portion of pulpy epithelium. Again, four days
afterwards, more softened skin was taken away. The ear was
well syringed, and all the smaller particles removed. Upon
examination of the ear with the speculum, the meatus was found
much improved in appearance ; the membrane slightly swollen^
from saturation by the glycerine ; there was still, however, a
portion of the cuticular deposition hanging on the left side.
Upon testing the patient's hearing with the sonometer, it was
found to have improved two degrees. The same treatment
was then continued, and at the end of a week the last piece came
away. The ears were again gently syringed, but with no fur-
ther effect. A small portion of wool was then placed in the
external opening of the meatus, and the patient was directed to
return to me in four days. Upon his visiting me as desired,
his hearing was again tested by the sonometer, and it was
found that he had improved six degress. There is little doubt
that the deafness in this case w^as owing to the mechanical ob-
struction in the passage of sound produced by the cuticular
deposition. When I last heard from this gentlemen, there had
been no return of his deafness.

H. M , a dissenting minister, thirty-eight years of age,

consulted me, Aug. 19, 1851, for long-standing deafness of both
ears, which he stated would ere long cause him to retire from
his profession, as he could hardly hear his own voice. The
meatus throu!:^hout had that " parchment appearance" so char-
acteristic where cerumen has ceased to be secreted. The
membrana tympani presented a similar appearance. The same
treatment was resorted to as in the foregoing case, and the re-
sult was equally successful. In sixteen days two soft, pulpy,
membranous pieces were removed, and in a month his hearings
on being tested by the sonometer, was found equal to the lowest
tone but one of the instrument.

During the treatment it was found necessary to attend to the
general health of this patient, and preparations of steel and the
mineral acids were employed with great advantage. 1 am i

h

1852.] Glycerine in the Treatment of Deafness, 53'

correspondence with this patient, and he still retains his im-
proved hearing. From the history he gave of his malady I
consider that the thickening was caused by constitutional pre-
disposition, or, as he termed it, a "deaf taint" in his family, as
several other members, both older and younger, were similarly
affected,

H. T consulted me at the Royal Free Hospital, (by di-
rection of Mr. Edwards, of Brompton,) Nov. 1851. He had
been deaf for twenty-six years, and presented, in every particu-
lar, a case of stronolv-marked cuticular thickenino-. He stated
that he had suffered from inflammation of the ear, experiencing
at the time excruciating pain. This lasted for three or four
months. He was told it was neuralgia. As the pain left him,
the deafness gradually supervened, increasing daily. This
case occasioned me much trouble, from the want of punctual
attendance on the part of the patient ; at length, however, a
considerable mass of almost cartilaginous consistence came
away from both ears, with very great relief to the patient's
hearing. Caustics had been previously used for the cure of his
deafness, to a very great extent ; but, as the man said, always
making him worse instead of better, causing pain and inflamma-
tion of the ear.

This case, in its result, was one of the mosc successful that
lias fallen under my notice.

In this report, I feel it absolutely necessary to caution the
profession against the use of the impure glycerine in the mar-
Icet. Several samples have been forwarded to me by both
surgeons and patients. Upon careful examination of the liquids,
I found only one sample to consist of pure glycerine ; the
others had a low specific gravity, or contained a considerable
quantity of lead or of rancid oil, having been manufactured
from putrid fat.

Several letters have been sent to me on this subject ; the
following extract is taken from one that I received from Dr.
Houseman, Newcastle-on-Tyne :

'* The use of glycerine in certain forms of deafness is likely
to suffer from the impure samples in the market : it would be
well to remind the profession of this fact. Messrs. Gilpin, of
this town, have supplied me with the preparation pure, and
several patients have been cured by the application. Glycerine
should be a clear, scentless syrup, intensely sweet, instead of
the rancid stuft' usually sold under that name," &c. &:c.

Thus it is easy to account for failures in many cases that
have been reported ; and I would strongly urge surgeons who
are treating certain forms of deafness with glycerine to test it
themselves, and thus be certain of the purity of their agent.

538 Eruptive Diseases of the Scalp. [September,

Pure glycerine should be a white, syrupy fluid, inodorous, spe-
cific gravity not less than r32, quite free from oily globules and
oxide of lead. The latter may be detected by passing through
it a current of sulphuretted hydrogen, which will easily blacken
it. Any fatty matter may be discovered by mixing it with
water : the disagreeable smell will at once prove that it has
been manufactured from putrid fat.

In conclusion, it may be said, that impure glycerine being
so easy of detection, it is desirable that its utility as an agent
in the treatment of deafness will not henceforth suffer from the
employment of an article that has no nearer affinity to glyce-
rine than the name. [London Lancet.

On Eruptive Diseases of the Scalp. By Charles A. Poole,
Esq., M. R. C. S. E., &c.

On account of the great discrepancy pursued in the treat-
ment of eruptive diseases of the scalp, and indeed of the small
degree of interest seemingly evinced in their management,
arising probably from the fact of their continuance not endan-
gering life although one disease at least produces a degree of
fatuity also of their peculiar obstinacy, I am induced to offer
a few observations on the treatment of these repulsive affisc-
tions, which tend to render families unhappy, and the afflicted
avoided.

Eruptive diseases of the scalp seem always to have been
difficult of treatment, which, instead of leading to indifference
should stimulate inquiry, with the view of treating these affec-
tions on sound rational principles, the want of which too often
sends the patient elsewhere for advice, and thus miserably ex-
tends the pernicious domains of quackery.

For the suggestion of the follow^ing remarks and plan of
treatment, I am indebted to Dr. Neligan of Dublin, whose sim-
ple and practically efficient division of these diseases into in-
flammatory and non-inflammatory I have followed, and this I
believe to be the true basis on which to build a rational plan
of treatment :

hijiammatory Herpes capitis ; vesicular ; contagious. Ecz-
ema capitis ; vesicular ; non-contagious. Impetigo capitis ; pus-
tular ; non-contagious. Pityriasis capitis; scaly; non-conta-
gious.

Non-inflammatory. Porrigo capitis; vegetable growth; con-'
tagious.

Of course there are other eruptions found on the scalp, but
they are in connexion with those generally situated on the other

1852.] Eruptive Diseases of the Scalp. 539

parts of the body, and therefore in this situation require no par-
ticular description.

As recjards prognosis, this depends more on the length of
time any given eruption has lasted, than on any particular kind.
When seen early, and properly treated, they are cured in from
a fortnight to three weeks, sometimes much sooner; but some
old chronic cases require from one to three months. They
seem to be curable generally in the following order ; 1st, Im-
petigo ; 2nd, Pityriasis ; 3rd, Moist Eczema ; 4th, Lupus ; 5th,
Dry Eczema.

The treatment is based on the fact of these affections being
both inflammatory and constitutional. That they are inflam-
matory is sufBciently evident ; that they are constitutional is
almost proved, from the advantage derived from alterative me-
dicines. The absence of this division has formed, I fancy, the
chief stumbling-block. Stimulant applications, usually applied
in chronic cases, frequently fail, and in recent ones are obvious-
ly injurious. Asa general rule, in all cases of these diseases,
the hair must be cut close with a pair of scissors, and kept so
during treatment; shaving, I believe, from the attendant irrita-
tion, to be highly injurious ; and the head should be covered
with an oil-skin cap. The local plan of treatment consists of
ointments and lotions of the carbonates of soda and potash, in
greater or less strength. The carbonate of potash, being the
stronger preparation, is more adapted for the chronic forms,
and when the attendant inflammation is slight. The quantities
of the carbonates, used as unguents, vary from twenty grains to
one drachm, to one ounce of prepared lard, as used in lotions,
from half a drachm to one and a half, in a pint of rose or dis-
tilled water. The ointment is to be applied three times a day,
smeared over the eruption, and washed off each morning with
the corresponding lotion. In cases where crusts or scales are
found, a linseed-meal poultice applied for twelve hours, and the
ointment for a similar period, render them easily removable by
washing gently with the lotion. Sometimes the unguents dis-
agree ; in that case, the lotion must be substituted, but used
four or five times daily. In the chronic forms, when stimulants
are necessary, they are best treated with an' ointment consist-
ing of from half a drachm to one drachm of the citrine ointment
to one ounce of prepared lard ; this applied at bed-time only, and
the lotion during the day. The alterative medicine Dr. Neligan
uses is the yellow iodide of mercury (Protoiodide P. L.,) in
combination with mercury with chalk, and aromatic powder.
To a child six years old he gives half a grain of the iodide, two
grains of mercury with chalk, and two grains of aromatic pow-
der, every second morning ; for an older child the same every

540 Eruptive Diseases of the Scalp. [September,

morning ; to a younger child every third or fourth morning ;
for infants he omits the iodide ; but I have found mercury with
chalk, aromatic powder, and sesquicarbonate of soda, given
more frequently, answer equally as well. During treatment,
the child should be kept strictly on milk diet. This plan of
treatment I have seen employed, and have used it myself for
more than five years with the most unswerving success. I
have not seen a single case resist this plan. In illustration, I
shall cite a case or two. I might relate many, but do not wish
to infringe on your valuable space :

Charles S , a fine boy about a year and a half old, has

been afiected with in?petigo capitis since a few weeks after
birth ; his health not materially affected ; appetite bad, bowels
constipated ; his whole head covered with greenish-yellow
crusts, which extend over the forehead, through which is a
slight discharge of yellowish matter ; the hair matted together ;
the scalp itchy and hot. A linseed-meal poultice was placed
on the scalp for twelve hours, and the following ointment to be
applied three times a day: One drachm of carbonate of soda
to one ounce of prepared lard ; and the corresponding lotion
every morning. The following powder w^as ordered : eighteen
grains of mercury with chalk, thirty-six grains of carbonate,
twelve grains of aromatic powder ; into twelve powders, one
night and morning. The hair to be cut close, and the child to
wear an oil-skin cap. In three or four days the crust had dis-
appeared, and the tendency to heat and irritation entirely sub-
sided ; this treatment was steadily adhered to for six weeks,
(with the exception of substituting the carbonate of potash in
lotion and ointment for carbonate of soda,) when there was not
the least tendency to a return of the eruption, his hair was
allow^ed to grow% and the boy to resume his usual diet, having
been kept during treatment on milk diet. Although more than
a year has elapsed there has been no return of the affection.

H. B , a lad twelve years old, was brought for advice ;

his mother states, about a w^eek since he complained of itching
of the head, and upon examination she found what she termed
little boils scattered over the head ; he was affected with impe-
tigo sparsa, the hair slightly matted together, and a little dis-
charge. June 3rd, 1850 : the hair to be cut close,. and an oint-
ment of half a drachm of carbonate of soda to an ounce of lard
to be applied three times a-day ; and powders containing mer-
cury with chalk, soda, and aromatic powder, twice daily. This
boy was well in a week, but as a precaution, used the remedies
a few days longer.

I might add many more, but it suffices to say that all the
eruptions seem equally amenable to the above treatment. If

1852.] Chloride of Sodium in Intermittent Fever. 541

you think this tends to simplify the matter and it meets your
approbation, I shall have gained my point, and shall reserve
my observations on the remaining (non-inflammatory affections)
for another occasion. [Ihid.

On the Employment of the Chloride of Sodium in the Treat-
ment of Intermittent Fever. By W. P. Lattimore, M. D.

The discovery of some agent capable of serving as a substi-
tute for Peruvian bark, or for its active principle, quinia, in the
treatment of intermittent fever, has long been desired, in con-
sequence of the high price of the sulphate of quinine, and the
great adulteration of the salt to which this has given rise. The
amount paid for quinine alone, is no small item in the annual
expenses of the country physician ; and this is likely to be in-
creased, as it is said that a company of English druggists have
monopolized the entire crop of Peruvian bark for many years
to come.

In view of the interest necessarily felt in this subject, we have
thought it might not prove uninteresting to the readers of the
American Journal, to give the results of investigations made by
the eccentric Piorry, upon the use of common salt in the treat-
ment of intermittent fever. The investigations were com-
menced at La Pitie, and continued at La Charite, where they
were witnessed by the writer.

The attention of M. Piorry was drawn to the subject by
a memoir, presented to the French Academy of Medicine, in
July, 1850, by Dr. Scelle Montdezert, entitled. Practical Con-
siderations upon the Treatment of Intermittent Fevers, and
upon the mode of action of the Salts of Quinia, and of the Chlo-
ride of Sodium.

In this momoir, M. Scelle Montdezert supposes that every
paroxysmal fever is due to the presence of fibrin in the venous
blood ; this fluid, in the normal state, being deprived of fibrin
by the process of assimilation. That the salts of quinia ow^e
their efficacy as anti-periodics to the fact that they dissolve
this fibrin abnormally present, thus restoring the venous blood
to its normal conditions. In casting about, then, for a substi-
tute, he saw that nature had largely disseminated both potassa
and soda, each possessing, in a remarkable degree, solvent
properties. Seeking, among the various combinations of each,
that one which, uniting with the divers elements of the blood,
should furnish the fewest insoluble compounds, he naturally
selected the cloride of sodium, which forms none. He admin-
istered it, and then goes on to say :

542 Chloride of Sodium in Intermittent Fever. [September

" On account of these considerations we experimented with-
out fear of injury, and we declare with satisfaction that the
results of its employment are such that salt may now be con-
sidered as sharing with the salts of quinia the prerogative of
arresting the paroxysms of intermittent fever. It is sufficient
to administer half an ounce of it in the morning, before eating,
during the apyrexia, in half a glass of infusion of coffee. Its
use should be continued for three days.

" Fortunate results, observed during several years, have con-
firmed our foresight. It is a counter-proof of our opinion, long
since emitted, upon the action of the sulphate of quinine, and
one which gives the most satisfactory solution of this therapeu-
tical problem."

M. Scelle Montdezert gives the history of no cases treated
by salt, although he alludes to many in which the agent was
successfully employed. Under these circumstances thejnatter
came into the hands of M. Piorry, who was one of the commit-
tee appointed by the Academy to report upon the memoir, and
his cases are the only ones known to us. From these researches
it will be seen that the chloride of sodium cures intermittent
fever, like the sulphate of quinine, by acting upon the spleen
and diminishing its volume, and this sometimes in less than a
minute. And in this connection it may be of interest to say
a few words in regard to the views of M. Piorry concerning
the spleen in intermittent fever, and his method of diagnostica-
ting the disease.

He holds that in all paroxysmal fevers the spleen is enlarged ;
that the anatomical lesion is the cause, the fever only the symp-
tom ; that wherever the spleen has a greater length (measuring
in a line extending from the middle of the axilla to the anterior
superior spinous process of the ileum,) than from 31 to 33 lines,
intermittent fever exists. Believing thus, the symptoms for
him are zero, while the state of the spleen stands at the other
end of the scale, and is everything percussion (pleximetric) of
course, being the experimentum crucis.

We cannot resist the temptation of here paying a tribute to
the skill with which M. Piorry employs percussion in making
a diagnosis. With him auscultation is but an infant when
compared with its full grown hToiher percussion. By its aid
he interrogates the abdominal viscera as frequently as the
thoracic, and wqth no less success, for he has brought it to an
almost incredible degree of perfection. With his plate of ivory
and his flattened fingers' ends he diagnosticates almost every-
thing tumours of the abdomen, abscesses everywhere, aneur-
isms, &c. All acknowledge the delicacy and accuracy of his
test, while the looker on is lost in admiration, and wonders

1852.] Chloride of Sodium in Intermittent Fever. 543

whether all his senses are not really concentrated in the ends
of his fingers, which by constant drumming have at length be-
come the very reverse of tapering.

Wishing, then, to experiment with salt, a few cases of inter-
mittent fever (old stagers,) contracted in Algiers were selected
as subjects. Behold, then, Piorry at the bedside. The patient
asserts that he contracted the fever and ague several years
since in Africa ; that he has frequently been cured ; but that
the disease has constantly re-appeared at the end of fifteen
days or one month at farthest. The type of the fever is tertian.
The spleen is percussed and found to be abnormally dull
throughout its whole extent ; the entire splenic region is sensi-
tive upon percussion, particularly over the dullest points ; and
each blow is accompanied by marked contortions of the coun-
tenance. This sensibility extends but little beyond the region
of dulness, which last occupies an extent of fiity-three lines,
measuring in the direction indicated above. To this patient a
drachm of salicine is administered without producing any
change in the dimensions of the spleen. A few minutes sub-
sequently, half an ounce of salt mixed with a cup of soup is
given, and upon carefully percussing the splenic region at the
end of four minutes this organ is found diminished one inch,
from above downwards. The next day the spleen is found to
be of the same size, but upon the administration of a second
dose of salt, it suddenly contracts and measures nearly three-
quarters of an inch less than yesterday. The resonance
throughout the entire organ has increased while the sensibility
has diminished. The succeeding day, the attack of fever is
very slight, and upon giving a third dose, the disease does not
return ; and when seen six weeks subsequently, the patient is
still free from his African enemy. Thus we see that a diminu-
tion of twenty-four lines in the length of the spleen was the
result of the medicament, the fever being cured more effectually
than ever before ; i. e., the patient had remained free from all
relapse for the space of six weeks ; one month having previously
been the longest period of immunity.

We have the notes of seven cases of well-marked intermit-
tent fever, in all of which the administration of the chloride of
sodium was followed by rapid decrease in the volume of the
spleen and cure of the febrile symptoms. We also have the
record of three cases in which salt was unsuccessfully used ; in
one of these, the sulphate of quinine effected a cure ; in a second
it too failed, while in the third it was not tried. These were
all well-marked cases of intermittent fever, such as would pass
muster in any of our own malarious districts.

Let it be remembered that most of the fever and a^fue met

o'

544 Chloride of Sodium in Intermittent Fever. [September,

with in the Parisian hospitals, is of long standing, and imported
from the malarious districts of Algiers, which generate a form
of the disease even worse than that found amid the marshes on
the banks of the famed Maumee ; that these cases have been
treated again and again, have been cured now by the sulphate
of quinine, now by arsenic, but only to reappear upon the
slightest exposure or imprudence ; in short, to recur as only the
shakes can recur.

We witnessed many of the experiments of M. Piorry, and in
the great majority of them, the fever yielded to salt quite as
readily as to the salts of quinia. And as to the theory of M.
Piorry, the spleen diminished under the use of the remedy,
j)a7^i passu, with the febrile symptoms, in every case where
the disease was cured, proving that this organ really shows the
influence of remedies over this class of fevers that it is, as it
were, a febro-barometer for the diminution of the spleen is a
constant phenomenon accompanying the cure of the disease,
whatever be the curative agent employed.

M. Piorry's method of administering the chloride of sodium
is, to give half an ounce in a cup of thin soup during the apy-
rexia and fasting. It usually agrees with the stomach perfectly
well, but in some few cases we have seen it excite vomiting
and diarrhoea. Three doses commonly suffice to effect a cure,
the first two to be taken on succeeding days, and the third after
an interval of one day. Should the spleen be undiminished in
volume by the first dose, we may be sure that the remedy will
not cure the disease ; and the same is true of all the antiperio-
dics. Excepting in rare cases, the diminution of the spleen
occurs immediately upon the administration of the remedy
(salt or sulph. quinine,) and may frequently be detected within
one minute, after which the organ remains stationary until a
second dose of the medicament be administered.

Is the chloride of sodium as efficient an anti periodic as the sul-
phate of quinine ? Are the cures efl!ected by the one as per-
manent as those effected by the other ? The first question can
only be answered by those possessing a larger field of observa-
tion than the writer. May we not hope for a solution from
those of our profession who observe the disease too largely
either for comfort or pleasure ? In regard to the permanency
of the cures, we apprehend there is not much difference, be the
medication what it may ; for relapses are only too common
after the greatest care and most patient attention.

Should the discovery prove as useful and applicable as it
promises, the benefit accruing from it will be immense. If it
be capable of taking the place of the sulphate of quinine in the
majority, or even in one-half the cases of intermittent fever,

1852.] On Chordee. 545

therapeutics will be largely the gainer. [Amer. Jour, of Med,
Science.

On Chordee. By John L. Milton, Esq.

[There are two facts to be noticed as to the cause of chordee
as bearing upon the treatment ; viz., that there is spasm, and
that this is attended by pain, caused, primarily or secondarily,
by the condition of the mucous membrane. The following ap-
pear the best known and most commonly employed methods
of treatment :]

Mr. Lagneau says, " for the inflamed chordee, bleeding frorr>
the arm, hot bathing to the perineum, lavements, eighteen or
twenty leeches to the canal of the urethra, two or three times
repeated, and when the pain is severe, gr. i. of the watery ex-
tract of opium, and gr. ii. of camphor," which he recommends
giving in the evening. He winds up this energetic treatment
by a solemn warning not to plunge the penis into cold water,
as it may be, and has been, followed by a metastasis of the
complaint of the bladder.

M. Ricord recommends gr. iiss. of camphor, and gr. ss. of
opium in a pill, of which two or three may be taken every
night.

Richter recommends that the patient sleep on a hair mattress,
and very cool, or else on a canopy, and do not turn on his
back. Eisenmann that the parts should be exposed to the in-
fluence of narcotic vapours ; or that infusion of camomile or
cherry-laurel water be injected or dropped into the urethra.
He found sedatives of no avail. He recommends the patient
to make water more frequently than necessary, because a dis-
tended bladder irritates the vesiculse seminales and the neigh-
boring parts. He objects, also, to dipping the penis in cold
water, and then recommends soothing injections, or poultices ;
opium being less useful. Peyrihe recommends ammonia and
injections of soap ley. Iodine, the empyreumatic oil of tartar,
and blue ointment, have also been praised.

Mr. Hunter says, " he has known twenty drops of the tinc-
tura thebaica take it (painful erection) away for a whole night,
and that the cicuta has likewise some powers in this way.'"'
For the chordee, he recommends opium joined with camphor,
praises local bleeding with the free use of hot vapour to the
parts ; poultices with camphor ; while the efflised lymph which
remains may be removed by mercurial ointment in friction.
He has seen the cicuta of service.

546 On Chordee. [September,

Mr. Wallace recommends calomel and hippo,* with opium
and camphor.

Such are the general outlines of the practice pursued by
surgeons, as we find it recorded in books. These plans bear
a pretty strong resemblance to each other, and are nearly all
calculated to lead to one point the allaying of pain by the use
of sedatives. The idea of attempting to remove it by tlie pure
antispasmodics, does not seem to have been worked out or even
entertained, although everything seems to show that it is more
amenable to them than to opium. I will add but one more
remedy, as remarkable for its originality as any I know, and
which was, I believe, first recommended in wanting by Dr.
Colles. It is, that when the patient finds the chordee coming
on, he do turn over^ and balance himself on his knees and elbows
till the chordee goes off. The reader can easily imagine what
effect such a remedy would produce. Let him figure to him-
self an exasperated patient struggling in the middle of the night
to get ease in this way ! Verily, this is surgery !

I now approach that part of the matter which has most of all
occupied my attention the substitution of some simple and
always applicable remedy for these different methods of cure.
I will not stop to point out the inutility or inapplicability of
antiphlogistic treatment to this symptom, as any one versed in
the disease must have observed cases where the chordee came
on though the patient had been treated most heroically. Seda-
tives I utterly object to, as I have never used them in sufficient
quantit}' to have any material effect on the chordee without
finding the patient much worse afterwards. They generally
disordered the stomach, produced headache and languor, very
often with constipation of the bowels. The scalding and dis-
charges were rendered worse and more obstinate, and, to crown
all, the chordee was merely abated for an instant, and returned
the moment they were left off; nay, even when they were
again administered without increasing the dose. Nor have I
ever been able to understand why they should be given, as the
pain appears to depend on a spasm, and when this is removed
the pain ceases ; whereas the spasm does not necessarily sub-
side when the pain is relieved.

I have tried the most powerful antispasmodics, as ether, gal-
banum, assafoetida, and chloroform, and can only say of them
that I have found nothing equal to camphor in the fluid form.
In powder, camphor is disagreeable to take, and did not appear,
to act so readily, I suppose from not being so equally diffused
and finely divided as in solution. In fact, in spasm a liquid

* Pulv. ipecac, comp.

1852.] On Chordee, 547

remedy, as admitting of a more rapid action, is always the
thing to be sought for. The spirit of camphor, taken in the
dose of 3j., in a small quantity of water, is equally energetic
and rapid. The objection that it immediately becomes insolu-
ble by contact with water, is sufficiently obviated by the fact,
that its operation is most certain and rapid, and that esscence
of camphor, in which the camphor is so dissolved that it does
not separate on the admixture of water, possesses, so far as I
have been able to judge, no advantage over the other.

As in many other cases, the chain of morbid actions must at
once be broken, and this is done much more effectually by two
or three full doses, repeated at short intervals, without the least
remission, till the chordee is completely stopped, than by small
quantities, however long continued and regularly taken. I
therefore invariably adopt the following plan :

A tea-spoonful is to be taken at night in water before going
to bed, and every time the patient wakes with the chordee, let him
at once rise and repeat the dose. In the milder cases, one dose
for a night or two is generally enough. In the more severe
ones, the symptom is generally removed at the end of the se-
cond night, becoming, in the meantime, milder and less frequent
after each dose. So long as the clap remains bad, I frequently
recommend the patient to take a tea-spoonful at night before
going to bed, which suspends the chordee till the cure is com-
pleted. This plan of treatment also answers well in the bear-
ing down pains to which women are sometimes subject in clap ;
but as here, contrary to what it is in men, these pains are gen-
erally worst in the day-time, it is best to use the esscence of
camphor largely in the medicine they may happen to be taking.

It must, however, be taken in full doses. A violent sudden
pain like that of chordee requires an equally powerful remedy,
and there is no use in trifling with it. A less quantity than a
tea-spoonful will not always suffice to abate the pain at once,
though it may materially alleviate it; just as a moderate dose
of chloroform will lull the acute pain of an operation without
rendering the patient insensible to what is going on, while a
smallar quantity, in one full dose, produces complete torpor.
Now, as a tea-spoonful or two may be safely taken, it is best
to insure success at once. In one or two cases, it has produced
some sickness, and, strangely enough, this has been more the
case with small doses than large ones ; this was probably caused
by something having been previously taken that had in some
measure disordered the stomach. Atanyrate,theinstanceshave
been too few to make the affair of any moment. I only allude
to it here, that no one might by its appearance be discouraged
from giving so valuable a remedy as camphor really is.

548 Epilepsy treated by Tracheotomy. [September,

The patient should be directed to keep the camphor in a
tightly-corked bottle, and in a cool place, and to have it by his
bed-side ready to take. It is best taken in water, as, if dropped
on sugar, it produces a strong sensation of heat in the mouth,
occasionally preventing the patient from getting to sleep a-
gain. [^Medical Times.

Case of Epilepsy treated by Tracheotomy. By W. H. Cane,
Esq., Uxbridge.

[In the case of a boatman, suffering under an extreme
epileptic seizure, after which he was left in a state of deep
apoplectic coma with asphyxia, inspiration being performed
only by seldom and short catches, whilst the veins in the head
and neck were every where visible, and greatly distended, Mr.
Cane, after the patient had remained in this state nineteen hours,
determined to perform the operation of tracheotomy ; acting
upon the suggestion of Dr. Marshall Hall, that as the epileptic
or other convulsion implied closure of the larynx with expira-
tory efforts, the attack of convulsive epilepsy would be pre-
vented by that operation.]

"Feeling convinced," Mr. Cane observes, "that the patient
must shortly expire, and that the root of the evil was in the
closure of the larynx, I at once proceeded to open the trachea,
a matter of no small difficulty, on account of the twisted state
of the neck, the engorged stale of the vessels, and the constant
action of the muscles. The operation of tracheotomy was per-
formed, and the tracheal tube is kept in the trachea to the pre-
sent time. The relief to the patient was immediate ; the air
passed into the lungs, the state of spasm subsided, with the
turgid condition of the head and neck, and the patient soon
recovered his sensibility. This was not the only gratifying
result : although the poor man had experienced his epileptic
seizures in increasing violence during seven or eight years, and
recently thrice a week, he had, on April 1st, during two months,
had no return of them. More recent accounts of the patient,
who is now in Staffordshire, confirm the former report ; the
tube is still kept in the trachea, and the epileptic seizures have
not recurred." \_Lancet.

Scarlatina. By Dr. Volz.

Dr. Volz has recorded his experience of a severe epidemic,
of scarlatina in Carlsruhe, from which he draws the following
deductions :

1. The extent and redness of the eruption are not in direct
ratio to the severity of the disease.

1852.] Creasote in Scarlet Fever. 64d

2. The proximate cause of the exanthem is a stasis in the
cutaneous capillaries.

3. The exfoliatininr scales of epidermis do not transmit the
contagious principle of the disease.

4. The mucous membranes undergo the scarlatinous erup-
tion equally with the skin.

5. The lesions of the throat are of three varieties, catarrhal,
inflammatory, and gangrenous.

6. The inflammmation of the parotid which accompanies
scarlatina seldom terminates in suppuration : that which fol-
lows 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:
congestive apoplexy, suffocation, pyaemia, and anaemia. \_Prov.
Med. and Surg. Journal.

Creasote in Scarlet Fever. By T. E. Waller, M. D., of Pa.

In April, 1851, my three little boys were attacked with Scar-
let Fever, The two youngest, though the fever was very high
for a few days, recovered, without any of the sequelae of the
disease, in the course of three or four weeks. The eldest, a
stout, hearty child, under four years of age, was the worse case
I ever saw live ihroucrh an attack in its malignant form. Though
it was not followed by any of the common effects of the disease,
except swelling and final suppuration of the glands of the neck,
it was two months from the time he was taken, before he was
able to stand on his feet. I pursued the ordinary antiphlogistic
and cooling treatment, until the commencement of the suppura-
tive stage. I was then at a loss what to do, so deeply and exten-
sive were the mucous surfaces affected. Indeed, it seemed to
me the case must, in spite of all known remedies terminate fatal-
ly. Matter (pus) was discharged profusely from the nostrils
and ears, and his eyes were almost closed for several days, from
the same cause. The pulse became more rapid, and other
symptoms supervened, indicating extensive suppuration and
the absorption of pus, and delirium was almost constant during
the latter part of the day and night. I felt convinced that if
something was not done very soon to arrest the suppuration,
the child must certainly die.

In the absence of council, and in that state of mind natural
to a parent under such circumstances, I felt bewildered and
almost overwhelmed in contemplating the case of my little suf-
ferer. But presently, under a sense of the pressing emergency,

N. S. VOL. VIII. NO. IX. 35

550 Creosote in Scarlet Fever, [September,

and the responsibility weighing so heavy upon me, I rallied, and
resolved to make an effort to save my child. For an hour or
more I examined authors, cases, remedies, and reflected, but
without finding anything satisfactory.

The use of pyroligneous acid then came to my mind as some-
thing available ; and then Creasote as still better, which I im-
mediately resolved upon trying. I mixed three drops with an
ounce of water, put it into a common sized tumbler nearly full
of water, and directed half of it to be given during the night, as
a drink. The balance was given during the following day, and
continued at the same rate for three or four days. A decided
improvement was perceptible before the first three drops were
all taken, and by the second night he rested better ; the pulse-
became slower and fuller, and the discharge diminished very
much. I also washed out the mouth and throat as much as I
could, and the nose and ears, with a solution of Creasote, six
drops to an ounce water. I believe it was on the fifth day that
I discontinued the internal use of Creasote, the discharge having
nearly ceased ; but applied it externally, three or four times a
day, to the mouth and nostrils, until they were healed. He
recovered, though very slowly; and I believe it was the Crea-
sote that saved him.

I had no other cases until the spring, when I had an opportu-
nity of trying it again in seven more very severe cases. In one
of them, gangrene of the throat (or glands,) took place, so that
in approaching the patient, the smell was very offensive. \n
two days' use of Creasote, the change for the better was truly
astonishing. It seemed as if the child had been suddenly rais-
ed, from a state bordering on decay and inevitable destruction,
to convalescence! I never saw a remedy act so like a charm
before. All of these seven cases were as bad as any I ever
saw, (and I have seen hundreds,) and I have pursued nearly the
same treatment with each one, with the same result recov-
ery. I used water and lard externally, (sometimes a warm
bath,) and to show the high degree of the fever, I will state
that, after "peeling" all over, as they all did, the cuticle on the
bottoms of the feet,^ in one case a boy over nine years of age
came off whole, like the sole of a shoe.

In one case, I gave about half a drachm of carb. lig. three or
four times a day, in connexion with the Creasote water, and in
four of the last cases, before suppuration took place, I applied
a solution of nitrate of silver (gr. x to the ounce,] to the throat
and glands, which I think had the effect to diminish the local
inflammation a good deal. But to cleanse the mucous surfa-
ces, and check suppuration, thereby destroying its poisonous
effects by absorption, creasote^ in my humble opinion, is the rena<*

1852.] Syncope. 5Si

edy. I do not know whether any other physician has ever
used it in this manner or not ; but if this brief and imperfect
sketch will be the means of giving it a more extensive trial,
perhaps the profession and the public may be benefited by its
publication. I regret that I did not take notes, so that I could
have given an exact and complete report of each case. Still, I
trust the main feature in my treatment is rendered intelligible.
I have thus treated eight very bad cases successfully ; five boys
and three girls, ranging in age from four and a half to nine and
a half years. I will therefore sum up as a general treatment
of scarlatina maligna, as follows:

Open the bowels every other day with Castor oil or some
mild aperient apply cold or cool water and lard alternately
to the whole body frequently warm mustard bath, if necessa-
ry, and tepid water with vinegar solution of nitrate of silver,
in the first stage, to the throat, once a day and in the suppura-
tive stage, three drops of Creasote in twenty-four hours, until
the discharge abates wash and gargle the throat, &c., with
Creasote water, six drops to the ounce, three or four times a
day; and for the hoarseness and dry state of the larynx, before
or during convalescence, give from five to ten drops of balsam
copaiba on a little sugar, three times a day. After the patient
gets up, great care is necessary to prevent taking cold, and the
diet should be light for at least two weeks in most cases. The
Pulv. Jalap Comp. will generally keep down or remove dropsi-
cal efl?usion or anasarca, if that state supervene.

N. B. I forgot to state that, in one of the above cases I took
blood from the arm. But no general rule can be laid down for
that the physician must be the judge, in each case, of such
necessity. [Philadelphia Med, and Surg. Journal.

We think the suggestion of Creasote as a remedy in the sup-
purative stage of Scarlatina entitled to peculiar regard, and have
therefore placed the above article upon our pages. We must,
however, dissent from the use of cathartics or even laxatives
so often repeated in a disease which tends so rapidly to a pros-
tration of the energies of the system. We think it of the
utmost importance to husband the resources of life in Scarla-
tina.[Ed. S. M. & S. J.

Syncope from Entrance of Air into the Facial Vein. By Mo-
ses Guxx, M. D., Professor of Anatomy and Surgery In the
University of Michigan.

The substance of the following case was transmitted imme-
diately after its occurrence, to the chairman of the committee

552 Ammonia in Cynanche Tonsillaris, [September^

on surgery of the National Association ; but no notice having'
been taken of it by that committee, and deeming it not entirely
devoid either of interest or novelty, I now seek to lay it before
the profession through another channel.

The patient appeared at the college clinic with a small, hard,
oblong, tumor, lying under the base of the inferior maxilla, in-
volving the facial vessels so as to require their division in its ex-
tirpation. Previous to commencing the operation, in accordance
with my usual custom before making incisions in this region, I
sought, by compression with my hand upon the lower portion of
the neck, to ascertain the course of the external jugular vein,
but was not able to detect the vessel. An incision was made
parallel to the base of the jaw, and the tumor separated from
its bed, except at a point near its posterior extremity where it
involved the facial vessels. These were divided, the tumour
detached, and its place occupied by a sponge, removing which,
in order to secure the facial artery, I instantly noticed a move-
ment in the open mouth of the facial vein, heard a bubbling
sound, and my patient sank back in a state of syncope, from
which he recovered with some difficulty by the ordinary means.
The wound was immediately stopped on noticing the move-
ment in the open mouth of the vein, and by means of a firm
compress, hemorrhage and further entrance of air w^as sought
to be prevented, and the wound allowed to heal by granulation.

This case is interesting from the fact that the accident arose
from the entrance of air into a vein as small as the iacial, and
had it not been reinforced by some other, it would seem impos-
sible for its division to be attended with such results. But it
will be borne in mind, that the external jugular did not pass
down the neck in its usual superficial course, but probably
united with the facial, and emptied by a short thick trunk com-
mon to both into the internal jugular. The facial I undoubtedly
divided at the point of junction. I have once met with just
such a distribution of the veins upon the dead body. \_N. Y.
Journal of Medicine.

On the Use of Muinate of Ammonia in Cynanche Tonsillar
ris. By A. B. McKay, Green Bush, Illinois.

Although this disease is rarely fatal, yet it is one of the most
distressing the human family is subject to. It is this which
has induced me to lay before the profession a few remarks o
a remedy which I have used with complete success in many
cases of this disease ; in fact, in every case it has succeeded, i
which I have used it. The remedy is muriate of ammonia,, ot
sal ammoniac r

1852.] Treatment vf Neuralgia. B^

My usual method of administering it is as follows :

S)^, Amnion. Mur 5iii.

Tine. Opii, f3i.

Aceti, f!iv. Misce.

As soon as the vinegar is well saturated with the ammonia, I
let the patient use it freely and often, as a gargle. In the ab-
sence of vinegar and laudanum, I have powdered the ammonia
and blown it on the affected parts. This remedy has succeeded
so perfectly in my hands, that I am almost inchned to think it
a specific in this disease. I use it with equal success in all
stages. [Buffalo Med. Jour, and Rev.

On the Treatment of Neuralgia. Extracted from an article in
the Western Lancet, by Landon Rives, M. D., of Cincinnati.

" Most practitioners use opiates to produce an anodyne ef-
fect ; and in this, I think, the fault usually lies in the treatment
of this affection. When opiates are used with persons of good
constitution, they may effect their andoyne influence, but if
administered to persons of debilitated constitution and nervous
temperament, laboring under neuralgia, the excitant effect will
more than counterbalance all the good which can be expected
from the subsequent sedative operation of the medicine.. The
functional derangement in this disease is an exalted sensation
hence it is wrong to administer a medicine which excites, even
in its primary action, for, although the secondary action may
be the one desired, the primary excitation will irritate the dis-
eased tissue, and render the subsequent paroxysms much mcy'e
violent. A more appropriate, and in my hands a much more
efficient remedy to meet this indication, is small and frequently
repeated doses of extract of hyoscyamus. This medicine, un-
fortunately, is not always kept of a good quality in the shops ;
hence, care should be taken to procure a good article. With
a view to prevent the recurrence of the paroxysms, there can
be nothing used more efficacious than quinine. It has been my
good foitune to cure a number of cases of neuralgia, with sul-
phate of quinine and extract of hyoscyamus, given in doses of
one and a half grains each, at periods of from two to four hours
during the intervals of the paroxysms. It is often necessary,
and I may say, generally well to premise this course, by some
I gentle cathartic. I have sometimes relieved the pain and cut
short the paroxysms by a pill of two grains of extract of hyos-
cyamus alone.

" If the distinction is properly drawn between neuralgia and

554 Letters upon Syphilis. [September,

those affections only involving the neurilemma, and a sedative
anodyne, instead of an excitant anodyne used in connection
with quinine, this disease vj\\\ cease to be an opprobrium to
medical science, and its treatment will become much more sat-
sactory to the practitioner as well as to the patient." [A^. /.
Med. Reporter,

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French by
D. D. Slade, M. D.

FIRST LETTER.

My Dear Friend, The modern doctrine upon syphilis meets
the lot of every scientific discovery. For nearly twenty years I
have sought by my teachings and by works to infuse this doctrine
into the minds of my cotemporaries. I see, however, that it is
not equally understood by all the world ; certain adversaries
still raise objections, which I have refuted a hundred times;
and more curious still, certain others take up objections started
by myself, and imagine, a little ingeniously, perhaps, to subdue
me by arguments which I have introduced into this discussion.
At this I am neither astonished nor indignant. I find in it, on
the contrary, a new incentive to continue my task, and far from
complaining of my adversaries, I shall thank them rather for
not suffering my zeal to languish, by thus keeping it awakened.
Therefore, I ask of you permission to give to the world, through
the columns of your widely-spread Journal, the true doctrines
of the " Hopital du Midi." I ought to tell you that it is more
a general exposition, that I intend to make, than a special reply.
Upon my path I shall meet with objections, and I shall try to
answer them. I shall preoccupy myself also as far as I ought,
with a recent publication from the pen of one of our fellow-
laborers, who to find followers had no need of going to seek
them modestly " en Province." I present to you, my dear friend,
a preliminary reflection induced by the publication of which I
have just made mention. Although it is not given to an obser-
ver to see all the facts of one entire department of pathology,
and to establish a general system, we must not conclude that
this observer has not seen, done or established anything that his
studies and his researches ought to be regarded as useless, and
that we ought to hold his teachings as nothing.

This manner of philosophizing in medicine, perhaps a little
too common at the present day, is convenient and expeditious,
but it is neither true nor just. In syphilography especially, this
manner of proceeding would lead to deplorable errors. A seri-

1852.] Letters upon Syphilis. 55S

ous study of our art demands more moderation in language,
more justice in appreciation. For myself, I am pleased to re-
cognize and to say, that far from disdaining everything in
syphilographic literature, those who know how to search for
them can find worthy and curious observations, good precepts,
even sometimes doctrinal whims which, in discrediting their
source, no one thinks worthy to exhume. Certainly the long
discussions upon mercury, guaiacum, sarsaparilla, are not entire-
ly void of utility. Light can be thrown upon the history of
blenorrhagia by the observations of those who have preceded
us. Without doubt the spirit of charlatanism and of speculation
have left too frequent traces of their passage, but you will find
often the marks of judicious minds, of a true scientific tendency
and praiseworthy efforts to arrive at a classification and a doc-
trine. These works, if they had no other interest than that of
giving the ideas and opinions of past times, would not merit the
disdain, in my opinion unjust, which som-e have wished to throw
upon them. I shall say the same of modern observers. The
critic, I know and 1 think to have proved it, finds frequent op-
portunities to exercise himself upon their works. But is that
saying that we should hold them of no account ? Far from me
this unjust thought. On the contrary I hold in great estimation
the works of Bell, of J. Hunter, and of Swediaur ; the time has
come to render complete justice to Culleriar, to M. Lagneau
especially, whose reputation was legitimately popular, in fine
to all those industrious and intelligent laborers in our science
who by conscientious studi-es have with difficulty opened the
road in which we can march more freely. Would I be unjust
towards my cotempararies? Heaven forbid, dear friend.
Whatever may be our differences, it is with pleasure and spon-
taneously that I render the most sincere homage to the works
of MM. Baumes, Gibert, Cazenave, Cuilerier neveu, Bottex,
Ratier, Puche, Diday, Reynaud, Payan, Lafont Gouzi, Venot,
in France ; of Wallace, Carmichael, Babington, and of my pu-
pils Acton and Meric in England; Thiry, Herion, in Belgium;
to the remarkable publications of laborious Germany and indus-
} trious Italy. I do not feel any sentiments of injustice or of ha-
tred either towards the past or towards the present. You will
excuse me from declaring this very distinctly before entering
upon my subject. I explicitly say that I do not partake in any
way the opinion of those unreasonable critics to whom ancient
and modern syphilographic literature is but trash unworthy of
attention. I believe, on the contrary, that this branch of path-
ology is as fertile as any other in useful works and in valuable
researches. However, the labors of ancients and moderns
could not preserve this portion of our science from the general

556 Letters upon Syphilis. [September,

revolution brought upon medicine by the physiological doctrine.
The school of Broussais, in blotting out the past, had again
questioned everything. Was there a syphilitic virus? The
virole, did it exist ? You know how physiologism resolved
these questions. The greatest confusion reigned in the science,
and was introduced into the publications of the times. Doubt
was everywhere, certainty nowhere. It was at this lime, that
having become by "Concours" surgeon of the central bureau
of hospitals, chance caused me to enter the hospital " du Midi."
There I encountered a man, honest and loyal, a practitioner
earnest and strict, M. Cullerier, who abandoning the traditions
of family, so to speak, took upon himself to doubt his own ob-
servations, and appeared no longer to believe in that which he
had seen. Everywhere doubt had taken the place of belief.
The cause of syphilis was doubted, its effects also, and, in con-
sequence, its therapeutics. And remark, that which they called
the modern doctrine was presented suri'ounded by much scien-
tific display. M. Richond des Brus had written an enormous
book filled entirely with facts; M. Desruelles supported new
ideas upon statistics, which passed for being indisputable; all
exerted themselves from the desire to combat the speciality of
the disease, and the remedy. History was made to contribute
largely by a very learned writer of our century, who in one of
the most remarkable works of our time amused himself with
taking the observers " corp? a corps," and placing them in oppo-
sition with themselves. An easy triumph, if the critic, in a severe
and partial analysis, does not know how to establish a marked
dilTerence between the author's own ideas, those which result
from his researches from his own observations, and those which
he draws from the scientific medicine of his day. Tlie former
are useful materials and worthy of preservation, the latter con-
stitute the prejudices of the epoch, and have no historical value.
Jourdan did not make this distinction ; it sufficed for him to com-
bat the speciality of syphilis, to show the confusion in the con-
tradictory opinion of our predecessors, and this he did with a
profuseness of learning which would have been extolled in a
sounder critic.

Such, then, was the state of minds and of science when I
entered the Hospital "duMidi." P\)r some there was a de-
stroyed edifice to rebuild ; for others, at least, it was to be con-
solidated. That which was especially necessary was to take
up again the study of the cause of syphilis. Is there a special
cause, a virus ? or do venereal accidents spring from a common
cause? For this research and study, two modes of investiga-
tion were ofl^ered to me. The first was the simple observation
of phenomena, that observation which our predecessor had

1852.] Letters upon Syphilis. 557

practised, and which had conducted them to opinions so differ-
ent ; to observation similar to that of Devergie, analogous to
facts ah'eady reported by Vigaroux, by Bugny, &c. ; to that
observation, for example, relative to three officers, who had con-
nection with the same young female suffering from a discharge
and who all three found themselves infected, the one with an
urethritis, the second with a chancre, and the third with vege-
tations. It is true that Devergie has deprived history of a slight
information that of the precise state in which he found this
young woman, whom he had not examined with the speculum.
Evidently this mode of investigation was worn out, and could
only conduct to barrenness or confusion of results. The second
mode satisfied my mind better ; in other respects it was more
in confornjity with the demands of modern science ; it seemed
to me to open a sure way to study, and to conduct to incontes-
table results. I mean experimentation. I proposed to myself
the following obligations : To follow the cause of syphilis to a
known source ; to place it upon a region visible and easy to
observe ; to note the effects.

You see, experimentation alone could fill these conditions.
But already experimentation had been consulted, and through
it contradictory conclusions had been anived at. When J.
Hunter said yes Carru, Bru, Jourdan, Devergie and M. Des-
ruelles said no. To what could such diflferent conclusions be
owing, after the employment of the same method of investiga-
tion. I did not know then, but I have learned since. That
which my reason convinced me then, was that experimentation
well and accurately made, ought to conduct to precise results,
and that the difl^erences of experimenters should not discourage
me. These researches were difficult and delicate. Conviction
was necessary, and 1 say it also, courage, to undertake them.
It was necessary to be sure of thoroughly appreciating the con-
ditions in which I was about to act; it was neceseary to aid
myself by antecedent experimentations ; it was especially ne-
cessary to support myself upon the purity of my intentions, and
upon the testimony of my conscience. I was not contented, in
fact, with the great name of Hunter, with the experimenters
cited by Bell, with the work of Hernandez, although crowned
by the Academy of Besancon ; with the authority of Percy, and
other great names as recommendable ; but I wished to study
the question in itself, to place myself in the condition of a true
inventor, in order to take upon myself all the responsibility of
the results.

How was it necessary to proceed to this experimentation?
1 could inoculate a healthy individual from a patient. I could
experiment upon the patient himself. The first mode, that is

558 Letters upon Syphilis. [September,

the inoculation of a healthy individual from a patient, appeared
to me one that should be always rejected by the phj^sician. I
do not think that we have the right to make such experiments.
Not only the physician cannot make use of his natural author-
ity to induce an individual to undergo experiments of this nature
but I think that the physician ought to resist against the wishes
of those, who seduced by a generous devotion, wish to volunta-
rily expose themselves to the risk of experimentation. I do not
cast any blame upon those who have acted differently. I re-
peat, only, that, for me, 1 did not wish to proceed in this way.

The experimentation upon the patient himself remained
would this offer inconveniences and dangers for the patient?
In case it did not, would it conduct to conclusive results?
Here is what history, observation, and experience learned me
in this respect. It was generally admitted that a first conta-
gion would not prevent a second, and the old proverb of " virole
sur virole" had yet all its authority. We know to-day what
this means. As to the inconveniences and the dangers, we see
every day that it is rare that the primary accidents are isolated,
that they multiply themselves with great rapidity, and that, to
speak explicitly, the gravity of the disease is not in relation to
the number of these accidents. Thus, to throw light upon such
an important question of etiology and of practice, art could with-
out inconvenience, do that which nature constantly does. A
much more important question presented itself here. The
grave and consecutive accidents of infection being feared,
ought they to be in accordance with the number of primitive
lesions. Strict observation, and the clinical observation of all
times, has proved and proves every day, that the constitution-
al virole is not in ratio with the number of primitive accidents,
existing at the same time and developed at the same epoch. One
accident more does not add any more chance of infection if
we know how to direct the experimentation.

The question of surface remained, to know if an extensive
ulceration exposes more to a general infection than an ulcera-
tion of small size. Well, here again observation has shown
that a more or less extent of primitive ulceration has no influ-
ence upon the production of consecutive accidents. A very
small chancre exposes just as much to a general infection as a
very extensive one ; and vice versa, a large ulceration exposes
neither more nor less than a small one. In fine, the question of
the seat of the ulceration remained, of the place of election for
experimental inoculations. It had been said by Boerhaave,
among others, that venereal accidents contracted in other ways
than by the genital organs, presented a very great gravity ; but
clinical observation proved to me, and it has shown me since,

1852.] Iodide of Sodium in Syphilis. 559

that this opinion was erroneous. I well know that upon this
point a great noise has been made of diseases contracted b}'
physicians, by nnidwives, inconsequence of examinations, of
wounds, &c. There are very good reasons, but I do not wish
to point them out here, why these accidents should give rise
to a great commotion. What I can say without injuring any
rules of propriety, is, that the men of art to whom these acci-
dents happen, have no motive to conceal them, while common
people attacked by syphilis have always strong motives to keep
quiet.

I rested, then, convinced that the seat of the ulceration could
have no unfavorable influence upon the production of consecu-
tive accidents, but even that it could diminish or annihilate
certain grave consequences, such as the production of buboes.
Thus observation had already proved that the primary chan-
cres of the thigh were almost never followed by enlarged glands,
and in fact in my numerous experiments, I have never seen
enlarged glands follow from the punctures of inoculation upon
the thigh.

Thus, my dear friend, by histor}', by clinical observation of
all times, by experimenters who had preceded me by the testi-
mony of my own conscience strictly interrogated, I arrived at
thisencouragingconclusion. In experimenting upon the patient
himself I did not communicate another disease. I did not in-
crease the gravity of the accident by which he was already at-
tacked. 1 did not expose him more to the chances of a conse-
cutive infection.

These first and capital conditions being ascertained, it was
necessary to search out those w^hich offered to science and art
all the guarantees to be desired. An explanation upon this
point will be the subject of my second letter. [Boston Med.
and Sur^. Journal.

o

On the employment of the Iodide of Sodium in the Treatment of
Secondary Syphilis, By Dr. Daveri.

Notwithstanding the great success which has attended the
employment of the iodide of potassium in the treatment of ven-
ereal disease, its disagreeable taste, and the gastric irritation it
sometimes gives rise to, induced Dr. Daveri to try how far the
iodide of sodium might be advantageously substituted for it. In
the nineteen cases of secondary syphilis affecting the bones
and periosteum, in which he has employed it, he has found it
equally beneficial, while it is far more palatable. It is also
t)orne in larger doses, and these can be more rapidly increased ;
so that the duration of the treatment is abridged. Some cases

560 Nerves in the Skin of the Fingers. [September,

which proved rebellious, or only slowly yielded to the iodide
of potassium, have been rapidly cured by the soda prepara-
tion. [BuUetino delle Sc. Med. ' Brit. <^ For. Med. Chir. Rev.

On the mode of Termination of the Nerves in the Skin of the
Fingers By Dr. Rudolph Wagner.

This celebrated physi('logist has recently been making the
distribution ofthe nerves in the skin of the tactile extremities of
the fingers his peculiar study ; and has communicated the fol-
lowing results of his inquiries to the Royal Society of Gottingen.

What are usually called the tactile papillae are of two kinds
namely, vascular papillas, which only contain capillary loops ;
and nervous papillae, which are placed between them. These
last have a conical form ; and each of them contains in its inte-
rior a peculiar corpuscle, also of conical form, which receives
the finest of the nervous fibrils that enter the papilla. Each
primitive nerve-fibre divides into a great number of smaller
branches, to whicli these tactile corpuscles are attached ; and
thus each is connected with several corpuscles. It is further
considered bv Wacrner that each single fibre conducts the im-
pression made upon any of these branches to a certain spot in
the nervous centres ; and that thus but a single sensory impres-
sion is produced, whether the corpuscles supplied by any one
fibre are touched separately, or all together. [Gaz. Med. lb.

On the Influence of ttie Sympathetic Nerves on Sensibility^ and
on Calorification. By M. Cl. Bernard.

This industrious experimenter has recently communicated t6
the Societe de Biologie two very remarkable results of his ex-
periments on the sympathetic nerve, which we believe to be
altogether new. It has long been known that section ofthe
cerebro-spinal nerves tends to diminish the temperature ofthe
parts which they supply ; and in the case ofthe pneumogastrics,
to lower the temperature of the body generally. But, accor-
ding to M. CI. Bernard, when the trunk which unites the sym-
pathetic ganglia of the neck is cut through on one side, the tem-
perature on that side ofthe face undergoes a remarkable increase
which is not only perceptible to the hand, but which shows
itself in a thermometer introduced into the nostrils or the ears,
to the amount of from 7 to 11 (Fahr.) When the superior
cervical ganglion ofthe sympathetic is removed, the same ef-
fect is produced, but with yet greater intensity. This difference
is maintained for manv months, and is not connected with the

1852.] Injections of Salt in Intoxication. 561

I

occurrence of inflammation, congestion, oedema, or any other
pathological change in the part. The eflect is not prevented
by section of any of the other nerves of the face, whether sen-
sory or motor.

A not less unexpected efl^ect is produced by division of the
sympathetic upon the sensibility of the parts supplied by it:
for this, instead of being diminished, is greatly augmented. As
the appreciation of this fact, by ordinary methods, is difficult,
M. Bernard had recourse to the woorara poison, the effect of
which is to produce a gradual destruction of sensibility over
the whole body ; and he found, that when the cervical gancrjion
had been removed, the whole of that side of the face retained
its sensibility much longer than did anv other part of the surface,

[Gaz. Med. lb.

Injections of Salt in Intoxication. By M. Lalaux.

The difficulty with which intoxication is sometimes distin-
guished from comatose cerebral affections, renders valuable
the possession of a simple means of at once aiding the diagnosis
and dissipating the symptoms. This, M. Lalaux declares,
exists in the administration of an injection of warm water con-
taining two tablespoonfuls of salt. He explains the benefit de-
rived by the partial evacuation of the poison in the copious
stools that are promptly produced. The injection also some-
times induces vomitinpr, when mechanical irritation of the
fauces has failed to do this. \^Gaz. de Hop. lb.

Wild Cherry Bark. By Joseph S. Perot, of Philadelphia.

This bark being undoubtedly an important article to the
physician, I undertook a few experiments with a view towards
ascertaining at what season its properties (which depend prin-
cipally for their efficacy on the amount of prussic acid which it
will yield) exist in greatest perfection, and consequently when
the bark is best adapted for collection. For this purpose I
procured at intervals during the season at which it is brought
to market for sale, portions of the inner bark from the same
tree, (or from trees of apparently the same age,) and from por-
tions of the largest branches of about the same age, which, be-
ing carefuliy dried and deprived of the epidermis, were bruised,
macerated for a short time with water, and distilled in a close
vessel ; the product was treated with a weak solution of nitrate
of silver, which, reacting with the prussic acid in the solution,

562 On Peach-Leaf Water, [September,

formed a precipitate of cyanide of silver; this being carefully
washed, dried and weighed, the quantity of hyodrocyanic acid
in each portion of bark was estimated by the ratio of chemical
equivalents, The distillate was also treated with a strong
alkaline solution, and afterwards with a weak solution of nitrate
of silver in the manner proposed by M. Liebig, (See American
Journal of Pharmacy, vol. xxiii., p. 253,) but the results coin-
ciding very closely with those obtained by the former process,
it was deemed unnecessary to enumerate them.

The results obtained from these experiments, with the dates
at which the bark was collected, may be seen by the following
statement.

1000 grains of Bark collected April 1st, 1851, yielded .478 grains Prussic Acid.
1000 " " " May20ih, " .856 " " '

1000 " " " June 18th, " 1007 " " ,*

1000 " " " August 28lh, " M34 " "

1000 " " " October 16th, " 1-436 " " "

The bark used in the preceding experiments was taken from
a flourishing tree in Philadelphia county.

1000 grains of bark collected May 23d, from the trunk of a
tree in Jersey, yielded "876 grains of prussic acid.

1000 grains collected June 13th, from the trunk of the same
tree, yielded 1*159 grains.

In order to ascertain how the bark which has been kept on
hand for a length of time compares with that freshly collected,
I made an experiment about the middle of October upon some
bark which had been collected during the previous spring, and
found 1000 grains to yield 567 grains of prussic acid.

It being the opinion of several eminent members of the medi-
cal profession, that this bark contained also phloridzin, a prin-
ciple known to exist in the bark of the apple and of some other
fruit trees, to the possession of which they supposed its tonic
property might be owing, I made a number of experiments in
the manner directed for the preparation of phloridzin, both upon
old specimens of bark, upon fresh bark of the branches and
trunk of the trees, and upon fresh bark taken from the root
under ground, at several successive times, but in all instances
failed completely to detect any indications whatever of the
principle sought. [Amer. Jour. Pharm.

On Peach-Leaf Water, By Messrs. Fellenberg and Konig.

The authors distilled in 1847 and 1848, peach-leaves with
water, and the difference in the proportions of prussic acid in
these two sorts of water was very considerable. The leaves
which yield the smaller proportion of prussic acid, were those

1852.] Improved Mode of Preparing Cafeine, 563

of the year 1848, when the tree had an abundance of fruity
whilst in the year 1847, it had only one fruit. Mr. Konig in-
Bern, found in 1000 parts of a peach-leaf water, prepared by
himself, 1*407 of prussic acid. That prepared by Fellenberg,
in 1848, contained in 1000 parts, 0437 parts. [Land. P harm.
Journ., from Central Blatt.

[These facts are interesting in connection with the observa-
tions of Mr. Perot. Ed. Am. Jour. Pkarm.']

Improved Mode of Preparing Cafeine. By H. J. Versmanw,
Apothecary, Lubeck.

All the authors have prepared cafeine from good Brazilian-
coffee, and have operated on quantities of five, ten, and one
hundred pounds. In the preparation of cafeine, the direction is
usually given to boil the raw coffee-berries, to combine it with
oxide of lead, and then to separate it by sulphuric acid. This
plan the author has tried, but has found it rather unprofitable,
and has'gained but little profitable results. By the boiling, the
gum, and the mucus with which the oil is combined in coflTee^
were dissolved, and the separation of the pure caffein is render-
ed difficult. On the other hand, he recommends the following
process, as simple and suitable to the purpose : Ten parts of
bruised coffee are mixed with two parts of caustic lime, previ-
ously converted into hydrate of h'me. This mixture is placed
in a displacement apparatus, with alcohol of 80, until the fluid
which passes through no longer furnishes evidence of the pres-
ence of cafl^ein. The coffee is then roughly ground, and brought
nearly to the state of a powder, and the refuse of the already
once digested mixture from the displacement apparatus dried,
and ground again, and mixed with hydrate of lime, is once more
macerated. The grinding is more easily effected after the
coffee has been subjected to the operation of alcohol, having lost
its horny quality, and the cafeine is thus certainly extracted.
The clear alcoholic fluid thus obtained is then to be distilled,,
and the refuse in the retort to be washed with warm water to
separate the oil. The resulting fluid is then evaporated until
it forms a crystalline mass, which is to be placed on a thick filter
and the moisture expressed. The moisture, after evaporation,
still furnishes some cafeine. The impure cafeine is freed from
oil by pressure between folds of blotting paper, and purified by
solution in water with animal charcoal, and is afterw-ards obtain-
ed in shining white, silky crystals. In general, not more than
three drachms were procured from five pounds of coffee, from
ten pounds seven drachms, and from one hundred pounds^ the

564 Extractum Lohelice Fluidum. [September,

largest quantity, viz: six ounces and four scruples of caffein ;
a proof that a large quantity nriust be operated upon if, in a
quantitative respect, a satisfactory result is to be obtained.
Thus it is seen, that good Brazilian coffee contains 0.57 per cent
of caffein. At the same time it may be observed that it con-
tains about ten per cent, of a green liquid oil, and tw^o per cent,
of a yellow, firm fat (Palmtin.) \_Fhar, Journ. and Arcliiv
der Pharmacie. Ibid.

Extractum LohelicB Fluidum, By William Procter, Jr.

Having had occasion to prepare a fluid extract of lobelia at
the solicitation of a druggist, the following process v^as em-
ployed, which is based on the fact, that in the presence of an
excess of acid, the lobelina of the natural salt which gives ac-
tivity to the drug is not decomposed and destroyed by the
heat used, as explained on a former occasion, (vol. xiv. page
108 of this Journal.)
Take of Lobelia (the plant) finely bruised, eight ounces, (troy)

Acetic acid one fluid ounce.

Diluted alcohol three pints.

Alcohol six fluid ounces.

Macerate the lobelia in a pint and a half of the diluted alcohol,
previously mixed with the acetic acid, for twenty-four hours ;
introduce the mixture into an earthen displacer, pour on slowly
the remainder of the diluted alcohol, and afterwards water until
three pints of tincture are obtained ; evaporate this in a water
bath to ten fluid ounces, strain, add the alcohol and when mixed,
filter throufrh paper.

Each teaspoonful of this preparation is equal to half a fluid
ounce of the tincture. It may be employed advantageously to
make a syrup of lobelia, by adding two fluid ounces of the fluid
extract, to ten fluid ounces of simple syrup, and mixing. Syrup
of lobelia is an eligible preparation for prescription use, incases
where lobelia is indicated as an expectorant. [Ibid,

New Symptom of Pneumonia. By Wm. M. Boling, M. D., of
Montgomery, Alabama.

I have frequently observed in pneumonia a symptom of which
I do not remember to have seen mention made by any other,
and which I have never noticed in any other disease. It con-
sists in a deposition on the teeth, just along the margin of the
gums, of a matter of different shades of colour, from a light

1852.] Iodine in the Treatment of Dysentery. 565

orange to a dull vermilion, forming a line about the sixteenth
of an inch wide, and of a deeper tint at the gums, and paler as
it recedes. Unlike the blue line said to be found in the margin
of the gums in lead poisoning, and the line on the same part, of
a deeper shade than the rest of the gum, noticed by Dr. Theo-
philus Thompson in phthisis, and mentioned in the London
Lancet, for September 185L The appearance in question is
seated on the teeth ; from which, indeed, with care, it may be
principally removed by wiping, though, occasionally, a some-
what durable stain remains upon the enamel.

In regard to the manner of its production, I am at a loss for
an explanation, though it is probably an exudation from the
margin of the gums. At first I thought it might be produced
by the deposition of the colouring matter of the expectoration,
but I have seen it in cases in which bloody matter was not
expectorated ; indeed, in a few cases of latent pneumonia,
where there was neither cough nor expectoration ; and, in one
instance, I was led to suspect the presence of this form of the
disease, which I ascertained with certainty by auscultation, by
this symptom alone. Perhaps the miasmatic poisoning of the
system may, in some way, lead to its development in pnemo-
nia ; for it is likely, that, if it were of as frequent occurrence
in other localities as in this, it would have been noticed before.
Still, I do not remember to have seen it in any of the forms of
uncomplicated miasmatic fever.

I have made no note of the proportion of cases in which I
have observed it, but I think, at least, in one-third or one-fourth.
The cases in which it is present are generally severe, it being
very rarely found in mild cases. [^Am. Jour, of Med, Science.

Iodine Clysters in the Treatment of Dysentery.

Dr. Eimer believes that the great point to which practition-
ers have to direct their attention, is the enormous amount of
organic losses consequent on the continuance of this affection ;
so that according to CEsterlen,* within three weeks, more than
the entire blood-mass may pass away as albumen in the stools.
As a means of cutting these discharges short, he strongly re-
commends iodine clysters ; which, in recent cases, may at once
arrest the progress of the disease, and in all diminish the num-
ber of stools, and normalize their condition, whatever the indi-
vidual peculiarities of the case may be. From five to ten grains
of iodine, and as much iod. pot., are administered in two or
three ounces of water, from two to four times a-day twice

* See British and Foreign Meclico-Chirnrgical Review, vol. v. p. 245.
N. S. VOL. VIII. NO. IX. 36

566 Starch in Cutaneous Diseases, [September,

daily usually sufficing. If the rectum is too irritable to retain
it, ten or fifteen drops of tr. opii are to be added, and a mucil-
aginous vehicle substituted for water. In spite of unfavorable
conditions, so constantly successful did Dr. Eimer find this rem-
edy during an epidemic, that he believes the disease will, as a
general rule, be found curable by it, if it be resorted to before
the organic changes in the intestine have advanced too far, ex-
haustion become too considerable, or important complications
set up. In some slight cases it was employed alone. General-
ly, a simple oily emulsion was also administered, and sometimes
acetate of lead and opium.- [B. and F. Med. Chirurg. Rev,,
from Henle^s Zeitschrift, Amer. Jour. Med. Science,

Starch in Cutaneous Diseases^,

M. Cazenave has lately employed, largely, powdered starch,
pure or mixed with oxide of zinc or camphor, in various dis-
eases of skin. In acute eczema, impetigo, herpes, acne rosacea,
after washing the parts with a weak alkaline solution, and well
drying them, some of the following powder is sprinkled, viz :
Oxide of zinc, one part ; starch powder, fifteen parts. In pru-
rigo of the axillae, the anus, or the genitals, a quarter part of
camphor is added. \_Med. Times and Gazette, from V Union
Medicate, lb.

Solution of Nitrate of Silver in Pruritus of the Genital Organs.

Winternitz has lately recommended a solution o-f nitrate of
silver (grs. iii ad l\ aquae) in pruritus of the vulva or scrotum.
The solution is applied three times daily, and two cases are
given in which it succeeded after a fortnight's trial, when al!
other means had failed. [Ihid., from Zeitschrift der Gesell. der
Arzte zu Wien, from Ibid.

Cauterization of the Glottis in Whooping- Cough.

M. Joubert has published the results of his experience of this
mode of treating whooping-cough. He has treated in all 98
cases in this manner, but he excludes 30 of these as not being-
worthy of reliance. The remaining 68 cases he divided into-
three series, according to the period at which the treatment was
commenced. Of these, the general results were, that in 40 the-
cure w^as rapidly effected, in 21 a marked relief was experien-
ced, and in 7 cases only the treatment failed altogether.[ Pron,
Med. and Surg. Journ. lb.

1852.] Injluence of Medicine, 6fC, 567

Influence of Medicine on the Temperature of the Body.

MM. Dumaril, Demarquay, and Lecomte have associated
themselves together for the purpose of inquiring into the effect
of medicines on temperature. Their experiments were made on
dogs. To state the results briefly, they found that cantharides,
in doses of from one to six grains, raised the temperature in six
hours nearly 4 Fahr.; canella, in a dose of from eight to ten
drachms, elevated the temperature 3 Fahr. ; and a second dose
raised 2 more. One drachm of secale cornutum in five hours
increased the temperature about 1^ Fahr. Acetate of
ammonia injected into the veins augmented also the tem-
perature ; put into the stomach, it produced the same effect
in a less degree. Phosphorus, in doses of a grain and a-half to
three grains, lowered the temperature. Strychnine produced
no effect.

Certain purgatives were tried, such as colocynth, castor oil,
etc., the effects varied according to the dose ; usually it was
lowered, and then elevated to about 1^ Fahr. above the stan-
dard.

Emetics as ipecacuanha, sulphate of copper produced in
small doses a little elevation ; but, in large doses, lowering of
temperature to the extent of 2 or 3 Fahr. [Med. Times and
Gazette, from L* Union Medicals Arom Ibid.

On Chloroform as an Emmenagogue. By David H. Gibson,
M. D., Fort Towson, Choctaw Nation.

Having nowhere seen, in the course of my professional read-
ing, any allusions made to the use of chloroform, as an emmena-
gogue, I am induced to submit the following facts for publica-
tion, partly from a desire that relief may be afforded to the
suffering, and partly from a sense of professional duty.

Case I and II. Occurring in the same person. In October

last, Mrs. W , having a violent headache, to obtain relief

resorted to the inhalation of chloroform. Within an hour after
the inhalation (which was but for a few seconds) she was flow-
ing freely, and continued thus for four days. There was no
irregularity of the function of menstruation in the succeeding
month (Nov.), but another attack of headache supervening, she
again had recourse to the chloroform, and in a half hour the
menstrual secretion made its appearance, the discharge con-
tinuing for five days. In both instances, the chloroform was
inhaled about ten days after the subsidence of her regular pe-
riods. Since the last inhalation, she has menstruated at her

668 Chloroform as an Emmenagogue. [September,

usual period. Mrs. W is slightly inclined to plethora,

general health usually good, aged thirty-five years.

Case III. In the absence of Mrs. W , from home, her

servant girl, having gotten hold of the chloroform, imitated
Mrs. W.'s example. A like result was produced upon the-
girl, v^ho menstruated for four days. The girl is very healthy
and about thirty years of age. The inhalation v^^as never re-
newed by her. In this case, the chloroform was inhaled two
"weeks prior to her usual period, at which time she again men-
struated. Since then she has menstruated regularly.

Case IV. Miss , aged 19 general health excellent

no deviation having ever taken place since her first menstrual
period, was, during a visit to Mrs. , induced to inhale chlo-
roform, through curiosity to experience the sensations produced
by it. In a half hour the menstrual fluid made its appearance
and the flow continued for four days. The inhalation in this
instance was ten days antecedent to the regular period, with
which it did not interfere. Mrs. W , my informant in re-
gard to the foregoing cases, is an intelligent and reliable lady.

Case V. Came under my immediate observation. Was:
called to see Mrs. H , found her suflTering much from sup-
pressed menstruation. To relieve urgent pain, ordered hot hip-
iDath, from which the patient experienced much relief. Waited
three hours after the use of the bath, without recourse to any
other means, having decided, as this was an opportune case, ta
exhibit the chloroform, which was done for thirti/ seconds, la
twenty minutes after its administration, the patient was flowing
freely and continued to do so for three days. Patient is of a
weakly constitution, the result of much hardship. Age of the
patient, about forty years. This case is the more remarkable
from the fact that the patient has not menstruated for more
than eight months.

The suppression was induced by causes not deemed necessa^
ry to relate at present. Prior to the suppression, she had been?
very regular for many years. Pregnancy has nothing to do
with the case, as the patient is not at this time, nor for many
years past has she been in that condition.

I regret that I have not a greater number of cases to submit
for the consideration of the profession. Being but a young
practioner, I am desirous that more experienced physicians^
should give the chloroform a trial, in order more fully, than my
position will allow, to test its value as an emmenagogue ; and
diffident of my ability to account correctly for the " modu
operandi" of the chloroform in the above cases, I shall without
comment submit them to those who have better opportunities?
for investigation. [Medical Examiner.

1852.] Ligature of the Thyroid Arteries for Goitre, 569

Ligature of the Thyroid Arteries for Goitre, Translated for
this Journal from the Journal des Connaissances Medico-
Chirurgicales.

Professor Porta has lately published in the Italian Journal,
Annali Universali di Medicina, a very remarkable case which
leads us to hope that Goitre will not always be incurable. Liga-
ture of one or the other, or even of both the superior thyroid
arteries has already been advised as a cure for this disease.
M. Porta thought that by ligating both the superior and inferior
thyroid arteries at the same sitting, success would be complete.
The following case, the first in which he had occasion to try
this plan, justifies his views.

Case. A young country woman of 17 years of age, present-
ed herself at the surgical clinic of the University of Pavia, in
July, 1850, to be treated for a goitre about the size of an ordi-
nary orange, situated upon the left side of the neck. This
goitre had developed itself within the last two years : it pushed
the larynx and pharynx to the right ; from this resulted a fa-
tiguing rattling in the throat and an impediment in swallowing.
The pulsations of the superior thyroid artery were distinctly
felt at the summit of the tumor, but those of the Inferior were
not. As the tumor was circumscribed and the neck naturally
elongated, M. Porta thought that now or never was the time
to try the ligature of the arteries.

On the 28th July, he began the operation by making a longitu-
dinal incision about three inches in length between the sterno-
mastoid and sterno-thyroid muscles, as if for the purpose of
iigating the primitive carotid. The inferior thyroid artery
being the most difficult to find, it was by this one he wished to
commence. After having broken up the cellular tissue at the
inferior part of the incision with the finger, he could feel the
pulsations of the artery distinctly behind, and a little below the
base of the tumour, between the primitive carotid and the tra-
chea. Continuing to use his finger as a guide, he passed a
curved needle under the vessel and ligated it with a silk liga-
ture. The superior thyroid was discovered without difficulty,
at the upper angle of the incision, and ligated with a fine ani-
mal ligature.

The operation was followed by unexpected accidents. There
was first an abscess, then hemorrhage, at the end of three weeks,
from the superior angle of the wound. Cicatrization was not
complete until the end of October, that is, at the end of three
months.

The success of the operation in distroying the bronchocile
,was entirely satisfactory. As soon as the swelling from the

570 Tannate of Quinine. [September,

operation subsided, the tumour was perceived to have dimin-
ished one half, at the beginning of October, sometime before
cicatrization was complete, there remained no traces of it, that
is, there was no enlargement.

Tannate of Quinine. By John P. Little, of Richmond, Va.

In the summer of 1850, I read a short paper before the Medi-
cal Society, in which I mentioned some experiments made to
remove the bitter and disagreeable taste of quinine. It was at-
tempted to remove this taste by giving the medicine dissolved
in strong tea ; and I was led to make these experiments by learn-
ing that coffee had been used for this purpose in France. The
result of my experiment was that the taste was almost entirely
removed, and that the injurious effects upon the brain and ner-
vous system, which so commonly result from the use of quinine,
did not make their appearance. I learned subsequently, from
the experiments of Dr. Thomas, of Baltimore, that it was the
tannin contained in tea which produced this loss of bitterness.
Having for two years past prescribed tannin and quinine in all
cases requiring the use of the latter remedy ; having found this
tannate of quinine a more efficient preparation than the sulphate,
both in the treatment of intermittents and neuralgia ; and hav-
ing seen none of those peculiar effects upon the head observed
ordinarily in the use of this article, I wish to call the attention
of the profession to its value. I have by me a number of cases
in which benefit has resulted from its employment, where the
sulphate had been used without good effect, or where its use
could not be borne. One case of intermittent, occurring in a
delicate child, in which I had used sulphate of quinine, various
vegetable tonics, iron, and finally Fowler's solution, without
any other than a temporary effect, yielded to this remedy. In
many other cases of neuralgia occurring in very delicate wo-
men, where I was assured that quinine had been frequently,
attempted to be given, and that its use could not be persevered
in because of the headache and other severe symptoms that
ensued, I have given large quantities of the tannate with happy"
effect on the disease and without any injurious result. In some
very susceptible persons a slight ringing in the head was per-
ceived, though not complained of, after a large quantity had
been taken. My usual mode of administering the remedy is to
have it made into pills, containing two grains of quinine and
two of tannin each ; or, if the patient is very susceptible to the
action of the remedy, three grains of tannin to two of quinine.
I prefer it in pill form, because, in solution with so large a pro-
portion of tannin, while the taste of the quinine would disappear

1S52.] Miscellany. 571

that of the tannin would be very disagreeably perceived. In
those cases of neuralgia where quinine and iron are indicated,
I have not thought fit to combine quinine, iron and tannin in
one pill, but have given on one day as much tannate of quinine
alone as I would have given of quinine combined with iron in
two days, and on the preceding day have also given as much
iron alone as I would have given combined in two days.

This compound of tannin and quinine is also serviceable as
an astringent in the dysentery of the season, and can be used
as such with good effect. I mention its use, that others may
be induced to try it, and that by the observation of many physi-
cians, its claim to notice, as a compound of quinine that can be
given without any injurious effect, may be decided upon. My
own experience is in its favor. \_Stetlio scope.

'Neio Theory of Tubercular Deposits. Dr. M. Troy, of North
Carolina, has written quite an interesting article upon tubercular
deposits, in which, after a brief account of the opinions hitherto ad-
vanced in relation to the pathology, he adds :

*' It now remains to state my own views of the nature of this deposit.
It is with the greatest diffidence that I attempt what some of the great-
est men who have ever adorned our profession have failed to accom-
plish, through a long life of patient toil and investigation, devoted to
the subject. But they have cleared the way, and but little is left to
do now but advance upon the smooth road they have made.

I consider tubercle to be the solid matter of the cutaneous excretion,
especially of the sebaceous follicles. This secretion not being expel-
led by the natural emunctories, is retained m the blood until, in the
attempt to eliminate it through an unnatural channel, it is deposited in
some other excretory organ, where its fluid matter being absorbed, it
becomes atubercle." \_Amer. Jour. Med. Science, July 1852,_p. 107.

Dr. T. then goes on to prove " that the secretion of the skin is of
sufficient importance to produce this effect when retained," by a
reference to its quantity, its constituents, and the acknowledged dele-
terious effects which follow its suppression or imperfect elimination,
as well as the morbid condition of the skin in various affections in
ivhrch this morbid condition is usually regarded rather as a complica-
tion than as a cause of the more obvious disease.

The following paragraph will serve to show Dr. T.'s conclusions.:

" I think I have shown that the nature and importance of the secre-
tion of the skin are sufficient to give rise by its deficiency of suspen-
jfiion to the accumulation of tuberculous matter in the blood ; that hi

57^ Miscellany. [September,

those individuals in whom consumption is hereditary, there is often a
congenital deficiency of the sebaceous follicles ; that the disease can
at any time be produced or aggravated by causes which depress their
action ; and prevented or relieved by causes which exalt it ; that the on-
ly well-ascertained product of the secretory action of these follicles is
found in large amount in tubercle ; and that it is deposited in precise-
ly such situations as we would be led to suppose, upon general princi-
ples of physiology, that the retained secretions of the skin would be.

This theory has at least the merit of being consistent with all the
phenomena of the disease ; of explaining the action of the causes which
produce it upon established physiological principles ; of explaining its
hereditary transmission by the same law which causes children to re-
semble their parents; of redeeming our practice from empiricism, and
making it rational, and most important of all, oi^ explaining the efficien-
cy of hygienic means, and thus impressing the necessity of them more
effectually than any amount of mere recommendation could do, even
though this were founded upon the largest experience. It differs from
the views of A^ndral and Carswell, by showing the nature and source
of the " peculiar secretion, " of which they speak ; and seems, upon
the whole, far more simple and definite than any other yet advanced.
^[Ibidp. 116.

We regret that we have not room for the whole of this very original
and ingenious paper.

On the Development of the Ductless Glands in the Chick, By Hen-
ry Gray, Demontrator of Anatomy at St. George's Hospital. In
this very meritorious paper, the author has demonstrated the evolution
of the Spleen, Supra-renal and Thyroid gland, and the tissues of which
each is composed, in such a manner as to show the place that may
be assigned to each in a classification of the glands.

The Spleen is shown to arise between the fourth and fifth days, in
a fold of membrane which connects the intestinal canal to the spine
(the " intestinal lamina"), as a small, whitish mass of blastema, per-
fectly distinct from both the stomach and pancreas. This fold serves
to retain it and the pancreas in connexion with the intestine. This
separation of the spleen from the pancreas is more distinct at an early
period of its evolution than later, as the increased growth of both
organs causes them to approximate more closely, but not more inti-
mately with one another ; hence probably the statement of Arnold,
that the spleen arises from the pancreas. With the increase in the
growth of the organ and the surrounding parts, it gradually attains the
position that it occupies in the full-grown bird, in more immediate
proximity with the stomach ; hence probably the statement of Bischoff,
that it arises from the stomach. Later, when its vessels are formed,
the membrane in which it was developed is almost completely ab-
sorbed.

The author then considers the development of the tissues of the
spleen, which clearly establishes, not only the glandular nature of the

1852.] Miscellany, 573

organ itself, but the great similarity it bears with the supra-renal and
thyroid glands. The external capsule and the trabecular tissues of
the spleen are both developed between the eighth and ninth days, the
former in a form of a thin membrane composed of nucleated fibres, the
latter consisting of similar fibres, which intersect the organ at first
sparingly, and afterwards in greater quantity. The development of
the blood-vessel and the blood are next examined. The former are
shown to arise in the organ independent of those which are exterior
to it. The development of the blood-globules is shown to arise from
the blastema of the organ at the earliest period of its evolution, and
continue their formation until its connexion with the general vascular
system is effected, at which period their development ceases. No de-
struction of the blood-globules could ever be observed. These ob-
servations disprove the two existing opinions of the use of the spleen,
as the blood disces are not formed there (excepting during its early
development), as stated by Gerlach and Schaffner ; nor are they de-
stroyed there, as stated by KoUicker and Ecker. The development
of the pulp tissue is next examined. At an early period, this closely
corresponds with the structure of the supra-renal and thyroid glands
at the earliest stages of their evolution, consisting of nuclei, nucleated
vesicles, and a fine granular plasma, the former constituting a very con-
siderable portion of its structure. When the splenic vessels are
formed, many of these nuclei are surrounded by a quantity of fine,
dark granules arranged in a circular form, and these increased up to
the time when the splenic vein is formed, when nearly the whole
mass is composed of nucleated vesicles, the nuclei of which gradually
break up into a mass of granules which fill the cavities of the vesicles.
The Malpighian vesicles are developed in the pulp by the aggregation
of nuclei into circular masses, around which a fine membrane soon
appears, in a manner precisely similar to those of the supra-renal and
thyroid glands, with which they bear the closest analogy.

The author then traces out the development of the Supra-renal
glands, and shows the c^ose analogy that exists between them, the
spleen, and thyroid, from the similarity which their structure presents
at the earliest period of their evolution with those glands, and from
the development of the several tissues following the same stages in
all. They are shown to arise on the seventh day as two separate
masses of blastema, situated between the upper end of the Woolfian
bodies, and the sides of the aorta, being totally independent (as con-
cerns their development) of those bodies, or of each other. At this
period, their minute structure bears a close resemblance to that of the
spleen, consisting of the same elements as that gland, excepting in
the existence of more numerous dark granules, which give to the
organ, at a later period, an opaque and darkly granular texture. The
gland tissue of the organ, in the form of large vesicles, makes its
appearance on the eighth day, whereas in the spleen it did not exist
until near to the close of incubation, an interesting fact in connexion
with the function of the former gland, which is mainly exercised dur-
ing foetal life, whilst the spleen exerts its function mainly in adult

574 Miscellany. [September,

life : hence, the difference in the development of the tissues at differ-
ent periods. The manner in which this tissue is developed is similar
to that by which the gland tissue of the spleen was formed viz : by
an aggregation of nuclei into circular masses, around which a limitary
membrane ultimately forms : these are first grouped together in a mass,
without any subdivision into cortical and medullary portions. On
the fourteenth day the first trace of this subdivision becomes manifest,
by the vesicles being aggregated into masses which radiate from the
circumference towards the centre of the glands, in some cases com-
plete tubes being formed by the junction of the vesicles, as indicated by
hemispherical bulgings along their walls. Ata later period, the organs
increase in size, they attain their usual position, and a more complete
subdivision into cortical and medullary portions is now observed.

The author lastly traces out the development of the Thyroid glands,
and shows the great similarity that exists between them, the spleen
and supra-renal glands, from the similar structure they present, and
from the development of those structures occuring in a similar man-
ner in each. These glands are developed between the sixth and
seventh days, as two separate masses of blastema, one at each side of
the root of the neck, close to the separation of the carotid and subcla-
vian vessels, and between the trachea and the bronchial clefts, but
quite independent, as far as regards their development, of either of
those parts. Their minute structure at an early period closely corres-
ponds with that of the spleen and supra- renal glands. Later, when
the gland-tissue, of which the thyroid gland ultimately consists, is
formed, it is developed in a manner precisely similar to the same tis-
sues of the spleen and supra-renal glands a fact which shows the
analogy they bear to one another.

From these observations, the author concludes that a close analogy
exists between the glands already described, so that the propriety of
their classification under one group, as the " Ductless Glands," may
be considered clearly proved. And although the spleen by many has
been excluded from them, the author considers that its classification
with them is correct, for the following reasons : 1st. From its evolu-
tion being similar with that of the supra-renal and thyroid glands ;
2ndly, from its structure, which at an early period closely corres-
ponds with them ; and 3rdly, from the development of its tissues fol-
lowing the same law as that upon which the tissues of the allied
glands are formed. [Proceedings of the Royal Society, Jan. 15, 1852.

[Every contribution to the anatomy and physiology of these per-
plexing structures is of value, as tending to throw some light upon the
nature of their function ; and Mr. Gray has most ably filled up a la-
cuna which had been left by the many excellent anatomists who have
devoted their time and abilities to this perplexing and, as yet, profitless
inquiry. [Medico-Chir. Rev.

On the Changes producible in the Properties of Bodies by Pulveri-
zation. By M. DoRVAULT. To the present time, pharmacologists
have always considered pulverization as a mere change of form in

1852.] Miscellany. 575

bodies each particle of the divided body being regarded as a diminu-
tive, without change of property, of the entire mass. While admitting
that, in most cases, this is a mere expression of the fact, M. Dorvault
believes that there is a greater number of substances than is suspected,
in which this operation induces a modification of their chemical char-
acters and medicinal properties. At present, he can only adduce two
or three decided examples in justification of this opinion. Every one
knows that sugar, on being powdered, loses a portion of its solubility
and sweetening power. Is this referribleto an altered electrical con-
dition of the sugar, as the phosphoresence which is developed during
pulverization in the dark might lead us to suspect ? Again, gum
arable, when powdered, possesses neither the same taste nor solubility
as when entire ; and pulverization so diminishes the solubility of
arsenious acid, that while a kilogramme of water will dissolve forty
grammes in the vitreous state, it will only dissolve fourteen of the
powder. In the above examples, the modification is exhibited by di-
minution of solubility, but in other cases it may manifest itselt in
other directions. [L' Union Medicale. Ibid.

A new instrument for cauterizing the Urethra. By E. S. Cooper,
M. D. Reported by L. C. Lane, M. D.,of Peoria, 111. An instru-
ment for cauterizing the urethra has been invented by Dr. Cooper of
this place, which for facility of application and certainty of results is
superior to all other means hitherto used, combined.

It consists of a copper catheter, with the end for half an inch a little
smaller than the body, and perforated with several holes. This is in-
troduced down to the stricture, and then filled with dilute nitric acid,
which acting on the copper, soon produces the nitrate, which coming in
contact with the urethra through the "holes, produces cauterization to
the extent desired.

The strength of the solution and the length of time the instrument is
permitted to remain, regulates the degree of cauterization completely.
Dr. Cooper generally uses one third of nitric acid, and two of water,
and permits the instrument to remain for one and a half minutes,
though a much shorter time will often answer.

The shape of the instrument may be varied to suit the case ; thus,
when several strictures exist in the strait part of the urethra a strait
catheter might be used, with holes at several places to correspond to
their number and location.

Though great contrariety of opinion exists among medical men in re-
gard to the degree of cauterization most valuable, this instrument com-
mends itself alike to all ; for whether it is believed that caustics should
be applied bodily so as to cause the detachment of a slough, and thus
physically enlarge the canal, or by a slighter application modify the
action of the lining, the variations are easily made with it. [])^led.
Exam, and Rec. of Med. Science.

New Instrument for examining the interior of the Eye. M. Follin,
prosector of the Faculty of Medicine, in Paris, has presented to the

576 Miscellany. [September,

Surgical Society of that city, an ingenious instrument, by which the
retina, crystalline lens, and different parts of the eye, may be examin-
ed. It consists simply of a wax candle placed behind a lens, by which
luminous rays are thrown upon a mirror from which they are reflec-
ted into the eye. By means of an eye-glass, of varying power, placed
behind the mirror, the bottom of the eye is seen, illumined and mag-
nified. The light is mild, and of equal intensity on every part, and is
of a yellowish color. The bloodvessels of the eye can thus be seen,
forming a beautiful net work, and the blood within them distinguished.
M. Follin has seen the vascular center of the retina, and recognized
the point where the central artery and vein spread into branches. He
thinks that by the aid of this instrument the different states of conges-
tion of the retina can be distinguished, its ecchymotic and varicose
states, the cancerous deposite which sometimes form upon its surface,
Sz;c., and also the condition of the crystalline lens. [iV. Y. Med. Times,

Test for the Purity of Cod liver Oil. Sir James Murray, in calling
attention to the numerous adulterations which are made by druggists,
incidentally speaks of cod-liver oil, which is extensively falsified by
the admixture of other oils, animal and vegetable. The test which he
recommends was suggested to him by the knowledge that in a cotton
factory the spindles which were made of brass always obtained a de-
posit of verdigris when a bad oil was used, which was not the case
with pure spermacetti oil. The test consists in heating the suspected
oil in a copper capsule ; if it be genuine cod-liver oil, no discoloration
occurs, whereas the spurious oils throw up a quantity of the salts of
copper, forming a green film on the surface. [Dublin Med. Press,

Artificial Production of the Flavours and Odours of Fruits and
Flowers. One of the most surprising achievements of modern chemis-
try is the artificial production of the flavours and odours of fruits and
flowers; the imitation in the crude laboratory of the chemist of the
most delicate of the productions of nature, and one which it might have
been supposed was beyond the reach of art.

Dr. Playfair, in his lecture on the great exhibition of 1851, furnish-
es us with the following interesting information on this subject :

" The jury in the exhibition, or rather two distinguished chemists of
that jury, Dr. Hoffman and Mr. De la Rue, ascertained that some of
the most delicate perfumes were made by chemical artifice, and not,
as of old, by distilling them from flowers. The perfume of flowers
often consists of oils and ethers, which the chemist can compound arti-
ficially in his laboratory. Commercial enterprise has availed itself of
this fact, and sent to the exhibition, in the form of essences, perfumes
thus prepared. Singularly enough, they are generally derived by
substances of intensely disgusting odour. A peculiar fetid oil, termed
" fusel oil, " is formed in making brandy and whiskey. This fusel
oil, distilled with sulphuric acid and acetate of potash, gives the oil of
pears. The oil of apples is made from the same fusel oil by distilla-
tion with sulphuric acid and bichromate of potash. The oil of pine-

1852.] Miscellany. 577

apples is obtained from the product of the action of putrid cheese on
sugar, or by making a soap with butter, and distilling it with alcohol
and sulphuric acid, and is now largely employed in England in the
preparation of pine-apple ale. Oil of grapes and oil of cognac, used to
impart the flavour of French cognac to British brandy, are little else
than fusel oil. The artificial oil of bitter almonds, now so largely
employed in perfuming soap and for flavouring confectionery, is pre-
pared by the action of nitric acid on the fetid oils ofgas-tar. Many a
fair forehead is damped with eau de millefleui's, without knowing that
its essential ingredient is derived irom the drainage of cowhouses.
The winter-green oil, imported from New Jersey, being produced from
a plant indigenous there, is artificially made from willows and a body
procured in the distillation of wood. All these are direct modern ap-
pliances of science to an industrial purpose, and imply an acquaintance
with the highest investigations of organic chemistry. Let us recollect
that the oil of lemons, turpentine, oil of juniper, oil of roses, oil of co-
paiba, oil of rosemary, and many other oils, are identical in composi-
tion, and it is not diflScult to conceive that perfumery may derive still
further aid from chemistry." [Phila. Med. News.

Bromohydric Ether a new AncEsiheiic Agent. Some experiments
have been recently made with this substance on birds, etc., and M.
Ed. Robin, who conducted them, is satisfied that it will prove an ex-
cellent ansesthetic agent. This preparation of ether is without taste,
and possesses an agreeable aromatic odor ; and, when taken by inha-
lation, produces rapid etherization, without any subsequent suffering
or distressing symptoms. [Joitrn. des Connaiss. Med. Chirurg, and
Charleston Med. Jour.

Prescription for Chronic or Inveterate Intermittent Fevers. We
find in the " Journal des Connaissanoes Medico-Chirurgicales,'' the
following old prescription which has been supplanted by quinine, but
is now proposed to be revived in consideration of its real value in those
old and inveterate forms of intermittent fever which we now and then
find to return, although repeatedly " broken" with quinine. The for-
mula was formerly highly recommended by the Montpelier School.
Pulverized Red Peruvian Bark, .... 40 scruples.

" Rhubarb, 15 "

Muriate of Ammonia, 5 "

Syrup of Peach-tree Blossoms, ....9s.
Mis. Make a mass, and divide into 20 boluses, four of which must
be taken daily for five days. They should be taken at intervals of one
hour and so that the last will have been taken two hours before the ex-
pected paroxysm. If found to be too large the bolus may be subdivided.

Furunculoid Epidemic in England. It appears that the great in-
crease of " boils, carbuncles, whitlows, pustules, and superficial ab-

578 Miscellany. [September,

scesses," in London, has attracted the attention of the Epidemiological
Society, and that Mr. Hunt, at the request of the President of the So-
ciety, read a paper on this subject. Mr. H. states that he had found
it prevailing in the British Isles, in France, Austria, the East and
West Indies, the south of Africa, and the United States. We have
seen no notice of it in our country this year, although its prevalence
last summer upon the fingers was noticed in Washington City and
by ourselves in the April No. (p. 256) of this Journal. We think that
whitlows are now more common here than usual. Furunculoid dis-
eases have been on the increase in England ever since 1847. Mr.
Hunt remarks, that the deaths from phlegmon have nearly trebled
during the last few years, and that the fatality from small pox and
pustular diseases have likewise been trebled of late. Carbuncles also
have been very numerous and fatal in England.

Ricord's Letters on Syphilis. We commence with this number,
the publication of a series of Letters from the distinguished physician
of the Parisian Venereal Hospital, and will furnish our readers with one
in each of our subsequent issues. We feel assured that they will be
read with interest, as containing the last and matured views of the best
living authority on the subject. The lively and peculiar style of the
letters will not detract from their intrinsic merit, but on the contrary,
form a happy contrast with the very dry reading of the accompanying
pages. They are being translated by different hands, for the New
York Medical Times, and the Boston Medical and Surgical Journal,
which saves us the trouble of doing so ourselves.

Mobile, Alabama, July 26, 1852.
To the Medical Profession of the Southern and South-Wesiern States ;

Gentlemen At the last annual meeting of the American Medical
Association, I was continued as Chairman of a Committee, to report at
its next session, on the prevalence of Idiopathic Tetanus, (not endem-
ic, I as was erroneously notified by my first appointment). Permit me
therefore to solicit your assistance, to the extent of your information,
either from personal experience or enquiry, embracing the immediate
circuit of your professional supervision. Your attention to the fol-
lowing queries and answers seriatim, forwarded by mail to my address,
on or before the 1st day of January, 1853, will not only serve the
special object of the Association, but particularly oblige.

Very respectfully, your ob't. serv't.,

A. Lopez.

1st. Are there any physical causes, in or about your locality, pro-
ductive of Idiopathic Tetanus ?

1852.] Miscellany. 579

2nd. Have changes by clearing of lands, change of culture, or any
other circumstances, been the cause of such disease 1

3rd. Has Tetanus been of frequent occurrence, and if so, does it
hold an analagous or independent origin of malarious diseases ?

4th. Does it follow the laws which govern climatic Endemics, in
sufficient number, and simultaneous prevalence to warrant the belief
of its identical origin ?

5th. Have meteorological variations governed the production and
character of the disease ?

6th. The average number of deaths from Idiopathic Tetanus ?

7th. Have adults or children been most liable to its attack 1

8th. What sex?

9th. Proportion of whites to negroes ?

10th. Duration of disease previous to fatality ?

11th. Interval between cause and development 1

12th. Does Trismus Nascentium ever observe an Idiopathic or
symptomatic character ?

13th. Are negro or white children most liable to it ?

14th. Your belief as to its origin ?

15th. Proportion of deaths to cures ?

16th. Have you found any form of treatment more successful than
another, in either Idiophathic Tetanus or Trismus Nascentium?

The Knoxville Primary Medical School went into operation on the
16th of Feb., with one pupil. Several applicants have been rejected
because they did not possess the requirements designated as necessa-
ry before commencing the study of medicine by the American Medi-
cal Association. Others declined because not satisfied with the terms,
[East Tennessee Record of Med. and Surg.

BlBLIOGBArHICAL.

We beg leave to return our thanks for a large number of publica-
tions received within the last two months, and regret that we have not
room to give an extended notice of some of them. Among the most
interesting, are " The Quarterly Summary of the Transactions of the
College of Physicians of Philadelphia ;" the " Proceedings of the
Medical Association of the State of Alabama ;" the " Report of the
Eastern Lunatic Asylum in Virginia ;" the " Third Annual Report
of the Board of Commissioners for the Georgia Asylum for the Deaf
and Dumb ;" '' Tableaux of New Orleans ;" and " Contributions to
Experimental Physiology, by Bennet Dowler, M. D. ;" the "Proceed-
ings of the 7th Annual Meeting of Medical Superintendants of Ameri-
can Institutions for the Insane ;" " A Lecture on Gun-shot Wounds,
by R. McSherry, M. D., of Baltimore ;" " Observations on the freez-
ing of Vegetables, (Sec, by Prof. John LeConte, of Georgia j" " The

580 Miscellany.

Topography, climate and Disease of Middle Georgia, by E. M. Pen-
dleton, M. D., of Sparta ;" " Practicability of probing the fallopian
tubes, by S. A. Cartwright, M. D., of New Orleans."

The Principles and Practice of Surgery illustrated Z>^ 316 engrav-
ings, on wood. By Wm. Pirrie, F. R. S. E., Regius Professor in
the Marischal College and University of Aberdeen, &:c. &c., edi-
ted with additions, by John Neill, M. D., Surgeon of the Pennsyl-
vania Hospital, &c. &c. Philadelphia ; Blanchard &; Lea. 1852.
pp. 885.

Prof. Pirrie, although not as extensively known as some of the sur-
geons of the British metropolis, shows by the work before us that he is
an able teacher and can make a good book for the use of Students and
general practitioners. Being written expressly as a text-book for
those in attendance on Lectures, it very properly combines both the
Principles and the Practice of Surgery, instead of having separate
works for each of these branches of study, as is the case with Prof.
Miller's works. We predict for Pirrie's Surgery an extensive sale to
students, while Miller's more elaborate productions will be most used
by special practitioners of Surgery.

We agree with one of our most esteemed cotemporaries in seeing
no objection to the American custom of appending notes or other
matter to the reprint of British works, so long as by so doing the anno-
tator adds to the intrinsic value of the work without increasing unrea-
sonably its cost to the purchaser. Dr. Neill is " a growing man" and
deserves well of the Profession for his talents and industry.

Pure Medicinal Extracts. Messrs. Philip Schieffelin, Haines &
Co., Druggists of New York, sent us sometime since, a small collec-
tion of their Medicinal Extracts for trial, and we are happy to say that
they have proved to be some of the very best we have ever used. We
therefore take pleasure in recommending them. The difficulty of
getting pure and fresh preparations of belladonna, cicuta, hyoscya-
mus, stramonium, (fee, has long been felt seriously by the profession,
and those who, like this firm, will contribute to remedy the evil, should
be rewarded by extensive patronage. We presume that their choice
extracts and powders, &;c., can be obtained from any of our City
Druggists.

Advertisements. We have to remind our correspondents that no
advertising sheet is appended to this Journal ; hence, the omission to
attend to their requests.

SOUTHERN

MEDICAL AND SURGICAL
JOUBML.

Vol. 8.] NEW SERIES. OCTOBER, IM. [No.. 10.

PART FIRST,
rigxnal (Jlommunuationa.

ARTICLE XXXIV.

Typhoid Fever in East Alabama. By G. T. Wilburn, M.D.,
of Farmville, Alabama.

After so much has been written upon Typhoid fever, it may
appear to some a labor of supererogation to attempt to add
anything new, or to interest members of the profession, in a
subject already exhausted. But we are fully aware that the
multiplicity of articles upon this dreaded malady give evidence
of the difficulty met with in its management. Every practi-
tioner will readily testify to the embarrassment and difficulty
he experienced in the treatment of typhoid and other fevers
when first he entered the medical arena. The so-called sys-
tems of Cullen, Brown, Broussais, Rasori, and a host of modern
authors, seemed mere individual opinions, and calculated more
to confuse than to enlighten the tyro in medicine. He exam-
ined, in vain, the "innumerable volumes of cases, and inter-
minable heaps of insulated precedents," with the feeble hope
of reconciling the inconsistencies of antagonistic systems, and
of discovering the true principles of correct practice. And
thus the young practitioner is bewildered by authors who write
more for fame and a desire to propagate their own particular
dogma than for the elucidation of truth and the advance of
medical science.

It is objected to the term Typhoid, as not expressive of the
Anatomical lesions of the disease. A similar objection might

N. S. VOL. VHI. N0 X. 37

582 Wilburn, on Typhoid Fever. [October

be made to the terms designating other diseases. The terms
Typhus, Intermittent, Remittent, &c., are not more happy.
None of these appellations teach the anatomical lesions of the
diseases they serve to designate. The term Typhoid, as ai>-
plied to distinguish a certain class of fevers, we believe, first
originated with Louis, of Paris. He discovered that the Paris-
ian fevers v^^ere closely allied to each other by a uniformity of
their lesions, the most constant of which were inflammation of
thQ elliptical follicles, known as the glands of Bruner and Peyer,
and a softened condition of the spleen. I do not say that the
term Typhoid is the best that could have been selected, but
as its signification is now sufficiently understood by the pro-
fession, medical science does not suffer in its retention.

There are some who contend that typhus and typhoid are
identical, and others who even deny the existence of the latter
disease. These (latter) know no other fevers than remittent,
intermittent and continued terms that express nothing, and
consider all other fevers as but modifications of these types.

'Tis with our judgments as our watches ; none
Go just alike, yet each believes his own.

I believe typhoid fever to be a disease sui generis, differing
essentially from all the fevers known to the world, in its attack,
progress, lesions, symptoms, and termination ; and requiring a
treatment peculiar to itself So long as practitioners look upon
it as but a modification of remittent, intermittent, &c., or as
identical with typhus, they may expect to fail in treatment, and
to oflfer a considerable barrier to a clear knowledge of the dis-
ease and the progress of medical science. Physicians, above
all others, should be U'QQ from dogmatical prejudices their
labors are continued researches after truth.

All American writers, with a careless or casual investiga-
tion, have followed English authors in the unity of continued
fevers. It is as difficult to break down the despotism of litera-
ture as it was to sever the bands of political union. We
yet yield a blind obedience to the teachings of our mother
country.

To the identity of these fevers is due the great confusion
among writers in giving the symptoms of typhoid fever. Many
of the symptoms of the typhoid also belong to the typhus ; but

1852.1

Wilburn, on Typhoid Fever.

583

there are other symptoms which serve to distinguish these dis-
eases. The terms Typhus Mitior and Typhus Gravior have
contributed greatly to the difficulty in distinguishing the two
diseases, and literally made confusion confounded. But let us
examine these diseases impartidlly, and see if they be one and
the same.

Typhoid.
Stupor, accidental and develop-
ed slowly.

Subsultus, occasional in ma-
ny instances totally absent.

Loss of hearing slight, some-
times absent, and recollection but
little impaired.

Tremors and spasmodic con-
tractions of muscles rare, but dan-
gerous symptoms when present.

The eyes bright, and slightly
but not invariably reddened.

Congestion of the capillary ves-
sels of the extremities slight.

The foetor of exhalation
.even in severe cases.

slight

Rose spots, few in number, of-
ten only six or eight, rarely more
than thirty ; rather larger, more
elliptical, and more elevated, con-
fined mainly to the abdomen, oc-
casionally extending to the chest,
thighs and upper parts of the arms,
but not to the whi^le surface not
seen sooner than the eighth, nor
later than the fifteenth day.

The intestinal inflammation acts
as a positive disturbing cause.

Pulse, from 100 to 120, soft
and compressible, often undulating
so much as to become a true bis
feriens pulse, varying but little
during the course of each parti-
cular attack.

Typhus.

Stupor, a prominent symptom,
almost pathognomonic comatose
at an early period.

Subsultus, present in nearly
every case.

Loss of hearing considerable
and almost invariable, and recol-
lection greatly impaired no dis-
tinct impression of what has taken
place during confinement.

Tremors and spasmodic con*
tractions of muscles frequent, but
do not add to the gravity of the
prognosis.

Conjunctivas reddened from con
gestion.

Congestion so great as to give
a bluish tint to the extremities.

Exhalation from the skin very
peculiar and offensive, the smell
almost pathognomonic of the dis-
ease.

Exanthema extends over the
whole body, papulae rounded, va-
rying from a point to the eighth
of an inch, occurs on the third day,
continuing generally five days, oc-
casionally twelve or fourteen days.

The intestinal disorder is limits
ed to the indirect influence of the
fever and the cerebral disturbance.

Pulse, from 100 to 140, and
even 160 the variations are con-
siderable.

584 Wilburn, on Typhoid Fever. [October,

Typhoid. Typhus.

In the thorax of typhoid, con- In the thorax there is conges-

gestion is limited mainly to the tion of the substance of the lun<is,

bronchial membrane, giving rise as manifested in feeble respiration

to sonorous and sibilant rhonchus. and sub-crepitant rhonchus.

By a careful examination of 'the symptonns, as presented in
this tabular view, it will be plainly seen that the nervous and
cerebral symptoms of typhus are much more developed than
those of typhoid fever. Many points s^ub-judice J hstve pur-
posely passed sub-silentio : one of the most important of these
is the contagiousness of the two diseases. In the celebrated
work of Tweedle, as revised by Dr. Gerhard, the latter re-
marks, that the diagnosis of typhoid and typhus fever is not
often made in the United States, because the latier disease
(typhus) has hardly appeared for the last twenty years, except
on a few occasions in two or three large cities. He also re-
marks, that many of the symptoms of typhoid are similar* to
those of typhus fever, but follow a different order of develop-
ment. To those who are not creed-bound these distinctions
are sufficient to overturn the identity of these two diseases.

After having thus, as I confidently trust, thrown some doubt,
at least, upon the minds of your readers as to the identity of
typhoid and typhus, I would invite attention to a cursory re-
view of the former disease and its treatment, as observed and
practiced by the writer in Eastern Alabama.

The Typhoid fever first made its appearance in this section
tion of country in the fall of 1850, and was very successfully
treated by my co-partner, the late Dr. Thos. J. Welborn, f
then being absent from the State. It continued to enlarge its-
circle until the first of June following, and gradually declinetf
toward the first of July. I saw no case in the fall of 1851,
though some few cases occurred, as I am inforl^ed, in the prac-
tice of other physicians around me. The first case of the fever
I saw was on the first of June of the present year ; the cases*
however, have been few, though very malignant in character
and stubborn in treatment.

This disease did not confine itself to negro cabins and ther
cottages of filth and wretchedness, but was a frequent visitor
to the well ventilated and pleasant mansions of the opulent.
In houses where deanlii^ess was strictly observed, yards and

1852.] WiJburn, on Typhoid Fever. 585

under-houses well swept, the inmates well clothed and fed, ex-
cellent water, situated at considerable distances from creeks,
ponds and marshes, this fever attacked every member of the
families, as frequently and as malignantly as it did the dirty
hovels of negro quarters and cabins of the poor in marshy sec-
tions and otherwise unhealthy localities. (I do, by no means,
intend this remark as an argument in favor of filth, but as a
fact observed in my practice: perhaps, minus in par vos 7nor bus
furit, leviusque ferit leviora Deus.)

The symptoms observed in these cases were nearly the
same, cceteris paribus. 1 prefer not to mention any other
syn)ptoms, than those already stated, as peculiar to this dis-
ease, and which distinguish it from its great cousin-german,
Typhus fever.

The etiology of Typhoid fever is yet a mooted question
the pathology somewhat settled. I have assisted in the post-
mortem exarijination of only one case of this fever. (Were it
not too great a digression, I should be pleased to express my
views of the superstitious prejudices of the country to post-
mortem examinations. The people need information upon this
point.) In this case, nothing new presented itself; softening
of the mucous membrane of the stomach and spleen, enlarged
mesenteric glands, thickening and ulceration of the elliptical
plates of the ilion. These anatomical lesions have been ob-
.served by nearly every one who has examined those who have
<iied of typhoid fever. There are other lesions occasionally
-met with, which, however, are not peculiar to this disease, but
"due to its complication with other maladies, such as softening
of the brain and hepatization of the lungs, &c.

Treatment. I come now to the prime purpose of this arti-
cle, the treatment of typhcid fever. I never bleed from the
arm ; venesection in this section is sure to seal the doom of the
patient. I see other practitioners adopting general bleeding
is a sine qua non. Dr. H. G. Davenport (N. O. Medical and
Surgical Journal, March 1852,) remarks: "In every case
which has come under my charge for the last five years, where
I have been called to them in the beginning, I have always bled,
having an eye to the age, constitution, etc., of the patieoL I

586 Wilburn, on Typhoid Fever. [October,

have never seen any fatal consequences follow its use ; it lessens
the frequency of the pulse ; it becomes softer and slower, and
remains so during the whole course of the disease." Dr. R.
L. Scruggs (same Journal, Jan. 1851,) remarks : " In Ten-
nessee, I occasionally, but very rarely, bleed from the arm, and
never had occasion to regret it. In this country, (Shreveport,
La.,) however, I have not deemed it advisable to resort to
venesection in any case of typhoid fever coming under my
care, although, I should not hesitate to do so, at any time, even
here, if the appearances seemed to justify it." This quotation
from Dr. Scruggs, expresses, I think, the secret of venesection
in this form of fever, that whilst it may be a therapeutic agent
of great value in some localities, in others, it is not to be relied
on, but to be positively avoided. Practitioners, therefore, who
reject, or adopt venesection, should not be condemned, as both,
may be right.

I never give quinine. In the language of Dr. Scruggs, " It
was my good fortune, at the commencement of my practice, to
have the advice and friendship of an old, able and experienced
practitioner who had treated and become familiar with this
fever, and who guarded me upon this-point, (the use of quinine,)
but whose sudden and untimely death left me to my own re-
sources, and soon I wandered from his teaching, gave the qui-
nine to extend the morning intermissions and to lessen the
.evening excerbations, to, my afterwards, great regret and
mortification. In no instance where I gave the quinine did
I observe any benefit to the patient, but in every instance an
increase of the dangerous symptoms and a hastening of the-
stage of collapse. I have rejected the quinine from my prac?
tice in this fever, not from prejudice, for I am of the Quinine-
school, Augusta, Ga., but from the repeated fact, that it proved
deleterious to every case, and fatal to all, where its use was
persisted in. I have lost only one case where the quinine was
not used, and I have treated about fifty cases, within eighteea
months, of typhoid fever. Dr. Scruggs remarks, " If I know
anything of the matter at all, quinine given in typhoid fever^
with the view of arresting the fever, as in the remittents, and
persisted in, is as certain to result in disaster and death, as that
any given cause whatever, will produce its legitimate effect.."'

1852.] Wiiburn, on Typhoid Fever, 5S7

I have generally l)listered in high intestinal inflannmation,
but do not believe it to be beneficial. I have no doubt but
many physicians have, like myself, discovered, that so soon as
the blister was applied that the discharges became bloody and
frequent, and most difficult to control. I agree with Dr. H.
G. Davenport, that " blisters do more harm than good." There
is such an intimate relationship existing between the skin and
bow^els as to render it highly important that the former should
be preserved. Prof. Michael Levy (Medico-Chirurgical Re-
view% Jan. 1846) says : " It will not be out of place hereto
point to the enormous activity of the skin, the large amount of
its circulating blood, and to its close and inseparable sympathies
with the more purely vital organs of respiration and digestion ;
nor is it necessary to recall to mind the imminent danger of
alarming or fatal congestions of the bronchial and intestinal
mucous surfaces, consequent upon checks to the free action of
the complex glandular and vascular apparatus lodged in the
cutaneous organ."

There are, however, many of the profession who consider
the blister their sheet-anchor in all visceral inflammations, and
from such I may reasonably expect an unconditional and relent-
less condemnation. I entered the profession with the same
dogmatical prejudices in favor of the Herculean power of blis-
ters to subdue intestinal inflammation, but a few winding sheets
have greatly obstructed my view of their remedial efficiency,
and directed my attention toother means more reliable in their
action, and less dangerous in their consequences. I have gen-
erally been able to control the bowels so as to obtain two oi*
three evacuations during the day, whilst I employed poultices,
&c., but so soon as I applied the blister, the discharges were
bloody and frequent, followed in almost every instance by dis-
tressing tormina and tenesmus, not to mention the great annoy-
ance and restlessness occasioned by the supervention of stran-
gury. A cheerful spirit is an elixir of great value in all diseases,
but in none is its restorative and supporting power more to be
desired than in typhoid fever. But wlio does not know the
despondency, the despair, which patients exhibit when galled
by a blister :

" Nor does old age a wrinkle trace
More deeply than despair."

588 Wilburn, on Typhoid Fever, [October,

Thus much I have thought proper to write in opposition to
the use of venesection, quinine and blisters, as therapeutic agents
in typhoid fever.

My treatment has not been the same in every case, but
modified according to circumstances \ in other words, I usually
treat symptoms rather than a name.

When called to a case proving to be typhoid fever my gene-
ral plan has been to give 10 grs. of hydr. sub. muriate, or 15
grs. of blue pill, to an adult, to be followed immediately by an
injection of warm water and soap, &c., and by a saline cathar-
tic in eight or ten hours. I cannot too forcibly urge upon the
profession, the propriety of injections. Their therapeutic use
in affections of the bowels is certainly understood by every
practitioner, but in no disease do I consider them to be more
positively demanded than in typhoid fever. They unload the
rectum of irritating scybalae, and act as a quietus upon the
nervous system. Given at bed time they frequently procure
for the wearied patient a comfortable night's rest, a thing
highly desired.

After a free evacuation of the bowels I administer the fol-
lowing powder every four hours.

Hydr. Sub. Mur. . . . grs. iii.
Ipecacuanha, .... grs. ii.
Pulv. Doveri, .... grs. v.

Should the puls6 be quick, I do not hesitate to give the ver-
atrum viride. To an adult, I commence v^nth six drops (Nor-
wood's) in about half a fluid aunce of sweetened water in ten
minutes, seven drops in ten minutes more, eight or ten drops,
and wait the result ; which is free emesis, a reduction of the
pulse, a soft skin, and gentle perspiration. I then continue the
veratrum, giving six drops (the first dose) in four or five hours
and increasing one drop every four or five hours until ten drops
are reached ; I then continue ten drops every six hours and
gradually increasing the period to twelve hours. Some pa-
tients cannot reach ten drops ; in such cases, the practitioner
should stop at that number which produces emesis, and falling
one drop below it, continue the dose every six hours, and gradu-
ally extend the period.

The veratrum should be followed in every instance by free

1852.] Wilburn, on Typhoid Fever. 589

drinks of slippery elm or gum arabic water, as also by the fol-
lowing powders, every two hours, extending the time as the
period of the veratrum is extended.

Ipecac, .... grs. ii.

Dover's, .... grs. iv.
I speak from experience when 1 recommend the veratrum
viride to the profession. I am as much opposed to nostrums
as any one, but 1 do think that when a medicine has been sug-
gested to the profession which answers a desideratum might I
not say, wipes away an opprobiium medicorum it is but jus-
lice itis but a just regard tothe high and nobleclaimsof science,
that it should be fairly tested. I have derived the most flatter-
ing results from its use and as yet have seen nothing in its ac-
tion to induce me to discontinue it. I am no enthusiast of any
remedy, and would by no means pen one line concerning any
drug, which might induce practitioners to essay its virtues at
the imminent peril of their patients. That the veratrum con-
trols the action of the heart, is beyond question, and that this
was a desideratum in medicine is equally undeniable. The
digitalis has hitherto been employed for this purpose, but thai

iit is uncertain and even dangerous in its action is known to
fevery one who has used it. It frequently proves powerless, and
not unfrequently like a cowardly giant, watches the auspicious
moment when it may exert its feigned prowess upon a helpless
and prostrate viccim.
The veratrum, when properly administered, is certain in its
action, and does not like the digitalis apparently sleep until it
has gathered sufficient force to storm and overpower. I have
employed the veratrum in other diseases beside typhoid fever.
Pneumonia, pl^^aritis, puerperal peritonitis, palpitation of the
heart, and convulsions of children, and in all with signal bene-
fit to the patient.
It is objected that the veratrum inflames the alimentary
canal. This it will not do, if given as I hav.e advised. I should
state, however, tliat 1 use the elm bark fresh from the tree, and
not a worm-eaten ground Indiana elm. They who complain
of its irritating qualities, gave it, probably, too frequently, or
without water, or an impure preparation. I have administered
the medicine in numerous instances, and attempted to watch

S90 Wilburn, on Typhoid Fever, [October,

closely its effects, and never yet have 1 observed the results
spoken of by other physicians. It sometimes produces stupor in
children, resembling approaching coma, but if continued until
emesis is brought about, this symptom speedily disappears.

I have been told by some practitioners that they considered
the veratrum a humbug and never gave it.^ Such have set
aside a valuable remedy, and worthy to be tried, and as it is
not yet too late, I say, try it.

Some, on the other hand, are fearful to use it. These indi-
viduals give frequently a more dangerous medicine the digi-
talis purpura. I have written more upon the veratrum than
I at first intended, but should what I have written prove effec-
tual in inducing practioners to try the virtues of this medicine,
I shall feel amply compensated for my labor.

After evacuating the bowels, the use of the compound pow-
der, the veratrum, injections, &c., as described, I cup and scari-
fy the epigastrium and right iliac fossa. I then order a poul-
tice of corn meal and Cayenne pepper to be applied over the
bowels every hour, whh sinapism to the spine. Should the
poultices not prove sufficient to allay abdominal heat, I put on
a sinapism over the bowels to remain ten or fifteen minutes,
and re-apply the poultice. This sinapism should be repeated
every six or eight hours until the heat of the surface is subdued.
The poultices and injections should be kept up during the whole
course of the disease. The injection should be given at least
once, if not twice, every day. The kind of enema must vary
according to circumstances such as warm water ; salt and
soap ; warm water, laudanum and starch ; acet. plumbi, and nit.
argenti,&c. These, as many other things, depend upon the judg-
ment of the physician. As a diaphoretic, tonic and diuretic, I
use the seneka and spts. nitre : a free drink of the former, and
teaspoon doses every three or four hours of the latter.

In severe cases, I blister the entire spine and give ice freely.
There are many opposed to the use of ice ; more especially,
those of the Yulcan school. Some cases, no doubt, die, where
ice has been used ; but should it be rejected because a few
die under its use ? This does not prove that ice w^as the
cause of the death. Calomel is given, and the patient dies ;
do you then reject it from your practice? And so we

1852.] Wilburn, on Typhoid Fever. 591

might say of any medicine; patients die under the best treat-
ment.

In low muttering delirium^ the ice appHed freely to the scalp
and given internally, in pieces, to dissolve in the stomach, will,
in nine cases out of ten, arouse them to rationality. I write
what I have seen at the bed-side. It relieves the heat and dis-
tress of which the patient so frequently complains whilst rack-
ed by the fever. It should be given in as large pieces as can
be readily swallowed. I sometimes, give lemon water with
ice, but do not order a free drink of any iced water. Its solid
state is the best form in which it has been administered. Ap-
plied in iced bags or bladders to the abdomen, and given freely
internally, it is our sheet-anchor (I speak positively) in danger-
ous intestinal inflammation. I know that there is a prejudice,
with many of the profession, so deep and lasting against the use
of ice and cold water, that they will not credit the treatment of
any one who embodies them among his therapeutic agents.
Such men add but little to the progressive march of medicine :
they dare not step one side an old and routine practice, for
fear of committing an error : they err, in being too cautious,
and condemn because they do not experiment. I do not intend
to say that practitioners should experiment upon the lives of
their patients far from it; but I do say, that when life is fast
failing, the physician should do all in his power to save it, and
if his usual remedies prove powerless, he should try others
which have been highly recommended. Short of this, he does
not perform his duty.

I have now given a short and very imperfect sketch of my
treatment in typhoid fever. I have not thought it proper to
write the varied changes which are so often observed in this
fever, preferring to leave the treatment of them to the judg-
ment of the physician, as no two cases will be precisely alike,
but varied in their progress, by constitution, habit, vicissitude of
weather, &c. My purpose has been to discuss plainly and
concisely that form of treatment which I believe to be most
successful in typhoid fever. I wish also to be understood as.
speaking of this locality ; for I write from experience in thijs
place alone, and do not by any means attempt to dictate to any
one ; but should what I have written attract the attention of

592 Wilburn, on Typhoid Fever. [October,

any member of the profession, and "enable him hereafter to
diagnosticate correctly, and to treat the disease successfully,
I shall feel amply rewarded for the little toil it has cost me to
write this article, and feel, too, at the same time, that I have
done the profession some service."

Addendum. Since there are many who do not believe in
the existence of Typhoid, as a distinct disease, I make the
following propositions:

1st. That physicians of Georgia, Alabama, Mississippi, Flori-
da, Louisiana and Texas, report their names to the New Or-
leans Medical and Surgical Journal and the Southern Medical
and Surgical Journal of Augusta, as either for or against Ty-
phoid fever, as a separate and independent disease.

2d. That as many as can find it consistent with their labors,,
write out their views as to its independence or identity with
other diseases, and the treatment found most successful.

I believe that every member of the profession is honest in his
opinion ; but, if possible, we should know the truth of the mat-
ter. If there is any hope of settling these vexed questions, let
it be done before they are pushed upon another age. We are
probably as well prepared to discuss the identity or non-identity
of typhoid fever now as we will ever be. Many consider it a
modification of remittent fever some of intermittent some
as identical with typhus. It would be proper for these to state
what they consider remittent, intermittent and typhus fever,
and further, to relate clearly the nature of that modification
which gives rise to those peculiar symptoms known to many
as typhoid fever.

I wish to see an interest manifested in the profession in diag-
nosis, not only in typhoid, but in every other type of fever. If
typhoid be intermittent or remittent fever, its treatment is
clear; if not, its nature should be ascertained, that it may be
properly treated. I should be pleased to see a table of physi-
cians' names, as to identity or non-identity of this fever, and
in that table I shall risk my name as to its non-identity, and
in favor of the doctrine, that it is a disease sui generis.

I am fully aware of the incoherency of this article, written at
many sittings, caused by professional duty. This, however.

1852.] Harris^ Anomalous Cases. 593

could not be avoided, and should it not meet with approbation^
I have the consolation to know

"Nee semper feriei quodcunque minabitur areus."

ARTICLE XXXV.

Anoinahus Cases. By E. Y. Harris, M. D., of Fayette C. H.,
Alabama.

Every physician, of much practice, occasionally meets with
cases, the peculiarities of which he never heard or read of be-
fore; these, if reported, might be interestinof, if not instructive,
to some of the profession. Cases similar to the following may
have come under the observation of othei's, but as yet I have
never seen or heard of anything of the kind.

Case I. In 1845, while I was practising on the Yazoo Riv-
er, in Carroll county, Mississippi, I was called one night to see
a negro woman who was in the seventh month of her fourth
pregnancy. The white family had gone offthe previous day and
left this servant by herself in charge of the house. On my arri-
val, I found her laboring under uterine pains, which came on
about every fifteen or twenty minutes. I learned that on the
previous night a man had visited her for carnal purposes ; that
she had resisted him, at which he became incensed and struck
her with his fist two or three times in the left side, when she
cried out so loudly that he became alarmed and left. I bled
her and gave an opiate. Next morning she expressed herself
as much better, said she felt the child move. She continued to
feel better up to the third day after receiving tiie blows, thougb
there was some discharge of bloody mucus from the vagina
with occasional pains in the uterine region. Felt heavy and
sleepy, considerable soreness of the left side where the blow&
had been inflicted. On the third day she washed a large quan-
tity of clothes ; in the evening felt worse, uterine pain, some*
what increased ; she remained pretty much in this condition up
to the sixth day, feeling better during the morning and worse in
the evening, declaring all this lime that she felt the child move
distinctly. At 10 o'clock, on the night of the sixth day after she
had received the injury, she was takea with strong uterine pain.

594 Harris' Anomalous Cases. [October,

I found the uterus in its proper place ; os tincse thick and soft,
and cooi, and not dilated in the least; skin cool and moists
pulse full and a little frequent ; tongue natural : said she felt
the child move, and when a contraction would take place re-
ferred all the pain to the left side. Prescribed 2 grs. opium
and 1 gr. ipecac ; warm fomentation over the abdomen. Next
morning, found she had rested well during the night ; com-
plained of her back, and occasional uterine pain. Gave an
enema of soap-suds, which operated lightly, and, as the pulse
Was full and strong, bled to 16 oz. continued warm fomenta-
tions, and gave a pill composed of opium 1 gr., ipecac \ gr.
She expressed herself as feeling much easier, and desired to be
left alone that she might sleep. At 10 o'clock, I returned,
after being absent four hours : found her lying on her back ;
eyes half open, but not turned up ; pulse natural ; breathing
regular and deep ; skin moist and cool. She seemed to be in
a very deep sleep, and snored loudly. I attempted to arouse
her, but soon found that it could not be done: she had gone
into a sleep never again to awake. I dashed water in her
face, poured it on her head ; applied mustard sinapisms to her
spine, extremities, and over the abdomen ; but all in vain.
Pulse, breathing and skin, all seemed natural; no tympanitis;
every organ seemed to perform its function with regularity ;
the nervous system seemed only to be at fault. In whatever
position she was placed, there she remained ; if the eyelids were
drawn apart they remained so ; if closed, they remained closed.
A large blister plaster was applied over the abdomen and bound
close to the skin for thirty-six hours, but did not vesicate in
the least ; one was also applied to the back of the neck, which
very slowly blistered; but nothing that was done gave any re-
lief.

On the morning of the eighth day of her illness, in attempt-
ing a vaginal examination, my hand came in contact with the
child lying at the vulva and between the thighs, with the pla-
centa beside it. There was not the least hemorrhage ; at what
time in the night the child was born no one knew ; there was
an old negro with her during the night, but she could give no
account of it. Upon examination, it was evident that the child
had been killed by the blows received by the mother eight

1852.] Harris' Anomalous Cases. 595

days before. The child had received two injuries ; one was on
the left side of the head ; the parietal and temporal bones were
both driven in, and the parts considerably tumefied and red;
the other was on the left side, just below the arm, where the
cuticle was of a very dark red, and bruised ; two or three of
the ribs were broken loose from their articulation with the spine,
and driven in. The child certainly had been dead sometime,
as putrefaction had taken place, notwithstanding the mother's
assertion that she felt it move. This clearly shows that a wo-
man may be mistaken as to foetal movements, my patient re-
mained in this cataleptic condition five days and died. She did
not seem to get any worse until the day before her death,
when all the symptoms became aggravated and she gradually
sank.

Here was a strange condition of the nervous system, brought
on probably by the injury she received from the wretch, who,
for a moment's gratification sacrificed two lives. Was this
condition of the nervous system brought on by the injury ? If
so, would the same have produced similar nervous disturbance
if she had not been pregnant ? During the whole of her coma-
tose state, her pulse was good, her skin natural and moist, urine
passed involuntarily until the day before her death. I have
seen two or three cases of catalepsy in my life but none like
this. In the Medical Examiner for 1845 or 46, there is a case
of catalepsy reported which was supposed to be consequent
upon the puerperal state; the patient died in five or six days,
but, if my recollections serves me right, the symptoms of this
case were very dissimilar to the above.

Case II. On Monday, 5th July, 1852, William Davis, a lad
of about 15, attended a temperance celebration in Fayetteville.
About three weeks previous to this time, he had had an attack
of dysentery, bul was quite well on the day above mentioned.
He stood about nearly all day, occasionally eating ginger-bread
and drinking beer; late in the evening he complained of a sick
stomach and slight headache, went to bed, eat no supper, but
vomited two or three times between that and midnight; about
2 or 3 o'clock, A. M., he was moaning most plaintively, and on
being asked, by his father, what was the matter, replied, that
he felt very curious. The after part of the night he rested

596 Harris* Anomalous Cases. [October,

badly, sometimes lying still and apparently sleeping soundly
then rising up and rolling about, and moaning, as though in
great pain ; at day-light, his father attempted lo arouse him to
go home, a mile from town, but as he appeared to be sleeping
so soundly, thought best to let him lie awhile ; in a short time,
however, he was discovered to be completely delirious, and
went into a convulsion, which lasted but a short time : he then
sank into a deep sleep. At this juncture, I was called in, and
found him lying on his back ; breathing deep and full; skin
rather cool and moist ; pulse 65 to 70, weak and easily com-
pressed ; jaws seemed to be a little stiff'; great rigidity of the
abdominal muscles, which were a little sunk in, and felt as
hard as a board and ridgy. This rigidity gradually extended
to the legs, spine, neck, and finally to the arms, so that by 5
o'clock, P. M., he was as stiff" as though he had no joints. He
w^ould have very restless paroxysms, during which he seemed
to suffer great pain : between these, he would be quite still,
and apparently asleep. While his restless paroxysms existed,
he would exert himself to such a degree as to become perfectly
exhausted, and sink down to rest fifteen or twenty minutes ;
then suddenly spring to a sitting position, scream and moan
loudly, scratch his head, and rub his hands over his face, as
though washing it ; fall suddenly down, roll very quickly from
one side to the other, and at times rest himself upon his knees
and forehead in fact, during his restless moments, he would
assume every attitude imaginable, and all this time he would
scream and moan in the most plaintive tones, indicative of the
most intense suffering. He never spoke nor articulated a sin-
gle sentence from the time he lost his mind. These paroxysms
of pain and restlessness continued until the rigidity became
general they increased in frequency and violence until about
3 o'clock, when the rigidity became so general that it confined
him to his back. I could have placed my hand under the oc-
ciput and raised him to his feet without bending his body in the
least ; his head and spine were inclined to draw back a little
in fact, during the last moments of his life, the occiput rested
upon the spine, between his shoulders ; his jaws became com-
pletely locked, so that it was imposible to prize them open half
an inch.

1852.] Harris's Anomalous Cases. 597

As to the treatment, we could do but little. From the first,
he had a difficulty in swallowing, and it soon became impossi-
ble for him to take any thing at all that way. His feet and legs
were bathed in warm water; mustard sinapisms were applied
to his legs and arms, over the abdomen, and along the whole
course of the spine ; a large warm pepper poultice was applied
over the abdomen ; temples cupped ; back of the neck blister-
ed ; one-twelfth gr. strychnine given two or three times, though
it is not quite certain he swallowed it ; he was sponged all over
several times with spts. camphor, and hot brandy, laudanum and
spts'. turpentine, in pretty large quantities, were frequently rub-
bed over the abdomen and spine. I commenced giving chlo-
roform to inhale as early as 10 o'clock, and continued it during
each paroxysm. It seemed to shorten the paroxysm of pain,
and this was the only good I could discover. I made a lini-
ment of chloroform, sweet oil and spirits ammomia, and applied
it frequently to the spine and abdomen. I attempted to give
him an injection of strong soap-suds and salt water, but so great
was the contraction of the sphincter ani that it was with con-
siderable difficulty, I could introduce the canula, and when I
did accomplish this, could not force up any of the contents of
the svrinore. Two or three hours before he died his breathinf^
became very laborious, and continued to increase until five
o'clock, when he expired. Nothing that was done seemed of
any avail. I would remark that during the whole time he was
delirious he kept his eyes shut ; the pupils were dilated. His
former health had not been very good ; he had been chlorotic
for three years ; pale and swarthy ; appetite pretty good ; little
exercise produced considerable action of the heart and quick
breathing, but he had been better of this for the last six months.

Case III. On the 15th July, 1852, I was called to see a
negro man, Joe, 25 years of age, stout and athletic, had never
been sick before. While hoeing cotton, that day, he complain-
ed to his master that when hoi stooped down he felt an acute
pain in his forehead, and when he raised up it moved to the
back of his head. He had felt this pain, occasionally for two
or three months, but at this time it was worse than usual : he
had tied a string very tightly around his head, but it failed to
give relief.

N. S. VOL. VIII. NO. X. 38

598 Harris's Anomahusr Cases. [October,

Not more than five minutes after Joe had this conversation
with his master, he fell. His master ran to him and found him
resting upon his knees and head. On being addressed he made
no reply, but fell on his side, his face and mouth became con-
vulsed and drawn to the left he had also spasmodic twitchings
of the right arm and muscles of that side, but not so decided as
those of the face ; the head was so much twisted to the left that
his master feared the spinal marrow would sustain some injury,
he attempted with all the strength he had to twist the head
back, but could not move it. In twenty minutes the spasm gave
way but he remained unconscious in this condition he was
carried half a mile to the house, a vein opened in the arm and
30 oz. blood drawn, and a blister applied to the forehead, a ta-
blespoonful of No. Six poured into his mouth, but being unable
to swallow, it ran out. A spasm would come on about every
hour and last fifteen or twenty minutes, during which time his
head would twist around to the left side, and the muscles of the
face and right arm twitch and jerk. As soon as the spasm would
go off he would try to bite his fingers or anything he could get
hold of; he chewed off two or three spoon handles, and his
tongue did not escape receiving some injury. He would do
his best to bite those who were holding him, and being very
strong, it required five or six to prevent his doing himself serious?
injury.

When I arrived I found him in the condition above described ;
pulse full, strong, and a little hard, 80 to minute ; skin, natural
temperature ; occasionally he would place his hand upon the
occiput and moan. He had become alittlecalm and was covered
up; on uncovering him I discovered that there was a great
increase of sensibility ; for whenever a fly would rest on any
part of him, he would jerk from it as though a pin or a knife
had stuck him. If I touched the hair any where over the oc-
ciput, he would flinch instantly and seemed fully as sensitive
as if the whole cuticle had been, pealed off"; sensibility was not
near so acute over the parietal, temporal and frontal regions.
I had him held up and bled from the arm 24 oz., when the
pulse became softer and slower he now became more rational,
called for water I gave him a large dose of epsom salts ; he
complained of a lancinating pain in the back of his head, said

1652.] HsivWs Case of Extra- Uterine Fcetation. 599

he was much easier when sitting up than when lying. I shaved
the whole occiput and applied a blister plaster that covered it
and extended down the back of the neck six inches; in three
hours gave him another dose of salts, and in three more the
blister had drawn well in a few hours the salts had operated
finely, producing serous discharges ; he gradually improved and
now, two weeks from the date of his illness, he is quite well.

ARTICLE XXXVI.

A Case of Extra- Uterine F(taiion. By M. W. Havis, M. D.,
of Minerva, Georgia.

June 28th, 1851. A negro woman, of large frame and
respectable embonpoint, aet. 39, the mother of nine healthy
children, in second month of pregnancy, was ill of metrorrha-
gia; the hemorrhage inordinate ; pulse 100, full and large; v. s.
20 oz. Ordered, hips elevated; cloths saturated with acetic
acid dil. to vulva; acet. plumb, grs. ij. ; opium grs. j., every
three hours, until relieved,

29th. Greatly improved convalescence rapid.

July 25th. Similar attack ; treated as before : relieved.

August 28th. Hemorrhage active ; uterine pains severe
and expulsive a foetus at four months delivered. Hemorrhage
continuing excessive, ordered ol. ergotae gtt. 20 every half
hour, until sufficiently diminished. Two doses only were given.
In three weeks she was convalescent and resumed her place
as cook.

Oct. 1st. After slight pains in uterus during the day, they
increased at night, and were effectual in expelling a considerable
mass of hydatid-moles. Upon the use of tannin injections, the
next day, more were dislodged. She was not confined to bed,
and without inconvenience continued in the exercise of her
duties. In November, she complained to me of a bad feeling
in her abdomen, amounting to pain, at times, of a dragging
character. I interrogated her relative to her former labors,
and learned that, up to last April, they were all normal, at
which time metrorrhagia obtained and she aborted ; foetus four
months advanced. Subsequent to this she was troubled with

600 Havis's Case of Extra- Uterine Fcstation. [October,

partial hysteroptosis, but, conception again taking place, the
prolapsus was relieved. She suffered during prolapsus, from
costiveness and dysuria. I examined per vaginam, found the
vaginal mucous membrane in a phlogosed condition, the cervix
uteri engorged, uterus slightly prolapsed and a very acrid mu-
co-purulent discharge, evidencing an extension of the inflamma-
tion to the intra-uterine superficies. With these facts before
me, the indications were apparent to reduce the inflammation
and thus cut short the leucorrhoea and relieve the prolapsus.
Ordered, hyd. sub. mur. et. rhei, aa grs. iij., every other night;
cataplasm to sacrum ; vesicated surface to be stimulated with
ung. sabinse. Inject aqua acet. plumbi, three times per diem.

At the end of two weeks, very little improved; leucorrhcea
profuse; pains in loins ; lassitude and cephalalgia. Ord., tinct.
lyttae gtt. xx., three times a day ; aq. acet. plumbi continued.
At the expiration of two we'eks, declared herself well of leu-
corrhoea. Uterus in " statu quo." Gave pills of carb. fer. et
rhei. She improved, and for three weeks did her labor as cook.

January 2d, 1852. Was taken very ill. Found her with
pains in the loins and hypogastrium ; pulse 100, full and tense ;
bowels costive ; stillicidium urinse ; cervix-uteri engorged, in-
durated and painful to touch: v. s. 16 oz. ; hip bath; calomel
grs. iij. ; jalap viii. grs.; spts. nitre and flax-seed tea,jo?'o renata.

Jan. 23rd. Pulse 90, soft ; three alvine dejections ; mictur-
ition guttatim. Ordered, infusion of uva ursi, diosma crenata
and carb. sodse to be taken during the day ; pul v. Doveri grs. vii.
at night. This treatment was persevered in for two weeks.
Micturition normal ; no febrile condition since 23rd ultimo.
Vaginal tract injected, cervix firm and of bluish tint, deep
fissures of semi-crucial figure divide its substance, from which
exude creamy shreds of vitiated mucus; os uteri firmly closed.
Ordered, cataplasms to sacrum ; pil. hydrarg. grs. iij. every
othernight ; anodyne injections ; salines, ^ro re tig^^z.

For two weeks, gradual improvement. At this time pneuma-
tosis abdominalis supervened and induced a despondency which,
with hysteria, placed her in a very unhappy state. Amm. tinct.
valerian cum assafoet. proved a veritable sine qua non. Upon
taking a fright, she strained her muscular system violently.
I found her greatly prostrated : womb at os externum ; fissures

1852.] I{3i\'is^s Case of Extra-Ulerine Fcetation. GOi

deep, and the eminences firm as cartilage; pulse 110, feeble
and quick. Replaced the womb ; enjoined recumbent pos-
ture. Ordered, syrup ferri iod. gtt. xx., three times per day;
oleum tiglii. to spine; salines; inject sol. nitras argenti, twice
a day. The caustic not effecting any good, it was suspended
at the end of two weeks, and the ung. iod. ferri. substituted.
Under this treatment, improvement was not apparent. I now
consulted with my respected friend, Dr. J. Riley. He propos-
ed, in addition to the use of ung. iod. free scarrifications of the
cervix, and the vinous sol. iod. ferri, instead of the syrup. At
the end of two weeks the vinous sol. iod. ferri proved such an
irritant to the stomach as to cause its suspension, and the syrup
was resumed. She now, for a short time, gave evidence of
improvement, but soon retrograded. In conversation with my
much esteemed preceptor. Dr. G. T. Cooper, I explained the
nature of the case, and, at his suggestion, resolved to apply
the solid caustic. She was at this time much emaciated :
tympannitic; nervous tremors quite frequent in her limbs;
considerable weight in left hypogastrium ; appetite capricious ;
cervix uteri very hard. I applied the caustic freely every
other day, and gave pills composed of carb. ferri. grs. iij. ;
rhei and gum myrrh aa. grs. ij., and ext. gentian q. s. one
three times per diem ; oleum tiglii continued to spine. The
day succeeding the second application of caustic, she declared
her conviction of a speedy convalescence, for " she had a new
feeling a great weight was removed from her bowels, and she
now felt strong there." From this time (x\pril 23d) she made
gradual progress to recovery.

May 10th. The caustic having been applied eight times, I
deemed its further use unnecessary, as the cervix uteri had
nearly returned to its normal size and consistency.

May 20th. I was summoned to my patient, whom I found
in a kind of exstacy delight beaming from her eyes : she ex-
i\ tended towards me her hand, in which she held what seemed
j! to be a peg of dark wood, and at the same time exclaimed, "I
I' will now surely get well, for here is the peg and spiders which
|i have so long troubled me." I found, upon examining these
>' wonders, that the peg was the tibia, corresponding to a foetus of
1 1 four months ; and the spiders, hydatids on a large scale. She

602 Havis's Case of Extra- Uterine Fcetation, [October^

had, early in the morning, been troubled with considerable
pain of a pricking character in the position of the left ovarium,
and in three hours thereafter had three alvine dejections, in
rapid succession. Upon examining these, found the bone
and hydatids, chiefly in last dejection, consisting of a yellow
aqueous fluid, with flocculi, in which the bone was imbedded
and the hydatids attached. Since this, she has passed two ribs,
one scapula, two bones of cranium, tibia, ten metacarpal, one
carpal. She is now walking about the yard without incon-
venience, performing such duties as require manipulation
chiefly.

The case is surely a novel one in several particulars; and, if
I mistake not, the only one reported where nature has relieved
herself of so serious a freak, without a vast amount of febrile
disorder, and where the skeleton made its exit through the
intestines, with so little trouble, not even preventing the wo-
man from laboring.

Candor requires an acknowledgment of my entire ignorance
of the existence of an extra-uterine pregnancy, previous to the
20th of May, when I had an ocular demonstration of it. The
prolapsed uterus, diseased cervix, and a fluor albus of eight
years duration, satisfied me as to the disease requiring treat-
ment.

The two last months of the woman's illness, she complained
of a "knot," as she termed it, in her abdomen, just beneath the
left ovarium, which at times would swell, give her much pain,
and then subside. I examined her abdomen repeatedly, when
its parietes were thin and flaccid, and could detect a " knot,"
'tis true, but never could appreciate its swelling and subsiding,
as she did.

Since the convalescence of my patient, I questioned her
very closely, and find that, in October, 1851, one month subse-
quent to discharge of hydatid moles, her catamenia appeared,
and at no time up to the present date have their periodicity
been disturbed. In November, she felt symptoms which had
obtained in all her previous conceptions, and was led to believe
that she was pregnant, but was surprised to find her menses con-
tinue. If she conceived in November, the foetus died several
months previous to expulsion per rectum, and if such be thefaet,!

18B2.] Havis's Case of Extra-Uterine FcBtation. 603

cannot account for the absence of febrile excitement. How
the foetus, without the uterus, enclosed by a membrane so ob-
noxious to the most violent inflammation upon the presence of
a foreign body, (which the foetus was after death,) did fail to
induce inflammation, is to me quite inexplicable. Her tongue
I scarcely ever found of an abnormal appearance. She at times
had pains in the back, hips and loins ; but these were nervous
and easily removed by sinapisms. In the fifth month of her
illness, she was troubled with a burning pain in the womb,
which was attributed to the phlogosed utero-vaginal mucous
membrane. Her pulse ranged from 70 to 85 beats per minute,
save during hysterical paroxysms, when it would grow to 100
and 110, small and feeble. So, excepting her attack on the 2d
of January, she had no febrile disorder.

As regards the timiC of conception, there is a doubt. It may
have taken place coincident with her ninth pregnancy, and the
foetus perishing at four months, have caused subsequent abor-
tions. But the most plausible view would be, to fix the con-
ception in November, when all the signs of pregnancy were
present, save the cessation of the catamenia.

The foetus must have occupied a place within the peritone-
um, below and posterior to the left ovarium, at a point cor-
responding with the commencement of the rectum, judging
from the seat of the pricking and weight and amount of faeces
discharged, before the dislodgement of bones, &c.

ARTICLE XXXVII.

Extracts from the Records of the Physicians' Society for Medi^
cal Observation, of Greene and adjoining Counties^ Georgia,
By D. C. O'Keeffe, M. D., of Penfield, Ga., Secretary.

July 12th. On the Use of Compound Spirit of Ether, By
Dr. A. A. Bell. It is sometimes pleasant to turn from the
more abstruse questions in our Science, and retrace paths less
environed with difficulties. I have been using Hofl^man's
anodyne (as it is familiarly called) for several years, and from
the pleasant effects I have derived from its administration, I
am induced to make this report, as it corroborates the virtues
that have been accorded to it.

604 O'Keeffe Reports of Society for [October,

That it has the property to produce sleep, and tranquiHze
the nervous system, where opium or its kindred remedies will
not, I think may be verified upon trial. The first instance in
which I used it, with any very notable effect, was a case of
delerium tremens. Laudanum had been administered freely,
with occasional portions of brandy ; the latter seemed to ag-
gravate the symptoms, and the comp. spts. ether was substitu-
ted. It had a decided tendency to calm the nervous action, and
allow repose to the patient.

I have also noticed its action in hysteria. I was called to a
married lady who had been laboring under this singular malady
for several days: the administration of comp. spts. ether had
the effect of lessening sensibly the unpleasant nervous symp-
toms, and ensuring a great deal of comfort to the patient. It
was continued, with a cathartic, with the like happy result.

I have likewise noticed its influence upon the system in
cases of morbid vigilence, which frequently occurs in the course
of an attack of acute diseases, especially in individuals who are
in the habit of using intoxicating liquors. Several cases of this
kind have come under my care ; one, in particular, in which
laudanum and black drop were given freely, without the de-
sired effect. The patient's pulse at this crisis was 115, and
he had passed several restless nights. I now gave him f. 3iss.
comp. spts. ether, and in the course of two hours he had a re-
freshing sleep, with considerable diminution in the frequency of
the pulse. It was repeated, in the course of four hours, with
like effect.

The cases in which it is most applicable are those of a ner-
vous character, not dependent upon any decided inflammation,
at least, of such degree as not to require active antiphlogistic
measures.

On a Case of Monstrosity. By Dr. E. V. Culver. There
has been a difference of opinion among the members of the
medical profession for centuries, as to the cause of monstrosi-
ties, or irregular births as to whether the foetus in the uterus
can be effected in its growth or development by external
causes, acting through the imagination of the mother ; if so at
all, at what period of utero-gestation can a perversion of growth

1852.] Medical Observation. 605

take place ? These are questions that have excited the members
of the profession time and again, and it would now be presump-
tion in me to offer an opinion upon such a subject. Without
even presuming to form any conclusion in a matter so myste-
rious, I will detail the following case; at the same time I will
remark, that I have been unable to learn any thing, or circum--
stance, that excited or alarmed the mother. I have carefully
inquired into the particulars attending her during utero-ges-
tation.

Mrs. was taken in labor on the evening of the 3rd

July (inst.), with her thirteenth child. She was awakened
from sleep by a discharge of water, the membranes having
ruptured spontaneously, and without the least pain. Free
uterine hemorrhage immediately came on. I found her very
much exhausted from the flow of blood, and complaining in the
usual way from its loss. As soon as I entered the room, she
informed me that the "child" was dead, and gave as a reason,
that she had not felt it move for the past thirty-six hours. 1
made an examination, and found the uterus dilated and yielding,
the feet presenting. The labor progressed slowly, and she was
delivered, in eight hours, of a child of common size, still-horn,
she having gone the full period of utero-gestation.

The following appearances were revealed upon examina-
tion, not being permitted, nor having the time, to make further
scrutiny into the case : The face, not more than one-fourth as
large as it should have been, with no part I could call a head ;
the frontal bones wanting, with exception of a narrow ridge just
above the orbits, only a few lines in breadth; the temporal
bones the same, there being a very narrow piece articulating
with the sphenoid, the piece containing the glenoid cavity for
articulating with lower jaw ; the parietal bones were entirely
deficient ; the occipital also wanting, with exception of a small
piece for its articulation with the atlas. The above seemed to
be the situation of the cranium, from the examination I made.
Not being permitted to use the knife, I am unable to speak
confidently as to how much the bones were deficient.

The head, commencing a few lines above the eyes, down to
the vertebrae, presented the appearance of a coagulum of blood,
soft to touch, the hand meeting with no resistance over the

606 O'Keeffe Reports of Society for [October,

entire surface ; the mouth was right, as to position and forma-
tion ; very little sign of nose, except two small openings, just
above ihe mouth ; the eyes seemed to be in proper place, but
protruding about three-fourths of an inch from the surface, of
an unusual large size ; the ears were very much out of place,
Approaching too near the eye, presented the appearance of two
small horns they were about one-third the usual size, and
very much elongated ; the part called the head^ with the face,
formed a triangle, the largest diameter not more than one and
a half inches ; the vertebrae of the neck were immovable and
fixed the face slightly inclined forwards ; the fingers were
bent upon the palms of the hands, and there firmly united.
The other parts of the foetus were well formed, and free from
any deformity.

The above are the details of the case, hastily given ; and
now, in conclusion, I will again repeat that the lady is unable
to call to mind any instance in which she has been much
alarmed, and the only thing of any note that has a bearing upon
the case, is the fact, that she has frequently experienced pain
and uneasiness in the right side whilst riding on horse back,
which she occasionally practised. She says she has no doubt
from her sensation, that the back part of the head of the foetus
was firmly united to the right side near the stomach, and that
she knew when it separated. I merely state this as she so often
says, she is sure it is so. She is fast recovering.

Hemorrhage from the Umbilicus after separation from the
Funis, ten days after birth. By J. E. Walker, M. D. Mrs.
C, primapara, was delivered of a small but apparently healthy
male child, on the second day of March, 1849, after a somewhat
protracted labour. Both did w^ell until the sixth day after de-
livery, when I was called to see the child, whom I found labour-
ing under haematuria, which I treated with astringent diuretics
buchu, &;c., with entire relief. It went on well then until the
twelfth day from this, at which time blood began to exude from
the umbilicus ; the cord had separated about the sixth day, and
the part appeared to be sound and healthy. I was consulted
in relation to the haemorrhage, and as it was described as a
simple oozing of blood from the part, and by no means calcu-

1852."] Medical Observation. 607

lated to excite alarm, I therefore prescribed tannic acid and a
compress to be applied, and requested to be notified if the bleed-
ing should not cease after the prescription was used. This was
neglected, and although the application did very little good, yet
the haemorrhage was allowed to go on for twenty-four hours
before I was sent for ; I arrived as early as possible to see it,
when called, and such a spectacle I never saw ; the bleeding
had continued until the child was almost entirely anaemic. Its
clothing had been often changed, all of which w^as completely
dyed in blood ; it lay almost lifeless, unable to take nourishment,
and almost senseless ; I regarded the prognosis unfavorable,
even if I should succeed in arresting the flow. I lost no time
in the trial of creosote, which had but temporary effect, as it
was washed away by the blood. I applied sugar of lead, and
tannin, &c., with no better success. I used lunar caustic, but
still the blood poured forth. The actual cautery suggested it-
self, and was proposed, but the parents would not consent, as
the child seemed to be dying. I then determined to try the
ligature as a dernier resort, as I feared the vessels were dis-
eased the ligature, en masse, was decided on, that the whole
bleeding surface might be embraced and secured. It was
impossible to decide from whence the blood issued whether
from the arteries, veins, or the tissues surrounding the vessels.
I accordingly passed a common suture needle, armed with a
silk thread, through the umbilicus, from right to left, and from
left to right, and, after the third stitch was made, I drew^ the
threads pretty tight, and secured the ends together, and had
the gratification to find the bleeding arrested. During the
operation, the child made not the least complaint, but was un-
concious of pain. As a further precaution, I applied the sul-
phate of iron, in fine powder, after being heated to draw off the
water of crystalization, which, uniting with the blood left around
the part, formed a hard compress, over which I applied a band-
age. I now sought to bring about reaction, by pouring into
the mouth wine whey, in small quantities and at short inter-
vals, which, by the following morning, had so far succeeded
that the child could draw a little at the breast. I recommend-
ed the wine to be continued, until strength was restored. In
about four days suppuration was established, and as the threads

608 O'Keeffe Reports of Society for [October,

had become loose, I divided and gently withdrew them. There
was no more haemorrhage the part healed kindly, and left
the navel almost natural in appearance. The child has since
enjoyed good health, and is now a sprightly boy.

Remarks. I have conversed with many physicians who had
met with this accident, and have found their report unfavora-
ble, without an exception. This, doubtless, has been owing to
their depending on styptics and compresses alone; the bleed-
ing, no doubt, is, in general, from the arteries sometimes from
the veins and arteries combined; and it is always difficult to
apply compresses to that part with advantage, owing to the
softness of the abdominal walls.

When I performed this operation I had seen no authority for
it, and it might be said I was not justifiable in its performance;
but had the actual cautery been used, sloughing and secondary
haemorrhage might have been the consequence, and the life of
the child only prolonged to endure a larger amount of suffer-
ing. All other means in common practice had been tried,
without exerting any influence whatever.

It is to be regretted, that so little has been said by authors
on this subject ; and this case has been brought to the notice
of our society for the purpose of eliciting the views of its mem-
bers, and directing more attention to the subject.

In my reading, since I treated the above case, I have found
ligature, en masse, recommended by Paul Dubois and Dr.
Bowdich ; but their cases were not successful. Their operation
differed from mine in this particular they used the hare-lip
pins, with figure of 8 suture, while I used the thread, as you
have observed, alone. It has been objected, that there is dan-
ger of peritonitis. That, I admit, may be true ; but the opera-
tion has succeeded where death must have been the inevitable
result without it. Death has often followed upon amputation ;
but that is no argument against such an operation, when it so
often succeeds, where death would be the certain result, if it
should be neglected.

Ecchymosis of Vagina from rapid Parturition. By Dr. D.
C. O'Keeffe, of Penfield, Ga. This occurrence happened to
the wife of a much esteemed medical friend. The patient, aet.

1852.] Medical Observation. 609

about 20, was delivered of a mature child in the short space of
one and a half to two hours from the beginning of labour. She
had aborted in her first pregnancy, and was frequently threaten-
ed with abortion in the present, but with great care and occa-
sional V. s. she went her full term.

The hsemorrhagic diathesis was strongly marked in her case,
as shewn by her tolerance of bloodletting, and a very frequent
discharge of blood from a nasal polypus with which she was
affected.

For a short time (an hour or two) after delivery, she was
very comfortable and expressed a natural pleasure when her
offspring was shewn her, somewhat suddenly, however, she
felt acute pain between the hip-joint and perineum on the left
side, which extended down the thigh of the same side ; there
was also exquisite tenderness under the slightest pressure exter-
nally in the region above designated. A sisapism was applied
forthwith to the seat of pain with no benefit ; a strong mor-
phine plaster was next applied, which mitigated her suffering
considerably. Moderate pain and tenderness to the touch
remained however for two days, and her pulse and other symp-
toms indicated a febrile condition of a moderate degree. Dur-
ing these two days her bowels were kept open by aperients,
and the lochial discharge was normal. The period of lactation
now arrived, attended with increased pain and febrile action,
and the pain about the hip and perineum threatened to be as
distressing as when it was first felt. It is proper to state that
our friend regarded this pain to be of a neuralgic character,
but lest there should be some occult cause about the uterus, he
determined to explore that organ.

A vaginal examination revealed a tumour nearly filling up
the vaginal canal its entire length, the index and medius could
with difliculty be passed up to the os uteri along side of it.
About four inches long and one and a half inches in diameter,
it extended from just within the labia minora along the vaginal
wall on the left, to a level with the os uteri a line drawn from
the upper extremity of the tumour transversely across the
vagina would strike the lips of the os uteri at right angle. It
was painful to the touch and tolerably tense ; micturition was
easy, but the bowels were disposed to be confined defecation
caused an aching sensation in the left iliac fossa.

610 O'Keeffe Reports of Society for [October,

From the knowledge our friend had of the rapidity of the
labour, and consequently the illy prepared state of the parts,
and moreover, an unusually compact and unyielding cranium
on the part of the child, he was prompt in recognizing the tu-
mour to be an ecchymosis produced by injury to the soft parts
and treated it accordingly. For four or five days from the
date of its discovery, there was high febrile action, the pulse
was sometimes as high as 125 to 130. During this time she
took some mercurial, was bled moderately from the arm once,
and leeches were applied freely to the lower abdomen perine-
um and to the lower extremity of the tumour itself. These
means checked a strong tendency that existed to metritis, and
relieved the tumour of tenderness in a great measure. At this
stage of the case, another physician and ourself were request-
ed to see it, and found it in no-wise different from what it has
been described, aryl we could not but concur in the diagnosis
pronounced by our friend. The tumour had diminished but
little, if any, from the time it was discovered, but was less sen-
sitive to the touch ; the tongue was slightly furred, the surface
pleasant, and the pulse 120 and rather feeble there was gen-
erally a febrile exacerbation in the afternoon and a remission
in the forenoon. A speculum was employed to ascertain the
color of the tumour, which was found to be a deep purple ;
this disclosure corroborated our diagnosis.

It was agreed, unanimously, to open it, which was done with
a thumb lancet, tied to a small stick, and introduced through
the speculum the lower portion only could be brought within
the field of this instrument, and here a free incision was made.
The discharge from the incision was very small and consisted
of very dark coagulated blood, intermingled with a few drops
of pus. It was now seen through the opening in the tumour
that it was composed altogether of coagulated blood, and that
the main indication in treatment consisted in its removal. It
was accordingly deemed advisable to inject tepid water into
the tumour through the opening, in order to break down its
coagulated contents which succeeded but partially. This
course, (the tepid water injections,) kept up three times a day,
however, for three days, nearly entirely emptied the tumour of
its contents a silver probe was worked about in the tumour

I

1852.] Medical Observation. 611

freely, which doubtless aided materially in breaking up the
coagula.

At the time we write, the patient is much better ; tumour
nearly gone ; is free from pain; pulse 106; tongue improved.
From the time the tumour was opened, a dose of Quinine was
given every morning, and a more nourishing diet allowed.
Mercurial ointment is now being rubbed over the part with a
view to produce absorption of any coagula that should be left,
for it was feared the vitality of the parts was very much im-
paired indeed this fact seemed evident from the circumstance,
that there was not the slightest pain felt in making the incision.

ARTICLE XXXVIII.

Chloasma. By E. F. Starr, M. D., of Rome, Ga.

This disease of the skin (known also as Maculae Hepatica?,
Liver spots, &c.) usually makes its appearance on the chest,
shoulders and arms, or neck, and extends in irregular patches,
so as sometimes to spread over a large portion of the body.
These patches may unite and cover a larger continuous surface
of some inches across. As far as the disease extends, the skin
is made to exhibit a yellowish or dull brown color. The cuticle
is very slightly elevated, and minutely scaly, and desquamates
to a moderate extent. It seldom produces any sensation or
irritability of the skin, and its existence, in many cases, would
not be known if it were not seen, though it may sometimes
produce troublesome itching. It is annoying, and especially
so to ladies, on account of its appearance, which, upon the
whole, is dirty and repulsive, and is apt to excite a sense of
shame in those who are troubled with it.

Its cause, I think, is unknown it has been attributed, of
course, to derangement of the internal organs, such as the
stomach, liver, &c., but it has no established connection with
any such causes, for most generally I have seen it on persons
with whom there were no symptoms of bad health otherwise.

The treatment of this disgusting little affection has not, I
think, generally been satisfactory and successful. My object,,
therefore, is to introduce a remedy which is simple and efficient.
In the year 1845, from analogy of a known property of sulphu-

612 Snoring Prevented. [October,

ric acid, I was induced to try it in a case of this kind, and
found that it effected a cure in a short time. I have since tried
it in a number of cases with uniform success. The method of
using it is to dilute it in the proportion of about a drachm of
the acid to a pint of water, more or less, according to the sen-
sibiHty and tenderness of the skin of the patient, and to apply
it, thus diluted, to the affected part, by rubbing it on with the
hand, or a bit of sponge ; and sufficient friction should be used
to rub off the separable scales and cuticle. The strength of the
wash should be so regulated as to produce a slight stinging sen-
sation, without much pain. The application should be made
once or twice a day, until the skin resumes its natural appear-
ance, and then occasionally, for several days afterwards, to
prevent a return of the disease.

These remarks have been induced by an extract in the South-
ern Medical and Surgical Journal of last year, from the New
Hampshire Journal of Medicine, by Dr. Gray, in which he
proposes the " sulphur fume bath as a remedy " and suggests
that "if any member 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." I consider my renredy equally as
certain, more simple, and much more easily applied.

ARTICLE XXXIX.

Snoring prevented hy excision of the Uvula. By the Editor.

Case. A. D , about 5 years of age, had for two or three

years suffered from considerable enlargement of the tonsils*
which impeded respiration so much during sleep as to cause
him to snore very loudly and to seem to be on the point of
suffocation. About a year ago, I excised both tonsils, after
which the respiration was very much improved, and the snor-
ing nearly ceased. In March last, his respiration during sleep
had become as bad as ever, and his parents apprehending that
he might actually suffocate, again requested medical aid. Upon
examination, I found that the tonsils had again become some-
what enlarged ; that the uvula hung flabbily between them and
Tested upon the base of the tongue, and that this state of things

1852.] Letters upon Syphilis. 613

taken in connection with the natural, yet extraordinary small-
ness of the bucco-pharyngeal aperture, was sufficient to account
for the impediment in respiration. It should be remarked,
however, that although the uvula appeared flabby, it was not
paralyzed, for it would sometimes retract spontaneously, and
always do so when touched with an instrument.

As the tonsils projected but slightly beyond their proper lim-
its, and their further excision was very difficult, if not hazard-
ous, in consequence of the smallness of the mouth and extreme
narrowness of the throat, I resolved to try the effect of simply
clipping offthe uvula. The child has not snored since, and has
from that time slept without any impediment in his respiration.

Would it not be advisable to resort to this simple operation
for the relief of snoring in adults ? It is certainly worthy of
trial, and might add very much to the comfort of those who
are annoyed by a snoring bed-fellow.

PART II.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French by
D. D. Slade, M. D.

[Continued from Page 559.]

SECOND LETTER.

My Dear Friend, I am not waiting a didactic work ; I have
a great desire so to do, but you know that at this moment I am
not able. I address you some letters familiarly written, and for
which I ask all the privileges of the epistolary form that is to
say, freedom of style and spontaneousness of thought. There-
fore, that which I have not said in my preceding letter, I shall
say unceremoniously in this, without a loo rigid adherence to
plan, method and other restraints of composition, elsewhere so
useful.

In order that my first letter should be complete in the rapid
sketch of the attempts made in experimentation, I ought not to
omit to bring to mind the facts of the attempts at inoculation of
syphilis from man upon animals. Either to avoid the inconve-
niences which could result from the inoculation practised upon
man himself, or to resolve the curious problem of the transmis-
sion of syphilis to animals. Hunter and Turnbull had already

N. S. VOL. VIII. NO. X. 39

614 Letters upon Syphilis, [October,

attempted in vain this inoculation from man to animals. I have
repeated all those experiments, and have arrived at the same
negative results. However, lately a young and industrious
feJ low-laborer, M. Auzias Turenne, has repeated these experi-
ments, has varied them, has employed other methods than those
which were known, and be has thought to have an'ived at the
experimental demonstration of the transmissibility of syphilis
from man to certain animals. It was my duty, then, to renew
these experiments, and I was convinced anew that syphilis was
decidedly not communicable to animals, and that the facts as
stated by M. Auzias were illusory. M. Cullerier, at the Hos-
pital "de Lourcine,^ has studied this subject with much care,
and has arrived at the same conclusions as myself. My col-
league, M. Vidal (de Cassis,) has experimented in his turn, with
I believe the same results.

The direct observation, the experimentation upon the patieni
himself, were then the only sources to which I could have
recourse ; to these alone, then, I resolved to apply myself

It was necessary, first, to seek a sure source from which I
could draw the principle, towards the research of which, I
wished to direct all my investigations. One could no longer
rely upon the stories of patients ; it was necessary, also, to avoid
the objections justly brought against the experiments of Hunter
and of Harrison, against the facts stated by Bell, against the
experiments of Hernandez ; and for this purpose, I first endeav-
ored to well ascertain the state of the tissues from which I
took the principle reputed specific.

It was no longer enough, as Petronius formerly said, that a
woman should be considered diseased; it w^ould no longer do,
to take at hazard a morbid secretion coming from the genital
organs of the woman, and to make of it, according to the pic-
turesque expression of Alexander Benedictus, a venereal dye,
throwing a uniform color upon all the accidents which could
result from it. No, the scientific tendencies of the minds of my
day, and the demands of my own conscience, required of me
the employment of a method more authentic and of proceedings
more rigid.

I do not wish to lay stress upon the facility with which
eflfects were drawn from the cause. But who would not be
surprised, that in a question like that of venereal maladies,
where ignorance ^ud fraud, according to the expressions of
Hunter, are such frequent sources of error that in a disease
which above all, and almost always, is a flagrant proof of
immorality, the observers, even the most judicious, should so
often trust to the reports of patients, and invoke without ceasing *
the moral worth of the testimony.

1852.] Letters upon Syphilis. 615

The testimony! under such circumstances, is there anything
more deceptive ? and especially as regards women? Let me,
cite to you two little examples, where you will see one of the
most strict observers caught in the snare of feminine testimony.

Babington wishes to destroy this law laid down by Hunter,
that when there is neither j)us nor puriform secretion, the disease
cannot be communicated ; so that the infection is not possible
before the appearance of a gonorrhoea or after the cicatrization
of a chancre. *' This conclusion is not without danger," says
Babington, " which one can see tVom the following facts, which
are far from being rare."

" A married woman was taken with the ordinary symptoms
of gonorrhoea, which much surprised her, as her husband was
free from all disease. However, the husband having been
questioned, confessed that he had had relations with a suspect-
ed woman, about eight days before his wnfe perceived herself
diseased, but he positively affirmed that he had had no discharge,
nor any morbid sensation, and certainly he offered no symp-
toms of disease. At the end of four days, that is to say, about
fifteen days after the impure connection, and one week after
the time when he should have communicated the disease to his
wife, a CTonorrhceal discharge manifested itself in him.

" A traveller exposed himself to the risks ofa syphilitic infec-
tion, and arrived home at the end of three days. About four
days after his arrival, his wife was attacked with gonorrhoea.
It was not till ten days after the infection that he perceived, for
the first time a discharge, and that he was attacked by the other
symptoms of gonorrhoea." (John Hunter's complete works,
vol. xi., page 167. Notes by Babington.)

If, in presence of similar facts, Babington had not sought to
obtain more- complete confessions (there are some confessions
that women never make, even, as I have had the opportunity
of too often seeing, under the fear of the greatest dangers.) but
had assured himself by a rigid inspection of the true state of
things; he would have seen that in these cases the infecting
cause was not in the genital organs of the candid husbands.

It was not, then, possible to think of basing any pathological
tfuth whatever, in syphilis, upon the morality of the testimony
of the patients. I had no longer confidence in the doctrines
and in the facts based upon recitals of this kind. It was neces-
sary to be removed from the mysteries of the " alcove," to bring
to the light of experimentation the principle which I wished
to find. This principle where ought I first to seek for it?
At its source ; that is to say, in the genital organs of the woman,
in their external portions as well as in their deepest folds.
Chance was propitious for me. The Hospital " du Midi " then
received the unhappy beings that the dispensary sent there.

616 Letters upon Syphilis, [October,

Here you will permit me to recall, my dear friend, that before
my entrance iato the Hospital du Midi, the manner of examin-
ing a woman consisted in making her sit upon the border of a
chair, in separating the external genital organs, and if no lesion
of the tissue was found, every morbid secretion coming from
higher up, was invariably considered as a blennorrhagic dis-
charge. At the circle of the vulva, my predecessors appeared
to have placed the columns of Hercules of chancre. I could
not, nor ought I, to have been satisfied with this superficial and
incomplete examination. We were at no great distance from
the time when M. Recamier had so fortunately exhumed the
speculum from the surgical armentarium. You are aware of
the happy applications that this celebrated practitioner had
made of it, in the diagnosis of diseases of the uterus. But this
valuable instrument had not as yet been applied to the diagno-
sis of syphilitic diseases ; its employment, even in these cases,
appeared and was reported to be contra-indicated. I did not
pay any attention to this widely-spread opinion. I made a
general use, on the contrary, of the speculum upon all the
women in my wards.

I do not know if posterity w^ill partake of the opinion af one
of my learned critics, who reduced to a very small compass that
which I had to do in syphilopathy. However, my dear friend,
when I call to mind the profound obscurity which enveloped
the diagnosis of syphilitic diseases before the application of the
speculum when I compare the embarrassment of practitioners
of that epoch in settling up their opinion, with the truly won-
derful facility of modern practitioners in giving an undeniable
diagnosis ; when the recollection of all the services that the
speculum has already rendered to this part of practice comes
to my mind, I think, that should my participation in its progress
be thus limited, this opinion might appear rather severe. The
employment of the speculum permitted me to examine with
great care all the surfaces venereally aflfected, and to ascertain
with precision the condition of the tissues which furnished the
secretions.

These conditions established, I had to study all the accidents-
reputed venereal, and comparatively with other morbid secre-
tions.

I commenced with blennorrhagia. You understand, my
dear friend, that I ought to suppose the state of the question, at
the time when I undertook my experiments concerning blen-
norrhagia, to be perfectly understood by my readers. Once
more, I do not here write volumes with a complete history, but
a simple and concise exposition of facts which belong to me.

I sought to resolve by experimentation that problem already

1852.] Letters upon Syphilis. 617

differently resolved, by the observation which you know
Does blennorrhagia recognize a specific cause ?

Hunter had taught that the pus of a chancre inoculated pro-
duced chancre. It" blennorrhagia recc^gnizes a specific cause,
said I to myself, the muco-pus which it secretes, being inocula-
ted, will produce without doubt phenomena similar to those
which pus coming from a chancre produces.

But to vv^ell ascertain the result, to isolate it from every com-
plication, and from every cause of error, it w^as necessary first
to inoculate the muco-pus coming from perfectly simple blen-
norrhagias ; it was necessary to take this muco-pus from tissues
completely free from all ulceration ; and you see how valuable
the employment of the speculum was to me. Without it, these
experiments were not possible.

Now these first experiments, made in great number, and a
long time continued with perseverance, conducted me to this
first fundamental result, which I here give in the form of a pro-
position.

PROPOSITION.

Every time that the muco-pus has been taken from a jmicous
surface not ulcerated, the results of the inoculation have been
negative.

All experimenters who have followed me in this course have
arrived at the same conclusion ; and this, whatever has been
the period of the blennorrhagia in which the experimentation
has been made. Thus, it is with great surprise that I have
read in your Journal the following passage, where M. Yidal,
in his letters upon syphilitic inoculation, reproaches inoculation
for being very often fruitless in the question of blennorrhagia ;
*'In fact," says my learned colleague, "a distinguished Interne^
M. Bigot, has tried, under the observation of M. Puche, physi-
cian at the Hospital du Midi, sixty-eight inoculations with
jnuco-pus coming from the urethra, and these sixty-eight inocu-
lations have been followed by no result.'"' I am astonished at
the surprise of M. Vidal. These sixty-eight negative inocula-
tions conform entirely to the facts which I have before advan-
ced; they confirm and corroborate my opinion upon the rarity
of syphilitic blennorrhagia ; and when my opposer asks you
"Do you believe that of these sixty-eight blennorrhagias there
were none, where virus was present, no one that contained the
seeds of a verole?" answer him confidently, no; and for this
reason, that the inoculation has been negative.

A logician as skillful and as exact as M. Vidal, could not be
prevented from perceiving that the results of experimentation,
upon whatever subject exercised, are either positive or negative
but that scientifically speaking, the negative results are no less

618 Salines and Opiates in Dysentery. [October,

valuable than the possitive. The inoculation of vaccine does
not give rise to any phenomenon upon those subjects who have
ah'eady had the variola ; is that saying that the negative result
is without importance and without consequences?

But we shall soon see how much value and force these neg-
ative results have derived from the positive results of inocula-
tion. I notice, in passing, a first objection which w'ill at a la-
ter period find its complete lefutation. Some writers on syph-
ilis have thought with Hunter that blennorrhagia was a ibrm
of syphilis peculiar to mucous membranes. I confine myself
for the moment to remarking that the experiments before indi-
cated destroy entirely this opinion ; we shall see later that the
virulent virus of chancre, placed upon a raucous surface, pro-
duces there, in every respect, the chancre.

From experiments shown, I shall draw this conclusion.

CONCLUSION.

The blennorrhagia, of which the muco-pus being inoculated,
gives rise to no result, does not recognize the syphilitic virus as
cause.

This conclusion, as you know, has given rise to numerous
and grave objections. But I fear that you cannot to-day afl^ord
me suflicient room to undertake the refutation and exposition
of these. This will be, with your permission, the subject of
my third letter. [Boston Med. and Surg. Journal.

On the use of Salines and Opiates in Dysentery. By F. E.
Gordon, SI. D., of Alabama.

Having made a report to the Alabama State Medical Asso-
ciation, by appointment, on the diseases of Marion, which was
lost through the illness and absence of Dr. Jackson, its late
Treasurer, I herewith submit the following remarks on the use
of Salines and Opiates in Dysentery.

This disease prevailed here as an epidemic during the spring
and summer of 1851, and gave rise to great diversity of opinion
and treatment. This is not strange, as its pathology and man-
agement have been, for more than two hundred years, disputed
points amongst the ablest medical writers. Chisholm, and
James Johnson more particularly, contended "that the liver
itself forms the primary seat of the disease in every instance,"
and hence urged the use of mercurials even to ptyalism, while
the more venerable opinion of Sydenham, which locates it in
the larger intestines, is more generally received in this day ;
and hence a revival of his practice is likely to ensue, if it may
not be said to have done so already. With the exception of

1852.] Salines and Opiates in Dysentery. 619

blood-letting, Sydenham's plan of daily purgation, followed by
his own potent laudanum at night, is not easily improved upon.
That he would have abandoned bleeding, had he lived to this
day, (to say nothing of this climate) his great practical sagacity
and the example of his able successors in London, warrant us
in saying.

Watson contends that the sheathing of the lancet has been the
result of Cholera, which, since 1832, has modified the charac-
ter of diseases, and many eminent physicians on this side of
the Atlantic equally ignore the abstraction of blood, though ac-
counting for its inapplicability in different ways.

From a glance at the various reports made to the Alabama
Association, which, though conflicting in many respects, gen-
erally assign a greater mortality to this disease, we would be
disposed to set down our epidemic as very mild. Indeed w^e
think fever did not make its appearance in the onset of an at-
tack oftener than once in ten cases. We are admonished,
however, that in the b'eginning of the epidemic theigdisease did
prove fatal in many cases ; not, however, from its malignancy,
but, as we think, from the inefficiency of the practice by which
it was met. Such as died were literally worn out by the ex-
cessively frequent and painful discharges, giving rise to irrita-
tive fever and emaciation. Ulceration, we are satisfied, did not
occur once in three hundred properly treated cases.

Our attention was first directed to the value of Salines and
Opiates in Dysentery, by an article in the Charleston Medical
Journal for July, 1848, "on the comparative eflicacy of certain
medicines in the treatment of Dysentery and other intestinal
Fluxes of hot climates."

Dr. Papillaud, the author of this paper, made his observations
in a province of Brazil, in twenty-nine degrees of South lati-
tude, and found the usual plan of treatment adopted in Paris
with success, to fail entirely in this warm region.

" He experimented with castor oil, ipecacuanha, calomel, sul-
phate of soda ; of the vegetable astringents, he tried rhatany
and simarouba ; of the mineral astringents, lime, acetate of lead,
alum and nitrate of silver ; of narcotics, extract of opium and
sulphate of morphia ; from the results of these experiments he
determined to abide by sulphate of soda and opium, the effects
of the other medicines being variable and uncertain." He says,
*' The English practice of calomel and castor oil is very unsuc-
cessful." "Sulphate of soda, he thinks, deserves the praise it re-
ceived from Bretonneau and Trousseau, acting energetically
and most rapidly. One or two drachms dissolved in a small
quantity of vehicle, and given in divided doses, usually arrest a
dysentery in twelve, twenty-four, or forty-eight hours at the

620 - Salines and Opiates in Dysentery. [October,

longest." He says, " Inflammation once considered a cause, is
only one form, alteration of secretion another."

" The indications for local bleeding are very rare ; that for
general bleeding only as an exception." " Opium he considers
equal to sulphate of soda, and together they formed one of the
most efficacious combinations."

My first trial with this remedy was soon after its publication,
and proved highly satisfactory. In a few sporadic cases I con-
tinued to use it with success. It was not, however, until the
period referred to above, viz : the spring of 1851, that I had an
opportunity of witnessing its efl^ects on a large scale. Insensi-
bly I fell into using Seidlitz Powders amongst my white patients,,
as being more agreeable, and finding free purgation to relieve
both tormina and tenesmus, for about six hours I usually fol-
lowed it up by a dose of morphine. The fractional doses of
neutral salts and morphia were then resumed.

It was remarkable that in some cases, where hypercatharsis
had been induced, (the patient in one instance taking one pow-
der every half hour until eight were consumed) the recovery
was most prompt.

Generally, when much opium had not been previously taken,
from two to four Seidlitz Powders at half hour intervals, freely
evacuated the bowels.

As regards pathology, I do not think inflammation of the
mucous membrane of the colon so much as engorgement of it^
can be predicated of a disease so easily relieved by a serous
drain from the bowels, and so often independent of fever.
Whether the neutral salts act also as a " local modifier*^ on the
mucous membrane, according to the French view of this sub-
ject, or as a " sedative^' I am unable to say.

In order to establish the claims of this method of treatment,,
and to vindicate it from the charge of empiricism, I subjoin
reports from two of our most intelligent and respectable physi-
cians. Dr. England says

"Enclosed you find a list of cases of Dysentery that came
under my care during the present year, up to date, 15th August,
1851. It comprises all ages, from infancy up to advanced age.
All were subjected to the saline treament except two in Janua-
ry, which were treated by mercury and opium, and but one
death occurred among them. This was a case of unusual
severity, first seen thirty-six hours after being attacked,
yet under the use of Salines the Dysentery gradually yielded,
so that in three days only slight sanguinolent discharges occa-
sionally recurred, and these subsided entirely forty-eight hours
or more before death, which occurred from nervous exhaustion,
following the excessive excitement of the system. There were

1852.] Salines and Opiates in Dysentery. 621

many other cases (where a single prescription relieved the
Dysentery) that required no visiting or attention, of which 1
made no note."

" P. S. In addition to the above, there occurred thirty-five
cases during the spring and summer in the Judson Institute,
which did not come under my immediate care, yet were treated
with salines according to my directions all of which recover-
ed."

Here follow^s the table referred to by Dr. England :

Months,
January,
February,
March, '
April,
May,
June,
J uly,
August,

Total, 80 79 1

Under date of August 12th, 1851, Dr. Bryant encloses me
the following statement, arranged in a tabular form. He re-
marks : Agreeable to your request I send you the above list of
cases of Dysentery, treated by myself during the present year."

Dys. Cured. Died. Adults overly. Children under W. Totals

Cases.

Recoveries.

Deaths.

4

4

0

6

6

0

8

8

0

12

12

0

14

14

0

20

20

0

14

13

1

2

2

0

March 2, 2

0

1

1

April 12, 12

0

8

4

May 22, 22

0

7

15

June 24, 24

0

10

14

July 14, 14

0

6

8

August 8, 8

0

3

5

82^

I have Dr. Bryant's authority for saying, that with the ex-
ception of a single case, otherwise treated, these were all man-
aged, with the highest degree of satisfaction to himself, by the-
use of Salines and Opiates. In the latter part of the epidemic
he sometimes used Sup. Tart. Potass in the more protracted
eases, with decided benefit.

These gentlemen here cited will bear me out in saying, that
Calomel given to relieve the portal circulation excites a free-
gush of bile, which is, to use Dr Johnson's language, like so
much boiling lead, throws the irritable intestines into painful
contortions, and then the tormina and tenesmus are intolera-
ble ;" and hence, like myself, they abandoned its use for the
Salines, which produced a gentle action on the liver and copious-

622 Observations on Tetanns. [October,

discharges from the bowels, quieting for a time all distress like
a charm. The bile in these discharges was blunted by the
quantity of fluid with which it was mingled. [iV. O. Med. and
Surg. Journal

Practical Observations on Tetanus. By V. H. Fugate, M. D.,
of Mississippi.

Dear Sir, In the July No. for 1852 of your Journal, on
page 87, I notice the following remark : " We are rather dis-
posed to give the credit of the cure to the judicious regimen
adopted by the physician, and to the lapse of time it being
well understood that this formidable disease is but little influ-
enced by the most enlightened medication," etc. From the
above remark I am induced to ask your indulgence while I de-
tail a few cases (from my scrap-book) of Traumatic Tetanus,
that have occurred in my practice.

First. Negro boy, aged about 15 years, had the balls of his
first and second finger slightly split with the teeth of the gin-
saw. No inconvenience resulted until the sixth day, when he
was violently attacked with painful muscular rigidity and te-
tanic spasm of a general character, as I learned from his mas-
ter.

Saw him on the seventh day (at night) after the accident ;
found him perfectly inflexible at every joint; could bend no
joint ; pulse quickened ; surface warm ; wounds on the fingers
healed and dry; spasms frequent and severe, returning as often as
one per minute, when undisturbed, though the slightest touch, the
softest breeze, the least noise induced the spasms at any instant,
always accompanied with a fearful and suppressed scream
his jaws being firmly locked. I applied a blister to the ends
of his fingers ; a batch of carded cotton from the nape to the
sacrum, wet with turpentine, to which I applied a lighted torch,
blistering him the whole length of the spine in an instant ; gave
him as much as a grain of Morphine, and ordered that as much
good French brandy as he could be induced to swallow should
be forced down him, with one grain of Morphine every hour,
until some change obtained.

On my arrival next morning, twelve hours from the time I
left him, no change had taken place, except that I could bend
his knees slightly ; the spasms less violent, though quite as fre-
quent. He had had taken twelve grains of morphine, and more
than a pint of brandy. I now ordered that the brandy and
Morphine be continued night and day, with the addition of 20

1852.] Observations on Tetanus. 623

grains of Quinine three times a day, dissolved in the brandy,
and that all the strong beef tea that he could swallow or retain
by injection, be allowed him.

On my next visit the ensuing day, I was astonished at the
amount of Morphine and brandy consumed, and rejoiced to find
an abatement of all the symptoms. I continued this course for
four days, without any variation, except as the symptoms con-
tinued to abate, the amount of dose was corrrespondingly di-
minished, and the time between doses increased.

I neglected to mention, that on the second day, after I saw
him, he drank a quart of brandy. I saw him three days after
almost entirely relieved ; dismissed him ; brandy aud "Morphine
were continued three times a day for several days, however.
The boy recovered rapidly.

Second Case. Negro woman, aged 50, fell in the fire and
burnt her hand. When the ulcer was quite healed, she took
general tetanus, assuming on the second day Opisthotonos.
The spasms were violent, frequent and general ; jaws so locked
that I had difficulty in getting her to swallow anything. I
treated her alone with whiskey, Morphine, laudanum and beef
tea, as in the former case, that is, forcing down as much as pos-
sible. She recovered in two weeks and thre^ days.

Third Case. Child, aged 11 years. Clothes caught on fire,
burning nearly the whole surface ; two weeks after the ulcers
nearly healed, tetanic spasms made their appearance.

I saw her seven days after I had disrnissed the treatment of
her burns, in the most aggravated form of general tetanus, truly
distressing, from her emaciated condition. I put her under tlie
influence of Chloroform, which lasted half an hour. J then gave
her a large dose of Morphine, ordering her to have as much
brandy and Morphine as she could bear or swallow.

I repeated the Chloroform next morning, with entire relaxa-
tion as before, which, however, did not last long, the spasms
returning in an hour, though much milder at first, and gradually
increasing in severity and frequency.

After this I continued as before to prescribe brandy, Mor-
phine and Quinine, with the most nutritious diet, for five days.
Pronounced her cured.

Fourth Case. Negro boy, frost bit toes. Ulcers became
dry; Tetanus supervened.

I saw him four days after he had spasms first ; could bend no
joint ; took him by the head and set him up on end like a log;
could not get one drop of anything down him ; having, when
undisturbed, two spasms per minute.

I gave him an enema of Chloroform and Camphor, and pre-
sently applied the Chloroform sponge to his nostrils, containing

C24 Influence of Chronic Diseases upon the Blood. [October,

3ii, gradually approaching it nearer and nearer, until I em-
braced his mouth and nose with the sponge ; in three minutes
he was as flexible as a string, and breathing stertorously.
This condition continued five minutes, when on puncturing his
ear he opened his eyes. I gave him two grains of Morphine
in this relaxed condition. The spasms returned slightly during
the day.

Next morning put him under the influence of Chloroform
again ; continued Morphine and brandy several days, as in the
former cases ; he recovered rapidly.

I have treated several others in the same way. What say
you ?

Answer Mayhap the cases recovered in spite of the Doc-
tor's heroic doses. Ed. [Ihid.

I

On the Influence exerted by Chronic Diseases upon the Compo-
sition of the Blood, By MM. Becciuerel and Rodier.

The following are the conclusions of a paper recently read
at the Academic des Sciences, detailing the results of MM. Bec-
querel and Rodier's latest haematological researches: 1. The
majority of chronic diseases and various anti-hygienic circum-
stances induce an increase or diminution in the three principal
elements of the blood the globules, the fibrine, and the albu-
men, and this either separately or simultaneously. 2. The
globules undergo diminution in the course of most chronic dis-
eases of long duration, and especially in organic diseases of the
heart, the chronic form of Bright's disease, chlorosis, marsh
cachexia, haemorrhages, hsemorrhoidal flux, excessive blood-
letting, the last stages of tubercular disease, and the cancerous
diathesis. The same result is observed in those whose food is
not sufficient in quantity or reparative power, or who are ex-
posed to insufficient aeration, humidity, darkness, &c. 3. The
albumen of the serum of the blood is diminished in quantity in
the third stage of heart-disease, great symptomatic anaemia,
the cancerous diathesis, and insufficient alimentation. 4. The
fibrine is maintained at its normal proportion, and sometimes
increased, in acute scorbutus. It is diminished in chronic scor-
butus, as also in the scorbutic condition svmptomatic of certain
chronic diseases, which is most often and most markedly ob-
served in organic diseases of the heart. 5. In all the above-
mentioned circumstances, the quantity of w^ater contained in
the blood becomes very considerably increased. 6. A dimi-
nution of the proportion of globules is especially accompanied
b y the following phenomena : a colourless state of the skin,

1852.] Influence of Chronic Diseases upon the Blood. 625

palpitations, dyspnoea, a b?'uit de scuff et heard at the base of the
heart during the first sound, an intermittent bruit de soufflet in
the carotids, and a continuous bruit in the jugulars. 7. The
diminution of the proportion of albumen, even though not very
considerable, when it takes place in an acute manner, rapidly
gives rise to the production of dropsy, but it requires to be
much more considerable when not appearing in the acute form.
Considered in a general manner, dropsy is the symptomatic
characteristic of a diminished proportion of the albumen of the
blood. 8. A diminished proportion of fibrine is manifested by
the production of cutaneous or mucous haemorrhages. 9. In
anaemia, symptomatic of considerable haemorrhage or insuffi-
cient alimentation, the change in the blood is characterized by
a diminution of its density, an increase of the water, diminu-
tion of globules, a maintenance of the normal proportion or
sometimes a slight diminution of the albumen, and a normal
proportion of fibrine. 10. In chlorosis, which is an entirely
distinct affection from anaemia, there may be no changes in the
blood whatever. When such are present, they consist in a
diminution of the proportion of globules, an increase of that of
the water, and the normal quantity or an increase of fibrine
11. In the acute form of Bright's disease the fibrine continues
normal, and the albumen is diminished. In the chronic form
there is a diminution of globules and albumen, and sometimes
of fibrine. 12. Most of the dropsies regarded as essential de-
pend upon a diminution of the proportion of albumen j and
usually originate in a material cause, consisting in a degenera-
tion of the solid or fluid parts of the economy. 13. In diseases
of the heart the blood becomes more and more changed, as they
approach the fatal termination. The changes consist in the
simultaneous diminution of globules, fibrine, and albumen, and
an increase of water. 14. In acute scorbutus, the principles
of the blood do not undergo any appreciable modification. In
the chronic form the fibrine is notably diminished, while the
globules are sometimes considerably increased. In both forms,
the increase of the proportion of the soda of the blood explains
all the circumstances; but it has not yet been demonstrated.
15. The above modifications should influence our therapeutical
management of these diflferent morbid conditions, as each ele-
ment of the blood is susceptible of special modification. Thus,
when the proportion of albumen is diminished, we prescribe
cinchona, and a tonic strengthening diet. A diminution of
fibrine and an increase of the soda of the blood are to be met
by good diet, vegetable acids, and appropriate hygiene ; and
by hygienic measures and the exhibition of iron, we combat
the diminution of globules. IV Union Medicale. British and
Foreign Med. Chir. Rev.

C26 Influence of Acute Diseases and Menstruation. [October,

0?i the Reciprocal Influence of Acute Diseases and Menstrua-
tion. By M. Herard.

M. Herard terminates a recent memoir with the following
conclusions; 1. All acute diseases exert a pretty similar effect
on menstruation. 2. This influence varies accordingly as the
disease becomes developed during a menstrual epoch, or during
an interval. 3. In the first of these cases the menses are usu-
ally suppressed completely or incompletely, when they may
re-appear after some hours or days, though usually in dimin*
ished quantity. The patients regard the suppression as being
the cause of the febrile disease, although the contrary is the
fact : and even in the case of acute febrile disease becoming
manifested after suppression, we must regard it as a consequence
of the chill that has produced this. 4. When an acute febrile
disease is developed in the interval, if the next epoch is near at
hand, so that the fever continues to it, the menstruation is fa-
voured by the increased haemorrhagic congestion of the uterus
and ovaries. 5. The menses are usually absent or notably
din]inished in quantity, at the periods which occur during the
decline of a disease, or in convalescence. This secondary
amenoirhoea, though sometimes persistent, usually only contin-
ues for from one to three months. 6. The menstrual eruption in
nowise predisposes to disease. 7. Menstruation exerts no ap-
preciable influence on the issue of acute febrile affections. The
progress and termination of these are the same, whether the
discharge appears or not, w^hether it is increased or diminished
in quantity, is earlier or later in appearance, or whether this
takes place at the beginning or end of the affection. 8. In
treating acute febrile aflJections, it is the condition of the disease
that must engage our attention ; for it is rare that any special
therapeutical indication is derivable from the state of the men-
ses ; and we must act absolutely in the same way if the menses
are on the point of appearing, or are expected, as if they were
not so. 9. Bloodletting does not, in general, prevent their ap-
pearance or continuance. 10. The sudden suppression of the
menses by the development of an acute febrile disease, or
amenorrhoea consecutive to such disease, does not, in general,
call for any special treatment. \_Ibid,

On the Influence of Pregnancy and the Puerperal State on the
Progress of Phthisis, By MM. Grisolle & Dubreuilh.

M. Grisolle, in reporting to the Academy of Medicine upon a
vnemoir presented by M. Dubreuilh, observes, that the views

1852.] Infiuence of Pregnancy on Phthisis, 627

he formerly expressed* have only obtained additional confirma-
tion. In none of the thirteen cases related by M. Dubreuilh, or
in the thirty-five now collected by M. Grisolle, has the powei
formerly vaguely attributed to pregnancy of staying the pro-
gress of phthisis, been observed. In some cases, indeed, it
seems to have played the part of determining cause, and in
others to have aggravated the condition. According to M.
Grisolle's observation, cases in which the first symptoms of
phthisis are developed at an early period of pregnancy, and
amidst a state of health otherwise satisfactory, are more com-
mon than those in which the pregnancy is consecutive to the
early appearance of the organic disease. Both observers are,
indeed, of opinion that phthisical women conceive with difficul-
ty ; and M. Delafond assured the reporter that cows, even at
at an early period of the disease, usually remained sterile, even
though they continued fully alive to the attentions of the bull.
He added, also, that in such as did conceive, abortion was
common about the fifth or sixth month ; while in such as went
their full time, the progress of the disease was in nowise modi-
fied. In M. Grisolle's former papers he stated that pregnancy,
in his cases, so far from retarding, hastened the progress of
phthisis ; and although the rate was found to be somewhat slow
in M. Dubreuilh's cases, this probably arose from their having
occurred in private practice, while M. Grisolle's were all hospi-
tal patients. Both sets of cases, however, amply disprove the
suspending power of pregnancy ; and M. P. Dubois' experi-
ence has long since led him to a similar conclusion. Phthisis
which has appeared at an early period of pregnancy pursues a
constantly onward course; and if improvement is to take place
at all, it never does so until after delivery. It is rare for phthisis
thus complicated to present those intermissions or sudden sus-
pensions of progress sometimes met with in ordinary phthisis.
The children brought forth by phthisical mothers, though usu-
ally small, are plump and well-looking to an extent that would
not, a priori, be expected from persons suflfering from so ex-
Itausting a disease.

M. Dubreuilh expresses a theoretical opinion in favor of the
prevalent belief that the progress of phthisis is hastened by de-
livery, but his facts are against him ; and so complete is the'
suspension of the disease sometimes, that delusive hopes of cure
are entertained.

In regard to the influence of phthisis on pregnancy, both ob-
servers are agreed that such patients ordinarily go their full
time ; which must be regarded as a remarkable fact, when it is

* British and Foreign Medico-Chir. Review, vol. vi., p. 261-,

1628 Hereditary Transmission of Phthisis. [October,

considered that more than one-half the pregnant women at-
tacked by pneumonia, abort. Both also find that these women
usually have very easy labours a fact due to the smaller size
of the child and the relaxed state of the tissues. Both, too,
consider that the attempt to suckle exerts the most disastrous
influence upon both mother and child. [Bulletin de I'Acad.
Rev. Med. Ibid.

On Hereditary Transmission of Phthisis. By M. Guillot.

Since 1825, M. Guillot has been tracing out the history of
certain cases of phthisis, in order to illustrate the laws which
regulate the hereditary transmission of this disease. He follows
the history of the family-line, in order to ascertain whether this
does not, by successive degradation, become exhausted and
extinguished. He refers to the case of a man who died of
phthisis, aged 66. Before the age of 48 all his four children
died of the same disease ; all had children, but the third gene-
ration did not survive the period of the first dentition, all being
carried off either by pneumonia supervening on tubercle, or by
tubercular meningitis. In another example, a grandfather died
of phthisis. One of his daughters also died of it at 30. The
other daughter is still living, but three of her children have died
either of tubercular pneumonia or meningitis. The general
conclusion is, that in proportion as phthisis descends in the
genealogical scale, its manifestation takes place at an earlier
period of life. A child will therefore run greater chance of
falling a victim to the consequences of the numerous accidents
of a tubercular affection, in proportion as the phthisical parents
who have given birth to it have not attained advanced age. In
a diagnostical point of view, then, the existence of tubercular
disease in the offspring while yet young, offers a very strong
presumption of phthisis. The practical importance of this is
iespecially evident in pneumonia, so common is it to find tuber-
cles of the lungs in the bronchial glands, masked by the signs
of this affection. [L' Union Medicale. Ibid.

On Measles as observed in Idiot Children. By M. Delasiauve.

The remark has been frequently made, that in certain classes
of the insane, incidental diseases exhibit a severity which is
not usually observed in persons in the possession of their facul-
ties. Exactly the contrary to this has been, it is true, main-
tained by some, and a supposed immunity asserted. Georget

1852.] Cause and Diagnostic Value of MuscceVolitantes. 629

and Esquirol, however, have shown that insanity disposes the
subjects of it to be more severely affected than are others by
ordinary diseases; and Ferrus especially points out dementia
and idiocy as unfavourable conditions in this point of view. M.
I'hore, also, in a special essay on the subject, adopts the same
view. M. Delasiauve deduces the same conclusion from the
opportunities he has had of observing epidemics of measles at
the Bicetre. The children o^ the employes of the establish-
ment were recently attacked in great numbers, and from these
the disease was communicated to the idiot and epileptic chil-
dren. While among the former the eruption pursued a nor-
mal and favourable couise, anomalous conditions complicated it
among the latter, and very often lendered it fatal. In differ-
ent epidemics, there has been observed a predominance of some
one of these, such as engorgement of the lun^s, of the brain, or
the parotid, oedema, &c. Violent dianhoea was the especial
characteristic of the present one. Besides this, however, in
six out of eight cases, occurring in one section, asphyxia from
bronchitis occurred, endangering the lives of the whole, and
terminating fatally in two. [Aiinales Med, Psychol. Ibid.

On the Cause and Diagnostic Value of Musccb Volitantes.
By M. Tavignot.

M. Tavignot Tissigns as the cause of this phenomenon, the
passage of the luminous rays through a very circumscribed spot
of the semi-transparent tissue of the iris, which has become de-
prived of its pigmentary matter a fissure in the uvea. This
theory explains: ist. Why the muscae are placed near the visual
axis, but always on one side of it; 2d. It explains the fact of
their disappearance in obscure light, and their especial distinct-
ness in a bright one, which induces the contraction of the pupil,
and the enlargement of the aperture in the uvea; 3rd. Also
their varied form, according to the different action of light upon
the eye, and the effect of this upon the size of the fissure; 4th.
It exf)lains their appearance after sudden movement of the eyes
upwards, which is always accompanied by a contractile oscilla-
tion of the iris, as also their diminution or disappearance as the
pupil enlarges.

if this theory be sound, the muscae ought to disappear when
the pupil is dilated by belladonna ; and M. Tavignot declares
that his experitnents have convinced him that they do disappear
in proportion as artificial mydriasis is thus produced, and that
they return again with the returning motions of the iris. It is
to be borne in mind that these remarks are referrible only to
essential muscae volitantes ; M. Tavignot intending to show

N. g. VOL. VIII. NO. X. 40

630 Treatment of Syphilis in Pregnant Women. [October,

hereafter, that in the sympathetic form (as in glaucoma) an
altered condition of the texture of the iris explains the appear-
ance, and adds confirmation to the above view.

Artificial dilatation of the pupil enables us to decide whether
we have to do with muscse volitantes, properly so called, or
with the spots known as scotomata, which are found in partial
opacities of the cornea, and in incipient cataract ; for while ihe
muscse volitantes disappear on the production of the mydriasis,
the scotomata persist, and even become m.ore distinct. [Craz.
des Hop, Ibid.

On the Treatment of Syphilis in Pregnant Women. By M.
Devilliers.

The following are the conclusions with which M. Devilliers
terminates a memoir upon this subject : 1. A pregnant woman
usually supports mercurial treatment pretty well during the
first half of pregnancy, and even from the first week. 2. Any
injurious efl^ects that may occur during this period, seem princi-
pally to depend upon a want of tolerance in the digestive or-
gans, and consequent nervous irritability. 3. The foetus is
more sensitive to the effects of syphilis, and to the action of
specific remedies, in proportion as it approaches the perfection
necessary for extra-uterine life. 4. In the application of treat-
ment, the following circumstances in relation to the progress of
syphilitic disease in pregnant women should be borne in mind
viz. {a.) The condition of conception may excite the exter-
nal manifestation of symptoms which, for a greater or less
period, had remained dormant, {h.) The symptoms frequently
exhibit oscillations during pregnancy, and have an especial ten-
dency to re-appear about the sixth, seventh, or eighth month,
(c.) They generally disappear spontaneously, and rather quick-
ly after delivery. 5. Palliatives for primary symptoms in the
early months are useless, and a radical treatment should at once
be resorted to. It is still more urgent to treat without delay
any secondary or tertiary symptoms that may be present. 6.
Active treatment undertaken or re-commenced towards the
latter part of pregnancy i. e. the period when abortion from
syphilis is most likely to occur requires greater precautions to
be observed than during the early period. 7. When the treat-
ment during the first half of pregnancy has not been completely-
interrupted, or has been so only for a short time, its resumption
on the re-appearance of symptoms during the latter period ex-
poses both mother and child to less chance of accidents. 8.
Treatment should not be discontinued too quickly after the dis-
appearance of the symptoms, but persevered with in very small

1852.] On Edible Earths. 631

doses as long as possible. 9. The trealmeni seems to be well
borne both by mother and child at all periods of gestation, in
proportion to the compHcated and aggravated condition of the
syphilitic accidents. 10. The syphilitic symptoms, whether
primary or secondary, which are manifested during the latter
weeks of pregnancy, require general as well as local treatment.
The child is then more amenable to treatment, if this be re-
quired after birth. 11. We must not wait too long after de-
livery, to commence or resume treatment, deceived by the
decrease of the symptoms so common at that period. If the
child, suckled by the mother, exhibits any mark of syphilis, we
must not wait later than the eighth or tenth day. 12. In
the early period of pregnancy, internal mercurial treatment
is often ill borne. This is less frequently the case in the
middle and later periods. In the former, inunction should be
resorted to.

M. Gibert, commenting upon the above essay, likewise says
that the ill effects which several practitioners have observed to
result from the administration of mercury in syphilitic women,
have arisen from their giving it internally. It frequently ex-
cites vomiting and colics in the fourth and fifth months ; and
mercurial frictions are infinitely preferable. Abortion from
syphilis ordinarily occurs after the fourth or fifth month ;
whence, if treatment is to be preventive, it must be commenced
early. [^m/Z. de VAcad. Bull de Therap. Ibid.

On Edible Earths, By Ehrenberg.

Various kinds of edible earths were known in China in very
ancient times, and it may be presumed, that many of them are
mixed or pure tripolitan fresh water bioliths i. e. species of
earths or stones, the elements of which consist chiefly of rem-
nants of microscopic living beings. In the year 1839, Biot read
before the Academy of Sciences in Paris a treatise, containing
everything that was then known on this subject, to which his
son, the oriental linguist, Biot, furnished translations from Chi-
nese and Japanese works. From Schott in Berlin, Professor
Ehrenberg obtained in addition the following information taken
from Chinese sources. The first mention of edible earth dates
from the year 744 after Christ, and is contained in the Chinese
work Pen- tsao-kang-mu, where it is called Schi-miam, Stone-
bread, or Mi-anschi, Breadstone ; the article in the Japanese
"Encyclopaedia," which Biot has translated, is taken from this
work. The Pen-tsao says, according to Schott, that stones
contain several substances which are edible, especially a yellow
meal and a fatty liquid, which is contained in the white Yii,

G32 On Edible Earths. [October^

(a stone.) and is, therefore, called the fat, marrow, or mucilage
of the white Yii. An earthy substance, prolonging life, and
called Schi-nas, is found in the very smooth stone Hoa-shi,.
which is supposed to be Steatite, and may, perhaps, be decom-
posed Steatite. The Schi mian is only used as a substitute for
bread in times of scarcity, when it is miraculously found in
different localities, as is believed. The imperial annals of the-
Chinese have always religiously noticed its appearance, but
have never given any description of the substance. The Pen-
tsao quotes, under the emperor Hiuan Tsung, of the great
dynasty Tang, in the third year Tian-pao (744 after Christ) a
spring in Wujin (now Liang-tschen-fu, in the province Kan-su)
which ejected stones, that could be prepared into bread, and
Were gathered and consumed by the poor. (Schott.)

Under the emperor Hian-Tsnnof, of the same dynasty, in the
ninth year of the period Yiien ho (809 after Christ) the stones
became soft and turned into bread. (Biot.)

Under the emperor Tschin-Tsung, of the dynasty Sung, in
the fifth year of the period Ta-tschong-Tsiang-fu (1012 after
Christ) in the fourth month, there was a famine in Tsy-tschen
(now Ki-tschen in Pina-Yang-fu, in the province Schan-si,)
when the mountains of Hiang-ning, a district of the third rank
in the same part, produced a mineral fat (Stonefat) resembling
a dough, of which cakes could be made. (Schott.)

Under Jin-Tsung, in the seventh year of the period Kia-yeu
(1062) stone meal was found. (Biot.)

Under Tschi-Tsung, in the third year of the period Yuen-
fong (1080) the stones turned into meal. All these kinds of
stone-meal were collected and consumed by the poor. (Biot.)
Very recently, in the year 1831 to 1834, similar kinds of
earth have been found in China, and were used as food during
the great famine, as has been reported by the Chinese mission-
ary, Mathieu Ly, who resides in the province Kiany-si. In
the year 1834, he writes: "Many of our (Christians will sure-
ly die this year from starvation. The Almighty alone can aid
them in such great distress. All harvests have been destroyed
by the floods. For three years a large number of persons have
lived upon the bark of an indigenous tree; others have eaten a
light white earth which has been discovered in a mountain. It
can only be obtained for silver, and not every one can, there-
fore, procure it. The people have first sold their wives, therr
their children, then their furniture, at last they have pulled
down their houses and sold the wood. Many of them were,,
four years ago, wealthy men." The missionary, Rameaux, also
reported in 1834, from the province Hu-kuang, ihat many Chi-
nese Christians have sent for him to administer to them the last

1852.] On Edible Earths. 63?

rsacrament, and foreseeing the hour when they were to die from
starvation, actually died at that very time. The very dense
population and industry which necessarily takes possession of
everything^, are, in cases of earthquakes and deluges, the cause
of these circumstances in China.

The districts where stone-bread has been found are the north-
ern province of Schan-si, the east provinces of Schan-tongand
Kiancr-nan, on the mouth of the Yellow river (Huang-hu,) the
provinces Hu-kuang and Kiang-si, in the valley of the Blue
river (Yantsekiang). It is very desirable to know the masses,
localities, extent of occurrence of these earths, as well as their
geognostic character. The analysis of the two kinds, which
the author has obtained, renders it very probable that all similar
substances belong to antediluvian deposits, some of which are
very probably tripolitan, fresh water bioliths of infusoria, while
others appear to be clay mixtures or real clays. (Letten.)

A. White Edible Earth of 1834, from China. The author
obtained in the year 184J, by Humboldt, from Paris, a sample
of the edible white earth, sent to Paris by the French mission-
ary in China. One of the two pieces measured two inches in
diameter, the other one inch. It has a white colour, similar to
chalk, but is as light as Kieselguhr or Meerschaum, is some-
what fatty to the touch, not soiling the fingers, but very brittle.
The pieces having been broken in those directions which weie
indicated by a previous crack, some of the internal surfaces had
a rusty colour, but only superficially. Acids caused no effer-
vescence. According to the analysis, this earth is n)erely
silicate of alumina, the peculiar lightness of which is striking.
If heated, it assumes a ^ray colour. In fifteen samples no or-
ganic mixture could be discovered by microscopic examination,
which latter shows also no similarity between this substance
and Meerschaum ; there is also an entire absence of magnesia.
This earth has much resemblance to lithomarge-like Kaolin,
but its lightness and the different form of the microscopic parts
admit no identity between them. Irregular, mostly globular
bodies of various sizes, with soft obtuse outlines, compose the
whole mass. Perhaps it is a deposit of a precipitate from hot
siliceous waters.

From the blackish mould left in the impressions of the
smoothly scraped natural surface, it is obvious that the fossil
has not been taken out from the midst of rocks, but was dug
out from a black mould. Analysis have shown eighteen differ-
ent microscopic forms, 'which are enumerated in the 294th
analysis of the micrologeocrjcal researches of the author.

B. Yellow Edible Earth from China. In the year 1847, the
I author obtained from one of the great geological' collections in

634 Chloroform for Hemicrania and Neuralgia. [October,

London a small sample of this earth, which from a gray passes
almost into a sulphur-yellow. It resembles a very fine clay,
does not soil the fingers, but is brittle, and shapeable when
moistened. Acids produce no effervescence, and when heated
it becomes first black, then somewhat redish. Its microscopic
elements are a rather coarse, double refracting, mostly quartz
sand, surrounded by a somewhat finer mould. Intermixed are
isolated, small green and white crystals, mica, and Phytolitha-
ria, with now^ and then traces of Polygastric shells and silicious
casts of stone kernels of Polythalamia. In ten analytical ex-
aminations were found fourteen forms : one Polygaster, nine
Phytolitharia, one Polythalamium, and three crystals. The
substance is therefore, according to this, a loamy or clayey
substance. All the Phytolitharia contained in it are in a cor-
roded porous state, just as they occur in antediluvian tertiary
layers. The presence of Polythalamia, and in particular of
Textilaria globulosa in a stratum, very likely of the interior
continent, indicates chalk formations in the vicinity of the
place, or at least in the aquatic district of the river. This ap-
pears to prove that the clay similar to the edible Tanah ambo
in Java, which it very much resembles, is a tertiary fresh-water
formation in the modern sense of geognosy, incumbent on
chalk, or mixed with fragments of chalk. The forms occurring
in it are :

1. Polygastria: Trachelonionas Icevis,

2. Phytolitharia : Lithodontium Bursa, L. nasutum, L. ros-
tratum, Lithosphosridium irregulare, Lythostylidium clavatum,
L. IcBve, L. quadratum, L.rude, L. trahecula,

3. Polythalamia: Textilaria globulosa.

4. Inorganic forms : green crystalline prisms, white crystal-
line prisms, plates of mica.

The sum of the discovered species is eleven organic forms
and three inorganic ones ; among which are ten fresh-water
formations and one marine formation, Textilaria. [Pharm.
Central Blatt and Phar. Jour. Canada Med. Journal,

Chloroform Ointment for Hemicrania and Neuralgia,

M. Cazenave, of Bordeaux, recommends the above ointment,
which is prepared as follows : Pure chloroform, three drachms ;
cyanide of potassium, two drachms and a half; axunge, two
ounces ; add a sufficient quantity of white wax to make an oint-
ment of the usual consistence. [^Lancet.

%

1852.] Miscellany. 035

ill i 0 c c 1 1 a n 2

Deaths hy Chloroform and Ether. We know not whether it be
from the increased use of anaesthetics, from negligence engendered
by their frequent administration, or from the manufacture of impure
articles, that their fatality has became so common, but it is quite obvi-
ous that the profession is not sufficiently awake to the hazard attend-
ing their indiscriminate use. Scarcely a month has elapsed during
the present year, in which the medical press has not recorded one or
more deaths from chloroform or ether ; and in most of the cases the
operations for which they were administered were comparatively tri-
vial the extraction of teeth, for example. We would not censure nor
repress the laudable desire to mitigate human suffering, but we feel
it a duty to take a stand against the rashness that would resort to
means, the danger of which is altogether disproportioned to the neces-
sity of relief.

It is true that chloroform has been administered to thousands of
parturient women with almost uniform immunity from its bad effects.
This is easily accounted for when we reflect upon the circumstances
and mode of administration. The parturient woman who inhales it,
does so with a free will, without reluctance ; (for if she objected, no
one would urge it upon her) ; she takes it to subdue pain she already
suffers, not to make her unconscious of mutilation ; she has probably
taken no food for several hours ; she is in the horizontal position ; she
inhales it very gradually and rarely takes more than enough to induce
an agreeable state of intoxication and partial insensibility.

The circumstances are very different in cases to be prepared for
surgical operations. The idea alone of an operation carries terror with
it ; chloroform is proposed, but the patient is afraid that he may not get
enough to make him entirely insensible before the knife is plunged
into his flesh, or that he may take too much and die. Even if you
satisfy him that he will neither feel the pain nor be killed, he cannot
be reconciled to being mangled whilst asleep. The consequence is
that in the great majority of such cases, the handkerchief or sponge
has to be held forcibly to the nostrils of the patient, whose struggles
to remove it increase with his intoxication, until he falls back in a
comatose state, not unfrequently preceded by convulsive movements.
The wonder is that there are not more accidents under such circum-
stances.

We find the journals teeming w'lih precepts for the safe administra-
tion of anaesthetics. We are admonished not to resor' to them if the

636 Miscellany. [October,

patient be disposed to affections of the brain, heart, lungs, &c., and
yet death has usually occurred when these precautions were observed,
and when there seemed to be no reason to appprehend it. We believe
that by far the most important precepts, are : never to administer
them in any other than the horizontal position ; nor to persons in whom
syncope may be easily induced, as nervous and hysterical females or
anaemic individuals ; nor to persons who are afraid of their effects ;
nor shortly after a meal. We believe that syncope is most common-
ly the immediate cause of the mischief for with the sensibilities
blunted by the remedy, it is then extremely difficult to produce the
impressions and actions necessary to restoration. The horizontal po-
sition is the best protection agamst syncope, and it is to the neglect of
this precaution we attribute the numerous deaths in the hands of den-
tists. With regard to repletion of the stomach, its danger is to be
found in the fact, that vomiting is frequently induced by the anaesthetics,
and that the insensibility of the patient then favors suffocation by al-
lowing the food to pass into the trachea, or to obstruct the larynx.
The patient should be immediately turned upon his side with* his head
down, if he attempts to vomit

In speaking as we do, we trust that we will not be understood as
opposing the use of so great and vaiuble a boon, whenever the impor-
tance of the case may require it. We repeat that we desire simply to
lend our air ii. repressing its indiscriminate use, until its administra-
tion may be so regulated as to lessen the risk of fatal consequences.

Influence of Climate upon Consumption. The value of a removal
to the south, of persons affected in the northern states with consump-
tion, has been heretofore very generally admitted ; but it is now asked
whether much, if any, advantage is to be derived from spending merely
the winter months at the south and returning to the north in th'e spring
and it is added that if a temperate atmosphere be all that is needed, this
may be obtained in New England by means of a well regulated sys-
tem of artificial heat. We believe it to be an error to suppose that
the southern states owe their immunity from phthisis pulmonulis alone
to the mildness of their winters. If such were the fact, all temperate
climates ou^ht to be equally exempt, and all cold latitudes alike unfa-
vorable Yet phthisis is much more common upon the seaboard and
in the mountainous districts of the southern states than at intermedi-
ate points, and it is comparatively rare in the northern portion^ of
Canada and Russia, whilst it makes frightful havoc in milder Eng-
land, France and our northern states.

1852.] Miscellany. 637

That a temporary sojourn in the southern states is advantageous,
we doubt not ; but that a permanent residence here is still more so, we
feel quite certain. Every practitioner of experience and who is ac-
quainted with the means of accurately determining the state of the
lungs, must have often observed how wonderfully large abscesses will
heal here, which would have certainly proved fatal in a less genial
clime. The writer knows persons in this state who had tubercular
abscesses as long as twenty years ago, which healed kindly and have
left them ever since in the enjoyment of apparently good health. That
all are not equally fortunate is too true; yet we feel assured that it is only
by remaining in the south, both summer and winter, sufficiently long
to acquire the peculiarities of a southern constitution, that lasting bene-
fit may be expected. The best locations are obviously those in which
the disease orignates most rarely, and these are unquestionably to be
found midway between the mountains and sea-board.

BIBLIOGRAPHICAL.

Records of Maculated, or Ship Fever, with suggestions of treatment :
being the result of a series of observations made during the preva-
lence of this disease at South-Boston and Deer-Island Hospitals in
1847-48 with Plates. By J. P. Upham, M. D. 1852.

Clinical Reports on Continued Fever, based on an analysis of 164 cases :
with remarks on the management of Continued fever ; the identity of
Typhus and Typhoid fever ; Relapsing fever ; Diagnosis SfC. to
which is added a memoir on the transportation and diffusion by con-
tagion, of Typhoid fever, as exemplified in the occurrence of the dis-
ease at N. Boston, Erie Co., N. Y. By Austin Flint, M. D.,
Professor, 6lc , in University of Buffalo, &;c. 1852.

The publication of works upon Typhus and Typhoid fevers at this
time is quite opportune, as the extension of continued fevers into por-
tions of the Southern States hitherto exempted from them, makes it
very important that they be thoroughly understood. The interest felt
upon the subject by the profession at the South is manifested by the
great number of communications, on "Typhoid Fever," received and
published by our periodicals, and although they all evince a -spirit of
inquiry that cannot be too highly commended, some of them bear
unequivocal evidence of a deficiency of accurate information, both in
regard to diagnosis and treatment.

The works before us are not such as most- persons like to read, be-
cause they are dry statements of facts yet they are just the kind that
every man ought to read who wishes to become thoroughly acquainted
with disease. They are Clinical Reports drawn up at the bed-side ;

638 Miscellany. [October,

and whose powers of description can ever equal those of nature ? A
few clinical reports of any disease will convey a better idea of it than
the most laboured and skilful description framed in the closet. We
need more clinical reports in our country ; it is only by these that we
can establish any valuable comparison between the diseases of Ame-
rica and those of the old world ; it is by these alone that we can
effectually study their natural history and treatment. The desire for
short roads to knowledge as well as to geographical points, so charac-
teristic of our people, has induced the translators of some of the most
valuable European works to mutilate them by leaving out all their
clinical cases, the very materials upon which the works were based.
Who, for instance, would recognize the great monument of Laennec's
genius and industry in the miserable skeleton presented by the trans-
lation. Two large volumes, full of facts, cut down to a thin octavo
"to suit the market!"

In conclusion, we beg leave to recommend the works of Dr. Upham
and Prof. Flint especially the latter.

The Transactions of the third annual meeting of the Medical Society of
the State of Georgia, held in the City of Augusta, April, 1852.

We congratulate the Medical Society of the State of Georgia upon
the publication of so creditable a contribution to Science. The work
before us contains one hundred pages, and should be regarded as an
earnest of still better things, when the organization will include a larger
number of members. The following are its contents : Minutes of
Proceedings; Report on Empirical Remedies of R. Campbell, M. D. ;
Report upon Surgery by H. F. Campbell, M. D. ; Report on the Dis-
eases of Perry (Houston Co.) by G.*F. Cooper, M. D. ; Report on
the Diseases of Roswell (Cobb Co.) by W. N. King, M. D.; Report
of cases of Urinary Calculus by P. F. Eve, M. D. ; Observations
upon the use of certain new remedies by L. A. Dugas, M. D. ; Ad-
dress before the Society by H. F. Campbell, M. D. ; Catalogue of
officers and members.

The Report on Empirical Remedies will attract attention, both
from its intrinsic merits and from its fearless denunciation of Charla-
tanism and its abettors. But what avails the shaft hurled by viituous
indignation at an evil which derives its very origin and sustenance
from the peculiar nature of the human mind ! unless we could blot
credulity and cupidity from the psychological chart, how are we to get
rid of dupes and knaves ! It is in vain that we expose one species of
imposture, for, phoenix-like, another will arise from its ashes.

1852.] Miscellany. 639

The Report upon Surgery is a faithful expose of what was done in
this department during the preceding year in Georgia. Its matter is
judiciously arranged under the three heads of surgical injuries and
pathology ; surgical operations ; and surgical medicine or treatment
nearly all the facts, we are proud to say, are derived from the pages
of the Southern Medical and Surgical Journal. It is gratifying to find
that, with very few exceptions, the physicians of Georgia have evinced
their State pride by making their publications in the medical periodi-
cal of their own State. The following is a list of the writers whose
contributions are noticed in this Report . F. T. Matthews, L. A. Du-
gas, H. Rossignol, H. F. Campbell, D. C. O'Keeffe, C T. Quintard,
P. F. Eve,R. Campbell, H. V. M. Miller, W. H. King, H. M. Jeter,
J. Harriss, W. N. Kin^, J. S. Wilson, W. W. Haws, \. C. Hart.

The Report of Dr. G. F. Cooper is admirably drawn up, and may
serve as a model for works of the kind. That of Dr. W. N. King is
also very good, but not as extensive and minute. We hope to find
such documents multiplied. We regret that our space will not per-
mit us to reproduce, at present, any of the papers contained in these
Transactions, but may do so hereafter. Dr. H. F. Campbell's Ad-
dress on " The Difficulties and Privileges of the Medical Profession,"
is a very chaste and creditable production.

We would take occasion to direct attention to the following extract
from the minutes : "Resolved, that the Transactions of this Society,
when published, be withheld from such members as may fail to remit
their assessment to the Treasurer, Dr. R. C. Black, at Augusta."
We understand that there are several delinquents, who have, doubt-
less, forgotten the passage of this resolution.

God in Disease^ or the Manifestations of Design in morbid 'plienomena.
By James F. Duncan, M. D., Physician to Dunn's Hospital, Dub-
lin. Philadelphia : Lindsay & Blakiston. 1852.

This is a neat little duodecimo of about 230 pages, the contents of
which are divided into twelve chapters bearing the following titles :
On disease, as depending upon an active and intelligent cause ; on
the nature of the design which disease is intended to accomplish ;
on the existence of disease in general as affording evidence of design ;
on the varieties of disease as affording evidence of design ; on the pain
of disease as affording evidence of design ; on the modifications of pain
as affording evidence of design ; on some other symptoms of disease as
affording evidence of design ; on processes of preservation in disease ;
on processes of reparation ; on processes of adaptation j on the phe-

640 Miscellany. [October,

nomena of disease as illustrating spiritual truths; on the conduct of
the physician as illustrating the dealings of God with His creatures;
conclusion.

These subjects are treated with clearness and in an easy style, en-
tirely free from pedantry as well as bigotry. An attentive perusal of
the work is calculated to dissipate many erroneous ideas, and to sub-
stitute for them the rational views of sound Christian philosophy. It
may be read with equal advantage by both patient and physician.

Hints to the People upon the Profession of Medicine. By Wm. M.
Wood, M D. Surgeon U. S. Navy, Author of " Sketches of South
America," "Polynesia," &c. Buflalo : George H. Derby & Co.
1852. 12mo. p. 67.

We have never seen a work better adapted to the purpose of cor-
recting popular errors with regard to the medical profession than this.
It should be procured by every physician and circulated among such
of his patrons as will not get it tiiemselves.

The Transactions of the Medical Association of the State of Missouri^
at its second annual meeting. St. Louis, April, iy52.

This is decidedly one of the best productions emanating from the
State associations of this year. It contains an excellent Address by
the President, and able Reports, by Professors Pope and Pallen, upon
Surgery and Obstetrics, besides several other articles of general in-
terest. The Report of Dr. T. Reyburn upon the Domestic Adultera-
tion of Drugs and Liquors is especially deserving of attention.

The Transactions of the twenty-ninth annual meeting of the Medical
Society of Virginia, together with the Presidents annual address and
the Constitution of the society . Richmond, 1852.

These Transactions consist of the minutes of proceedings nothing
more. The Old Dominion must do better or it will lose caste.

Braithwaile^s Retrospect and Ranking's Abstract have been receiv-
ed, and contain their usual amount of valuable information. They
are excellent works, but would be better if they contained more Ame-
rican matter.

Pumpkin seed for Tcenia. It appears that the use of pumpkin seed
in the treatment of Taenia, did not originate in our country as was
thought by some, but that its efficacy was stated by Dr. Mongeny, up-
wards of thirty years ago in a French periodical, the " Journal XJni-
versel des Sciences Medicaids," He used a paste composed of three

1852.] Miscellany. 641

ounces and a half of fresh seed and double the quantity of Honey, given
in three doses at intervals of an hour, and alleges that he thus almost
invariably succeeded in expelling the worm in the course of ihe day.

So simple a remedy is well worthy of systematic trial. Perhaps
it would be effectual in the removal of other intestinal worms.

Turpentine Frictions, SfC, in Intermittent Fever. Among the nu-
merous remedies proposed for the purpose of dispensing with the use
of quinine in the treatment of intermittent fevers, a French practitioner
recommends frictions to the spine with spts. turpentine and chloroform,
(3| oz. of the former, and 5j. of the latter,) an hour or two before the
expected paroxysm. It is well known here that a few cups, or even
a sinapism over the dorsal vertebrae will very often prevent the parox
ysm. In cases of obstinate and recurring attacks of the disease, a fly
blister to the same region has long since been regarded by us as one
of the most effectual means of permanent relief.

Operation for Hare-lip M. Guersant, the distinguished surgeon
of the Children's Hospital in Paris, has recently performed with suc-
cess the operation for hare-lip upon an infant one day old.

Professor Liehig. This celebrated chemist has left Giessen to take
up his residence in Munich at the solicitation of the Bavarian govern-
ment.

The Doctorate at the St. Louis University. We perceive that the
St. Louis University requires of candidates for the Doctorate, the fol-
lowing imitation of the Hippocratic pledge of old.

5th. And that he publicly assent to the following promise, prior to
the conferring of the degree, viz :

" You, A B., do solemnly promise that you will, to the utmost of
your ability, exert your influence for promoting the welfare and res-
pectability of the profession; that you will demean yourself honora-
bly in the practice thereof; that you will not put forth any nostrum or
secret method of cure, nor engaiie in any other species of quackery ;
and that you will not publish any matter or thing laudatory of your-
self, or derogatory to the profession ; and in the conferring of this de-
gree, it is done with the express understanding that ihe Faculty
reserve to themselves the right and privilege to revoke said degree
whenever the promise here made shall be violated."

Remarkable Case of Precocity Menstruation occurring at four
years of age. By C. R Kemper. A servant girl, owned at this
time by Mr. C. M. VV., of our village, is the subject of a precocious

642 Miscellany. [October,

development of the female reproductive organs and appearance of the
menses. The development of the general system in this girl, from a
year old, was noticed to progress rapidly, till she attained her third
year, when an increased size of the mammary glands was first ob-
served, and, shortly after, there appeared the usual growth of hair on
the pubes. When she was four years and one month old, her cata-
menia made their first appearance, and have continued regularly to
return up to this date. She is now just entering her thirteenth year.

The development of the brain seems not to have kept pace with the
physical growth, but she is possessed of a degree of intelligence usual
for her age. She is much larger than an older sister, and has the ap-
pearance, from the breadth of the chest and pelvis, to be a fully devel-
oped woman, [Stethoscope.

A Curious Philosophical Experiment,

Charleston, August 25, 1852.

Gentlemen : I find the enclosed article in the New Orleans " Delta."
It describes an experiment of such interest that I wish to bring the
subject before the intelligent and philosophical readers of your jour-
nal. Whoever the writer may be, he has certainly proved his claim
to whatever honors the French Academy may see fit to extend to M.
Andraud. The latter gentleman is wrong ; and his error is clearly
detected, and the true experiment shown by the real discoverer, the
clerical correspondent of the Delta.

The best manner of detecting the globules is with a lens ; though
the perforated hole shows an interesting spectacle. The iris of the
eye is also superbly magnified and rendered beautifully visible with
two lens, a small and a large one, placed five feet apart ; the larger
one directed to the moon or a lamp, and looking at it with the smaller
(inch focus) placed close to the eye. Indeed, the experiments may
be varied so as to produce the finest effects, at once novel and beauti-
ful. Next to a telescopic view of the heavens, I know nothing in
science so interesting and at the same time so simple as this " seeing
the interior of the eye" with the eye itself. The Rector of St. John's
j)arsonage has conferred a philosophical treat upon experimenters in
physical science by his discovery. Trusting that my friend, the edi-
tor of Le Courrier des Etats Unis, will notice the article which I have
sent you, by giving the extract an insertion, I remain gentlemen,
yours respectfully,

Beaufort.

[Fro/71 the New Orleans Delia.']

The following interesting communication from a distinguished lite-
rary gentleman and excellent clergyman of the Episcopal Church,
<3annot fail to arrest the attention of the curious in optics. We have
ourselves verified the experiments herein recorded, and noticed one
fact which our correspondent does not allude to, viz : the image of a
friend, who was standing near us and at a certain angle with our

1852.] Miscellany. 643

retina, projected from that nervous expansion, as it were, into the plan-
et-like disc, where it resembled the face in the sun, as we see it printed
in childish books !

The communication may be headed, " The Art of Seeing the In-
terior of the Eye with the organ itself!"

To the Editors of the Sunday Delta :

Gentlemen : I have recently read in some of the journals a state-
ment in relation to a late discovery, said to have been made by M.
Andraud, an eminent French engineer. The paragraph to which I
allude reads as follows :

" Some attention has been excited by the alleged discovery, by a
French engineer of some celebrity named Andraud, of some means
of seeing the air. If, says he, you lake a piece of card, colored black,
of the size of the eye, and pierce with a fine needle a hole in the mid-
dle, you will, on looking through that hole at a clear sky or a lighted
lamp, see a multitude of molecules floating about ; which molecules
constitute the air. We shall see whether the theory will obtain the
sanction of the Academy of Sciences, to which it has been submitted."

My object in drawing your attention to this extract is in order to
correct an important error touching M. x\ndraud's alleged discovery.

The atomic globules v/hich were rendered visible to M. Andraud,
by means of the perforated card, are not aerial molecules. I have
been, for some months past, familiar with this interesting experiment.
The beautiful globules seen by means of the hole in the card are the
atomic colorless globes which constitute the crystalline fluid witlmi the
eye. M, Andraud supposes they are external and in the air, when
the truth is they are internal and within the chamber of the eye.

The experiment may be tried, and the fact verified by any person,

in the followino- manner : Take a thick visitinsf-card and black it

P
with ink, or a piece of pasteboard opaque enough to forbid the trans-
mission of light through it, and perforate the centre with a pin-hole.
Place the card between the eye and a candle-flame, or a globe-lamp,
and not more than two inches from the eye, and the same distance
from the light ; but this distance will vary according to the convexi-
ty or flatness of the seer's eye, who must adjust it till he finds his focus.
Instead of seeing the flame of the candle, the beholder now discerns a
circular disc the size of the iris of the eye. This disc is bright and
planet-like, and is crossed by innumerable lines like the fibres visible
on the surface of a magnified rose-leaf. It appears to he beyond the
eye, between the card and the light ; and it is this illusion which de-
ceived M. Andraud, and led him to suppose that he saw a portion of
the atmosphere magnified. But this visible disc is, in fact, a spherical
section of the fluidal crystalline lens within the chamber of the eye^
strongly illumined by the concentrated pencil of light, passing from
the candle into it through the minute hole in the card ; and the veined
appearance of its surface is the recticulated materia of the ordinarily
transparent coat of the cornea rendered visible.

The chamber of the eye thus lighted up by the intense line of ligh:

641 . Miscellany.

passino^ into it through the minute orifice (which acts as a strongly
magnifying lens,) there is conveyed to the optic nerve an image (ex-
actly the size of the pupil through which the ray passes) of a circular
section of the crystalline fluid, with its atomic particles intensely mag-
nified. The spectable is one of surpassing wonder and beauty.
Myriads of illuminated molecules distinctly appear in tremulous mo-
tion in the bright fluid ; some of them are simple globes, others are
encircled bv two or more concentric rings like exquisite miniatures of
the planet Saturn, as seen through a telescope. Some of them are
transparent, like infinitely small soap bubbles, and float about as light-
ly, while others are of the white color of pearls.

By contracting the eye, or by gently moving the head from side to
side, these beautiful millions of globular atoms are made to undulate
within the chamber of the eye, and change places, some ascending
and others descending; while others thrown nearer the focus of the
light dart across the disc like shooting stars in a lesser firmament;
while others revolve about each other in orbits of infinite diversity.

The experiment is a highly interesting as well as a philosophical
one, and will well recompense whoever attempts it. It will require
some practice in a tyro to adjust the card to the proper focus, so as to
obtain the clearest disc ; but any one who knows how to use a micros-
cope will easily discover when the card is in focus. If the flame of
the candle is seen through it it is out of focus, and it must be advanced
or drawn back until a round planet-like shape is discernible. This
planet like shape, which will appear crossed by a net- work is the
corner coating of the eye maa;nified. The pupil of the eye must now
be expanded, as when one examines closely a very minute object,
when the atomic world of globules that compose the crystalline fluid
will be discerned behind the net-work surfice of th- cornea ; and the
steadier one gazes the clearer is this wonderful and beautiful spectacle
perceived in all its surprising variety of form, beauty, and motion.

A better medium ihan the card proposed by M. Andraud 1 have
used in making this experiment. It is a small lens, (the eye piece of
a broken spy-glass,) with an inch and a half focus. This held to a s^lar
lamp or candle, at six feet distance, or turned towards the full moon,
(which is better still,) the chamber of the eye is far more intensely il-
lumined than by means of the perforated card.

The lens of ordinary magnifying spectacles will serve equally as
well as the eye- piece named, by covering the surface with opaque
paper, having in the centre a clear space to transmit the light through-
out into the pupil of the eye.

Trusting that this experiment for seeing the elementary molecules
of the crystalline lens will aflTord to others the pleasure which I and
many friends have derived from it, and trusting to the indulgence of
M. Andraud for rejecting his theory of aerial atoms, I remain, very
'truly, yours, I,

St. John's Parsonage, Aberdeen, Miss., June 7, 1852.

SOUTHERN

MEDICAL AND' SURGICAL
JOUBML.

Vol. 8.] NEAV SERIES. NOVEMBER, IM. [No. 11.

PART FIRST.

rtglnal Communications.

ARTICLE XL.

Veratrum Viride, or American Hellebore. By W. C. Nor-
wood, M. D., of Cokesbury, South Carolina.

We trust that the profession will pardon our appearing so
frequently under the above caption. The great incredulity of
many in reference to the powers of Veratrum Viride, and the
apprehension by others of its poisonous properties, as well as
the imperfection of our previous communications upon the sub-
ject, must plead our apology for now giving a more minute
account of our experience, and urging the great importance of
the subject, perhaps, for the last time. We intend to state facts
and events that have repeatedly come under our immediate
observation. We shall not pretend to account for the modus
operandi nor the wonderful and magical effects of veratrum
viride upon the system, in overcoming and subduing dis-
ease, nor shall we attempt to specify what or which are its
primary or secondary, its direct or indirect effects. But we
will add the opinions of a number of medical gentlemen, with
the effects witnessed by them from time to time. By this course
the medical world will be put in a condition to judge how far
our observations and experience have been sustained by those
of others who are not so personally interested as we are. Vera-
trum viride, as a therapeutical agent, had excited comparatively
little interest previous to June, 1850 ; and it was noticed for a

N. S. VOL. VIII. NO. xc. 41

646 Norwood, on Veratrum Viride. [November,

time after that date, more on account of the extravagance of
the claims set up for it as a remedial agent of superior powers,,
than because of any belief that it was possessed of peculiar and
valuable properties. We could, if necessary, in this place, name
several medical journals which noticed the article or articles
written by us and spoke of the extravagance of our statements.
If we recollect correctly, it was about the year 1835 that Dr.
Charles Osgood's interesting article on the powers and proper-
ties of veratrum viride made its appearance. The only addition-
al information he conveyed was that it is destitute of cathartic
powers, which give it a superiority over the Veratrum xA.lbum
or European Hellebore, in the treatment of cases where active
cathartics are inadmissible. Be this as it may, it is certain, and
cannot be successfully controverted, that prior to June, 1850, it
was not known positively to possess any superiority over vera-
trum album ; indeed the one was supposed to answer the same
purposes as the other.

Without wasting time in the proof, or in noticing the
remarks that others have made up to the period stated, we
will simply observe, that from all we find in works upon materia
medica or therapeutics, and in the standard works on the prac-
tice of medicine, there are no claims set up for its superiority
to its '-'European congener." It stands unnoticed, is not even
named as a remedy, and still less as a leading and valuable
remedy, by any of the standard authors of the day in their trea-
tises on the practice of medicine. Dr. Wood, of Philadelphia,
in his very able, extensive and superior practical work on Medi-
cine, even as late as 1849, does not mention or recommend it
in the treatment of a single disease. It does not form a portion
of the work upon New Remedies, by Dr. Dunglison, a man of
untiring industry and application, and who never slumbers
until all that is known is placed in his valuable works, nor
has it a place in his work on the Practice of Medicine.

Now, if the peculiar powers and properties we claim for the
veratrum viride had been known and established if its pecu-
liar adaptation to the successful treatment of typhoid pneumo-
nia, typhoid fever, scarlet fever, puerperal fever, &c., &c., had
been known, these very learned and deservedly distinguished
authors would not have failed to notice it. We have entered

1852.] Norwood, on Veratrum Viride. 647

into the above brief notice to show how little was known of
the value of veratrum viride prior to the notice given of it in
June, 1850. When we furnish the testimony in our possession,
it will be seen what a valuable remedy it is, and what a wide
spread reputation it has acquired in the short time it has been
before the public. Why Dr. Osgood ceased to give further
notice of its powers we are not prepared to say : whether his
silence grew out of a want of confidence in its remedial powers,
or from death, we are wholly ignorant. We do not wonder
at the violent and drastic effects he witnessed ; but we rather
wonder, from the large doses given, that he obtained any bene-
ficial effects. Be this as it may, if it possesses the powers and
properties we attributed to it, and is adapted to the treatment
of the symptoms and diseases indicated by us, the discovery
must be eminently valuable. Greatly enlarged experience and
observation have strongly confirmed us in the belief of the cor-
rectness of what we stated on a former occasion, namely, that
when its powers and properties are fully known and understood,
it will constitute a new era in the treatment of disease.

In July, 1844, we first used it in the case of Mrs L. She had
been laboring under a severe attack of pneumonia typhoidesfor
several days. Calomel, blisters, Dover's powders, &c., failed
to afford relief We had been informed by a friend and an
eminent physician, that veratrum viride "was analogous in its
powers and properties to blood-root more narcotic and less
emetic, and that a fluid drachm, or a tea-spoonful of the tinc-
ture was a dose." We had often used blood-root with marked
success in pneumonia, and especially in the cases of a bilious
character. This case having annoyed us by its severity and
obstinacy, and opium producing unpleasant effects, without re-
lief to the pain, we determined to make a trial of the tincture of
veratrum viride. We withdrew all other remedies, and put
her on tea-spoonful doses of the tincture, to be repeated every
three hours. Instead of making it by using (as was directed)
"one pint of undiluted alcohol, of the strength of the shops, to
eight ounces of the green root, or diluted alcohol, if the root
was dry^' w^e added one pint of undiluted alcohol to eight
ounces of the dried root^ This is the formula we gave to the
public, and is the one we now use. It has been said by some,

648 Norwood, on Veratrum Viride. [November,

that it was an extravagant formula, that we used an unneces-
sary quantity of the root. We always like to have our tinc-
tures, of very active agents, of the same or uniform strength,
and would much prefer the waste of a little root to the uncer-
tainty of an untried tincture. But, if any one will read Dr.
Robert's valuable article on Veratrum Viride, in this Journal,
for June, 1852, it will be seen that he added double our pro-
portion of alcohol, and that he had to use double the quantity
of the tincture ; thus demonstrating that we were as correct in
estimating the quantity necessary to saturate the alcohol, as
we were in our representations of its remedial effects on the
system. We would not pretend to deny that less might do, if
the root were dug at the right season, (between the 1st of Sep-
tember and frost.) and properly assorted and put up. But in the
form in which it comes to us, it is rare that less ean be suffi-
cient.

But, to return to our case: We gave her a tea-spoonful at
11 A. M. About 1 P. M. we were sent for in haste, as the
medicine, or something else, was acting drastically. We found
the patient vomiting every few minutes ; skin cold and cover-
ed with perspiration ; great paleness, nausea distressing ; com-
plained of a sense of sinking and exhaustion. After the vomiting
had ceased, the pulse was found not more than 60 per minute,
full and distinct.

In a few cases, in which nausea was great and the vomiting
frequent, we have found the pulse very slow, small, and almost
imperceptible at the wrist ; but as soon as the vomiting and
consequent exhaustion subside, the pulse will be found slow,
full and distinct. The nausea or vomiting, when in excess,
can be readily and gertainly relieved by one or two full por-
tions of syrup of morphine and tincture of ginger, or laudanum
and brandy.

In this case, before administering the tincture of veratrum
viride, the skin was hot and dry; pulse 130, small and soft;
circumscribed flush on the cheeks ; pain severe; breathing hur-
ried and difficult; cough frequent; expectoration scanty. The
very striking effects of the medicine, the great reduction in the
frequency of the pulse, and the sudden breaking up or arrest of
the disease, in this and another case, profoundly enlisted our

1852.] Norwood, on Verairum Viride. 649

attention, and led us from that period to observe more particu-
larly its powers.

The second case in which we used the veratrum viride was
that of Mrs. M., who was also laboring under a severe attack
of pneumonia. Pulse from 130 to 140 beats per minute ; pain
violent, and extending from the right side, near the spine, to, and
under the sternum ; tongue red on the edges and tip, and cov-
ered in the centre with a thin, dark, dry fur; bright scarlet
circumscribed flush appearing first on one cheek, and then on
the other, rarely on both at the same time ; the end or tip of the
nose and chin frequently red; very pale around the mouth;
expectoration scanty ; mucus streaked with blood ; cough fre-
quent and very harrassing; great increase of pain under the
sternum during a paroxysm of coughing ; decubitus on the
back; breathing labored and difficult. Did not see her till the
fourth day : she had been bled, and otherwise treated, with little
or no relief. Applied a blister, and gave a camphorated powder
to allay the cough and violent pain, and to excite diaphoresis.
At the expiration of three hours, to commence with the tincture
of veratrum v iride.

The first portion excited intense nausea, violent emesis, great
paleness, coolness and a sense of sinking or of exhaustion. The
patient and friends becoming alarmed, another physician who
Hved much nearer than myself, was sent for in great haste, but
when he arrived the nausea and emesk had ceased ; the patient
was comfortable, pain and febrile symptoms subdued, pulse
sixty-five, full and distinct. The doctor was surprised to find
the condition of the patient so different from the representation
given by the messenger. The disease was really broken up
and a crisis and resolution brought about. Our friend, the
doctor, ordered a little paregoric and quinine, in which we fully
concurred on our arrival, as there w^s entirerelief of all active
febrile and inflammatory symptoms.

We would here observe that notwithstanding the complete re-
duction of the inflammatory symptoms and pulse, the peculiar cir-
cumscribed redness on the cheek or cheeks continued for three
days. In another case of pneumonia, we observed the same
peculiarity, with the additional fact, that although there had
lieen more tendency to coma or uninterrupted and deep sleep

650 Norwood, on Veratrum Viride. [November,

the patient then became preternaturally wakeful, somewhat
flighty and disposed to get out of bed. This continued about
forty-eight hours. We do not know how to account for this
continuance of the red cheeks under such circumstances. A
case occurred in Georgia, in which a corpse was kept a week
in consequence of the persistence of this redness.

Deeply impressed with the peculiar effects of verat. viride, we
determined to make farther and conscientious trial of it in pneu-
monitis. The third case in which we administered it was that
of Mr. T., who was taken sick when on a visit to his friend
in this section of the country. We ordered the tincture given
every three hours, beginning with eight drops, to be incieased
one drop at each dose until nausea, vomiting or some other
visible effect was produced. On the dose reaching twelve
drops it induced vomiting with but little nausea. The pulse
was reduced from 135 to 78 beats per minute ; the surface, from
being hot and dry, became cool ; and the severe pain was now
but slightly felt on taking a deep inspiration. The interval
between the doses was extended from three to five hours ; but
as twelve drops induced too frequent vomiting, the quantity
was reduced to seven drops and continued three days without
any return of the symptoms, when the case was dismissed and
the patient was soon able to return home. This case was one.
full of interest on account of the success and promptness with
which the violent symptoms were removed and the disease
cured.

We might report any number of cases, but as many of them
have already been given by others, we will confine ourselves to
such facts only as may tend to illustrate particular points. We
continued our experimental trials with various doses from three
to twelve drops, increasing or diminishing them according to
circumstances, until we acquired a perfect knowledge of its
eflfects, and could graduate them at will.

We ascertained that in cases which had run on for sometime
or in which emetics and cathartics had been freely used, a very
small quantity was necessary. Where tartar emetic has been
given, it is almost sure to act harshly and drastically. Where
tartar emetic had been taken, we would therefore always give
a full portion of syrup of morphine, at least one hour before

1852.] Norwood, on Veratrum Viride. 651

entering on the use of the veratrum viride, and in such cases
would not commence with more than six drops for a male adult.
Fre venesection increases very materially its activity, especial-
ly its unfavorable or drastic eiTects. No one should think of
followino^ a larsre bleedins: with the veratrum viride, unless
with the greatest caution. The depressing influence of the loss
of blood upon the brain and nervous system generally, cannot
fail to render the use of so potent a sedative as veratrum viride
exceedingly hazardous. The administration under such cir-
cumstances of an agent capable ofreducing the pul?e from 130
or 140 down to 75, 70, or even 50 beats in the course of a iQ\Y
hours, cannot be too carefully watched.

Intending to resume and to conclude in the next number of
this Journal the account of our experience in the use of vera-
trum viride, we beg leave now to append the tebtimonyofsome
of those who have kindly written to us upon the subject.

RoswELL, Ga., May 1st, 1852.
Dear Sir I find, in experimenting with your veratrum viride, it is
all in all things you have represented it, and is certainly the only arte-
rial sedative on which we may at all times rely with certainty, and the
most invaluable agent of this class in the whole materia medica.

Very truly,

WM. NEPHEW KING, M.D.

Columbia, Nov. 17th, 1851.
Dear Sir In experimenting with the tincture handed me, (vera-
trum viride,) 1 have been very much pleased with its controlling
powers over the heart and arteries. I have only given it in typhus
fever, and one or two cases of pneumonia. It certainly reduces the
pulse without any of those immediately prostrating and alarming
symptoms which take place after the continued use of digitalis ; nei-
ther does it irritate the mucous membrane of the bowels, as the salts
of antimony do, when continued lor days. I have given it in several
cases of typhus, in which there was dry red tongue, great thirst, dele-
rium, frequent dejections from the bowels, with soreness and disten-
sion of the abdomen, without the least aggravation of any of tliose
disagreeable symptoms. I have not found it immediately to arrest
the diseise, or cut it short at once, after fully formed, but certainly
to make it assume so mild a form as to require very little hi the future
treatment. I have, in several cases, broken up the forming stage of
the disease, by keeping the heart below a natural and normal action
for two or three days. In fact, I regard yoiir tincture of every im-
portance in the above diseases, and fully meeting the exp^rtations of
its warmest advocates. It certainly is the very article to fill the place

652 Norwood, on Veratrum Yiride, [November,

(a thousand times better and safer) of the tart, emetic in the contra-
stimulant treatment of the " Italian school." * * *
I remain yours, most truly,

SAMUEL FAIR, M. D.

Newbesry Court House, Nov. 16, 1851.
Dear Doctor I have given the medicine you sent me, (veratrum
viride,) to two patients labouring under typhoid fever, with the best
effect. In both cases the pulse was reduced from 120 and 140 to 70
and 74 beats in the minute, by giving from three to four doses, there
was no return of fever afterwards. The medicine was continued five
days in one case and seven or eight in the other. I was sent for
two weeks ago to visit a patient in consultation with an eminent
physician, labouring under pneumonitis. I saw her on the ninth day
from her attack her physician had used all the remedies usual in such
cases she seemed to grow worse. When I was called in, he said he
had no hope of her recovery all the symptoms were unfavourable. I
proposed giving Dr. Norwood's medicine, as I called it ; he smiled, and
said he was afraid it was a humbug, but consented, as he considered
the case hopeless. We gave her (a young lady fifteen or sixteen
years old) live drops; increased one drop each dose until we gave eight
drops to the dose. It produced nausea of the stomach by this time ;
her pulse was reduced from 120 to 88 beats in the minute. Her
physician remained with her during the night; he stopped giving the
medicine. The next morning I saw her again and found her with a
pulse of 110 beats in the minute. I asked the doctor if he had discon-
tinued the medicine ; he said he had. We commenced giving it again,
in eight drop doses ; by the third dose her pulse was reduced to 74
beats in the minute ; said she felt much better. The doctor discontinued
the medicine again for eight or ten hours to see the effect. The pulse
rose again to 108 or 110 beats in the minute. We resumed the
medicine again about the third dose the pulse was reduced to 70.
We kept it from 70 to 74 beats for several days, some six or seven.
She is now convalescent. I will say to you, however, that the doctor
has sent to me a second time for a small vial of the medicine, as he is
giving it to some two or three cases of typhoid fever, and says he is
very much pleased with its effects.

Your friend,

J. B. RUFF, M. D.

Bainbridge, Ga., June 5th, 1851.
Dear Sir Since receiving the veratrum viride, I regret that I have
had but one favorable opportunity of giving it a trial ; in that, however^
it succeeded beyond my most sanguine expectations. The case was
one of Pneumonia, complicated very decidedly with typhoid symptoms.
The patient being four years old and the pulse 130, I proceeded after
trying all other modes of treatment unavailingly for ten days to give
the tincture in common doses. The first was ejected as soon as swal-
lowed, but was repeated instanter and was retained. The little patient
now becoming tranquil and not anticipating any very sudden change,

1852.] Norwood, on Veratrum Viride. 653

I suffered myself to engage in common fireside conversation for some
thirty minutes, when my attention was attracte'd to my patient by the
extreme palor of his countenance, and upon examination found his pulse
reduced to about 80, the skin bathed in perspiration, and, as far as one
could judge, the disease gone, and the patient sleeping sweetly. But
in order to assure myself that these results were produced by the
medicine and nothint; else, I withheld the second dose and the result
was that the fever rose in five hours. The dose was then repeated
and the same results followed as in the first instance. The portion
was again withheld, whereupon the fever rose again in eight hours.
But a repetition of the remedy subdued it as promptly as before, and
by continuing it at intervals of six hours, there was no return of the
symptoms : thus conclusively showing that the favourable results
obtained could not be ascribed to the agency of any other article.

Yours, very respectfully,

E. R. RIOLEY, M. D.

Waynesboro', Burke Co., Ga., August 4th, 1852.
Dear Sir I had intended, as a matter of great gratitude, at an
early day to write you an acknowledgment of your prompt kindness
in sending me a specimen of your tincture of American Hellebore, as
well as to congratulate you upon your discovery of the controlling
powers of that article over abnormal organic reaction. * * * j
am satisfied with the display of its magical powers, as presented for
my consideration. I am satisfied that a great desideratum has been
accomplished. I am proud of it as an achievement of American
medicine T am proud of it, particularly, as a triumph of Southern
experiment and observation, and believe that it will weave for the
brow of the discoverer a chaplet of green, and with the lancet, win a
partition of empire in the domain of practical medicine. * * * *
I will further, and more familiarly, say, that price shall be no bar to
my keeping a supply in my office. I will never be without it, if mo-
ney can get it. Deprive me of it, and I verily believe I should " throw
physic to the dogs." I still have a small portion of the specimen you
sent me. I intend to keep it until I am satisfied I can obtain a supply
of equal purity and power. * * * * Pi-. Montgomery requests-
me to say that he is every way satisfied with the article that it has
furnished him with a number of beautiful cases and subject matter
for a communication for the Journal ; but he must plead laziness ia
extenuation of the omission. To use his emphatic language : " Take
it from me, sir, and I'd quit the practice of physic." Before you dis-
pose of what you have on hand, root or tincture, I must get some. I
must be sure it comes from your hand I dont care what the price is^
* * * * I remain,

E. L'ROY ANTONY, M. D.
[To be Continued.]

[Dr. Norwood informs us that he has been at considerable-
expense of lime and money in procuring the fresh and genuine

654 Hammond, gu Calculi in the Urethra. [November,

Root of Veratrum Viride, in order to supply the many calls
upon him by physicians who were unable to obtain it. IJe
still has some on hand which he would like to dispose of, so as
to be refunded, in part, at least. The Doctor certainly deserves
the thanks of the profession for his exertions to supply the arti-
cle, until it is generally kept by the druggists. He will keep it
no longer.] Editor.

ARTICLE XLI.

Operation for the Removal of Calculi in the Urethra. By
D. W. Hammond, M. D., of Culloden, Georgia.

Professor Pancoast, in treating of strictures of the urethra,
has most truly observed tlmt, "no class ofsurgi-cal diseases de-
mands more attentive study on the part of the practitioner than
that which involves, as one of its consequences, a retention of
urine." My remarks, on this occasion, will be entirely con-
fined to retention from impacted calculi in the canal of the
urethra, and requiring the knife for their removal. It may be
proper here to observe that, in each of the following cases, the
ordinary means were used for the removal of the calculi, prior
to resorting to the knife.

The operation is usually performed in the following manner :
The median line is opened directly over the urethra, which is
deepened until the foreign body is reached and extracted ; a
<;atheter is then introduced into the bladder, and the external
wound closed with stitch and adhesive plaster this is the
plan now recommended by Dr. Mutter. There are many ob-
jections to this operation, which will be pointed out in the
sequel.

In my first case, I performed the operation as recommended
by this distinguished surgeon, and in consequence of a fistulous
opening remaining in the urethra for some considerable time,
and which required much trouble and pain for its eradication,
I determined, should ever another similar case occur in my
practice, that I would perform the operation in a difl^erent
manner.

Case I. In the fall of 1829, my associate in the practice of
medicine, Dr. Richard Banks, the distinguished surgeon now

1852.] Hammond, on Calculi in the Urethra. 055

of Gainesville, was summoned in haste to see the son of Mr.
Wm. Sodlers, of Elbert county, about 5 years of age. He
being absent, I was requested to visit the case. The messen-
ger having apprised me of the condition of the patient, I fortifi-
ed myself with the necessary instruments. I found the little
boy in the most intense agony from retention of urine ; the
bladder was very much distended, reaching nearly or quite to
the umbilicus. On making an exploration of the urethra, I de-
tected a calculus lodged in the canal, just anterior to the bulb.
Making some abortive efforts to remove it, I cut down upon it,
and readily extracted it through the opening ; the urine gushed
from the wound with considerable force, to the great relief of
the little sufferer. A catheter was introduced, and the wound
approximated, and confined by stitch and adhesive plaster.
From the constant stillicidium of urine through the opening,
the plasters were soon washed away, and the pain and irrita-
tion produced from the presence of the catheter becoming so
insufferable that I was compelled to withdraw it. Considera-
ble tumefaction of the penis and scrotum ensued ; this, howe-
ver, subsided in a few days by appropriate treatment. The
patient recovered from the operation, with the exception of a
fistulous opening, as before stated ; this was, in the course of
five or six weeks, closed by frequent applications of the nitrate
of silver.

Case II. In the year 1831, (as well as I now recollect, for I
kept no notes of the case,) my co-partner and myself were re-
quested to visit the son of Mr. Wm. Alexander, a child about
three years of age, near Ruckersville, Elbert county. He had
retention of urine, from the lodgment of a stone in the mem-
branous portion of the urethra. The operation was performed
in the following manner: The patient was secured as for the
operation of lithotomy ; an assistant, placed on the right of the
patient, with the fingers of the right hand forcibly drew the skin
across the perineum from left to right, and held it firmly
against the ramus of the ischium by this procedure the raphe
or median line of the perineum was from a half to three-fourths
of an inch from its natural position, and to the right of the
urethra; an incision was now made in an oblique direction
down to the stone, which was readily removed by a small pair

656 Hammond, on Calculi in the Urethra. [November,

of forceps. The assistant removing his hold upon the skin, it
at once assumed its normal state. The orifice through the skin
was now found from a half to three-fourths of an inch from the
median line, and on the left side of the urethra. The wound
healed by the first intention.

Case III. On the 15th of August last; I was requested to
see the child of Mr. Orlando Holland, about one mile from Cul-
loden. The little patient had been laboring under a difficulty of
micturition for several days, for which he had taken diuretics
and mucilaginous drinks, without relief. On the introduction
of a silver probe, a small calculus was found lodged just behind
the glans penis, about midway between the glans and front of
the scrotum. Making some effort to force it out of the urethra,
and failing to accomplish it, I proceeded to remove it by the
knife. The penis was grasped by the left hand, twisting the
skin from the left to the right side, and holding it firmly a
scalpel held in the third position completed the operation. The
penis being released, the skin at once retracted, throwing the
orifice mac^e by the scalpel on the left side of the penis, and
one-half inch from the median line beneath, presenting the
appearance of the operation having been performed through
the corpus-cavernosum instead of the corpus-spongiosum ure-
thrae. In this case, union took place by the first intention; not
a drop of urine ever passed through the wound.

Remarks. In the first case, we had a troublesome' fistulous
opening to contend with for several successive weeks, caused,
no doubt, by the manner in which the operation was performed.
When the opening is made through the integuments, directly
over the urethra, the wound has a natural tendency to gape,
from the traction constantly kept up by a contraction of the
skin in a lateral direction superadded to this, a portion of the
corpus-spongiosum is almost certain to protrude through the
lips of the wound ; the presence of the catheter in the urethra
causes great pain and irritation, and at the same time distends
the calibre of the canal beyond its natural size, which keeps
open the rent in the urethra ; and, in addition, the stitch recom-
mended to close the wound, developes, in a majority of cases,
still more irritation, and not unfrequently ulceration is the con-

I

1852.] Williams, on Typhoid Fever, 657

sequence. Many other objections nnight be urged, but I think
it would be an unnecessary consumption of time to do so at
present.

In the plan I propose, as detailed in the second and third
cases, neither of the foregoing objections obtains. The opening
through the skin is some distance from that in the corpus-spon-
giosum urethrae, consequently the external integuments imme-
diately over the wound are entire. After the operation is
performed, all that is necessary to complete the cure is proper
pressure. The slight tumefaction which always succeeds the
operation, produces a rigidity of the integuments -this thick-
ening and immobility of the parts institutes a steady and con-
stant pressure, and this, too, being so accurately applied, and
steadily maintained, that there cannot be any impediment to
union by the first intention ; w^hereas, in the old pl3n of per-
forming the operation this seldom ever takes place, for reasons
already stated.

ARTICLE XLir.

Cases of Typlwid Fever, By J. A. Williams, M. D., of Pike
county, Ga.

Case I. Called 7th June, 1851, to see Mr P., aged 25 years,
who had been complaining some ten days, the last three or four
of which he was confined to his bed with a dull headache, in-
disposition to exercise, indolent stupid feeling, no appetite, and
a slight diarrhoea. I found him somewhat emaciated, skin hot
and dry, pulse from 100 to 110, some deafness, tip and edges
of tongue red, centre covered with a white fur, bowels tender
to pressure, with the usual gurgling noise and other less promi-
nent symptoms, characterizing a simple case of typhoid fever.

Treatment. A blister to the nape of the neck, a pepper poul-
tice to the bowels, gum or elm water to be drank constantly ;
no other food allowed ; laudanum when necessary, to control
the bowels.

June 11th. Patient in the same condition the symptoms a
little aggravated: ordered treatment continued, laudanum in
creased.

June 20th. Patient doing well, no pain, pulse 90, skin moist^

658 Williams, on Typhoid Fever. [November,

slight diarrhoea: ordered small portions soup or gruel. Patient
dismissed with instructions to keep within doors, guard the ap-
petite and continue the laudanum if necessary.

Case II. Mrs. W., aged about 40, the mother of eight chil-
dren, a woman who leads quite an active life, of stout and robust
habit, somewhat inclined to corpulency, was attacked about
the 1st of July, 1851, with a dull headache, a disinclination to
exercise, no appetite, unpleasant taste, in which situation she
remained untd the 4th, when I saw her ; emaciated, skin hot
and dry, tip and edges of tongue red and parched, a brownish
fur on the centre with distinct papillae appearing through the
coating, pulse ranging from 120 to 140 rather full, bowels ten-
der, a little distended, slight diarrhoea. In connection with the
above, Mrs. W., had a slight cough, and upon exploring the
chest detected some irritation in the right lung.

Treatment. A small blister over the occipito atloid articu-
lation to combat tenderness, a pepper poultice to the bowels,
gum or elm water drank constantly, scjuills occasionally, a Do-
ver's powder at night, laudanum if necessary.

July 10th. Little or no alteration in patient; treatment con-
tinued, squills increased.

July 17th. Sent for in haste to see patient. No abatement of
fever, bowels distended and very irritable, tongue red: applied
a blister plaster to the abdomen, former treatment continued,
with instructions, should strangury ensue.

July 20th. Blister acted like a charm, swelling in the bowels
subsided, some abatement of fever ; treatment continued. Or-
dered a little rice water, in a day or two with instructions to
increase the diet as the stomach could bear.

July 25th. Patient convalescent; skin moist and cool, pulse
nearly natural, tongue cleaning off, sharp appetite. Dismissed.

Case III. January 6th, 1852. Called to see Archer, a negro
boy, the property of Mr. R., who had been sick about a week.
Mr. R., had given him salts once or twice, and a dose of Cook's
pills ; all ineffectual. Archer presented the usual symtoms of
typhoid fever with a slight attack of pneumonia.

About this time. Dr. Norwood's preparation of hellebore
made its appearance ; thinking I had a proper subject for its use>
commenced by giving five drops every three hours until nausea

1852.] Williams, on Tyj)hotd Fever. 659

was induced, which occurred in ten hours, with vomiting, at
which time I left, ordering the veratrum viride again in five
hours, to be repeated as before. This practice was continued
until the 10th, with the effect of reducing ibe force and frequen-
cy of the pulse during its administration, but upon its discon-
tinuance that symptom would resume its former station. Be-
ing satisfied of the inefficacy of veratrum viride in this case,
my patient was put upon the palliative plan and recovered in a
few weeks, the fever having run its course uninterrupted by any
therapeutic agent.

Cases IV and V. April, 1852. Called to the family of
Judge E. ; found his son, a youth of 15 or 16 years old, with
headache, hot and dry skin, tongue red and pointed, bowels
regular, with other characteristic symptoms of typhoid fever.

Treatment Elm water, a Dover's powder at night, lauda-
num if necessary. While attending the above, my attention
was directed to a negro woman in the same family, who pre-
sented the same symptoms as above. Treatment the same ;
both were relieved in four or five weeks.

Remarks. The object of reporting the above cases is to in-
duce some one more competent than myself to experiment, note
and publish the result of the palliative treatment in typhoid
fever. In looking over the Journals of the day, we see that
some rely on mercury as the sheet anchor, others on veratrum
viride, and a few on stimulation ; all of which (according to
my experience) are useless, if not detrimental. In genera}',
mercury only serves to debilitate, and in some instances ag-
gravates the already irritated bowels ; veratrum viride merely
exercises a temporary control over the vascular system, and of
course leaves the alimentary canal in an irritated state, and
more subject to colliquative diarrhoea ; stimulants cause in-
creased nervous and arterial excitement about the brain, indu-
cing nervous derangement, subsultus tendinum delirium, coma,
&c. So, upon the whole, our main dependence in typhoid
fever are, palliatives, good nursing, and the vis medicatrix na-
turae.

660 Knight, on Vicarious Menstruation. [November,

ARTICLE XLIII.

Vicarious Menstruation. By A. W. Knight, M. D., of While
Springs, Hamilton Co., Florida.

Mr. Editor The following case may, perchance, interest
some of your readers, or, at least, it will go to prove our text-
books correct, v^'hen they assert that an evacuation m^y take
place at various parts of the body, vicarious of the normal
uterine periodical secretion.

On the 8th of February of the present year, I was called to

visit Mrs. W , of Columbia county, who was much alarmed

at a hemorrhage from the left eye : she is about 30 years of
age, and the mother of six children. Reported to me, that for
four or five nights past, she had perceived that her left eye had
been bleeding about a table-spoonful during the night, as near
as she could judge, from the stain upon the pillow, and that the
eye was suffused with blood during the day. During the same
period, she had a slight hemorrhage from the nose, and had
discovered traces of blood in the expectoration. Feeling no
pain in the eye, and having never received any injury from
blow or otherwise, she was at a loss how to account for it.

Making particular inquiries into the case, I learned that she
bad menstruated in the usual manner only three times in twelve
years, and that this was the proper time for the menses to ap-
pear. Her general health, during this time, has not been good,
and her appearance, at the time of my visit, was decidedly
anaemic, with some tendency to anasarca.

On careful examination of the eye-lid, I could detect some
slight congestion of the minute blood-vessels ; otherwise not dif-
ferent from the other. With a view to the improvement of her
general health and to the re-establishment of the uterine func-
tion, I prescribed mineral tonics, chiefly the preparations of
iron, for the interval, and special emmenagogues for the week
on which the menses ought to return. Up to the present month
she has had no return of the vicarious menstruation.

She followed my prescription for about one month; but the
normal discharge not taking place, she became discouraged,
and discontinued the medicine. Having understood that, some
years since, her menses appeared after a few days bathing in the

1852.] Thompson's Case of Frost-bite. G61

sulphur spring at this place, and as there has been no return of
the regular menstruation, 1 have advised her to try the bathing
again.

A few weeks since, I was called to treat her for intermittent
fever, and was struck with a remark of her's that the side on
which the vicarious discharge appeared "felt numb when the
fever was on." Does this throw any light upon the state of the
nervous system in ** intermittents?" Could the peculiar con-
dition of the uterine system cause any loss of sensation in the
nerves of one side more than the other? Here is a point wor-
thy of investigation by older practitioners than myself.

The "intermittent" yielded readily to treatment; and once
,since the convalescence she says that symptoms have induced
her to think, that the vicarious discharge may again return from
the eye.

August 24th, 1852.

ARTICLE X.LIV.

Case of Extensive Sloughing of the Foot from Frost Bite ;
Amputation beloiv the Knee. By B. M. Thompson, M. D.,
of Danielsvile, Ga.

It is not uncommon to see cases of frost bite of more or less
severity in this climate ; but it is rare to see a whole limb de-
stroyed by congelation alone. Such accidents are of much
more frequent occurrence in the higher latitudes. The follow-
ing case is interesting on account of the extent of the injury
sustained and the consequences resulting from it the loss of
the entire foot and leg. My object in reporting it for the Jour-
nal is merely to record it, to furnish a link for the great chain
of medical statistics.

The patient, a Negress, about 25 years of age, a native of
Virginia, the property of Mr. J. W. H., of this county, ran-
away from her master about the 18th January last, and was out
during the very cold weather experienced here about that time.
She was out some three weeks, and when found near her mas-
ter's plantation, was unable to walk from the swollen and pain-
M condition of the left foot and leg. The foot, however, was

N. s. VOL. vin. NO. XI. 42

662 Thompson's Case of Frost-hite. [November,

neither niuch swollen nor very painful, but a considerable por-
tion of its skin was off, and there was a good deal of redness in
the denuded part. This redness, as I was informed by her
owner, was soon succeeded by a bluish colour ; there was very
little sensibility in the part. There was a good deal of soreness
about the ankle, which was greatly swollen. There was no
sloughing of the soft parts, except of the integuments, as before
mentioned, when she was brought home. The foot was dressed
with poultices wet occasionally with spirits of turpentine. This
treatment had but little effect other than to stimulate the efforts
of nature to cast off the lifeless foot. In the course of a few
days the soft parts around the ankle joint began to slough, and
when I was called to the case on the 29th of February, I found
the sphacelated foot almost ready to drop off at the ankle joint.
It was black, dry and hard, not unlike diied beef in appearance.
The sloughing was extensive, especially on the inner side of the
articulation, the tarsal bones were more or less exposed. The
foot was only prevented from dropping off by the tendo-achilles,
a small portion of the skin and some of the ligaments on the
outer side of the joint. . The other tendons, the nerves and
bloodvessels were completely severed, and the arteries occlu- ^
ded. The leg for some distance above the ankle presented a H
very unhealthy appearance it was nearly twice as large as ^
the other, oedemetous, of a bluish or livid hue, the integuments
appeared to be thickened, and it resembled elephantiasis. Th&
lower ends of the tibia and fibula could not be seen on account
of the swollen condition of the tissues which covered them. A
considerable quantity of very offensive pus was discharged from
about the joint; there was a number of pale and exceedingly
unhealthy looking granulations shooting out from the stump,
which would slough upon the least handling. There appeared
to have been very little constitutional disturbance amid all
this local disorder. Her constitution was good, she was greatly
emaciated, but was free from symptoms of organic disease of
any vital organ.

Amputation of the diseased member seemed the only mode
of relief and the circular operation was performed on the 5th
day of March, by Dr. Benjamin V. Willingham, of Lexington,
who at my request kindly consented to operate, assisted by his

1852.] Starr's Instrument for Hare-lip, 663

brother and associate, Dr. Willis Willingham, of the same place,
Dr. William Johnson and Mr. Howard, medical student, of
Oglethorpe county. The limb was taken off about three finger's
breadths below the tubercle of the tibia, the patient being under
the influence of chloroform. It was performed in the usual
manner, and with much skill and dexterity by my friend, Dr.
Willingham. I had some apprehensions as to the final result
of the operation, as the patient was at times stubborn and re-
fractory, but she convalesced rapidly and satisfactorily and is
now (June 1st) entirely well, with a good looking stump. It
may not be amiss here to state that this patient had her right
foot frost bitten in the early part of last winter, (being runa-
way at the time,) which was followed by considerable sloughing
of the skin and subcutaneous tissue of various parts of the foot;
these ulcers healed slowly and had not entirely cured up when
she went off in January: they are now, however, well there is
slight contraction of the flexor tendons of that foot together
with a little stiffness of the ankle joint.

The chloroform had the happiest effect in this case ; about
three drachms of this article poured on a piece of sponge and
enveloped in a handkerchief folded into the shape of a hollow
cone, were applied to the patient's nose, which produced com-
plete suspension of sensation in less than two minutes. She re-
mained under the influence of this wonderful " pain killer" in
all about twenty minutes, perfectly unconscious of what was
going on during this time, and awoke after the operation was
over as from a pleasant slumber. It produced no unpleasant
symptoms in this case, the pulse was as full, soft and regular,
and the breathing as easy and natural as that of a person in the
most perfect health.

ARTICLE XLV.

A Simple Instrument for Operating upon Hare-lip. Described
in a letter to the Editor, by E. F. Starr, M. D., of Rome,
Georgia.

Dear Sir Enclosed I send you a small plate made of pew-
ter, with eyes, or loop-holes, on the back, which, if you will
adjust upon one prong of your long straight dressing forceps,

664 Dugas, on certain New Remedies. [November,

will make (should it fit well) a convenient instrument for oper-
ating for hare-lip. To have the lip firmly clasped the entire
distance it is to be cut to have it well supported by a sub-
stance which will not destroy the edge of the knife when cut
upon, and to have a guide for the knife in making the cut are
objects to be desired. These may all be obtained by this instru-
ment, thus arranged, in one cut. It might be well, perhaps,
to have a thin piece of leather pasted upon the face of the plate.
The opposite blade of the forceps should be rough like a file,
longitudinally, to prevent slipping. An instrument might be
made for the purpose with plate attached, and the edges or
sides of the opposite prong should be m.ade straight, as guides
for the knife. Jn using it, the operator should take hold of just
so much of the lip as he wishes to remove, then cut along the
edge of the outer prong, next the body of the lip, down to the
plate on each side. You will readily perceive its application,
however. The plate may be made wider or narrower, to suit
individual cases. I used this one not long since in an opera-
tion, and found it quite a help.

ARTICLE XLVI.

Observations upon the use of certain New Remedies. By
L. A. Dugas, M. D., Professor, &:c.

Believing it to be the duty of members of associations of this
kind to make known such results of their observation as may
be useful, I will beg leave to offer a few remarks upon the use
of some of the remedial agents recently brought into notice.

Chloride of Sodium or common salt has been, at various pe-
riods, proposed as a valuable remedy, but has attracted more
than usual attention during the last twelve months.

I have long been in the habit of prescribing it alone, or in
combination with the Bi-carbonate of soda, in certain forms of
dyspepsia and general debility. From 10 to 30 grains of salt in
a tumblerful of cold water, taken every morning on rising from
bed, is highly promotive of appetite and digestion when the
dyspepsia is unattended with organic lesion of the gastric sur-
face and seems to be rather dependent upon a state of atony.
The soda, in an equal quantity, constitutes an useful addition

1852.] Dugas, on certain New Remedies, 665

where there is a tendency to acidity, and also when the kidneys
do not secrete freely and properly. The remedy appears to
be especially applicable to the cases of general debility and
nervous irritability so common among our ladies of sedentary
habits. It may be sometimes necessary to commence with a
smaller dose than just mentioned ; but I have stated that suited
to the majority of cases.

In Acute Dysentery, I have found connmon salt often of strik-
ing usefulness, but it must in general be given early in order to
realize its value. It is now ten years since I first witnessed its
efficacy in this disease. I had been attending a mulatto boy,
eight years of age, for four or five days without being able to
ameliorate his condition. The onset of his attack was attended
with high febrile action, which, however, gradually subsided
as he became exhausted by the continuance of the countless,
bloody, mucous stools, and painful tenesmus. The rectum
rejected anodyne enemata as fast as they could be administered.
Nothing I could suggest seemed to bring any relief; and I left
him one night, thinking his case hopeless. On the next morn-
ing I found him wonderfully relieved, and was congratulating
myself with the idea that my last prescription had " done the
deed," when the boy's father announced that he had taken the
liberty to omit my prescription and to give his son last night,
in lieu of it, a cupful of strong fish brine, which aflforded so
much relief that he had just again repeated it. The stools be-
came watery and less frequent, the tenesmus was entirely re-
lieved and the patient convalesced rapidly.

I have ever since that time resorted to salt and water ; when
the high febrile excitement conter-indicated the immediate re-
sort to anodyne enemata ; and when the administration of these
failed to give relief. In the early and high febrile stage, it will
often subdue the fever and tenesmus most admirably, and the
patient will rapidly recover.

The efficacy of this and perhaps of other saline purgatives
in dysentery, probably depends upon its combined depletory
-and revulsive operation. The depletion is derived from the
^mall intestines in the form of serous stools, and this action
.must also relieve, by revulsion, the morbid condition of the la?'ge
intestines. The case loses the painful and alarming character

666 Dugas, on certain New Remedies, [November,

of dysentery and assumes that of ordinary diarrhoea, which will
either gradually subside or yield to vegetable astringents com-
bined with opiates.

In the spring and in autumn, when the causes of periodical or
paroxysmal fevers combine with the vicissitudes of temperature
to produce diseases in which the phlegmasiae and the neuroses
are so commingled as to re-act injuriously upon each other,
we often find dysentery prevailing to so great an extent as to
constitute an epidemic. If the febrile excitement be then
closely observed, it will often be found to present daily exacer-
bations, which must be prevented by the use of quinine during
the remissions, in order that the remedies directed to the local
affection may have time to prove beneficial. If the quinine be
withheld each febrile exacerbation will aggravate the intestinal
inflammation, and this, in its turn, will make the next paroxysm
more alarming until it be too late to avert the fatal result.
The same may be said of the so-called epidemics of pneumonia,
which are most prevalent in mild winters and in remittent fever
districts.

In cases unattended with fever, I am in the habit of resort-
ing, as soon as the bowels are thoroughly emptied^ to enemata
consisting of a teaspoonful of laudanum, or half a grain mor-
phine suspended in half a gill of thin starch or mucilage, re-
peated until retained long enough to give complete relief This
plan will be found to succeed in the great majority of such cases.
Yet, we occasionally encounter one in which the anodyne will
not be retained, and it is then that I resort to the salt and
water.

The dose I administer is a teaspoonful of salt in a cupful of
water, to be repeated every three or four hours until the stools
pass off freely and without tenesmus. If the tenesmus returns,
the salt should be again given, but at longer intervals.

I am aware that the sulphate of soda in similar doses has
been highly recommended, and I have sometimes used it, as
also the sulphate of magnesia, with decided advantage. Com-
mon salt, however, is less disagreeable, more convenient, and, I
think, more efficacious.

Common salt has been of late urged in France, especially by
M. Piorry, as a valuable substitute for quinine in Intermittent

1

1852.] Dugas, on certain New Remedies, 667

Fever ; and if it can be thus used advantageously, the discovery
would be one of great importance to those who cannot afford
to purchase the more costly article. I have prescribed it in
only two cases of Intermittent fever ; in one of which it proved
successful, the patient having had but one paroxysm after its
use was commenced. In the other, which was complicated
with tubercular disease of the lungs and intestines, it increased
the diarrhoea so much as to cause its discontinuance after the
second dose. In these cases a teaspoonful in a tumblerful of
cold water was ordered three times a day. It is to be hoped
that this application will be fully tested by the Profession.

Lemon Juice in Rheumatism. There is perhaps no disease,
for the relief of which more remedies have been and are still
being continually suggested, than Rheumatism. The last in the
list is lemon juice, of whose efficacy the British Journals are
full. It may be known to some of those present, that I have
for many years advocated the theory (first suggested by Prof.
J. K. Mitchell, of Philadelphia,) of the Spinal origin of Rheu-
matic affections, and consequently the use of counter-irritants
in the vicinity of the origin of the nerves leading to the seat of
pain. My views upon this subject were pubhshed in the South-
ern Medical and Surgical Journal in 1837, and I have seen no
reason to change them since. We however, not unfrequently,
meet with cases of acute Rheumatism of great intensity, in
which the spinal treatment cannot be energetically carried out
on account of the inability of the patient to rest in any other
position than upon his back. In these cases it is difficult to cup
the spine often, and very painful to apply blisters to this region.
We are then compelled to resort to other means. I should also
add that the spinal treatment is by no means so speedily effec-
tual when large joints are much affected with acute inflamma-
tion, as in cases of less violence. This is of itself an additional
reason for the use of internal medication, than which I have
found nothing more useful than repeated emetics of tartarized
antimony, followed in the evening by full doses of opium or
morphine.

Within the last few months, however, I have been induced
to try the Lemon Juice in a number of cases of acute rheuma-
tism and in the exacerbations of the chronic form of the dis-

668 Dugas, on certain New Remedies. [November,

ease, and always with most decided advantage. Tiie remedy
is very grateful to the palate, and the patients own that they
feel better as soon as they begin its use, and v^^orse when it is
omitted. I usually order a tablespoonful of the lemon juice of
the shops to be taken every four, three, or two hours, accord-
ing to the violence of the case and the toleration with which it
is received by the stomach and bowels. It seems to promote
the action of the kidneys, to keep the bowels solvent, to lessen
general excitement, and to diminish pain.

So simple and pleasant a remedy in so formidable an affec-
tion is well worthy of farther and systematic trial.

Collodion and its kindred preparations, the solution of Gutta
Percha in Chloroform and Gum Shellac in Alcohol^ are agents
which promise to be useful. Collodion has been much lauded
as an application to Erysipelas, and it is, therefore, proper to
hear the testimony against it as well as that adduced in favor
of its efficacy. Having recently had charge of a case of this
disease, I applied the collodion very early to the part affected
and a little beyond the inflamed surface. But the disease ex-
tended rapidly from the ear to the face and scalp, and in a few
days invaded the entire head and a portion of the neck. The
collodion was persevered in to the last without appearing to ex-
ercise any controlling influence whatever. My patient recov-
ed, it is true, but I cannot attribute this result to the local ap-
plication. This is the only case of erysipelas in which 1 have
used it.

Solution of Gutta Percha in Chloroform. This is made by
dropping into a vial containing chloroform small fragments of
pure gutta percha until the solution acquires the consistence
of thick mucilage. It is then applied with a camel hair pencil,
which should afterwards be repeatedly dipped in pure chloro-
form and carefully wiped with paper or old linen so as to pre-
vent its becoming stiff and unfit for farther use.

I will now relate the result of its application in two cases of
cancerous affection.

Mr. L. had been troubled with an epithelial cancer of the
lower lip which had resisted all applications for eighteen months.
There existed, upon the right side of the median line and at the
junction of the skin and mucous surface, a small and thin scale

1852.] Dugas, on certain New Remedies, 6G9

or scab, which would occasionally fall or be rubbed off, leaving
a raw surface of exquisite sensibility exposed to irritation until
another scab would be formed. Beneath this surface there was
an induration about the size of a common pea, or rather a little
larger, in which the patient frequently felt a very annoying
sense of burning, and sometimes darting pain.

At this stage of the case, as the patient was averse to the
knife, he was advised to try the application of collodion, which
he diligently persevered in for about six months, applying it
three or four times daily. This arrested the farther growth of
the disease, relieved its itching and burping, protected its
surface from ordinary irritants, but did not heal the denuded
surface. He then substituted the solution of gutta percha in
chloroform in lieu of the collodion. In a letter to me he thus
describes its effects : *' In a few days I saw and felt a change
in the color of the sore and in the irritation ; in a week or ten
days, the lump disappeared and the irritation subsided, and in
three weeks it was almost entirely healed over ; in less than a
month it was well, leaving an indentation on the lip."

In a note dated the 1st of this month, (April,) my patient
writes me : "I begin to feel a return of it in the same place the
cure was made eighteen months ago. Recently a lump has
appeared in the lip ; it is hard and sometimes a little sore it
gives me no trouble yet, but I am afraid of it." I will advise
him to use the gutta percha and chloroform again.

The next case was that of Maria, a negress, about 50 years
of age, who was sent to me from the country on the 3d of No-
vember last, with a cancerous ulceration of the mamma of sev-
eral months standing. Both mammary glands were very much
atrophied, but the affected one was the smaller of the twOy
presented nothing but a mass of schirrous induration which
seemed adherent to the thoracic walls, and in the depressed
centre of which the remains of a nipple were to be seen drawn
back and ulcerated. The ulcer covered a surface equal to the
areola^ The axillary glands were much enlarged, and the pa-
tient a prey to continual pain, especially at night, which de-
prived her of sleep.

Feeling satisfied that the knife promised no relief under such
circumstances, yet unwilling to send her off without trying

670 Dugas, on certain New Remedies. [November,

something, I put her upon the use of the gutta perchaand chlo-
roform, thoroughly coating the whole breast daily with it. The
discharge from the ulcer would at first cause the pellicle of
gutta percha to become loosened in tw^enty-four hours, so that
the surface had to be cleansed before the re-application of the
remedy. The suppuration, however, gradually lessened until
the coating would remain a week the painting still being made
each morning. Under this treatment, the patient was gradu-
ally relieved of all pain about the breast and even in the axilla.
She slept quietly at night, enjoyed her meals and felt quite
well. Her general health improved, and she left at the end of
one month, with instructions to continue the treatment perse-
veringly, and to get her master to inform me of the result. I
have had no report from her since, but have learned incidental-
ly that she never applied the remedy after she left here, and
placed herself under the charge of some one who professed to
be able to cure cancers with what result, I know not.

These two cases are narrated with the simple purpose of
directing attention to an application which may stay, if it does
not cure, so formidable an affection as cancer.

Solutipn of Shellac. The costliness of the solutions of gun
cotton and of gutta percha renders it desirable to have a cheap-
er article that may be used as a substitute in cases which
require the consumption of a large quantity of such plastic
materials. A solution of shellac in alcohol has therefore been
proposed for this purpose. This may be prepared by adding
successively small bits of shellac to the alcohol of commerce
until enough be dissolved to make a mucilaginous solution.

Some of the French practitioners having attributed to collodi-
on extraordinary antiphlogistic properties when applied over
afffected joints and other inflammatory affections, even more
deeply seated, I determined to try, during last winter, the shel-
lac solution in an old case of Rheumatism, in which most of
the joints of the extremities were being successively invaded.
The toes, ankles, knees, fingers, wrists and elbows were nearly
all alternately implicated becoming very painful and rapidly
swelling, so as to be almost doubled in size in a day or two.
I furnished the patient a bottle of the shellac solution and or-
dered it to be painted over and around the joint as soon as it

1852.] Ricord's Letters on Syphilis. 671

would commence to be painful, and to repeat the application
several limes a day until a thick coating remained, after which
it might be applied only once a day. Under this treatment I
was gratified to find that the patient could, in a few hours, ar-
rest the pain and prevent the swelling of the joints to which he
made the application. He stated that he never had any thing
to give him such prompt and effectual relief, although he had
been suffering such attacks every winter for the last ten years.
One joint or another continued to annoy him for a month,
during all of which time he resorted to the shellac with the
same success.

This is the only case in which I have tried this solution.

[Trans, of the Med. Soc. of the State of Georgia.

PART II.
(c[ttiit Pii^artnunt.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French by
D. D. Slade, M. D.

[Continued Irom Page 618.]

THIRD LETTER.

My Dear Friend, The conclusion which terminates my
last letter, The blennorrhagia of which the muco-pus being-
inoculated gives rise to no result^ does not recognize the syphil-
itic virus as cause, this conclusion, deduced from undeniable
facts, again places the history of blennorrhagia at the same
point from which it has been transmitted to us in the book of
Leviticus. Old as man, older than he, for animals created be-
fore him are subject to blenorrhagia, and not to the verole, this
disease has nothing in common with the syphilitic infection.

In spite of those, who, since Paracelsus, Bethencourt and Fal-
lopius, have wished to make of blennorrhagia, not symptomatic
of chancre, a new disease identical with syphilis, the researches
that T have made, corroborating the descriptions so exact of
Alexander Benedictus and of Cataneus, have given to the doc-
trines of Balfour, of Todus, and of Duncan, the value and the
solidity that Bell would have given them himself, if he could
have explained the facts supposed to be exceptional, as we can
explain them at the present day.

But blennorrhagia, as I understand it, absolutely different

672 Ricord's Letters on Syphilis. [November,

from syphilis in its causes, in its form, and in its consequences,
does it depend upon a special virus?

There would be nothing repugnant in admitting a special
cause having the power specifically and constantly ot" producing
blennorrhagia and its consequences. Nothing is more apt, in
fact, to determine a blennorrhagia, than the muco-pus furnish-
ed by certain inflamed mucous surfaces. But when we go
back in the strictest manner, and with the most rigid observa-
tion, to the causes determining the best characterized blennor-
rhagia, we are forced to see and to confess that the blennor-
rhagic virus ordinarily has no share in it.

Nothing is more common than to find women who have
communicated blennorrhagia the most severe and the most
obstinate, with the most varied and the most serious blennorrha-
gia consequences, and who were only aflTected with uterine
catarrhs, sometimes scarcely purulent. Quite often the men-
strual flow appears to have been the only cause of the commu-
nicated disease. In a great number of cases, in fact, we do
not find anything, or only some errors in diet, fatigue, excess
in sexual relations, the use of certain drinks, such as beer, or
of certain articles of food, such as asparagus. From these cir-
cumstances spring that frequency of belief very often correct,
that a gonorrhoea has been caught from a woman perfectly
healthy.

Upon this point I am certainly aware of all the causes of error
and I pretend to say that no one is more careful to guard against
the frauds of every kind sown upon the steps of the observer
than I am. It is, therefore, with full knowledge of the causes
that I sustain this proposition.

PROPOSITION.

Women frequently give blennorrhagia without having it.

Blennorrhagia, such as some individuals persist in understan-
ding it, that is to say, as the consequence of a contagion, is as
rare in women as it is common among men. I do not believe
that I advance too much when I say that women give twenty
gonorrhoeas where they contract one. And this is easy to
understand, for women so subject to discharges not syphilitic
from the genital organs, are the most frequent source of dis-
charges which in the man cannot be considered as an effect of
contagion.

It has been impossible for me to consider as serious the doc-
trine of m^y learned colleague, M. Cazenave, who admits very
readily that many women under the influence of chronic utero-
vaginal catarrhs, can have sexnal relations without communica-
ting any thing, provided that they are not '' echaufees" to the

1852.] mcords Letters on ISypliiiis. 673

degree of virulence, or that they are not raised, so to speak, to
a red heat. Is it not more simple to understand and more ration-
al to sav, that with a less degree of excitement, the secretions
are less irritating, and that the being habituated to these secre-
tions, would produce an immunity for some persons, and a sort
of acclimation. It is thus, as I have frequently seen, that a
married woman can cohabit with her husband without commu-
nicating any thing; but should a lover come, this last contracts
ablennorrhagia. The husband was acclimated, the lover was
not. When one studies blennorrhagia without prejudice, with-
out preconceived ideas, he is forced to acknowledge that it is
often produced under the influence of most of the causes which
determine the inflammation of other mucous surfaces.

The experience of Swediaur is here to prove this. This
observer injected volatile alkali into the urethra, and produced
a blennorrhagia. Does this experience show that a blennorrha-
gia can be always produced, and at will, by irritating injections?
jVo, certainly not, no more than a coryza or an ophthalmia
could be produced by the same means. For a blennorrhagia,
as for every other inflammation, the pre-existence of predispo-
sitioij, that great unknown influence which dominates over all
pathology, is necessary. This is proved by the fact that a blen-
norrhagia is not always taken in those same conditions where
it is the most evidently communicable. Without this fortunate
immunity which the absence of predisposition gives, blennor-
rhagia, already very common, woulJbe still more so.

An experience of twenty years has taught me, and permits
me to affirm, that excepting blennorrhagic discharges sympto-
matic of chancre, it is often perfectly impossible to recognize
the cause of a blennorrhagia.

I know that many of my colleagues obstinately refuse to ad-
mit this opinion ; every blennorrhagia awakens in them the idea
of syphilis, and their therapeutic prescriptions are but the logi-
cal result of their prejudices.

Here, my dear friend, I ought to make to you a confession,
and I shall make it publicly. This persistence of some of my
honored and learned colleagues, to always consider and to
treat blennorrhagia as an accident of a syphilitic nature, has
often astonished me. Thus it has many times happened to me,
not to satisfy a frivolous curiosity, much less to yield to a cul-
pable, slanderous motive, but to enlighten and re-assure my
mind, to have recourse to a stratagem of which I wish to make
the avowal with all the reserve and the delicacy that I owe my
honorable brethren.

It was under the following circumstances : A man present-
ed himself at my consultation with well-marked blennorrhagia.

674 Ricord's Letters on Syphilis. [November,

He stated to me that he had had relations with but one woman,
and that this woman was his wife or his mistress. This man
was uneasy or alarmed. He brought with him the woman the
cause of his trouble, and the latter, protesting her innocence,
along with the patient, supplicated me to submit her to the
most rigorous examination. This examination, made with all
the attention and care of which I was capable, showed me the
sexual organs of this woman in a perfectly healthy ?tate. There
was nothing, absolutely nothing, m the most profound folds of
those organs which could explain the blennorrhagiaof that man.
I becrged the woman to pass into a neighboring room, and alone
with the patient, I made use of all the means possible, of which
I spare you the details, to arrive at this certainty, that the
patient had had no sexual connections but with this woman ; it
was in these alone that he could have contracted the disease
which he had. I reassured the husband or lover; I acquitted
the wife or the mistress ; but I begged them both to be accom-
plices in a little stratacrem, which it remains for me to indicate.
I sent them both and separately, let it be well understood, to
such of my learned colleagues whom I know to be direct anta-
gonists to me upon the question of blennorrhagia. I said t^ the
patient, demand clearly this question: is my blennorrhagia
syphilitic? I said to the woman, demand distinctly, could I
give a blennorrhagia to a man? The couple returned to me,
the man with a diagnosis thus written '^syphilitic hlennor-
rhasia ; the treatment fonowed ad hoc. The woman return-
ed with this '' the perfectly healthy state of the organs permits
me to affirm that madam could not communicate a malady which
she has not.^^

It is not an isolated fact that I point out to you, my dear
friend ; this experiment I have often renewed, and sufficiently
so, with some variations, to corroborate my convictions, and to
re-establish my ideas. ^

What do these facts signify ? That the cause of a blenor-
rhagia cannot be always known; that this disease can be pro-

* There are some facts more curious still than those relating to blenorrhagia
contracted Avith healthy women. A case analogous to the following has not
been presented, perhaps, to the notice of M. Ricord, but of its authenticity it
is not possible for me to raise the least doubt.

A man ol thirty years of age, a physician, had been continent for more than
six weeks, and his last sexual relations were not of a suspicious character. A
fortuitous circumstance permitted him to pass almost an entire day in company
with a young woman whom he loved. From ten o'clock in the morning until
seven o'clock in the evening, he made vain efforts to overcome the resistance of
this woman, whose virtue did not yield. But during all this time, this physi-
cian remained in a constant state of excitement. Three days after, he was
taken with a blennorrhagia of the most violent and painful kind, which lasted
forty days. Most assuredly here is the lorm of a blenorrhagia not syphilitic.
Aok of ike Editor.

1852.] Ricord's Letters on Syphilis. 675

duced by causes common to all inflammation, if there is a pre-
disposition ; but that the most special agent of blennorrhagia
is the muco-pus furnished by the inflamed genito-urlnary sur-
faces.

This manner of regarding it appears to me more rational
than that which would attribute the blennorrhagia called vene-
real to a sort of half vii'us imagined by our very learned brother
and ingenious writer on syphilis, M. Baumes. To this practi-
tioner, blennorrhagia is a degenerated kind of chancre ; it can
give rise to a constitutional syphilitic infection, more feeble
however, than that produced by^chancre, but without being able,
nevertheless, to reproduce this lattei by means of contagion or
inoculation. "One can then foresee," adds M. Baumes, "the
greatest similarity between the constitutional symptoms which
are the consequence of the one and of the other of these disea-
ses ; and in fact experience proves that the difference between
these symptoms lies not in their nature, but only in their degree
of intensity, in their gravity, and in their situation, which after
blennorrhagia extends generally to few^er tissues, and to a small-
er number of organs, than after chancre." Baumes, Precis
the or ique et pratique sur les maladies veneriennes, torn. ']., page
259.

Here is a true half-way doctrine. This mere theory is neith-
er justified by facts, nor by observation or experience ; one con-
dition is alone wanted to it the proofs.

Hitherto, then, and it is certainly my present opinion, that
simple blennorrhagia is completely stranger to syphilis as to the
causes which can produce it.

But it has been objected to this, that the pus of chancre, that
is to say the syphilitic virus, can produce blennorrhagia. This
opinion is very old ; it has been sustained since the appearance
of the verole in Europe, and it can be very legitimately still
sustained. But what does this mean? Are the observations
of the ancients to be relied upon? They are incomplete and
insufficient ; it is impossible with these to proceed scientifically
from the efiJect to the cause. Would you appeal to experi-
ments similar to those of Harrison, w^ho drew his conclusions
from the production of a blennorrhagia by the introduction into
the urethra of pus furnished by a chancre, without knowing-
what it had physically determined. No, we shall arrive more
simply and more logically at the conclusion of the possibility of
the production of a non-virulent blennorrhagia, by the pus of a
chancre, in considering this pus as having the power to act in
the manner of simple irritants. A woman having chancres at
the inoculable period, could thus produce a blennorrhagia in a
man which could not inoculate. We can thus understand the

676 Ricord^s Letters on Syphilis. [November,

observations of Swediaur and others, in supposing that they had
not committed some error in diagnosis, inasmuch as these ob-
servers made use of neither speculum, nor inoculation obser-
vations which prove that men affected v^^ith chancre, have com-
municated blennorrhagia to women.

Here is what clinical observation teaches, and that which
experiment can demonstrate. It is not rare to see patients with
a chancre of the glans or of the prepuce, successively taken
with balanitis or with balanoposthitis, determined by the irrita-
ting action of the pus of the chancre. But while the chancre
furnishes pus inoculable, the pus furnished by the balano-pos-
thitis is not so. (We shall see later that in order that the viru-
lent pus should act specifically, some conditions are necessary
which are not always met with.)

Faithful to my first conclusion, reducing to their just value
these first objections, I affirm that when Harrison produced
blennorrhagia with the pus of the chancre, either this pus acted
after the manner of simple irritants or it produced an urethral
chancre which was not ascertained. We shall see also later,
than when Hunter produced a chancre with some pus supposed
to be blennorrhagic, it was with the product of a true urethral
chancre that he had operated.

But if inoculation has proved that the cause or the causes of
blennorrhagia, whatever may be its seat in the two sexes, differ
from the specific principle, from the virus whichchancre fa^aZ-
/?/ produces, the consequences of blennorrhagia ought always
to differ from those of chancre ; and yet many constitutional
veroles are attributed to blennorrhagia. These are the ques-
tions which will make the subject of my next letter. We shall
see, also, if it is possible to establish a differential diagnosis
between two affections which some wish systematically to con-
found. You will permit me first to speak a word upon the in-
oculation of blennorrhagia. Yours, Ricord.

FOURTH LETTER.

My Dear Friend, As I promised, I shall say a few words
upon the incubation of blennorrhagia. Incubation has been
made a condition of virulence. Every virulent disease ought
to present a period of incubation. Thus those who admit that
blennorrhagia is a product of a virus, admit equally that this
virus does not produce its first effects till after a time of incu-
bation roore or less long.

I say more or less long, and it is not without reason. The
authors, in fkct, as w^ell for the incubation of syphilis properly
called, have admitted for that of blennorrhagia a period the
most convenient. The term of the incubation has been fixed

1852.] RicorcVs Letters on Syphilis. G77

between some hours (Hunter and others) and fifty and some
days (Bell.) What shall I say ? MM. Cullerier' and Ratier
have reported the history of an incubation which lasted during
five months. Assuredly a very elastic incubation. You know
that matters are far from passing thus in the virulent diseases
where the incubation is incontestable. The limits of the period
of incubation can be more accurately fixed in the variola, in
vaccinia, in scarlatina, in the measles, and in hydrophobia. The
fine works of M. Aubert Roche have ever told us the certain
limits of the incubation of the plague, which never exceeds
eight days. For blennorrhagia, it is a far different thing, as you
will see; here there are no certain limits.

What is, then, this incubation of blennorrhagia, which they
have made me again very recently deny? We must under-
stand this matter ; it is a pure question of words. I do not deny
the evidence ; and consequently I do not deny that between
the action of the cause, and the appearance of I he first pheno-
mena of blennorrhagia, there is a period more or less long;
but is there present an incubation properly called, an incuba-
tion similar to that of the variolic or vaccine virus ? I contest
this, and I explain that time, more or less long, which exists
between the action of the cause and the appearance of the phe-
nomena, by the disposition and by the particular susceptibility
of the tissu-es which have undergone the influence of the cause.
There is no nK>re incubation present in this case, than there is
between the action of an exposure of the feet to cold, and the
appearance of a coryza. One does not blow muco-pus imme-
diately from the nose after such exposure to cold ; there exists a
certain period between these two actions. Do you call this
period the incubation of the coryza ? Why then make use of
a similar expression for blennorrhagia?

In those cases where blennorrhagia does not appear till long
time after one is exposed to the suspected cause which pro-
duced it, is it not more rational to admit another cause which
remains unknown, than that pretended incubation which noth-
ing explains, nothing justifies ? Is it not so in almost all inflam-
mations ? Can you always go back to the direct cause of a
pneumonia, of an arthritis, of a phlegmon? Without doubt,
in man the sexual relations are the most direct cause of blen-
norrhagia; but we should fall into strange errors, if we wish to
refer all blennorrhagias to a virulent cause. I could give you
some very singular examples which prove the contrary, but I
refer the reader to the interesting note with which you have
accompanied my preceding letter.

From this exclusive manner of considering the etiology of
'blennorrhagia, there results often, in practice, a singular manner

N, S. VOL. VIII. NO. XI. 43

678 Record's Letters on Syphilis. [November,

of interpreting facts. A man affected with blennorrhagia has
had connection with several women ; he hastens to make a sort
of moral choice among these women, and by means of elimina-
tion he happens lo fall often upon the most innocent. This
sort of application of the law of suspicion has caused strange
errors to be committed, of which I have often been witness.

Let us then conclude upon this point that the effects of blen-
norrhagia can follow at some distance from the cause which
produces them, but that nothing proves that the period which
exists between the action of the cause and the appearance of
the morbid phenomena, is the result of a true virulent incuba-
tion.

I should prefer, my dear friend, not to make too frequent di-
gressions from my programme, but how can I avoid deciding
incidental questions when they present themselves beneath my
pen ? Such is that of the specific seat of blennorrhagia. You
know that the question of this seat has been much agitated. In
man it has been made to travel from behind forward, from for-
ward backward \ to advance or to retreat, at the will of the fer-
tile imagination of writers upon syphilis. From the spermatic
passages, in passing successively by the glands of Cowper, the
fossa navicularis and the follicles of Morgagni, the seat of blen-
norrhagia has travelled a good deal. It is true that Bell, in es-
tablishing different degrees in blennorrhagia, has made its seat
retrograde from before backwards. But it is laot with these
questions, so well known, that I wish to detain you. I will call
your attention, however, to a singular prepossession of Hunter,
This great observer admitted, as you know, a virulent blennorr-
hagia to be identical to chancre ; he placed the seat of it in the
fossa navicularis ; but he inquires if the inflammation which pro-
pagates itself by degrees towards the posterior portions of the
urethra, continues to be virulent beyond the fossa navicularis.
We must confess that the genius of Hunter yielded to the spirit
of system. Besides, in studying Hunter, we see his observing
genius constantly in contest with his theory of blennorrhagia.
He started with a false idea ; facts come constantly to prove it
to him, but theory is there to obscure his intellect, and in place
of dismantling his theory by facts, he endeavours, on the contra-
ry, to make facts agree with his theory an excellent example
of the dangers of pre-conceived and systematic ideas in the cul-
tivation of the sciences of observation.

In the female, Graff placed the seat of the virulent blennorrha-
gia in the follicles in the neighborhood of the urethra. One of
our brother physicians of Bordeaux, who died a ^qw years since,
Moulinie, thought he had seen in the glands of the vulva (so
well described by Bartholin, and of which Boerhaave has traced

1852.] Ricord's Letters on Syphilis. 679

the pathological history, resumed and completed in our day by
M. HuD^enier) a sort of organ of virulence in a blennorrhagic
point of view.

In the midst ofall these opinions, strict observation shows that
those portions of mucous surfaces the most exposed, are those
which are the most easily affected. Nevertheless, we must
allow that the mucous surface of the urethra in the two sexes is
more often affected after sexual intercourse than the other mu-
cous surfaces of the genital organs. This fact is an argument
for the partisans of the virulent contagion. I will corroborate
it, if they wish, bv this proposition, which appears incontestible,
that a woman attacked by blennorrhagia of the urethra can be
considered as having the most commonly contracted it from a
man suffering from blennorrhagia; and you see that this propo-
sition could have its importance in legal medicine. Thus, for
me, I should be ready to admit that a woman in whom I discov-
ered a blennorrhagia of the urethra had taken it from a man.
But does this fact come in aid ofthe existence of a virulent con-
tagion ? No, and I explain it by this other fact, alone true and
incontestable, that pus furnished by the urethrals the most irri-
tating ofall pus for certain mucous surfaces.

While certain writers on syphilis contest the existence of
blennorrhagia ofthe urelhrain the female, others do not admit
in her of a blennorrhagia except when it has its seat in the
urethra. These two extreme opinions are erroneous. Obser-
vation has led me to admit all the varieties of blennorrhagia upon
all mucous surfaces.

Whilst lam here, will you permit me to disembarrass myself
of some other incidental questions relative to blennori'hagia ? I
shall proceed more freely and more i-apidly afterwards, on the
great questions which remain for me to treat of If I examine
the lesions of tissue which blennorrhagia produces, whatever
may be the mucous coat affected, I do not find anything that
simple inflamation cannot produce. There is sometimes a slight
erythematous condition without secretion. It is the dry blen-
norrhagia of some writers, a denomination ridiculous and absurd,
introduced into the writings upon syphilis, and in view of which
we can admire the persevering efforts of M. Piorry to bi ing a-
bout a reform in the nomenclature. Sometimes we have to do
wMth a mucous element, catarrhal, and with all its products at
different degrees, mucous, mucoso-purulent ; in fine there are
some true phlegmonous complicaticjns which we meet with, from
which result in man for the urethra, the blennorrhagia accom-
panied with chordee, and the quite frequent production of ab-
scess upon the course ofthe urethra.

But neither in the state ofthe tissues nor in the nature of the

680 Ricord^s Letters on Syphilis. [November,

products do we find anythihg which can be compared to theac-
cidents of syphilis properly called.

Are the consequences of blennorrhagia comparable to those
of syphilis? It has been said so, but it has not been proved.
There are some'analogies, v/ilhout doubt, but some notable dif-
ferences also. Thus one of the first accidents which blennor-
rhagia can produce, and which resembles one of those produced
by syphilis, is bubo. But in the first place, enlarged glands are
infinitely more rare as the consequence of blennorrhagia, than
of chancre. In the next place, the bubo is never met with ex-
cept in blennorrhagia of the urethra, in the two sexes, the other
varieties never giving rise to enlarged glands. I well know that
one of our fellow medical men of Belgium speaks of buboes
peri-aiiric2daires, which ought to manifest themselves in blen-
norrhagia of the eye, but I must confess that I have yet to look
for an example. In fine, the blennorrhagic bubo has this spe-
ciality, that purely inflammatory, it has very little tendency ta
suppuration, and when this happens it is never inoculahle.

Do you wish to follow out that which blennorrhagia can pro-
duce ordinarily upon the two sexes ? Take blennorrhagic
ophthalmia, which never manifests itself but during a blennor-
rhagia of the urethra : in good faith, is it possible, unless we
wish to confound everything, to establish the least comparison
between this ophthalmia and syphilitic iritis ?

With regard to blennorrhagic rheumatism, is it reasonable to
establish the least difference between this affection and the acci-
dents produced by syphilis upon the osseous system ? Is there
anything in the world more unlike than blennorrhagic arthritis
and exostosis, for example ?

What should I say of the cutaneous affections, except that I
am profoundly astonished that some physicians have wished
to discover a resemblance between the cutaneous affections pro-
duced by certain remedies employed in the treatment of blen-
norrhagia, and the special affections of the derma that syphilis
produces. The previous holding of a false doctrine has here
produced some very strange confusions. Blennorrhagia, it has
been said, produces cutaneous affections like the chancre; and
the roset^la which succeed the use of copaiba and of cubebs
have been cited as examples. I assure you that these roseola
do not appear but when these resins are given. They answer
me but they do not appear except when there is a blennorrha-
gia existing. I answer, in my turn, that copaiba and cubebs
are not given, but when there is a blennorrhagia. I add, and
this is important, that I have administered copaiba in cases of
vesical catarrh, and I have often seen these exanthemata make
their appearance.

1852.] Ricord's Letters on Syphilis. 681

But these resinous exanthemata have characteristics so
marked, that with the strongest disposition in the world, it is im-
possible to confound ihem with genuine syphilitic exanthemata.
They are developed generally with great rapidity; they are very
icute, of ruheolic form, or often connected with lichen urticar-
ias ; if they are not very confluent, they are grouped preferably
in the neighborhood of the articulations, and in the sense of ex-
^nsion, such as about the wrist, elbow, knee, instep, and around
the ears ; they are commonly accompanied with much itching,
which is the contrary of syphilides, and a most important con-
dition ; so that we can say of them suhlata causa tollitur effec-
tus. In fact, they rarely survive a week the cause that produ-
ced them.

These exanthemata bring to mind a curious fact, which I ask
you to permit me to relate in the form of an episode; it has also
its instruction. Two or three years since, one of our most dis-
tinguished brother physicians presented himselfat my house
very much friglitened. Until now, said he to me, 1 have had
faith in your doctrine, but I find it at fault, and in my own case,
that is truly hard. So saying he took off his clothes and said,
" What is this?" showing me his chest and back. I examined
and said, ''That is a beautiful syphilitic roseola," "Syphilitic,
do you say ; and are you very sure of it ?" "Perfectly sure !"
"" Ah, well, you convict yourself. I have never had in my life
any other venereal accident than a blennorrhagia, and that was
twelve years ago." " On your side are you very sure of that .i'"
*'Just as sure as of my existence. I examined my friend from
head to foot, and having done so, I said to him gravely, and with
a certain air of solemnity, "Friend, you have rece/i^/z/ had a
chancre upon the ri^ht hand, and the chancre was situated
neither upon the ihumb, nor upon the index finger, but upon one
of the three last fingers." "You are joking," said he. "lam
joking so little," I added, "that you still carry a bubo," and I
made him feel, in fact, an axillary gland still enlarged. Then
my friend, recalling his thoughts, told me that some months be-
fore he had attended and dressed a woman who had chancres ;
that an ulceration had come upon the middle finger, that he had
not taken care of it, and that this ulceration had cicatrized.
There is the source of your roseola, said I, and act accordingly.

Finally, what physician at the present day could confound
the blennorrhagic epididymitis with the syphilitic sarcocele ?
It is no longer possible, since the time of Bell, still less possible
since the works of Astley Cooper, and since what I myself have
done in regard to this subject.

You will permit me to pass in silence the pretended tubercul-
ous diathesis invented in Germany as a consequence of tlieblea-

682 Elephantiasis, [November,,

norrhagic virulence. The question of tubercles in general is
already sufficiently obscure, without adding to it any new dark-
ness.

You see, dear friend, that I approach at last the programme
that I had traced out for myself. In my next letter I shall enter
upon it resolutely. \_Boston Med. and Sur. Journal.

Elephantiasis Arahum of the Hght inferior extremity success-
fully treated by Ligature of the Femoral Artery. By J. M.
Carxochax, M. D., Professor of the Principles and Opera-
tions of Surgery in the New- York Medical College, Surgeon
to the State Emigrants' Hospital, Opthalmic Surgeon to the
same Institution, &c., &c.

Case. Charles Roller, of lymphatic temperament, and short
stature, set. 27, born in Aix-la-Chapelle occupation, mei*chant,
left his home in December, 1849, landed in New- York in
February, 1851, went thence to Connecticut, where for eight
months he worked in a factory, standing during his hours of
labor; thence went to Virginia, where he worked on a farm
for about six months, at the expiration of which period he was
taken with fever, of an intermittent character. Up to that
time, he had always been in good health.

During the fever, the inguinal glands became swollen and
painful ; the swelling and pain extending in the course of the
femoral vessels as far as the knee. The pain was followed by
swelling and redness of the thigh down to the knee. From the
knee, the pain and swelling continued to extend downwards as
far as the toes ; being, at this time confined chiefly to the por-
tions of the limb along the course of the saphena vein, and also
of the posterior tibial vessels. The redness and tumefaction
here, as in the thigh, was preceded by deep-seated pain. The
tumefaction of the limb continued to increase; while, at the
same time, febrile exacerbations occurred at intervals, varying
from two to six days. After a period of about six weeks from
the commencement of the disease, the fever entirely disap-
peared, and by this lime, also, the pain and redness had entirely
ceased ; the limb, however, remaining hard, swollen and rough,
and presenting, in a marked degree, the peculiar characteristics
of elephantiasis Arabum, in the chronic period of the disease.
From this time forward, the hardness and intumescence gradu-
ally increased, and the limb became so cumbersome, that the
patient was obliged to give up all business, and confine himself
chiefly to a recumbent posture. In this condition, the patient
left Virginia for the purpose of seeking medical relief at the
New- York Emigrants' Hospital, into which he was admitted

1852.] Elephantiasis, 683

the fifteenth of January, 1851. The appearance of the patient
upon entering the Hospital was somewhat emaciated. He had
no febrile symptoms, and the chief difficulty, under which he
labored, arose from the enlarged and hypertrophied condition
of the right inferior extremity.

The limb was enlarged from the toes to within a short dis-
tance below Poupart's ligament. The thigh, although enlarged,
was not much indurated ; while, from a short distance above
the patella, downwards, the limb presented a dense, hypertro-
phied, hard, scaley, shapeless mass, the appearance of which
will be best apprehended by referring to accompanying plate,
the morbid condition of the tissues pervaded the foot and toes,
there presenting groups of t uberculated growths. The circum-
ference of the limb around the ankle, was nearly as large as
that of the calf; measuring fifteen and one-half inches, while
the circumference of the calf measured nineteen and one-half
inches.

The patient was put under treatment upon entering the
Hospital. The recumbent posture was enjoined, and for some
time various discutient lotions were used. Bandaging w^as
resorted to, with frictions of ung. Potass. lod. ; the Iodide of
Potassium being also prescribed internall}^

At times, also, the limb was painted with strong tincture of
Iodine; local and general baths were used, regular bandaging
of the limb, from the toes upward, being the while carefully
observed.

This plan of treatment was perseveringly adhered to from
the fifteenth of January to the twenty-second of March, a pe-
riod of a little over two months, without any amelioration.
Having thus tried, without success, the method of treatment
most approved of, I proposed to place a ligature upon the fem-
oral artery, with a view of changing the morbid condition of
the structures supplied by the branches of this arterial trunk.
A consultation was held, and my proposition was acceded to as
preferable to amputation, the usual alternative resorted to in
this stage and extent of the disease. Accordingly, on the
twenty-second of March, 1851, I secured the femoral artery, a
short distance below the origin of the arteria profunda. Upon
exposing the femoral artery, this arterial tube was found to be
changed, so as to present an appearance somewhat like the
color of the aorta of the ox, and to be larger than the commoK
iliac of the human subject. In consequence of this appearance
of the artery, after some hesitation, I applied the ligature, pre-
ferring to do this, ratner than to expose the external iliac, of the
soundness of which I could not be certain.

The ligature came away from the femoral artery on the

684 Therapeutic Properties of Arnica Montana. [November,

eleventh day, accompanied by secondary hemorrhage, the oc-
currence of which I had expected as probable. For the pur-
pose of arresting the hemorrhage, \Y[Q external W'ldiC. artery was
secured by ligature, by Dr. A. E. Hosack, who happened to be
on duty at the time in the Hospital. The external iliac was
found to be about the size of the brachial artery. This, for a
time, apparently had some influence upon the hemorrhage ;
but on the following day, bleeding was again renewed from the
orifice, in the femoral artery, with as much profusion as ever.
The hemorrhage was now restrained by the prompt applica-
tion of a tourniquet, on the cardiac side of the bleeding orifice,
by the house surgeons, Drs. Thompson and A. K. Smith.

This even failed to stop permanently the hemorrhage, and
the blood recommenced oozing copiously at intervals. The
patient was now sinking fast, and the ligature of the common
iliac, or amputation at the hip-joint, appeared to be the only re-
sources left. But the hemorrhage now being evidently reflux^
it was suggested to apply the tourniquet, so as to produce com-
pression on the distal side of the bleeding orifice : this was
done, and was followed by a complete cessation of the bleeding.
From this time, (April fourth, 1851), the house surgeon kept
an instructive record of the case, which record I have now
before me. For several days, the pulse ranged from 115 to 108 :
the dressings were carefully attended to, and light diet pre-
scribed. On the twelfth, the leg was found to be considerably
reduced in size, and the ligature of the external iliac, came
away. On the seventeenth, brandy and quinine, with good
nourishment, were ordered. On May the first, finding the leg
still more reduced and the lower wound healed, I ordered tinc-
ture of iodine to be painted on the leg, and the bandage to be
continued ; I also ordered a solution of chloride of soda to be
used as a wash on the upper wound, which continued to dis-
charge freely.

The patient now went on gradually improving in strength
and appearance, and left the Hospital in the latter part of
June, completely cured of his malady. At this date, sixteen
months after the ligature of the femoral artery, the patient is
In robust health, and presents no indications that the disease
will j-eturn. [^New York Journal of Medicine,

On the Therapeutic Properties of Arnica Montana. By M.
Martin Lauzer.

Contusions, Ecchymosis, Sanguineous Tumors, etc. The
efliicacy of arnica in these affections was first discovered in
Germany ; and gained for it the name of Fallkraut, or herba

1852.] Therapeutic Properties of Arnica Montana, 685

lapsorum. It was formerly applied as a topical remedy ; but
at present it is more usual to trust to nature, and to employ
rather camphorated spirits and saline lotions. It is not unrea-
sonable, however, to give arnica internally after a fall, if the
patient has, as often happens, undergone violent concussion
amounting to stupor; but when reaction has set in, medicines
of another class must be used.

Pulmonary Diseases. Murray extols the power of arnica
in a host of various diseases ; and, in the first place, we have
pulmonary affections, of which the names have in the present
day changed : such as pain in the side with dyspnoea, false
pleurisy, humeral cough removing in the summer and autumn ;
cachectic and o^demalous cough ; asthma arising from sudden
chill, with rheumatism of the chest and back; asthma follow-
ing delivery, with alteration of the voice and pain in the nape
of the neck ; peripneumonia. The tonic and stimulant proper-
ties of the arnica would evidently be far from always service-
able in these diseases, some of which correspond to pneumonia
and pleurisy, others to catarrhs, or to convulsive coughs. But,
according to Dr. Roques, the nauseating properties of arnica
have several times triumphed over obstinate catarrhs. In these
cases, the arnica should be combined with pectoral medicines,
and its use must be persevered in for some time. Arnica is no
less useful, according to the same author, in cases of pneumonia
of an ataxic character. In these cases, the arnica is given
with extract of cinchona ; this combination excites the powers
of the system, reanimates the action of the lungs, and favors
expectoration.

M. Martin Lauzer remarks that M. Guitrac gives large
doses of tartar emetic in chronic catarrh ; and Professor Brous-
sonet and Cruveilhier give large doses of ipecacuanha in the
same affection and in the pneumonia of old persons ; and sug-
gests that arnica might produce similar effects, in such cases,
to those of ipecacuanha.

Arnica has been recommended by various authors in inflam
mation of the liver with petechiae, suppression of the menses or
lochia, uterine haemorrhage, congestion of the spleen, nodosities
of the breast, general atony, hectic fever, atrophy, calculous
nephritis, and contractions of organs.

Paralytic Affections. The writers of the last century have
chiefly pointed out the effects of arnica in cases of paralysis.
Juncker states, that he cured more paralyzed and contracted
limbs with arnica alone, than with combinations of remedies.
Collin states, that he cured tremblings, convulsions, palsies,
and other nervous affections. Under the influence of this
remedy, the patients had pain in the eyes, creeping and tick-

686 TJiei^apeutic Properties of Arnica Montana. [November,

ling sensations in the limbs, and a sense of heat ; and these
phenomena almost always were prognastic of benefit. These
effects are precisely those produced by strychnine ; hence
arnica would be a succedaneum for this formidable agent ; and
why should it not be employed before having recourse to the
preparations of nux vomica? Collin says that, in cerebral af-
fections, arnica is contra-indicated until the fever has ceased,
or has diminislied ; and then nitre must be added to it. Korn-
beck extols the action of arnica in mercurial paralysis : it would
evidently be only useful in asthenic palsies, in whatever situa-
tion. Dr. Roger relates the case of a woman who, after fever,
had a sense of weight and loss of power in the lower limbs.
Under the use of powder of arnica flowers, she experienced
creeping sensations and pain, followed by complete restoration
of motion and sensation. According to Collin, Murray, and
Conradi, arnica has also cured cases of asthenic amaurosis ;
but M. Martin Lauzer believes, with Schumucker, that it al-
ways fails in cases of amaurosis which have slowly gained
their highest degree of intensity.

Spas7ns and convulsions : convulsive cough. Arnica, accord-
ing to Murray, has cured tremblings of the limbs or tongue,
opisthotones, convulsive movements of the head, and twitch-
ings of the limbs. If these affections are nervous, of asthenic
origin, and consequently calling for the employment of tonics
and stimulants, arnica may be of use.

Intermittent Fever. Collin, Stoll, Aaskow, Deiman, and
Voltelen, praise arnica as a remedy in ague. Stoll was very
successful in the treatment of a quartan, which resisted cincho-
na. He made an electuary with flowers of arnica and syrup
of orange peel ; and gave a piece as large as a nutmeg four
limes a day. This dose caused severe pain in the stomach,
and cold clammy sweats, with a large, full, and very slow
pulse ; but opium calmed these symptoms, which, however,
were the forerunners of a rapid cure of the fever.

Typhoid Fever. It was in the treatment of this disease that
arnica enjoyed its best days; but here its fame also suffered
dire shipwreck, thanks to its abuse by the Brownians, who
almost used it as a specific in continued fevers. Collin said
that arnica, by its cardiac power, removes stupor, somnolence
and delirium, in putrid fevers, brings back the eruption of sup-
pressed exanthemata, and resolves metastatic swellings. But
Murray judiciously adds that, in order that the desired result
may be produced, we must take account of the season and of
general conditions; words full of justice, a reflection on which
would have prevented the abuse of using a single remedy in a
disease so variable in its form. Stoll, who introduced the use

1852.] Therapeutic Properties of Arnica Montana. G87

of arnica in putrid fevers, gave it only in those cases in which,
the pulse remaining nearly quiet, the patient was feeble, stupe-
fied, prostrate, in a state of somnolence, or muttering delirium.
Arnica is also particularly indicated where the pulse is small,
weak, and fluttering, with torpor and prostration of the muscu-
lar system. Dr. Roques says that it should be used especially
in the enervating diarrhoea, in the obstinate dysenteric flux
which, in the third stage of typhus, threatens to entirely destroy
the vital powers. Murray recommends it, combined with cam-
phor, when gangrene has supervened on other adynamic symp-
toms.

In the campaigns of the empire, the good effects of arnica in
the army-typhus have been observed and recorded. Dr. Ca-
zin, who used it successfully in the army hospitals during the
campaign in Germany in 1809, has since that time frequently
employed it in the adynamic stage of typhoid fevers, combining
it with the roots of valerian and angelica, which dilute its
emetic and cardialgic properties.

Gout. Barthez has recommended arnica in the treatment of
gout. Dr. Roques was of opinion that the best treatment of
gout is to torment the patient as little as possible with medi-
cine.

Summary. Arnica is an energetic excitant, which is far
from meriting the oblivion into which it has fallen. Its tonic,
excitant, and emetic action, allies it to ipecacuanha ; and the
nervous symptoms which it secondarily excites, give it some
relation to the prepaiations of nux vomica. Gilibert considered
it tonic and aperient in small doses : and in large doses emetic,
purgative, diuretic, sodorific, and emmenagogue. When given
alone, it is liable to produce more or less severe pain in the
stomach. This may be prevented or assuaged by combining
the arnica with a small dose of opium or some aromatic, such
as angelica, canella, or ginger. But if its nauseating eff*ects be
desired, it must be given alone.

Doses and mode of administration. The infusion^ accord-
ing to the formulary of the hospitals of Paris, is made by in-
fusing for an hour, a drachm of the flowers in a quart of water^
and straining. The decoction is made with the same propor-
tions: it is more powerful. The dose of the infusion may be
as much as an ounce, sweetened with syrup.

The powdered flowers may be given in doses of from ten
grains to three or four drachms, in electuary or bolus ; this
form is preferable in cases of paralysis. The powdered root
may be given in the same manner.

The dose of the distilled water is from an ounce and a half to
three ounces of the alcoholic tincture (one part of the root to?

688 Ancesthetic Agents in Gun-shot Wounds. [November,

eight of alcohol) from fifteen minims to five drachms; of the
ethereal tincture (one part of flowers to four of ether) from fif-
teen minims to two and a half drachms ; of the aqueous extract
(one part to five of water) from seven grains to a drachm, in a
draught or in pills; of the alcohoHc extract (one part of flowers
to eight of alcohol and one of water), the same quantities.

For External Use, the leaves and flowers may be used as a
poultice: and the powder may be employed as a sternutatory.

Compound infusion of arnica flowers. (Roques.) Take of
arnica flowers, valerian root, each two drachms; infuse them
in a closed vessel with half a pint of boiling water ; then strain,
and add, of peppermint water two ounces, simple syrup one
ounce, ether a drachm, tincture of opium from fifteen to twenty
drops ; to be given by spoonfuls in the adynamic period of
typhoid fever.

Compound preparations of arnica. The above-named pre-
parations are advantageously combined with wine, cinchona,
camphor, and valerian.

Compound powder of arnica root. (Roques.) Take of ar-
nica root in powder fifteen grains ; camphor three grains; to
be given every three hours in dysenteric typhus, to combat the
prostration of the vital powers.

Stimulant bolus. Take of camphor, arnica flowers, and trea-
cle, each fifteen grains ; divide into twelve boli, and give one
every hour.

Stimulant electuary. Take of powdered arnica root an ounce
and a half, crude opium three-quarters of a grain, syrup a suffi-
cient quantity. Divide it into six doses ; one to be given every
two hours in case of purulent absorption.

Aromatic tincture of arnica. Take of arnica flowers an
ounce and a half; cloves, canella and ginger, each two and a
half drachms ; anise, three ounces ; alcohol, a quarter ; macerate
for eight days, and strain. A spoonful in water two or three
times a day in contusions. [London Jour, of Med. Ibid.

On the Effects of Ancesthetic Agents in Operations for Gunshot
Wounds. By J. B. Porter, M. D., Surgeon U. S. Army.

In our former paper, the case of WilHamson was presented
with some remarks in relation to the use of sulphuric ether for
producing anaesthesia in operations in the General Hospital at
Vera Cruz, in 1847. In the summer of that year, an amputation
of the thigh was performed, the patient having been put under
the influence of ether, in which the hemorrhage was almost un-
controllable. The blood spouted in all directions, and I have

1852.] Ancesthetic Agents in Gun-shut Wounds. 680

never seen an operation where it was necessary to secure so
many bleeding vessels. Even after every small vessel that
could be got at was secured, it was necessary to use cold water
freely to suppress the general oozing of blood. At the time, 1
imputed the obstinate hemorrha^ze to the pernicious influence
of the ether. In gunshot wounds anaesthetic agents are almost
universally unnecessary, and are almost universally injurious.
It was for this reason that they were entirely given up in the
hospital at Vera Cruz.

It may be well questioned whether anaesthetics are not cal-
culated to produce injurious effects in all important amputa-
tions ; but they certainly do so in operations performed for
gunshot wounds. M. Velpeau says: "Chloroform evidently
depresses the nervous system, and as great prostration always
exists in patients who have received gunshot wounds, it is ad-
visable to refrain from any anaesthetic means." Ranking^s
Abstract, 1848. Mr. Alcock refers to the cases of soldiers
wounded in battle, where the excitement is such as to carry
them through almost any operation. I regret that Mr. Alcock's
paper is not before me. These are the cases spoken of by Mr.
Guthrie: " Soldiers in general are anxious to undergo an opera-
tion when they find it inevitable, and frequently press it before
the proper time; that is, before they have sufficiently recovered
the shock of the injury." Gunshot Wounds, p. 232. These are
the cases which require a little more time, some "encouraging
words," and perhaps a little wine or brandy and water; but
no anaesthetics, for the patients are already sufficiently de-
pressed.

There are two sets of cases; in one (Velpeau's), the shock
to the nervous system is great, from which the patient may
not recover, and the use of anaesthetics would be awfully de-
structive; in the other class, they are unnecessary, and would
prove useless and injurious. In the flap operation they must
prove more injurious than in the circular ; from the fact that
muscle forms almost the entire covering for the stump ; and the
contractility of the muscular tissue is for a time almost annihi-
lated, to be recovered irregularly at irregular intervals. Fur-
ther, after the use of these agents wounds do not heal so readily
by the first intention.

M. Jobert, on the use of ether, states that the local inflam-
mation has proved less, and that union by the first intention has
been prevented. I am able to bear testimony to the correct-
ness of M. Jobert's statement.

I must be permitted to refer to the Transactions of the Amer-
ican Medical Association for 1851, pp. 271, 272, 315,32a In
the Massachusetts General Hospital :

690 AncBsthetic Agents in Gun-shot Wounds. [November^

**It does not appear that the fatal results of amputation have
at all diminished b}' the introduction of anaesthetic agents.'*'

New-York Hospital :

" The general mortality has been for three years and a quar-
ter forty pe?^ centum. As regards the method of operating, we
observe that the amputations of the thigh, in which the fatality
was as high as thirteen in seventeen, were all flap operations.
Eleven of the leg were removed by the circular, one died ; while
of four by the flap, two died."

That is, mue per cent, in one set of cases, and fifty joer cent.
in the other.

"In almost every case chloroform or ether was employed ; but
while it is admitted that anaesthetics may have had some influ-
ence in the increased mortality in the New- York Hospital over
precedingyears, since union by the first intention waspow much
less frequently observed ; still it is to be remembered that hos-
pital gangrene, entirely unknown before and purulent cache-
xia and erysipelas, extensively prevailed there during the past
three years."

Could the anaesthetics have had an influence in producing the
" hospital gangrene, entirely unknown before," and the "puru-
Jent cachexia and erysipelas," as well as prevent union by the
first intention ?

Dr. Lent, Resident Surgeon of the New- York Hospital, says :

"In almost every case, however, either chloroform or ether
was employed ; generally the former until the occurrence of a
fatal case from it in this hospital ; afterwards the latter, from
which we have never had any bad consequences, and which has
never failed to prove efl^ectual. * * * Anaesthetics came into
general use about the period of the commencement of these sta-
tistics. May not the employment of these have had its influ-
ence upon the mortality? This is a very important question.
We do not deny that it may have had some influence in aug-
menting the facility of operations ; but we have seen no reason
to infer that it has, except perhaps the fact that union hy
adhesion seems to have been much less frequent since the
introduction of anaesthetics into this hospital than before.
Whether the two are in the relation of cause and eflfect, it is,
we fear, impossible to determine at present."

In an unhealthy atmosphere or climate, the healing of wounds
by adhesive union is doubly important for obvious reasons ; and
I have often regretted that etherization was so much resorted
to in capital operations at Vera Cruz during a portion of 1847;
nor can I avoid congratulating both the patients and myself that
before the summer had passed away, its employment was wholly
abondoned. Anaesthetics poison the blood and depress the ner-

1852. [ Wound of the Liver. 691

vous system ; and in consequence, hemorrhage is much more
apt to occur, and union by adhesion is prevented. [A?ne?^ican
Jour, of Med. Science.

Wound of the Liver Excision of a large portion of the right
Lobe. By J. C. Massey, M. D., of Houston, Texas.

Some three weeks since I was summoned, in great haste, to
visit a son of Mr. Simmons, at a distance of some thirty miles
from this city. A brother of the unfortunate youth wounded,
had a gun lying across his lap, picking the flint ; it went off,
the contents of the whole load passed into the right hypochon-
drium, and mostly out about the region of* the epigastrium.
The youth, who is about seven years of age, was standing close
to the gun, and it was charged with large shot ; a portion of
the liver protruded through the external wound. A physician
in the neighborhood was sent for, who reached the case about
four hours after the accident. After examination, he viewed
the case as hopeless, and consequently declined doing any
thing ; he visited the case, however, on the next day, and ad-
vised that I should be sent for. On the fourth day after the
accident I visited the patient, accompanied by my friend Dr.
Black. We found him in a very deplorable situation; the an-
terior margin of the right lobe of the liver was protruding
through the cavity on the right and a few lines above the um-
bilicus ; it was in a gangrenous condition, with a portion of the
omentum attached ; the substance of both was so much altered,
that it was really difficult to tell what the protruding portion
was; the abdomen was very tense and hard, the least pressure
giving severe pain ; there was great arterial excitement, ac-
companied by a high inflammatory fever. This is a brief and
very succinct account of the condition of the little patient,
and my friend Dr. Black, as well as myself, regarded the case
in a hopeless condition. I informed his friends, after making
known to them the danger of the operation, that I would oper-
ate, remove the gangrenous portion of the liver, and give him
all the possible chance there could be left for his life. From
the external ciiaracter and appeaiance of the wound, I was
fearful gangrene had extended within the abdominal parieties.

I commenced the operation by enlarging the orifice about
four inches; on examining the substance of the liver, I found
two shot had passed at least two and a quarter inches from its
inferior border, penetrating through it ; the substance of the
liver which was in juxtaposition to the wounds had a thick,
grumous appearance, with sphacelated portions. Under the
circumstances, I determined to excise every portion of the
liver which had the appearance here described.

92 Jaundice of Infants. [November,

Blanchard, in his Anatomica Practica Rationalis, says, " A
small portion of the substance of the liver may be removed
without necessarily inducing a fatal result ; and Dr. Henen,
{Mil. Surg., p. 43li) says, "A deep wound of the liver is as
fatal as if the heart itself was engaged."

I felt great apprehension in excising the amount I was neces-
sarily compelled to do, and when I inform you that I excised
quite one half of the right lobe, equal to twice the amount of
the left, you will then see how easy it is for persons high in the
profession to make statements without proper data.

When the operation was finished, I passed a strong suture
through the abdopiinal parietes, closed the wound, and subse-
quently a vigorous antiphlogistic treatment was adopted. I
wmII not encumber your pages with a long detail of the daily
treatment of this case. Nothing very remarkable, except for
about ten days his discharges were passive, and he could exert
no control whatever; at the present time he is able to exercise
in his room, secretions natural, wound nearly healed up, and I
consider him entirely out of danger.

This is an instance among many which may occur, and which
may serve to prove to the profession, that a case, however des-
perate it may appear, should never be given up without an
effort ; and I do deem it very reprehensible, when professional
men retreat, if I may use the term, in desperate cases. An
operation once undertaken, should always be concluded secun-
dem artem according to the circumstances of the case, howe-
ver desperate may be the supervening results, or the obstacles
that may seem to render the operation unavoidable. Some-
times he will find in spite of all opinions, the patient recovers.
I had a patient to lie apparently lifeless, in Grimes County,
-which is well recollected, under my own Scalpel, and under this
embarrassing situation I finished the operation, and my doing
so is the means of his present enjovment of health, and his friend-
ship to me. I was kindly assisted by my friend Dr. Black.
[^New Orleans Med. and Sur. Journal.

On the Jaundice of Infants. By M. Duclos,

Although this frequent affection of early infancy does not, in
the great majority of instances, present any danger, it occa-
sionally gives rise to important occurrences, and indeed, when
complicated with other affections, may sometimes prove fatal.

Besides the yellow colour, the icterus of infants may be at-
tended with fever, somnolence, tension of the belly, and colic,
with constipation or diarrhoea. Its causes may be ranged under
Sve different heads, which it is of importance to distinguish.

1852.] Burns and Scalds, 693

1. Retention of the meconium is the most frequent of all. If it
be not evaciiaied within twenty-six hours, colicky pains are set
up, and the skin becomes yellow. The colostrum is in this case
the best purgative. When the child cannot or will not suck,
a tea-spoonful or two of the syrup of rhubarb, chicory, and
peach-flowers, equal parts, may be given. When, after the
meconium has been passed, a considerable degree of tympanitis
remains, together with what is called " windy colic," prevent-
ing sleep, M. Duclos administers small doses of rhubarb and
calcined magnesia. 2. The next in frequency is spasm of the
digestive organs. The child suffers from cardialgia and colic,
is in a state of fever, is constantly trying to suck, and has few
or greenish stools. Sometimes convulsions occur. Purging
and vomiting aorgravate in place of relieving the condition.
As retained meconiurii is usually the origin and cause of the
symptoms, that must first be obviated, and then recourse had
to emolient baths, mild anti-spasmodics, linseed poultices, fric-
tion with camphorated oil, and mild lavements. If the milk is
too old, the nurse should be changed ; and when an anodyne
is required to relieve the violent colic; a little lettuce- water
should be added to some sugared water. This description of
medicine, however, requires care, and opiates in any form are
inadmissible. Narcotism, which induced death in one child
and was nearly fatal in another, was brought on by a clyster
containing ten drops of laudanum. 3. Engorgement of the
liver is another cause, and one especially acting after compress-
ion of that organ by the uterine contraction in foot and breech
presentations. When this condition is present, purging the
child is not sufficient. It must be kept warm, and its skin rub-
bed with hot flannel; with gentleness, however, lest erysipelas
be induced. When the skin is rough and hot, emolient tepid
baths are useful adjuvants. 4. Bad nourishment is a frequent
cause of icterus, the milk disagreeing with the child, or impro-
per food being given to it when brought up by hand. 5. Cold
and humidity: young infants are very susceptible to changes
of temperature too great heat or cold being alike injurious to
them ; but as regards the present aflfection, cold is especially
mischievous. \_Rev. Med. Chir. Med. Chir. Rev.

Burns and Scalds.

There is no practical subject in our profession, in which the
disastrous and fatal efl^ects of mal-treatment by medical men, as
well as the mischiefs of popular ignorance are more apparent,
than in the remedies resorted to in the cases of scalds and burns,
now unhappily so frequent in our country, by reason of the

N. s. VOL. viir. NO. XI. 44

694

Burns and Scalds.

[November,

murderous recklessness of human life in the m^n entrusted with
our public conveyances, in which steam is employed.

So long ago as 1830, in the first American edition of Coop-
er's Surgical Dictionary, published by the Harpers, of this city,
we took occasion to urge upon the profession and upon the pub-
lic the importance of a better philosophy and practice in the
medical management of the mischiefs resulting from such acci-
dents, than that usually in vogue. We then stated the results
of our experience for ten years in the treatment of scalds and
burns by the instant application of wheat flour, an article always
at hand, and the perseverance in this application alone until
all the acute inflammation had subsided. Our theory and prac-
tice thus promulgated, was approved and recommended in the
then forthcoming edition in London, by Mr. Samuel Cooper
himself, and has since found its vvay without credit into numer-
ous publications at home and abroad. Even in the late Ther-
apeutical work of Dr. T. D. Mitchell, of Philadelphia, this iden-
tical practice is ascribed to Dr. John Thomas of England f
who in 1832 called the attention of the profession thereto, as we
are told, in the Ohio Medical Lyceum; two years after our
publication as aforesaid, and twelve years after our testimony to
its eflJicacy had been published.

But waiving the unimportant subject of priority, we are
grieved to learn from the public press that such multitudes are
annually perishing by scalds in steam-boats, and from burns by
camphene, spirit gas, and otherwise ; nearly all of whom, how-
ever severely burned, w^e do not hesitate to say might be pre-
served from a fatal result if this simple practice were adopted
immediately after such accidents. Instead of this, however, we
hear of the application of cold water, lead water, molasses, oils,
cotton, ^' pain extractors,''^ &c. &c. accompanied almost uniform-
ly by the death of the sufferer, and often " after lingering in ex-
cruciating torture" for days or hours.

Now it ought to be promulgated to the profession, and for
humanity sake to be known to the whole people, that in any
case of burn or scald however extensive, all the acute sufl^ering
of the patient may be at once and permanently relieved, and
that in a moment of time, by sprinklingr over the injured surface
a thick layer of wheat flour by the hand, or what is better, by a
dredging box. Every vestige of pain produced by such injuries
is instantly removed, and the suflTerer not only escapes the shock
to the nervous system accompanying such torture, but w^ill'gen-
erally fall into a quiet sleep the moment the atmospheric tem-
perature is thus excluded- from the wounds.

Why then should persons thus injured be allowed to die with
intense agony, occasioned by burns and scalds, as they often do.

1852.] Poisonous Chloroform, 695

if not without treatment by the applications so often made, many
of which augment their sufferings, and render such injuries
irreparable ? Even in the late explosion on board the Rein-
deer, it is said that many of the scalded lived for hours, suffer-
ing all the time from their external injuries, and then treated
with raw cotton, lime water, and linseed oil, &c. &c. until they
were dead. Not a pang need have been endured beyond the
time necessary to apply the flour, w^hich must have been at
hand, if the ignorance of their friends, and the antiquated preju-
dices of their medical advisers, had not led them to rely upon
the miserable substitutes which superstition has canonized for
centuries. And so, we affirm of every case of burn and scald,
even if the entire surface has suffered.

In the New York and Bellevue Hospitals this mode of treat-
ing burns h'As been long in use; until recently, as we learij, the
same object has been effected at the former institution by the
analagous method of covering the injured parts with a muci-
lage of Gum Arabic, so as to protect the denuded surface from
the atmosphere, and which the surgeons there prefer to the flour
in some cases, where the weicjht of the latter becomes an incon-
venience. To this method we make no objection, but having
for so many years employed the flour alone, to the exclusion of
all other agents, and in every variety and extent of injuries by
fire, we have thus reiterated our testmiony, and as this agent is
found in every house, andean be instantly procured with more
readiness than any of the other articles named, we give it the
preference over all others. And we repeat our full persuasion
that not one in a hundred of those perishing by burns and scalds,
need succumb under their injuries if they were at once, or as
soon as may be, covered with wheat flour. We have applied
it successfully, after numerous other remedies had been unsuc-
cessful, and when many hours had elapsed after the accident.
To give this suL^gestion to the people, and scatter it broadcast
over the land, will save a multitude of lives in a single year.

{^New York Medical Gazette.

Poisonous Chloroform.
To the Editor of the Boston Medical and Surgical Journal.

Sir. The numerous deaths which have recently taken place
from the inhalation of chloroform, seem to require that I should
state what I know upon this subject, without waiting: for more
extended researches which I have now in progress ; for a word
in time may save human life, and I shall therefore present my
views,even though some may think thai I ought to w^ait until my
work is completed to its full extent before publication. I have

696

Poisonous Chloroform.

[November,

formerly been charged with dilatoriness in presenting my dis-
coveries to the public, and wish to avoid a repetition of this
accusation, even though my work, in its present state, is not so
complete as would be required for scientific purposes.

I have long had a strong suspicion that the very sudden deaths
resulting from the inhalation of chloroform, must have been pro-
duced by the presence of some poisonous compound of amyle,
the hypothetical radical of Fusel oil or the oil of whiskey ;
and I began a series of researches upon this subject several
years ago, but was called off from my work by unexpected per-
secutions. This work I have resumed, and I will now state
what facts and inductions I am able to lay before the public.

1st. When chloroform, and the alcoholic solution of it called
chloric ether, was made from pure alcohol diluted with water,
no fatal accidents took place from its judicious administration.

2d. When chloroform was made, as it now too frequently
is, from common corn, rye, and potato whiskey, deaths began to
occur, even when the utmost care was taken in its administra-
tion.

3d. In the Chelsea case, where this kind of chloroform was
probably contained in the alcoholic solution incorrectly called
chloric ether, death took place in a very sudden manner, and
the post-mortem appearances of the subject indicated the usual
effects of poisoning by chloroform.

From these data, it might justly be inferred that some poison-
ous matter exists in the cheap chloroform of commerce, and 1
suspected that it arose from the Fusel oil which exists in whiskey.
This opinion, at my suggestion, was published by two of my
friends, to put the public on their guard, and those gentlemen
urgently advised that physicians and surgeons should return to
the use of pure sulphuric ether (oxide of ethyle,) as originally
prescribed by me.

It is well known that I have always preferred my original
anaesthetic accent to all the substitutes that have been proposed
since ; but still I have always been willing to give the proposed
.substitutes a fair trial, and did try them all, first upon myself, and
then upon such of my pupils as felt willing to allow the experi-
ment to be made upon them. I also in a measure compromised
with that powerful anaesthetic agent chloroform, by mixing small
proportions of it, about one fourth or fifth part, with sulphuric
ether, so as to concentrate the anaesthetic agent into a smaller
bulk, and I have extensively used this preparation in the pro-
duction of anaesthesia, and without producing any dangerous
or even unpleasant symptoms in any case, but I always took
care to ascertain that the chloroform used by me was pure.

Having, during the last month, succeeded in procuring some

1852.] Poisonous Chloroform. 697

very pure Fusel oil (of whiskey), I undertook the researches
which have resulted in the conviction that it is this amyle com-
pound that produces the poisonous matter of certain kinds of
chloroform. When mixed with hyperchlorite of lime (bleach-
ing powder) and water, in the same way as we prepare alcohol
for the production and distillation of chloroform, 1 found that
the mixture in the retort, after agitation and standing some time,
became warm, indicating that a re-action was taking place be-
tween the Fusel oil and the hyperchlorite of lime.

After some hours the retort was placed in a water-bath and
distillation was effected, the volatilized liquid being condensed
by means of one ofLiebig's condensers. A clear colorless
liquid came over, which was at once recognized as having the
peculiar odor of bad chloroform. It is perhaps a ter chhiride of
amyle, but has not yet been submitted to analysis. It is so pow-
erful that merely smelling of it makes one dizzy, and working
over it made me so sick that I was obliged to go out of doors for
fresh air several limes during my operations on it. In order to
make sure that the Fusel oil was all decomposed, I again mixed
the product of the distillation above mentioned with a new lot
of bleaching powder, and water; and after three hours, with
frequent agitation, it was again distilled, and gave what I regard
as the pure unmixed poison. This I am now to test on such
animals as have proved good ether subjects, and shall make
report of my results in this Journal.

If my views are correct, it follows :

1st. That all chloroform intended ^ox inhalation as an anois-
thetic agent should he prepared from pure rectified alcohol, to
be diluted with water when used for distillation from hyper-
chlorite of lime.

2d. That no druggist should sell for anaesthetic uses any
chloroform which is not known to have been properly prepared
as above suggested.

3d. That the mixtureof chloroform and alcohol, commercial-
ly known under the name of strong chloric ether, must be made
with the same precautions as chloroform.

There is lessdanger of the existence of Fusel oil in sulphuric
ether, which is always made irom strong rectified alcohol.

There is more danger of the existence of sulphurous acid in
this liquid, and that is a dangerous poison, but it is one readily
detected ; and persons will object to inhaling ether containing it,
on account of'its wellknown disagreeable odor of burning sul-
phur.

Fusel oil itself, according to the microscopic researches of
my friend Dr. Henry C. Perkins, of Newburyport, appears to
act as a poison. His experiments were suggested by an article

698 Poisonous Chloroform. [November,

published by Mr. Henry A. Hildieth, imputing the poisonous
qualilies of some kinds of chloroform to Fusel oil contained in
it.

It is important now that this Fusel oil has been introduced
into medicine as a remedy in phthisis, that the profession should
know that when it is inhaled it may produce fatal results, and
that great caution is necessary in the use of so powerful an a^ent.
Administered, a few drops at a dose, by the stomach, it does no
harm, but is undoubtedly useful in some forms of disease. Ex-
perience will soon show how far it is remedial in tuberculous
diseases; and this remedy is in good hands at present Dr.
Morrill Wyman and Dr. Perkins having engaged in the re-
searches as to its medicinal use.

1 annex a letter which 1 have just received from Dr. Per-
kins, deeming it an interesting contribution to physiological
science.

Respectfully your ob't serv't, C. T. Jacksox, M. D.

Assay er to the State of Mass.
Boston, Sept. 1, 1852. and to the City of Boston.

Newburyport, Aug. 27, 1852.

My Dear Friend, Noticing the other day, a paragraph in
one of the papers, which attributed the evil effects ot chloroform
to the Fusel oil it contained, 1 tried an experiment upon a frog
with a few drops of this oil dissolved in ether, and found that
after inhaling it for a short time the same effects were observa-
ble under the microscope as appear when chloroform is used,
viz., an almost eritire suspension of the circulation in all the
bloodvessels ramitying upon the web of his foot; there was in
fact, only a very slight backward aud forward motion to be seen
in one single vessel ; in all the others the blood was perfectly
stagnant. The frog w^as insensible for a much longer period
than when the ether alone is used. He is now bright and ready
for another experiment to which I proceed.

I exposed him to the vapor of a few drops of Fusel oil dis-
solved in about a drachm of New England rum, for about Fix
minutes, when he closed his eyelids and seemed under its influ-
ence. He was then placed upon the stand of the microscope,
but not the slightest appeai-ance of circulation was to be found
in any of the vessels of the web; it w^as unusually pale and ex-
san^;uinous. He removed his foot twice or thrice trom the
stand, and gasped several times. I was now called away, and
was absent about half an hour. Upon my return, the frog was
found dead.

Several queries suggest themselves, which you will allow me
to propose ;

1852.] Statistics of Hernia. 699

1st. Is there any Fusel oil in sulphuric ether?

2d. Can the Fusel oil be removed from the chloroform ?

3d. Would the vapor of New England rum, rot-gut whiskey
(which contains this oil.) produce anaesthetic effects?

4th. In what ether liquors is this oil found?

5th Does it in small doses, as administered by our friend,
Dr. M. Wyman, and as I am now trying it upon his recommen-
dation, diminish the pulse and act as a direct sedative?

To the third and fifth queries I shall direct my attention.
The others I leave for your investigation.

Very truly your sincere friend, H. C. Perkins.

Statistics of Hernia. By M. Hutin.

At a recent examination of the pensioners at the Hotel des
Invaiides, M. Hutin found that among the entire population of
3177 pensioners, there were 670 who had hernia. These
were distributed as follow :

631 Inguinal (2J3 double, 418 single.)
6 Femoral (5 left, 1 right.)
18 Umbilical.
11 Superumbilical.
2 Subumbilical.
2 Near spine of ilium.

670. [Rev. Med. Cliir. Med. Chir. Rev.

ill X 0 c c 1 1 a n 2 .

Should the Use of White Lead as a Paint he forbidden hy Pithlic
Authority ? This question is exciting considerable interest in France,
one of the few countries in Europe where a due regard to the public
health is part of the business of government. In England, and this
country, we are too jealous of individual rights, too independent, if you
please, to allow our rulers to watch over the well-being of the com-
munity.

We shall therefore merely present facts, without comment, as
given to us in a memoir of Dr. H. De C.astelxau :

" In his remarkable memoir on Painting with White Zinc, Dr.
Bouchut advised the government, if it had due regard for the health
of workmen, to forbid the use of white lead as a paint on all the public
buildings, and that an example should be presented for imitation by
the substitution of an article less deleterious. The favorable manner
in which this proposition was received by the Academy of Medicine,
at its session on the 4th of Novenaber, 1837, indicates their full accord-

700 Miscellany. [November,

ance in the idea, although they were necessarily restrained from en
tering into the merits of the question of economics, and we derive a
similar indication of opinion in the large premium bestowed by the
Institute, in 1849, on iM. Le Claire, for his essay on the means of
rendering occupations less unhealthy.

All these circumstances have doubtless tended to aid in diffusing a
report that government is about suppressing the manufacture of white
lead. To aid such a measure, a few details on the point of sickness
and mortality will be of use.

In accordance with a requisition from the prefect of police, the ad-
ministration of hospitals demanded an annual return of all cases
admitted into them of diseases from lead. It thus appears, that during
ten years (1838 to 1847,) 3142 were admitted, and that 112 of these
died, being an annual mean of 314 sick and 11 dying. There can,
however, be scarcely a doubt but that the first number is too low.
There is very frequently a doubt as to the nature of the complaint on
admission indeed lead affections take some time to develop themselves
and thus cases are frequently referred to other diseases. It is highly
probable that at least 400 cases are annually admitted, and that fifteen
deaths occur.

Of the gross number (3142,) three-fifths (1898) were cases of work-
men engaged in the manufacture of white or red lead, and the remain-
ing two fifths were persons employed in using these products, as paint-
ers, grinders, makers of porcelain cards (so called,) &c.

Then again, there are many cases treated at their own dwellings,
but unfortunately we have no data exactly to estimate their number.
It is quite probable that they are at least equal to those treated in hos-
pitals, and if this be conceded, we have annually 400 cases of lead
disease in those who are strictly manufacturers of the preparations of
lead, and of which 14 die. It would be too extravagant to carry this
proportion throughout France. Reducing it ninetenths, and with a
due regard to the statistics of provincial hospitals, we are certainly
safe in stating the total annual result at 2000 cases of disease and 80
deaths. These would be at an end with the suppression of the manu-
facture.

But there is another matter to be also considered. The average
sojourn of a patient with saturnine disease in a hospital is 16 days.
Add to this, the illness and loss of time that precedes, and the debility,
broken health, and loss of business that follows so many of the work-
men. Even if we do not estimate this last, still, the hospitals will be
relieved annually of sixteen or seventeen thousand days of sick persons,
not to take into account the permanent residence of many incurables.

Can there, then, be a doubt that the public health will be greatly
improved by the suppression of these manufactories? Still, however
powerful may be the arguments in favour, it would hardly answer to
attempt their suppression, unless we could find a proper substitute,
both in the healthiness of its manufacture, and its value in the arts-
Can both of these objects be accomplished by the employment of the
white oxide of zinc {le hlanc de zinc ?)

1852.] Miscellany. 701

As to the first, Dr. Bouchut, just at the time of concluding his me-
moir, in July, 1851, received the following return from the company
manufacturing zinc at Asnieres. Up to the date named, they had
employed 151 workmen, who together had performed labour during
3 1,585 days and had been in the factory 1^6,156 days. In other words
the average was 209 labour days, and 344 days of residence for each
person.

It is scarcely possible to present a more fevourable bill of health.
Who ever heard of a manufacturer of white lead remaining in its man-
ufacture during 344 successive days ? Besides, most of the above
workmen still remain, and are able to count upwards of lOQO labour
days.

Dr. Bouchut has carefully studied what should be called the effects
rather than the diseases caused by this species of manufacture. They
are as follows :

1. Pains in the throat and slisht cough occur durino; the first
days of labour, until the mucous membrane becomes accustomed to
the exhalations from the white zinc. But they disappear very soon,
and the workmen there are no more subject to cough or throat affec-
tions than the same given number of any other persons.

2. Many of the workmen are at various periods subject to a curious
species of innervation shown by febrile or non-febrile restlessness at
night. But this does not affect the general health, and they return in
the morning to their labour. Occasionally, there is a species of ex-
citement, temporary, such as Delaroche and Barbier ascribe to the
oxide of zinc, but with most it is the short feverish feeling just descri-
bed. It is always of short duration, never danfjerous, and disappears
after the system has been accustomed to the employment.

3. Occasionally eruptions appear on the skin, of reddish papulae,
which readily disappear with proper treatment.

Having thus noticed the effects, Dr Bouchut proceeds to mention
three cas^ of slight disease, ascribed to this cause. But a careful
analysis proves that they were not owing to it.

Here, then, we have results which are frequently produced by
emanations from the most harmless suhstances, when inhaled in the
form of powder. The difficulty only extends thus far. But while
while lead as powder causes its severe results also, we must recollect
that it is equally noxious when manipulated in the humid form. From
this, however, white zinc is totally free. It is only the powder of it
that affects the workmen.

We should also remember the large doses that have for many years
been administered of the white oxide as a medicine, without causing
any accident M. Orfila, the highest authority in toxicology, gave 20
grammes ( ) to small and feeble dogs, with only the result

of gentle vomiting, and a subsequent perfect recovery. How very
different are the consequences of administering white lead.

As to the economic value of white zinc. It can be manufactured
for exactly the same price as white lead, and being much lighter, a
larger quantity can be sold for the same sum of money. It cannot be

702 Miscellany. [November,

adulterated. This, indeed, has been made a formidable objection to
it. White lead is very commonly mixed with sulphate of barytes, and
not unfrequently with chalk. White zinc can be used with equal fa-
cility as a paint. It does not dry as readily as white lead, but the
difference in time is small. It has been objected that it does not set
well as a paint, but this is altogether a mistake. Two coats cover
wood very nearly as well as white lead, and there is this further advan-
tage, the vapours of sulphuretted hydrogen do not affect it, whilst all
the preparations of lead turn black from them.

M. Leclaire, an eminent house-painter, and others, have verified
its use, on more than two thousand buildings, some of them public ones,
to the satisfaction of the community.

The results, then, of suppressing the use of white lead by public
authority will be to save annually the lives of eighty workmen to
prevent 2000 cases of disease, some of them, indeed, incurable and
to enable active industry to continue its labours uninterrupted.

[Abridged from La Lancette Francaise (Gazette des Hopitaux)
American Jour, Med. Sciences.

The influence which Daguerreotyping exerts upon the Health of
Dagiierrean Artists, together with some Observations on Light and
Actinism. By Charles W. Wright, M. D., of Cincinnati.

It is stated by Chevalier, in the Annals of Public Hygiene, that
the vapors of iodine exert no injurious effect upon the health of the
workmen engaged in its preparation; but this observation does not
appear to hold good in other pursuits, where persons are compelled
to inhale the vapors of this substance. Thus, there are some phe-
nomena presenting themselves in the art of daguerreotyping, that would
seem to indicate that the vapors of iodine, when inhaled for a consid-
erable length of time, produce all of the peculiar effects of that agent
when administered by the mouth. It must, however, be borne in
mind, that besides iodine, the chloride of iodine, bromine end hydro-
fiouric acid are employed in the photographic art, and that the vapors
of these bodies are floating in the atmosphere along with that of iodine;
and as these substances belong to the same class, and when adminis-
tered produce similar effects on the system, may contribute also to
the appearances observed.

The influence which these vapors exert on the respiratory aparatus.
The most striking effect is the continual clearing of the throat. This
the operator is frequently not aware of himself, until his attention is
called to it. This symptom appears not to result from irritation or
inflammation of the respiratory passages, but seems to be caused by
thickening of the bronchial mucous. The same symptom is frequent-
ly induced by inhaling chlorine. Occasionally there is considerable
difficulty in dilating the chest, but where the rooms are well ventila-
ted, this is rarely observed. Inflammation has never been observed
as a result of the inhalation of these vapors, as they are ordinarily
diffused in the operating room. Some operators mix their compounds
by the sense of smell, and not by weight or measure.

1852.] Miscellany. 703"

Effects on the Brain and Nervous System. These vapors frequent-
ly produce determination to the brain and vertigo. Sometimes a
species of intoxication is observed, where the fumes are very strong,
but this is not common. These effects speedily disappear by exer-
cise in the open air.

Effects on the Sight. Irritation and chronic inflammation of the
conjunctiva are sometimes observed. This membrane is so sensitive
to the vapor of iodine, that many operators can detect its presence in
the operating room more readily by its effect on the eyes, than by the
sense of smell. It exerts no influence on the sense of hearing and
touch.

On the appetite. It very frequently diminishes the appetite, and lit
no case have I ever known it to be increased.

On the bowels. It exerts no perceptible influence on the condition
of the bowels.

On nutrition. It has not been observed to cause emaciation, nor
any decided increase of flesh.

On the salivary secretion. In no case was salivation observed, but
very frequently dryness of the mouth and fauces w^as complained of;
at the same time the secretion of the nose was diminished.

On the kidneys. The urinary secreuon did not appear to be either
increased or diminished. The urine passed when the operator is
actively engaged in coating plates, always contains iodine, and by
operating on a considerable quantity at a time, I never failed to detect
its presence. In some cases there is considerable irritability of the
bladder, and in one instance the individual could not retain his urine
for a longer period than two hours.

On the skin. The skin does not appear to be much affected by
these vapors. In one instance, however, the eruption which is some-
times observed to result from tha use of iodine, made its- appearance.
This person was sent to the country, when in the course of three
weeks the eruption disappeared, but in returning to the same pursuit,
it again developed itself, and the individual is at the present time af-
fected with it.

On the genital organs. These vapors sometimes act as an excitant
to the genital organs. In some instances this excitement was follow.
ed by an almost total extinction of the sexual appetite. In- one case
there was an absorption of one of the testicles, with atrophy of the
other.

It will be observed that all of the foregoing appearances are those
that can be produced by the administration of iodine alone, and it
would seem to be the active agent in these cases ; but the bromine
and chloride of iodine may, and probably do, contribute to the same
result.

The mercury which is employed to bring out the image, is so small
in quantity as never to produce the symptoms of mercurial poisoning;
at least I have never noticed it, or heard of its producing a bad effect.

In galvanizing the silver tablets, the fingers are sometimes plunged
into the solution of cyanide of silver, which induces a painful ulcera-

704 Miscellany. [November,

tion around the nails, which, however, speedily disappears by proper
treatment.

The above is the result of three years investigation of this subject,
and the facts are o^athered from the history of tbrtv-three daguerrean
artists, who have been in the business for periods, varying from two
to twelve years.

Before leaving this subject, I would call the attention of the pro-
fession to the subjects o^ Actinism and Light, as these promise, above
all others, to give us a clearer insight in regard to the influence which
the atmosphere exerts upon health and disease, than any other branch
of the natural science.

It is found that the actinic force is influenced ])y the seasons, tern-
perature, the quantity of light which is transmitted through the atinos-
phere, and other causes which are not well understood. Thus the
quantity is greater in iMarch and April than at any other period of the
year; and Prof. Draper states that in his progress from New York
to the Southern States, he found it to diminish ; and this is in accord-
ance with the experience of daguerrean artists. The extinction of
actinism in the atmosphere is not the same as that of light. Thus on
certain. dark, close days in the spring, the actini force is much less
than it is when the air presents a more hazy appearance. There is
also a very marked difference in the atmosphere of the city compared
to that of the country, in regard to extinctive power. When a given
amount of change is produced on a sensitive surface in the country in
two seconds, it will frequently require thirty seconds to produce the
same etfect in the city, under the same circumstances. The extinc-
tive power of the atmosphere of Cincinnati is about twice that of Lou-
isville ; and the atmosphere in the vicinity of Harrodsburgh Springs,
Ky., possesses less extinctive power than that of any other locality
which has been examined in the W.est.

Electrical action is quickened by actinism, and I found by making
a sensative plate a part of the galvanic circuit, that the action of ac-
tinism was favored by the electrical current.

It is to be hoped that some one who has the proper apparatus, will
investigate the magnetic properties of oxygen in its relation to actinism,
as these subjects must Imve a very important phvsiological bearing.

The fallowing is a summary of our knowledge of solar radiations,
by Prof. Hunt :

1. The rays having different illuminating or colorific powers, ex-
hibit different degrees and kinds of chemical action.

2. The most luminous rays exhibit the least chemical action upon
all inorganic matter. The least luminous and non-luminous manifest
very powerful chemical action on the same substances.

3. The most luminous rays influence all substances having an or-
ganic origin, particularly exciting vital power.

4. Thus, under modifications, chemical power is traced to every
pari of the prismatic spectrum ; but in some cases this action in posi-
tive exciling, in others nego-iive drjjressiug.

5. .The most luminous rays are proved to prevent all chemical

1852.] Miscellany, 705

chanire upon inorganic bodies, exposed at the same time to the influ-
ence of the chemical rays.

6. Hence, actinism, regarded at present merely as a phenomenon
different from light, stands in direct antagonism to light.

7. Heat radiations produce chemical change in virtue of some com-
bined action not yet understood.

8. \ctinism is necessary for the healthful germination of seed;
light is required to excite the plant to decompose carbonic acid ; calo-
ric is required in developing and carrying on the reproductive func-
tions of the plant.

9. Phosphorescence is due to actinism, and not to light.

10. Electrical phenomena are quickened by actinism, and retarded
by light. [ ^yestern Lancet.

Lucifer Match Making and AmorpJious Phosphorus. The an-
nouncement of Prof. Shrotter's discovery of the mode of preparing
amorphous phosphorus, derived much of its practical interest from the
supposition that the phosphorus in this state would be less dangerous
and injurious to the persons engaged in the manufacture of lucifer
matches. A medal was awarded to Mr. Albright for the introduction
of the prepared phosphorus as an article of commerce, and it may
now be obtained at a moderate price of Messrs. Sturge, of Birming-
ham. The dreadful disease to which the makers of lucifer matches
are liable, from inhaling the fumes of ordinary pliosphorus, having
been described and brought under public notice, it might have been
supposed that no time would have been lost in ascertaining the value
of the above discovery as a means of alleviating so much human suf-
fering. Matches prepared with the amorphous phosphorus were
shown in the Great Exhibition, and it was stated al the time that in
the manufacture of these matches, the evils arising from the inhala-
tion of deleterious fumes were obviated, while the result of the experi-
ment was satisfactory.

It is, however, difficult to introduce any innovation of this kind into
an extensive branch of manufacture. A series of experiments must
be made to test the efficacy of the new preparations, the most advan-
tageous mode of employing it, the quah'ty of the goods, and the econo-
my of the process. In the mean time the several departments of the
manufactory are progressing like clock-work. All hands are busily
employed, the proprietor is fully occupied with superintending the
operations and the accounts, and a large box of amorphous phosphorus
remains in the office unpacked, waiting for a convenient opportunity
to complete the experiments.

Such was the state of affairs at Mr. Dixon's manufactory al Newton
Heath, near Manchester, on the occasion of a recent inspection. Out-
side the building large piles of timber were stored up ready for use,
A machine worked by a steam-engine was reducing blocks into the
form of matches. A block previously cut the length of the match, and
pressed against the side of the machine, disappeared m a few seconds^
The sticks being removed into the next room were tied into bundles

706 Miscellany. [November,

about eight inches in diameter, ready for dipping in sulphur. This
was done in another room in an iron vessel over a furnace. Imme-
diately after the dipping, the workmen give each bundle a slight pres-
sure with a rotatory movement to separate the matches from each other
at the moment of soliditication, otherwise the sulphur would cohere
into a solid mass The matches are next transferred into a room
where they are arranged, so as not to be in contact with each other,
in frames about two feet by one foot, ready for the phosphorus
dipping. The composition used for this purpose consists of chlo-
rate of potash, phosphorus, and glue, and it is spread in a thin layer
on a stone or marble slab, heated below by steam or hot water.
The operator holds the frame lengthways, and dips the ends of the
matches in the composition, taking care that all of them are coated.
Sometimes the sticks are in the first instance cut twice the required
length, dipped at botii ends, and afterwards bisected. In the process
of cutting they occasionally ignite, occasioning loss and also vitiating
the atmosphere. When the dipping is completed, they are taken to
the sorting room and packed in boxes. In another room the boxes are
labelled and sent to the packing room. The boxes are made on the
premises, the shavings cut, and the tops and bottoms stamped by ma-
chinery, cut to the proper size, glued, and fitted, which operations
are performed in separate apartments. Each box of lucifer matches,
price retail one halfpenny, passes through the hands of seventen per-
sons, chietiy childen. The Factory Act is not applicable to these es-
tablishments, and the children, averaging from seven to twelve years
of age, work twelve and sometimes thirteen hours in the day. They
earn (by piece work) from 3s. to 5s a week, iind the adults from 9s. to
12s.

The cases of disease occur chiefly in the phosphorus dipping room,
sometimes in the room where the matches are sorted and packed in
boxes, but seldom in other parts of the establishment. The nature of
the disease is described in the Dullia Quarterly Journal of Medical
Science, for August, page 10, by Mr. Harrison:

" An affection ensues which is so insidious in its nature that it is at
first supposed to be common tooth-ache, and a most serious disease of
the jaw is produced before the patient is fairly aware of his condition.
The disease gradually creeps on until the sufferer becomes a miserable
and loathsome object, spending the best period of his life in the wards
of a public hospital. * * * * Many patients have died of the
disease ; many, unable to open their jaws, have lingered with carious
and necrosed bones; others have suffered dreadful mutilations from
surgical operations, considering themselves happy to escape with the
loss of the greater portion of the lower jaw."

Mr. Harrison's paper contains much interesting information, with
the medical reports of several cases.

It would be foreign to our purpose to enlarge upon this view of the
subject ; but the disease being of chemical origin, the modus operandi
of the poison may involve a chemical enquiry. Does the phosphorus
when inhaled destroy the vitality of the bone by chemical action on its

1852.] Miscellany. 707

substance ? or does it operate merely as an irritant on the tissues,
causing inflammatory action? Tlie bone in its diseased state has a
spongy cellular appearance, with excrescences of a similar character
adhering to it. The teeth generally continue sound and white, while
the jaw which contains them is altered in texture, dead, and discolor-
ed. We believe the diseased bone has not been chemically examined.
Whether such examination would throw any light upon the subject is
a speculative question ; but we think it not unworthy of consideration.

There are at this time in the manufactory several persons who iiave
suffered severely from the disease, and who, on recovery, immediate-
ly returned to their work not however to the dipping department.
In the Museum of the Manchester Infirmary is the lower jaw of a
young woman who is now at work Her face is much disfigured by
the loss of her chin, and in looking into her mouth the root of the
tongue is seen connected with her under lip, the space formerly occu-
pied by the jaw being obliterated by the contraction of the cheek. A
young man who has lost his jaw is also in the factory. They are not
isolated cases.

It is stated in the factory that the workpeople have sometimes
applied the phosphorus paste to decayed teeth, under the idea that
it was a cure for the toothache, and to this imprudence some of the
early cases of the disease are attributed. The frightful nature of the
disorder is now sufficiently understood to serve as an mcentive to great-
er precautions. Increased attention has been paid to ventillation and
cleanliness, and the practice of taking meals on the premises is not
allowed. It appears, however, from the statements of some of the work-
people who are engaged in the phosphorus dipping room, that their
clothes become incandescent in the dark, and although the cases of the
disease are less frequent than they have been formerly, a security
against its recurrence is not attained. The proprietor of one factory
states that he has had no cases in his establishment on account of a
more careful method of dipping the matches, by which the face of the
operator is further removed from the source of danger ; but we are in-
formed that some patients, from that factory have applied for medical
relief in the neiojhborhood. Mr. Standrinoj informs us that there is now
in the Manchester workhouse a young woman suffering from a " phos-
phoric jaw." She worked three years in a match manufactory ; she
th^n went to a silk mill, where she had been about a year and a half
before the disease first made its appearance. Eleven months since
she was was admitted into the infirmary and remained there eighteen-
weeks, since which time she has been an inmate of the work-house-
The disease at present affects only one side of the jaw a portion of
which is likely soon to be detached.

Various means of prevention have been tried, and others suggested.
In a manufactory in Dublin, camphor is added to the composition^
which masks the smell, and is said to act as a prophylactic. This-
latter opinion requires further proof. Mr. Taylor of Nottingham, sug-
gests ihe use of a mask with a tube communicating with the outside of
the building. Mr. Stanley of St. Bartholomew's Hospital, recommend*

708 Miscellany.

the exposure of oil of turpentine in saucers about the workrooms,
as a solvent of the fumes of phosphorus. Dr. Baur recommends the
use of a sponge or handkerchief moistened with a solution of soda or
potash and applied to the mouth. The proprietor of the factory above
referred to states that he has diminished the quantity of phosphorus to
less than a third of that which he formerly used, and that by this and
other precautions the prevalence of the disease has been greatly dimin-
ished. He has tried the amorphous phosphorus on a small scale, by
way of experiment, and says that it is more expensive than the ordina-
ry kind, as a larger quantity is required. But the chief objection ap-
pears to be that the composition now in use answers quite well. The
matches never fail ; the mode of preparing the composition is under-
stood ; the result is known, and the demand for the matches unceasing.
The amorphous phosphorus requires further trial; the makers are not
yet accustomed to it. If it should fail their trade would be injured;
the experiment would interfere M-ith the habits of the factory ; there-
fore the operations are continued in the usual way, the box of Sturge's
phosphorus remains unopened in the office, and the value of the discov-
ery is not fairly put to the test. {^London Pharmaceutical Journal.

American Medical Association. At a meeting of the Association
held at Richmond, Va,, May, 1852, the undersigned were appointed
a committee to receive voluntary communications on medical sub-
jects, and to award two prizes of $100 each to the authors of the best
two essays.

Each communication must be accompanied by a sealed packet,
containing the name of the author, which will be opened only in the
case of the successful competitors. Unsuccessful communications will
be returned on application after June 1st, 1853.

Communications must be addressed, post-paid, to the Chairman of
the Committee, Dr Joseph M. Smith, 56 Bleeker-st., New York, on
or before the 20th of March, 1853.

Joseph M. Smith, M. D.
John A. Swett, M. D.
W. Parker, M. D.
GuRDON Buck, M. D.
New York, Sept. 17th, 1852. Alfred C. Post, M. D.

Another Medical School. We perceive by the newspapers that

our Savannah friends are about to establish a Medical School in that

city, and that the Fatuity has already been organized, as follows :

R. D. Arnold, M. D., Professor of Practice.

P. M. KoLLocK, M. D,, Professor of Obstetrics and the Diseases of Women

and Children.
Wm. G. Bl'lloch, M. D., Professor of Surgery.
C. W. West, M. D., Professor of Chemistry.
J. G. Howard, M. D., Professor of Anatomy.
H. L. Byrd, M* D., Professor of Materia Medica.
E. H Martin, M. D., Professor of Physiology.
J. B. Reid, M. D., Professor of Pathological Anatomy and Demonstrator of

Anatomy.

SOUTHERN

MEDICAL AND SURGICAL
JOUBIAL.

Vol. 8.] NEW SERIES. DECEMBER, 182. [No. 12.

PART FIRST.

rxgtnal (Eommtinuations.

ARTICLE XLVII.

Morbid Sensibility of the Stomach. By G. T. Wilburn, M.D.,
of Ridge Grove, Alabama.

In writing a treatise upon Dyspepsia, no important result can
be anticipated if the same old beaten track is to be pursued, or
if the same accustomed tale of woe is to be repeated. But,
young as we are in physic, how dare we brave the long-received
opinion of the anacks in medical lore ! Shall we stand alone
against a host of medical pfiilosophers, and attempt to teach
sages truth and science? Shall all the labor of physicians to
discover the nature and cause of dyspepsia prove to be naught,
and the proud monuments which have been erected to their
genius be hurled to the dust ? Yes, let it all go, if science can
be advanced thereby. We have a right to our opinion, and,
should it be correct, let it be received; should it, however,
prove erroneous, let others prevail : we adopt your motto '/e
prends le bien oiije le trouve."*

Works on Practice contain much upon dyspepsia journals
likewise have their pages frequently filled with essays upon
this popular theme. Dyspeptics write the history of their
own feelings and spin out a long theory of their cause and pro-
gress. These writers have been our teachers upon this dread-
ful malady, because we take for granted, what is far from being
true, that a sick man can tell the nature of his disease.

N. s. VOL. viii. NO. xir. 45

710 Wilbmn, on Morbid Sensibiliti/ of Stomach. [December,

We have read many of these essa3's, and confess, honestly,
that we have not, as yet, seen one word concerning what we
consider the true cause of dyspepsia. Inattention to diet lux-
urious indulgence in aliments indigestible by quality or quan-
tity sedentary habits mental application the habitual use
of coffee, tea, tobacco, liquors, &;c. have all been arraigned
as the cause of this vexatious disease. The pathology is almost
universally considered to be a morbid condition of the gastric
nerves.

Before stating what we believe to be the true cause of Dys-
pepsia, let us examine the situation of the stom.ach and its rela-
tion with surrounding parts. We shall here avail ourselves of
the views of Cruveilhier.

The stomach is situated at a juncture of the upper tenth
with the lower nine tenths of the alimentary canal, between
the organs of deglutition anci those of chylification. It occu-
pies the upper part of the abdominal cavity, almost entirely fills
the left hypochondrium, and advances into the epigrastrium,
as far as the limits of the right hypochondrium. It. is main-
tained in its place by the oesophagus and duodenum, and also
by some folds of the peritoneum, which connect it with the
diaphragm, the liver and the spleen. The stomach is directed
obliquely downward to the right side, and a little forward.

The anterior surface of the stomach is directed forward,
and a little upward. This surface is in "relation with the
diaphragm, and is separated by it from the heart; with the
liver, which is prolonged upon it to a greater or less extent;
with the last six ribs, being separated from them by the dia-
phragm; and with the abdominal parietes in the epigastrium.

The posterior surface of the stomach is directed downward
and backward, and is seen in the sac of the omentum, of which
it forms the anterior wall. It has relations with the transverse
mesocolon, which serves as a floor for it, and separatesit from
the convolutions of the small intestines; with the third portion
of the duodenum, called the pillars of the stomach, (ventriculi
pulvinar;) and lastly, with the pancreas. The duodenum, the
pancreas, the aorta, and the pillars of the diaphragm, separate
it from the vertebral column, upon which it rests obliquely.

Such is a short account of the position and relations of the

1852.] WWhurn, on Morbid Sensibility of Stomach. 711

stomach. We have given the natural position of this viscus
when empty; when distended, its position is somewhat altered :
for instance, the great curvature is directed almost vertically
downward in the empty condition of the organ, and almost
directly forward when it is full. Again, the lesser curvature is
directed upward when the viscus is empty, upward and back-
ward when it is full ; and it then embraces the vertebral col-
umn in its curvature, being separated from it by the aorta and
the pillars of the diaphragm ; it also embraces the small lobe of
the liver or the lobulus spigelii, the coeliac axis and the solar
plexus of nerves.

The great cul de sac is in close relation with the spleen, and
when distended is moulded upon that viscus. This portion of
the stomach corresponds in the greater part of its extent to the
left half of the diaphragm, which is in accurate contact with it
and separates it from the lungs above and from the last six
ribs in front. It is more or less elevated, according to the de-
gree of distension of the stomach, and from this we can easily
understand that difficult respiration may be caused by two
large a meal. The great extremity of the stomach has rela-
tions behind with the pancreas, and with the left kidney and
supra-renal capsule.

The human system is accurately made. Every organ has
its own locality and relations, and its position is mathemati-
cally exact in each individual.

We do not say, that all the organs are located mathematical-
ly the same in all persons, comparitively, but we do say, that
each organ in each human being, is mathematically adjusted
with the remaining organs.

So long as each organ maintains its mathematical relation
with surrounding organs, the system is in a state of health, (we
here speak only of position.) but any permanent deviation from
this mathematical relationship is productive of disease, acute or
chronic. We wish to be understood here as discussing mal-
position alone as a cause of disease, we are not now examining
the multiplicity of causes which may produce disease.

Let us apply the rule to the stomach a wheel in the great
and complicated machinery having its place to maintain and
its relationship to observe in order that it may perform its
proper function.

712 Wilburn, on Morbid Sensibility of Stomach, [December,

We select an individual whose stomach is located as we have
previously described. Now, the important questions are What
will be the result upon that viscus and surrounding ones, should
its position and relations be altered? and would the functions
of each organ, now, as before, be properly performed ? Sup-
pose (and it is sometimes the case) the great extremity of the
stomach to be dragged downwards in a displacement of the
spleen ? In this case, we must necessarily have an altered re-
lationship of the abdominal viscera. Every part connected
with the stomach must undergo a corresponding change in pos-
ition. Now comes the questions Will each organ during this
displacement perform its proper function ?

The watch is a beautiful machine. Its parts are admirably
adjusted for the purpose for w^hich the machine was intended.
But if the several parts had been differently shaped from what
they are, (we speak of an individual watch) of a different size
from what they are, or placed in any other order than that in
which they are placed, either no motion at all would have been
carried on in the machine, or none which would have answer-
ed the use that is now served by it. (Paley.)

Is not the argument equally potent when applied to the
human organism? The machinery is transcendently more
important in its structure and purpose ; the parts are more nice-
ly adjusted ; and, consequently, derangement of any organ must
be productive of consequences proportioned in mischief to the
importance and relations of the organ thus altered in position.
There is, however, one point of difference between a deranged
wheel in a watch and a deranged organ in the human system.
The altered position of a wheel does not necessarily imply an
injury to the wheel, per se, but an altered position of an organ
must imply an altered function of that organ.

This we believe to be particularly true of the stomach. It
is located in each system, with a hair's-breadth nicety. The
space through which it may play in the act of digestion, with-
out mischief to itself or other organs, is mathematically circum-
scribed. Its limits of distension are exactly fixed, and its
motions necessary for digestion are governed by immutable
laws. No other position than its original one no other mo-
tions and play than such as were primarily given it no other

1852.] Wilburn, on Morbid Sensibility of Stomach. 713

space for action than that which was first assigned it, can be
consonant with its healthy and proper function.

This, to some, may appear a.petitio principii an assumption
of the question originally intended to be demonstrated and
proved. We cannot stop to discuss minor points, but must
content ourselves for the present with the statement of general
propositions whose ultimate deductions are clear and intelligible.

There is a separate screw to each string of a violin, and
each string depends for its tension and tone upon its own in-
dividual screw. Should that screw be broken or altered in
position, to which is attached the base, that string must evi-
dently suffer in proportion to the damage done.

So in the human system, though in a greater degree, if an
organ is altered in position, the nerves, blood-vessels, &c. must
suffer a proportional injury, and the result of their action, as
in digestion, chylification, &c., must be correspondingly altered.
To suppose otherwise, would be to affirm omnipotent action
in any organ, and that its peculiar and individual ends could
and would be accomplished, under any and all circumstances,
irrespective of position or relationship with other organs.

We lay down, then, this broad affirmation : That morbid
sensibility of the stomach is primarily due to displacement of
that viscus, and that the morbid sensibility of the gastric nerves
is a secondary affection supervening upon or originating from
the visceral displacement.

Professor I. P. Garvin, in a communication published in the
Southern Medical and Surgical Journal, in Dec, 1846, gives
as the ''most prominent cause of" dyspepsia, "food of an im-
proper quality, or in undue quantity." We admire the profes-
sor and sincerely regret that we cannot endorse an opinion so
honestly entertained.

If the sensibility of an organ be an index of its liability to
disorder from outward agents, which seems to be the case in
the eye and in serous membranes, certainly this test is want-
ing in the stomach, which bears the presence of substances such
as no other organ undefended by epidermis could tolerate.
Here the ingesta are, as it were, suddenly deprived of their
active properties ; for the scalding liquid, the pungent spice,
the acrid medicine, the frozen sweetmeat, nay, the mechanical

714 VI Whmu, on Morbid Sensibility of Stomach. [December,

irritant, are often forgotten, when the impressions which they
left upon the tongue, the fauces and the gullet, have been effaced.
The necessity for such an organization that neither pain nor
the derangement of which it is the criterion, should be easily
excited, is obvious from a moment's consideration of the dif-
ference between its circumstances and those of every other
hollow 'wiscus. The heart, the bladder, the intestines, all re-
ceive substances, more or less chemically prepared for them,
and differing but little in their composition at different times;
but into the stomach are carried the most heterogeneous agents,
which have received only a mechanical adaptation to the or-
gan which they visit. (Tweedie.) This organ escapes injury,
from a wise provision of its organization, the copious secretion
of mucus, and the capability possessed by this organ particu-
larly of accommodating itself to varying quantities of blood.
But, independent of the adaptation of the stomach for the re-
ception of its varied ingesta, it would somewhat puzzle the
learned Professor to account satisfactorily for all the symptoms
he relates in his own person.

We have not space nor leisure lo copy his article, but we
will group together the symptoms as he relates them. (Med.
& Surg. Journ., Dec. 1846.)

Discomforture after eating.

Fulness and distension acid eructations.

Flatulence, headache, excitement of circulation.

Burning heat in the stomach.

Bowels costive scybalae.

Liver occasionally disordered.

Heart deranged in action.

Functions of the brain disturbed.

Distressing malaise.

An indiscribable sensation radiating from the stomach to the
surface, resembling aura epileptica. This is succeeded by a
general trembling. At the close of these attacks there is al-
ways a copious discharge of colorless urine.

The above constitute the principal symptoms found in the
article alluded to.

We submit the question to every candid reasoner: From
the anatomical position and relationship of the stomach, would
not its displacement give rise to every symptom related ?

1852.] Wilburn, on Morbid Sensibility of Stomach. 715

Why discomforlure distension fulness after eating, and
its subsidence in a few hours? Evidently, because, the free
and original action of the organ cannot take place during dis-
placement, and hence an uneasiness is felt when this viscus
attempts to perform its accustomed duty, due to resistance
from, and pressure upon adjacent parts. The affections of the
heart, bowels, liver, kidney, lungs, brain, &c., are easily ex-
plained according to the theory of displacement.

The malaise aura epileptica morbid condition of the gas-
tric nerves, &:c., are probably due to a deflection of the nerves
of the stomach from their original and proper direction. We
are aware that here we stumble upon a new theory of nervous
action, but it is not to our purpose at present to discuss it. We
would suggest, however, that neuroses can probably be more
easily explained upon the principle of deflection of the nerves
from their original direction, than upon the theory of nervous
lesion.

The stomach derives its nerves from the eighth pair and
from the solar plexus. By means of the eighth pair this organ
is connected with the oesophagus, the lungs, the pharynx, the
larynx and the heart. Through the nerves, from the central
epigastric plexus, it is connected with the ganglionic system,
and is brought into relation with the numerous viscera of the
abdomen.

This extensive and intimate connection of the stomach with
the entire system is a proof of the importance of the organ,
and its displacement cannot result otherwise than deleterious
to the whole organism.

No one will deny skill and design in the Creator, in the order
of parts their positive and sympathetic relationship, and their
separate and peculiar function. If each part was thus particu-
larly and mathematically adjusted, no other arrangement of
parts no other order no other location no other connection
or relationship can answer fully the ends of the original design.
To reason otherwise would be an imputation upon the wisdom
of Deity.

We submit what we have written to a heartless and relent-
less criticism. We are fully apprised of the meager garb in
which our subject must go dressed before the world, but under

716 l^ong, on the Topography and most prevalent [December,

existing circumstances the evil could not be remedied. The
object of the present article has been more to state clearly our
views than to discuss them. We have not thought it proper
to anticipate and answer objections, neither have we propped
our assertions by cases and logical deductions, as these did not
come within the sphere of our original design in writing this
article. We have discussed briefly such points only as were
essential to render our views intelligible.

ARTICLE XLVIII.

Remarks on the Topography and most Prevalent Diseases of
lower East Tennessee. By J. A. Long, M.D., of Tennessee.

That portion of country familiarly known as lower East
Tennessee is a high, broken, and well watered country ; the
spring water is mostly impregnated with lime, but is occasion-
ally found pure. Most of the tillable land lies in valleys, and
is rich and productive, especially along the water courses. The
banks of the streams are high, and always sufficient to prevent
overflows, so that we never suffer from inundations at any
season of the year. Nearly all our water courses, from the
smallest tributary branch, to the largest rivers, are swift run-
ning and shoaly streams, with good banks, as above stated ;
consequently the creeks are blocked up, from head to mouth,
with numerous mill-dams. This, no doubt, is a fruitful source
of fevers in this section. The climate is extremely variable,
so much so, that sudden and severe changes take place even in
twenty-four hours hence our great liability to influenzas,
inflammations, and diseases of the respiratory organs in gener-
al. We are subject, in this section, to all the diseases (with
but few exceptions) that are common to the United States.
Up to the present, we have had no cases of cholera, small-pox,
congestive, nor yellow fever. The natural growth of this coun-
try is oak, hickory, poplar, ash, gum, walnut, chesnut, pine,
&c. The diseases of this season are pretty much as in former
years, though they seem to be undergoing a gradual change,
especially the fevers.

Fevers constitute, probably, one-fourth of the whole sick-

1852.] Diseases of lower East Tennessee, 717

ness in this region; next in importance are the diseases of the
respiratory organs, with occasional epidemics of measles and
scarlatina. Diseases peculiar to women, should occupy a
prominent place in the consideration of the diseases of this sec-
tion, as they are probably as numerous in this as iri*any other
rural district ; and this, 1 think, is satisfactorily accounted for
by the fact, that, parturient women are almost entirely in the
hands of uneducated midwives, and also by the variableness of
our climate. Puerperal diseases, and especially puerperal fe-
ver, have been very rife in past years ; so much so, that parturi-
ent females have looked for it as an unavoidable or necessary
consequence. Notwithstanding its prevalence, it has never
yet appeared to me to present any of the features of an epi-
demic, nor has it appeared to be contagious or communicable,
in any way, from patient to patient, through the medium of
the practitioner, or otherwise. This disease (notwithstanding
it has presented all the characteristics of general puerperal
fever, as laid down in the books) has not been that formidable
monster spoken of by the older writers, but has, in a great
majority of cases, yielded promptly to remedial measures,
when timely administered. These remarks on the prevalence
of puerperal fever, are more especially applicable to my own
immediate bounds of practice. My patients invariably recov-
ered under a moderately antiphlogistic treatment such as,
bloodletting, purging, fomentations, blisters, &c. Venesection,
however, was found necessary only in a small proportion of
cases. Calomel and opium was used, with the happiest effects,
in all the cases that came under my care, in the proportion of
from 6 to 10 grs. of the former, with 1 to 2 grs. of the latter,
and this, too, in cases of obstinate costiveness, as well as when
diarrhoea was present. The medicine, in obstinate cases, was
afterwards continued in smaller doses, with a view to its con-
stitutional effects. There never was any more difficulty ex-
perienced in procuring free alvine discharges, when the opium
was used in connection with calomel, than when it was with-
held ; on the contrary, it seemed to relax, and materially aid
this desirable end. Fomentations, followed by large blisters,
were invaluable auxiliaries in the treatment of puerperal fever ;
nor was it necessary, in all cases, to use blisters, as the abdom^

718 Long, 071 the Topography and most prevalent [December

inal pain and soreness seemed readily to abate under the per-
severing use of hot fomentations in conjunction with other
appropriate remedial measures. Most of the cases convalesced
slowly, and relapses were very common and dangerous.

An epidemic influenza has prevailed here, more or less, for
the last few years, of a typhoid type, and often mistaken for
genuine typhoid fever, especially when both diseases existed
simultaneously in the same family, or the same neighborhood.
They had many points of resemblance, but were sufficiently
distinct, in their modes of access and general course, to be
readily and properly diagnosed by the attentive observer.
The greatest points of resemblance were, that both typhoid
fever and influenza were seen attacking whole families, or
neighborhoods, as if from contagion: both were attended with
diarrhoea, continued fever, great weakness, restless jactitation,
&c., f^specially at night. These symptoms were common to
all cases of typhoid fever, from the mildest attacks to its gravest
form whilst, in influenza, they were only noted in the graver
forms of the disease. The onset of the two diseases was
strikingly diflTerent ; that of typhoid fever was almost invaria-
bly slow^ and gradual, whilst that of influenza was as uniformly
sudden. The former continued several weeks, and was not
controlled by treatment whereas, the latter was of short du-
ration, and readily yielded to proper remedial means. Both
were attended with a cough, but this was mild in typhoid fever,
whilst, in influenza, it was severe and troublesome, constituted
one of the leading symptoms of the disease, and was most gen-
erall}^ accompanied with a severe pain in the side.

Dysentery, is another disease that claims a place in this
report, whether it be considered in reference to its frequency,
or to the severity of its symptoms. This disease has also par-
taken of the prevailing typhoid type, and required to be man-
aged with great prudence. The treatment almost uniformly
successful in my hands was the free use of mucilaginous drinks
and injections, suppositories of opium, fomentations to the ab-
domen, &c., with the occasional use of small doses of calomel,
acetate of lead, and opium, or its equivalent in Dover's powder ;
but this internal medication was not often repeated, nor given
to induce constitutional eflfects. Blisters proved, in some cases,

1852.] Diseases of lower East Tennessee. 719

highly beneficial, especially in the chronic form of the disease.
The oil of turpentine was extensively used and greatly lauded
in many portions of the country. Having had no experience
in its use in this disease, I can say nothing of its CiTects, but am
inclined to oppose its administration, unless it be in an ex-
tremely advanced chronic stage, and then with great caution
and distrust. Oil of turpentine has been recommended by
Dr. Wood, in his Practice of Medicine, in the chronic stage of
typhoid fever, to excite a more healthy action in the intestinal
ulcers, known to be so common and obstinate in that disease :
hence, probably, its introduction in the treatment of dysentery.
I have no hesitancy in saying, that in all cases of dysentery, in
which the patient recovers after the use of calomel, oil of tur-
pentine, and other similarly irritating drugs, he does so, in spite
of both disease and treatment ; and that he would have recov-
ered much more readily, if left to nature and a good nurse.
When the patient is robust, and the inflammatory symptoms
run high, venesection may be resorted to w-ith benefit, if cau-
tiously done with the finger on the pulse, and with an eye al-
ways to the prevailing typhoid type. Then it is only necessary
to clear the alimentary canal, by the use of castor oil, preceded
or not by from 2 to 5 grs. of blue pill, with from 1| to 2 grs.
opium ; after which, nothing of an irritating or indigestible
character should be taken, either in the form of medicine or food.
Pneumonia is a very common disease in this region of coun-
try, and for the last few years, or since the prevalence of
typhoid fever, there has been a good deal of that form denomi-
nated pneumonia typhoides. Nearly all diseases have become
less inflammatory, and partake more of the low or typhoid
form, than in former years, in this section of country. The
lancet is not used half so often as formerly. Fevers have un-
dergone an almost entire revolution since I commenced the
practice of medicine, nine years ago. The prevailing type
then, was almost universally intermittent and remittent, with
occasional cases of inflammatory continued fever, wholly dif-
ferent from the typhoid of the present day. Typhoid fever
became more prevalent, and periodical fevers less so ; as the
former increased, the latter diminished, and periodical fevers
were rarely seen until, the present summer and autumn, in

720

Long, on Topography and Diseases. [December,

which we have had nearly an equal number of periodical and
of typhoid fevers. I shall not remark further in this place on
the subject of typhoid fever, as I have already given my views
of it in this Journal. (June No., 1851, p. 324.)

Consumption has prevailed here considerably of late years.
The great prevalence of influenza, and of the typhoid type in
all diseases, combines two circumstances which tend to pro-
duce it viz., irritation of the respiratory apparatus, and an
asthenic condition of the whole system ; the former acts as an
exciting cause, and the latter perpetuates it. Three deaths
take place in this section from consumption where one did five
years ago, or prior to the prevalence of influenza ^nd typhoid
fever. Nearly as many deaths have taken place from phthisis
pulmonalis here, in the past spring and winter, as from all other
diseases combined together, and I do not recollect a single
case, under my care, or that of others, that could not be traced
to a severe attack of influenza, or to typhoid fever. It is hard-
ly necessary to remark on the treatment of consumption ; it is
sufficient to say, that the patients invariably died.

Worms are very common in this locality, especially the lum-
hricoid; it is not uncommon for them to be discharged in great
numbers, by the use of domestic remedies or in the course of
the treatment of other diseases, both in children and adults, es-
pecially when calomel is given.

Diarrhoea, in children, has been prevalent and obstinate
during last summer; it seemed to be very little under the con-
trol of medicine, especially when chronic, as was the case in
a majority of the instances I saw. The discharges were not
difficult to check by fractional doses of calomel and ipecac,
sometimes combined with small doses of pulv. Doveri, or what
was better, acetate of lead ; but this appeared only to sicken and
prostrate the little sufferers. Having derived decided benefit
from the use of chalybeate waters, in a case in my own family,
I have since prescribed a weak solution of sulphate of iron
with advantage.

1852.] ^{di.vv, on the Treatment of Dysentery. 721

ARTICLE XLIX.

Additional Remarks upon the Treatment of Dysentery. By
E. F. Starr, M. D., of Rome, Ga.

In a former number I offered a few remarks upon Dysentery,
and the use of large doses of opium in its treatment. I now
propose to direct attention to apian of treatment which differs
somewhat from that in general use. I would do this, because
I believe there is some room for improvement, and that the
want of success is not to be charged altogether to a fault in the
resources of the materia medica. It is a fact worthy of some
notice, that, of late years, while medicine has been triumphing
in so remarkable a manner over some forms of disease, dysen-
tery has not been shorn of its terrors, and its treatment now is
little more successful than it was many years ago. As we
have certainly not arrived at a point beyond which we may not
advance, we are justifiable in casting around us to see if there
be not means as efficient for the relief of other diseases as
quinine is for the cure of autumnal fevers. Is there no reliable
remedy for dysentery ?

If I am told there is a vast weight of authority in favor of
the calomel treatment, and that it has been the established
practice for scores of years, 1 appeal to the number of deaths
by the disease at the present day. Comparatively but a few
years ago, calomel was considered the great remedy for au-
tumnal fevers ; yet the physician who knows no better now is
far behind the times. I esteem calomel very highly as a reme-
dy; nor is my design so much to wage war against it, as to
place it in the back* ground, compared v/ith opium, in the treat-
ment of dysentery. I am disposed to " retain the mastodon in
harness," and to make it useful by judicious and cautious ad-
ministration whenever necessary, which will rarely be the
case in dysentery. A patient with sound bowels may perhaps
take a full purgative dose of calomel v/ith impunity, but that
one with inflamed intestines can do so with entire safety admits
of much doubt. Unfortunately, from the word bile has been
derived bilious, and from this, bilious attacks, and bilious fever,
and bilious colic, and bilious dysentery, and bilious every thing
else to which the term could be applied ; and to this prevalence

722 Starr, on the Treatment of Dysentery. [December,

of the bilious idea is to be attributed the belief, that to cure
these affections there is little more necessity than to purge out
the bile and "regulate the secretions," with calomel, of course.

Dysentery is a primary inflammation of the parts ostensibly
affected, and it is not to be expected that it can be promptly
and certainly cured, without directing attention to the condi-
tion of the diseased locality ; nor need we hope to obtain suc-
cess in the use of an irritating and motor-exciting treatment:
for an inflamed organ needs rest, and to place it in the most
favorable condition for a restoration to health, it must have
rest. The hazard to which a little untimely exertion may sub-
ject a patient suffering with acute inflammation of any import-
ant organ is well known how certainly then must undue
action in an organ, itself inflamed, produce injurious effects.
The value of opium, therefore, and the danger of a different
class of agents, must be apparent under this view of the sub-
ject.

With regard to the use of cathartics, I would not be misun-
derstood : they are sometimes useful and necessary, but should,
in such cases, be cautiously used, and, in general, be combined
with opiates. I think there is often too much anxiety among
practitioners upon the subject of scybalae, and too great a pas-
sion for producing discharges of foecal matter ; yet I would not
produce the impression that the contents of the bowels are to
be left entirely witjiout attention, but, that they are of little
importance compared with the intrinsic features o{ the disease.
In confirmation of this view, I will quote a fact from Dr. Bran-
don's article, in the March No. of this Journal. In describing
some violent cases, which came under his notice, he says, that
he "seldom observed foecal matter in the discharges until a
change for the better had occurred." The improvement, then,
could not have been produced by the feculent discharges, but
these must have been the result of an amelioration of the dis-
ease showing that the disease may be first subdued by opium
and other remedies, and the bowels afterwards emptied more
safely.

In the treatment of dysentery, our object should be to effect,
promptly, the cessation of spasm and pain, and the reduction of
inflammatory and febrile action. These indications are all un-

1852.] Starr, on the Treatment of Dysentery. 723

der the control of the therapeutic properties of opium, to a
greater or less extent, and if these indications and these pro-
perties are properly weighed and considered, in connection
with each other, the tendency will be towards the establish-
ment of the treatment which I am endeavoring to urge upon
the attention of those who may notice these suggestions.
The reason why so little reliance has been placed in opium, is,
that it has not been given in sufficient quantities in doses
large enough to overcome the force of disease, and to produce
its legitimate and peculiar antiphlogistic and antifebrile effects.
There is no confidence to be placed in an ordinary or medium
dose of opium when the patient is suffering the effects of vio-
lent inflammatory action, the tortures of pain, or the depressing
adynamic influences of malignant disease. The dose must be
proportionate to the emergency of the case. I suggested from
two to four grains, but this should not be considered the limit ;
this quantity is rather the minimum than the maximum cir-
cumstances must determine the precise amount. In dysentery,
if the pain, fever, and flux persist, they are sufficient evidence
that enough has not been given six grains are not too much
in such cases. The antiphlogistic virtues of opium seem gen-
erally to be imperfectly known or understood, or if known, not
appropriated and applied. All agree in admitting its usefulness
as an anodyne, as a soother of pain and promoter of sleep, etc.;
but who administers it with a view of overcoming fever, or
who looks to it principally to subdue some severe forms of
inflammation. Yet, what diaphoretic will produce such cer-
tain and general opening of the pores and genial moisture of
the surface ? what will so equalize the circulation ? what so
control the heart and arteries? and what aflx)rd such suspen-
sion of pain, thereby breaking the chain of the morbid actions-
of inflammation? Fever and inflammation cannot well persist
under such circumstances under the effects of full doses of
opium.

To carry out more efl^ectually the suggestion above made, in
relation to the indications of treatment, it may be often proper
to resort to one efficient bloodletting, in cases where there is
much fever and no want of strength. This will render the
system more susceptible to the favorable influence of opium.

724 Trent, on Dysentery. [December,

which now, if properly administered, will never fail to mitigate,
and seldom to relieve entirely, the sufferings of the patient.
When this is done, the use of opium is not to exclude other
substances as auxiliaries ; such, for instance, as calomel or oil,
when they are needed, or sugar of lead and other astringents,
when, after the subsidence of the inflammatory symptoms, the
discharges remain too frequent and watery. These, with fo-
mentations, blisters, enemata of watery solution of opium and
starch, &c., may be resorted to : but opium in large doses,
given either by the mouth or rectum, in the early stage of the
-disease, should be the leading remedy and chief reliance.

ARTICLE L.

Dysentery treated with Sulphate of Magnesia. By Peter-
field Trent, M. D., of Richmond, Ya.

June 18th, 1852, I was called to see Polly Gentry, a colored
woman, of robust constitution, aged 50 years; found her suffering
with acute dysentery. Prescribed : 2 grs. calomel, 2 grs. acet.
plumbi and \ gr. opium, every two hours ; enema, night and
morning, of 10 grs. acet. plumbi and 30 drops tinct. opii. in 2 oz.
of starch-water ; diet, milk thickened with arrow-root, or rice
and milk ; drink, toast water, or the water in which rice had
been boiled, to which a little salt was to be added. 6, P. M.,
visited my patient again ; found her no better. The tormina
still excruciating ; the tenesmus constant and harrassing ; the
fever slightly abated ; the dejections frequent and blended with
blood and lymph, with a great deal of water. Ordered a con-
tinuance of the treatment directed in the morning patient to
be allowed to dissolve 'small particles of ice in her mouth, to
relieve the urgent thirst.

June 19th. Patient no better. Same treatment to be con-
tinued. 4, P. M., a little better the discharges having more
of a foecal appearance.

June 20th. Patient easier, but no decided improvement in
the evacuations. In hopes of procuring some action from the
liver, ordered 5 grs. calomel a'nd 5 grs. acet. plumbi every two
hours ; enema, as at first, omiting the tinct. opii. 6, P. M.,
evacuations very dark, but watery, no appearance of blood ;

1852.] Trent, on Dysentery. 725

tenesmus harrassing ; epigastrium very tender upon pressure
to relieve this, a mustard-plaster to be applied. No change in
the other treatment.

June 21st. Patient apparently better discharges more
fcecal. Thinking I had given mercury enough, I ordered no
medicine this visit : her diet to be the same as heretofore.
4, P. M., sent for in haste : patient in every respect worse.
^ Ordered 5 grs. tannic acid and 3 grs. acet. plumbi every two
hours. 11, P. M., evacuations consisting entirely of bloody
mucus. Repeat prescription ordered in the morning ; give an
enema 3ss tinct opii to 3ij starch water.

June 22d. Again sent for me in haste. Patient evidently
worse and sinking passing her evacuations involuntarily. Or-
dered wine whey requested consultation. In the meantime,
directed enema of 20 grs. acet. plumbi, 60 drops tinct. opii., to
5 ij starch water, to be given immediately. My friend, Dr. Bol-
ton, met me, at 2, P. M. We found her complaining of dryness
of the throat and violent thirst; the tenesmus being very violent;
epigastrium very sore, evacuations of pure blood, though fre-
quent, yet small. We determined to try the following :
^. Sulph. Magnesia, !i. ; Tinct. Opii. 3i. ; Aq. Menth.
Pip. iiv. Dose, 5 ss. every two hours. Enema, of 9j. Argent.
Nit. Crystal, to ii. Aq. Dist. (I may here state, that by mis-
take the enema was not given.) 10, P. M., no better.

23d. Patient a little better; had vomited first dose of saline
mixture. Treatment continued. ' P. M., evacuations more con-
sistent ; patient easier.

24th. Patient better ; tenesmus but slight ; no epigastric ten-
derness ; evacuations appearing like those of diarrhoea. 6, P. M.,
patient improving, discontinue saline mixture. If tenesmus is
annoying, use acet. plumbi and tinct. opii. enema, as before.

25th. From this time until I ceased visiting her, she slowly
improved, and is now (July 10th) well enough to resume her
duties as a washerwoman.

I have treated some ten cases since the above successfully,
with the salts and laudanum, not having given any other med-
icine from my first visit to the last.

The case just reported is a fair example of one of the most
intractable forms of the disease, and requires all the physician's

N. 3. VOL. VIII. NO. xn. 46

726 Wellborn, on the Circulation of the Blood. [December,

skill. The intense suffering of the patient and the probability
of a fatal termination, unless the disease be arrested within a
short period, appeal strongly to his humanity. He applies
active counter-irritation he administers mercury, opium, as-
tringents and demulcents, per orem et rectum an amendment
takes place the patient is convalescent at the very next
visit his hopes are dashed by the recurrence of all the worst
features of the case : the treatment has been palliative it has
not effected a radical cure. Let us consider the pathological
condition in such a case. There is inflammation of the mucous
membrane of the rectum and perhaps of the adjoining colon;
or it may be still more extensive. The tenaceous bloody mu-
cus, tenesmus, tender abdomen and symptomatic fever, tells
us this. We want then to eject thoroughly all scybalse or
other local irritants ; we want to deplete the hypersemic sur-
face we want to change the character of the secretions, from
a thick, tenaceous matter, which requires wearisome and pain-
ful efforts to dislodge it, and produce instead, a loose, watery
matter, which will run off almost insensibly. Such are pre-
cisely the effects of sulphate of magnesia a refrigerant purga-
tive reducing the fever and cleansing the intestinal canal
effecting local depletion by drawing off the serous portion of
the blood from the over-distended vessels, changing the un-
manageable dysentery to a manageable diarrhoea. Opium and
calomel are highly valuable as adjuvants the former quiets
the spasmodic action of the muscular coat of the intestines and
obtunds its excessive sensibility by composing the whole
system, it relieves the sense of weakness and exhaustion. The
latter keeps the portal circulation flowing freely, and thus re-
lieves the congested vessels, which pour their contents into it ;
at the same time, by its specific action, it aids in restoring a
healthy secretory process.

ARTICLE LI.

On the Circulation of the Blood. By A. R. Wellborn, M. D.,
of Newton county, Ga.

Having noticed a great deal said in the Boston Medical and
Surgical Journal, since last January, in regard to Mrs. Wil-

1852.] WeWhorn, on the Circulation of the Blood. 727

lard's Theory of the Circulation of the Blood, it was our inten-
tion to write an article proclaiming the merits of a theory
much more satisfactory ; professional engagements, however,
have prevented our doing so, and we only give an outline of
Dr. Draper's theory, to those who have not examined the sub-
ject, hoping it will call forth remarks from some more able pen,
and thus justice be done the author.

It was for a long time supposed that the circulation of plants
was carried on by the forcing power existing in the spongioles
or extremities of the roots, aided by a kind of suction power
in the leaves. This, though a plausible reason, does not ac-
count for the downward flow of the sap. By means of the
spongioles, the water holding the different saline properties de-
rived from the earth is taken up, and by means of capillary
attraction is carried through the body of the tree or plant to
the leaves. On the surface of the leaves, a change in the
chemical constitution of the watery solution takes place. It
obtains, on coming into contact with the air, a portion of car-
bonic acid gas, and is, by the agency of sunlight, decomposed,
and a mucilaginous solution ensues. This mucilaginous solu-
tion, containing the nutritive material, is then forced back
through the proper vessels to the bark of the tree. This
elaborate sap, in its descent to the root of the plant, moves
through a system of vessels which anastomose with each other,
and imparts nutrition. If we take a capillary tube of such
length and diameter that when one end is immersed in water
the fluid will rise to the top break off a portion of that tube,
and again immerse one end, the fluid will rise to the summit,
and remain stationar}^ unless there is something to produce an
exhausting effect. We see, then, it is owing more to the ex-
hausting action of the leaves that the capillary movement is
continued, and not to their suction power, and that the chemi-
cal changes account for the elaborate sap being driven for-
wards to the under side of the leaf, thence to the bark of the
tree. The circulation, then, of the nutritive juices, both in the
vegetable and animal kingdoms, rests upon this physical princi-
ple, "that if two liquids communicate with one another in a
capillary tube, or in a porous or parenchymatous structure,,
and have for that tube or structure different chemical affinities*

728 WeWhoru, on the Circulation of the Blood. [December,

movement will ensue, that liquid which has the most energetic
affinity will move with the greatest velocit}^ and may even
drive the other fluid entirely before it, that this is due to com-
mon capillary attraction, which, in its turn, is due to electric
excitement."

Dr. D. remarks, that even gaseous substances, as is shown
experimentally in the appendix of his work, pass into one ano-
ther with a force greater than the pressure of a column of
water seven hundred feet high, so that to elevate the sap in a
tree, or to drive the blood in an animal, is an insignificant de-
mand on the energy which this force could put forth. Let
us then apply these principles, to account for the circulation
of blood in the higher animals. The arterial blood passes
from the left ventricle, to the capillaries, burning out the effete
carbonaceous matter of the tissues, and perhaps converting its
hydrogen into w^ater. Having obtained carbon, venous blood
is formed, and is driven forward along the capillaries of the
veins ; the affinity which then exists between the venous blood
and the oxygen of the lungs, causes it to rush forward, driven
by the momentum received by the chemical change in the
tissues. In the first place, the intense affinity which the oxy-
genized or arterial blood had for the carbon of the tissues,
causes it to rush toward the extremities ; it then undergoes a
chemical action, and the condition of the affinities is changed.
The venous blood is now driven toward the heart by means of
the affinity existing between the carbon of the moving mass of
blood and the oxygen existing in the lungs.

We see, then, the two forces which are brought to bear
the one expressed by the intense affinity existing between
oxygen and carbon, the other arising from the physical prin-
ciple before mentioned, that if two liquids communicate with
one another in a capillary tube, or in a porous or parenchyma-
tous structure, &c.

It does seem to us clear, that the primzim mobile of the circu-
lation cannot reasonably be attributed to the caloric evolved
in decarbonizing and oxydizing the blood, but that the chief
force lies in the chemical affinities, as illustrated by Dr. Draper.
We do not say that caloric has no influence, but if it has any
propelling power, it is merely a subsidiary or resulting action.

1852.] Wellborn, 6^71 ^//e Circulation of the Blood. 729

Neither do we deny that the heart has an important agency
in keeping up the circulation of blood it certainly does have ;
but we must agree, with Dr. D., that this central organ is given
us more to act as a regulator between the pulmonary and sys-
temic circulation.

To strengthen the view here taken, it is to be considered
that plants are wholly destitute of a heart, yet the sap flows, and
their juices circulate. In many animals the circulation is car-
ried on without a heart. In insects no such central organ exists.
But we are asked, how do you account for the circulation in
the foetus ? Let us consider the foetal circulation for a moment.
We find here, the blood passes from the placenta through the um-
bilical vein, a large branch of which having passed into the liver,
the blood from which is driven into the hepatic vein, and thence
conveyed to the ascending vena cava, the principal branch con-
veying the blood immediately into the vena cava. From the
vena cava ascendens, it passes into the right auricle, guided by
the eustachian valve through the foramen ovale into the left
auricle ; from the left auricle, it passes into the left ventricle,
and from the left ventricle, into the aorta, whence it is distri-
buted by means of the carotid and subclavian arteries, princi-
pally to the head and upper extremities : from the head and
upper extremities, it passes through the descending vena cava
to the right auricle ; from the right auricle, it is propelled into
the right ventricle ; from the right ventricle, into the pulmona-
ry artery, and through the ductus arteriosus into the descend-
ing aorta. It is then distributed to the inferior extremities,
whence it returns to the placenta through the umbilical arte-
ries. We find here a circulation, commencing in a capillary
system and terminating in a capillary system. How, then, can
we say the heart is the cause of such a circulation being pro-
duced and kept up ? Why cannot the same principle apply
here that did in the adult circulation ? If we say the placenta
has the power, as some believe, of vivifying the blood, then
precisely the same aflinities are applicable, and act in the same
way. If, as others believe, the placenta has not this power,
still the same reasoning applies ; for we find the foetal circula-
tion similar in many respects to that of the portal circulation
in the adult, and we bring in the same general principles

730 Dugas' Case of Ovarian Tumor. [December,

explaining the mechanical causes of circulation in this case.
" That, for the physical reasons which have been assigned, a
pressure will always be exerted by the fluid, which is ready to
undergo a change upon that which has already undergone it ;
a pressure which, as there is no force to resist it, will always
give rise to motion in a direction from the changing to the
changed fluid."

We will remark, in conclusion, that for some time past, since
typhoid fever has been prevailing in its malignant form in this
section of country, we have noticed an irregular pulse in the
majority of cases. How to account for this we are at a loss.
The blood, no doubt, is vitiated, and contains a poison what'
that poison is, we are not prepared to say : it may be hydro-
sulphate of ammonia, according to the experiments ofM. Bon-
net, or it may be carburetted hydrogen.

In those cases which proved fatal, we are not aware that any
lesion of the brain existed ; nor have we detected any pressure
of the brain from symptoms during life ; nor have post-mortem
examinations revealed any to the eye.

May it not be that the poison in the blood produces more
or less derangement in the chemical aflinities, that a languid
circulation is the result, and that in consequence of the ab-
normal stimulus the heart receives, this irregularity of pulse
is produced.

ARTICLE LII.

Sudden Rupture of an Ovarian Tumor peritonitis recovery.
ByL.A. DuGAs,M.D.,

Mrs. D., aged about 42, the mother of thirteen children,
had always enjoyed good health until the birth of her last
child in March, 1851. Her delivery, although natural, was
followed by considerable hemorrhage, and she has ever since
felt a fixed pain or soreness in the left iliac region. At the end
of a few months a distinct tumor could be perceived by
pressing firmly over the painful region, and this gradually ac-
quired a volume equal to that of a foetal head. When turning
over in bed upon the light side, a sense of dragging would
always be experienced to so unpleasant a degree as to prevent

1852.] BugSiS Case of Ovarian Tumor. 731

her sleeping upon tliis side. Tiie left lower limb would some-
times be swollen, and often feel benumbed. Sitting upon a
very low seat became so uncomfortable, from the pressure of
the thighs upon the abdomen, (the patient being corpulent,)
that the night-glass for ordinary use was placed in a chair of
usual height.

Such was ihe state of the patient when, on the 5th January
last (1852), she was taken with uterine hemorrhage. She was
in the habit of menstruating during lactation, and had done so
ever since her last confinement, with the exception of the two
last periods, which induced the belief that she was now two
months pregnant, and was about to miscarry. The hemorrhage
did not yield to ordinary means, but rapidly increased and be-
came attended with uterine contractions. Ergot was now
freely administered a mole or false conception was expelled ;
but the loss of blood continued so excessive that fatal exhaustion
appeared inevitable. A tampon was introduced and the ergot
continued, which arrested the flow, but she remained pulseless,
with often recurring syncope, and a cold sw^eat during ten or
twelve hours, notwithstanding the additional free administra-
tion of brandy. The hemorrhage was effectually stayed, and
did not return upon the removal of the tampon.

The patient recovered very slowly ; the anemia continued
very great, and the painful annoyance in the iliac region
increased. At the end of a month she was still unable to walk
about the house without fatigue, and on the 4th of February
was carried down stairs to a room below for a change of scene.
General debility and distressing tenderness in the region of the
left ovary were now the prominent features of the case. On
returning to her bed-chamber in the afternoon of the 4th of
February, she inadvertently sat upon a night-glass to urinate,
instead of using the chair, as heretofore. As she did so, she
suddenly felt a most excruciating pain throughout the entire
abdomen, swooned, and fell upon the floor. On recovering, she
attributed her suffering to intense cramp colic, and said she felt
as if all her intestines were violently constricted or " drawn
up." There was no discharge per vaginam. Enemata and
warm fomentations were resorted to, and the bowels were
\cuated, but without the least relief I saw her about two

732 Dugas' Case of Ovarian Tumor. [December,

hours after the accident : she had not yet been able to have her
garments taken off to get into bed, but was lying upon a couch.
She felt a " burning, drawing pain" throughout the entire ab-
domen, which was exceedingly tender to the touch, but not at
all tense. Her pulse was frequent, and her respiration short
and thoracic. She had thrown up the contents of the stomach,
but felt thirsty. The tumor could no longer be recognized by
the touch. She thought she had bruised it with her thighs, in
sitting upon the vessel to urinate. The fact was evident, that
she had not only bruised, but actually ruptured the tumor, and
that its contents had escaped into the abdominal cavity, in-
ducing peritonitis, which, in her enfeebled condition, could not
be otherwise than extremely dangerous. 40 drops of lauda-
num were immediately administered, and a large blistering
plaster applied over the abdomen ; the laudanum to be re-
peated in two hours, unless relieved.

5th Feb. The blister is well drawn; the tr. opii. had to be
repeated in the course of the night, and again this morning.
Abdomen still very sore and somewhat full ; pulse small and
very frequent ; surface hot and dry ; eructations and occasional
vomiting ; great thirst ; breathing short and thoracic ; cough-
ing very painful. Ordered, the lateral surfaces of the abdomen,
or flanks, to he covered with blistering plasters, and the ano-
dyne to be repeated as often as necessary to mitigate the inten-
sity of the soreness. Bi-carb. soda and lime water, alternately,
in small quantities of cold water, for beverage.

6th. Local symptoms about the same, with the exception of
a little increase in the volume of the abdomen. General state,
better. Continue same treatment.

7th. Abdominal tenderness less marked : passed a comfort-
able night ; nausea relieved ; pulse not so frequent. Continue
same beverage take a little chicken broth occasionally.

12th. The peritoneal inflammation gradually subsided, but
the abdomen is still tumid. No fever patient convalescent.

May 1st. Mrs. D. is now in her usual health, but still feels
a soreness in the iliac region. No tumor can now be detect-
ed. She has menstruated regularly at each period since the
attack of hemorrhage, with the exception of that which came
on at the time of the rupture.

1852.] Report of the Committee on Surgery. 733

It will be observed that the details of this case are given with
considerable minuteness. This was necessary, in order to con-
vey a correct idea of its nature, and to show the reader the
grounds upon which the diagnosis was established. One can-
not be too minute in describing cases of such rare occurrence
as one in which an ovarian tumor has been ruptured by vio-
lence and emptied into the abdominal cavity, without causing
death.

PART II.
(Btltciit Btipaxtmtni,

From the Transactions of the Medical Society of the State of Georgia.

Report of the Committee on Surgery. By H. F. Campbell,
M. D., Chairman.

The resolution under which the Committee on Surgery was
appointed having contemplated in its plan, only Surgical facts
occurring to practitioners in the State during the past year,
leaves a very restricted field for a report. The only practical
mode of collecting these facts, viz : by a review of the journals
and by calling on the Profession "throughout the State in a pub-
lished card has been adopted. The result of our efforts with
this mode of procedure will, we fear, present but little of in-
terest to the Society.

We find that most of the Surgery publisher^ in the State du-
ring the past year has been transmitted to the Southern Medical
and Surgical Journal, there being, so far as we know, but one
case published elsewhere.*

In presenting their review of the journals during the past
year, the Committee have adopted as their system, that of
classing the matter under three heads, viz: Surgical Injuries
and Pathology ; Surgical Operations ; and lastly, Surgical
Medicine or Treatment. We have placed reports under these
three heads, according to the respective importance presented
by these three features. Thus, cases published on account of
the interest attaching to the pathology, on account of some pe-
culiar mode of Treatment or remarkable surgical operation,
have found their places accordingly under these respective
heads.

In thus classing these cases, the Committee have taken the
liberty of exercising their own judgment as to the particular

Charleston Medical Journal and Review. Case of Injury of Cranium, by
F. T. Matthews, M. D., herein reported.

734 Report of the Committee on Surgery. [December,

head under which such cases should appear, and it will be seen
by a reference to the journals from which our collection has
been made, that we have sometimes found it necessary to dwell
upon points as interesting in these cases, which their original re-
porters appeared lo view as of minor importance, and vice versa.

In making our collection, the Committee has in view of the
paucity of the published reports, determined not to exclude any
that have come under their observation ; our object has been
to present a faithful resume of the Surgical facts, of the past
year, throughout the State, and to show as far as we were able,
the amount of Surgery practiced or reported in the State du-
ring that period. In doing so, we have used the space between
January, 1851, and the present time, which, though the time is
somewhat more than tw^ehe months, we have still felt author-
ized in doing.

Of thethi-ee departments of Surgery arranged by the Com-
mittee as heads, we have found a greater number of cases
occurring under that of Surgical Pathology than under either
Operations or Surgical Medicine.

SUEGICAL PATHOLOGY.

Under the head of Surgical Pathology we have placed all
those cases which have come under the observation of the
Committee in which the pathological condition of the patient
appeared to be, in our judgment, the most remarkable feature.

The following case has been deemed appropriate for this re-
poi't from the fact that, though it comes more properly under
the domain of general practice, still the Surgeon is moi'e fre-
quently consulted for the I'elief of such affections than the
ordinary practitioner.

Progressioe Muscular Atrophy. L. A. Dngas, M. D., Pro-
fessor of Suigery in the Medical College of Georgia, in some
favorable editorial remarks upon the Treatise of Dr. F. A.
Aran, of Paris, on this subject, coincides with Dr. A. in the
opinion that such cases are often mistaken for nervous diseases,
and incidentally relates the following case from his own prac-
tice as corroborative of this opinion :

*' The case was that of a much esteemed professional brother, who,
in the pritne of life, and the possession of a vigorous constitution,
perceived that he was gradually losing the power to flex the thumb of
one band. The loss of the use of the thumb having become complete,
the finger next to it began to weaken also and became useless ; the
middle finger followed next, and thus, successively all the fingers of
that hand became powerless. The loss of voluntary motion invaded
the wrist and then the elbow, and finally all the muscles of the shoul-
der. When it reached the elbow of this hmb, the thumb of the other
hand began to give way precisely as the first had done and the disease

1852.] Report of the Committee on Surgery, 735

progressed in this limb as it did in the other until both arms were left
as dangling appendages to a robust frame. It is worthy of remark
that such was the slow progress of the malady, that its ravages were
not complete, I think, until the lapse of two years ; that during the
whole of this time the patient's general health was perfect ; that the
sensibility of the affected parts was entirely normal; that he suffered
no pain ; and that the loss of motion regularly coincided with the
complete atrophy of the muscles. The limbs and the shoulder-blades
appear completely emaciated and are soft and flabby to the touch.
Although about ten years have elapsed since the occurrence of this
affliction, he still enjoys fine health and unimpaired mental powers,
and is enabled to discharge the duties of an active practice in the
country. Sensibility being yet perfect he judges of the pulse as
accurately as ever, when his fingers are placed upon the artery by
the assistant who accompanies him.

" Our friend was not only treated by ourselves, but also sought
the advice of most of the distinguished practitioners of the United
States in vain. He submitted patiently to the trial of every remedy
and mode of treatment, that had ever been recommended in paralytic
affections without any modification or check of the disease. M. Aran
thinks that Galvanism will sometimes arrest its progress, but it proved
unavailing in our case."*

As the Doctor rennarks, the subject is enninenlly worthy of
further investigation, and it is on account of the novelty of the
case, this being the first, so far as we know, related in the United
States, that tiie Committee have here recorded it. Dr. Aran's
views on this subject, a synopsis of which has been given in
the Journal, are well worthy the attentive consideration of the
Profession.

AncBsthesia from Turpentine. In the same volume of the
Journal, among other Surgical cases, Dr. Henry Rossignol re-
ports the following as having occurred under his observation in
the practice of his associate, Dr. L. A. Dugas. The notes,
taken by us of the case are the following:

The patient, a negro man aged 60 years, an old drunkard by-
habit, had of late resorted to Spirit of Turpentine whenever alcoholic-
liquors could not be procured ; on one occasion, after a large potation
of Turpentine, he fell asleep before the fire, with his feet resting on
the burning wood. He required to be aroused by another person
after the shoe, stocking, and a large portion of the pantaloons had
been consumed. He then got up, walked about, said he felt no pain,
and did not believe his foot burnt at all. The limb was so extensively
injured that amputation was necessary. The patient having evinced
symptoms of mania a potu, died ten days after the operation, the stump
having partially healed.

In the same report we find two cases given to show the un-
Southern Medical and SurgicalJournal, vol 7., N. S., p. 244.

736 Report of the Committee on Surgery. [December,

certainty which attends the injury produced by falls. In one,
the patient fell from the fourth story of a cotton-factory, a dis-
tance of fifty feet, and yet sustained but little injury, being per-
fectly well in a few days, while in the other case the patient
sustained very extensive injury, as excessive concussion of the
brain and its accompanying effects, (even temporary insanity)
which continued nearly two weeks. Here the patient had
fallen but twelve feet.

In connection with these cases the reporter would beg leave
to refer to a case occurring in his own practice, wherein a
child of six years of age was precipitated over a banister to
the ground, a distance of nearly twenty-five feet, and yet no inju-
ry was sustained with the exception of slight bruises on promi-
nent portions of the ileum and greater trochanter of the side
upon which she alighted.

In the same paper, we find also a case of Encephaloid Car-
cinoma of the Thigh, wherein the patient recovered after
amputation. A case of extensive sloughing from an old burn.
The patient was affected with Epilepsy at the time of the re-
ceipt of the injury, but never after did he have a convulsion.

Upon this case we may make the remark, that although the
Epilepsy was here relieved apparently by the revulsion occa-
sioned by the burn, still this is by no means the invariable
result in cases of this character ; for how common is it to see
patients horribly disfigured by burns received during their con-
vulsions, and yet the Epilepsy continues in unabated severity.
It is but seldom that we can effect a compromise with this
terrible malady, even at the expense of scorched bodies and
mutilated extremities.

Also, a case of Ulcerated Lipoma of the Occiput, and one of
Fibrous Tumor of the Mamma. For a minute detail of these
>ye refer to the Journal.

In the Charleston Medical Journal and Review, we find an
interesting case of Extensive Fracture of the Cranium, report-
ed by F. T. Mathews, M. D., of Muscogee county, Ga.

"The blow which had inflicted the injury was received while
riding on the coupling pole of a timber wagon. The chain confining
the lever gave way, and the latter, impelled by the weight of a heavy
green pine log, swept through its full course and descended violently
upon his head.

"The patient exhibited very severe symptoms of compression,
which continued unabated after purgation and venesection. The pa-
tient was trepanned seventeen hours after the receipt of the injury.
The cranium was found extensively fractured in the frontal and pari-
etal bones, and the pieces removed, left a space the size of a dollar.
Consciousness and speech gradually returned, after the operation, and

1852.] Report of the Committee on Surgery. 737

the case, with but little exception, progressed regularly to complete
recovery."

At the conclusion of this report, the Doctor remarked that
"this case is strongly confirmatory of the general opinion that
fractures occasioned by a rounded body, though the force ap-
plied be very great, is not so fatal in its consequences, as in
those instances where it results from a more pointed one, im-
pelled with much less violence."

That this is a common opinion, we may perhaps admit, but
certain it is that we frequently see cases which are very
strangely confirmatory, of the very reverse of this proposition,
while at the same time our knowledge of the anatomy and re-
lation of the cerebral mass to its containing structure, would
make this converse opinion most rational.

Among the cases militating against the review of the report-
er, we would adduce Dr. Harlow's celebrated case, reported by
Professor H. J. Bigelow, wherein an iron crowbar, a pointed
instrument, passed through the centre of the cerebrum, and yet
the patient scarcely lost consciousness, and finally, entirely re-
covered with the loss only of an eye.

Another case, somewhat similar, is that of Dr. H. F. Camp-
bell, wherein the patient, a negro man, had the cranium deep-
ly cleft with an axe, a sharp-edged instrument, and the chop
extended deeply into the cerebral mass, and yet, like in the
former case, the patient did not lose his consciousness and had
no bad symptoms during the whole treatment, the w'ound heal-
ing kindly after trephining.

We would explain the escape of the patients, in these instan-
ces, by the fact that in the case of the sharp-pointed and edged
instruments only the portion of the brain infringed upon is
affected, whereas in the case of the fracture by blunt instru-
ments, the whole brain must be affected or compressed, as the
instrument does not enter readily as in the other case, but
presses before it the cerebral mass and thus compresses it in all
its parts against the walls of the cranium.

Although w^e have deemed it expedient to signify our differ-
ence of opinion with Doctor Mathews on the above points, we
would here remark, that we consider his case quile an interest-
ing one, and one in which he does himself credit, both as an
operator and a reporter.

In the September number of the Southern Medical and Sur-
gical Journal, D. C. O'Keeffe, M. D., of Penfield, details the
particulars of a case of Uterine Polypus, and accompanies the
report generally, and the difficulty attending their diagnosis, by
some reflections on uterine tumors, which we consider very
judicious and worthy the attention of the Society.

738 Report of the Committee on Surgery. [December,

Prof. C. T. Quintard reports a case of Glossitis in the South-
ern Medical and Surgical Journal, page 77. This is quite a
rare disease in this section of our country, that is, to occur
idiopathically. The treatment pursued in this case was bleed-
ing, active purgation, and the application of cups ad nucha,
and the administration of sedative doses of morphine to relieve
pain.

There are reported iu the 7th volume of the Southern Medi-
cal and Surgical Journal, the notes of a post-mortem examina-
nation by Prof. Paul F. Eve, in which the patient died of a
Stricture of (Esophagus. The subject was extremely emacia-
ted from long continued abstinence previous to death. The
stricture had been caused by the accidental swallowing of a
piece of caustic potass, by a child three years old. The autop-
sy was made about five months after the receipt of the injury,
and "revealed a permanent contraction with thickening of the
tissues of the onsophagus. The diameter of the strictured por-
tion being reduced to about a line, for an inch and a quarter,
and which was quite tortuous. The stomach was contracted
in its capacity, but the ileum was largely distended with feces.

Dr. Eve has also furnished us with the particulars of an ex-
tensive injury of the cranium, in which a large portion of the
frontal bone was removed, together with a portion of its orbitar
plate and also the crista galli of the ethmoid bone, so extensive
was the injury. The patient lived, we think, about one week
after the receipt of the injury. As we understand fiom the
Doctor that this case will be published shortly in detail, we
forbear further remark, as they would be anticipations of his
own report.

In the April number of the Southern Medical and Surgical
Journal, for the present year, we find an interesting account of
a very unusual epidemic Paronychia, by the Editor, Dr. Du-
gas, a part of which account we here insert. After some very
pertinent remarks in relation to the mystery and inscrutability
investing the advent, progress, and departure of epidemics, the
Doctor thus relates the result of his observations in this disease.

" On returning to our post, about the first of October last, we were
surprised at the frequent occurrence of sore fingers among our employ-
ers, and on enquiry found they were equally common in the practice
of other physicians, and had been so for several months. In some
families, nearly every inmate suffered more or less. Upon a large
plantation in this vicinity they were so numerous as seriously to in-
terfere with working the crop, and to lead to the suspicion that they
were designedly induced in order to furnish an excuse for idleness.
We learn from physicians residing at various points between this city
-and our northern frontier counties, that they also saw an unusual

1852.] Report of the Committe on Surgenj. 739

number of Whitlows during the same period. The cases commenced
in July and continued to present themselves until the beginning of
November. We are not informed whether such a state of things ex-
isted in the counties south of this.

"The disease generally assumed some one or other of the forms of
Paronychia or Whitlow the majority of them being superficial, and
the smallest number affecting the theca of the tendons and periosteum.
Although occurring spontaneously in most instances, the slightest
abrasion or irritation of the finger or hand would terminate in suppu-
ration more or less troublesome. Erysipelas complicated some of the
cases, and proved fatal in one of tliem here.

" The season was one of the warmest and driest ever known in
Georgia. The health of the city, and indeed of the whole State, is
represented as having been unusually good. The supervention of
cold weather put a stop to the sore fingers, and the writer has not
seen one since."

It appears that this tendency to Epidemic Whitlow has ex-
isted elsewhere than in Aus^usta; for in the January number
of the American Journal of Medical Sciences we also find a
short article on the subject, by James E. Morgan, M. D., De-
monstrator of Anatomy in the National Medical College at
Washington. '* Paronychia," says Dr. Morgan, " has, without
doubt, existed in Washington this summer as an epidemic.
Scarcely a day passes but that I am called upon to prescribe
for several cases of this apparently trifling but always painful
and sometimes fatal disease." He details the particulars of a
fatal case, with the autopsy. The bronchiae and air cells of the
lungs were found infiltrated with a thick bloody mucus. The
Doctor regarded this as a case of spasmodic asthma, caused by
the same pathological condition of the pneumogastric nerves,
which exists in the spinal nervous system in Tetanus, its medi-
ate cause being Paronychia.

The case which terminated fatally in Augusta, it will be
observed, was entirely unlike the above here Erysipelas was
the fatal complication, and not anything of a nervous character.

On the subject of this Epidemic the Reporter would beg leave
to add his testimony to the prevalence of Whitlow during the
time specified, it having been necessary to amputate more than
one finger on this account during the past season.

Robert Campbell, M. D., Assistant Demonstrator of Anatomy
in the Medical College of Georgia, has given, in the Southern
Medical and Surgical Journal, the account of a case of Senile
Gangrene. The patient was a white man aged about 50 years,
of spare habit and in extremely bad health from intemperance.
Amputation was performed by the Doctor, but the patient died
five days after the operation.

This case was reported by Doctor Campbell on account of

740 Report of the Committee on Surgery. [December,

the rareness of the disease in this region, and he has handed to
the Committee the notes of two unpublished cases occurring in
the practice of his brother, Dr. Henry Campbell, and himself,
during the same year. The first case, was an old man aged 60
years, who first evinced symptoms of the disease by the forma-
tion of a small blackened patch on the bottom of the heel. This
continued for several weeks, when the foot and limb became
swollen, and finally oedematous. The disease continued to
progress delirium and fever supervened, and in consultation,
amputation was decided on and accordingly performed. The
delirium continued for nearly a week after the operation but
the appetite gradually returned. Brandy was freely allowed,
and afterthelapseof nearly eight months, the stump healed and
the patient is now in the enjoyment of tolerable health, for an
old drunkard, as he will be probably, to the day of his death.

In this case, the use of brandy proved highly beneficial ;
without it, it is our opinion, the case certainly must have termi-
nated fatally.

The other case w^as that of a negro woman aged about 72
years, who, on the receipt of a slight abrasion on the ankle
evinced symptoms of mortification and oedema; amputation
was performed but the patient died the day succeeding the
operation.

In all these cases, ossification of the arteries was without
doubt, the cause of the disease.

H. V. M. Miller, M. D., Prof of Physiology and Path. Anato-
my in the Medical College of Georgia, has contributed an elabo-
rate and highly creditable article to the pages of the Southern
Medical and Surgical Journal, on Phlegmasia Dolens, and its
Pathology. And the conclusion to which his observations on
this subject have led, are the following : That Phlegmasia
Dolens or Phlebitis is caused by the introduction of diseased
matter, usually pus, into the blood that inflammation of a vein
is not an essential part of the primary affection, which precedes
constitutional symptoms, even when morbid matter has found
its way into the circulation through a vein, and that when the
veins are inflamed, it is an effect ^nA not the cause of the recep-
tion of diseased foreign matter into them.

This view of the subject. Doctor Miller strengthens by a
reference to the known effect of the introduction of foreign
matter, and especially pus, into the blood, as has been establish-
ed by the experiments of John Hunter, and more recently of
Mr. Henry Lee, of London.

This view of the Pathology of Phlegmasia Dolens is original
so far as we know. The application of the effect of pus on blood
is ingenious and certainly very rational.

1852.] Report of the Committee on Surgery. 741

Doctor D. C. O'Keeffe, the Secretary of the " Physicians
Society for Medical Observation of Greene and adjoining coun-
ties," reports a case of uterine polypus which occurred in the
practice of Doctor H. H. King, of Greenesboro. The disease
occurred in the person of a negro woman, and the weight of
the tumour after removal was three pounds. The tumour had
been extruded from the vagina by uterine contractions previ-
ous to the operation for its removal.

A tumour of a similar nature was removed in this city during
the past year, by the Reporter, though in this case, the most
difficult part of the operation consisted in extracting the mass,
which was the size of a child's head, from the vagina.

Robert Campbell, M. D., Assistant Demonstrator of Anato-
my in Medical College of Georgia, details the particulars of a
case of Ovarian tumor occurring in a child about ten years of
age. This child presented an excessive abdominal protuber-
ance, attended with general emaciation. She was attacked
with fever, suffered from obstinate vomiting and in a few days
died.

Post mortem examination revealed the following condition of
organs : Spleen very much enlarged, peritoneum injected, espe-
cially around the tumor, which was found in the cavity of the
pelvis, in the situation of the ovarium and attached to the uterus
and Fallopian tubes. This tumor weighed 36 drachms and
was of the color of ordinary liver. It was nodulated and slightly
reniform in shape ; soft almost fluctuating in its consistency.
The Doctor considers it a case of encephaloid cancer. The
lymphatic glands in the mesentery and in the lumbar region be-
ing very much enlarged favors somewhat this opinion.

We know that encephaloid cancer is apt to occur in any
region or organ of the body, and that in youth it is more apt to
manifest itself, all the circumstances attending this case appear
to establish the opinion of its encephaloid character.

Doctor O'Keeffe also reports a case occurring in his own prac-
tice, wherein urethral inflammation was produced in a female
by continued use of the catheter in paralysis of the bladder.

Lastly, under the head of Surgical Pathology, we find an un-
usual case of Amaurosis, reported by Henry F. Campbell, M.
D., of Augusta. In this case the retinae were partially paraly-
tic. The whole of one nerve being diseased, both eyes were
consequently affected. The following is an extract from this
article to the Southern Medical and Surgical Journal, vol. 7 :

"At the time of our observation, the patient frequently remarked
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.

N. S. VOL. VIII. NO. XII. 47

742

Report of the Committee on Surgery. [December^

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 successively, 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 riglit, at which he could not distinguish it. This experiment
we repeated frequently and invariably with the same results.

'^To explain this 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 inpressions, with only a small amaurotic
spot, corresponding to the healthy spot in the amaurotic eye, we will
review some of 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 geniculate 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 con-
stitute the optic nerve of the eye on the opposite side, into whose retina
they are finally expanded, forming by far its greater portion ; but the
few fibres which do not cross and only approach the 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, secondly, the retina of
each eye is produced out of fibres from both sides of the brain conse-
quently the destruction or injury of either nerve behind the chiasm
would afiect 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.

" On a careful consideration of our case, we think the following facts
in the anatomy of these nerves may be considered, in a great measure,
corroborated by it : Firstly, 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 retina 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."

SURGICAL OPERATIONS.

Under the head of Surgical Operations^ the Committee hav&
deemed it advisable to report those cases in which the operation^

1852.] Report of the Committee on Surgery. 743

has been the most important feature, either on [account of its
novelty, the skill with which it was performed, or the success
attending its result. A review of the journals will consequent-
ly show a somewhat greater number of operations performed
during the past year, than are recorded under this head of the
report, for the Committee have placed many cases in which
operations have been reported, under the head of Surgical
Pathology, and injuries as better deserving that position than
the present.

C. T. Quintard, M. D., Prof of Physiology and Pathologi-
cal Anatomy in the Memphis Medical College, has reported a
case of trepanning, in the Southern Medical and Surgical
Journal, the circumstances of which are the following:

" The patient had received an injury by a stone of two pounds
weight on the frontal bone near the coronal suture which produced
fracture and depression followed by haemorrhage. Coma soon super-
vened which lasted several days and suddenly subsided, and the patient
was able to walkabout seemedconsciousof surrounding objects, but
had lost the power to articulate distinctly. The wound healed but
there remained a fistulous opening discharging matter. Audition was
much impaired, this symptom being attended with ' a constant roaring
in the head.' General health good at time of operation.

" The operation of trephining was performed and the depressed
bone, together with several spiculse, removed. Immediately instantly
on the removal of the bone the noise in the head ceased, and all
disagreeable symptoms subsided. The wound was dressed, adhesion
rapidly progressed and the case resulted in entire recovery.

" The remarkable feature in this case is the immediate and sudden
relief obtained by the operation."

In the same Journal, Doctor Quintard relates the particulars
of another operation, viz., Exsection of a portion of the inferior
maxillary bone for the removal of an osteo-sarcomatous tumor.

The patient, a young woman aged about 14 years, in her
general health, bore all the unpromising featuresof the cancer-
ous cachexia. The operation was performed in the usual
manner. The bone was divided with Hay's saw, first above
the angle and afterwards at a point to the right of the symphi-
sis, and the piece removed. The wound^healed rapidly. Eight
months had elapsed since the operation ;* at the time of the re-
port no disposition to a return had been evinced. A member
of this Committee had an opportunity of examining this case
some months after the operation. The deformity was but
trivial, and the general health of the patient appeared remarka-
bly good.

H. M. Jeter, M. D., of Buena Vista, Ga., reports a case in
which he successfully performed the Caesarian operation. The

744 Report of the Committee on Surgery. [December,

patient was a very delicate woman, aged about 30 years ; was
in labor with her sixth child. She had been confined to bed
for two months previous to the operation, and was affected
with general anasarca of the whole system. After using every
possible means of delivery, as turning and embriotomy, for a
portion of the foetus was delivered, and waiting as long a time
as the safety of the woman would permit, finding that she was
rapidly sinking, Doctor Jeter proceeded to perform the csesari-
an operation, which he thus describes:

" Having given the patient a stimulant, ' I made an incision along
the linea alba six inches in length, cutting down carefully to the peri-
toneum, upon dividing which, the head of the foetus presented, show-
ing that my apprehensions were correct in the womb having been
ruptured sometime 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 occipitofrontal circumference, and
twenty-eight inches two lines in its perpendicular circumference. It
was hydrocephalic' The head and remaining portion of the body
being removed the placenta was also found without the uterus within
the cavity of the abdomen. This was removed and the womb was
found contracted down to the size of a small cocoanut, and the cavity
of the abdomen filled with coagulated blood, from the hemorrhage
which took place at the time of the rupture. Having carefully re-
moved the blood, the wound was dressed by the interrupted suture
and adhesive straps, leaving a space of two inches at its inferior ex-
tremity for the discharge of fluid."

The patient was extremely weak, stimulants were freely ad-
ministered. Vomiting and fever gave much trouble, but these
were finally relieved ; the soreness in the abdomen gradually
subsided, and the patient, when visited for the last time, on the
29th day after the operation, was sitting at the fire and direct-
ing the domestic affairs of her family.

Lithotrity. Professor L. A. Dugas reports a case of Litho-
trity in the Southern Medical and Surgical Journal. The
patient had suffered in early childhood from Phymosis. The
orifice in the prepuce being only large enough to admit a small
knitting needle, the prepuce was always distended during mic-
turition. His general health was bad in consequence of the
concomitants of retention of urine. He was relieved of all
these symptoms by circumcision in his twentieth year, after
which his health rapidly improved. Though he was still trou-
bled with severe nephritic pains, he continued to attend to his
usual occupation, and on urinating one day, he felt a stone fall
into his bladder a short time after, on attempting to urinate,

1852.] Report of the Committee on Surgery. 745

the water was suddenly arrested by the engagement of tlie
calculus in the urethra. These details have been given in or-
der to establish that he did know the exact time at which the
stone came into his bladder. He was shortly afterwards exam-
ined by Dr. Banks, at that time his attending physician, who
readily detected the stone.

On the arrival of the patient in Augusta, Dr. Dugas, finding
the stone small, determined to crush it. Dilating bougies, slip-
pery elm tea, with the hip baths, and rest, in reclining position,
were used for a week preparatory to the operation.

Heurteloup's Brisepierre, as modified by Charriere, was the
instrument used. The bladder was filled with tepid water.
The stone was readily seized and crushed three times on this
sitting without pain. Fragments of stone passed away during
that evening and next morning with the urine. There being
but little irritation produced by this operation, it was repeated
on the next day, and all the remaining fragments passed out
during the night. The man said he was entirely relieved next
morning, and Dr. Dugas could detect no fragment on the most
careful examination.

The'dimensions of the stone, as ascertained by the crushing
instrument, were about one inch in length and half an inch in
thickness. Analysis, by Prof Means, proved it Oxalate of
Lime. It was very hard.

" The features in the above case, which I deemed most interesting,
are : 1st. The existence during twenty years of a Phimosis attended
with almost a complete closure of the prepucial orifice, and which
seriously implicated the general health of the patient before he applied
for Surgical relief. 2d. The occasional recurrence of nephritic pains
during ten years after circumcision, which pains finally became con-
fined to the left side. 3d. The accurate indication by the patient of
the precise moment at which the stone came into the bladder. 4th.
The passage of the stone into the bladder just after micturition ; and
lastly, the circumstance that a stone entered the bladder tliree months
after the last nephritic attack. These are facts which, although al-
ready, perhaps, within the domain of Science, are not of very frequent
occurrence. Such may be on record, but I do not remember a case
in which the know^ledge of the precise moment at which the stone came
into the bladder, is so well established."

Lithotomy. In the same volume of the Southern Medical
and Surgical .Journal, we find recorded three cases of Lithoto-
my ; one performed by W. Nephew King, M. D., of Roswell.
subject a child 7 years ot age. Bilateral operation perfectly
successful. The stone measured in its greatest diameter two-
thirds of an inch, and in its shortest one-third of an inch, and
was composed of the Oxalate of Lime.

746 Report of the Committee on Surgery. [December,

The two other cases are reported by Henry F. Campbell,
M. D., of Augusta. The first patient was a young man 18
years of age. Bilateral operation. Amount of calculous
matter removed, one ounce and a half. Composition, Uric
Acid deposit, formed into three separate calculi of nearly equal
size.

The second case was a child 8 j-ears old. Bilateral opera-
tion. Here there was but one calculus composed of the Oxa-
late of Lime, the largest diameter of which was one inch and
three-tenths, the shortest diameter seven-tenths of an inch.
Weight, two drachms and one scruple immediately after the
operation.

The reporter will also here refer to another case unpublish-
ed, operated on in this State by himself during the last month.
The patient, a child 4 years of age, a native of Ireland, had
been troubled with symptoms of Stone from a very early age,
shortly after birth. We made the Bilateral operation ; remov-
ed three calculi of about the size of a chestnut. The case
progressed regularly, and like the other two cases referred to,
was followed by entire recovery. The great peculiarity of
this case, is the extremely tender age at which the patient be-
gan to evince symptoms of the disease. We know of not less
than three children who are Irish immigrants, all of whom
have been affected with stone from a very early age two of
them were of one family. We cannot attribute this to the
change of climate entirely, as two of them were subjects of the
disease before leaving the land of their nativity.

Juriah Harriss, M. D., of Augusta, has contributed to the
pages of the Southern Medical and Surgical Journal, a valua-
ble article on Fissure of the Anus, in which he develops the
treatment by sudden dilatation of M. Maisonneuve, of Paris,
which, as he remarks, is really a revival of Recamier's treat-
ment; the only difference between the two being, that Re-
camier recommended the gradual, and Maisonneuve the rapid
dilatation of the Sphincter ani in those cases which depend
upon its permanent contraction. The Doctor thus describes
the operation as performed by M. Maisonneuve :

< 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."

As the Doctor remarks, this operation possesses many ad-
vantages over other modes of operation : 1st, no cutting instru-
ment is used ; 2nd, no wound is left to heal ; 3rdly, there is no

1852.] Report of the Committee on Surgery. 747

danger of Pfflebitis, and lastly, the pain, which is but momenta-
ry, can be entirely avoided by the use of Anaesthetics.

We would certainly recqpimendthis mode of treatment, ex-
cept in cases complicated with hemorrhoids, as occurred to the
reporter of this committee a few months since. Here the case
was relieved by repeated cauterization with the Nitrate of
Silver.

The same gentleman also reports a case of Phymosis in
which he operated upon Ricord's plan with Phymosis forceps.

Doctor King, of Roswell, reports a case of Comminuted
Fracture of the Leg, wherein he amputated for mortification,
which afterwards attacked the stump and produced a fatal ter-
mination. The patient was of a Cachectic Diathesis and quite
anaemic

SURGICAL MEDICINE AND TREATMENT.

Under this head, the Committee have reported all surgical
cases coming under their notice in which the treatment pre-
sented any thing of novelty, or was attended with any marked
degree of success.

John S. Wilson, M. D., of Muscogee county, has furnished
to the pages of the Southern Medical and Surgical Journal, a
short treatise on the internal and external application of the
Nitrate of Silver, in which he details the particulars of several .
pertinent cases. The surgical applications of the remedy re-
commended by Dr. Wilson are its application to Ulcers of the
Leg, Stomatitis, Metritis and to Anginose and Herpetic affec-
tions. And also in Ophthalmia, Opacity of Cornea, &c.

Tetanus. W. W. Haws, M. D., of Houston county, reports
a case of undoubted: Tetanus, treated by himself with success.
The disease resulted from frost-bite, attended with loss of the
toes therefore came under the class Traumatic was quite
violent. Treatment consisted in the administration of calo-
mel, opium, quinine, with veratrum viride, and Indian hemp,
together with the application of general bathing and extensive
revulsion. Case lasted from the 11th to about the 23d of Janu-
ry. " He rested on his nates and occiput all the time of his
illness, except one day and night, and then, opisthotonos was
complete. The Indian hemp which I used," says the Doctor,
" presented all the physical qualities of a fine article, but was
certainly devoid of all the fine action ascribed to it by Doctor
O'Shaughnessy. The quinine seemed entirely out of place ; it
proved rather conservative of the spasm, than otherwise, and
I attribute the sudden increase in the violence of the disease on
its administration, to this drug alone. The veratrum viride

748 Report of the Committee on Surgery. [December,

effected such sedation as to give unwonted potency to the Do-
ver's powder, and it was for this I stopped it, feeling confident
I could continue the sedation as we]l with the Dover's powder
alone, as with the hellebore, and secure a more decided action
upon the gastro-enteric function."

Our attention has been called to a similar case of Traumatic
Tetanus, treated by Dr. Hart, of this city. Cause, injury from a
plank falling on the occiput. Treatment, which was successful,
principally consisted in large doses of morphine in combination
with chloroform. Indian hemp was also used without any
known good effect.

Dislocations and Fractures. In the Southern Medical and
Surgical Journal, Professor Dugas has given the report of se-
ven cases of Dislocation of the Radius and Ulna backwards at
the elbow. His remarks on the extreme difficulty of the diag-
nosis of this injury are very pertinent, but more especially
would we call attention to his suggestion in the application of
forces, for the reduction of the bones, for these, we think, in
certain particulars are original and peculiar. Referring to Sir
A. Cooper, Listen, Miller and Druitt, the Doctor says, " with
due deference to these high authorities, I think a very import-
ant element in the mechanism of this process has been over-
looked, which, if borne in mind by the surgeon, 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, then gradually extend those of the forearm, making
at the same time gradual traction. It will be found, that the re-
sistance offered to reduction is principally produced by the
lodgment of the coronoid process in this fossa but that as soon
as the extension is carried a little beyond the straight line, the
olecranon 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 car-
ry the forearm a little farther back than the straight line, with
the humerus, if he wishes 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 should dictate a
cessation of our efforts rather than hazard the consequences of
such lacerations as might be produced, especially in old cases
and with pullies."

In the February number of the Southern Medical and Sur-

1852.] Report of the Committe on Surgery. 749

gical Journal of the present year, there is also an article on
Fractures of the Clavicle, by Doctor Dugas, in which the Doc-
tor gives his mode of treatment, which, on account of its sim-
plicity, as well as efficiency, we think worthy of attention. In
the following we find embodied all the important points of his
treatment :

" The sling bandage is that to which I have given a decided pre-
ference for the last fifteen or twenty years. It is unnecessary to
describe the numerous modifications of this simple bandage, proposed
by surgeons of all countries, and I will therefore proceed to describe
at once the one I habitually use, without, for a moment, pretending
to originality, lest perhaps some book- worm might* discover that pre-
cisely the same had been proposed by others.

^' The displacement having been carefully reduced by movements
of the shoulder in various directions, according to the particular case
and by direct action upon the fragments themselves, lei an aid main-
tain the reduction by placing the ends of the fingers of the affected
limb upon the top of the opposite shoulder by bringing the elbow
against the side, and by pressing up the elbow so as to cany the
shoulder upwards, outwards and backwards, as will be done under
those circumstances. The next step will be to secure the limb in
this position. For this purpose, I procure a square yard of cotton
fabric, (unbleached shirting, for example, as this is softer than the
bleached, which is usually starched,) and cut it diagonally, so as to
obtain a triangular bit ; to the acute angles of which should be sewed
slips three inches wide and three or four yards long.

" Apply the middle of the base or long side of the triangle beneath
the elbow, leaving a margin of about two inches behind, and carrying
the obtuse angle towards the fingers. One of the acute angles with
its strip, will now be carried between the arm and chest, up to the
fractured clavicle, around the back of the neck over the shoulder, in
front and beneath the axilla and finally around the chest including
the arm just above the elbow. The other end and strip will be car-
ried in front of the forearm, up to the sound shoulder, behind and be-
neath the axilla, and around the chest and arm^so as to meet its fellow,
and to be tied to it firmly. The margin left projecting behind the
elbow should then be elevated, doubled, and so secured with stitches
as to prevent the elbow from sliding out of the sling in that direction.
The portion of the triangle situated along the forearm should be also
folded around it, and thus secured. Lastly, the strips encircling the
chest and arm should be stitched, to prevent the upward and down-
ward displacement. If it be necessary to press down the sternal
fragment, this can be elTectually done by interposing a little pad be-
tween the bone and the bandage which passes over it.

"The advantages of this bandage are to be found in its perfect
adaptation to the necessities of the case, in its great simplicity, in the
facility with which it may be made secure, and in the very slight
inconvenience to which it subjects the patient. Children as well as

750 Treatment in Traumatic Tetanus. [December,

adults bear it without murmur ; and if it becomes necessary for pur-
poses of cleanliness to remove it, any intelligent mother or nurse may
re-apply it, if the physician be not accessible. Whilst it cannot be
denied that under any plan of treatment, there will occasionally re-
main some unevenness or deformity at the seat of fracture, I must say
that I have very rarely seen any thing of the kind in cases treated on
this plan, notwithstanding the fact that I have not unfrequently, after
applying the bandage once in the presence of the mother, left the sub-
sequent management entirely to herself."

In closing this part of their Report, this Committee would
express their regret that they have found the contributions on
the important subject of Fractures and Dislocations so few ;
for here, it is well known, rests the opprobrium of American
Surgery, and here the French and English practitioners have
been, to the present time, our superiors. It appears and we
should confess it with much regret that the treatment of these
injuries have been regarded as of secondary importance by our
countrymen. The broken bone, when properly mended, tells
no history of the skill with which it was managed, but the mu-
tilated and useless limb through which the knife has passed,
marks, on a glance, that here has been the Surgeon, the brilliant
and bold operator. Hence less attention has been paid to them
than they actually deserve, and their treatment is therefore often
unsatisfactory in its results. It seems that unless there is some-
thing to cut, something to destroy and leave a memento of our
exploits, we do not regard the affection of the first importance
surgically. We would therefore take this occasion to urge,
most respectfully; on the practitioners of our State, a greater
amount of attention to this important and much neglected de-
partment of Surgery.

HENRY F. CAMPBELL, Ch'n.^
J. M. GREEN, . I

GEORGE F. COOPER, ^Committee.

R. J. KODDY,

J. M. SIMMONS, J

Augusta, Ga., April 14, 1852.

On 'the Value of Local Treatment in Traumatic Tetanus,
By Mr. Eddomes.

[Mr. Eddomes narrates the case of a man in whom tetanic
symptoms supervened upon a wound of the thumb with a pack-
ing needle. The symptoms came on three days after cicatri-
zation. The treatment consisted in removing the cicatrix, and
applying morphine to the wound. A blistered surface was
also made in the opposite hand, which was also sprinkled with

1852.] Treatment in Traumatic Tetanus. 751

morphine. He stated that the spasms never became general,
and that the stiffness of the jaws did not entirely subside till
the eleventh day. The author appends the following remarks :]
There are many points of interest in this case, and I w^ould
wish to call attention to one or two of them.

1. This man's symptoms first came on after the healing of
ike wound, a circumstance by no means unusual, though I am
not aware that any reasons have been given why such should
be the case. 1 think that one of Dr. M. Hall's experiments,
showing that the extreme terminations of nerves possess the
excito-motory power in a much higher degree than the trunk,
will help us to furnish an explanation. "If," says he, "after
removing the head of a frog, we divide the integuments along
the back, and raise them by means of the forceps, we observe
the trunks of many cutaneous nerves. Now, if we irritate
these trunks no movements follow ; but if w^e irritate the cuta-
neous texture on which they ramify, movements of a very en-
ergetic nature are produced." Now, in the healing process of
a wound it must be evident that the extreme distributions of
the cutaneous nerves would only be involved when that pro-
cess was nearly or wholly completed. And may it not be the
involving these, the more easily excited terminal branches, that
is the starting point of the disease. Another point of interest
in this case is

2. He had spasm of the wounded hand and arm as one of the
earliest symptoms ; it continued throughout, and at last was the
only remnant of the diseam. This condition is not a reflected
one, but the result of disease in the reflex or motor nerve ;
while, on the other hand, the trismus, with the aflfection of the
abdominal muscles and legs are reflected, resulting from injury
to an incident or excitor nerve. Had the spasm been a reflect-
ed action, we should have had the opposite extremity affected
in a similar manner ; and it would not have occurred till later
in the disease, I merely mention this as being a curious and
interesting circumstance, showing that the injury to a reflex
nerve is more persistent, and less easily influenced by remedies,
than an injury to an incident nerve.

3. The treatment of traumatic tetanus. It is needless to say
what a formidable and intractable disease it has always been
found ; but I believe that the ill success has in some measure
resulted from not acting upon proper principles in the treat-
ment. Look over the melancholy records of this affection, and
what has been the treatment? Venesection, narcotics, anti-
spasmodics, mercury, cold bath, warm bath, and a hundred
other plans all given to afl^ect the system generally ; while
the seat of irritation, the primum mobile of the disease, is en-

752 Total removal of the Collar Bone. [December*

tirely passed over, or receives only a secondary share of atten-
tion.

I would suggest that such plan of treatment is most unphilo-
sophical, and that the treatment should begin at the seat of
irritation, to allay which should be our first and most strenuous
effort.

In conclusion, I would remark that, in the treatment of the
present case, all I claim is, that it is simple and rational. Is it
not simple to apply a soothing remedy to an irritated part ? Is
it not rational, when a morbid stimulus is transmitted from one
extremity of the spinal cord, to be reflected on the system at
large, to transmit a sedative influence to the spinal cord at the
opposite extremity ; a morbid stimulus from the left hand, and
a sedative influence from the right, meeting at the same portion
of the cord. [Medical Gazette.

Total removal of the Collar Bone. By A. J. Wedderburn,
Prof, of Anatomy, in the University of Louisiana.

Michael Foggerty, age 21 years, a labourer, was admitted
into the wards of the Charity Hospital on the 21st of January,
1852, with caries of the clavicle, so extensive as to require its
entire removal, by disarticulation at both extremities. The
operation was made whilst the subject was under the influence
of chloroform.

Operation. An incision was made down to the bone over
its entire length, and sufficiently fr beyond its articulating
points, to enable the disarticulation to be effected. The soft
parts attached to the upper surface and the anterior border of
the bone, were separated next the separation from the acromi-
on effected the dissection w^as then continued close to the
bone beneath, whilst the parts were kept on the stretch, by eleva-
ting the bone from the point just indicated. During the dissec-
tion the bone broke, from its diseased condition, about one and
a half inches from its sternal articulation, which rendered the
dissection connected with this portion of the bone more tedious
than it would have been, had there been a sufficient length of
bone left to have given a purchase. For the removal of such
a diseased part as this, there can be no established mode of
operation. Circumstances must always govern. Caution and
a thorough knowledge of the region, is all that is necessary to
make such operations simple and easy. The result of this
operation was perfectly successful recovery was rapid, and
the case was discharged cured, towards the last of April, in
something less than three months after the operation. When
the case left the hospital, the use of the arm was perfect, the

1852.] Case of Hermaphrodism. 753

shoulder occupied its natural position ; it was neither depressed,
projected forward, or drawn nearer the sternum, and no other
evidence presented that a operation had been made, than the
cicatrix. He was discharged on the 8th of April.

Treatment. The cavity from which the bone was removed
was filled with lint saturated with a solution of quinine, and kept
in this condition for twenty-four hours. The next day the cut
surface was brought together with adhesive plaster, over which
was placed a compress of lint, w^et with a solution of quinine,
about 5 grains to the ounce of water. No other treatment was
resorted to during the cure. The shock from the operation was
so slight, that he was sitting up in twenty-four hours after the
removal of the bone. The solution of quinine was chiefly used
in this case for its prophylactic effects against erysipelas, which
was prevailing in the hospital at the time.

The total removal of the collar-bone has been done but twice
before in this country. By Dr. Valentine Mott, in its success-
ful removal for osteosarcoma of the left clavicle, in 1828, and
also, by Dr. Warren, in 1833. In Europe, it has been made
by Meyer and Roux, on account of caries ; by Travers, " on a
boy often years of age, who, in consequence of a fall probably
broke the collar-bone, without rupturing the periosteum, had
large effusions of blood within it, which formed a tumor, that
by degrees involved and destroyed nearly the whole bone,
except at its sternal end." [New Orleans Med, Register.

Case of Hermaphrodism, involving the Operation of Castra-
tion and illustrating a new principle in Juridical Medicine,.
By S. D. Gross, M. D,, Professor of Surgery in the Medical
Department of the University of Louisville.

The following case, which came under my observation in
1849, will, if I mistake not, prove both novel and interesting to
my professional brethren. So far as my information extends,
there is no account of any operation for a similar object upon
record.

The subject of the case, at the time I first saw her, was three
years of age, having been born on the 10th of July, 1846. She
had always, up to this period, been regarded as a girl, and had
been so pronounced at her birth by the accoucheur. At the
age of two, however, she began to evince the tastes, disposi-
tion, and feelings of the other sex ; she rejected dolls and similar
articles of amusement, and became fond of boyish sports. She
was well-grown, perfectly healthy, and quite fleshy. Her hair
was dark and long, the eyes black, and the whole expressiort
most agreeable. A careful examination of the external geni-

754 Case of Hermaphrodism. [December,

tals disclosed the following circumstances : There was neither
a penis nor a vagina; but, instead of the former, there was a
small clitoris, and, instead of the latter, a superficial depression,
or cul-de-sac, covered with mucous membrane, and devoid of
everything like an aperture, or inlet. The urethra occupied
the usual situation, and appeared to be entirely natural ; the
nymphae were remarkably diminutive ; but the labia were all
developed, and contained each a well formed testis, quite as
large and consistent as this organ generally is at the same age
in boys. Her hips and chest, thighs and superior extremities,
were perfect.

It being apparent, from the facts of the case, that it was one
of malformation of the genital organs usually denominated
hermaphrodism, the question occurred whether any thing could
or ought to be done to deprive the poor child of that portion of
the genital apparatus which, if permitted to remain until the
age of puberty, would be sure to be followed by sexual desire,
and which might thus conduce to the establishment of a matri-
monial connection. Such an alliance, it was evident, could
eventuate only in chagrin and disappointment, if not in dis-
grace, ruin of character, or even loss of life. Certainly, im-
pregnation could never occur, and even copulation could not
be performed, except in the most imperfect manner.

I need not say that I gave the subject all the consideration
and reflection that I was capable of bestowing upon it. I was
deeply sensible of the responsibility of my position. Anew
question involving the rights and happiness of my little patient,
and the dearest interests of her parents, was presented to me.
I examined the case in all its bearings and relations moral,
physical, and juridical ; I appealed to the recordsof my profession
for a precedent, and I sought the counsel of medical friends.
The parents were anxious for an operation ; they were intelli-
gent, kind, and tender-hearted, and were willing to sacrifice
everything for the welfare of their child. Their only object
was to save it from future suffering and misfortune. My own
mind was made up ; but, before I proceeded to take any further
steps, I determined to consult my excellent friend and colleague,
Professor Miller, in whose judgment and integrity every one
who knows him has the utmost confidence. He saw the child
and examined her. He viewed the case, as I had previously,
in every possible aspect, and his conclusion was, that excision
of the testes was not only justifiable but eminently proper under
the circumstances ; that it would be an act of kindness and of
humanity to the poor child, standing as she did towards society
in the relation, not of a boy or a girl, but of a neuter, to deprive
iier of an appendage of so useless a nature; one which might, if

1852.] Case of Hermaphrodism. 755

allowed to proceed in its development, ultimately lead to the
ruin of her character and peace of mind.

Backed by such authority, I no longer hesitated what course
to pursue. I performed the operation of castration on the
20th of July, 1849, aided by my pupils, Dr. D. D. Thompson,
of this city, Dr. Greenburg R. Henry, of Burlington, Iowa, and
Dr. William H. Cobb, formerly of Louisville, now of Cincin-
nati. The little patient being put under the influence of Chlo-
roform, I made a perpendicular incision, about two inches in
length, into each labium down to the testis, which was then
carefully separated from the surrounding structures, and de-
tached by dividing the lower part of the spermatic cord. The
arteries of the cord being secured with ligatures, the edges of
the wound were brought together with twisted sutures, and the
child put to bed. Hardly any blood was lost during the opera-
tion. About two hours after, the left labium became greatly
distended and discolored ; and, upon removing the sutures, the
source of the mischief was found to be a small artery, which
was immediately drawn out and tied. No unpleasant symp-
tom of any kind ensued after this, and in a week the little pa-
tient was able to be up, being quite well and happy.

The testes w^ere carefully examined after removal, and were
found to be perfectly formed in every respect. The sperma-
tic cords were natural.

I have seen this child repeatedly since the operation, as her
parents live only a few squares from my office, and have care-
fully watched her mental and physical development. Her
disposition and habits have materially changed, and are now
those of a girl ; she takes great delight in sewing and house-
work, and she no longer indulges in riding sticks and other
boyish exercises. Her person is well developed, and her mind
uncommonly active for a child of her years.

I would fain preseht this example as a precedent in similar
cases. The reasons which induced me to recommend and
perform this operation in the instance before me have been al-
ready mentioned, and now, after a lapse of three years, I have
no cause to regret the undertaking, or to think that I acted
harshly and inconsiderately. If the records of surgery and
medical jurisprudence are silent upon the subject ; if the learn-
ed doctors of the Sorbonne, the fathers of the Royal Academy
of Paris, and the Fellows of the Royal College of London have
left us no precepts ; and if the experience of the present day
furnishes no examples ; all this, and much more, does not prove
that the practice Tiere recommended is not perfectly just and
proper, and vindicated upon every principle of science an(J
humanity.

756 Belladonna in Hooping Cough, [December,

A defective organization of the external genitals is one of
the most dreadful misfortunes that can possibly befall any hu-
man being. There is nothing that exerts so baneful an influ-
ence over his moral and social feelings, which carries with it
such a sense of self-abasement and mental degradation, or which
so thoroughly " maketh the heart sick," as the conviction of
such an individual that he is forever debarred from the joys and
pleasures of married life, an outcast from society, hated and
despised, and reviled and persecuted by the world. Nothing
but the most perfect resignation, and a well-founded confidence
in the mercy and justice of the Creator, can render the lot of
such a being at all supportable. \_Amer. Journ. of Med, Sci.

We doubt that many of our readers will agree with the dis-
tinguished Professor in the validity of the reasons assigned for
the above operation. This will certainly not obviate the evils
so forcibly set forth in the last paragraph by the author.

[Ed. s. m. & s. J.

Extract of Belladonna in Hooping Cough,
Dr. H. Corson, of Pennsylvania, recommends (Am. Journ.
Med. Sc.) very highly the use of Belladonna in Pertussis, and
states that he rarely fails to arrest the disease in from one to
three weeks. This remedy was proposed nearly 20 years ago
by Dr. Jackson of Northumberland, and has since that been
occasionally referred to in the periodicals. We have frequently
tried it alone, and in combination with camphor and carbonate
of iron, but have seldom succeeded in arresting the cough, ex-
cept in cases which had already existed several weeks, and which .
had therefore nearly run their usual coui'^e. Dr. Jackson pre-
scribed it in doses of 1 gr. to a child 2 years of age ; but Dr.
Corson thinks this too much, and gives, of a solution of 8 grs. in
1 oz. water, to those under one year of age 9 drops every 2 hours
until the pupils are dilated, the face flushed, the mouth dry, and
vision confused. The dose to be increased or diminished ac-
cording to effects but to be given daily. [Ed. s. m. & s. j.

Nitric Acid in Rain- Water,

M. Barral has lately found, after very careful and well-
'Conducted experiments, which stretched over more than six
months, that the rain-water collected at Paris contains appre-

1852.] Yeast in the Treatment of Boils. 757

ciable quantities of nitric acid. This discovery has been con-
firmed by a committee appointed by the Academy of Sciences,
and composed of Messrs. Dumas, Boussingault, Gasparin,
Regnalt, and Arago. It is supposed that the presence of nitric
acid in rain-water will explain certain hitherto ill-understood
telluric phenomena, and lead to some practical applications.
It is due to Dr. Bence Jones, of St. George's Hospital, to say,
that he had already pointed out the fact, in the Philosophical
Transactions of 1851, as to the rain-water collected at Kings-
ton (Surrey), Melburg (Dorset), the neighborhood of Cork, and
in London."^ Dr. Bence Jones was herein in opposition with
Liebig, who has denied that rain-water contained appreciable
quantities of nitric acid. [Lancet.

Yeast in the treatment of Boils,

Mr. MossE, in a communication in the Lancet, July 31, 1852,
states that, "During a period of eight years and more, being
in practice in the West of England, where these annoyances
rather raged, and were known by the name of ' pinswills,' I
was induced to try the efficacy of common yeast (having failed
to give relief in general modes of treatment), in doses of a
tablespoonful with some water three times a day, for an adult,
and smaller doses for children.

"I have now practised in this tow'n nearly six years, and
have had frequent opportunities also here of witnessing the
good effect of yeast in these troublesome affections, easily con-
summating a rapid and complete cure without further recur-
rence, and by a most simple remedy, within reach of all."

[Medical News.

Lateral Hermaphroditism.

Dr. Banon brought before the notice of the Surgical Socie-
ty of Ireland (May 1, 1852) a very remarkable instance of
lateral hermaphroditism a fusion of the generative organs of
both sexes. The subject of it had died of phthisis. Dr. B.
had not become acquainted with the sexual peculiarities of this
individual until shortly before death. Dr. B. ascertained, how-
ever, that at the birth of the individual there was considerable
doubt as to the predominant sex, but that at length it was pro-
nounced to be a female, and baptized by the name of "Anne."
In a year subsequently, however, the organ representing the
penis had so increased in size that a different conclusion was
arrived at, and the name changed to " Andrew," since which
period he had been always treated and looked on as a male ;

N. S. VOL. VIII. NO. XII. 4S

758 Lateral Hermaphroditism. [December,

and as he grew up, even excelled in many of the manly exer-
cises. His predilections were, according to his own state-
ment, for females, and it was ascertained that he had never
menstruated.

Dr. Banon gave a full and minute description of the external
and internal organs of generation which were present in this
individual, by which it appeared that he possessed a penis of
the usual size in the male adult, and provided with glans and
prepuce, but that it was imperforate, a rudimentary opening
only existing in the site of the orifice of the urethra. The indi-
vidual had himself stated that it was, during life, subject to
erections. On raising up the penis, Dr. Banon observed that
the female external organs were present in a nearly perfect
condition. The labia were well marked, but terminated behind
rather abruptly, the fourchette being absent. Within these the
nymphae were seen occupying their usual situation, and be-
tween them there was a longitudinal opening which led direct-
ly to the bladder. Behind this urethral opening was observed
one of a more circular form leading to a canal in the direction
of the uterus, and separated from the bladder in front and the
rectum behind by distinct septa. This orifice was so small as
to admit only of a No. 8 catheter, and was surrounded poste-
riorly by a distinct hymen. The mons veneris was not devel-
oped, which might have been owing to the great emaciation
present. Many of the secondary characters of the male were
observed. The hair, arms, hands, lower limbs and feet, the
larynx, all partook of the male character. The voice, during
life, was decidedly masculine.

On the other hand, there was a feminine character in the
features of the upper part of the face, and the pelvis and skull
were decidedly those of the female. The occipital regions of
the latter were unequally developed on each side, which point
was dwelt upon by Dr. Banon as illustrating, in this instance,
the interesting physiological fact, that the development of the
reproductive organs is influenced by this portion of the brain,
these organs being, as he afterwards pointed out, situated princi-
pally on the side of the body opposite that of the increased devel-
opment in the posterior lobes of the cerebrum and cerebellum.

On dissection, the penis was found to be composed of crurse,
uniting in the usual manner to form the body. A substance
similar to the corpus spongiosum urethras, could be traced an-
teriorly to the glans, and behind becoming bifurcated to inclose
the longitudinal opening leading to the bladder. The prostate
and Cowper's glands were absent. The spermatic cord on the
right side was large. On the left, it rather deserved the name
of the round ligament of the female.

1852.] Lateral Hermaphroditism. 759

On dissecting the parts within the pelvis, a well-formed but
small uterus was found in its normal position between the blad-
der and rectum. It was supplied with but one Fallopian tube,
which passed from its left cornu backwards and inwards, be-
tween the rectum and uterus, to the right side of the latter,
where it terminated in a well-marked " corpus fimbriatum,"
being permeable throughout its whole course.

The corpus fimbriatum rested on an ovary which, as well as
the Fallopian tube, was single, no trace of a second being visi-
ble. Not far removed, however, from the ovary already men-
tioned, was observed a testis, pendulous into the true pelvis, in
front of the right sacro-iliac synchondrosis, and immediately
behind the internal iliac artery, as it decends into the pelvis.
Applied to its anterior surface was seen the epididymis in a
partially unravelled state, and the spermatic artery and vein
were traced into close connection with it. The vas deferens
was plainly seen emerging from the epydidymis, and taking a
remarkable course at first, forwards and outwards, in the di-
rection of the right internal abdominal ring, to which it had
reached about halfway, when it turned back, forming a loop,
with the convexity towards the ring : it then took its course
inwards and somewhat backwards in the direction of the uterus,
to which it was finally conducted by the broad ligament of the
right side. It could be traced into the substance of the uterus,
into the cavity of which Dr. Banon proved that it opened by
pressing mercury gently through it. Dr. Banon could not find
any trace of vesiculae seminales, nor of a second testicle. Dr.
Banon here gave a minute description of his dissection of the
different organs, and of the appearances of some of them under
the microscope, which enabled him to speak with confidence of
their identity. He then entered at some length into the discus-
sion of the means of discriminating between the spurious forms
of hermaphroditism and those which are entitled to be consider-
ed as a real blending together of the reproductive organs of
both sexes, or the " true hermaphroditism ;" and cited some re-
markable cases, both in the human subject and the lower classes
of animals, in which both forms had been observed. In the
present instance, he came to the conclusion that it should be
placed under the division of '* true hermaphroditism," termed
"lateral," by Professor Simpson. Dr. Banon also alluded to
some of the most interesting of the physiological changes which
take place in the earlier development of the embryo, and ex-
plained how an error of function at this period in the corpora
Wolffiana, by which both the male and female reproductive
organs, the testes and ovaries, are originally formed, would be
likely to cause subsequent anormalities and malformations to

760 Miscellany. [December,

appear. He also entered into the question How far the con-
ditions necessary for self-impregnation were present in the case
of Andrew R. ? And although he was obliged to admit that
were the testis by any means so excited as to cause its secre-
tion to pass through the vas deferens into the uterus, there was
nothing to prevent the semen from proceeding farther, through
the Fallopian tube, to the ovary ; still, from the absence of the
procreative elements (the spermatozoa) in the seminal fluid, as
proved by the microscope, and also of the germinating elements
of the ovary, self-impregnation in this instance could not have
occurred. Dr. Banon concluded a highly interesting paper by
stating that it was his intention to publish it in full, and bring
it before the profession in a form rendered complete by the ad-
dition of lithographic plates of the drawings and casts which
he had now the pleasure of exhibiting to the Society. [Duhlin
Medical Pi^ess.

A Case of Doubtful Paternity.
By W. L. Sutton, M. D., Pres't. of the Med. Society of Kentucky.

What distinguishes a child of pure White blood, from one tainted
loith that of the Negro ? About a fortnight ago, a child was brought
to Georgetown by its reputed father, accompanied by his physician,
a gentleman of some forty-five or fifty years, for examination by the
physicians of the town, partly with a view of ascertaining whether any
course could be suggested which would insure the continuance of its
life, and partly to silence some neighborhood talk which had arisen on
account of its color. The physician believed that the color of the
child was occasioned by the foramen ovale remaining open ; in proof
of this, he alleged that when the child cried he became much darker
decidedly blue and thought that the imperfect aeration of the blood
consequent upon the patent condition of the foramen, was sufficient to
account for the permanent dark color of the skin. Another physician
who had seen the child at two months old, behoved then that he labor-
ed under inflammation of the brain, and, from some cause, suspected
the foramen ovale was open. Among other things he suggested a
trial of the advice of Prof. Meigs, respecting position.

The moral testimony in the case was, that up to the birth of the
child, the mother had been entirely above suspicion. In fact, she was
considered a very modest woman. She was said to have fair com-
plexion, light hair, and blue eyes. The husband, who accompanied the
child, had nothing remarkable as to complexion ; hair of the ordinary
brownish color. His mother reported to be very dark, with black hair.

The child is a boy of four months, with black, straight hair, the

1852.] Miscellany. ' 761

fine hair on the forehead black ; rounded forehead, broad nose, partic-
ularly expanded at the alae, skin dark, yet not darker than purely
white children are sometimes seen. Near the extremity of the coccyx,
and rather to one side, was a spot, oval in shape, about three- fourths
of an inch long, decidedly dark. No other dark spot perceived. There
is a popular notion that when a child is tainted with African blood, the
scrotum and a streak down the back are always dark. Nothing of
that kind existed.

Three physicians (the one who had seen the child at two months,
among them,) were unanimous that the color did not depend on cyano-
sis, and that there were appearances about the child of very suspicious
tendency ; but declined any expression as to admixture of blood, without
a better acquaintance with the relatives of the husband and wife.
One, however, could not believe that two parents of the temperament
of the husband and wife, could produce a child of that color. Another
thought it possible that with a grandmother decidedly dark, a child
might be even that dark ; but could see no good reason why a child
purely white should have such a nose. The third thought that
although the appearances were suspicious, they were not enough so to
give an opinion unfavorable to a woman as free from suspicion as the
mother had been.

The family physician, who had unshaken faith in the chastity of the
woman, expressed his unfeigned astonishment that any hesitation
should be felt in giving an opinion tending to exculpate the mother
from all suspicion. Not satisfied with the result of this consultation,
he procured the attendance of some five or six others at the residence
of the parties. These last, I understand, took very much the same
view of the case that had been taken in the consultation.

Subsequently it is reported that the woman acknowledged that she
had had occasional connection with two negro men in the neighbor-
hood.

As this is a point which has been but little investigated, (some little
discussion in Beck's Medical Jurisprudence being all that I am aware
of,) it may not be amiss to make a few comments. Many persons
think nothing would be easier than to "tell a white child from a black
one;" but like a great many other things, the more it is studied, the
more difficulties start up. From the nature of things, our European
brethren give us no authority upon this point. Beck, vol. 1, p. 485,
gives us a case which occurred in New York. In this case, a mulatto
woman swore a child to a black man. On trial, when the child was
one year and seven months old, it appeared in evidence " that the child
was somewhat dark, but lighter than the generality of mulattoes ; and
that its hair was straight, and had none of the peculiarities of the
negro race. Many of the most eminent members of the medical pro-
fession were examined, and they all, with the exception of Dr. Mitchill,
declared that its appearance contradicted the idea that it was the child
of a black man. I)r. Mitchill, for various reasons, placed great faith
in the oath of the female, and persisted in his belief of its paternity,
although he allowed its appearance was an anomaly. The Mayor

762 Miscellany. [December,

(Hon De-Witt Clinton) and the Court decided in favor of Whistelo,"
i. e. that the child was by a white man.

Dunglison ridicules the opinion of Dr. Mitchill. But Mitchill was
altogether as respectable in the profession, and probably as cautious
as Dunglison. Beck comments upon the above case as follows: " It
will not do, however, to extend this rule too positively with what may
be called mixed breed.^^

Parsons gives an account in the Philosophical Transactions ot a
black man married to an English woman, of whom the offspring was
quite black. In a similar case, the child resembled its mother in fair-
ness of features, and indeed the whole skin was white, except some
spots on the thigh, which were as black as the father.

White, in his work on the Gradation of Man, mentions a negress
who had twins by an Englishman. One was perfectly black, its hair
short, %voolly, and curled ; the other was white, with hair resembling
that of an European.

So, also, Dr. Winterbottom knew a family of six persons, one-half
of which were almost as light colored as mulattoes, while the other
was jet black. The father was a deep black, the mother a mulatto.

"The offspring of a black and white," says Lawrence, "maybe
either black or white, instead of being mixed, and in some rare cases
it has been spotted."

I have made the above extensive extract from Beck, (which is all
he says on the subject,) because of the liability of such cases to arise
in this community, where we have not only the white and black races,
but every conceivable degree of mixture. In a note to the above
extract. Beck adverts to the fact that, "At birth it [the new-born black
infant] cannot be always distinguished from the white ; its hair has not
yet its peculiar make, and we can only notice the tendency to dark on
some parts of the body. In a few days, however, the change commen-
ces on the countenance, and gradually extends over the body." This
is rather too positive. In many cases, a child of purely black parents
is so white at birth as to exhibit no " tendency to dark" on any part of
the body ; and like other changes, this sometimes takes place much
more slowly than in others.

There is much truth in the extracts made by Beck above, as care-
ful examination of our mulattoes will shew. In this town there is a
family the father half white, the mother three-fourths whose chil-
dren vary very much in color. Some being pretty good samples of
the negro, and others, at five or six years old, not only as white as
most white children, but having straight and light-colored hair.

The spots spoken of in the above extracts are certainly rare ; nor
do I know to how much consideration they are entitled. There was
one on the child which gives rise to these remarks. On the other hand,
without being able at this time to refer to any particular case, I am
certainly under the impression that I have seen persons, entirely free
from suspicion of admixture, who had a dark spot on some part of the
body. I, some time since, owned a negress who clearly had no white
blood in her, yet she had a large spot on the forehead and temples
greatly darker than her skin in other parts.

1852.] Miscellany. 763

The hair, although a very important feature, is not conclusive in
determining our judgment. It does not necessarily begin to assume
its distinctive character in a few days, as we might infer from the ex-
pression of Beck. In half-breeds, generally, it is only curly, and not
knappy, as in the negro ; frequently it is no more curly than occurs
occasionally in persons purely white ; whilst again it is as knappy as
in the negro.

It seems that no reliance can be placed upon the popular notion that
the scrotum and skin over the spine are dark in children having an
admixture of African blood. I have examined several children of six
to eight years old without finding it in any of them ; they were how-
ever, more than half white some two-thirds, some three-fourths.

We must pay some attention to what is called moral testimony, but
that like other considerations, must be watched. The above case
shows how guilty a woman may be, and yet escape suspicion..

In stating facts, I have gone upon the presumption that they were
really as they appeared. For instance, in the family referred to as
living in this town. Some of the children may be by fathers purely
white, and others by those wholly black. I can only say that no
suspicion attaches.

The case cited in which an Englishman impregnated a negress, one
child being white and the other black, may be as reported, yet we
have a case reported of a woman in Virginia having connexion with
her husband, and very soon afterwards with a negro man, and be-
coming impregnated by both.

There is, perhaps, no subject connected with our profession which
presents more knotty points than this. For this reason and because
no one knows when he may be consulted upon such a case, and further
as we have so little authority on this point, and because the country
South of Mason & Dixon's line could and ought to furnish the facts and
authority upon this subject I have thrown together the above facts
and suggestions, in hope that they may be a means of drawing others
out on the same subject. \^WesiemMed. and Sur. Journal.

Report on Variola and Vaccination.

[The following Report relates to a subject of so much interest both
to the profession and the community, that we think we shall be per-
forming a useful service by giving it an insertion. The facts therein
set forth should be extensively circulated.] Med. News cf- Library.

The Committee appointed at the last meeting of the Medical Socie-
ty of the State of Pennsylvania, to investigate the accuracy of certain
views relative to smallpox and vaccination, recently put forth by
Drs. Gregory, of London, and Cazenave, of Paris, and referred to in
a communication made to the Society at its last session, Report :

That, considering the high authority heretofore attached to the
names mentioned, the opinions in question, if erroneous, are calculated
to unsettle the views of physicians, and shake the confidence o[ the

764 Miscellany, [December,

public in regard to the protective powers of vaccination, more than
any promulgated since its adoption. The Committee think these
grounds sufficient to justify them in treating the subject with particu-
lar attention.

The principal points and questions calling for consideration, are:

1. Whether persons vaccinated, lose, through lapse of time, any of
the protective power once afforded against smallpox ?

2. Whether the prophylactic powers of vaccination performed
during infancy, are restricted to the first fifteen years of life, and of
no avail afterwards?

3. Whether the accumulated evidence of the present day is calcu-
lated to sustain Dr. Gregory in his belief, that the efficacy of cowpox
as a protection against smallpox has diminished, and a large increase
of smallpox resulted from the extension of vaccination ?

4. Whether, as asserted by Drs. Gregory and Cazenave, inocula-
tion after the fifteenth year of age, of persons previously vaccinated,
produces a specific papular eruptive disease of anon-contagious char-
acter, unattended with danger, and giving protection in after life
against smallpox ?

5. Whether circumstances exist which render it most advantage-
ous to substitute inoculation for vaccination, after the fifteenth year
of age, as proposed by Dr. Gregory ?

The morbid miasm, or agent productive of smallpox, seemed for a
long while kept in check by the prophylactic power of vaccination,
which, indeed, at one time, promised the complete extermination of
variola. But it cannot be disputed, that of late years variolous attacks
have been common among those hitherto considered as completely
protected. A new form of disease has, in fact, become known, desig-
nated "ram/oirf," from its resemblance to variola, or smallpox, of
which it is generally regarded a milder form, as if modified and ren-
dered less formidable, through some remaining prophylactic influence.
This, of course, long before Dr. Gregory promulgated his peculiar
views, furnished grounds for believing that the protection once relied
upon from vaccination, was diminished by lapse of time, or that the
potency of the smallpox miasm had increased.

Dr. Gregory's views, when first promulgated in England, were well
calculated to rouse the attention of the medical profession, and elicit
inquiry. The Epidemiological Society of London, appointed a spe-
cial committee to investigate the important subjects of vaccination and
smallpox, and this committee has recently collected and placed before
the public, some highly important facts, through its chrirman, Mr.
Grainger. As the information thus derived is so highly valuable,
and directly calculated to meet the points started by Dr. Gregory, the
committee think they cannot do better than give a short abstract from
Mr. Grainger's statements.

In the evidence brought forward by the committee of the Epidemio-
logical Society, we have the results of the experience of a large num-
ber of medical practitioners in different parts of England ; and it is
interesting to find that, out of 430 replies to questions issued by the

1852.] Miscellany. 765

Society, one, only, expresses any doubt of the protective power of
smallpox vaccination ; and this one doubt simply amounts to this :
that having been inoculated during infancy, this gentleman felt him-
self more secure than if he had been vaccinated.

With regard to opinions founded upon observations prosecuted in
hospital practice, the committee would remark, that the results are so
often influenced by the existence, here and there, of modifying cir-
cumstances, that an appeal to the experience of any single one would
certainly afford most incorrect data, on which to found important con-
clusions, as these should always rest upon multiplied facts, and ob-
servations extended through long periods.

In a table presented by Dr. Gregory and published in his paper,
given in the London Medical Times, for 1849, we find the following
statement of the results exhibited in the Smallpox Hospital, over which
he presided :

Total.

Unprotected cases 254

Vaccinated with cicatrices .... 365
Vaccinated, without cicatrices . . 63
Total vaccinated .... 428
Previously inoculated 3

Now the rate of mortality here presented is so much greater than
that generally met with in other institutions, or in common practice,
as to leave little doubt that the patients had been subjected to some of
those malign influences, such as defective ventilation, &c., which have
so often operated most injuriously in rendering mild cases severe, and
originally severe ones almost inevitably fatal. If we compare the
results exhibited in Dr. Gregory's Hospital practice, with those pre-
sented in 30 returns received from medical practitioners, by the Lon-
don Epidemiological Society, taken without selection, we shall find
the contrast most striking :

Percentage

Deaths.

of Deaths.

103

40

38

10

25

39

63

14

1

33

Percentage

Total.

Deaths.

of Deaths.

1756

361

20.85

927

32

3-44

Natural smallpox in the unprotected
Smaflpox after vaccination . . .

Previous to the introduction of vaccination, the annual mortality
from smallpox amounted to 40,000 per annum, in the British Islands
alone, being about 1-lOth of all the deaths from every source. The
average number of deaths per annum in London from smallpox, a cen-
tury ago, namely, during a decennial period ending in 1750, was 2036;
which presents a proportion strongly contrasted with the annual
average of a decennial period ending in 1850, which is 498. This,
shows a mortality four times greater during a period when the popula-
tion was not a fourth of what it was at the time last named.

Dr. Casper, of Berlin, shows in hfs statistics that the deaths fron^
smallpox, in Berlin, during the eight years, from 1814 to 1822, were
535 out of a general mortality of 51,389, being only one de?ith from.

766 Miscellany, [December,

smallpox in 1000 from all diseases. This exhibits either an almost
total absence of epidemic influence, or a very general diffusion of pro-
tective means. It is stated in a publication containing the regulations
for medical and other officers, issued in Berlin in October, 1803, that
smallpox caused, on an average, 40,000 deaths a year in Prussia,
in a population of about 10,000,000, during a period when inoculation
was the only protection relied upon. In 1849, when the population
had increased to more than 16,000,000, the average mortality from
smallpox was 1760 ; showing that during the first period, when inocu.
lation was the sole reliance, the proportional mortality from small pox
was 37 times greater than when vaccination became generally diffused.
These striking facts are, we think, very far from sustaining Dr. Greg-
ory's opinion that an extension of vaccination Jias resulted in an in-
crease of smallpox ; nor do they offer any encouragement to those who
would restore the former practice of inoculation.

The frequent occurrence, of late years, of smallpox after vaccina-
tion, with instances of mortality, have been much commented on, and
occasioned no smaU alarm. Hence, the great value af such accurate
information as the following, furnished in 356 replies sent by physi-
cians to the Epidemiological Society.

Of these, 182 state, expressly, that they have never seen a death
from smallpox after vaccination.

44 state their experience in numbers, and give an aggregate of
70 deaths.

127 give no statements of their experience.

From the same source we gather the results of the experience of
thirty physicians on the respective degrees of mortality of natural
smallpox, smallpox after smallpox, and smallpox after vaccination.

Percentage

Cases.

Deaths.

of Deaths.

1731

361

20.85

58

22

37.92

929

32

3.44

Natural Smallpox

Smallpox after smallpox . . .
Smallpox after vaccination . .

It is remarked, in reference to the 32 deaths reported after vaccin-
ation, that in 7 cases the evidences of vaccination were not satisfac-
tory, whilst in six other cases the deaths were owing to superadded
diseases. Deducting the 13 deaths, the ratio of fatal cases occurring
after vaccination would be scarcely 2 per cent., whereas that of
smallpox after smallpox is nearly 38 per cent.

To these statements of results of very extensive experience abroad,
we are glad to have it in our power to subjoin evidence equally con-
clusive as to the protective power of vaccination, obtained among our
own practitioners. In the report on varioloid, the protective power of
vaccination, &c., presented to the College of Physicians of Phila-
delphia, in Nov. 1846, replies to interrogatories of the committee
were received from 51 practising physicians of the city and districts,
who reparted 776 cases of varioloid as having occurred in their prac-
tice during the epidemic of that period. Forty of these cases occur-

1852.] Miscellany. 767

red after inoculation or a previous attack of smallpox in the natural
way, and the remaining 736 after a reputed vaccination. Of the whole
number of 776 cases, but 12 deaths occurred, or less than 2 per cent.,
and of these cases several were attended with serious complications.
These cases all occurred in private practice, except two, which took
place at the Smallpox Hospital at Bush Hill.

It is worth noticing, among the evidence from abroad upon this sub-
ject, that Mr. Marsden, resident physician of the London Smallpox:
Hospital, has, within the last sixteen years, vaccinated no less than
40,000 persons, not one of whom had returned to the hospital with,
smallpox. Had there been any considerable number of the vaccinated
aitacked subsequently with smallpox, there is reason to believe that
very many would have found their way to an institution which receives
multitudes of patients from the same ranks in which the vaccination
took place.

Statements made by Dr. Grainger, prepared from official returns
received from all parts of England to the Poor-law Board, show a great-
er neglect of vaccination than could be well imagined to exist among
civilized people. In London, 13 unions, exhibiting 21,598 births, re-
port the number vaccinated at only 4641, or 21 percent.; whilst 31
unions in the country give only 9.2 per cent, of vaccinations under
the first year of life. In many others, the proportion of infants vaccin-
ated in the first year of life is much less, being occasionally as low
as 1 per cent. Whilst such is the sad case in the country boasting a
national vacfiine institution, and acts of Parliament for the promotion
of vaccination, things seem to be even worse in Ireland. In a very
valuable report, made by Mr. Wilson, of Dublin, contained in the re-
port of the census of Ireland for 1841, it is stated that, of the 56,000
deaths from smallpox which occurred in that country in the decennial
period from 1831 to 1841, jjo fewer than 79 per cent., or 45,824 were
of children under 5 years of age. Dr. Gregory gives results for
England very nearly the same. He states that of 9762 persons who
died of smallpox in that country during the years 1837-38, the deaths
under 5 years were 7340, or about 75 per cent, of the whole. If, as
Dr. Gregory asserts, in his valuable lectures on eruptive fevers, the
protective power of cowpox may, tor all practical purposes, be consid-
ered as complete, at least till the eighth year of life, the frightful in-
fantile mortality here exhibited from smallpox, proves a neglect ofvac-
cination almost equal to that which prevails to such a lamentable
extent in Ireland.

In Prussia, Sweden, and some other countries, legislative authority
has been brought into play with considerable efficiency in promoting
the general extension of vaccination. But still, in despite of every
precaution and exertion yet made, it would seem there are every
where to be found thousands of unprotected persons, among the im-
provident, ready to become victims to smallpox whenever this may be
introduced through epidemic or contagious influences.

In estimating the protective powers of vaccination, the public mind
often seizes upon individual and isolated cases of death occurring after

Miscellany. [December,

vaccination performed in childhood, without forming, at the same time,
a just estimate of the vast number of individuals who are thereby
enjoying- immunity from the ravages of variola. Persons are not
given to reflect that such deaths constitute the exception to the general
law of exemption, and that they happen only among a very few indi-
vidual6,peculiarly susceptible to the variolous poison. It is also highly
probable that the limited class upon whom vaccination appears to exert
Jittle or no protective power, are rendered no more safe by inoculation
or An : attack of smallpox, as we find occasional instances of death
; from la second attack of genuine smallpox, even in persons who have
.had the disease so severely as to be extensively pitted.

Ahe to the new form of eruptive disease asserted, by Drs. Gregory
-and Cazenave, to be developed by inoculation performed upon those
vaccinated previous to the fifteenth year, the Committee has been pre-
vented from testing its verity by actual experiments, penal laws ex-
isting against inoculating within the city and adjoining districts, em-
braced within the limits of the Board of Heahh. A few experiments
have, however, been made during the past year, by Dr. D. F. Condie,
of Philadelphia, on persons situated beyond the jurisdiction referred
to, the results of which were by no means calculated to sustain the
views of Drs. Gregory and Cazenave. Although such limited expe-
rience cannot be regarded as furnishing evidence sufficiently conclusive
upon the subject, we think it proper to place the results before the
Society.

Ten cases were experimented on by inserting varioldbs matter in
the arms of individuals, six of whom had been previously successfully
vaccinated by Dr. Condie, and of the successful vaccination of the
other four he had the most unquestisnable evidence.

In three of the cases, between seven and eight years had elapsed
since the period of the vaccination. ^

In Jive, betwean thirteen and fourteen years.

In two, between fifteen and sixteen years.

In one case, a local variolous pock appeared upon the arm at the
place of inoculation attended, between the eighth and ninth days,
with a pretty smart fever. The scab separated on the twentieth day,
leaving a decided cicatrix. The remaining portion of surface was
entirely free from any form of eruption. This individual had under-
gone successful vaccination seven years and two months previously.

\nfour cases, the local disease was attended with a general erup-
tion of acuminated pocks with hard base and slight areola sparsely
disseminated over the surface. In different cases, from twenty to one
hundred pocks appeared. In these cases, the pustules on the arm and
over the body were attended with a very slight fever about the fifth
day after this period they desiccated very rapidly, forming small,
light brown conical scabs, which commenced failing off on the eighth
day, leaving no cicatrix. The periods which had elapsed since vacci-
nation in these cases were, thirteen years in two, fifteen in one, and
fifteen years seven months in another.

In five cases a local inflammation, but no pustule, occurred at the

1852.] Miscellany. 769

part where the matter was inserted, which disappeared within four or
six days, leaving no cicatrix. These cases were unattended with
fever, or any form of cutaneous eruption. These patients had under-
gone vaccination seven years and five months, seven years and nine
months, thirteen years and six months, and in two between fourteen
and fifteen years.

These experiments were performed without the jurisdiction of the
Board of Health of Philadelphia, with the consent of the parties and
their friends, and with due precautions to prevent the individuarls op-
erated on from becominsc foci of contafi^ion.

It certainly appears strange that the poison of smallpox, whichu
when taken the natural way by persons previously vaccinated, pro-
duces the disease in its regular, pustular, and contagious form, should-
when introduced by inoculation into the systems of persons similarly
situated, develop an entirely different form of disease, such as that
described by Dr. Gregory as a specific papular eruptive affection of a
non-contagious character, unattended with danger, and giving tlie most
perfect protection in after-life against smallpox. Even supposing the
result to be as stated by Dr. Gregory, the production of such a mild
and benignant train of symptoms as those he describes from the intro-
duction of the smallpox virus, affords one of the strongest evidences
of the inestimable protective power exerted by cowpox.

In regard to the fifth and last point of inquiry, your Committee have
no hesitation in expressing it as their belief, that no circumstances
exist to justify the general substitution of inoculation after the fifteenth
year of age, as proposed by Dr. Gregory. And they regret that, at
the present time, whilst strenuous efforts are making through individ-
ual exertion, occasionally helped forward by judicious legislation,
statements calculated to lessen confidence in the protecting power of
vaccination, should have been promulgated. Happily, however,
abundant evidence exists to show that although the hopes of complete-
exemption from smallpox, once fondly indulged, have not been fully
realized, vaccination still offers the only dependence for protection
against a disease, the fearful ravages of which have tended so much
to darken the pages of history previous to the precious discovery
made by Jenner.

As the neglect of vaccination, especially among the poor and im-
provident, may, we think, be regarded as the principal cause operating;
to promote the extension and mortality of smallpox, the Committee
would urge it upon the State Medical Society to continue their efforts
to obtain from the legislature the passage of a law providing for the
gratuitous vaccination of the poor, and calculated to secure, as far as
practicable, the fullest extension of vaccination in every portion of
the commonwealth,

G. EMERSON,
SAMUEL JACKSON,
JOSEPH WARRINGTON,
ISAAC PARRISH,
JOHN D. GRISCOM.

770 Miscellany. [December,

Ice as a Local Ancesthetic. By W. A. Berry, M. D. Washing-
ton, D. C. I propose to make known to the many readers of your
valuable Journal the application of a new local anaesthetic agent,
which probably is not familiar to a large majority of them. This
agent is applicable to but a very limited part of the frame, but its
efficacy is such as to cause its use in all like cases. I refer to the
local anaesthetic effect of ice in the removal of the nails of the toes or
fingers. This most painful operation is disarmed of all its terrors by
this simple means, and the patient witnesses it with as much compo-
sure as his operator. The agent was first made use of in the wards
of M. Velpeau, during the past summer, in Paris, by one of his in-
ternes, and afterwards successfully applied by himself in a number of
cases. The ice is powdered finely, and mixed with a sufficient quan-
tity of salt ; next enveloped in a thin cloth, and the two phalanges of
the great toe or thumb enveloped in it ; the application should not be
continued over five or six minutes, this time being sufficient to pro-
duce the most perfect anaesthesia. M. Velpeau proceeds with the
operation in the following manner : Immediately upon removing the
ice, the nail is divided in its length with a common sized bistoury
from its free extremity to the root, then seizing each half successively
with a strong forceps, it is removed with a moderate jerA:. The fre-
quent necessit}' for the performance of this operation, and the great
pain attending it when removed under other circumstances, is suffi-
cient to cause its universal application by the profession. M. Velpeau
directs the application of compresses of cold water to the part during
the first twenty-four hours ; and the simple cerate dressing for a few
days is all that is required.

It may be objected that the reaction under the application is such
as to prevent its use ; I will simply say that of the six patients that I
saw operated upon by M. Velpeau, no such accident occurred to any
one of them ; and to the one case in which we applied it but a few
days since, (and which has suggested this communication,) we have
reason to believe that the agent is free from any unhappy results.

The simplicity and efficacy of this piece of min-or surgery, and the
so frequent necessity of some surgical interference in these cases, has
induced me to send you this communication. [Medical Examiner.

New mode of applying Leeches. Dr. Sloan, of Ayr, says, that by
-covering leeches with a cupping-glass and exhausting the air moder-
ately by means of an air-pump, they suck much more rapidly, and
.soon become fully distended and fall ofi*. A sufficient quantity of
blood may be obtained by continuing the exhausting process after-
wards. The erysipelatous appearance which usually follows leech-
bites, is thus prevented. [Monthly Journ. of Med. Sciences.

Mineral Springs. Doctor John Bell, (Philadelphia,) who is pre-
paring a work on mineral springs, more especially on those of the
United States, is desirous of procuring, at an early day, all accessible
information on the subject. With this view, he requests his profes-

1852.] Miscellany. Ill

sional brethren to transmit to him all the facts in their possession,
which may throw light on the chemical composition and curative pow-
ers of the waters of the springs, in their respective neighborhoods.

Proprietors of these waters, would oblige by sending to Dr. Bell
authentic accounts, on these points ; and also, of the topography of
the springs, and the roads by which they are approached. [Medical
News and Lihrary.

Medical Classes. It would seem that the classes in some of the
Northern Institutions are unusually small this year, and that the cir-
cumstance has been attributed to the emigration of young men tO
California in search of more profitable employment. We are happy
to say that the youth of ^^ these diggins'^ have been more considerate,,
and that they have preferred to remain at home. The class in attend-
ance at the Medical College of Georgia this session is unusually
large.

Death of Daniel Drake. The Profession of our country will learn,
with profound regret, the demise of Professor Daniel Drake. An ac-
complished physician, scholar and gentleman, Dr. Drake was an honor
to his profession and to his country. We hope that his biography will
be written by an able hand, and that the queen city of the West
will erect a suitable monument to the memory of her most gifted and
patriotic citizen.

A new Syringe. Dr. Mattson, of Boston, has made improvements
to the syringe so as to adapt it to various purposes. It is represented
as much better than those in common use.

BIBLIOGRAPHICAL.

On Syphilis, constitutional and hereditary ; and on Syphilitic Eriip'
tions. By Erasmus Wilson, F. R. S., &c. with 4 colored plates.
Philadelphia : Blanchard & Lea. 1852. Pp.284.

The writer of the work before us has been favorably known as the
author of a Treatise on Diseases of the Skin, and of other interesting
papers. We believe that his reputation will not suffer in the present
instance, and that his contribution to the study of so important a class
of affections as the Syphilitic, will tend to the elucidation of points
already too long within the domain of controversy. The work is di-
vided into eight chapters, comprehending The syphilitic poison,
Primary syphilis. Secondary or constitutional syphilis, Evolution or
the syphilitic poison by the skin. Local affections of syphilis. Con-
genital syphilis, Hereditary syphilis, and the Treatment of syphilis

772 ^ Miscellany,

the whole judiciously interspersed with cases illustrative of his con-
clusions.

We would recommend the book to the attentive perusal of general
practitioners.

A practical treatise on Diseases of the Skin. By J. Mooke Neligan,
M. D., M. R. I. A.., &c., &c., Lecturer on the Practice of Medicine
in the Dublin School of Medicine. Philadelphia : Blanchard &;
Lea. 1852. Pp. 330.

Diseases of the skin are so little understood, that we ought not to
hesitate to read anything that may be published upon the subject by
so judicious an author as Dr. Neligan especially when he tells us
that his object is to simplify their study and treatment. The work is
small, concise and well written, and will doubtless amply compensate
for a more minute inspection than we have as yet been able to give it.

General Pathology, as conducive to the establishment of rational princi-
ples for the diagnosis and treatment of disease ; a course of Lectures
delivered at St. Thomas's Hospital in 1850. By John Simon, F.
R. S., one of the surgical staff of that hospital, &c. Philadelphia :
Blanchard & Lea. 1852. Pp. 211.

These Lectures were originally published in the London Lancet,
and met with much favor. The profound attainments of Mr. Simon
have enabled him to comprehend in a comparatively brief volume
much of most valuable matter, especially in reference to the morbid
conditions and products of the blood. Tumours, Scrofula, Nervous dis-
eases, and morbid poisons. The author is one of the ablest patholo-
gists of the age, and his writings should be i^tudied by all who wish to
practice medicine with proper discernment.

A practical treatise on Dental Medicine, being a compendium of Medi-
cal Science, as connected with the study of Dental Surgery ; to
lohich is appended an inquiry into the use of Chloroform and other
ancBsthetic agents second edition, revised, corrected aud enlarged.
By Thomas E. Bond, A. M., M. D., Professor of Special Patholo-
gy and Therapeutics in the Baltimore College of Dental Surgery.
Philadelphia : Lindsay & Blakiston. 1852. Pp. 366.

Professor Bond's work is deservedly popular with the Dental Pro-
fession, and has already reached its second edition in less than two
years. It is an excellent book, both as regards manner and matter.

To Correspondents, We are compelled, for want of space, to defer
until our next issue the publication of several valuable papers among
which is one from the pen of Dr. Charles T. Jackson, of Boston, upon
Anaesthetic agents.

INDEX TO VOL. VIII,

Abdomen, wounds of, by Guthrie 247

Abscess, retropharyngeal 163

Abscesses, pelvic, by Dr. Churchill . . 293

Acarus, discovery of the male 131

Acromion, fracture of the 115

Adherent foetuses 76

Advertisements 580

Air-passages, foreign bodies in 510

Air, entrance of into the facial vein . . 551
Alabama, appeal to the Legislature of 67

Alcohol, uses of 68

Aloes and Soda, solution of 382

American Medical Association 196

383
" " " 516

" " " 578

" " 127

u it u 708

.( u 128

Amputations in children, by M. Gu-

ersant, 379

Amputation of the entire lower jaw 437

" of leg for frost-bite 661

Anasarca in disease of the heart 62

Anaesthesia of the skin in neuralgia. 425
Anaesthetic agents in gunshot wounds 688

" Ice a local 770

" Bromohydric tther, a new 597

Anemia, extract of beef's blood for . . 181

Aneurism, novel treatment of 509

Animal matter preserved by sulph.

zinc 388

Anonymous writers and personalities 513

319
Anomalous cases, by Dr. E. Y. Harris 581
Antony, E. L., on Veratrum Viride.. 517
Appropriation for the Botanic School

in Greorgia 452

Arnica Montana, properties of 684

Arnold, Dr. elected Mayor 68

Asthma, nitric acid in 501

Asphyxia infantum, treatment of .. . 381

Astringent mixture 452

Attaway, A. F. on Polypus Uteri.. . 532

Bartlett on fevers 451

Bebeerine, sulphate of 368

Beck's materia medica 193

Belladonna in hooping cough 756

Blood, influence of chronic diseases

upon 624

Blood, motive power of the 68

726

" " 526

.. 280

115

Bones, new method of whitening 323

Bond's dental medicine 772

Booth, G. W. on cold water in puer-
peral convulsions 153

Brandon, W. C. on epidemic Dysen-
tery 133

Braithvvaile's Retrospect and Rank-

ing's Abstract 640

Brighi's disease 417

Bromo-hydric ether, a new anaesthetic

agent 577

Burnett, Dr, on Pathologic Micro-
scopy 261

Burns and Scalds 693

Campbell, H. F. report on Surgery . . 733
Cancerous affections, by Prof. Stone, 117

Cancers, on, by Prof. Pope 84

Cancer, epithelial, by Dr. Humphry, 300
" " gutta percha solu-
tion and collodion in 668

" treated by lactate of iron 434

" of mamma, gutta percha sol. in 669
Cafeine, improved mode of preparing 563
Calculi in urethra, operation for the

removal of 654

Cannabis indica, substitute for ergot, 319
Carpenter's Elements of Physiology, 193
Castration in a case of Hermaphro-

dism 753

Catalepsy treated by ether inhalation, 466
Cazenave & Schedel on diseases of

the skin 194

Cerebral disease, premonitory signs

of 106

Charcoal cushions for deodorization, 507

Cherry bark, wild 56i

Children, mortality of 323

" alvine discharges of 374

Chloroform, external use of 426

" stimulant previous to using.. . 251
" in fractures and dislocations.. 448

" an Emmenagogue 567

" and ether, deaths from 635

" poisonous 695

" suicidewith 67

" in painful micturition 126

" in chorea 81

" " gonorrhoea 188

" " delirium tremens 311

" ointment in hemicrania and

neuralgia 634

Chlorosis of pregnancy, by M. Ca-

zeaux 477

Chloasma, by Dr. Starr 611

Cholera, strychnine & turpentme for 180

Jl i1 JLT U .V

Cholera infantum, quinine in 58

Chordee, by J. L. Milton 545

Christison's Materia Medica, error in 516
Ciliary movements, duration of after

death 253

Circulation of the blood, by Dr. Will-
born 726

Clark, Sir James and Kossuth 68

Clavicle, removal of, by Prof. Wed-

derburn \ 752

Clavicle, fractures of 69

Cod-liver oil, use of 24

" substitute for 131

" test for the purity of 576

" new mode of disguising the

taste of 187

Consumption, influence of climate on 636

Convulsions, puerperal 153

Conjunctiva, nitrate of silver stains of 231

Correspondents, to 452, 772

Corpus cavernosum, morbid states of 99
Corrosive sublimate, antidote for . . . 382
Cooper's B. B. Lectures on Surgery . . 515

Craniotomy, by Dr. King 325

Croup treated with cold water 448

" tracheotomy in, by M. Trosseau 512

Cutaneous diseases, starch in 566

" eruption from tart, emetic, 465, 334
Cynanche tonsillaris, muriate of am-
monia in 552

Cynanche trachealis, treated with ve-
ratrum viride 334

Daguerreotyping, effects upon health

by 702

Death of distinguished men 67

Deafness, new treatment of 449

" glycerine in 534

Delirium tremens, chloroform in, by

Dr.Pratt 311

Delivery, on bandaging after 371

Dental Surgery, colleges of 68

Deodorization by charcoal cushions, 507

Diarrhoea, sulphuric acid in 186

" nitrate of silver in 503

Dickson's essays on life, sleep, &c . . . 195

Dislocation of the femur 119

Dislocations, &c. chloroform used lo-
cally in 448

Diuretics in diseases of children .... 120

" external, by Dr. Cain 355

Doane, death of Dr 260

Doctorate in St. Louis University. . . 641
Donald, Dr. on the use of electricity

in disease 337

Drake, death of Prof 771

Dropsy, meadow-sweet in 186

Ductless glands, development of 572

Dugas, L. A. on fractures of the clavi-
cle 69

" on a singular epidemic 256

" Eye destroyed by a bird-shot . . 404
* Exophthalmia from tumor in
orbit 405

Dugas ,L.A. Gun-shot wound ol face 406
" Wound of the intestines re-
covery 407

" Astringent, or anti-diarrhcEal

mixture 452

" Snoring prevented by excision

of the uvula 612

" Fatal effects of chloroform and

ether 635

" Influence of climate upon con-
sumption 636

" on the use of certain new reme-
dies 664

" Sudden rupture of an ovarian

tumorrecovery 730

Dysentery in Floyd county 133

'* treatment of, by Dr. Starr 721

" " " 530

by Dr. Trent 724

" common salt in 664

" Iodine clysters in 565

" salines and opiates in 618

" treated with spirits turpentine, 503
Dystocia, veratrum viride in 524

Earthquakes, &c. by Prof. Gorini 65

Ear, affections of in cerebral disease 176
" observations on the diseases of the 222
" Exfoliation of the ossicula of the 225

" foreign bodies in the 227

Edible Earths, by Ehrenberg 631

Electricity, use of in disease 337

Elephantiasis, arabum, treated by lig-
ature of femoral artery 682

Emmenagogue, chloroform as an ... . 567

Epidemic, a singular 256

" furunculoid in England 577

Epilepsv, treated by tracheotomy 548

Ergot, fluid extract of 190

Errata 324

Eruption, from internal use of tartar

emetic 343

Eruptive diseases of the scalp 538

Erysipelas, on the constitutional ori-
gin of 61

Ether, compound spirits of 603

Eve, J. A. case of adherent foetuses . . 76
Excretion of sulphates & phosphates,

by H.B.Jones 59

Ex-ophthalmia caused by a tumor in

the orbit 405

Extra-uterine fcEtation 599

Eye destroyed by a bird-shot 404

'" new "instrument for examining 575

Fat, use of in the animal system .... 51

Fats and fixed oils, new method of
preserving 64

Fever, intermittent, affecting only one
half the body 60

Fever, intermittent, prescription for
chronic 577

Fever, intermittent, turpentine fric-
tions in 641

INDEX.

775

Fever, typhoid, bismuth in 120

" " cases ot 274

" " successfully treated... 389

" " in Alabama 581

" " cases of, by Dr. Wil-
liams 657

" " treated with veratrum

viride 334

" typhus, yeast mixture in pete-
chial 318

Filter, accelerator 388

Flesh, preservation of 65

Flavors and odors, artificial produc-
tion of 576

Flint's reports on continued fever . . , 637

Foreign bodies in air passages 510

Formulary, Beasly's pocket 194

Fractures of the clavicle 69

" acromion 115

" near the ankle-joint 366

" treatment of ununited, by Dr.

Brainard 444

" ununited, treated with tincture

of iodine 510

" and dislocations, chloroform ap-
plied locally in 448

Frosi's materia medica 514

Furuncles, yeast in the treatment of. . 757

Gargle,dilutedpyro-ligneous acid as a 318
Genu Valgum, causes and treatment

of 236

Gentianin, a substitute for cinchona 382

Glands, development of ductless 572

God in disease, by Dr. Duncan 639

Goitre, ligature of thyroid artery in. 569
Gonorrhea, abortive treatment of by

chloroform 188

Grant, W. T. Remarks on Mrs. Wil-

lard's theory of the circulation . . 280
' further remarks on do. do. do. 526

Granular eyelids 66

Graham's Elements of Chemistry. .. 451
Griswold on the climate of Panama. 195

Gun-shot wound of the face 406

" wounds,reportof Acad. Med. on 453
" " anaesthetics in operation

for 688

Gutta Percha, solution in chloroform 668

Hammond, D. W. operation for cal-
culi in the urethra 654

Harriss, Juriah, case of Phymosis.. 21
" synopsis of reports on gun-shot

wounds 453

Harris, E. Y. application of cold wa-
ter to the head in narcotism 461

" Anomalous cases 593

Havis, M, W. Tetanus successfully

treated 204

" case of extra-uterine foetation . . 599

Hare-lip operation for 641

" simple instrument for operating
on 663

Heart, anasarca in diseases of the . . . 62

Haemorrhage, umbilical 606

" pressure above the pubis in

uterine 184

Haematuria 495

Haemorrhoids, tetanus from ligating 179
Henderson, conversion to Homccopa-

thy ofProf. 192

Hermaphrodism,involving castration 753

" lateral 757

Hernia, strangulated 145

" of long irreducible 513

" singular case of strangulated. . 533

" statistics of 699

Hip-joint, position of the limb in dis-
eases of the 308

Hyperesthesia, &c. in neuralgia 425

Hysterical atfection of the hip-joint. . 307

Idiots, distribution of prizes to 66

Intestines, wounds of small 407

Intoxication , in jections of salt water in 56 1
lodo-Hydrargyrate of Potassium 363

Jackson's introductory lectures 6"

Jalap, purgative syrup of 381

" " " erratum 516

Jaundice of infants, by M. Duclos . . . 692

Jaw, amputation of the entire lower . . 190

Joints, treatment of diseased 359

Journal discontinued 26C

Kiestein, Dr. Veit on 183

Kinesipathy 129

King,W. N. remarks on craniotomy, 325
KoUock, P. M. on cutaneous eruption
from internal use of tart, antim.. 465

Kossuth and Sir James Clark 68

Knee, inflammation of, treated with

urate of ammonia 172

Knee-joint, successful removal of. . . 442
Knight, A. W. on vicarious menstru-
ation 660

Labor, on the induction of premature 184

Lactation reproduced 161

Leeches, new mode of applying 77"3

Lapra, sesquicarbonate of ammonia

in 18-

Leucocythemia, by Prof. Bennett. . . 479
Liebig, Prof, removal to Munich . . . 641
Liver, excision of a large portion of

the 691

Ligature, experiments on animals

with 113

Lobelia inflata 394

" fluid extract of 564

Long, J, A. case of onanism 20S

" Topography and diseases of E.

Tennessee 71G

Lucifer match-making, &c 705

Malignant growths, histological char-
acteristics of 254

776

INDEX.

Mammary abscess, verat. viride in . . 334
Marasmus, wine and honey in infan-
tile 381

Meadow-sweet in dropsy 186

Measles in idiot children 628

Medical education, free 64

" Colleges, female 68, 128

" College of Georgia 257

' Colleges in New York 322

** College of Constantinople 131

-^^" Classes 771

" Society of Kentucky, transac-
tions of 67

" Societyof Greene county, trans-
actions of 68, 141 394, 603

w-ii' Society of the State of Geor-
gia 128, 196, 260, 320, 638

" Society in Paris, American . . . 195
" Society of Missouri, transac-
tions of 638

" Society of Virginia, transac-
tions of 640

" school in Savannah 708

'-^* schools, preparatory 132, 579

" institutions in Lima 191

" profession in Paris and Russia 192

'' periodicals, new 323

" statisticsof the Georgia census, 151
Medicine, influence of on tempera-
ture of the body 567

Meigs' obstetrics 515

Menstruation, Jiealthy and morbid,

by Dr. Bennett 345, 409, 468

" imanagement of women after

the cessation of 478

" reciprocal influence of acute

disease and 626

" vicarious 660

Mercury, anti-syphilitic agents to re-
place 178

" detection of in the body 185

" salivation and sloughing by

small doses of 317

Micturition, chloroform in painful . . 126
Microscope, as a means of diagnosis, 190
Microscopic pathology, by Dr. Bur-
nett ! 261

Miller, H. V. M. pathology of phleg-
masia dolens 5

Miller's Principles of Surgery 451

Milner, W.A. case of chorea treated

with chloroform 81

Mineral springs 770

Monomania, religious 188

Monstrosity, cases of 76, 604

Moragne, N. H. on typhoid fever. .. 889
Muscae volitantes, causes and diag-
nosis of 629

M3'ringitis from foreign bodies in the
meatus 227

Narcotism, cold water to the head in 461
Nebvus of the scalp treated by tart.

antimony 508

Naevus, cured by vaccination 508

Neill's outlines of the nerves 515

Neligan on diseases of the skin 772

Nerves of the fingers, termination of 560

" sympathetic, on sensibility of. . 560
Neuralgia, hyperesthesia and anaes-
thesia of the skin in 425

" treatment of 553

" Chloroform in 634

New remedies, observations on cer-
tain 664

Nitric acid in rain water 756

Norwood, W. C. additional remarks
on veratrum viride 17

" on veratrum viride 645

Odours and flavours, artificial pro-

duclion of 576

O'Keeffe's extracts from Records of
Med. Soc. of Greene Co. 141,394, 603
" cases treated with veratrum vi-
ride 197

Onanism, a case of 208

Ophthalmia, scrofulous 66

Ovarian tumor, rupture of and re-
covery 730

" " congenital 47

" irritation, by Churchill 42

Paternity, case of doubtful 760

Peach-leaf water 562

Pertussis, belladonna in 756

" Nit. Arg. to the pharynx in . . . 316

" cauterization of the glottis in . . 566

Pericarditis, causes of 165

Pereira's materia medica 194

Pirrie's Surgery 580

Phimosis, case of 21

Phlegmasia dolens, pathology of 5

Phthisis, influenceof pregnancy on.. 626

" hereditary transmission of 628

Philosophical experiments on vision, 642

Pleuritic effusions, diagnosis of 63

Pleurisy, paracentesis in acute 234

Pneumonia treated with veratrum vi-
ride.. 148, 198,200,201,274,330, 519

" typhodes treated with veratrum
viride 274,518,521, 522

" catarrhal and lobar, by M.
Trousseau 423

*' new symptom of 564

Podophyllum peltatum, efiectsof. .. 378

Polypus uteri 147, 532

Prolific woman 66

Precocity, remarkable 641

Priesnitz, death of 192

Prizes, distribution of by French In-
stitute 322

Professorial changes 514

Pruritus of the genital & anal regions 186

" Nit. argent, in 566

Psoriasis, sesqui-carb. of ammonia in 187
Puerperal fever treated with vera-
trum viride 197

INDEX.

777

Puerperal convulsions treated with

veratrum viride 520

Pulverization, changes produced by 574

Pure medicinal extracts 580

Pustule maligna 124

Cluackery, a new , . 190

Cluarantine laws 66

Gluinia, sulphate of, made soluble by

tart, acid 382

Cluinia, tannate of 570

Reese's analysis of physiology 451

Revellents, effects of gastro-intestinal, 33

Rheumatism, chronic 488

" lemon-j uice in 667

" shellac solution in 670

Richardsone, death of Dr 324

Robert, W. H. observations on the

use of veratrum viride 330

' singular case of strangulated

hernia 533

Rossignol,H. report of surgical cases 404

Salt, in dyspepsia and dysentery 664

Sanitary reform, lectures on 67

Sciatica, treated by inoculation of

morphine 57

Scalp, eruptive diseases of the 538

Scarlatina, spontaneous origin ol 398

byDr. Voltz 548

" creosote in 549

Scutellaria lateriflora 115

Scull-cap, medical properties of 233

Shellac, solution of 670

Simon's lectures on pathology 772

Skin, the, as a diagnostic of health.. 314

Smith's Operative Surgery 132

" Analytical Compend 195

Snoring, prevented by excision of

uvula 612

Spinal cord, reunion of wounds of the 185
Starr, E. F , treat, ol dysentery . .530-721

" on Chloasma 611

" instrument for operating for

Harelip 663

Stomach, morbid sensibility of 709

" diagnosis of diseases of the . 92
" puncture and protrusion of ., 122
" bloodvessels of (he mucous

membrane of the 185

Suicide by fire-arms 388

Summer, W.J. use of veratrum viride
in typhoid fever and pneumonia 274

Snper-fcElation, umbilical 187

Suppositories 505

Surgery in Georgia, Report on 733

Symphisesof ihe pelvis, relaxation of 112

Syphilis, Ricord's lectures on, .. 554, 578

" " " .. 613, 671

*' Iodide of sodium in 559

* treatment of in pregnant wo-
men 630

" substitutes for mercury in . , . 178

Syringe, a new 771

Tennessee, topography and diseases

of 716

Tenia, pumpkin skin for 640

Testicle, swelled, treated with vera-
trum viride 18

.Tetanus, from ligature of hemor-
rhoids 179

" case by Dr. Ha vis 204

" practical observations on 622

" local treatment of 750

Temperature of the body, influenced

by medicine 567

Thompson, B.M. case of amputation

for sloughing, &c 661

Thompson's lecture on logic in medi-
cine 195

Throat diseases by Dr. Warren 211

" " yeast in putrid.., 218

Thrush in children 141

Trent, P. Dysentery treated with

sulph. magnesia 724

Tubercular deposits, new theory of. . 571
Tympanitis exfoliation of ossicula,
&c 225

Umbilical hemorrhage 606

Upham, on maculated or ship fever. . 637
Urethra, new instrument for cauter-
izing the 575

Urethral inflammation in the female, 149
Uterine hemorrhage, pressure upon

the pubis in 184

Uterus and intestines, sympathy be-
tween the 253

Uterus, nerves of the 254

Uterus, irritable 289

Uvula,snoringpreventedby excision 612

Vaccination, report on by Philadel-
phia Medical Society 763

Vaccine fluid, an internal remedy

for smallpox 230

Vagina, inversion of during labour. 252

Vagina, ecchymosis of the 608

Varicose veins,treatment of 380

Veratrum Viride, by Dr. Norwood . . 645

17
" casesby Dr. O'Keeflfe.. 197
" " typhoid fever and typh-
oid pneumonia 274

" " on use of, by Dr. Robert 330

" " cases by Dr. Antony. . , 517

Vision, experiments upon 642

Wellborn, A. R. on the circulation of

the blood. 726

White Lead as a paint should it be

forbidden] 699

Wilburn, G. T. on Typhoid fever of

Alabama 581

Wilburn on morbid sensibility of the

Stomach 709

778 INDEX.

Willard's Mrs. theory of the circula-
tion 68, 155, 526

Williams, J, A., cases of Typhoid

Wilson on Syphilis 771

fever 657

Wilson, J. S. on Statistics of the
Georgia Census 151

Wilson, J. S., on Eruption produced
by internal use of tart, antim. . . 343

Wilson, J. S. on catalepsy treated by
Ether inhalation 466

Wood's Hints to the people on the
profession of medicine 640

1

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Southern ..edical snd i>--rpical J_,
A|.i> 8-1352

arn